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Episode 122: Dr. Cindy Rubin (She/Her) of In Touch Pediatrics & Lactation - Westchester, IL

Updated: May 22, 2023

Direct Primary Care Doctor


Episode 122: Dr. Cindy Rubin of In Touch Pediatrics & Lactation - Westchester, IL
Dr. Cindy Rubin

Dr. Cindy Rubin earned her BA in Psychology from Stanford University in 1994. Not sure what she wanted to do when she quote unquote grew up. She took time after graduation to live life, which included a volunteer program in Israel. After her time in Israel, she had the confidence she needed to pursue a career in medicine.


She completed her pre-med courses at Northwestern University and then earned her medical education at Georgetown University Medical School. She attended her pediatric residency at the University of Chicago Corner Children's Hospital and then worked as a hospitalist at community hospitals in the Chicagoland area.


Ultimately she was not satisfied with caring for patients in the short term as a hospitalist. She yearned for the long-term deeper relationships that one makes as a primary care physician, and that drew her to outpatient general pediatrics. She spent 13 amazing years working for Loyola University Medical Center as an outpatient pediatrician where she taught residents and expanded her own knowledge.


She developed a particular interest in breastfeeding, earning her certification as a lactation consultant in 2019, and then pursued additional training to create a niche as a breastfeeding medicine specialist. In 2021, she made the tough decision to leave Loyola and took a leap in order to practice medicine in a way that felt more true to her own goals and was a better fit for her style as a physician.


She ventured out of the insurance-based medical system and opened In Touch pediatrics and lactation in order to provide pediatric and lactation care in a personalized, compassionate, and patient-centered way. For her, DPC is the model that allows her to spend more time with her patients, something sorely lacking in the traditional system of medicine.


This not only provides her patients now with better care but also provides her with a more fulfilling experience as a doctor.


In this episode, Dr. Cindy Rubin discusses her motivations for choosing to practice Direct Primary Care (DPC) medicine. Dr. Rubin shares how her experiences working in a traditional medical system left her feeling dissatisfied with the level of care she was able to provide for her patients due to the pressure to see more patients in shorter appointment times. She describes how DPC allows her to spend more time with each patient and provide more personalized care.



 

Dr. Rubin's Video on Mom Guilt


Read Dr. Rubin's Blog



 


LINKS/RECOMMENDED RESOURCES:

For the LATEST in DPC News: DPCNEWS.com

In Touch Pediatrics & Lactation WEBSITE: HERE

Dr. Rubin's YouTube

Dr. Rubin's Recommended Bubbles


CONTACT:

Contact Dr. Cindy HERE

Mailing address: One Westbrook Corporate Center, Suite 300, Westchester, IL 60154

Phone: (708) 725-0887

Fax: (708) 746-8473

Email: info@intouchpeds.com


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Transcript*


Direct Primary care is an innovative alternative path to insurance driven healthcare. Typically, a patient pays their doctor a low monthly membership and in return builds a lasting relationship with their doctor and has their doctor available at their fingertips. Welcome to the My DP C Story podcast, where each week.


You will hear the ever so relatable stories shared by physicians who have chosen to practice medicine in their individual communities through the direct primary care model. I'm your host, Maryelle conception family physician, D P C, owner, and former Fifer Service Doctor. I hope you enjoy today's episode and come away feeling inspired about the future of patient care direct primary care.


Direct pediatric care allows me to provide people with the care they deserve, and also allows me to practice medicine in a way that feels good and aligns with my values and the reason I went into medicine in the first place. I am Dr. Cindy Rubin of InTouch Pediatrics and Lactation, and this is my D P C story.


Dr. Cindy Rubin earned her BA in Psychology from Stanford University in 1994. Not sure what she wanted to do when she quote unquote grew up. She took time after graduation to live life, which included a volunteer program in Israel. After her time in Israel, she had the confidence she needed to pursue a career in medicine.

She completed her pre-med courses at Northwestern University and then earned her medical education at Georgetown University Medical School. She attended her pediatric residency at the University of Chicago Corner Children's Hospital, and then worked as a hospitalist of community hospitals in the Chicagoland area.


Ultimately she was not satisfied by caring for patients in the short term as a hospitalist. She yearned for the long term deeper relationships that one makes as a primary care physician, and that drew her to outpatient general pediatrics. She spent 13 amazing years working for. For Loyola University Medical Center as an outpatient pediatrician where she taught residents and expanded her own knowledge.


She developed a particular interest in breastfeeding, earning her certification as a lactation consultant in 2019, and then pursued additional training to create a niche as a breastfeeding medicine specialist. In 2021, she made the tough decision to leave Loyola and took a leap in order to practice medicine in a way that felt more true to her own goals and was a better fit to her style as a physician.


She ventured out of the insurance-based medical system and opened InTouch pediatrics and lactation in order to provide pediatric and lactation care in a personalized, compassionate, and patient centered way. For her, D P C is the model that allows her to spend more time with her patients, something sorely lacking in the traditional system of medicine.


This not only provides her patients now with better care, but also provides her with a more fulfilling experience as a doctor.


Welcome to the podcast Dr. Ruben.


Thank you. I am so excited to be here. It was a long wait.


I am, I'm glad that this day has come because just a few months ago we were sitting at dinner and we didn't fit get to finish our conversation cuz there were so many D P C doctors all around us chatting about their lives and asking each other questions.


And so I really am excited to highlight you and your story. So I wanna start with going back into your history of being a doctor and the motivations that led you to choosing the practice that you have now. Back in 2021, you had viral exposure through Kevin MD as well as through your blog because you had posted about your experience in your life before D P C.


Can you share with the audience what you wrote about then that really touched so many people after they heard your words?


Yeah, I actually wrote that. As I was getting ready to quit my job, I was still working and nobody knew. My colleagues knew, but nobody higher up knew that I was leaving. And I was a little nervous about having it be out there, but I just sat down one day after just having this horrible day in clinic and wrote it in probably five minutes or something because I felt like I could not be practice medicine in a way that was in any way serving others.


And it was not, certainly wasn't making me feel like a good doctor. So I had, med student had asked me, why do they book your well checks for 15 minutes? Kind of offhand, huh? That's interesting that they book your well checks for 15 minutes. And I said, Everybody gets 15 minutes for everything and they were shocked because it doesn't make sense.


But I think we are so brainwashed in medicine to think that the way medicine is is the only way and is the right way. And at this point I was realizing that it's not, and there is another way.


And something else that you wrote in that blog that really hit home, especially as I shared before we started recording, my husband's position was recently eliminated because the clinic that I worked at and that he is working at, as of the day of this recording, his position is being eliminated because the clinic is going towards a non-physician model, which is legal in the state of California, as well as many other states in the nation.


And the part that hit home even more for me after getting that gut punch of you sharing about the 15 minute visit with the innocent med student who is naively going into medicine not knowing the things that we didn't know about medicine, was that you wrote. The, I'm the only pediatrician who gives my teens 30 minute well checks, and I take a pay hit for this.


So can you tell us about that financial part that you mentioned specifically because you worked over a decade where you were and you were dedicating your life to the kids that you served, and for you to be taking a pay hit for someone who's worked over a decade in their position doing a fantastic job, how did that portion play a role in your, your sense of deval from the system?


I was paid completely based on vus. So it, the more patience I saw and the more I build, the more I got paid. And. If I changed anything about my schedule from the 15 minute visits, I was going to be seeing fewer patients. And it didn't matter that was the right thing to do, but there was no way around that.


There's no way that you could get compensated for being a better doctor or doing all of the things, taking care of all the things that your patient actually needed. And in fact, to top it all off, it's like the things that we actually do get. Bonuses on or whatever are things that are so irrelevant and just check boxes that we're checking off that really have nothing to do with the good care of our patients.


And yeah, it just didn't feel good. I did that with newborns too, and because of that, I ended up seeing fewer newborns because it was harder to get them in with me because everybody else had 15 minute appointments and it was harder to find those 30 minute slots, but that didn't make sense either, and it just really feels lousy to not be able to get people to see what's going on.


Then it's one of the biggest things that I'm still seeing in D P C because. There's definitely a lot of education that needs to happen for people to see what D B C really is and where the value is. And yes, there's a reason why you might actually pay your doctor. People are so used to not seeing the money, not seeing the money in healthcare.


It has been really taken out of the equations. The money for your insurance comes out of your paycheck so you never see it. And then you walk into your doctor's office to have an appointment. You have no idea how much it's going to cost when you walk in. You maybe have to pay your copay when you get there, but you have no idea how much the final bill is gonna be, but you go because that's just the way it works.


And if and when you do get that bill later on, Half the time you might not even remember why you were at the doctor, let alone like might have made sense to get these charges and you just pay it. And it's this system that has just been perpetuated and perpetuated so that when I am not taking insurance and I ask to be directly paid, people just absolutely have no idea what to do it there no concept of it.


And it doesn't feel good to me too. Like I don't like asking for money for something that I'm doing because I want to be doing it. I'm not doing it for the money, but I still have to make a living. And it's a really hard hump to get past for people.


So on that note, I wanna ask, because this is something that was pretty heavily discussed while I was at the Peds Mastermind that was in Orlando that you spoke at.


When we talk about how we don't even know what we're getting into necessarily after medical school training. We go into residency and we are just told, this is the magic way that you get paid. You do your bills, you do your, you do your patient visits. This is how much time you, you are given, you get your codes and then you go into the next patient.


The academies that we. Have signed on with American Academy of Family Practice, American Academy of Pediatrics, all of the academies that no matter what type of physician, if you're part of the fee for service system, is what is most prevalent in those systems. So when I think about the Mastermind and the American Academy of Pediatrics, and the most common type of visit in pediatric clinics is going to be fee for service.


Recently they released an update about obesity and pediatrics, and one of the things they talked about in their opening section was inequities in healthcare. And that was where the argument was really getting. Hot and heavy at the PEDS DP C Mastermind because there was a large argument and a very valid one that D P C can remove those inequities because of access to quality healthcare for everyday Americans.


This is a loaded question, but what is your opinion when it comes to, does D P C remove inequities when it comes to kids all over, no matter where, what background? They're coming from getting quality care, so it makes a huge impact in their health going into the future?


I think it does. I think about all the guidelines that get put out about everything. How in the world are you supposed to do all of that in 15 minutes? No way. Can you do all of that in 15 minutes? And actually, I'm on the co-chair of the Illinois AE chapter and I'm co-chair of their breastfeeding committee. And went to one of their meetings and this was exactly what coming up, like how can we do better by our children?


And the big barrier that kept coming up was time. We do not have time in our clinics to do all of these things. And the obesity issue was one of the ones that, that we were talking about. Uh, and I think that those inequities are absolutely seen in the fact that I think people for who are disadvantaged, sometimes they don't have a medical home at all, and they.


May just get their shots on some mobile van and their school physical by who knows who, and that's the one time that they get seen every few years and none of these other things that are truly important. Whether or not, I'm not gonna say whether or not I think that the obesity guidelines were on target or not, but if you want us to talk about all of these things, you have to give us more time.


I think about it like even as a doctor, as a family practice doctor who takes care of kids. When I had my first kid, I was like, You can't discharge us because I actually don't know what to do with this baby. Like you've been taking, this is pre pandemic. I had my first in 2017, but it was like you took the baby to the nursery and then we would feed the baby and then you would take the baby back.


So I don't actually know what to do when you give me this baby. Like I don't know what to do. And, and as a physician I'm thinking that how much more someone who might be like the youngest person I delivered was 13 years old. How can you expect anyone. In 15 minutes, especially English is not their first language.

They have other children in the room that they can't pay attention to you. All of the situations where 110% agree with you that we cannot do our jobs without having time with each patient that they deserve, and that time will change. Sometimes you don't need as much time, but other times you need a ton of times.


So I'm so glad that you are at the level you are in your state chapter of the American Academy Pediatrics, and I'm glad that there are other people in the D P C community who are speaking out at the state and national levels when it comes to our patients deserve better and we deserve better as physicians.


And that's one thing that people actually complain about with the Academy of Pediatrics in particular. I don't know exactly how all the other academies are, but they advocate for the patients. They think, but don't advocate for the physicians who are stuck in this mess trying to do everything and needing to do everything and wanting to do everything, but not being given a, an appropriate arena in which to do that.


And I do think that D P C can bypass many of those barriers because people also think of D P C as concierge and it's not concierge. And I hesitate to use that term even to get people to understand the model a little bit because people think about that and think it's just for the wealthy and it's not.


This is affordable care. It is on top of your insurance if you have insurance. It is, but it may allow you to take a less expensive insurance because insurance is for the big things. Insurance was not originally supposed to be something that paid for everything. Like your car insurance does not pay for your oil changes.


Yeah. And it's so interesting you say that because recently I've been thinking about if I had my brothers, I wish that people in high school would have economics, that they would have home ec. And when I say economics, like everyday economics, like this is how much money it costs to have a child. This is how to budget your finances so you save it for your retirement, that type of stuff, rather than Adam Smith and the history of economics.


But one of the things I've been thinking about recently is it would be so helpful for people to learn to create a cultural change earlier on. Yeah. How to. Play in the healthcare system, and hopefully this healthcare system doesn't continue to burn like it is right now, as we are rising up of the ashes to take better care of our patients and ourselves.


But when it comes to how to use your healthcare dollars, just like you pointed out, it's insanely important for people to understand, look, you could have paid Dr. Rubin this amount of money and because you've paid her this amount of money, your child was kept out of the ER for croup, for a rash, for whatever.


And each time a child goes to the er, how many hours are spent in the er? How many thousands of dollars are racked up? Especially if a person has insurance, the insurance only covers so much, and then magically it's on your dime. That's why so many people are going bankrupt in this country. So like you said, we don't see the money.


We need to see the money for sure. And D P C definitely is helping people bridge that inequity of not understanding our healthcare dollars and spending.


And I think it is very important to be transparent. I have my prices on my site now. I know that yes, some people are gonna look at my site and say, I can't afford this and I want this, but I can't afford this.


And I'm still relatively new. But I think most D P C docs find that it feel that it is very important to be able to take care of people who maybe still can't afford what affordable fee we are charging and will figure out a way to do it. And I do already do that. I would like to be able to do that more as I grow.


So we actually have the time that is necessary to put. Into all of that to put into figuring out how we can take care of everyone who seeks us out and just have the time to do everything that's needed. It's just, ugh, it just keeps coming back to that. I just remember what it felt like to be in that room, and I think, I can't remember if the quote that you said, if this was included, but I was always running late and my ma, who I loved and was like trying to keep me on track, out of the goodness of her heart, she.


Was going to make me get out of the room on time, and she was gonna knock and make me stop no matter what I was doing to get out of the room. And I was like, forget it. I'm not leaving the room. If I haven't finished what I need to finish, I'm sorry, I can't do that. And it's just infuriating. You can see. I just get so, so mad thinking about it.


And I get mad now like I got out of that system, but I still feel like I'm stuck in that system because everybody else is stuck in that system.


So as you have shared, What was going on before you opened InTouch? How you came to learn about D P C? So I was actually at a breastfeeding conference and there were a couple of people at the conference who were planning to start DPCs, and I had never heard of it.


And I remember just thinking, oh, whatever. Like that's not for me. I'm never gonna do something like that. What in the world? And these people kept repeating that message into my ear in various. Places along the line after that, and it just started to make more and more sense. I learned more about it. The Facebook groups have been just phenomenal at helping people to understand what it really is and how to have a practice like this.


And as I was trying to navigate my way out of my other job, I was really struggling for years before this to figure out what I could do that would be any better. I just felt like everything I looked at was gonna be just more of the same, just in a different place. And D P C was the one thing that offered me something completely different and it scared the what out of me, and it still does because I never wanted to be a business owner either.


And I loved the fact that I had nothing to do with the finances, but in the end, that just doesn't make sense. It's doesn't allow you to do what you want and need to do as a physician or no matter what you're involved in. To be able to make those decisions yourself is so important and so empowering, and it is so freeing.


As you talk about this empowerment and this freedom that you experienced, even though you had hesitancies about taking money from people selling yourself in terms of selling your services, how did you overcome those fears of, I, I don't know how to take money. I don't know how to market myself because of, to achieve your freedom?


How did you overcome those, those fears or those hesitancies when you were getting started? Yeah, I'm still working on it. They work in progress. I think as my fury gets louder and louder, like I just realize that this is the way to do it and there's no reason why I shouldn't be paid directly for my services in anything else.


That's the way it works, and I think I've just come to accept that I am also now a business person and my family depends on me, and I have to allow myself to take that role and to be the business person, but still like I'm not in it to make a million bucks. And that's the difference between us and those administrators who Yes, are also, they're the ones about the money, but they don't even see the patients.


They're so far removed and I think it just takes. Time and doing it, and then seeing the results, seeing the effects that you have, and seeing the relationships that you're able to develop with the patients that are so different and feel much more rich and meaningful to me now than they did in the old system.


I love that it's such a common thread that. We are not burned out by our patients. Yes, there are some people that are that do they work our patients beyond belief. But in terms of overall, when we talk about what was our last straw when everyone has shared on this podcast, like what led them to practice under the D P C model, it's not the patience, it's always the other things.


So, so when you talk about opening your business and having a chance to even be a better doctor with your patients because you have an even deeper relationship, how you have become not only a pediatrician but also a breastfeeding specialist. You have two of your own, but you are an I B C L C, so an official lactation consultant who is also a physician, which is flip and amazing because you cannot replace the importance of how.


That medical knowledge really supports what we know and get and answer questions on when it comes to breastfeeding. So how did you decide to incorporate I B C L C into your services and your journey as a physician? I. It was interesting because I decided long before I left my job to become more knowledgeable and able to care for my breastfeeding patients.


And that just made things worse at my job in terms of not having enough time. So it led me to where I ended up. But as many people who go into lactation professionally, we had problems with our own kids or problems with our own breastfeeding journeys with our kids, and I did. And I wanted just to be able to better serve people.


And I just wanna clarify the difference between I B C L C and breastfeeding medicine actually. So I didn't know this at first either, but there is something that is called breastfeeding and lactation medicine and what this is physician level care. Of breastfeeding problems that may be more complicated than can be handled by an I B C L C.


It's just simply out of their scope of practice. They may even have an idea of what's going on and know about it, but they can't practice medicine. And an I B C L C is a counselor and an educator and that's where they have to stop. And as a physician, I have training that is geared specifically towards physicians and how to work up diagnose.


And manage more complicated problems. So this is something that most people don't even know exists. Most people being IBCLCs and other doctors and patients, and unfortunately there's so much mismanagement out there of breastfeeding issues because it has not been prioritized. Women's health in general has not been prioritized in this country.


So people who have these issues end up going to the only doctors they can to deal with these things. Usually they're ob, maybe they're pediatrician, maybe a breast surgeon. And those people, unless they sought it out themselves separately, they did not receive training on it. So they're flying by the seat of their pants.


They wanna be able to help, but they don't have the training. And so then things get mismanaged. And that leads people to stop breastfeeding essentially. In the end, they either are miserable and have mental health problems because of it, or they stop. And now that there are more physicians being trained in breastfeeding medicine, we are able to help solve those problems and hopefully nip them in the bud and prevent them from getting mismanaged.


I actually just had a patient that I saw for a prenatal visit who had a disastrous experience with her first baby and wanted to try to prevent it the second time around, and she has some, she had some complications and it's hard to know for sure that some of that there won't be any problems this time.


But I said, I cannot promise you that is not going to happen at all, but what I can promise you, Is that it will not be mismanaged this time. So it will not turn into that big disaster that it turned into last time. You will have people, you have sought out, the right people to be able to support you, and we will make sure that you are okay and you can lactate hopefully, and hopefully much more successfully than last time.


And it felt really good to be able to say that. And I don't know that I, I was doing some breastfeeding medicine in my old job, but now I can again do it the way I. That I need to with longer, much longer appointments and spend a lot more time getting the word out. I'm focusing because I am a business person now on advertising this breastfeeding medicine service, and I think that if I had stayed where I was, I would've just been in this little place doing it, but not, I certainly wouldn't have had the time to really be advertising about it and getting the word out that it exists.


So hopefully this will start in the Chicagoland area. There will be more and more of an ability to help these people because people will know that the services exist. And there's me, there's, there are other people practicing this as well in the Chicago area.


I love it. And while we're talking about breastfeeding medicine for in physicians involved in breastfeeding medicine, I know you had mentioned some resources at the PEDS Mastermind, so can you mention some for the listeners that I'll also put in your blog?


Absolutely. First of all, I have a YouTube channel where I try to put out some good information, but for other physicians in particular who are looking for maybe thinking about getting an I B C L C or thinking about learning more about lactation, There are resources out there that are geared specifically towards physician education.


We are in the process of creating a certification for breastfeeding and lactation medicine, so, You may want to look into that more and not get your I B C L C because there's nothing wrong with getting your I B C L C, but if you really want to be able to manage more complicated problems and make this a focus of your practice, then physician level training makes more sense.


And so I A, which stands for the Institute for the Advancement of Breastfeeding and Lactation education is absolutely amazing. They have wonderful conferences and tons of information and resources on their website as well, and I think are going to be more and more other. Resources out there as more of us get this certification and get this training.


Fantastic. And I will definitely include your YouTube as well as I able, and any other resources that you think of after our recording will say that I love the I able cases that they'll drop in your box the, it's a drip rather than a flood. Because when you having sat through conferences through i a it is a lot and you're just like, yes, my experience has been like, I didn't learn that in medical school.


Wow. And I had, I'm very grateful. I had a very positive breastfeeding experience with both of my boys. But having attended those conferences, it gave me answers that I didn't have prepared with me when I was counseling other moms who were having breastfeeding issues. So I definitely s support I able as a fantastic resource.


So thank you so much for that. And definitely check out Dr. Urban's accompanying blog with this podcast. So another one that I just wanna throw out there though is P S I, which is, oh, it's Postpartum Support International. I believe. It is an amazing mental health resource for perinatal mood and anxiety disorders that are so prevalent, and it's really important for physicians and families to know that this is a resource out there.


So that's something to just have in your toolbox.


So as you have talked about, The experience that you had before D P C, and you've talked about how you've had a, a mind shift going into owning your own business and operating your own business. I wanna ask about your business model first. When you opened InTouch Pediatrics and lactation, you opened as similar to my opening, and this is what we talked about over dinner as a a virtual and home visit based model.


Can you tell us about why you decided to open up your practice in that way? And had you thought about any other models and what was the reason you ended up choosing the model you did? Yeah. Part of why I chose it was just being able to start out with low overhead. I think that's really important. I didn't have some big summer money to.


To support me. So I didn't ha I didn't have to worry about rent, which is wonderful. So I figured that would be a good way to get my feet wet. And breastfeeding medicine and pediatrics and taking care of babies after parents, after they have children. It just lends itself, I think, to home visits. And it's funny that the only.


Home visits that are really paid for in the fee for service model are geriatrics, but they're not the only ones that need this. So it just was a kind of a natural decision, I think because of the breastfeeding. It's just so much easier to figure out how to help somebody when you're in their space and you see both with breastfeeding as well as pediatrics.


Like what do they even have blocks? If I'm asking if their kid can stack a tower of blocks, do they even have blocks? I can see where a child sleeps. I can see the chaos or the lack of chaos in the house and some chaos is good actually. And it can make a big difference on what I can help them with. And I'm not claiming to be perfect in my own home in any way.


I have my own issues, but it just really helps you to take better care of the entire picture, essentially. So I really enjoy that aspect of home visits and kids are just, they just tend to be more comfortable in their own environment and so I can really observe their development so much more naturally.


I don't even have to ask my developmental questions like I feel like in the office I really did because usually the kid is like just sitting on their parents' lap and you don't really, and they're scared of you and you don't really get to see what they are truly like if they're in those much younger years.


And at home you can see everything. And I, I really love that. I also offer fourth trimester packages, and this has evolved over time. But I think that I have found the package that works, which is a six week package where I am the pediatrician and the lactation support person, and just the overall like cheerleader for this family as they transition to having this new baby.


Whether it's their first, second six, doesn't matter. And it's interesting that I've had more people sign up for this package who it wasn't their first baby, because people don't realize how hard it's going to be until they've done it. But it feels so good to just on these rainy days and snowy days, I'm the one who comes out into their house, not, they don't have to lug them.


Baby and the toddler and the everybody out and I think helps that transition so much. And I have loved doing this. Now that being said, I really do love all of the home visits, but it does limit. My ability to see more patients, which I, yes, I don't wanna be seeing 15 minute appointments, but I do feel like the time is taking me to do the driving.


It's a lot and it's, I'm not really getting reimbursed for my driving time and it's just wearing on me a little bit. So I do think that I probably will get some sort of brick and mortar something or another over sometime in the next year or so. So maybe at around the two year mark, I. And I don't know what that'll exactly look like, but I think it will help me to especially see more of the breastfeeding.


And I think I will still have the fourth trimester packages and still see newborns and whatever breastfeeding I can in person. But I think that it will help me to just be able to have a better work-life balance too, which is what I was looking for originally as well, and to not have to do that driving.


And I love that because as you pointed out, like you were thinking about on how to get out of your job years before you actually made the leap into your own practice. But that took years, and you've been in practice for less than five years so far, and you're just like, yeah, I'm gonna change my fourth trimester package.


I'm gonna do this because it works for me. And I love that. I think about how Dr. Tom White reflected that he was so grateful that he's doing D P C, and if he had learned about D P C earlier before his sixties, he would've done D P C, but he didn't know about it. So I think that I am so grateful for yourself, for myself, for all of these physicians who are finding D P C earlier on in their careers.


Because we have more years ahead of us to then change and adapt to our communities the way that our communities need us to. So I absolutely love that you are thinking out loud about this and thinking about it's not all sunshine, lollipops, and rainbows when we were at dinner. Like I totally empathized with you for me, and I'm gonna ask you about what your tools are, especially because I recently asked Dr.


Rosa Lasa an update about her tools because she went from exclusively home visits to having a clinic space also. But I would forget things left and right and I had to create my systems and yetta. But absolutely like when I go to into a home visit, it's typically two hours long. Yes. And so when I see somebody for two hours and I could have seen more than one patient in that time with a clinical space, I absolutely hear you.


But I also think that's super genius when it comes to. You're wanting to open. You don't need a clinical space. You have your person, you have your training, you have your brain, you have your tools that you need, and you have gas. You can go do those things that you need to do without the high overhead to start.


So I love that you are morphing and you are adapting, and this is how you continue to own your business. So I'm like, go Dr. Ruben.


Yeah. Love it. And the other thing is that the D P C community is so supportive. I don't know how much of my pivoting and everything is just for my own ideas. It's like, Hearing what other people are doing and hearing what works and what doesn't work and what other options are out there.


And even just locally within this area at the other D P C docs are all like, we all just wanna help each other survive. Because the more of us survive, the more we can change medicine and the more each of us survives, the more each of the rest of us will survive. And I think we know that, and it's so refreshing to be in that sort of community where everybody wants to help everybody else and just this.


Podcast is so amazingly helpful to just get the word out, but also talk some specifics about what has worked and what hasn't worked. So that can help people down the line. Absolutely.


And for years to come. That's what I love, is that you could pick up your story five years later, 10 years later, and somebody can still be learning from your experience.


Yes. So that said, on on the, on the topic of tools, because you are doing breastfeeding medicine, your fourth trimester package, you do ear piercing, you do general pediatrics. What are your tools that you are typically carrying when it comes to home visits?


So I have a scale. I think that's very important.


I have a baby scale and I have a bigger scale. And I finally found, took me a while to find ones that I liked for that too. I have, I use a big bulky backpack for the majority of my tools and I have one little baggie that has all of my like telescope and my otoscope and my head circumference tapes and my H E N T bag, which is head eyes, ears, nose, and throat for people who are not medical bag.


And then I've got my blood pressure stuff and I've got all my blood pressure cuffs cuz you just never know what you're gonna need. And I think the big thing that is probably. Different about being home visit pediatrics is also, I've got my little cooler for my vaccines and isn't simple. I feel like I finally have it down.


You need to be able to have the vaccines at a very specific temperature, not only when you're storing it in your office or wherever, these are just being locally stored, but on your way to a bunch of visits. They need to stay that temperature. And so I have my little thermometer and. But I always forget to turn my thermometer off when I get home and my family's, what's that beeping?


What is that? I'm like, oh, it's just the thermometer is telling me that the temperature isn't right, but that's okay cuz there's no vaccines in there anymore. But it's kinda, it's really fun actually. This is the stuff that I didn't do. I never gave vaccines, so I've had to learn all about this and like, where do you even stick the needle?


And it's fun. It's like having a whole new career actually, to be able to learn about these things and do these things. So that's my vaccine stuff. And my vaccine bag has all my different sized needles and my little buzzy bee, so my buzzy bee. This is something that just helps with pain control. And I learned from another D P C person to have some essential oils for distraction to, which I think is great with vaccines and bubbles.


So I always give these little. Things of bubbles because they're great distractors. It's a good toy to just be able to give the kid to as their little visit gift instead of a sticker or lollipop. So I give the bubbles, but I can use them to distract a kid while I'm doing vaccines. Or an older kid can actually blow the bubbles themselves because that makes them take deep breaths in and deep breaths out.


And that's exactly how people can calm themselves down when they're nervous about getting shots or some other procedure. So I use it for my ear piercing too, because. Despite wanting to get your ears pierced. Many people are nervous when the moment actually arrives, so I think my bubbles are big. I actually had gone to the dollar store and bought a bunch of random toys initially, and then when I got these bubbles I was like, no, this is just gonna be my thing.


It's perfect. I love it. I bet you a bunch of people are opening their Amazon app to buy bulk bubbles, which is awesome. I should send you the link to the bubbles I have because they're actually, they're just a cheapo giveaway and they are the best bubbles ever. They're teeny little bubbles cuz it's just this teeny little thing.


But they are really good bubbles.


Yeah. And there is a difference between good bubbles and bubbles that don't Oh yeah. Actually become bubbles. Oh yeah. I love that. I do this because I love shopping on Black Friday, but I have a notepad note in my iPhone where I keep a list of things and links that I wanna buy on Black Friday.


And I have the one that Dr. Naia Sharif had mentioned in her podcast. But I also have the Stadiometer that is like a triangle, that's wireless.


And yes, I have that too. Yes. And that was on Black Friday sale. So if you have links of things that are a little bit pricey and you're wanting to get them and you don't need them today, definitely something to think about.


Putting them in a list for getting ready for Black Friday. And then also if you just put them in your Amazon cart and then save for later. Sometimes you'll get alerts that, oh, the price has gone down by 10% or whatever. So just little tips there, but I cannot wait to buy these bubbles that you speak of.


Really good. The other thing that you don't realize that you're gonna need, I think, is a script pad. Um, we don't, we do electronic prescribing most of the time now, and for some things, at least in Illinois, we have to electronically prescribe, but. How do you write an order for labs? If somebody's going to just go to a lab, really, you have to write it on a script pad and for a referral or something like that.


So it's probably that old school thing that is still alive because it has to be used in certain situations. Like doctors still use pagers. It's totally outdated, but yet doctors still have it. And faxes, oh my gosh. My husband, when I was trying to figure out the facts situation and my husband's what in the hundred, oh, concept fact doesn't.


Yes, doctors still fax. They also send things electronically, but it always gets sent as fax to in my area, because we live in the forest, literally when there's no electricity and there's no electronic prescribing whatsoever, there's no phones whatsoever. That is another case scenario where doing home visits where you're prepared with paper, yes, to write a script on is definitely a use case that not too many people think about when they're doing a home visit or an office visit until they lose electricity or we saw a nowadays that can happen in any community and it doesn't have to be rural.


I appreciate you dropping those. Nuggets of gold when it comes to labs and when it comes to referrals, and those are things that can be faxed. I love that. So when it comes to, you spoke about how there are other breastfeeding medicine physicians in your area as well as other D P C physicians, Dr. CLA Ryan, Dr.


Leah Gupta, are two that come to mind. They were at the dinner with us. When you look at your practice and when you went from opening as a telemedicine and home visit model with. Low overhead. How did you market your practice and what did you find was the most helpful getting patients to join in at your practice?


I think I am just starting to figure that out actually. And I do think that that local moms groups, like moms just talk. They talk and they ask, who do you recommend for this, that, and the other thing. And I was a little bit squeamish about advertising myself in those kinds of groups. At first it just felt weird, but once I started doing it, I got some really great responses, and especially the breastfeeding and the fourth trimester stuff.


I think that's really helpful to advertise that way. And then just getting the word out to other people who work with your people. Right? So other e and doulas and midwives and people who take care of adults, they. Those adults have children. And so this is also my new career is figuring out how to market and network and all of that.


And it's definitely my least favorite part of this. It's way out of my comfort zone. But people aren't gonna come to you if they don't know that you exist. So you have to get yourself out there.


And like you said, your fury of you cannot ever go back to that system is driving all of the things that you do so that you can continue to be the awesome pediatrician that you are.


Yeah. So when it comes to talking with people who are adult medicine physicians, whether they're OB or family medicine, and when it comes to doulas, how do you approach them? Do you cold call them? Do you have a packet ready? How do you approach other people in the medical community?


So I think the, what I have learned is whatever you do, you have to do it again and again before people are really gonna respond.


It's that, I guess it takes seven touches before people are going to start to respond to whatever it is you're doing. So I have tried everything and I think certain things work for certain people, and if you have an in, if you can get introduced to somebody by somebody, that's definitely the best way. Or if you have some sort of personal connection to something about that person.


So do your research. So get onto their website or somebody just taught me this one, which I hadn't thought of, which is if you are going to cold call or cold walk into an office to look up. On the website, what is the name of their front desk person? So when you walk in, you can talk, you can say their name immediately and you will win them over.


And that front desk person is the one that you wanna win over. Cuz that's the person who knows everything that's going on and is going to be. Asked, oh, I'm looking for a pediatrician. Who do you recommend? Now, I can't say that I'm perfect at doing this, but I think that these are really important to just be persistent, keep doing it, and eventually it will work.


No matter what way you are trying to get yourself out there. People just have to see you again and again.


I love that and makes me think of how Dr. Leah Gupta was sharing at the DPC Summit last year, as well as on her podcast, how she would communicate with people through social media. Yes. And then say, Hey, would you mind if I came by for a visit?


And it didn't have to be another medical clinic or office. It would be anybody in general who could potentially be interested in D P C as a patient. So I think that. It's ironic because you are a pediatrician who's purposefully choosing to build good relationships, quality relationships with people.


That's how you're doing your marketing too. So I think that's really cool and it really speaks to how this is really a relationship driven model. One of the things I wanna ask when it comes to marketing and marketing yourself is you have some incredible pictures on your website. It's Dr. Ruben with this mom who's holding their baby and breastfeeding, or Dr.


Ruben with the otoscope. And so how did you end up getting those pictures and do you have any tips for other people who might want to get pictures similar to yours? When was this? I guess this was probably when I was expecting my second baby. I saw a photo on. A local mom's group. I just saw somebody posted like their family photo or something and it was very not staged and I loved it.


And we were getting ready to have family photos taken and we were about to have a baby. And so I contacted the person who posted that and said, who's your photographer? I really love that photo. And she told me who she was and I contacted her and she became our family photographer. And so naturally I asked her to be my business photographer as well cuz she's just so good at just capturing the moment and very candid shots.


And so she is. Going with me to some regular visits. But another thing I, I didn't, I don't feel super comfortable asking my patients. There are some that I feel more comfortable with cuz I just know in a different way. But I don't necessarily wanna want my patients to feel obligated to say yes to me if I ask them if they.


Would be models for me. So I actually put an ad out or a post in a mom's group about if anybody's interested in being a model, I will trade you a breastfeeding consult. And I got the most amazing responses, first of all, just responses. Saying that they would willing to be models, but I didn't realize that this was actually in and of itself, advertising my practice.


And some people were like, I'm looking for a pediatrician. Let me find out more about that. And so I found some people and so my photographer went with me to those visits and I've met some really amazing people that way. Yeah, so I think you have to find a photographer and just somebody that you like their style and just take 'em and tell 'em what you're looking for on your website, what you need on your website, cuz you're gonna need some vertical pictures and some horizontal pictures and some pictures of you.


And some pictures of just the babies or just the patients. And so we're still working on it. We're not done. We're. We got way laid a little bit in there, so we're still going out and taking more pictures, so there's more to come where that, so one of the things I love about your website is specifically on your fourth trimester postpartum package page.


As you're scrolling, which many Imam I am definitely one of those people at two o'clock in the morning when I was feeding my kids, I would be scrolling. Scrolling. You will see on your website facts about your practice. Feel confident as you navigate getting to know this little new human and your new role in your family and the way that you're scrolling the words that are empowering to your patients or what they would like to be empowered with are appearing on your page.


How you. Got your website, did you, do you design your website? Do you have someone design it for you? And how do you pull the copy that is relevant to your moms, your patients, your families?


I did my website myself, so I use Squarespace and in a weekend, and it has been tweaked since then, but I got the basics in the weekend.


I like Squarespace by the way, because you can put in your colors and it creates the scheme for you, which is really nice. And you can tweak that too. But, uh, I was comparing that with, uh, probably WIC or I don't know what I was comparing her with, but it was better in that sense. And, and then, The copy has definitely been tweaked over time and the copy is also all just mine.


And I sat there and I just wrote it. But those quotes, I learned through some marketing classes, how to sell things. And when you sell things, you look for people's pain points and you look for the things that are going to be emotionally powerful to them, cuz that's what's going to get them to keep scrolling and ultimately to purchase something, to think, oh my God, I cannot live without this.


And so, I just keep, I keep tweaking, but I guess it's nice to hear that I picked some good words. When I think about avatars, I definitely think about myself in the position of fill in the blank. And so when I was reading your website, thinking about how mines, man, I watched all seasons of Criminal Minds when I was breastfeeding my first kid.


And then when I was, oh, I've already seen that episode and scrolling on my phone, all these terrible habits, I would get really emotional with random things because, You're postpartum and you're not getting sleep as part of that. But when I read things like feel ready, feel empowered, have one less thing to worry about or to stress about, I sure as heck would emotionally react to and be drawn in by your website, especially envisioning myself as that mom at two o'clock in the morning.


So again, congratulations. It's amazing and thank you. You are showing up in your website, in your practice, and you couldn't do that with the time that you were limited to in your former practice. It's beautiful what you've created. Thank you. One thing I have to work on is SEO O because SEO is very important and you should have SEO in mind as you are building your website.


And I don't know that I did. I tried to do the things Squarespace told me to do, but. I'm not ranking super high on Google, and so I need to work on my SEO o. So that's just an important thing to remember when you're creating a website and if you're going through similar struggles, like how you said you took a marketing class to to learn about copy and to learn about selling yourself, there are ways to learn about how to work SEO in your neck of the woods.


So awesome. And I think it's, you go through, it's so interesting when people take courses when they've decided, or when they're actively doing D P C, the way that courses information manifests is so different than if we were to do it in a different industry. So yes, I think it's so cool to see what people create.


Yeah.


Yes. And also like my. Driving has not been for naught cuz I'm pretty much always listening to some sort of business book while I'm driving.

So as you're talking about your practice, I wanna ask about how you chose an E M R to support what you need supported in your practice. Because you're offering home visits, you're offering a six week postpartum package, as well as things like earring, ear piercings.


So how did you go about selecting an EMR to, to support what you do?


So I actually just have my ear piercings separate from my E emr. I, so far I have ke kept it separate. I was thinking that I was going to combine it, but it just made more sense for me to keep it separate because it doesn't require the HIPAA compliance and I just take the money in a different way.


So that's one thing, but I. I actually used, I chose one at first, like having no rent to pay. I chose one that was free to start out with because I have learned that one thing that is not a good trait in a business person is being indecisive. And I'm about the most indecisive person in the world world, so that does not fit my business person persona.


But I knew I wasn't gonna be able to decide right away. So I chose, I was started with charm, which is three period. I can't even remember if there's a. There might be a top number of patients that you can have, I can't remember, but, but there are things you can add on and pay for. But I just said, I'm not super busy.


I can do labs without having that integrated. I can do the billing without it being integrated. So I used that for a while and then started to get busier. I actually didn't mind charm, but the thing about charm is you cannot reach anybody to talk to about anything. So I knew that as things were gonna get busier, I was gonna need something with better customer support.


And so I. I really debated like the peds people are looking for very specific things. We want to be able to easily print out a school physical form and we want to be able to enter vaccines. And there's just very specific things that are not great in a lot of EMRs. And in the end, I actually just picked one because I really liked the people and I liked what they had to say.


They were building from the ground up. But people who had already been with them seemed very happy. And it's kind of forcing me to be more simple in my notes than I usually am. They don't have all the check boxes, right? So though you can make your note, whatever you want it to be, because you're not at the mercy of the insurance companies anymore and it doesn't have to have a 10 point rule of.


Review of systems. And so my notes don't have that. There's no review of systems being asked anywhere. So I really like that. And it also integrates the phone, like the texting and everything into the E M R, which was important to me because I was using Spruce, but I wasn't integrating it with anything cuz I hadn't decided what I was going to use.


And it only integrates with one, maybe two EMRs that I wasn't gonna go with those EMRs. But I really. Like being able to text and know that it is going to go right into the chart so that I don't have to then go and write a note about what I was just texting cuz it just saves time. And so I think that's a, something to look for sure in an E M R.


And it's got its ups and downs and there's a lot of changes coming with this e emr and so we'll see. I, it's an arrow that I ended up going with and they have merged with Hint and we have no idea what big package is going to be coming out soon. That will hopefully be like the Wonder e m r, so we shall see.


And when people are joining your practice, whether it's for pediatrics, whether it's for lactation, how does it work when a person is onboarded? What happens from their experience after they say yes.


So they get a link to my E M R to Arrow where they can, where they put in their information. So just their basic name, address, all of that.


And then they can, and. It's difficult not to put in their payment information. I do not charge anything right off the bat because I sign up everybody that same way. And my breastfeeding medicine people get charged one thing for their visits, and then my general peds are getting charged an enrollment fee plus then their monthly fee.


And so it's not standard what they need to be charged first. So once they put in their information that comes to me and I know that they are requesting to be approved and I approve them and then I can send them, then I can charge them if there's an enrollment fee, or I can wait to charge them if they're coming for a breastfeeding visit and I can send them all of my consent forms at that point.


And then once I get the consent forms back, then I start to. Put them in their monthly fee bracket or wherever they need to be. And then I set up an appointment and I really like, but even if I have a new patient then, and they've already been born, I wanna see them as soon as possible. Because if they're gonna call me and have a question about their kid, I want to have laid hands on that kid already.


So I like to schedule, I can't always schedule it. Yeah, usually schedule it for the same day at all, but, but within a week for sure. And for my own patients, like I do get calls from people who want just an acute visit or I got one once from somebody who had been thinking about signing up with me for a while, but hadn't, but had a kid now who was sick and wanted to know if I could see them.


And I was like going out of town the next day and I was like driving all over the city, seeing my own patients. And I was like, I'm sorry, I have to prioritize my own patients. I can't. But if you wanna sign. For my practice. You're welcome to do that, and then you can be my priority next time. So I think it works pretty well.


I think I still need to automate some things and hopefully this new package will make it easier to do that.


Fantastic. Yeah. And when you have your patients join you, no matter how they're joining onto your practice, you have a newsletter that is an option for people who are members and people who are not members.


In terms of the newsletter, how do you use that to keep engaged with your community, whether it be current patients or potential patients and people who are just wanting to know more about what you're doing?


To be honest, I've just been winging it with the newsletter. I kinda have a standard format there and.


Try to put something of some value in it every week, whether it is just truly informational about this breastfeeding topic or this peds topic, or just some thoughts that I've been having, or a new blog post that I just put. I don't do, I don't have very many blog posts up. That hasn't been a big thing for me.


And so I have that section. And then if there's anything, like when I had flu shots available, I put that in my newsletter so people knew that was available and then we needed to make appointments for that. And I ask for reviews. Reviews are a big way of finding more patients. People want to see that you have been vetted and people have been happy with your services.


So I do try to get out there and ask for reviews in my newsletter as well as other ways, and I ask people to share my newsletter as well. So that's helpful. If somebody sees something that's of value and they know somebody who it could be of value for, then just the more people are spreading the word, the better.


I don't know that I have mastered the way to use my newsletter, quite frankly. But I'm working on it and I'm going to like an event tomorrow. I'm a little resource fair, and so there I will hopefully be able to, I'm having a little raffle and in order to get into the raffle, you have to give me your email address to be on my newsletter list.


So that's how you have to get creative about getting just more people who are going to keep hearing about you so that they can get those seven touches and finally decide to sign up with you.


Love it. In closing, I wanna ask one last question because as you've shared your story, it's super valuable, but you've also shared how we came from a system that did not value us.


And so when you go in from a place where you're not. Really valued for your ability to take care of patients, which is what we all went to medical school for, to a place where you are your own boss, you're running your own clinic, you're taking care of your patients the way you wish to. How do you keep your head above water when it comes to making sure that you're always valuing yourself for what you are achieving every day?


That's a tough one, because that's always been a tough thing for me, just in general. And I am pretty damn proud of myself that I took that leap. That was really scary. And I look back and I'm like, I can't believe I actually did that. And I'm not going back. This may or may not end up working out for me, but I'm not going back and.


I think I have to remind myself of that when I'm feeling a little bit more stressed out and worried about my practice. I did really want to have a better work-life balance, and that's really hard with a new business, really hard. They say that having a new business is like having a newborn, and it's true.


And my kids, I wanted to have more time with them and I do. I have more flexibility to be there for school events and sports events and things like that, but I'm often like furiously trying to finish my minutes of work when they get home from school and I can't necessarily always be there, or I have to go to networking things at night and I do miss dinner and bedtime, which I really don't like doing, but I think I'm putting in my time now.


This is an investment. Somebody was just saying this to me that it is. An investment in myself that I am doing this. And I've started to ask my kids to be part of my decisions for them to understand more what this means to me. And I had this one night when I was like, I have to go to this thing. I have to go to this very high yield networking event.


I have to go. And I really didn't wanna go. I just was tired and just wanted to be at home that night. And I was driving with the kids somewhere. I said, guys, I know you're not gonna be happy about the fact that I have to go to this thing, but it's really important I have to go. And I just want you guys to understand that and to tell me whether you feel like it's okay for me to go or not.


And if they said no, I was prepared to not go because I really didn't wanna go. But they said, mommy, you can go. You can go. It's okay. In the end, I actually didn't go because in the end I realized that what I needed more was to just be with my family that night. So it was an interesting way of coming full circle and realizing myself what I needed and not necessarily trying to get that answer from other people.


But I guess my point is that I am, I'm still trying to balance work and life and finding time for myself. A few weeks ago, I was so exhausted and I didn't have anything super pressing on my plate, and I spent the afternoon watching Top Gun and it was lovely. Just like a movie from my childhood, and it was like comfort food, basically watching Top Gun and every now and then, it's okay to do things like that.


Because we have to feed our soul. Or like I tell my breastfeeding moms this all the time, no drop of breast milk is worth your mental or physical health. I need to be telling myself that cuz I'm not so good at it on my own. And I need to nurture that home part of me and my time with my kids and my husband and my family, the rest of my family and me.


So I'm working on it. I'm working on it, and you have the time and space to do it. So thank you so much Dr. Rubin for joining us today.


Thank you so much for having me. It's been so fun. Like I never thought I was going to be on my d c years ago when I was listening to it, so it's pretty exciting and it like when I met you at that dinner, I felt like I was total, I got really nervous cuz I was meeting somebody famous.


Oh man, I can't wait to see you again in person and give you a big hug. Thank you again. Yay. Absolutely. Thank you for having me. And thank you for what you do because you're really helping to widen the movement.


Next week look forward to hearing from Dr. Andy Burkowski of Relax Health in Ann Arbor, Michigan. If you've enjoyed the podcast and you haven't yet done so, subscribe today and share the episode with a physician you may know. Who needs to hear about dpc? Leave a five star review on Apple Podcast and on Spotify now as well as it helps others to find all these DP C stories.


Lastly, be sure to follow us on social media. If you're wanting to continue learning more about dpc in the meantime, check out DPC news.com. Until next week, this is Maryal Conception.




*Transcript generated by AI so please forgive errors.

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