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Episode 125: Dr. Cindy Dafashy (She/Her) of Archway Family Medicine DPC - Pasadena, TX

Direct Primary Care Doctor


Dr. Cindy Dafashy of Archway Family Medicine DPC - Pasadena, TX
Dr. Cindy Dafashy

Dr. Cindy Dafashy is a board-certified family medicine physician who is committed to restoring the patient-physician relationship. She is passionate about patient education, price transparency, and helping her patients navigate the complicated maze of the healthcare system in a simple and straightforward way. She feels strongly that a family doctor should work in the interest of the patient and not for the insurance companies.

Dr. Dafashy's academic career has spanned the state of Texas. Leaving her hometown of San Antonio, she attended Rice University in Houston where she graduated with her bachelor's in cognitive sciences. She then went on to obtain a Master's in medical sciences from UNT Health Science Center in Fort Worth. After her master's program, she moved to Galveston, where she worked as a research associate at the University of Texas Medical Branch or UTMB in the maternal-fetal medicine division in the department of OB-GYN. Dr. Dafashy thereafter attended Texas A&M College of Medicine, training in both Brian and Temple Texas. For residency in family medicine, she returned to the island to train at UTMB Galveston. Dr. Dafashy opened her DPC practice, Archway Family Medicine in Houston right out of residency, where she hopes to change the way patients are treated by offering a more affordable, transparent, and accessible option.



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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.


Into 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 fee for service. Doctor, I hope you enjoy today's episode and come away feeling inspired about the future of patient care direct primary care.


Direct primary care is at a superficial level, a billing model that charges a monthly membership for primary care services in lieu of billing insurance. But what DP C really is carries a meaning far deeper than that. It is time and access put back into the patient physician relationship. To me, it's a commitment to transparency for true shared decision making with my patients.


It's a net for those who have fallen through the cracks of the healthcare system. And it's autonomy restored to the physician who refuses to run the hamster wheel for someone else's game. I am Dr. Cindy Dhi of Archway Family Medicine, and this is my D P C story.


Dr. Cindy Dhi is a board certified family medicine physician who is committed to restoring the patient physician relationship. She is passionate about patient education, price, transparency, and helping her patients navigate the complicated maze of the healthcare system. In a simple and straightforward way, she feels strongly that a family doctor should work in the interest of the patient and not for the insurance companies.


Dr. Dfa, she's academic career, has spanned the state of Texas. Leaving her hometown of San Antonio. She attended Rice University in Houston where she graduated with her bachelor's in cognitive sciences. She then went on to obtain a Master's in medical sciences from U N T Health Science Center in Fort Worth.


After her master's program, she moved to Galveston, where she worked as a research associate at the University of Texas Medical Branch or U T M B in the maternal fetal medicine division in the department of OB gyn. Dr. Dhi thereafter attended Texas a and m College of Medicine training in both Brian and Temple Texas for residency in family medicine.


She returned to the island to train at U T M B Galveston. Dr. Dhi opened her D P C practice, Archway Family Medicine in Houston right out of residency where she hopes to change the way patients are treated by offering a more affordable, transparent, and accessible option.

Welcome to the podcast, Dr. Dhi.


Thank you. Thanks. I'm excited for to be here. That is definitely a mutual feeling cuz I was sharing with you right before we were recording, you know, hearing the power and the words in your opening statement. It just really, really is a much needed, you know, injection of enthusiasm and drive as to why this movement means so much to us.


So with that said, I was thinking when I was preparing for this interview about a conference that I had just attended where there were a lot of residents who had not yet heard about D P C. And so for you who was planning and dreaming and actively, you know, doing the things to, to open after you left your residency program, I wanted to ask you about this quote and where it came from that led you to open D P C after residency.


So at Archway Family Medicine, we believe we're stepping into something greater for the future of primary care. We're leaving behind a dysfunctional, wasteful, and backwards form of delivering healthcare. The current system prioritizes catering to insurance needs, packing doctor's schedules, and leaving patients in the dark about where their money is going.


So for me, when you're in medical school, you really don't see the gears that are moving behind the scenes of what it means to be a primary care doctor. I mean, you're like so focused on learning the medicine and not making some horrible mistake that you don't really pick up on the subtleties that are actually not so subtle once you're in it.


I guess once you're in your residency training, and I had a really great experience in my residency, I, I felt fully prepared to work on my own coming out of it in regards to the medicine. But there were moments, and really it was the sum of these tiny moments that spoke to me and said, This is not right.


It wasn't right that I could never answer how much something costs other than I, I could give them a good RX coupon. It wasn't right that a huge focus of our training was how to build to the highest level, and then how to document for said billing. And I wondered what could we be learning instead if we didn't spend so much energy on becoming experts in billing and documentation.


That's not my job. That's not why I went into medicine at all. It wasn't right to me that even the way physicians talked about patients would circle around their insurance status and assumptions we made. If someone was uninsured, even treatment decisions sometimes would be scaled back because they quote, couldn't pay or they assumed they quote, couldn't pay.


And it wasn't right that I'd be in rotations and I'd be learning from various subspecialties and then I was in my own clinic and they say, well just refer them out. There was just this disconnect between the physician I wanted to be and the physician I was being trained to be. I mean, to be fair, you know, I, a lot of that, that focus on billing and documentation, I think it comes from a good place.

You know, the program really wants you to transition well into the, you know, the real world quote.


But, and that's the system that traditional fee for service clinics operate in. So I, I get it. They wanted us to be prepared, but to me I was, this is not medicine for me. And when you were in that place, what was it that eventually had you put those little pieces together to then, you know, commit to and after residency, I'm going to be the physician I, I'm training to be and who I've dreamt about being to open up Archway Family Medicine.


So I was, um, at the beginning of my second year of residency when one of my co-residents actually told me about Direct Primary Care. It was a model that they were. Always interested in practicing in, and I had never heard of Direct Primary Care. I heard of Concierge Medicine and, but even that superficially, I suppose.


So I, I looked into it just to read about it and I read, I, I'm not even, I can't even remember where I was reading a blog post, but it was, it was interesting. And so I said, okay, I'm gonna read another article. And then I read another article and then another article, and then I decided to buy Paul Thomas's book.


And I mean, I flew through that book probably in two days, which is a commitment when you're in residency and you probably should be doing something else. I just was like, this is it. I mean, this is exactly how primary care should be practiced. This is how I wanna practice medicine. I mean, I went on Amazon and bought every other d p C book out there and just ate it up.


And my brain just felt like it was on fire. And I was like, I have to tell everybody about this. I mean, I, I told my husband and he was incredibly supportive. I just knew I didn't wanna step one foot into the current system coming out of residency. And we knew that now would be the time to take the dive.


I mean, I have, this is the time where I can take the risk to take the quote pay cut starting off because I'm already not making much money as a resident anyway. And I mean, that fire, it just grew and the fire that came out of my mouth was probably even hotter because I probably told every person I came across.


About DP C. Anyone that was willing to listen, my co-residents, my family, my friends, faculty specialists who don't even care about primary, primary care. And I probably wasn't very interesting for a period of time there cuz it's literally all I would talk about. But I mean, I think that's how you spread the word of direct primary care is, is you get excited and people just wanna learn.


They wanna learn this new model and everyone says that word of mouth is the best form of advertisement for D P C. And that's how I heard about it. And. That was kind of my goal is to kind of just keep talking.


That right there people that is legit D P C Kool-Aid and that is the entire experience during DP C Summit, any of the DP C conferences that you should attend.


That is my biased opinion this year because that people is legit the DPC Kool-Aid right there when the fire is hot as heck coming out of your mouth because you are so excited about living again and about being able to live as a physician like you've always dreamed about and always to and, and being able to take care of your patients like you thought you were going to be able to after medical school.


That right there. Okay, so when people though are saying, wait a minute, you, you opened, like you started thinking about it, dreaming second year, read all the books, got all the resources, but then how did you plan and how did you actually open after residency? Not taking any side gigs. What's your answer to those people?


Sure. So there was a lot of planning up front because of, I learned about it my second year. I really had a lot of time to look into it. I basically took all those DP C books that I had and created my own to-do checklist on Google. And I just added and added and I just kept adding. And every time I, you know, I might be in clinic and something would come up and I would say, oh, I wonder how I would do that in my own clinic.


And I would add it to my to-do list and figure it out. Or maybe I'll do this in such way. And that, I mean, that to-do list grew to maybe an 11 page Google document, which was overwhelming. But I think as I moved through residency, I, I, I made that decision I need to start training or I need to approach residency with the mindset that I'm gonna do everything on my own.


And that, I think that's what really helped me. And it, it made that to-do list, actually not that bad because I've started kind of answering some of those questions on my own. And then towards the end of third year, I took that to-do list and started creating an actual timetable out of it, which I had a lot of help from my sister to do it cuz she's very organized and she kind of helped restructure my brain.


So my husband is also a physician and he was also graduating residency at the same time as me. I mean, it was exciting. This is just, it was exciting that we were both finishing and we were both gonna start and do what we've been training for so long to do. And we, we made that decision that. I was going to just put all my energy into opening the clinic rather than taking a side job.


Um, I also had, I just had had a baby at the end of my third year of residency, so I kind of was, I had a lot on my plate that I wanted to focus on and I didn't have, I think I knew I didn't have the bandwidth to take on, you know, a side job and the baby and starting my own clinic and figuring out how to do it all, as in doing, setting up the clinic itself.


That is a lot to bear and I think that it feeds into you doing the research and you planning your D P c that you made that decision about your own autonomy with, with those three things on the table. Like, which of the, these three things am I going to choose not to pursue so that I can really make sure that the two things that I need to.


You know, dedicate my time to my, my baby, and then my business baby that they are taken care of. So I think that that is even something that not a lot of people would be able to think about, especially when you're coming from a residency program where it's like when you get that ER page, you go to the er, like you don't question it, you just go.


And so we're so trained to, you know, yes, I will be there. Like, yes, I can do that. Yes, I can take on another thing. Like, yes, I can learn to code better. So I totally, I think that that is one thing that you should be proud of yourself for anybody who's thinking about D P C while in residency should be proud of, because that's putting yourself first.


And if you don't take care of yourself, you can't take care of any patients. Oh, yeah. The power of of no is a big lesson that everyone needs to learn. I mean, I, I don't think even going through residency. You know, actually even towards the end when I was, when everyone's starting to apply for jobs, people approached me with different job opportunities.


And I mean, yes, maybe if I hadn't heard of D P C I probably would've gone for them, but I think I realized I need to just stick with what I've decided and just go full force and say no. And there's, you know, there's always gonna be opportunities, but it's about sifting out which one's actually taking you to the next step of your goals.


I love that. And when you talk about how your list turned into an 11 page document, your sister helped you with the timeline. Did you make that timeline based on goals or how did you prioritize that document? It was such a crazy document. I originally had it organized by categories, so I had. Like a legal side.


I had office logistics side figuring out my workflow side. I had a marketing section, but what my sister did, so my sister started her own business, not in medicine, but she took that same principle of what needs to happen first for everything else to happen. And so it was really organized that way. The book, if you have you read the book, the One thing, the one thing I thought was such a great book because it really teaches you what is the one thing you need to do right now for everything else.


To work, and that's how I set it up. It's like, well, you know, I can't do anything without my business being formed as a legal entity. So we're gonna start there. Then once it's formed. Okay, so now we need to set up an email and grab a domain name because everything's gonna funnel back. To one, that email address and the website is just to kind of grab it.


I think. I don't, I guess you really didn't have to start it off with the email, but then it was financial. So what is your banking? And then everything else could play out because you can't get an emr, you can't buy supplies. I mean, you can, but then you'd be using your personal accounts and you really should separate it.


So all to say every, everything about that timeline was what needs to happen first. What is the most important thing now? What is important but not necessary. So actually how she divided it, I'm trying to remember her categories. It was like critical in order to open, like literally cannot open without this, like registering your business can open but don't necessarily need this yet and then would be nice to add, but down the road.


So I still have stuff in that bucket that I haven't gotten to. It was really a good way to just keep me moving and keep me going through the steps and not feeling discouraged or overwhelmed by the to-do list. No, that's great. It's very like Eisenhower matrixy sounding as you describe it like that. And I think that it also helps, like when I think about the separation there, as you described it, it's like it takes you out of emergency mode for everything and it's like these are the things that it's okay to take a breath on.


So I love that, especially for people who are not MBAs like, you know, you and I did not go to MBA school and yet here we are. So love that. Now with you having just absorbed all of this information about D P C, what would you say the difference is between prepared and being ready?


Yeah, so being prepared is making that checklist, but being ready is actually doing the actionable steps to check them off.


You know, I think I could have sat on a to-do list throughout residency and just kept adding and adding and adding. But I think when I was reaching the end of my residency, I said, okay. This, this, the time is coming and it, I, there's, you know, yeah, I'm not graduated yet, but even in the last month's, my residency, I said, well, I can still form the business.


There's things I can do and not have to be clinically, you know, unavailable or whatever it may be. So I felt prepared definitely through my second year and then the beginning of my third year. And then it wasn't really till my third year where I said, okay, I'm ready to start taking the steps to actually do day one.


Cuz each step that you do in each check box that you complete feels so satisfying. Cause that's one less thing you have to do. And it's not so scary when you just cross off One thing, I remember when I registered my business as a P L L C, I was like, wow, okay, things are happening. I have a name. It's out there.


That's all I have. But it's out there. I mean, I took a step. It's happening. It's a real thing. My clinic is gonna come it and it, it's energizing.


It absolutely is. It's like, I, I really do equate it to a business baby because it does also cause sleepless nights. But it's like when you have that feeling of pride and just cheer joy, that it's something that, especially for you, as I was reading about and listening to your previous interviews, like you are very passionate about honoring your creative side.


And so I, I definitely feel that for people who. Love creating things that DP c's a really good fit for physicians who are also creative in whatever, you know, hobby, art form, whatever they do that's not related to their physician job directly. That I, I think that this is a, it's a great opportunity to, to really represent yourself as an individual.


And so with that said, given that you're in Houston, did you entertain the idea of ever joining another DP C versus opening your own? And what was it like in the end when you decided that you were gonna open your own clinic? So I did. I went back and forth on if I wanted to start my own or if I wanted to join and really, What I wanted to do first was actually visit other d p c clinics to, to just get a feel.


So I did design my own elective, um, in third year where I just a direct primary care elective. No one had any idea what I was doing. I mean, there's like, okay, you designed it. Go do what you think needs to be done. And so I visited just one direct primary care clinic in Houston, first primary care, which is huge.


You've interviewed Dr. Goyle before. He's wonderful. His whole clinic is awesome. All of the physicians and, and nps and everyone who works with him are just great people. And it was so fun because I spent so much time kind of reading the theory of direct primary care and then to see then action. First of all, it just solidified my decision even further, but I was able to kind of see the, the two sides. So I got to talk with Dr. Goyle, who started the clinic himself, but I also got to talk with some of his other physicians who, who joined his clinic. And honestly, I think it comes down to just personality type. I just really wanted to start something on my own.


I think joining D P C is such a great option in that it even is an option now. Whereas, you know, five, 10 years ago it wasn't a thing. There's probably, you know, there's this wave of people opening DP C clinics, but there's like a parallel wave of people that are joining these DP C clinics. It's two totally different, maybe not totally different experiences, but I think it, it allows different kinds of physicians to now join DP C.


And it doesn't have to be those, you know, the ones who start. I think you have to have a certain excitement and, and entrepreneurial, entrepreneurial energy about you. Um, even if you've never been in business before, but you have to be excited about it cuz it is a big undertaking. Whereas some other people are just worker bees and they just love being worker bees.


They just wanna do a good job, they wanna be doctors without, you know, the distractions of the fee for service model. And joining a DP C practice is such a good alternative now. And I, yeah, I, I really heavily weighed the two and I think I just, because I wanted to do something from scratch and have that kind of satisfaction or, or to be able to see that I could do something from the beginning and design it the, my own way, you know, set up how I wanted the practice run.


I guess I didn't even think about joining a DP C when I first started reading about it, just cuz a lot of the books, they don't, I mean, they kind of talk about it, but not really. It's, it's, it's all directed from starting it on your own. I really didn't entertain the idea of joining practice till I visited because it was a viable option.


And then I realized a lot of DPCs all over Texas in particular are hiring. And I was like, man, I mean this, I, I didn't even think that I could do this. But then, I don't know, I guess I just reevaluated what my personal goals were and I, I really did wanna start it from the beginning. I love that. And when you made that decision and you said, you know, Hey, I'm going to open up, how did you end up finding your space?


Because it's next door to your father-in-law's office. Yeah, and it's inside of a med spa. It looks super well put together on your website. How did you end up finding your space?

So my father-in-law actually owns the building. So his clinic takes up a portion of it, and then he has a med spa and then there's a lab.


So there's three main offices. It's a small building actually. And when I told my in-laws about my idea of, of starting a direct primary care practice, they're so generous and they're so kind to me, and they're always been so supportive of everything that I do. They said, you know, we have, you have space there.


We don't use all the rooms in the med spa. Just consider it as an option. I weighed that decision for a while because it's. It's actually not too close to where I live. It's about a 30 minute drive for me. And I, you know, thought about, well, I really wanna be closer to where I live. Should I lease a space?


I kind of had talked to some different physicians in my area who are also looking to hire sublease a spot. And it's funny, the D P C summit of 2022, I was supposed to go in person and then I, I think, I think because my baby was so young, I ended up deciding to do it virtual, and I asked so many questions from the virtual side of things.


I think in several talks I would ask that question, do you think I should open at least from someone that's very close or have a little bit of a more affordable option using a family member space? But they're much further away. And people said, go for the more affordable options. So it was probably the best decision because it made the actual startup of my clinic a lot easier.


The space. I mean the, the, the space itself is already done. It was already an operating clinic. So I'm just creating my space from, I, I have two rooms, so I have one as my office space and then one as a patient exam room and gathering the supplies. They're very small rooms, so I don't, I can't fit a lot. So I really kind of pair down my list to what is the most essential and decided I would just buy as I go.


If someone, if it turns out I have a lot of people asking for ear lavages, then I'm gonna buy that when that starts coming up. But I wasn't gonna buy it upfront. It definitely, it's, you get hopped up on the, the, you know, excitement of, oh, I can get this too, and I definitely need this, and I definitely need, it's this.


But, um, I, I totally agree. Like I. You know, had some things myself that I forgot during doing home visits my first year and I was like, oh, they need their ear cleaned and I'm gonna go on Amazon and find out how to buy an ear cleaning kit because I didn't have one. So, yeah, I think that's great. And there, I wanna ask, like on your 11 page document, did you have a, an addendum for your things that you ended up buying and in, in what order you bought them?


I did. I ended up. Creating a sublist cut paste to do later. And I think I was so excited upfront adding so many things that, hmm, I probably don't really need to have something to do, uh, an exercise stress test just yet. Something that can wait. Do I need a treadmill? So, I love that you said that cuz I legit got a C PET in my, in my clinic because I'm building out Firefighter Physical, a firefighter physical program.


Mm-hmm. So being able to measure VO two max and having a C PET that I could have in my clinic was a big expense, but it's like, Knowing that this was what it was going to be used for. That was how I justified, okay, this is the expenditure that I'm going to, you know, be investing in so that I can do the care that I need to do.


And, but I didn't buy it on day one that, yeah, I bought, you know, earlier this year and it came a couple weeks ago. So that is really great. And it, it, it almost makes you wanna think about, if you could Eisenhower matrix your list of all the things that you're brainstorming you need, just putting it into like, okay, who are my patients?


If you have anybody, and like, who are they? Like if you know them from your previous practice, what are they usually, you know, coming in for? Oh, I definitely know, like that person has melanoma. I definitely need, you know, biopsying stuff or whatever. But I think that you just mentioned that Eisenhower Matrix made, makes me think or that the way of how you set up your priorities as mm-hmm.


As to how you're gonna tick off your to-dos. I think that that would be really effective for, for tools potentially.


Yeah. And. Can I just say side note, isn't that so exciting that you're doing this firefighter thing? I mean, when, when else would you be able to do something so cool? Right?


Absolutely, and I, I, even when I opened D P C, it was not even on my radar.


I didn't even know that our local firefighters did not have a firefighter physical. I just assumed everybody did. And so I have been, you know, very sadly shocked about the. Screening that goes on nationally when it comes to firefighters because like check with your local firefighters if that's something that interests you, because a lot of firefighter districts do not have their physicals being followed to the standards of the N F P A.


So just shout out to Dr. Erica Bliss and Dr. Christa Springs who have really helped me along that journey to develop this for our firefighters. But being able to live in the community and know every time that I pass an Ts, T's past fire district truck that like I am working to make sure that they're safe on the job.


It is such a rewarding thing. Like it is incredibly rewarding. So, yeah, that is so true. It's a whole other form of patient care. I mean, obviously you're taking care of these firefighters, but you are by extension, taking care of your community through these people. And I, I, I love that. I love that we can just dive into the community so much easier.


And without these restrictions and boundaries of who we can work with and what we can design, and there's no red tape, you can say, Hey, there's a need. Let me address the need done.

So that is also true when I was, uh, at the Capitol last weekend, uh, talking to lawmakers about a healthcare bill and also funding to support residency positions, developing and funding residency positions to in family medicine, specifically to serve rural and underserved areas.


I was googling my area and just making sure I had all my facts right, and one of those facts was that I am the only female physician who provides a. Obstetrical care of any physician in my entire county. And I was like, I grew up in Sacramento like my family has, like we are down the street from uc, Davis Med Center.


Like how is this even possible in a whole county in California? So when you talk about what you can do if you are available and able to serve the needs of your community, it is flipping fantastic. That's why when I asked Dr. Leski. In his interview, you know, like, will DP C work anywhere or are there places it won't work?


And he said, yes, it can work anywhere. And that is so true, especially if the value proposition is you are honoring yourself, you're honoring the patients, you're honoring the needs that both of you have, and you're not putting anyone, you know, in bankruptcy doing it. It is fantastic. So when we talk about, you know, this idea that D P C is so awesome, just jumping back into with you telling everybody, had you thought or had you found any ways that you can get the word through to not only residents, like people who are not yet in the system where, you know, we find people making excuses for the way that their job is treating them.


I know that there's those people, and I agree with you that there are the people who. That they just, the fee for service is their jam. They love it, no problem. But when it comes to opening the doors for people to be able to choose, you can take the red pill, you can take the blue pill. Like how do you envision getting the word out more to people like yourself who were in residency and like could dream and formulate a plan to open up their own clinic?


Yeah, I think that goes with me talking everyone's ear off. So from my program, there has been, I think one or two other former residents who joined D P C. So my program has heard of direct primary care, maybe, I don't know to what extent across all the faculty, for example. But I knew within the cohort of residents that I was with, I mean, people need very little.


So my second year I gave a lecture in my, in our didactics to my residency program about direct primary care. And then I did basically the same lecture again the next year for basically people who missed it or maybe I added a few more points. And then I went back again after I graduated and talked to the now graduating class just to kind of keep, keep it in their minds, keep reinforcing it so it's not this one time thing that they heard by some random person.


It's not a stranger, it's Cindy. That girl I literally just spent a month with in the hospital and she's doing it. I know her personality, I know her. She's, you know, she and I are the same, whatever. I think just constantly reminding people of the options. Whether they choose it or not, you're right, it should be their choice.


They, they should just know. And I, I really, what I really want to do is I really want to target first year medical students before they've made that decision of going into any specialty. Just to open their mind to primary care as an option, because everyone just paints such a bad picture of primary care.


And it's so sad. I think some people go into medical school wanting to be a primary care doctor and then they meet some specialist who just slams them down and says, no, you don't wanna do that. They are just miserable. They're overworked and there is some truth to those statements, but then they think that is life.


And it's unfortunate that you go through all of medical school and then you choose maybe a specialty. Because of that advice. And what if your heart really was with primary care and having long-term, lasting relationships with patients and then you end up in this track and now you're quote stuck, I guess in a specialty and then you're not happy.


And that's why just it, it tumbles. And so I think that is the area where we need to hit people. Pre-med might be a little bit too early. I, I actually was talking to a pre-med student the other day, and again, I could not stop talking. I probably overwhelmed him and I kept trying to scale it back and I said, okay, maybe this is not the age, age or population to really hit direct primary care.


I'll just talk about primary care in general. But first year medical students, second, second year medical students that are still exploring, I think is a good target. Well, I'm with you there in terms of like, Being in in a place where it's like, bam. There goes the D p C waterfall out of my mouth. And like I will say though, that the undergrads that I've talked with, when I ask them like, what's your healthcare experience been in your primary?


And they roll their eyes, they laugh. They have all of these like snide remarks about healthcare as a patient that they don't like. They're like, why would I go into primary care? But I'm in a pre-med club, like I'm definitely gonna go to med school, but why would I do that? Like, that's. Terrible job. And so I think that culturally, I mean, it's just like mm-hmm.


In California we have like the first five, uh, programs, like, um, the programs targeted to making sure that the, the first five years of a child's life are really enriched with different types of stimulation and activities and whatnot. It's like you can't teach 'em too early, is where I think that's a great thing that you're talking to even pre-meds, because you're formulating their outlook on life.


You're giving them an option even before they've chosen to medical school. Because if somebody is like, well, shoot, I heard, you know, Dr. Thompson and Dr. Allmans and Dr. Gonzalez's. Podcast and I wanna go to med school around Kansas so I can go to Via Christi or whatever it is. Like that can help them target their future path in medicine as well.


And I'm very, very honored that I get to talk to people like you who are whipping out that D B C Kool-Aid spirit all the time. But it is really important that people know. I mean, it's just like, I wish that we had home ec, I wish that we had like how much does it cost to have a baby? I wish that we had like how much, you know, does it, like how do you even open a business like in high school?


I wish we had that because I feel like I would've had a different outlook on. Financially being sound about retirement and about like how to budget and whatnot. So I think that that's a really good thing and I definitely would encourage other people if they have like connections to their pre-med societies around them or medical schools residencies to reach out and just say that cuz I, I do the same thing.


Like I talk to residents at my former residency and they eat it up. I mean they just like you and I did when we were learning about this. Right. So. Right. So with that said, with with you and I, you know, spewing the D P C Kool-Aid, one of the things I wanna highlight, and you mentioned your sister earlier, but your family has been like along with you on this journey, including your in-laws.

How have they all played a role in Archway family medicine?


It is crazy. Literally every single person in my family, from both my side and my husband's side has done something for archway. So, I mean, my husband, he is, I mean, I could not even enter this. Mindset without him supporting me and just asking the questions.


Cuz you know, it's, it's great to have someone who doesn't know the model to have kind of like a practice to teach, especially someone. So he's a specialist to, to, to explain it to that side of medicine. But anyway, so he's kind of the, the, you know, the main supporting character in this. My sister Gabby, she has had the biggest role in.


How the clinic has been built. I call, she's like my business manager is what I call her, even though she is not paid and she has her own business that she runs. But she really just, she set me up for success. She was someone that coaches people how to build their own apps in websites using a program where you don't need to know how to code.


So that's her area. And she took a skillset that she just had and created a business outta it cuz she saw a need. And so though she's not medicine, just the steps that you need to take. And I kind of already mentioned this stuff, it's the same, starting a small business, it's, there's a lot of things that are gonna be the same.


And her wife works this, her business with her and she is just marketing queen. So she has been the one that helped me kind of frame my website and copyright and, and figured out, you know, what words need to be out there to get the message across and. How are patients who are not coming at this from a medicine side, reading my material, what, whatever that may be.


I have a younger sister who's like social media queen, just a data analyst. That's her actual job and she's, that's, that's what she does. She works with social media. She's really been very helpful for my Instagram account. My brother actually came up with a name Archway. That's probably his biggest contribution.


Um, my sister-in-law's a lawyer, so she's looked over a lot of my legal paperwork. My brother-in-law, he's, he has his own business himself, so he's also been kind of like a business consultant. And then my in-laws as well as my dad, they're, they're actually all in medicine. There's a lot of people in medicine in my family.


It's been great to have that experience of someone who's worked in, they've all worked in different kind of practice types, so that's been very helpful. And then my mom, she translated my entire website into Spanish. So that is, that is the family rundown.


I just love that. To me, when I learned that, it was like, how awesome is that, that literally you're being held up by everyone in your family as well as all of the patients who join you.


Like there are so many people and like all the people listening to your story now, like the community that's, that is underneath us and with us in this whole, you know, endeavor of D P C, it's flipping amazing. Like I never felt that when I left Creighton, like I in residency, it was like, that's cool.


There's like some people in your class that like, are your besties and then like, then you go out to like no man's land and like you don't know anybody. But yeah, like it's, it's unreal what ties us together. And for your clinic, I think that that is so awesome that you were able to pull from your family to support your clinic and what you're doing when it comes to.


You mentioning how Gabby is owns her own business and what she's doing in terms of business coaching. You recently got a word of an a certain acceptance. Can you share with the audience Yeah. Um, what you got accepted to and what are you looking, uh, to achieve with this acceptance? I'm very excited. I just found out today, so I went to RICE for undergrad and Rice has this business accelerator program for small businesses.


Um, it's fairly new. They, they had a similar program mostly for I think, tech startups. And then last year they decided to open up this accelerator course for any small business. And I, you know, I just saw an advertisement for it on Instagram and I said, and it's, it's only, so the thing is you have to be a rice, either a rice student, staff, faculty, or an alumni.


So, and it said recent alumni and I was said, okay, I don't know what boundaries I'm pushing with recent, but you know, I'm gonna just go for it. And honestly, everyone should just go for it. That is my motto for things. If you don't try, you never know what you can get. So the accelerator course itself is a 12 week course where basically get lessons from different industry leaders for how to run a small business.


And it culminates with this pitch presentation at the end to some 600 people, uh, which is great. I'm excited to, to really, you know, cuz so much of, of building the clinic has been though I've had the help of all these people giving me advice. A lot of it, I, you know, I'm the one that has to put it all together and I'm the center of this Clinic and I, I wanna make sure that my clinic is built on a solid foundation and I think it is, but I'm so looking forward to this course because it will really at least tell me that I have built a solid business. And this is like, and what's nice is medicine really will have no real part in this. It's, it's all about the business itself.


And like you mentioned, I don't have a business degree. Most of us don't have business degrees, so it's nice to have a little bit of the structure and reinforcement and advice and mentorship. Um, and that'll take place throughout the summer. So, and honestly, now is the only time I could probably do it when my clinic is just now starting up and, you know, I'm not really cranking out patience and yeah, looking forward to it.


That's awesome. And one of the things that I also learned when I was preparing for this interview was that you are very big on linguistics. So when it comes to your education and linguistics and how that translates to. Using linguistics in real life and creating a solid business platform and one that is solid to grow from.


I wanna highlight this linguistics quote that you said in a recent interview and you said that language influences how we think. So when you were creating this solid foundation, cuz I'm gonna say it's a solid foundation, even though you haven't taken this business, uh, course yet, just because of all of what you've shared already when you were working with your family to develop your copy and then that translated into not only an English but a Spanish website and then getting patients into your clinic, how did you find language to be most effective, whether it be in English or Spanish or another language to really help your community understand what you were doing?


So language is, it is, it's very important to me. I care a lot about words and. Because I think the words matter. And the thing is, language is a cultural tool, and we have to use language to meet the cultural needs and to be understood from that culture. So medicine is its own culture. So if I talk about direct primary care from a physician's perspective, patients are not gonna understand.


You have to approach it from the patient's culture, the patient experience. And I think that's something where my sister-in-law, Kristen, where she helped me out, was, everything needs to be about the patient. It's not about you and it, and it, it is, it isn't, that's what I should say. It's, it's really not about your clinic and your services, though.


That's what you're trying to provide. You're trying to have the patient understand how you can meet their needs. And so in terms of the website, at least, I tried to frame everything from, you know, the intro page to. How I explain the member benefits, even just the little details of my frequently asked questions page.


I don't wanna overwhelm the patient with the medicine side because medicine is medicine. Whether you're practicing it in fam uh, fee for service or d p c, that's, that's not why they came to your site and that's not what they're looking for. They're looking to see how are you different, how are you gonna solve the problems that I've been facing?


The lack of access, the lack of time, the being pushed around, the not knowing who to call and being sent to voicemails and never seeing my doctor for months at a time. Those are the pain points. And so we use language to meet their needs. And I think if I'm talking about direct primary care to a patient, I really have to think of their, their side and their experience and, and use the words that are gonna speak to them.


It's a completely different conversation with a physician. And it's interesting when we talked about how I was preparing for entering. Direct primary care during residency, during that, what is prepared versus ready? So I spent so much time talking to colleagues about direct primary care that I really nailed the direct primary care talk to a physician.


And as I got closer to the end, I said, huh, I haven't actually explained this to patients, to non medicine people who, who wanna understand the model. And I didn't feel ready for that part. I didn't feel ready to take the steps I needed to practice the words. I didn't feel prepared. So I, I did have to shift in learning words and phrases and, and I reached out to friends and family fit.


What, what are your pain points? What are things that bother you about the current system? And I know the answers to some of this, but it's, if you've never really been a patient yourself, you learn a lot about the little things, the subtleties of the current healthcare system that are just not working.

So as you talk about.


This journey of going from learning to being prepared in the physician space, not necessarily in that equal space when it came to patients. Mm-hmm. And I know you, you've had help along your journey when it comes to social media, but as you've taken your talk about D P C into the patient space, you've created some great social media.


Like, you know, there was one on cholesterol where it's a reel. You have like your logo, you have your branding, and then you're talking about like, why does it matter that I. Like, care

about my health when I'm in my twenties and thirties and you gave like the greatest mini medical school lecture on like, in a real form.


Like, oh dang. Like, I've gotta pay attention to that stuff now. That's a really good idea. How do you find social media to be most effective as you're weaving the, the tenets of D p C into the medicine and the value proposition that you're bringing at your, uh, at your clinic? There's just so many sides to direct primary care that I wanna talk about.


And it's funny, my Instagram account has really been my way of exploring which of those sides speak to people the most. Which sides do people not really resonate with? So I've kind of, I've dabbled in a few different types of posts, I guess you could say. What I kind of struggle with is, like I said, I have so much I wanna say sometimes when I make those real.


So what I end up doing is I find either a pain point or I find a topic, a question that I get asked by a patient or even a family member. And I think, how can I explain this in the most simple, straightforward way, um, without complicating it, without using these ridiculous healthcare terms. And sometimes I even find myself just over complicating things.


So I'll record a video and I say, that was just too complicated. I mean, I, I still need to, I make it need to make it more simple, more simple not to, so that people can't understand the more complicated, but it, you can make something simple, it'll stick a little bit better. And I think the, the content that I've made that.


Address very simple, straightforward things like cholesterol in your twenties and thirties, or pediatric dosing of ibuprofen or FSA versus hsa. So it's not, not necessarily all medicine, sometimes it's just healthcare in general. People have so many questions, but those are the posts that seem to get the most feedback, whether they're actually commenting or people just talk to me.


I mean, my friends, they'll come up to me and say, oh, I listened to your thing. I didn't know this, or I learned that. Or, oh, I actually went home that day and I looked up, did I have the right medicine bottle? And I think that's so. You. This is such a, this is, again, this is just another awesome opportunity I have in Direct Primary Care to meet the needs of patients, these tiny gaps, knowledge and tiny pockets that they're filling with internet information instead of real information from a physician that you can just fill.


And it's so simple and it's fun. It's fun for me. It feels it's creative. I have a fun time figuring out what's the best way to present the information and I play around, should I draw it out? Should I. Just talk to the camera, should I use graphics? And that's both for me to figure out what, what works best for me, but also, yeah, what speaks to the audience best.


So I'm still trying to find, I, I think I'm still, I, I enjoy playing around with different, um, content types, but I, I actually have a fun time playing around rather than sticking to one type of post. That's my kind of girl. I swear. I, I will make crafts and never do them again, because it's just the, the exactly of doing it once that gets the desire to lessen a little bit.


So, w with that said, when you're, you know, teaching yourself and navigating the world of social media, how much time do you dedicate per week and do you schedule your social media posting time by day or by month? How do you attack your social media? I really want to be better about it. I really want to have a content calendar, a social media calendar, which I haven't yet. I've semi done that. Um, I think when I first started, I needed to just get the feel of it and just get a feeling for making content or, you know, I designed stuff on Canva and playing with Canva, the, the program, and figuring out what kind of information I wanted to put out.


So the first few posts was really me just exploring that. And then once I had a sense of what I really want to speak to, followers, viewers, whatever you would call them, then I started thinking about, okay, what's one topic I wanna address this week and how is that best presented? So right now I'm kind of just doing it week by week.


So I'll say, okay, I wanted to talk about cholesterol, what aspect of cholesterol is really needed? And then yeah, how is this best presented? And then I make that decision. And I decide that I only wanna post my sister, my other sister, Paulina. She helped me with this. You know, she, she kind of framed it as, for a clinic, you don't really need to be posting every day for one.


And I don't have time and I don't want that to become a, a need that I have in the future where I have to post every single day. I want it to be something sustainable. So my goal is to post maybe two or three times a week, and even if I just post once, I'm okay. But that was my goal two or three times.


And I tried to mix the types of posts. So I said, okay, one day I'll have maybe just a static post is what it's called, or a reel or a carousel type post where it's multiple slides. And I try not to, I got really excited at one point when I was doing a lot of healthcare talks in my account and I felt like I needed to mix it up.


And so it's, I, I think I'm still in the experimental stages of the type of content how often. And again, I don't wanna overcomplicate it, but I really do enjoy this social media side. So I do take some time. I probably. On Mondays, think about what it is I wanna post that week. I tell myself, oh, I'll wait and post this post on Thursday and then I just post it that day.


Cause I can't help myself. I love it. And And you get to do that because you get to manage your own schedule, like Yes. That's awesome. High five to you, man. That's great. I think it's so cool that you really get to be paid for being you like your patience. Are paying you, you know, in a typical DP C practice where they're paying monthly, they're paying annually, whatever, but you're being paid to be you as a physician.


There's no other Dr. Dhi, and this is part of Dr. Dhi. So I love that. Yeah. Now, another part of you that you've talked about already is that you are a mom of two kids that are under five. Mm-hmm. And we were talking before this interview that I, I can relate to that world. That world is very, very unique to the experience of the parents who've lived in that world of being in the workforce or just even having two kids who are under five, even if they're not in the workforce.


Like it's, that's being a parent of two kids under five is a lot. Mm-hmm. So that said, you've had a pretty crazy, you know, journey when it came to. Not only having your first baby at the end of third year residency, but then you also had another little one come in 2022. So what has your journey been like with balancing becoming an attending physician as well as a business owner and starting to bring patients on while you're, you're, you have two little ones.


It's been an interesting journey. So I had my daughter my fourth year of medical school, and that was actually not so bad because the end of medical school, you're kind of winding down, you're not doing very much. It was very close to match day. So I had months, you know, where I could spend with her, but then dove into residency.


Didn't really know anything else. I mean, I didn't know anything different. I started residency with the kids, so I don't know what it's like to do residency without a kid, so I could definitely see if you have a kid in residency, like in the middle of it, that's hard because that's a, that's a big adjustment.


So I think because I started residency with a baby, I learned how to do that balancing act from the beginning, which was when I'm in the hospital or in clinic, I'm there. But when I'm home, I'm not a doctor, I'm a mom and or a wife, and that's all I wanna be. I really, I really prioritize not doing anything unless it was absolutely necessary.


You know, some critical lab came back, yes, I'll address it, but I'm not gonna be spending time finishing notes or, you know, checking my chart. I had that, like checking my chart for a result to come back. That's really not critical. Yeah, I, I'm not gonna waste my time doing that stuff. I have a life to live at home and I get very few hours at home with that baby.


And because my husband was also a resident, it was difficult to find a daycare in Galveston that fit those hours. There was one or two that had kind of like a 6:00 AM to 6:00 PM but we needed more than that, which is so sad. I mean, there would be, it would, it wouldn't happen often, but, um, my husband would have days where he's leaving four or five in the morning, and then if I have to leave also five something in the morning, and then what if we both don't get back?


So we ended up going with a nanny, which was the best thing we could have ever done, and she's such a blessing to our family. So that's how we handle the kid throughout residency. And then at the end of residency is when I had my second kid, and that was a bigger adjustment because he was born a month before my board exam.


So I gave myself like a, a week to kind of adjust to the second baby in the house. And then I sat at my computer with my baby in my lap and would breastfeed him and would do questions and study. And that was just my routine. I had, I was on maternity leave, so I was able to study. But yeah, maternity leave is not a vacation.


It is work. It was, again, it was, well, I don't know anything else. I've never studied for my board exams without a newborn in my lap. So this is just the way that it is. It was very nice graduating residency to finally have time to just spend with them. And it's so sad. I think when I was, when I was growing up, I always imagined.


I always wanted to be a mom. Always wanted to be a mom, and I could just, I would picture myself being there for my kids when they wake up in the morning. And then maybe I'd go to work and I'd be there for them to pick 'em up from school. And as I moved through the medical training, I, I, that picture seemed to get further and further away.


Not because, not the idea of having kids, but being that kind of mom, being present for them and doing all the things that I wanted to do, being really engaged in their school life. And it was sad that it drifted away. And learning about direct primary care is when that picture came back into focus. And I said, I mean, this is bringing so much joy to me in so many different ways.


And it's true. I am so happy now that I get to work from home if I need to. I don't have any patients that come into the office. I get to hang out with my baby. So my baby actually, he decided he boycotted any bottle feeding. He literally fed from a bottle the last two months of my residency. We were going great.


Then I came home and I wasn't, you know, leaving all the time and he said, you know what, I'm gonna just be farm to table and it's breastfeeding directly from now on. And so starting up my clinic was a little bit tough because I'm speeding him every three hours and he would do some long feeds. And so the first few months I would, you know, work for two hours and then I would feed him.


And then it's like, to have to con, to constantly step out and then step back into the mindset, step out, step back in it has made me a little bit more efficient. But it's, it's a little bit of a struggle to bounce between the two to go from mom then to doctor or mom, business owner, mom, business owner. And you know, when you're doing something as big as starting your own small business, you really have to.


You know this book that I mentioned, the one thing it talks about, you really have to put all your energy into the one thing that you're doing in that moment. And eventually, I, I guess I just got used to it, the, the time breaks. I knew when he was gonna be feeding. So if, when I did start seeing patients, I always scheduled patients between those hours.


So cuz I literally would drive the 30 minutes to my clinic, see a patient or two, then drive back and feed him, and then some days drive all the way back to my clinic again. So that, I could keep seeing another patient. Some days I would have, so I have, and I have a nanny with my, my second kid. So she would help me.


Sometimes she would drive with me, hang out at the clinic, so just so I could breastfeed him on time and stick to our schedule. And we made it through. Now he's a year old and congratulations

on that, cuz that is not an easy journey. Breastfeeding is not always an easy journey for everybody. And then on top of that, you throw every three hours won't take the bottle.


My goodness. I love that you are, you know, I, I so appreciate that you're doing this interview. You're two hours ahead of me and like, oh my goodness. I. Cannot even imagine. So that is awesome though, that you can look back on this time and like check that first year off. Like, we did it, we made it through, and you're still awake and not a zombie.


So this is, this is awesome, you know? Oh my goodness. When it comes to continuing to honor yourself, and this what you said, which I love, like from eight to five I'm a doctor, and then after that I'm a mom. What are the rules in your clinic for your patients in terms of after hours access? You know, like you said, if there's something like a critical lab, you'll call them, but how do you address the, the fear that some people have about, oh, you're on call 24 7.


How can you do that while still being, while still honoring yourself and your goals to be able to live life the way you want to live it? I definitely took the advice of many D P C doctors before me who. Really emphasize setting those boundaries early. So I make sure that first appointment where I meet actually even before then, so I do an intro call with potential patients first and I'll tell them that they have after hours access, but I always give that caveat for urgent or emergent needs and I just throw it in there.


I don't go into details in that call, but then when they do have their first appointment with me, you know, I do the, the whole visit first. Uh, I focus on them and I do everything that we need to take care of. And then at the very end is kind of when I go over the rules of the clinic and I've typed up a document that I hand out to them, and I've kind of revised it a few times, but I just tell them from the get-go, I say, Hey, here is a private number that you're gonna have.


I want you to use this when you need me. I mean, I don't want you to be afraid to text me or call me if something bad is happening and you're scared or you're worried, or you really need to talk about it. But I want you to know after hours, meaning after my office hours are technically quote closed, I may not answer the phone or I may not answer the text right away.


I do see everything else I tell them, I screen it and if it come and I encourage them, I say, please leave a text or please leave a voicemail. Don't just call and not, cause then, I don't know, and I say, if, if it is a true, urgent or emergent need, I will get back to you. And if it's not, you'll hear from me the next business day.


I would never leave you hanging. And, and patients respect that. And I think when you set that boundary up front, they say, okay, got it. That's how you, you do your clinic and, and we're gonna abide by it. And patients are so nice. I mean, they'll still say, I'm so sorry for, for bothering you, and it's like 4:00 PM and I'm like, that's okay.


This is a regular hour. I mean, this is not a, not a big deal. And I have some patients who have greater needs than others and it's just kind of been a reinforcement. So I, I continue to reinforce those boundaries. Maybe not verbally, but maybe with. Non-verbal cues. So for example, I don't reply to their text right away.


If they are sending me lots of exclamation points for something that's really not that exciting, I'll get to their texts later. And they've seen with time, they say, okay, this is her normal. When it's very urgent, she calls me right away. When she's concerned, she lets me know. But if she's not concerned, she gets back to me.


She always gets back to me. But it might not be five seconds later. And I think there might be a little bit of training with some patients that that, and those are the patients that are high needs and that's okay. There's always gonna be patients like that. But even my high needs patients are not abusing the the after hours access.


That's great. And I love that. You know, as you mentioned, there's much more in the world of DPCs that have opened so that. You know, people like yourself who are open recently, people who are planning on opening, there's lessons learned from other people's experiences. Mm-hmm. And taking those lessons is so invaluable.


And that's why, you know, I, it, it is such an honor to talk with you and all of the guests who have come onto the podcast because you guys are sharing your lessons that you've learned. And there is someone out there, multiple people out there who are going to benefit from your words. When you were going into your checklist and the 11 page checklist, how did you design your clinic so that the tech you needed was going to support the way you wanted to practice?


I always knew I wanted the onboarding process to be as. Straightforward as possible. I wanted to have the least amount of technical requirements from the patients. So the, all the tech that I use is all electronic. They don't actually have to do anything by paper. I wanted just the most simple, straightforward way.


The softwares that I use, you can really set it up how you want. You could send them, you know, an email so that they register and then they fill out forms and all that stuff. But I knew that that's not how I wanted to start. I wanted them all to start with an intro call, because patients get overwhelmed when you send them a lot of instructions and paperwork, and that's, that's what all the fee for service.


Clinics do. I mean, they, you know, they make an appointment and they're given 10 pages to fill out on the clipboard and they're just like, Ugh, all this paperwork. And so while I had the option to, to do those things, I wanted to make sure I also had the option to not do those things. So I had patient just do their intro call first, and then on that call is when I tell them, okay, I'm gonna send you this link and this is how I open a chart for you.


After you get that link, you'll get this email from me, and then that's it. And, and so I, I try to make the email very simplified on every step of their enrollment process, which is really two steps. Again, at the bottom of those emails or messages, they'll say, you're on step this. And it says, so I have like step one, intro call, step two, register, step three, enroll.


And then so I highlight which step they're on so that it, it makes it easier for them. And I really just want do the least amount of paperwork electronically as possible because a lot of the stuff isn't necessary. And a lot of the stuff I'm asking again anyway. So for example, I initially thought I was gonna have like an intake questionnaire.


I, I do have a very brief one with our medical history and medications, but I started even creating a form of detailed questions and I thought, these are all things I ask anyway, and these are things that I wanna hear from them directly and explain. So I'm just not gonna do it. And I know it would save time.


And that's, and I think I was still in the mentality of the fee for service clinic is, How much work can I get done before I actually have to enter that room, because I have no time when I'm in that patient room. So whatever information can be preloaded, let's do it. And that, that's taking away from your conversation and it's taking away from building the trust and building the relationship.


So I said, I'm not gonna do it. I mean, I don't know, things might change as my clinic gets busier and whatever processes, workflows change and, and I'm, I'm ready to change, I'm adaptable and I know things will, I have to be flexible, but in this current moment, I don't need to. So I'm gonna make things simple and it's gonna be simple for me and simple for the patients.


I love that. And again, it's, it's your creativity, your adaptability, your. Person coming to show up or showing up and really designing your clinic the way that it needs to be designed for you and your community. So it's, it's absolutely the embodiment of the D P C Kool-Aid and what happens when someone drinks it.


So, love it. Now, spinning that on a 180. Recently I had read some posts about somebody deciding that they. That D P C just as a membership model was not gonna work for them, and they started taking insurance and comments were made about, you know, there's a lot of shame and a lot of embarrassment, you know, in within the community.


As supportive as we are, people feel that they're being looked down upon if they go into D P C and it doesn't work, especially if they've opened their own clinic or they've joined a D P C clinic and that, that didn't, that wasn't a good fit for them and they leave that D P C when it comes to the fact that in five years, over half of the businesses that have opened will close.


Um, in that time period, I should say small businesses, your spirit of resiliency that's come through in this whole interview, pulling from that. How do you address the, you know, question of, will I be viable in three years and five years? And why do you feel that way?


Yeah. So I can see why physicians might feel that way.


I think physicians in general are probably more type A people. You know, in medicine you have to approach everything with the utmost caution because mistakes in medicine are, life can be life-threatening, so we don't take risks lightly. And to enter d P C feels like a risk and you feel vulnerable and you're, you know, putting yourself out there doing something that's different.


And so when we quote fail, or if we feel like we fail, we feel like it's a failure of our own inherent abilities or it's our own. And we don't think that perhaps the failure could have been. The environment, something else? Maybe there's a, I mean, I'm not to say that there's not a role that you have in, if a clinic doesn't succeed, if it doesn't meet your needs or if the clinic doesn't turn out how you expected.


But yes, failures do sometimes happen and failures need to happen. I think sometimes you find opportunities out of these failures that you think of some of the greatest businesses and how many times they've remodeled. I mean, you think about Apple, how many times did they have to restructure their business model?


They had to fail. In order to succeed, you have to be vulnerable in order to succeed. I, when I was a resident, I typed, I typed up on a piece of paper vulnerability begets strength, and I. Posted it on our team wall because I felt like it was a message that everyone needed to see that it is okay to be vulnerable around people, to have weaknesses, to show that you're weak to ask for help because it is in those moments where you find your strength and you learn your resilient.


And honestly, if you're a D P C doctor who has chosen to close your clinic, or maybe it didn't work out the way you did, you were probably the best person to be in that position because you left the traditional system and you took that risk. You're someone who knows how to face adversity and you, you're someone who knows how to.


Think outside of the box and find out ways to do something better for yourself, for your family, for your career. And though a D p C clinic might have not worked, that doesn't mean you're, you have to go back into the system. And I wonder if maybe that shame or guilt comes from people feeling like, man, I had all this energy to leave this system, and, and they think, do I have to go back?

All that, everything I talked about was I lying to myself, to my patients. And it's not true. I mean, that it's, it's so cool to see how physicians who are stepping out of. The fee for service are also exploring other avenues of, for example, like sources of income. And it's cuz they're realizing you have been so focused on this one track career that medicine is medical school and residency, and then doctor in the system.


And you keep going, keep going, keep going until you retire. And now you're learning, hey, I did this whole thing where I started a business and that wasn't in my original plan. Maybe there's some other offshoot of medicine that I realized I was really into that maybe this would bring me more joy and I will be more successful at it because I have a, a bigger passion for it.


So I think actually D p C doctors are the prime example of strength and resiliency and those doctors who quote fail are probably gonna be the ones who come out of it the strongest. I really

truly appreciate you sharing those words. And you know, something that you had shared in the interview recently that you had done on the Hidden Gems podcast with Jen was that your journey into medicine was not undergrad.


Medical school residency attending. You know, you and I are alike in that journey too, in that the first round of applications I saw my best friend in, in undergrad, you know, George Washington got a interview, blah, blah, blah. Got an interview. We have this whiteboard going and here's Marielle's. Like there's the cricket side of the whiteboard, and there there's, you know, my best friend from undergrad's side of the whiteboard.


And so I think that when you talk about that early vulnerability and early lessons in quote unquote failure or not seeing what we thought we expected, we would see can lead to more resiliency, you know, at the end, because we've had maybe more time to learn those lessons. Mm-hmm. But I, I mentioned that one because you know, if that is, Your experience as a listener.


I definitely would say that's a real feeling. It's, it's very normal to have, you know, a fear about like, what if, like what if I do this? What if I don't do this? And bring those, those concerns to, you know, the mentorship groups at the D P C summit or when you, if you go to a mastermind or if you, you know, like the Savannah, Georgia doctors, of which there are a ton, you know, they, the D P C doctors in Savannah, they like meet up multiple times on Instagram.


They're like, Instagram famous. And I'm like that, that's the community. That is literally behind all of us. And so, you know, when it comes to this feeling isolated and not wanting to air out concerns or fears, definitely find your people because not everyone's going to be supportive, but they're sure as like our people that have tripped over things, scrape their knees and gotten up, you know?


Mm-hmm. And kept going. So thank you again for sharing that. And with that said, as you go into your future, what are the next goals that you're attacking at Archery Family Medicine? So, uh, I mentioned the, the business program that I'm gonna be doing, and I think I really want to set up a solid understanding of running a small business cuz like you mentioned, Yes, small businesses fail.


And it's a very, it's a reality that I don't want to ignore and I don't want to be naive about it. And I really want to, though I don't have a business degree, I take it very seriously that I am running a business and this is something that I have to learn. It is new. It's not medicine, it's not something I've trained for.


So it's really important for me that I really build that foundation. And I've started by just reading books. I, I just, I read, I think I'm such a book learner more than anything, and that's been great. But I think really hearing from people, not in medicine, but in the small business world or these kind of leaders would be helpful.


I love exploring. You mentioned your, the firefighters that you're helping. I love doing things like this, exploring the little pockets of, of need in the community. So I am constantly reaching out to different people. Like constantly I have little octopus tentacles all over the place trying to see what, what's out there, what's needed, like where can I help?


And. And so I'm kind of dabbling in a lot of, a lot of different things. I'm giving a talk in, in the future, a kind of a series with um, uh, the senior program at our local community center, um, which is on my side of town, not where my clinic is, purely to just talk to seniors and, and kind of find out what their needs are or what they would like to hear from their physician.


Um, I'm trying to set up some talks with the library. I've kind of engaged with different community programs in the town or the side of Houston where my clinic is to kind of meet those needs. So I'm still so much in that beginner stage that I am putting all my feelers out because I just wanna open all the doors right now.


And then which door, you know, is the brightest, which one I like the most, and where I wanna focus my attention. Cuz I know I'm not gonna be able to focus my attention in all these places and I don't wanna spread myself thin. And I, again, like we talked about, I, the power of no is very important and I can't say yes to everything.


But how am I gonna know what to say no to if I don't check? If I don't look what's out there?

Absolutely. Well, thank you so much Dr. Dhi, for joining us today. Thank you so much. It is my honor. I've learned so much from your podcast in Starting My Own. You provide such a valuable resource to residents, physicians, med students, everyone.


This is an incredible honor to be here.


Next week look forward to hearing from Dr. Lauren Scat of Brit House in Sioux Falls, South Dakota. 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 D P C. Leave a five star review on Apple Podcast and on Spotify now as well as it helps others to find all these DPC 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 Maryelle conception.


*Transcript generated by AI so please forgive errors.

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