Updated: Jun 3
Direct Specialty Care Doctor
With more than a decade of experience serving women in hospital and group practice settings. Dr. Skattum is thrilled to be a gynecologist in Sioux Falls, South Dakota, and has the honor of opening the second clinic in the state under the DPC model. She is passionate about empowering women to prioritize their health and wellness, and she has a particular interest in providing care for women following their childbearing years.
Dr. Skattum believes women are the center of their homes and their communities. Although women have a tendency to focus on others, it is when they are healthy and thriving that this positivity radiates to everyone around them. With an emphasis on hormones, metabolism, and lifestyle changes, Dr. Skattum provides a warm and welcoming environment where the nuances of individuals' health and wellness needs are met.
Dr. Skattum was born and raised in Alabama and attended the University of Alabama where she graduated Magna Cum Laude with a degree in biochemistry in 2006. She attended medical school at the West Virginia School of Osteopathic Medicine before completing her residency in obstetrics and gynecology at Mercy St. Vincent Medical Center in Toledo, Ohio. In 2014, Dr. Lauren served as chief resident and held leadership positions at the American College of Osteopathic, Obstetrics, and Gynecology.
When her residency was complete, she moved to Leesburg, Florida, where she practiced in a private group for eight years and served as both the vice chair and department chair of maternal child health.
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Address: 1905 W 57th Street Suite #1, Sioux Falls, SD 57108
Tel: (605) 250-2913
Fax: (605) 653-1536
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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.
DPC to me is old soul medicine. It is being there for your patients and having the time to make those connections and those lifelong relationships to be that old school doctor with a little black bag just now in four heels. I am Dr. Lawrence Gaden of Brit House, and this is my DP C story.
With more than a decade of experience serving women in hospital and group practice settings. Dr. Skat is thrilled to be a gynecologist in Sioux Falls, South Dakota, and has the honor of opening the second clinic in the state Under the D P C model, she is passionate about empowering women to prioritize their health and wellness, and she has a particular interest in providing care for women following their childbearing years.
Dr. Ska believes women are the. Center of their homes and their communities. Although women have a tendency to focus on others, it is when they are healthy and thriving that this positivity radiates to everyone around them with an emphasis on hormones, metabolism, and lifestyle changes. Dr. Skat provides. A warm and welcoming environment where the nuances of individuals health and wellness needs are met.
Dr. Sca was born and raised in Alabama and attended the University of Alabama where she graduated Magna Cum Ladi with a degree in biochemistry. In 2006, she attended medical school at the West Virginia School of Osteopathic Medicine before completing her residency in Obstetrics and gynecology at Mercy St. Vincent Medical Center in Toledo, Ohio. In 2014, Dr. Lauren served as chief resident and held leadership positions at the American College of Osteopathic, obstetrics and Gynecology. When her residency was complete, she moved to Leesburg, Florida where she practiced in a private group for eight years and served as both the vice chair and department chair of maternal child health.
Welcome to the podcast, Dr. Ska.
Thanks, Muriel. I'm so happy to be here.
As we were talking a little bit before this episode, I am super, super excited to be chatting with you because I cannot wait to hear your story, to hear your journey geographically, to hear your journey medically. And so with that, I wanna get started with Brit House.
So you know, typically we'll see something direct, primary care or something direct care or you know what, something that has the idea of direct in the name of the clinic. Can you start us off with how did you come to name your clinic, Brit House?
That's such a good question. So my maiden name is actually Brit, which is where that part comes from. And I met my husband on our very first day of medical school and we dated for six and a half years before we got married. And so by the time we got married, I was already Dr. Brit. So I told him, I was like, you know, I love you obviously, and I want to marry you, but I'm not willing to change my name. And so he was completely supportive, totally understood that I worked really hard to be Dr. Brit and so I was gonna stay Dr. Britt. So then fast forward two years later, we had our first child and he was like, Hey, you know what would be really cool is that if we all had the same last name? And I was like, oh, you're so right. So I ended up changing my name, but still practiced under Brit when I was in Florida.
And when we moved to South Dakota, I did end up changing my name and ending my double life because that way my kids' teachers would know who I was when I picked him up from school. And I decided with my husband's encouragement to keep Brit as kind of the core of the business. Because it was so important to who I was as a person and therefore wanted to keep it as part of how it was so important to this new, you know, medical home that I was creating.
And I, I chose house because I wanted it to feel like a place that women could come as like a safety and that, you know, doesn't matter what happens, you know, or the silly decisions you make or the, the weird problems that you have, like that you can always come home and, and to really own that. I love that.
And I think about, you know, when you talk about you meeting your husband in medical school, which I laugh because that's where I met my husband, but when we think about our journeys in medical school, did you ever go into medical school or medical training or even residency dreaming things that you just said?
Um, no, never actually. In fact, I never wanted to be an entrepreneur and I went to medical. I always wanted to be a doctor. I knew I wanted to be a doctor since I was like four. And I went to medical school wanting to be a cardiovascular surgeon and I am a sucker for medical missions and sleeping on dirt floors.
And I went and spent six weeks in Cameroon, west Africa between my first and second year of medical school. And it was there that I saw my first C-section , which was still the most horrific and awe-inspiring thing I've ever seen. Anesthesia and sterile technique and even air conditioning was like not a thing.
And that was incredible. And so from there, I really wanted to switch my focus to. Obgyn cuz delivering a whole person is like way cooler than a beating heart. So the other part of that that was most impactful for me was that women's worth in their community was based solely on the number of children that they could bear.
And with an H I V rate around 50%. And you know, there's no running water, there's no electricity, there's no other forms of entertainment. So you have sex. There's not condoms or public health, you know, opportunities to prevent that. And so infertility skyrocketed. And so these women were cast out of their homes and literally shoved into the jungle because they couldn't have kids.
And they were told they were worthless because they no longer contributed to the overwhelming good of their society. And that really stuck with me. That was, I feel like a defining moment in my career. So fast forward, we ended up in Florida. My husband is a general surgeon by training. He did a trauma fellowship in Orlando and we were only gonna be there like a year.
And I ended up finding his great job. And one of the retirement, I had an office in one of the retirement communities. And I had all these women who came to see me, who felt like they had worked their whole lives, they had had careers or they'd been moms or both, and that they had just gotten to the point where they had retired and it was gonna be this like great big, glorious thing.
And then they like walk into my office and they're like, I can't believe that this is it. Like, my hormones have crashed. I feel awful. I'm gaining all this weight. Like, what am I gonna do? And so that kind of sense of making sure that people felt empowered in their own worth and their own health really transcended into modern medicine and, and women in particular.
And when you came back, especially from Cameroon and then you transitioned to this job in Florida that you're describing along that journey, what did you see that was not in alignment with allowing a woman to feel completely empowered when it came to her healthcare and it wa when it came to her being valued by the medical system?
Well, I think that women in general are very well cared for and a lot of emphasis is placed on their care when they're having kids or when they are trying to have kids and. Then kind of after kids, we just kind of fall out of the limelight, you know, like the kids are there now the focus is on the kids.
And that's, I think, something that happens not just in the medical system specifically, but also in society as a whole. Like, and we also do it to ourselves, you know, like we are there for our children and we sacrifice a lot of things for them, whether it's time or talents or careers or sleep or, you know, I mean, I woke up this, so this was a very personal journey for me because I realized one day after I have two kids, um, there, they're 21 months apart to the day.
And I realized one day that, I was eating a lot of dinosaur chicken nuggets and I felt awful and I wasn't sleeping and I had an amazing career and a fabulous husband. And this. Like really great life, but I was exhausted, like to my core and I trained to be exhausted. I, you know, I get that, but this was something that was not recoverable and I did it to myself and I realized that if for somebody who is highly educated and very well supported and has a like a great spouse, that if I was struggling, then how on earth was everyone else in the world gonna do it?
And so that made it real for me. And I decided that there's just gotta be a better way. I love that.
And. Thinking about our training when it came to the way we learned medicine was very much in the insurance-based system. Did you have exposure to, you know, apart from going to another country and experiencing healthcare as they define it and as they practice it, had you been exposed to any practice development courses or experiences in your residency or your training or medical journey that allowed you to see a different way of doing healthcare through direct pay models?
No. My residency was done at a Catholic institution and we ran like a resident clinic and our residency director was very good about billing and bait and coding and , it drove me absolutely insane at the time and I hope he listens to this. But that was honestly probably one of the most important things.
That we learned and fought the whole time is how to bill and to code. And so much time is spent in billing and coding. And then when I left residency, I joined a single specialty private practice. So I never actually worked for a big hospital system. And so that knowledge, was very helpful in that realm.
We accepted insurance. It was just this kind of a typical practice. And I was very blessed to have a mentor who had started that practice 40 years ago, that I got to work with for five years. And he was just wonderful and just kind of by proxy, you know, I learned so much from him. But even then, like your time is so regulated and I mean, I would see 36 patients a day, and most of them were like GYNs.
They weren't just kind of quick OB visits. And I firmly believed that like the most important thing I could do for patients most of the time was just give 'em a hug or, or to listen to whatever their struggle was. Like their pap smear statistically wasn't going to change their life as much as like maybe somebody who just like really cared did.
So I would routinely wreck my day just because that's what I thought needed done and that was good care. And so I didn't want to sacrifice that in a new place when I moved. So I actually, one of the first places I learned about D P C was your podcast.
That is so cool. How did you end up finding it?
Well, I heard, I think my husband had told me about, Hey, have you thought about maybe doing this? And I said, no, I have no idea what that is. And so I, you know, like all normal people googled it and you were one of the first places that came up. And I'm a very auditory learner. And so the first thing I did was download at least like two seasons of your podcast.
And listened to absolutely everything. And I was like, you know what? This sounds exactly like what I wanna do. Like this is the model of care that I've always provided my patients, just with somebody else doing the billing. And I was like, I can totally do that.
I love it. And you know, as, as you're talking about that, like what mattered to a patient even more so sometimes than just the quick medical reason that they came into your clinic, was just the fact that you were supporting them even with a hug like that is why, for me, I love my rural community is that, you know, I see these people at the grocery store, I see them at the post office.
Mm-hmm. They will literally just like, oh, I have something for you and just come up on the porch and give me and my husband papers. And so, you know, I, I love being with the community and being in a model where we're able to do that and we get compensated for the care that we give to our community. Even when it comes to being able to be there for.
Hug included with their medical visit. Like, I think that's awesome. I I, and the reason I say that is because I was sitting at a, across from a, person who practices in rural Northern California, and her question was, well, I just, I'm, what I'm trying to figure out is how do I get paid for my inbox time?
Like, you know, I, I do an inbox message and that keeps a patient. Away from the clinic and it keeps 'em outta the hospital. But how do I code for that? And I like, you know, not to be rude, but it's like I said, you know, hey, that's exactly why I don't code anymore because I cannot, as a family doctor, especially like speaking from my experience, you know, family doctors, as I'm sure you've experienced as an obstetrician and gynecologist, you know, we are social workers, we are medically trained.
In, in you, in one of your interviews, you said your patient's best friend with a medical degree. You know, we do so many things to be able to care for that person. Like you said, you know, when a person is healthy or when they're not healthy. They matter. And so when you take the time out, when everyone who's doing care directly with patients takes the time out of their day to be able to give them, like you've said also in an interview, like if a person needs two hours because they're going through something that is really detailed or really heavily full of things that are, you know, socially impacting them or whatnot, that you have the time to say.
I'm gonna give you this time, not being crunched by the system tells me I need to only give you this amount of time. So I love that you found out about Direct Primary Care as a business model. I love that you just full out, opened a clinic in South Dakota where there was only one before you and you're killing it.
So with that, one of the interviews you had recently done was with 6 0 5 Magazine. They had interviewed you and , it's not a magazine that's, you know, just a paper read. It's, a magazine that has an audio component to it as well. You were mentioning how you, you know, you moved to South Dakota and we're recording this just 2, 2, 3 days before your one year anniversary of moving to a totally different state.
So how was the journey when it came to your mind and world being rocked by? Wow, this is like, I'm able to actually do all of the things I need to do for my patients and for myself going from. A model of care that wasn't like that, an estate that wasn't South Dakota to opening Brit house in South Dakota.
We had talked about moving to South Dakota for a couple years. My husband is originally from South Dakota and his whole family is here in town, which is one of the reasons why we moved. So in Florida we, you know, we both had great practices. We had great friends. Like it was warm, which it is not here, and we really loved it there.
But there was so much drive time and as our kids got older and got into activities and things like that, like it was just preclusive to like, we, you know, he was like an hour south. I was an hour north, you know, where kids were 30 minutes from my office. So like, just the amount of time that we spent in the car was just ridiculous.
We never saw each other and we really liked each other and we never saw our kids and we really liked our kids. And so that was really the impetus for moving. And we had talked about doing it for a while and just never felt like God's peace with going. And I went to a business meeting in 2021, and I came home and I told Andrew, my husband, and I was like, okay, time to go.
And he was like, like, like, like that, like just. That was it. I was like, yeah, that's, that's it. It's time to go. And so from there we looked for jobs and a lot of family support, which I think was critical. But I left Florida on great terms and knowing with an absolute certainty that I was meant to do this.
And it is going. South Dakota was actually the last holdout state on, the D P C mapper. And from the time that I got here to the time we actually opened is when that other clinic in Rapid had started, which I was like super cool, like, so happy for them and that we're kind of making this more known.
But people here are really, excited and really interested and , it is definitely a medically saturated community, which, Is maybe an interesting place to set up D P C. There's two major hospital systems here in town that have very large footprints all over the Midwest, and they're great systems, but they're still a system.
And so even having interviewed both of them and realizing that, you know, to reaffirm that the practice that I wanted just didn't fit within a system, and to know that, that that's really just what I wanted and that I wasn't willing to be told what I had to do. When you went through those interviews and you, how you mentioned you were reaffirmed that you, you couldn't, the way you wanted to practice was not going to fit in that system.
What were some of the things that clued you into that, specifically in South Dakota?
I don't know if it would've been different in South Dakota if it had been, if working within a system in Florida. It's just, I think as I got more sure of myself as a clinician and my medical decision making and seeing just what patients really needed.
In terms of their healthcare, like yes, there are people with disease and they need hospitals and they need insurance, and there's definitely a place for insurance, which I think all D p C practices, you know, encourage patients to have. But there's also a place where you can come and you're not just a number, you're not just the inbox, you're not just like one other thing that I have to do today.
Like, I genuinely care. Uh, I, I just, I do. And so I wanted a practice where I could care and not be told like, well, you can't cure in an hour long increment, you can only cure in like 25 minute increments. And that's even, that's pushing it cuz like most of the time it's like 10 minutes and you miss so much because you don't have time.
I spoke to a patient the other day who she was very normal. She's in her forties. You know, super healthy. And most of the time she would've been somebody who would've been like, okay, great, you feel good. Let's go do your pap and we'll get you outta here, type thing. And she would've been like a 15 minute visit and she actually ended the visit early because she had another appointment cuz she had no idea that she was gonna get so much time.
And we, you know, kind of unwed like all of this childhood trauma that she had gone through and how that was really impacting her health now, even in ways that she didn't know
it. And that's what that makes me think of is the 61 year old lady who I used to take care of in my fee for service clinic, she called doing a meet and greet for my practice.
And she said, but I'm healthy. I'm like, that's great. You know, that's your perception that you're healthy in terms of number of diagnoses, that's great. But like I know that this person in particular has a child who's in an orthopedic specialty who's struggling and that's impacting this patient's life.
And there's other things, like you're saying, when you look at the whole person and as you've gained respect and acknowledgement and you know, and the ability to acknowledge and the ability to now treat the whole person for all the facets that affect their health, their mentation, their everything. Those are the people I feel that when they.
Find our model of care when physicians, when patients find our model of care. It is so mind blowing. It is absolutely mind blowing. And when you talk about, you know, this is, this would've been a 15 minute patient visit. I'm laughing over here also because right before our interview, I just got off the phone, 29 minute visit with my patient and his partner, and my patient is over 90 and.
I was like, so your note from the urologist says that , they were with you for five minutes. Is that right? And she said, man, that was not even five minutes. That was her comment to me. So it's incredible that our patients are so used to the system. We are so used to the system and you have found another way.
And one of the other quotes that I love that you've said is, when women are healthy and happy, that means better things for themselves, their families and communities. Our team is excited to help make this the rule, not the exception. So there's not a whole marketing campaign with millions of dollars to lure people into a system that doesn't actually give them that care.
So when we talk about your level of care, when you're talking about this patient in particular, who are the patients who have found your practice thus far? So my, so I don't do OB anymore. I decided to give that up and I am actually not doing surgery anymore. And , I always preferred the moms to the babies anyway, but I did really love surgery and I found, I really struggled with that part of my identity in kind of, you know, this phoenix of development of my new life and practice and things like that.
And, And I came to realize though, that I can serve so many more people in this capacity and I think you can do surgery as a specialist in D P C, I think it is a little bit more dicey and part of this journey. I, , went to the Hint Summit last year in Colorado and that was pivotal. I would say that was probably one of the two most critical forks in the road for my D P C because it was kind of like a rock concert where everyone was so excited and just believed in you so much.
You were surrounded by all these other people who were like, Yes, you can do this and here's how you can brainstorm all the problems and here's like, you're just starting versus like, you're now getting like corporation contracts to, you know, and like everything in between. And that was really amazing to see that.
So as that happened, I also saw Reagan steig speak and about lifestyle medicine. And I have since my dinosaur chicken nugget date have, uh, have really tried to expand a lot of my own personal knowledge and therefore ha saw the changes that it made in my own life. And then, you know, impart that knowledge on my patients just because I thought it was good care.
And Reagan, you know, talked about lifestyle medicine and I was completely blown away because I didn't even know that was a thing. And so I talked to her afterwards and she, so she gave me all the information on the A C L M, the Amer College of Lifestyle Medicine. And so I went and did it. So I, you know, as a board certified physician, you can sit for their course and go to their conference and you, I think it's like 40 hours.
You have to write a case report and then you sit for the boards. And so I, I did that this year and that really, I learned even as much as I love to learn and to read in general, like I learned so much from that. And it seemed to be such a natural fit with D P C because you could spend as much time as you needed to in keeping people healthy.
And in the American medical system, we are really good at treating disease and throwing meds at things and saying, well, I don't know, maybe we just need surgery. And as a surgeon, You know, there's definitely a time and a place for surgery and as a traditionally trained doctor, there's definitely a time for medicine, but there's also like all this stuff that we don't get in med school with nutrition.
Like I got, I'm a do, I'm the crunchiest granola of everybody and I got no training. I'm talking zero hours of nutrition in med school. And if again, if we don't know it, how is anybody else gonna know it? And there's so many mixed diets and systems and you know, to really go to the source and medical journals of like, What the definitive answer is for a lot of these things or, or causes for these things.
And so D P C really kind of allowed me to do that. And so kind of melding that passion with my passion for women post child theory as we transition into menopause. Those are my patients. Again, it's a personal journey, so that's kind of where I'm at too. You know, I'm done having kids. Things have kind of leveled out from like, well, I guess not a career standpoint cause I just did this, but you know, like things are kind of starting to, you know, you're working yourself out.
There's not like a whole bunch of changes and then all of a sudden your hormones change and then everything goes up in smoke again and you're just like, I dunno what's going on. And so those are my people. And so how to keep those people healthy, my patient friends healthy, how to keep me healthy and how to use.
Those tools of our daily life choices to affect and modify our hormones and to replace them if needed. I love it. And just, you know, zooming out from your journey even thus far with your experience, especially you know, what you saw when you decided that you were no longer going to go into cardiovascular surgery, you know, you are able to now bring all of that knowledge and all of that appreciation for the whole journey of a woman's life to your patients.
And so with that, I wanna ask about marketing because as you said, you know, there's not too many direct care practices in your area yet there are two large hospitals systems that our patients are used to. How did you go about marketing Brit House and what are some of the strategies that you've found are super effective in your area in particular?
So as a classic doctor, I wanted to do it all myself and not ask for help. And so the other fork in the road for me in terms of my D p C journey was I actually went to a, it's called S D C E O, and it's a branch of the small business association here in South Dakota that specifically, , helps women entrepreneurs.
In that conference, the, the theme of it was that basically if you want to go fast, you go alone. And if you want to go far, you go together. And that changed the way that I looked at, like, trying to do all the things on my own. And so marketing has been, social media is definitely not one of the things that I have any passions for.
Actually got a Facebook account only like a couple weeks before I opened my practice cuz I, I'm just not a, a social media person. I like face-to-face interactions the best. So I have a social media person who, you know, We go through content and do that. I found a really great marketing firm here in town.
I think I interviewed at least eight of 'em and really found somebody who resonated with, you know, the needs that, like I'm a very small startup business. Like I don't have the budget for marketing like these big hospital corporations do. And that they were very sensitive to like, this is the budget.
Like, it's not like, okay, well here's what we can give you for what you're saying, and then here's what you really need at like twice the cost. And so when we had sent out mailers and done some other things and, you know, the price of postage had like just gone up like literally like we were Friday and we were sending them out Monday or something just absolutely ridiculous for timing.
And so she was like, you know what, it's a, it's fine. Here's what we're gonna do. Here's how we're gonna modify the budget for the rest of the year. Like, we've still got it. And so I think. When you look towards marketing that you need to ask those hard questions about like, how are you gonna work with me?
And I think that it's different for different areas. You know, for us here, a lot of the marketing was really involved in getting the word out about what D P C is because within those hospital systems, you know, I got an, an interviewing, I got to meet the providers for my specialty in those systems. And they're outstanding doctors, you know, all of them and super fun and like I would be friends with them, but they.
You know, but it's still within the confines of insurance and that's really where the problem happens. And so just informing people that like, well actually you don't need insurance to see me. Or, you know, you don't use your insurance to put gas in the car. You know, you use it for like a catastrophic event.
And so kind of equating that and really just educating the community as to what D P C is and how it's different and how it can even be better.
Absolutely. And you know, I think about it now, being in the D P C ecosystem, we don't even bill our patients. We just put in the magical codes and then their patients get billed from their insurance.
And that can absolutely lead to financial harm for a lot of patients because they didn't have the option of, do you wanna use your insurance? This is the cost of this. You know, whatever we're doing today for your visit, or you can pay cash and this would be the option. And you know, as laws have changed, and as you know, there's a fight for transparency, that's not an uphill battle for patients in the direct care world, even for those patients who are insured.
And so when it comes to, you know, not only pairing with a firm in marketing who understood, you know, what you're trying to bring to the table for your community, how did they market that value proposition of direct care and everything that direct care stands for through copy on the flyers or copy on your website, how did they boil it down for quick marketing to open up that conversation to then, oh, well, oh, Dr. Scat does this. Let, let, let's read more about Brit House.
I don't know if it was necessarily as much as B P C is that I'm also the only provider in the area who does like hormone replacement pellets. And so when I came in as something new, I mean I just came in all new and so I came in as no insurance hormones, lifestyle medicine.
Nobody knows what lifestyle medicine is here. And even speaking this out loud, I really did make it very hard for them. It sounds like in talking to marketing, the biggest piece of advice they gave me was that you have to be out there like you are the faith of your practice and there is no amount of copy or there is no amount of, you know, flyers or really, you know, static anything that is going to replace hearing you speak and your passion.
And even as much as I hate social media, like they got me on TikTok and I just, I'm not a TikTok person, but here I am, I'm on TikTok and I talk to anybody who's willing to listen to me. And I think people are, once they realize there's another option, they really are sick of the system. You know, in the early nineties, I think everyone was really excited to be part of a system and to be owned.
And like, I'm part of Kaiser, or I'm part of Mayo, or I'm part of Advent, or I'm part of, you know, whatever. And now as those systems have grown, like that, ownership just feels like you're like another number in the queue of getting through and there's not really that ownership anymore. And I think, you know, as everything kind of shifts in medicine and kind of that pendulum swing, we are going back to kind of that like old school doctor with their little black bag.
And I wanna be that doctor, like I wanna be the person who knows you and, and takes care of you and celebrates you and cries with you and. Like to really be your best friend with a medical degree and there's nothing like it. And you said this, in one of your interviews that you're doing old soul medicine, and I was like, that is totally the, the vibe that a lot of people understand this idea of like, you know, you just called your doctor and then your doctor like came on over with their black bag or whatever like that.
Do you remember hearing stories about that from your grandparents or whatever? And they're like, yeah. And then I find for me, that's what really starts, especially with my peers, the conversation of like, wait, so how are you doing that? So when we talk about speaking with other groups, you are definitely vocal in your community about, you know, sharing, about being the face of Brit house, about sharing what you do.
So when you talk to non-doctor groups, what kinds of groups have you spoken with and what types of things do you talk about when you're amongst those people?
So, I mean, I talk to everybody from moms at the ball fields, like, you know, I mean, I'll talk to anybody who's willing to fill and listen to me. There's a local teaching kitchen here, and they do culinary classes a couple times a week and super fun, like great business. And I had this idea that I really wanted to promote culinary medicine. And, you know, food is your first medicine. And that goes to the core of, of who I am. Like I, I'm from Alabama, food is my love language.
And so I wanted to be able to share that with people and how they could do it in just a really healthy way. And so I had this whole presentation set up about how I was gonna go talk to them. And we sat down and I was like, okay, so I wanna do this. And, and they're like, okay, well when you wanna come in?
And I was like, I'm sorry, wait, like I don't have any formal training, I just, I really like to cook. So I had this whole presentation. They didn't even care. They're like, okay, well, I mean, it sounds like you know what you're doing. So. Sure. So I've been doing that for the last couple months and that's been super fun.
I would say just getting really involved in your community. One of my best friends here is a lawyer. I've subsequently met a lot of other lawyers and you know, when they hear me talk, they're like, you know, that would be something that would really resonate with like this law board. And so I've talked to a bunch of lawyers.
I'm going to, , speak at the, South Dakota Women's Law Convention in June. You know, so really it's just kind of getting out there. And talking to people, because if you're excited about it, people want to be around people who are excited and it is palpable when you are passionate about the care that you're providing.
And even if you have like regular doctor who takes insurance or you have you who like maybe is a little bit out of the box and you don't get to pay for it with, you know, your insurance card, but they're gonna come and see you because you're not just the inbox and you're excited to see them in the grocery store and you know their name and their dog and their kids and all the things.
And you know, knowing the dog, there's, there's no code for that, but it sure as heck makes a difference in some people's lives. So, yeah. When it comes to speaking, I wanna highlight that you are also going to be speaking that another engagement you're gonna be speaking at is a conference in Colorado. So can you tell us about that and how you got involved in speaking at that venue?
So, , that is a flying Physician's conference. So again, it's like one of those things where you just, you talk to people and my husband is also a pilot and so he's a man of many talents and physicians are really interested in what you have to say and how they can get involved. It didn't, it actually got canceled for a snowstorm, but I was supposed to speak to the South Dakota Women's Republican Convention here, 12 inches of snow that day or something.
So it didn't end up happening. But one of my friends who is on city council was like, you know, women need to hear about self-care and taking care of themselves. And so it's not magic. You just have to go talk to people and they want to be involved as you're involved. And. Then as you get involved, then you reach more people.
And that snowball effect for good is a real thing. We had a like, just kind of like a meet and greet at one of the restaurants here in town, and one of our senators was upstairs, and so he just like walked down and he's like, what's all this d p c stuff about? And so that was really amazing to get like a one-on-one platform with Senator Thune for, you know, five minutes and just an organic way of opening the door to conversation about how healthcare can be done better.
And that better is better for physicians, better for patients, and better financially. So it definitely, for those people who understand the benefits, like I can totally see how they will want to engage and learn more. My question now is about when you are around either your peers or around other people who you know are not as engaging, who are not as inspired or understanding of what you as a doctor are doing, how do you react and respond in those situations?
I, that's probably where my like classic Southern comes out and I'm just like, oh, bless your heart. You just don't know that I, I crack up because, there, well, I think it was my cousin, he, he taught me that like, as long as you start any sentence with, oh, bless your heart, it, it sounds like you're a loving and caring basically anything.
Yes. I love that. So if there's someone listening who is not sure how to handle those situations, there's another tool that Dr. Ska just dropped on you, so that's awesome. There you go. Love it.
I mean, honestly I would say that, you know, you don't know what you don't know. And so part of part of D P C is educating not just your patients, but also your peers.
And I haven't met a single provider yet who is excited about only getting 10 minutes with their patients. Or being regulated by all the C P T codes or all the C M S regulations or, you know, like we didn't go to medical school to do paperwork, you know, or to look at computers all day. We went because we want to help people and at the core of who we are in our profession is not ambivalence.
It is a deep compassion for the human condition. And to be able to really tap into that, you know, people are either really excited, they're very interested, they have a lot of questions, or I think a lot of it is also that they're like really secretly jealous that they haven't done it. There wasn't an opportunity to do it.
And so I think that creates resentment. And so a lot of times if you realize that to those naysayers that it's probably doesn't actually have anything to do with you that is. The best piece of advice I could give that is so valuable for people to recognize because, you know, like we have seen even with our patients, sometimes we'll get aggression as the presenting, you know, behavior.
But it has nothing to do with us. It has everything to do with the system when it comes to patient visits. So, on the same note, when it comes to, you know, talking about what we're doing, just remembering that it has nothing to do with you is, is very helpful. And when you talk about, you know that there's no one out there who loves a 10 minute visit, I engaged with multiple physicians all over the state of California this past weekend and.
That is so true. You know, I mentioned the example of , the doctor who was wondering how she gets reimbursed for her inbox time. I also met a resident who is a Kaiser resident and who literally did a fellowship because she was so burned out by the way that she was being told she needed to practice and she doesn't want to go into clinical practice like right out of residency.
She wanted to do an additional fellowship to try and find a different way within the system of not practicing in what she was trained to do. So it was so interesting to hear different perspectives and, and defense of the system. People who. Were, you know, thinking those thoughts about like, is there a different way?
And then there was, , an older gentleman that I met, , also doing rural type clinical stuff more as an admin now. And his advice to people was, oh, I know how you change the system. You stay there long enough and outlive everybody else. And I am like, if my jaw could have hit the table, it would have, but I was just blown away by that.
There are people who have not, Heard of D p C, like that one, that one blew my mind. Like I'm, I'm very, like, both you and I are very biased in that sense, but just like you, like you shared, you know, you hadn't even heard about it and we are changing that, so. Awesome. When it comes to spreading the word even further, I wanted to ask about how you got to be interviewed by Dakota News now as well as the 6 0 5 magazine.
When you talk about speaking engagements, is that similarly, did you get these highlights in media from just talking to people, or did you reach out to these, , publications in particular?
, 6 0 5 reached out to me and then Dakota News now has segments that are sponsored, and so part of that was marketing.
And then as you get your name kind of out there, In the marketing, then those things also start to become more organic, I think. And so I'm actually going back to KE land or Dakota News now here in, I think it's next week actually. And so I'm doing a cooking segment for them. And so that is, that's in or organic thing.
, and so people start to look for your interests and your specialty and in different things. And so lifestyle medicine and the culinary portion of that specifically is, Is a passion project of mine. And so I think that's one of the ways that I've kind of really utilized that. But you know, if your passion is football or you know, and, and sports medicine or nephrology and how, you know, drinking water is so good for you or you know, whatever it is, just find what it is that you love and people will be drawn to you and want you to be a part of their own experience and how that influences them.
I love it when it comes to the fact that you are the second clinic in South Dakota to be open doing direct care, which is fantastic. How did you even develop your pricing? Because the other clinic in Rapid is a different type of clinic in terms of they're doing direct care, but their services are different.
How did you figure out how to price your services?
So with price transparency, you have the ability to get prices from large systems. I was very intrigued to know that it is still a substantial amount of work. And so basically I got their prices, I got both of their prices, I got the Medicaid prices and I compared them with like the price structure that we had in Florida for self-pay patients.
And then I went under that because I felt like once people realize that, and I feel like a lot of people will test it initially, that they're like, well, I'm spending all this money and she says she's gonna be there for me. Is she really gonna be there for me? And so there is kind of that testing period because it is new and like, you know, any kind of dating relationship where you're like, well, are they gonna be the one forever?
You know, you kind of need to like feel that out a little bit. But then once they realize that like you do really care and that you do get the time and that like I do answer them and that like if they call like I'm the one that calls them back, then there's not been an abuse of the system. And so really with that, I think my prices are very competitive without undercutting the service that I provide.
Cause you don't wanna price things too low because then people just kind of think that you're a quack and you don't wanna price 'em too high because then you can't stay competitive. But I think along those same, same lines, but just less because I'm not having to pace 17 people to fight with insurance to get reimbursed.
Half of what I build. So true. And I was speaking with someone who is the head of, you know, a, a very big regional rural set of clinics and, you know, the, the skepticism came in that overhead and, you know, I was just pricing out like, this is how much it is for E M R, this is how much it is for, you know, yada, yada, yada.
And. This person's mind was like, oh, like I didn't, I didn't know that you don't have to pay $40,000 for an E M R. Like, it was, it was like mind blowing for them. So I, but I think that that's, that's such sage advice, especially for those who are in specialty care because we all have medical degrees that takes a lot of training and hours and a lot of dedication to our profession.
And so when, you know, Someone's paying what, you know, $130 for a plumber to come out. It's like you are paying for their level of expertise in their service. And this is your level of expertise in your service represented through a price that allows you to continue working, continue serving your patients.
And like you said, like not putting them in bankruptcy or, you know, appearing like you're a quack. Just like, you know, everything's 99 cents. So I love that. When it comes to the particular services you offer, and let's talk about hormone therapy and hormone pellets. In terms of you being, like you bringing all these new things to South Dakota, how do you, , evaluate people and how do you use, , hormone pellets in particular?
Like I know Dr. Amber Becken, Hower, she uses particular places that she will order pellets from. How do you manage that at your clinic?
I'm the same way. So I have taken a lot of. The things that I learned on your podcast that others have done. I think that the D P C Facebook page, and especially for like other gynecologists who are kind of throwing this around, there's a D P C G Y N Facebook page, and I am not very active on those, but they have been very helpful and everyone's super kind to respond to questions and kind of things that everybody has going on.
And so I have instituted a, like a free 15 minute discovery call. And so that is, there's a link on my webpage where people can click and then it just takes them to, , like a Calendly scheduling page, and then they can schedule 15 minutes, which I am really bad about going over, not them, but me. And you know, trying to figure out like, is this a good fit?
You know, because if people are like, well, this is what I need. They're like, oh my gosh, I want hormones, but I don't wanna pay your prices. And they're like, well, but maybe you're not a good fit for hormones and you have a doctor that you've been with for forever and you really don't wanna leave them, then like, that's not, maybe that's not a good fit.
And so just kind of being able to establish that prior to any type of like patient enrollment has been really good. So the hormones themselves are, Again, like specialty ordered through, , various labs that have f d a regulation. And so I am not against compounded medications, but compounded hormones in particular I think are, it is very important to have a good quality standard.
I don't order creams because there's such a vast difference in potency concentrations. I had a, I had a patient who moved to Florida from Kentucky and she was getting creams there and she got creams in Florida and she's like, these are totally different. They feel totally different. What is going on?
It's the same thing. I was like, but is it? And so I think that, Compounded medications are great, but for hormones, you really need something that is f d a regulated to prove that, like what you say is a hundred milligrams is actually a hundred milligrams because the F FDA says it's a hundred milligrams.
And so I think that there's a lot of concern over hormone replacement. It's not something, again, like nutrition, shockingly, that is we are not well educated on. And if we're not well educated on, then the general public is also not well educated on, and they're gonna get all of their information from Google or you know, 20 year oldman's health initiative studies that are way out of date.
And so, You know, it's kind of our job to educate not only our patients, but also our peers on how to utilize this in a setting that is safe, is well regulated, is is very closely monitored and can be potentially life-changing to the appropriate patient.
Awesome. And when it comes to services specifically, you offer things like coposcopy, you do biopsies of the endometrium, you do vulva biopsies, cervical polypectomies.
When you opened, did you bring tools with you or did you invest in certain things so that you could open and offer these services? Or did you add these services on based on your population needing certain services in your clinic?
A little bit of both. So when I opened, We invested , in things kind of as they came up.
So I didn't go out and buy like a colposcope right away. Right. You know, as a patient had an abnormal pap smear, they needed a colposcope or a coposcopy, you know, then I was like, okay, well now is the time to go buy the colposcope. And so you did a lot of, you know, I had priced everything and had planned everything, but then like just pulled the trigger right off of the bat for the capital investment portion of things.
So as my patient needed the coposcopy, I had already, you know, decided what colposcope I needed, and so then I went and bought the colposcope. So I think that as you build it, Is good due diligence to work within the needs of your population. You know, like I would really love an autoclave, but I don't have the need for an autoclave yet from my volume.
And so as that kind of shifts then, you know, that'll be probably one of the other things that we start to get into. Cause it's hard to want all the things, and especially as a surgeon who's used to having all the tools available to, you know, be like, okay, well do I really want that tool or do I need it?
Or do I just really want it? So, and I, I don't know if you feel like this, but you know, experiencing medicine overseas has really allowed me to think differently about that question. Like, is it needed? Can you do an alternative to achieve the same goal, you know, without, Lowering standards of sterility and stuff like that.
But I don't know if you think like that too because of your experience specifically in Cameroon. Oh,
absolutely. Like I said, I'm a sucker for medical missions, so I've been, I don't know, a dozen countries where the various levels of resources or sanitation or like what you can do with things is highly variable.
And I also, I tease my husband all the time that like I'm a gynecologist. Like I can work with very little to accomplish a lot. And so I wouldn't necessarily call myself, I'm MacGyver, but I am definitely a problem solver. I also love to pack, so like, I like that problem solving aspect of like, okay, so here's the problem.
What are the ways that we can. Fix it in the most economical patient-centered way in doing like the coloscopy to do the biopsies. There's soft tissue biopsies that are available and as opposed to like the kevian, which is the big chunk that has to be taken out. And they're extremely diverse in the patient experience, but not in like the cost of pathology.
And so, you know, I talked to the lab that I contracted with and you know, was like, Hey, can we do this? And they're like, well, yes, but we don't really normally like to do it and it's kind of hard for us. And I was like, well, is the price different for the patient? And they're like, well, no. And I was like, Okay, so you're telling me that there's not any difference for them, it's just all your problem.
And they're like, well, yes, but we really like, and I was like, okay, well I'm sure they really like to not be in a lot of pain when they're having like portions of their cervix removed. So I'm confident that you're gonna figure it out. Just like, bless your heart that that's another great one to use. Like I'm confident that you'll be able to figure it out.
I'm confident in your skills. I love that. What about since you've opened, you know, with there not being, again, not that many options for people to experience direct care, what about medical students and residents? Have you had anybody approach you to say, Hey, will you take me to see if, if I can learn from you and learn what you're doing?
No. I haven't, the medical school here is, is contracted with the, the hospitals, and I honestly don't even know if they know about me really yet. I love teaching. I love, I loved having residents. I think that that's a really good way to give back to the community and inspire, kind of like that next generation.
So it would definitely be something that I would be open to. But, , I've had a lot of people ask me for jobs, but not necessarily just to shadow. That's, that's a good problem. That's a good problem. It's, yeah. One thing I will say here is that something that. I felt opened more ears, , in some people's groups that I was talking to this last weekend was when it comes to practice management and learning different options in practice management, different options.
And it does bother me that some people call DPC an alternative way of care when it's like, how is it alternative? That makes me feel like we are doing something, you know, very far out there. Like no evidence based. Yeah. You know, but when it comes to practice management and especially family medicine residencies, I'm finding that a lot of them are encouraging and developing ways of learning about different practice models, including independent practice with fee for service.
DPC is a model now, so, That might be a way for you and other listeners to, you know, start that conversation about how do we, you know, expose people in training to other ways of doing healthcare. The neutrality of practice management. Where is that in your residency? How are you guys, , you know, do you have a program?
, is that an option for you? And, and using, you know, if there's support by a national organization like a f p in support of the D P C model, you know, there, that's a way to also add some data behind the knowledge deficiency that's out there sometimes when it comes to, yeah, this is actually really supported on even the national level of your organization or whatever.
So just some thoughts there, but I hope that, Going forward that people do learn from you because especially if they wish to stay in South Dakota, like your husband returned home and that's where his family is. You know, there's lots of people like that's why I work in California cuz I was born and raised here.
But if you want to do medicine like you and I are doing, it's great to have an opportunity within your state that you wanna be practicing in to learn from another doctor like yourself. So that's awesome. When it comes to aesthetics, so is that something that you also added on after your patient population was asking for it and needing it, or did, was that something that you had been training in and then brought to South Dakota along with everything else that was new to your community?
The aesthetics portion of it? I was a little bit of both. My sister-in-laws are both nurse practitioners and so we had all done, , like an aesthetics course together and so. That's more started just because like, I personally love Botox. And so, you know, again, it's like one of those things that like, I don't want my patients eating dinosaur chicken nuggets.
So if I feel like it should be healthy, then you should do it. And, you know, if you're upset at your wrinkles and you, you know, frown at things, or whether it's kids or just stress or whatever it is, like, you know, to just be able to offer it to them as a, as another resource to, to make them feel better.
But that one I would say I, I kind of brought in early. I have hopes to add like lasers and things like that at some point, but I'm probably gonna get the autoclave first.
I love that priorities, especially given Yes. Trained through Jen. Love that you dropped some, some great tips on, you know, talking with your peers, talking with your community.
When it comes to people who are obstetricians gynecologists specifically, or those who are doing, you know, either a primary care specialty, but they practice gynecology and or obstetrics, what words of wisdom would you have for them if they're exploring, , learning about D P c, planning on D P C or trying to figure out if D P C will work for them?
I would say listen to your podcast. I would say go to any number of the summits that are available, , coming this summer and, and really just kind of do. Just ask some lots of questions. There's a couple specialists that I know of that are not OB Q Y N, but , are more like a procedural specialist who are looking to maybe kind of make that leap.
And it is really hard when you find yourself so tied to the hospital or things like that, but nothing is impossible. And if you're persistent enough and you make enough noise, then they do have to listen to you and so to whether it's contracting with them for a rate. For like child delivery or surgeries or things like that.
You know, there's even like specialty hospitals that are available that can do a lot of procedures. Even some majors are done at those hospitals. And so again, it's like one of those things that you take what you know and then you just get a little bit creative with it. Like, so this is my problem. How am I gonna work around this?
And I think things like Facebook and listening to other specialties become a really good, you know, talking to people will never, , fill the void of Google. And so it is something where your peers have have really good ideas about different things, I think. And I think that makes a big difference.
Community is that whole, if you wanna go far, you go together. That was pivotal and I would encourage. Everyone to ask for help and also to use local resources. Like I didn't realize that the small business association has all kinds of like accounting help. They help you set up small business loans and maybe that's like something I should have known, but I don't have a background in business.
And I think to the same spirit of which you are talking about management styles and residency is like, you know, to start asking for those classes as we come up through medicine because we're, we're just not taught. And I don't know if that's from systems, I don't know if that's based on insurance. I don't know who sets those curriculums.
But it's definitely, you know, as, as we pioneer through these things, you know, once you start to do it, then you start recognizing all the other things that like maybe need a little bit of tweaking. And then once you accomplish one, then you're like, oh yeah, I could do that. I'm gonna go talk to the med school tomorrow, or Hey, I'm gonna go start my 5 0 1, you know, my own 5 0 1 because I don't have anything else to do, but I see this need, so let's go do that too.
That's awesome. It brings up something else that , I learned this weekend as an example to highlight, , what you're talking about. Just, you know, go out there and, and do it. Nobody has asked Pfizer for Ella to be available over the counter. And so there was a push, , at the group that I was at to just even ask for Ella to be, to be available for people who are, you know, wanting it or needing it.
And that's, that's just a particular example, but of how to, you know, get your voice out
there. I mean, the worst case scenario is you ask and they say no, and then you're no worse off than where you were when you started, and then you ask again. Or you know, if mom said no, then you go ask dad. And if you're like, well, Mom didn't exactly say no, but she said she just wanted to check with you first type thing.
You know, like there's ways to work around the situation has to be persistent. Love it. Spoken like a true parent and a true entrepreneur. So thank you so much Dr. Scotton, for joining us today. Thanks so much, Muriel.
Next we look forward to hearing from Dr. Stephanie Arnold of Seven Hills Family Medicine in Richmond, Virginia. If you've enjoyed the podcast and you haven't yet done so, subscribe today and share the episode with us. Physician, you may know who needs to hear about D P C. Leave a five star view on Apple Podcast and on Spotify now as well as it helps others to find all these D P C stories.
Lastly, be sure to follow us on social media. If you're wanting to continue learning more about DP C in the meantime, check out DPC news.com. Until next week, this is Maryelle conception.
*Transcript generated by AI so please forgive errors.