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Episode 127: Dr. Stephanie Arnold (She/Her) of Seven Hills Family Medicine - Richmond, Virginia

Updated: Jun 13, 2023

Direct Primary Care Doctor

Dr. Stephanie Arnold of Seven Hills Family Medicine - Richmond, Virginia
Dr. Stephanie Arnold

Dr. Stephanie Arnold (she/her) is a board-certified family physician, committed to applying a social justice lens to her clinical work. She graduated with her BS in anthropology at Virginia Commonwealth University and earned her MD at Eastern Virginia Medical School. She completed her family medicine residency training at Columbia University Medical Center.

She opened her DPC Seven Hills Family Medicine in 2022 where she practices inclusive trauma-informed care and is passionate about shared decision-making with her patients.

In addition to her broad and comprehensive training, Dr. Arnold has obtained additional training and first-trimester abortion procedures. She is a master at engaging her community and has become a beacon in the Richmond, Virginia area, representing and delivering the high-quality personalized care that every person deserves.


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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.

Direct Primary care is about compassion and liberation and delivering the care that people need with the respect they and we deserve. I'm Dr. Stephanie Arnolds of Seven Hills Family Medicine, and this is my D P C story.

Dr. Stephanie Arnold. She her is a board certified family physician, committed to applying a social justice lens to her clinical work. She graduated with her BS in anthropology at Virginia Commonwealth University and earned her MD at Eastern Virginia Medical School. She completed her family medicine residency training at Columbia University Medical Center.

She opened her D P C seven Hills Family Medicine in 2022 where she practices inclusive trauma-informed care, and is passionate about shared decision making with her patients. In addition to her broad and comprehensive training, Dr. Arnold has obtained additional training and first trimester abortion procedures.

She is a master at engaging her community and has become a beacon in the Richmond, Virginia area, representing and delivering the high quality personalized care that every person deserves.

Welcome to the podcast Dr. Arnold.

Thanks for having me, Marielle.

This is so exciting. We were just talking about the fact that the last time I talked with you, we were on a phone call. So this is the first time that we've actually had a live chat when we can see each other's faces. So this is great. So when we were talking, I love, love, love that you are now open, you're thriving, you're bringing your value proposition to your community, to life every single day, and you're doing it in the way that only you can.

So I, I wanna go back to when you were even exploring d p c, you know, that what, what was going on in your life that even, you know, made you think about, you know, could I do it under my own roof and my own building? Yeah. My way.

Yeah. I'm, gonna probably give you like, way too long an answer, but. Here we are.

We're going for it. So I graduated medical school in 2015 and residency in 2018, and I feel like I was like jaded from the beginning in a way that, physicians who completed their training, you know, years before me maybe. Had some whiff of like a better functioning healthcare system that never existed for me.

I started hearing about like cash pay fee for service practices when I was in medical school. And I thought that was kind of intriguing in a very, like, looking back in a very naive sort of way. This was around 2012 and I'm like, you know what, this isn't gonna be necessary with Obamacare, which was very foolish of me, , because things have gotten, , much worse of late.

And so I kinda, it was like one of those things that was on the back burner for me. And then I did my intern year at a hospital in Boston, Massachusetts, and it was pretty apparent within a few months that things were going very badly. We were a new program, we were only the second class to get admitted, but the business interests of the hospital system were not aligning with our family medicine.

Residency program. And by December the, the program was voluntarily closed, so we all got disbursed as if intern year isn't stressful enough. We had to like find new residency positions. And so I ended up going to New York City. I've always had this passion for urban underserved and at a, like a very prominent, Ivy League institution that also was having trouble understanding exactly where family medicine fit in and the value of it.

So it's kinda like outta the frying pan into the fire a little bit. But I got a great. Education, great training. And then, you know, after that experience was very burnt out. But I think unlike maybe generations before me, the sort of influence of private equity and business interest, all of this was right there from the very beginning.

You know, my class was the first one that the number of us trained medical graduates was equivalent to the residency spots. So this idea of like not matching and the residency spots being frozen was kind of always in the forefront of everyone's mind. Like from day one when I started medical school, it was like, matching is gonna be a big deal.

It might not happen for you. You know, it was just like this underlying terror all the time of, you know, kind of this manufactured scarcity and these economic conditions. So I, you know, as I was finishing residency, I was having a hard time imagining myself going into a conventional practice.

It's just like, this is gonna be more of this, you know, we have this education and training that's designed to make us leaders in the field, and then you end up getting a job where there's like, Corporate overlords or MBAs and, and it's, it's, it's like the worst possible situation where you've, you've trained someone to do something and then you've put them in a position where they're basically not allowed to do it.

And I, I just knew that wasn't gonna work for me, but I also wasn't quite sure what the next step was gonna be. So I was pretty burnt out. After finishing residency, I decided to do urgent care for a couple years. I was a new mom, new baby. I just wanted to show up and clock in and leave and, and that's what I did for about two years.

And then covid happened and I got. A different job where I wasn't gonna have to be doing so much kind of face-to-face interaction cause I was pregnant again. And so like all these things kind of got in the way, like new mom, young kids, like just outta training, get a house, blah, blah, blah. But it was like always floating there in the back of my mind.

And then my very dear friend who we will talk about later, Vincent and I were kind of talking and like always knew that I had this idea of doing L G B T Q primary care and that I was an abortion provider and you know, that there was really like no reason for all this care to be stigmatized. And I, I was, I had sort of started learning about DP C in residency and I was like, started thinking about it, but I didn't really get it.

I was young myself, hadn't been to the doctor very much and then all of a sudden, you know, I'm like, I don't know, I had worked a double shift. I had a nine month old who had a fever. It was flu season. I'm like, I can't make any more decisions. My husband, who's non-medical is looking at me and is like, What do we do?

And I'm like, we're going to the er. You know, I'm like an idiot. Took my nine month old to the emergency room, you know, to who was like perfectly a fine by the time we got there. Of course classic. But then a couple weeks later we get this bill for $1,800 and I was like, I just we're so stupid. We're not, I mean that in the kindest gentles way, but we are like not trained or educated like on the financial side of these things.

So it was like all these little pieces sort of added up where I was like, wow, what I really needed in that moment, even though I have all this education training, just to be able to call someone else and be like, I need you to make the decision for me cuz I am like at the end of my limits here. Right?

And so it's like all these little things sort of started stacking up, like being a parent myself and interacting with the medical system as a patient in a way that I hadn't before. Seeing just how. Services that were in place, were failing patients. Seeing how, I mean, and it feels like every year and year it gets exponentially worse.

Just how my personal insurance was going up, the deductible was going up, the premium was going up. I mean, I, I don't know. And so by the time, by the time I actually decided to move on this, which was late last winter, it seemed like it was like I was behind the ball. You know, I kind of like simmered, simmered, simmered.

And then my, now two-year-old turned one, something just clicked for me where I was like, okay, I'm done with that. She's not a baby anymore. Now it's time. And you know, it was like a combination of her turning one Vincent calling my attention to these online platforms for, H R T for trans people, you, which are subscription based.

They're usually well over a hundred dollars. They don't include any primary care. And when I was kind of talking to him like, do you think people would be into this primary care thing? I don't know. And he was like, look at this. It's already happening. They're not getting any primary care. All they're getting is H R T.

Of course people are gonna sign up. And I was like, Okay, well I guess I'm kind of sold out, you know, and so all of these things just sort of like added up, like the frustration of lack of outside opportunities to be an employed physician and practice medicine the way that you wanted to, like personally interacting with the health system as a patient or the parent of a patient.

You know, seeing these other sort of subscription based platforms pop up. It all just sort of like really started percolating late last winter in a way that was like, this is unavoidable. And so I knew when it was time to do this that I would, I wanted Vincent to work with me. We've known each other for a long time, and actually we were just talking about this the other day, so it was May the third, I think last year.

Vincent, my husband Torres and I had a meeting to talk about like what this practice might look like with the three of us and like we're, you know, how we were gonna incorporate abortion care into it if, if we were gonna do that and. All these things, and we kind of had a tentative plan like, okay, a year from now, things will really pick up.

And then the day after that meeting, the Dobbs decision leaked about how Roe v Wade was gonna be overturned. And we were like, whoa, I like, maybe we need to open sooner. Kind of knowing geographically how Virginia plays into this, this whole thing. So for those who don't know, Richmond is on 95, right? On 95.

We're about two hours south of dc. We already see patients from North Carolina for abortion prior to this happening. Just because there are fewer clinics there, there are tighter restrictions. And a lot of times people, because we're right on the highway, can get to us faster than maybe waiting in their own state for an appointment.

And so knowing that kind of all these states to the south of us would fall like dominoes who are like, wow, this, this is gonna be a big deal. Maybe we should, we should move it up. And then we're like, but we, we don't have any money. Like, how are we gonna do this? You know? We were kind of like much the D p C way, like thinking about how are we gonna like, you know, bootstrap this off of my savings and, you know, picking up extra shifts or whatever.

Charles and my husband was just like, maybe would people wanna help us if they knew what we were doing? And I was like, you think so? And we were like, okay, maybe. And we kind of talked to Vincent about it. Cause we were like, if we're gonna do this, we're gonna be very public. Everyone's gonna know what's happening.

And so we just, we were like, it just feels like this is what needs to happen. And so in my living room, no practice name, no location, nothing. I just recorded a video that was like, trust me, I'm a real doctor and a real abortion provider. And we're gonna do this. And we like, felt like the video looked good.

And I mean, looking back now that I've like done more, I'm like, oh, I could have done that. That might have, but whatever. It was fine. You gotta, you gotta get started, right? So anyway, and so then we're like, okay, let's put it on GoFundMe. What should we set the goal at? And we're like, maybe 5,000. We're like, I don't know, that's too much.

Maybe we should just do 3000. We're like, no, if we, if we're gonna do it, we gotta go for it. Let's, let's do 10. And so we've put it up for 10. So the decision was leaked on Monday. We kind of thought about it on Tuesday, Wednesday morning. I recorded the video. I happened to have already taken c m E time, coincidentally, oh, by the way, Tuesday night I decide to email my boss.

By the way, you're probably gonna see this thing on social media. I'm gonna open my own clinic. Sorry. Wednesday morning I record the video. We put the GoFundMe up, and by Friday we had raised $10,000. So, and it was really incredible because that first round was like, All people that I knew personally, people that I'd been to medical school with, people that I knew from high school that I hadn't talked to in years, people that knew me from my time as a pre-med doing abortion activism work in Virginia that I just hadn't talked to in years, but like knew me, remembered me from doing that work.

And were like, yeah, we believe in you. And that honestly was like one of the most humbling experiences of my life because now you're like, wow, people have like given me money to do this thing. I really need to not mess it up. And so we went ahead and like bumped up our goal and I think, so that was early May and like kind of leading into June.

We were around 25,000 when the actual decision went through. And stupid me, I was like my mother-in-law who has done a lot of activism over the years and was very experienced in this stuff. She had asked me, she was like, are you ready for when the decision actually gets announced? And I was like, well, what do you mean?

Everyone already knows about it. They've already talked about it. And she's like, no, you need to be ready for when the decision is announced. And I, I learned very on that. If she says to do something, I just do it. So I was like, okay, we gotta get ready. And we had been wanting to do that anyway, like, you know, in that intervening time we picked a practice name, we got a website, you know, we, we got like much more organized because we could tell that when the video was getting shared amongst people that we knew, people were automatically donating.

But then it seemed to sort of trickle out after that, cuz those people were really excited. But to, you know, those kind of like tertiary contacts, they didn't know who I was. So we got the website, we got the practice name, we got ready for the actual decision, and it leaked on June 24th, which, Another kind of funny coincidence is the day that we're officially incorporated and by 4th of July we had raised $75,000, which was unreal.

And why we were able to open in October, kind of with the services that we're offering, cuz we, we operate at like a much higher overhead than a lot of DPCs would. You know, we have an ultrasound machine and all this stuff. So that was really huge in us just like getting up and going quickly. And there were plenty of people, some of which actually joined the practice in the first round that were like, I didn't think you were gonna do it.

And I was like, but here we are having our first patient visit. So it's so incredible. And you know, I, I just think about how. You know, people hearing your story, I hope it really gives them, you know, an injection of confidence, that direct primary care, however someone practices it in their community, there are people in the community all over this nation who will back what we're doing because it literally gives high quality access to everyday Americans, no matter who they are.

Right. So when we talk about everyday Americans, period, that there's no, you know, discrimination based on gender, based on color of the skin, based on socioeconomic history that you've come from. When you guys were talking and developing your value proposition specifically for Seven Hills, when you thought about, you know, really focusing on abortion services, LGBTQIA plus, you know, gender affirming, trauma informed care, as well as family medicine, how did you guys.

Think about branding to encompass those services in particular and how did you, you know, narrow down your copy so that you were, you know, when you go onto your, your website, it's direct, primary care, abortion services, you know, gender affirming care. And so it's, it's very like this is what Seven Hills is about.

But how did you guys get to that point? From the, like in my living room, no name, no nothing, but we have a ton of money that's just coming in because people believe in us in terms of the branding and the name. I'll start with that. It like was of the utmost important to all of us, but like really driven by me that we are not doing anything that should be special or different than whatever anyone else is doing.

There are forces, you know, unfortunately both in this country and in other countries that are always looking for a scapegoat, always looking for someone to make the bad guy. And you know, at times it's been. Unmarried women or people of certain racial backgrounds. And right now this sort of. Scary person.

Juju is like trans people and it's just like so unnecessary. And certainly we can and we should like get angry in the face of injustice. But what was really important to me was just to provide an alternative that's like, this is normal, this is wholesome and we're just taking care of people. I'm sure that some of the people listening might enjoy Ted Lasso, which is like one of my pick me up feel good shows.

But there was a quote last week or the week before Las that like sang to me where one of the characters was saying Don't fight back, fight forward. And I 100% just feel like that is sort of my. Personally, how I want to approach these issues with Vincent and Tara's support and they have their own kind of guiding principles that like, and the three of us together kind of inform how we approach all of this.

But for me personally, that's mine. And so like when it came time to pick a name, wow. We probably cycled through a hundred different names. I mean, just, you know, you, you kind of start with like. Like the classic, like what are the feelings I wanna invoke? And the idea, and like then you realize, oh yeah, everyone wants to feel like they're a safe harbor or a beacon.

And so there's a ton of practices with lighthouse in the name. Not that there's anything wrong with that, it's like common for a reason. But you know, we kind of, every time we thought that, we found one that we liked, you know, it was, it was kind of already out there. And so then we kind of started getting a little bit more abstract, a little bit more obscure.

But one of the things that I, I kept coming back to and when I kind of focus group, like we would get like a, like three or four that we really liked and then we would send them out and I tried to send them to trusted friends of like different age, race, sexual orientation, gender, just to get like a wide variety of opinions.

If I can give anyone any advice when it comes to this sort of stuff, definitely focus group, even if it's in the most casual way, your choices, because. You might really think it's a good idea and then someone else is like, okay, but like how are you gonna put that on a website or, I'm worried about the spelling.

And so we landed on Seven Hills cuz we found that all the names that we kept coming up with that were tied to geography had a sense of establishment to them to like have been around for a long time. Really concrete. And so that just really felt like what we wanted people to feel when they thought about us, even though we were a startup, because nothing that we're doing here is.

Out of the ordinary are different than anyone, any other primary care practice, like, we're just taking care of folks. And so, you know, we're really fighting back against the idea of being othered and kind of building on that idea. You know, we, we had this notion of what we wanted to do, but I, you know, I, I can't fully walk away from like all this like, classical training that I have.

So I went back and I looked at the needs assessments for the city and specifically there's one for the L G B LGBTQ community. And I, if you'd asked me before, I couldn't have told you this, but once I read it, I was like, that makes perfect sense. Across the board, trans people said that it was easier to have access to hormones than it was primary care.

You have these online platforms or people that will just, you know, like do the hormones, but accessing care for your hypertension or your back pain or whatever is like actually terrifying cuz you don't know what you're walking into. And so, I mean, we were already on the path, but that was just kind of like more fuel for the engine of like, this is exactly what we should be doing and, and this is where the need is.

It was also really important to me, you know, like when we were trying to decide the name, having like direct primary care in the name or family medicine, I just thought family medicine, it's my specialty, it's wholesome. It says what we're all about and it encompasses the fact that we do this other service on a fee for service basis, not just the direct primary care.

So that's, that was sort of the naming and then the aesthetics. I have to give full and 100% credit to Taris and Vincent, that was not my thing. Taris did all the graphics for our website. He did the graphics for the t-shirt that I'm wearing. But Vincent is kind of the one that came up with the idea of like sort of the watercolor with the skyline because we wanted it to like be a low key pride flag, like that.

It wasn't necessarily super obvious when people saw it, but if you like. The second it's up. Like when we did Pride last year, the second it was up with all the other logos that had been like Rainbow fired for Pride. Like ours fit right in and like looked great, but you can kind of put it anywhere and it fits.

And it's one of those things that if you're looking for it, it's there. But if you're not looking for it, you don't notice it. Which I like, you know. Absolutely.

It's so beautiful and you know, for those of you who have not yet seen the Seven Hills, family Medicine logo, you know, it one, I just wanna point out like you have highlighted on your website that Richmond is a, a beacon for the LGBTQ q a plus community, but also that it is the former Confederacy capital.

And you have this, you know, the, the way you explained how names with places in them had a presence different than, you know, a, a name that did not have a place in them. I think that's so, so interesting. But when you look at your logo, you really have to look like there are pictures of leaves and of different colors, different textures, and so it's a logo that continues to engage you where, you know, there is a particular logo where you're like, I've seen that logo before and then I see your logo.

And it's, it's so visually interesting as well as. Classy. So I, I just really love it. Yeah, and I love that, you know, it's Seven Hills. It's like, it's not like we're an l g lgbtqia a, you know, trauma, trauma informed abortion clinic. Like we're, we're a family medicine clinic period, and part of our services are, are these.

So I really, really love that. Now, when it comes to you guys fundraising, one of the things I loved as you quoted Ted Lasso, I wanna quote you because one of the things that you said when you were raising money for Seven Hills was that this is not charity. This is about solidarity. Mm-hmm. So can you tell us about, How you went to, I mean, you, you shared that it was people that you knew from medical school, people who knew about your abortion advocacy.

But how did you continue to trickle that word out? Because that's a ton of money, man. That's a ton of money. And you know, we hear people like, oh, I work urgent care. I do side gigs to make this money so I can fund my D P C. This is a unique way of, of raising money. And I mean, you guys were at burlesque nights, I think that was one of your major announcements.

Yeah. Like, you know, this is like, You are, you know, if you've seen one DP C you've seen one DP C, but if you've fundraised for one dpc, you have fundraised for one dpc. So can you give us more details about, you know, how you did it so that other people can learn from your experience, potentially use it for theirs?

I would love to, and I, but one thing I will say real quick, I certainly did not come up with, it's not about charity. It's a, it's about solidarity. That is like a, a long, known slogan for mutual aid. But kind of to back up a little bit, to like this whole process in approaching this, I do think that this information though, It's very unique to me.

There are lessons to be learned for everyone. You know, we kind of had this situation where the care that we were planning to deliver sort of perfectly lined up with a very public emotional thing that happened that people wanted to respond to. That being said, We put a lot of effort into continuing to come out with content.

We really focused on Instagram. We do have Twitter and Facebook accounts where our stuff gets pushed, but we're Instagram. I made a Twitter account. I mean, not Twitter, uh, TikTok, but I low-key am hoping it gets banned just so I don't have to learn it. I don't wanna deal with this. I keep, I keep looking for like a young undergrad or med student who knows TikTok.

I'm like, do you wanna come run the TikTok account for me because I, I can't do one more thing. Yeah. So we've focused a lot on Instagram and tried to make a point of every week having at least a couple posts, you know, you don't necessarily have to post every day, but having a couple posts, some of them informational, some of them kind of like behind the scenes, some of them talking about what our plan is, but even if you feel like it's not great, You have to give stuff for people to talk about, for them to share.

And really what happened, the huge thing was like, you know, early on, like, I mean within a month of going up, we had a couple hundred followers, which is great, but we really just saw everything take off. After the Supreme Court case was launched, the big thing was local independent restaurants. Found out what we were doing, and they started promoting us on their Instagram.

People we didn't know decided to do fundraisers for us. And so the big one that really helped out just so tremendously was Cobra Burger, which is a burger place here in town. And they said that they were gonna do a fundraiser for us, and then all these other restaurants jumped on. So every time they did that, it got shared on their social media and we picked up more followers.

And so I have probably, gosh, I don't know how most of my, most of my patients are coming from Instagram, either from a friend of a friend or just, they can't even really tell me. They're like, I'd follow you on social media. But you know, we definitely have people who were upset about the Dobbs decision, who started following, and then were like, but then you kind of started talking about primary care.

So I kept paying attention and I kept calling it, and I'm like, yeah, I really wanted to join. And so, That's just been like, awesome to see that happen. Yes. We did do a fundraiser at a burlesque show, so, Vincent and I actually met performing burlesque. It's going on like 10 years ago now. Like Right, right before I went to med school is when I started performing.

I have a dance and theater background from, you know, like when I was a kid. So I, I didn't wanna put all of my parents thousands of dollars of. Stance tuition, money to waste. So I started performing burlesque and when I was in medical school, I was in medical school about an hour and a half east of here.

And I would frequently come back on the weekends and perform, not necessarily like during my general surgery rotation, but there were times when it was doable. And so, you know, Vincent and I were like very well known in the community from that. And also very comfortable with public speaking and, you know, coming up with content that's interesting to people and, you know, all this stuff that's like so vital with the D P C.

And I would say, you know, I, I am lucky in that this skillset that I have lends itself very well to D P C, but for the doctors out there who maybe don't have these skills, you know, you just need someone else on your team who does, like someone who can hype you up. Like, you know, Vincent and I are lucky in that we can both do it.

And I feel like any kind of public event, if I can't be there, he can be there or vice versa. And, you know, we like have. 100% confidence, one in one another. But you know, even if you don't have that skill, like someone that you can add to your team, whether it be like an administrative staff person to help you or a nurse or something who like has those skills that you can help one another is huge.

Cuz you just have to like, kind of be annoying and relentless and like, just keep putting yourself out there again and again. And like some stuff sticks and some stuff doesn't.

That's so important because, you know, it goes back to the idea, if you've seen one dbc, you've seen one DP C, if something doesn't work, your workflow doesn't work, you know how your onboarding is, like, you know, getting chaotic or whatever.

Mm-hmm. You have the ability to pivot. And so I think that even when it comes to fundraising, that's really great and I, I love that people in your community were just backing you up. I also love that, you know, at the very top of your Instagram feed, if anyone goes there, you can see that, you know, your intro post and Vincent's intro posts are right pinned right there, so it's like mm-hmm.

There is no doubt that you have been a burlesque performer in the past and you continue to be so, but it's also, you know, you're a badass doctor and Vincent is a badass clinic director because you know, you guys have. It's like if people are drawn to even those two pictures and those two pieces of your feed and then they continue to go on, you had a great couple of series about myths, about, you know, myths about gender affirming care when it comes to, especially young people and gender affirming care, and also abortion.

Myths about abortion. Even what an abortion is like a miscarriage is an abortion. So you know that, that, that is unknown by some people in this country. So when, when we talk about how you have, you know, thrown it all out there, saw what sticks specifically when it came to the engagement that you got about the myths.

I wanted to focus on the myths about gender affirming care, especially when it comes to young people. Because you know, one of the big things that you highlighted was gender affirming care does not equal hormones. Like, talk about that because I think that is a big definition that people have that like this is.

When someone is talking about gender affirming care that equals, they're given a 12 year old hormones and like mm-hmm. You clearly stated in your feed how, like, I, I hear that. That's your belief. We're gonna take it back and put some facts into it. So, can you share with the audience about gender affirming care?

What does that mean to you and your patients?

Oh yeah, I would love to. Great question. So, you know, this is not anything new than what you're already doing. Like it doesn't have to be scary. This is simply respecting the person in front of you for who they are and who they're telling you that they are.

Right? Like we trust our patients to give us a history and, you know, we, we trust the information that they're telling us. Our whole practice as family doctors and specifically direct primary care doctors, is this relationship-based care and mutual trust. And if you start from that place like you're gonna be okay.

So just because I think sometimes numbers help people. Right now 30% of my members are trans or gender nonconforming, but only about a third of them are on H R T. But they specifically wanted to be able to come to a place where they could feel comfortable for primary care without having, you know, being misgendered or having the inappropriate pronouns used, or just knowing that they can be safe, you know, and, and vulnerable in the way that you need to in front of a doctor.

So yeah, gender affirming care. Get the name right, get the pronouns right. Like, you know, be respectful in the way that you talk about people's bodies and what they need. You know, just like you always would. I think a lot of times people, I hear this question again, how do I do a gender affirming care? How do I do a gender affirming care?

And like that, you know, if you're talking about H R T, honestly that's the easiest part of all of this. It's an algorithm. You just follow the, the dosing guidelines and then, you know, periodically check labs to make sure everything's okay. The, the harder part is the social stuff if you're not familiar with it, and certainly I don't wanna say that if you've never act interacted with a trans person before and you're not sensitive to the needs of the queer community that you should just.

Put a rainbow flag on your door and start seeing gender affirming care, cuz it's no big deal. Like, no, you need to put effort into it. But just like anything else, like it is learnable and you are closer than you think you are.

Also to be forgiving of yourself, like you're wanting to try and like, clearly you're not treating someone differently because they're, you know, trans, queer, gender nonconforming.

It it like that you're a person, so you're treating them like a person. And if you misgender, like, you know, I, I love Dr. Elizabeth Eman and I'm like frequently saying the wrong pronouns and I'm like, dang it. And she's like, it's okay. Like, You are trying and I'm still gonna continue mis-gendering someone because I made a mistake and it doesn't matter.

Like it's mm-hmm. You know, if you are not coming from a medical, training, a residency or a medical school where lgbtqia plus medicine was, you know, practiced and really where you were made to feel confident, practicing H r t algorithms or gender affirming care, you know, it's okay. Like, You know, we didn't know how to do pap smears at one point, and we learned that it's like, not to say that this is equal to pap smears, but just to reduce the myth, I guess, that people are like, this is really challenging.

It's like, you can do hard things. We can all do hard things. Like you said, we've done so many harder things. Yes.

Yeah. So, you know, I, I love that you broke it down in terms of like, just saying, To a person, Hey, it's great to meet you by your name and it's great to treat you like a person cuz you're a person and then let's take care of your hypertension.

It's not a big deal. Yeah. You do that with everybody and you don't even think about it. But when it comes to specifically addressing gender and. How to, you know, correctly address someone. It makes you more conscious, I feel. And to me, being conscious about someone's background and someone's culture and someone's, you know, their whole social aspect that goes along with the medical aspect is so important for family medicine, especially any profession, but especially the gps who are like looking out and zooming out and doing all the things that our patients need us to do.

Right. So, love that.

I was just gonna give a concrete example. So like, one thing that we see a lot, and especially when it comes to like pre-teens or youth is like, I can't tell you the number of, youth patients that I have that aren't necessarily on H R T, but they have come to me for gender affirming care because their pediatrician is like, just like hands off.

I don't do that. I don't do that at all. And the only thing I am doing is prescribing continuous birth control. So that they don't have the period because the period makes them suicidal. We're not talking about puberty blockers, we're not talking about testosterone. All I have done is put this person on Depo so they don't have a period anymore and like it's life changing for them.

Now they're going to school now they're not stressed out every day there. There's no reason that like all of us can't, you don't wanna do puberty blockers, you don't wanna do H R T, that's fine, but trust me, you probably already have trans patients that you could be helping in very small ways that you already know how to do.

And when it comes to numbers, can you touch on the younger person is when they are seeking gender affirming care, especially, you know, if they're, if they have not reached puberty in the non-hormonal realm of things like to how impactful it is in terms of a person's future, especially when it comes to mental health, to be able to properly gender or address a person's gender.

Yeah, it like dramatically reduced your risk of suicide. There are like few things in medicine we do that are so effective as to provide gender affirming care. Even on a base level, you know, having one adult in a kid's life who respects their name and pronouns is like immunization against suicide. I mean, it's really incredible and that there's a reason why all of these professional societies like the American Academy of Pediatrics, you know, support gender affirming care and why all these bands are just so distressing.

Because, I mean, this is the kind of stuff that is gonna like lead to suicide, you know? And in Virginia we haven't had any of those bands, though they certainly came up in the state legislature. But like even for folks who maybe are like in a state right now where you're like, oh, I don't have to worry about that.

Like my state isn't fanning gender affirming care. Okay. But your trans patients are like still distressed that this is happening other places. And every time it gets talked about in the media, like having your whole identity up for debate is really, really, really damaging. So even small things that you can do to just be affirming to your patients, you know, creating welcoming, safe spaces is huge.

And. When it comes to people listening, onboarding forms, you know, like, when a person is establishing care with a direct primary care doctor and they're not sure who that direct primary care doctor is, like, they might have engaged a little bit on their social media, but it's very different than when you're like, oh my gosh, you're like real, you're like five, two and a half, and you're like, I couldn't tell over zoom.

You know, like I totally get that reaction a lot with my new patients who I never took care of before because it's like blindly trusting you to take care of me. So when it comes to, you know, how you welcome your patients into your practice, do you have any tips as to how, you know, you think about your welcoming a patient versus a fee for service clinic and how it's done there?

Yeah, so kind of a couple things broadly and then specifically for trans folks. So there's a reason that Vincent is doing this with me. You know, Vincent and I both worked, part-time at an independent abortion provider. You know, he was working there as an MA and then I was working there part-time kind of leading up to this happening.

And so he had that medical experience, you know, some experience as an MA and then also has a lot of experience like running a small business, a retail business in the city. But it's has just been. One of the most exemplary human beings that I've ever encountered in life. And like just a warm, nurturing, thoughtful person.

You know, he wrote a lot of the copy on the website, you know, he was my first trans patient and that he just really had bad medical experiences and didn't feel safe going, going to people. And even before, you know, like years before Seven Hills opened, I was like, Don't worry, like, I got you. And, and, and so, you know, having him be a part of this, and not, not as an employee, but like as a co-owner and a co-founder has been huge because as kind of diligent as I am and as much effort as I put into this, I still have blind spots and he finds them, you know, and so the two of us working together, like when we were first setting everything up, he's like, okay, I know that they're asking about gender, but we actually need to do a test run and make sure that everything lines up the way that it's going to, because it sucks worse when you think that you're putting in information and then it doesn't show up when you walk into the room.

It's like even worse than if there was just. If it wasn't even asked about and it would've never occurred to me to do that. And sure enough, we did it and we found issues and like, you know, immediately put things in to compensate for that and catch it. And so the way it works right now is that people sign up through the website and that's kind of why, sorry I'm bouncing all over again.

But you know, you're talking about our profiles being up pinned at the top of the Instagram profile. That was actually a suggestion from a patient slash promoter who we have a relationship with who does a lot of like online influencing type stuff. And pretty early on was like you need to have pin post up at the top explaining who both of you are.

Cuz as a patient, if I'm coming and I'm curious and I can see like that's really gonna reassure me. And I was like, That's brilliant. That's, thank you for helping me. So, you know, we, that's, that's why we put those up like that. And then it's all, you know, our faces are all over the website. I have gone back and forth about this, where I'm like, I think my face is on the website a little bit too much.

And every time I say that, everyone is like, no, it's not. Because like people need to know that, that this is you and this is your face and this is what to expect. And so, you know, we have left it like that. Believe it or not, you, you know, as, as like out there as I am with performing, I too sometimes, like maybe this is a little too much, but, you know, so being like really thoughtful about that, that it's just like transparency in every possible way.

Like, this is who your care team is, this is who you're gonna be interacting with. So people sign up through the website, we use Hint, and then that kind of like triggers the train reaction. The first person they interact with is Vincent, who again is just so lovely and nurturing and warm, and he gets them set up with like all their information, lets them know what to expect, puts them on the books for a first intake appointment with me, which we're scheduling about three weeks out.

And then if anything urgent. You know, comes up between then we'll, we'll see them quickly. And I, that was not my brilliant plan. That was actually, a tip from Andrew Anderson. Of Kyla Help and Lynchburg. He's been really great for tips and, you know, really hitting the ground, running with like a fast-growing practice.

So, Vincent sets all that up and a lot of that communication is done through Spruce and then they come in. For me, the first visit is like straight up talking. I don't do any labs. I don't do any physical exam. We just talk about everything. Yeah. Just, I, I, because I mean, there's just, I mean, this is prevalent in like a lot of people kind of seeking primary care, but specifically for my population, lots of historic systematic.

Personal trauma, you know, and, and so we, I just like to take a really soft approach, kind of lay out the whole plan, and then I'll bring them back it sometimes as early as a week later, sometimes maybe it's six or eight weeks later for like a physical follow up, that sort of thing. And so far that's been working really well.

That hour long visit, usually 15 minutes or so is actually with Vincent, and he's the one who goes over with them, like how the practice works, communication. What to expect in terms of our pharmacy. If people have medications they're on, he'll kind of make a list of them and price check them for them.

And so yeah, we're like working as a team when it comes to that. I, I love that because you guys are, as you've always done, you know, you're fundraising together, you're opening together, you're polishing, you're practice together. Mm-hmm. And so when it comes to, you know, you knew Vincent going into this, you knew that his medical experience and you knew how he was gonna be working with you in terms of his personality, but in terms of when you think about how you got the confidence to together pair up and officially, you know, open the clinic, it's, was it different than when you guys were working together?

Three Seven Hills?

When I was in medical school, Vincent and I produced a series of shows together with a live band that we brought down from New England. And we did like different, like we did dc, Charlottesville, Norfolk, and so that was a small thing, but it was a pretty complicated process. The venue, I mean, in Charlottesville, I think it was like a 500 seat venue, you know, like, I mean, they were, these were not small, little, little things that we did.

So I had like a little bit of a sense of how we would work together. I, you know, Vincent is one of the most amazing parents I've ever witnessed, and so I've, you know, I've like really just personally, we've been through some stuff. We've worked on these projects. But also there was just a moment of like, this has to be done and I don't want to do it with anyone else.

And this like, honestly, probably seems like it's the hardest possible way to do it, because now I'm in a three-way marriage with my actual husband, and Vincent and myself. And it is really hard sometimes, you know, but we all have different skill sets that, that are so complimentary, but sometimes really challenging.

So I for sure, I'm the extrovert, I'm the brainstormer. I'm the engine. I'm like, we're gonna do all these things. And Taras and Vincent are both like, Let's take a breath. But they are very detail oriented and thoughtful and like we'll do the deep dive. And so I feel like, you know, TAR is very logic oriented.

He really kind of keeps us on track financially and kind of makes sure that we're thinking about that sort of long-term planning. And then, you know, Vincent is just the one that like, is our moral compass. Like he makes sure that, that everything that we're doing is like in alignment with our values and, and, you know, our priorities.

And sometimes we all have like a slightly different way that we want to go about things. And it, it, it can be rough, but like at the end of the day, See these are the right people in the right spots and it's like making it so good. Like it, it, so we're just moving at like a very not fast clip. We've taken a lot on, I have zero chill.

I'm like, if we're doing this, we're doing it like all the way and they have been gained the whole time. You know, like we all have small kids, we're all parents and we're just like somehow making it happen. I think we would all really like to sleep a lot right now, but it's coming.

That's awesome. I empathize with you a as we did when we were on the phone. You know, I didn't know that you had kids little, just like mine. And so that's a real thing. Like one day we will sleep, it's, it, it will be good. Oh my gosh. I love that.

Yeah, I, when we opened, I was still breastfeeding my youngest one, I, I just weaned her at the end of February and she turned two at the end of March and I'm like, I was ready and it's been wonderful.

So, oh man, every day it gets, every day it gets a little bit easier, a little bit closer to the, the end goal. Well, it's, it's awesome. And, you know, that goal continues to, to change. And so as the, you know, the, the ruling in our country changed with, you know, when Roe fell. I wanna go into the abortion services that you guys provide, because Yeah.

For other of her listeners who are, you know, in states that are affected either with restrictions or protection for the woman's rights to choose what happens with her own reproductive health. You know, because you, you shared earlier how you had already been doing abortion activism, but when it came to being an abortion provider in your clinic, how did you develop your services to service your community and the community that drives to see you?

Yeah, great question. So, and I'm gonna back it up just a little bit. When I was an undergrad pre-med that, and this'll, I get, I don't know if you have any Gen Z listeners, but I feel like that's the kind of thing that they'll scratch their heads about. But I had decided that I wanted to go to medical school.

I was taking all my pre-reqs and I was like, I need medical experience. I'm gonna go to Craigslist and see what jobs are available. And so I happened to see this one posting that was like pro-choice person needed for a clinic, no experience necessary, will train the right person. And I, in my little like young twenties feminist self was like, oh, cool.

Wonder what this is? Like, I don't, I dunno what, what I thought I was walking into. And then I got there, I was like, oh, okay. It's a abortion clinic checked. But anyway, I ended up getting that job and I worked there. Up until the time I went to medical school. So it was for three years and that was really eye-opening and kind of like looking back, it's like, ah, damn the, it was already there.

Cuz you know, in Virginia, Medicaid does not pay for abortion. Very few states Medicaid will pay for abortion. And at the time, so this was like 2008, most private insurances weren't paying for it either. So abortion has been a cash-based service for. Almost the entirety of its existence. And because of that, when you look at it compared to other services, the price is actually pretty low.

Like the price of an abortion has barely gone up since the seventies. And so on the one hand, it was overpriced at the time, but now, you know, it's like one of the, the less expensive medical procedures you can get compared to, you know, I know that like the medication that we would give there for IV sedation, if you were to give that with insur, you know, a, a combin, you know, one dose of ED and Fentanyl or whatever, with insurance, that's gonna be like a thousand dollars.

But when the clinics are doing it, They're giving it, you know, like a, a, a small but reasonable markup in charging people like between 25 and 50 bucks for something that if they were using their insurance would be a thousand dollars. And so, you know, just kind of going into D P C, like in retrospect, it's like, oh yeah, I had that information in the back of my mind about how insurance affects things.

I just didn't realize how it would be applied. So I did get, by working there for three years, I kind of started answering phones, cleaning toilets, sterilizing equipment, that sort of thing. And by the time I left, I was actually doing a lot of the onsite management of that clinic because the person who was the director was at a different clinic, outof State, helping them kind of.

Get things set up. So by that point I was like helping with payroll and ordering and all of those sorts of like little skills that I didn't realize I would need, but have been very useful. So I had this idea of how, you know, the kind of these like cash-based fee for service independent abortion clinics worked.

And it's very interesting, like the staff does all the work because if you think about it, physicians who provide abortion are very hard to come by. And so they usually have to go to different places. And so the patients all kind of. Get there at one point are prepped by the staff and then the doctor shows up and it moves very fast.

Boom, boom, boom, boom. And then they're on to the next place because there's not a doctor there either. And so, you know, that was like stinks, that it has to be that way. And if more people did abortions and it wasn't siloed and this, you know, kind of like ghettoized in these specific clinics, it wouldn't have to kind of be this type of experience.

And so in between 2020 and 2022, I was working at that same clinic part-time, like one night a week. And you know, I was just, every time I was there I was like, I could be doing other stuff while these patients are getting ready and then seeing them. And so that's how things work here. We have one staff person who's really incredible.

She does ultrasounds, abortion counseling. She's got like five years of experience doing this work, is really incredible with patients. And she gets them ready for me while I'm seeing the D p C patients. And so then, you know, kind of in between my D P C folks, I pop over. I review the chart, make sure there's no contraindications, you know, check vitals, allergies, all that stuff.

Look at the ultrasound, talk to the patient. I give them their miop, tritone, their first abortion pill with me. They have the opportunity to answer any questions and then they leave with their meso possible and they take that at home. And then I'm available. You know, I'm on call for them if they need anything.

So that's how the abortion by Pill works. It's a very small time commitment on my part. The reason that. It can be that way. It's because my staff is so experienced and knows how to prep them. But, you know, when you think about abortion by pill, like very few contraindications, like relatively healthy patients.

So that's how that works. And then we also do aspiration abortions. I do manual vacuum aspiration up to 12 weeks.

Usually I'll do like administrative work on site while they're getting prepped. That way if anything comes up or I need to repeat the ultrasound or whatever, I can do that. But it's just kind of like, you know, an opportunity to make things more efficient for the patients, make things efficient for me. It really, and, and you know, like destigmatizes it, the patients are so.

They're not expecting anything to be nice, right? They're like scared and they think things are gonna be crappy. And then they get here and like our building is beautiful and there's like plants and, you know, water and nice music and it, it's just like such a nicer like, relaxed environment to be able to be in a primary care setting.

Like this is just regular old healthcare. There's nothing special. The abortion procedure itself is like barely different than doing an, if you can do an i u D placement, you can do, an aspiration abortion, you know, and there's gonna be listeners that are like, you know, pro-choice, pro-life. Pro whatever their pro is or anti, whatever their anti is.

But again, what I love about my DP C story is that it's highlighting how people are operating, physician led DPCs all over the nation. Right? And so if there are people who are wanting to know that is helpful for them to hear, like, this is, you know, how it is. Because I think that that is not an easy thing to hear in terms of you can't really like hear, you know, on a podcast easily someone talking about how the, the workflow would work for that.

Mm-hmm. But it's like mm-hmm. It's a workflow that. Is just like any other workflow, it has a design to it to service your patients and your, your staff the best way possible. But, you know, when you talk about that, it's just another family practice visit and this is the procedure they're coming in for, not, you know, a skin re mole removal or something like that, but that this is the procedure that they're seeking.

I, I wanna touch on your tiers of membership because you know what I loved about your practice and how it is really making the ability to have a personal doctor equitable for everybody is you offer three different tiers and you, you talk about this in your social media, like, You get the same doctor, it's, it's still Dr. Arnold. The membership is gonna be different and how you're paying for it might be different, but everyone is, you know, paying for membership the same. And clearly this is separate from your services that are, you know, related to especially abortion. But when it comes to just inviting everybody into the practice, your tiers are set up so that is possible.

So can you tell the audience what are your tiers and how have you set them up to be accessible to everybody in the community?

Yeah, so we have three tiers and kind of the main tier, the one that we started with is the sustainable membership. And that's kind of like your standard D P C membership where age.

Three to 24 is 59 a month, and then age 25 to 64 is 85 a month, until I opt out of Medicare eventually. And, you know, it's like just pretty standard D p c. We also offer an equity tier. And this is for folks who if they can afford to pay a little more, they can. Oh, and I will say with a sustainable tier, with a standard D P C tier, we do an automatic discount for groups.

Single payer, we don't define the groups, it's just if there's one person paying, you get the group discount. So, you know, if we have three roommates who wanna sign 'em together, great. If it's one credit card, you get the discount. So that's the sustainable tier. And this is basically the cost of us doing business.

Like this is what we need people to pay in order to keep the lights on, pay the staff appropriately, and provide the service that we do. So then the equity tier is more than that. And I'll be honest with you, I don't even remember what the monthly. Equity spirit off the top of my head right now, I think that it's my, maybe like 20, $25 more a month, something like that.

I don't know. I'm sure TA is listening to this and like rolling his eyes so hard at me right now.

Let, lemme help you out. So I'm gonna go to seven Hills family Just FYI there. Yeah. So we're gonna go to the beautiful logo. It's popping up here. And then there's services and then there's Direct Primary Care.

So the tiers that we have on here are the accessible membership, like you mentioned, and then, the equity membership. The accessible adults start at 48 per month. Mm-hmm. Youth at 38 per month and a one-time enrollment fee of 52. And equity membership has adults at 105 per month. Youth at NI 69 and a one-time enrollment fee of a hundred and sustainable membership where adults are 85, youth are 59 per month.

And then there's a one team enrollment fee of a hundred, with a max of 500 per group. So yes, we're we're team, we're tag teaming. This, this is good.

Thank you. It's good. Yeah. We, so every, every little decision we make about money, I feel like I overthink every possible price. So in my mind I'm like, where did we actually land?

So, yeah. So the idea is that the equity memberships directly subsidize the accessible membership so that you'll notice the accessible membership, the, the monthly fee plus the signup fee. The first payment is basically a hundred bucks, right. And then it's $48 a month after that for adults and. We sort of, we don't have our, our system for the accessible memberships is not finalized yet, but at this point I think we have offered 10.

So just some stats cuz it kind of puts this thing in context. So I opened October 4th and the first month we enrolled like 54 people and it's been seven months. And today I'm at two 16. And so that includes 10 accessibles and. I don't know the number of equity members. It's probably around 10 if I had to, if I had to guess off the top of my head.

But we also did some fundraising specifically for the, the equity tier. And the idea is that we open accessible memberships up as we are able, knowing that we can guarantee them for a year. So we never want to open up an accessible membership and like have to, you know, revoke it or anything like that. So we do that carefully.

We're kind of now st. The last time we did this was. A couple months ago, like in March, we did 10 and we had about 20 people on the waiting list. So we, we are doing them first come first serve. We offered the first 10, and then some of those people, for whatever reason, it didn't work out, like maybe they're on Medicaid or whatever.

And so I think most of the people that were waiting. We're at least given an opportunity for a membership and they're filled. And so, you know, we're thinking kind of like a few times a year for right now, maybe like three times a year or something, we will open up more, but it'll be based on the amount of equity members we have and how much fundraising we've done specifically for the equity.

And then the other thing that we have is we actually have five memberships that are completely covered by a grant we got from a church specifically for L G B T Q primary care. So we, we, ba Vincent did this, he submitted the grant application, you know, for, I think it was like just shy of $5,000, basically the cost of care for a year for five people.

And they, they gave it to us. So, it's been really incredible. Like I had one patient who had signed up, but then like financial circumstances changed and because we had those grant options available, we just switched them to The grant membership. So now we know that they're good for the next year.

And then the others were ones again, kind of first come, first serve. People called us and needed us. I have someone who was uninsured and had been going to the local urgent care, you know, for primary care and owes them like thousands of dollars. And so, but now they're here for free for a year while they're like recovering that.

And just, you know, we have our own onsite pharmacy. So this person I think was paying like $45 a month in medication costs that I'm now doing 90 day supply for $11. So like, I mean just, it's like the value, like all these different levels and it's been really exciting. I mean, I just wanna help people, like, people always ask me like, you know, about like prices and stuff and like, what, you know what I'm like, I just, I want no one to have to pay anything and I just magically wanna get paid my salary, but, I think, you know, there's, a thing that happens where we don't want to think about money because it, something about it like doesn't feel noble, right?

Like, I'm above this, like, I just need to be thinking about the medicine and not about the business side of it. But if we're not thinking about that, there are other people who are less altruistic, who will be, be very happy to think about it on our behalf. So, you know, I've learned so much in this past year just about like business and the cost of things and value.

And so I, I'm feeling like really good about everything that we're doing and yeah, this, you know, carefully opening up those accessible memberships in a way that we can guarantee their sustainability, you know? Absolutely. It's so ironic though, how you're talking about, You just wanna provide the medicine.

And that is so our culture of healthcare in this country. It's like the doctors are altruistic. Just give them more work. Just make them do it. Make them be billers, coders, all the things they didn't go to school for because we're gonna pay them. They don't actually know how much they're worth, so we're just gonna pay them as the least amount possible to make them stay and make them think this is a great gig.

Right. So that's what I was thinking when you were talking about how you just wanna give care like that is so. Like, I am so guilty of that still. Like I had to rethink my workflows to say like, when a person has a procedure scheduled, we know what that procedure is. So they will get the, you know, consent.

They will get the pricing because I charge separately for my procedures, whether, you know, it's a shaved biopsy or a whatever, because I have to pay for things like g lidocaine and, you know, it can get pricey at sometimes to buy some, some of these materials. And so, you know, I, that's the way my, my D P C works.

But to have that discussion before a patient shows up is how I've found my comfort level. Like, I hate talking about money also when it comes to the patient, cuz it's like, I'm not, but I'm not making commission off of you. Like that's not the point of this. Like, I'm not trying to sell you a procedure.

It's like I'm literally trying to address your needs and I have a procedure to do that. So I, I just, I I really love that you said that because it's, that is our mindset when we're in the type of training and the structure of training and the, the paternalistic system of training that we have in our healthcare system, and you know that there definitely are exceptions to that, but generally where as I'm sure you experience most of my.

Places that I rotated, either in medical school or RO or residency, were more of a paternalistic side of type of training than not. And you know, this is, this is our trauma informed healthcare. Like we are literally bringing our experience to our practices. And I think that's why D P C is such an awesome movement and why it's growing like crazy because it's like, dude, my doctor's not a robot.

My doctor is like, they're telling me about when they miscarried or what they're telling me about their acne when they were 16, whatever it is. Cuz it's like, yeah, you're a person too, just like me. Like I might have a MD or d o, but that doesn't make me really any different. Like I ran into somebody the other day who's, I haven't seen her for 20 years and I used to teach zoo camp at the Sacramento Zoo and, and she's like, but you're a doctor.

And I was like, oh, I would still scare you in the middle of the night in the reptile house. Like there's no difference. Like I'm literally that same person. So, you know, I just, I love that we are so unique in our practices. Now when it comes to uniqueness, and you mentioned this, that your overhead expenses are a little bit higher than the typical D P C.

You purchased your building outright. Boom.

That's why I was No, no, no, no, no. Actually we did it. Okay.

Was that was the plan though, right? That was the plan, yes, that was the plan. So look, I will move mountains, handfuls of rock at a time. However, we were coming up against, we actually did put an offer in on one building and we didn't get it.

And this was in September at this point, I, my wait list was over a hundred. We either wait around for this or we just, and I just, I was like chomping at the bit. I was like, I, we just need to do something and like, so we decided that it was more in the spirit of which the money was donated for us to just.

Get open a s A P then to wait around for the perfect building situation. I was getting antsy at my job, which I was supposed to be staying at part-time and I definitely did not. I was like out of there, at the end of September and sort of all these things sort of like lined up. So right now we are renting, we do still have the hope of buying the building, but we have sort of put that on the back burner a little bit just just cuz it felt like it was more important that we were, we kind of felt like we were losing the forest for the trees a little bit and it's like we need to get open and, and start seeing people.

And I 100% think that was the right decision. Our realtor that we had been working with found us this place to lease. They're still looking at buildings for us and kind of like sending us options. So I think, you know, hopefully like in the next year or so, but for right now, We're settling in, we're renting, and it's, it's fine.

You know, that is a strategy to keep your overhead low is don't buy building outright. You know, I'm in that same place where I went from only telemedicine and home visits to having a space, but with the, with the shortest amount of time on the lease. That's a, you know, Dr. John Jacobson lesson that I learned from, talking with him.

And, you know, that allowed me to say like, could this space work? You know, could this space work until when, you know, what, what would I need, what would be the ideal clinic in the future? I wouldn't know that if I hadn't tried the spot that I'm at now out. Right. So, thank you for clarifying that. And when it comes to your experience so far, and I just like, every time you're mentioning these numbers, like, oh, a hundred people on my wait list, I'm like, oh, it's such a different place than when you and I spoke the very first time.

So in closing, I wanna ask. Because you've recently just been there when you're like, I'm the doctor who I'm still having all these, these like how do I questions? And now you are established when you think about other people who might be in that same spot that you were not too long ago. That was a frustration that we were discussing is just like, how do you get the advice of people who are helpful to your journey as to how you want to personalize your D P C?

So can you speak to how you would advise other people to find the people who are in alignment with their understanding of what D P C is, how D P C works, how to provide DP C to their community, and what words of encouragement would you have tho to those people,

as well? Yeah. So I do think that there's a lot of information out there.

I think one sort of observation that I had is like, I could, and it, it makes sense after, like the type of education and training that we all go through is like, you really want a specific to-do list where you're like, these are the tasks I need to do. I will master them and then I will succeed. And that does not exist.

So the trick, the skill is to look at what's out there and see the seeds of what applies to you. You know, I read Doug Farage's book, the Direct Primary Care book, and I, I thought it was super helpful for me, even though there were like, Plenty of things that I didn't necessarily do. I do feel like you can always tell the people who read that book and used it as an instruction manual.

There are certain things that pop up on the website where it's like, yeah, I know where you got that idea, but, but like to read that book and think like, what are the concepts here that I can tease out and use? For me, it doesn't really make sense for me to go to farmer's markets. I'm not doing like food as medicine in my practice.

I can. Trust and believe it. I'll be at all the burlesque shows and the drag shows and the L G B T Q markets, you know what I mean? It's like what makes sense for me specifically. And so there, there's a lot of information out there to tease through. I'm trying to think of all the things I did. Honestly, you just kind of have to like, just go for it.

Like, I pulled up my D p C finder, I found every D P C around me, and I just cold called them and sent them email. So I called Joe Fields, Johnson and Dandelion Health, and I was like, Hey, I'm thinking about opening. Let's chat. You know, and I think the first time we talked on the phone, it was over an hour and got really lucky and found out that we had a lot of values that aligned.

And so that was exciting. I talked with Kenneth, of, you doc, you know, a little bit further away from you geographically has been really great for networking. You know, like put, invited, started immediately inviting me to DP c events where I met other folks who were doing things, you know, that I wanted to, to be doing or like in a way that, that I wanted to do them.

And like, you just have to talk to like, as many people as possible and like, just know that like you, you have, it's almost like filter feeding. I don't know. Describe like my, my kind of process of like, I'm just gonna. Absorb all the information and the stuff that is not useful is going to disappear into the ether.

And then I'm gonna hold on for dear life to the stuff that like applies to me. And yeah, I had been listening to tons of episodes of my D p C story and I had kind of been trying to reach out to those people and no one was giving me like the answers to the questions that I wanted, and I was like, Well, I've never talked to Marielle before, though.

I've like, listened to hours of her podcast, but she seems to have talked to literally everyone, so maybe she will know who I should talk to and that's, I like, called you in a tizzy, like, uh, what do I do now? Which was amazing and helpful. So, yeah, I think just like, you know, kind of going into it of like, there is gonna be no specific protocol for you.

You have to find. The jewels and what's a juul for you is not gonna be a Juul for somebody else. Like everyone is different. And, and also these events, like you just never know who you're gonna meet. I, I'm like very excited to go to the, to the summit at the end of June. I didn't go, I didn't go to anything last year just because it was like, you know, breastfeeding baby and like other job and blah the whole thing.

But I'm super excited to go this year and I'm like, I don't even, I honestly, like, I know there are like c m E talks happening, but I don't, I don't even really care about that. I just wanna like shoot the shit with everyone.

It's, there's nothing like it. There's nothing like it. So I am, I am so excited to meet you in person.

I am five, two and a half. Fyi. I like, it was weird. I was like Dr. White. I asked him, I was like, how tall are you? He was like, why are you asking me this? And I'm like, cause I'm gonna see you in person. I dunno what to expect. So I'm two and a half for everyone out there. I am so excited to meet you. Thank you so much Dr. Arnold for joining us today. Thanks Marielle.

*Transcript generated by AI so please forgive errors.


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