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Episode 131: Dr. Shannon Scholl (She/Her) of GastroDirect - Raleigh, NC

Updated: Jul 9

Direct Specialty Care Doctor

Dr. Shannon Scholl of Gastro Direct
Dr. Shannon Scholl

Dr. Scholl graduated Summa cum Laude from NC State and earned her medical doctorate and Master's in Public Health from UNC at Chapel Hill while raising her two girls. She was in an area private practice for 14 years but became unhappy with the traditional way of providing medical care, which puts an emphasis on numbers rather than people.

When her daughter became ill, she took a hiatus and decided to explore other ways of delivering care. She enjoys getting to know patients as individuals and has had the privilege of caring for generations of patients within many families - the highest imaginable praise.

In addition to the Western medicine in which she trained at UNC, Dr. Scholl is well-versed in data-supported functional GI medicine, including leaky gut. She is proud to be The Plant Fed Gut Masterclass certified.




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New York Times Podcast featuring Dr. Scholl Transcript: HERE


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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 DPC 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, Marielle 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 specialty care has allowed me to spend more time with my patients, which is key to being the best doctor I can be, and that brings me incredible joy. It has allowed me freedom from administrators, partner meetings, and most insurance. Headaches, not all, but most. It allows me work-life balance and offers my patients affordable, reasonably priced care.

I'm Dr. Sch of Gastro Direct North Carolina, and this is my D P C story.

Dr. Shannon Shoul graduated summa cum laude from North Carolina State and earned her medical doctorate and master's in public health from U N C at Chapel Hill while raising her two girls. She was in an area private practice for 14 years, but became unhappy with the traditional way of providing medical care, which puts an emphasis on numbers rather than people.

When her daughter became ill, she took a hiatus and decided to explore other ways of delivering care. She enjoys getting to know patients as individuals and has had the privilege of caring for generations of patients within many families, the highest imaginable praise. In addition to the Western medicine in which she trained at U N C, Dr. Schul is well-versed in data supported functional GI medicine, including leaky gut. She is also proud to be the plant Fed Gut Masterclass certified.

Welcome to the podcast Dr. S Schul. Thank you. Nice to be here. Thanks so much for having me.

It's such a treat to have a gastroenterologist talking about direct care on this podcast because as we know, there are so many people in specialty care who are exploring the world of direct primary care as a business model and saying, Hey, I can adapt that to my practice, as well as a fill in the blank specialist.

So when we talk about story and we talk about how story convinces other people, Hey, you know, their, their story's very similar to mine. I want to open with pulling from the fact that you are a doctor and a mother, and what I had read was that. During the time where you were going between your old way of practicing and your new way of practicing, there was a time where your daughter ne was ill and she needed you.

And so a quote that I had pulled up in my mind when I read that was, know what matters most to you and be unwilling to compromise those priorities at almost any price from Frank Sonenberg. So can you open our interview with how did you go from your fee for service job and having already raised two girls, you know, even before residency to a direct specialty care doctor and still being able to take care of your girls in a better way?

Yeah. That, you know, that episode with my daughter informed what I'm doing now in a couple of different ways. So before I made the pivot, I was, I was on the golden hamster wheel. I, I was in a really successful practice. I was really popular in my area, very much in demand. I had, um, six to eight week.

Weights, which actually drove me crazy. I did not like that. My partner thought that was great, you know, it was job security, but I felt so guilty about it. And I would go into rooms and patients would say, you know, I'm feeling better, but it took so long to get this appointment that I didn't wanna give it up.

And I was like, what's the point? I mean, what's the point if, if they have to wait so long that they get better just by regressing to the mean, what am I doing here? And so I lengthened my hours. I started going in at seven 30 instead of nine. I worked through lunch. I stayed until six 30 and I saw 30 patients a day often.

And, and I would, I just got so burned out and I never felt like I was doing a good job. You know, patients liked me, they were vocal about that. But I, you know, you know what it is. You walk into a room and you is, uh, does this person have Crohn's or ulcerative colitis? I can't quite remember. I gotta check the chart really quick.

And I just didn't feel like I, I knew people well enough and I was doing good enough jobs. So anyway. My daughter got really, really sick. She was admitted to the hospital. She ended up being there for three months, but I didn't know it at the time. I just knew that she was really sick and I was going through some other life changes and just decided something's got to give.

And so I left the big practice. I left very suddenly and I focused on my daughter. And during the time that she was in the hospital, she was not getting better. And I, you know, I'm a, a doctor and I have some, some hospital experience, you know, and, and I'm, I have an mph, I, I'm familiar with the data. I'm capable of doing lip searches and stuff, and I was trying to talk to the doctors about, you know, what might be going on with her.

And I was getting dismissed. And I had the impression that they didn't know my daughter very well. And I found that really maddening, that sort of acted as a storm or crucible for me to find a different way and a better way to practice medicine. And so I was talking to a friend of mine who's a D P C doctor, we were at brunch.

And in her devious little way, she said, you know, have you ever thought about doing it differently? Not having a boss, not getting right back on that golden hamster wheel. And I just started looking into it and it informed my practice. I now, as you know, when you do D P C, you have a lot more time to spend with patients.

And that experience of being dismissed by, um, healthcare professionals really informed how I approach my patients. I have plenty of time with them and I enjoy that aspect of it very much. It's not. When I was doing traditional medicine, I felt rushed and in my mind there was always a, a clock ticking, and it was always trying to get the patient to tell their story and then get my story out and educate as much as I could, and then you're onto the next room.

Very unsatisfying. Now, I, you know, I feel like I, I can take as much time as we need. And, and I just love it. It feels so much better and as it should be. You know, it's, it's like we, we were talking a little bit before we started recording about how what we went to medical school for is really incongruent with what we see on the floors in our jobs after residency.

And when you talk about how like there's a time clock in your head and about like getting a little bit of the patient's story, at least I had read this, it was an I C U, I think it was a nephrologist who worked in the I C U. Their post was talking about how they have their workflow of how they make it through 40 patients in a day.

And it was like number one, number two, number three, number four. And then it was like number five. It wasn't number one, it was like number five or down further on the list. It was like, and have one sentence about the patient. This is the humanism in medicine, number six, blah, blah. And I was like, Ugh. I just shook my head because, and I get it, it works for some people.

And maybe, you know, that was the short version in the LinkedIn post that I had read. However, you know that idea that. There is an algorithm and you can only have one sentence to know your patient is how you get through 40 patients in a day. I am empathizing over here because your daughter being in the hospital for three months, my father was in the hospital I c u for 22 days before he went into hospice.

And the the same feelings of, you know, I, I actually can talk with you about differentials and about how his progress has been, you know, culturally what's going on. I'm sure the same things happened with you being the mother of your daughter. And it is really, really a disservice to our patients when we're not able to spend the time to talk with them.

And it really hurts even more when we ourselves, our patients or our family members, our patients, our people we love. So when you had this talk over, and I love that this is how you found out about the direct primary care business model, because everyone has their story of how they learned about it, but when it's fed to somebody, After an event, like what had happened to your daughter has happened, it's perceived differently because there's some people who will hear about D B C and they will not really act on it.

They won't actively think about it. What happened in your head after you, you heard about that, you started doing the research. What were the, the next steps that you took towards opening your direct specialty care practice? You know, I think I was kind of naive, but I'm grateful for that because, um, like anything, I mean, a, a journey begins, a journey of a thousand steps begins with one step, right?

Or whatever that saying is. And when you get to the end of the journey and you look back and you see how far you've come, it's like, wow, I had no idea what, what, you know, I was getting started, but I had daydreamed for a long time about getting away from insurance, you know, sitting there on hold for the peer-to-peer.

Many, many, many times I had fantasized about just not having to deal with this stuff. And I had this naive belief that because I. I thought I did a good job. I do think I'd do a good job. And because I had had a good following in the area, that I would be able to just say, Hey guys, I, this is where I am.

You know, come on and see me. It turns out I was right. It just took a little longer than I thought it would. So the first thing I did was, I guess I'm went home and built a website. I mean, I use Squarespace and I, I built a website and I asked my friend, you know, what EMR she used, which is Atlas and I, I started with Atlas and you know what?

And I think there are two kinds of people in the world. There are the ones who aim and aim and aim until they're sure they've got the target dead to rights, and then they fire. And then there are people like me who just start firing and eventually correct their aim until they're on target. I didn't even have a Scope contract.

I had set a date, a soft date of January, and then it turned into February. To open and I finally decided May 6th is the date that I'm gonna do it. And I put that on my website and everything. And then I, as the deadline approached, I was like, I'm really gonna figure this out. And, and I did. I made it happen.

I found a place cuz I was thinking, you know what, if I open May 6th and all I'm doing is telemedicine for my living room, fine. You know, these are probably gonna be people who, I mean, I have reviews in the area, so I felt like I had a, um, a little bit of a runway, but I, but I pulled it off. I got a place to rent and all the supplies.

Amazon is great for that. And I got a scope contract in place by the time it was time to scope my first patient. That's incredible. And because as, as it's mentioned on your website, you are opted out of insurances period. How did you end up getting to negotiate a scope contract and how do you make scopes affordable for your patients?

Yeah, this is a really important part for specialists. That was the hardest part to figure out. And what I ended up doing is I approached an entrepreneurial group, GI group in my town, and I negotiated with them. What I did is I asked them what they get paid their bundled price for minus the professional fee for a Medicare patient.

And they told me, and I said, well, I'll just pay you that. And so, and then I just tacked my professional fee on top of that. And actually, I guess you can't separate the professional, it's just a bundled price that they get anyway, so I, you know, at the end of the month, they bill me for the number of scopes that I did, and I've already collected from the patient.

So I use Atlas. And Atlas, um, runs with Stripe. I don't know if everyone's is like this. So their credit card is vaulted. So when I schedule them for the procedure, I just charge them. And then we do it at a fully accredited a s C, and then I pay the, the scope center after the fact. And, you know, they, they're looking for volume.

I mean, if they have rooms that are empty, then volume is good for them. And, and what I said to them is, I will bring you volume. You don't have to do anything. You don't have to call the patients. You don't have to see 'em. Um, you know nothing. I just show up. I scope 'em and I pay you, and that's it. And they were very happy with that arrangement.

That's awesome. And let me ask you there, because previously when I was doing scopes, like I had one patient who she went in because her insurance covered a screening colonoscopy, and then after a polyp was removed, it was a diagnostic colonoscopy and ding, ding, ding, there's a $7,000 bill. How do you work it so that the patient is paying you the bundled price plus being able to use their insurance or afford.

You know, something that turns from a preventative to a diagnostic scope.

I have those conversations with people all the time, and the way that I kind of approach it is a part of what I'm doing is educating the, the local public, right? Cuz not everyone knows about this trend. And so when people call me, I, I, my thing is I'm just, I just act like a good person.

I act like I want my mechanic to act when I go in and I don't know anything or my H V A C guy or whatever, I want them to be honest with me, you know, even if it's to their detriment, I want them to tell me the truth. So that's how I approach it with patients. So I tell them, you know, I get all their information, um, are, are we doing, uh, screening?

If that's the case, then you are granted a free colonoscopy every 10 years and here's the gotcha. If they find a poll. Then when you wake up, it was a diagnostic procedure now, and that's going to go toward your deductible. You have to pay through your deductible until you've, you've met it, and then your insurance will kick in at 70 or 80% or whatever.

And I tell them, yeah, I've got pretty good adenoma detection rate, so get it with me. You know, Chan, it's about a 50% chance that I'm going to find a polyp and take it out, and my scope price is $1,500, whereas all altogether bundled, whereas in my market it's 2,500 to 4,000. So, you know, it would be nice to have a crystal ball in moments like this.

I, I don't know whether you have polyps or not, but there's a decent chance that you do. And, and it's gonna be a lot less if you get it through me. Usually, I think two people, people just respond to authenticity and usually, I mean, $1,500 is not a big buy in this market. It's not small and everybody's different, but, you know, it's a, they're usually surprised that that's all it is.

And most of the time after we've talked for a bit, they, they wanna have it with me. I mean, there is, you know, in D P C we talk a lot about the, the cost, the healthcare costs to patients, but the quality is really important too. It's, it's higher quality care. So I haven't Absolutely, yeah. Hasn't been that much of a barrier.

I plus I believe in what I'm doing. Cause I know. I don't know if you read this on my website, but I grew up working class. My mom was a nurse and my dad was, uh, worked for Bell South and you know, they had three kids and they worked a lot of overtime and my dad was always screaming about the rrs getting into the damn attic and turning off those lights and, and all that stuff.

And he thought the doctors were crooks and, you know, never took the dog to the vet. And so I grew up with that, that ethos. And so when I'm talking to patients, I, I've always felt this tension between doing what's right for them and doing what and being a good shepherd of their healthcare dollars. So I just can't help but tell the truth.

And they, they usually really appreciate that honesty cuz they, they, this is all in education with them. They had no idea that. They would go to sleep as a screening and potentially wake up as a diagnostic with a huge bill.

It's so important. And you know, I think that as we've seen through the pandemic, when people don't have access to a doctor who has a relationship with them and who knows them, it really makes a difference culturally.

I mean, we see the number one doctor in the country is Dr. Google, and we see, you know, patients who, like I had a patient who she literally described that, you know, she sees me for her actual care, but she had to go in for her Medicare physical, and she described the, the visit that she timed was less than eight minutes, where the doctor was literally inching his way back towards the door handle on the door.

And she was like, I had lots to say because, you know, I had some questions, but that wasn't part of the Medicare physical. And I joked, I'm like, oh, you mean the one where you're not supposed to listen or touch the patient. Yeah. That's a great physical. So, you know, this is where, you know, the D p C model really embodies old school medicine.

And one more question there, because you know, as you mentioned, your, your dad's ethos when it come, when it came to doctors and how we are really bringing relationship race medicine back to our patients, what is it like after the colonoscopy or after the endoscopy? Because that is something where when I was doing procedures, I would, you know, go out to the waiting room, find the, the partner, the, the parent, whoever it was, and tell them this is what we, we found.

I would draw them a picture, yada, yada, yada. That is definitely not the standard of care in our area. So, When you went from fee for service to being able to bundle and transparently talk about pricing and do procedures for your patients, what does it look like after you're done with the procedure? I always, but, but no, I'll be honest, I just don't have it in me to, um, blurt at somebody while I know they're too drugged up to, to understand.

So I, I have always given them plenty of time to wake up and my nurse actually, now this has changed. So you know how this is now, instead of being part of a big group and you don't know what's happening, you can't really get your hands around all the pieces of this big operation. It's just me and my nurse.

And so my nurse is actually working in post-op at my endoscopy center part-time until we're full-time. So she works up there. So we have continuity of care for our patients. So they wake up and they see Lacey and I let them wake up and I talk to them and then Lacey calls them later that night or text them, you know, cuz we text like all D p C, most D DP C docs do D s C.

And so I've never said it that way, but relationship based is exactly what we do.

It definitely is. And I think it's important, you know, for, for people to hear your story because we're, you know, you are making an impression on people who are, are going to be future gastroenterologists and future gastroenterologist.

Choosing the direct care way or choosing direct specialty care. I. You know, my husband, who was also doing scopes as a family medicine doctor, that's what we saw in Nebraska. It's like, that's part of the care you do the scope, the, the patient, you know, wakes up and you go talk to them and they're family.

You answer the questions and then you check on them later that evening. That's how you do it. It's not done any other way. And so I really think it's important for, you know, as you go into the future that this is how you and Lacey work with your patients who you know, because this is what also your patients will be talking about when they spread, you know, oh, the story of going to Dr.

Schul as their gastroenterologist. Right. So I think it, it was really impactful all around. And when we talk about procedures, uh, in terms of you, you mentioned how, you know, it took a little bit more time, but people eventually found you. How did you end up, you know, opening, you got your website, how did people end up finding you?

It turns out that it's mostly through Google searching. So, um, I had to make sure that I was my name. I was using my name as one of my keywords on my website. And then, you know, it's probably worth hiring someone who knows such things, cuz I had a friend who helped me, you know, you need to say certain things on the front page of your website to help people, to find you, to get up to the top of the Google search.

So I did those things and I was lucky enough to get on a couple of, um, mommy boards on Facebook. I had been there in my old practice and that's just, I think luck. You know, people, people just said they liked me and so when I came back I announced that on the mommy boards. Hey, I'm back, you know, and I'm taking new patients and I'd love to see you.

That was really important. And, you know, for gastroenterologists, for specialists in general, I think it's also really important to market yourself on LinkedIn. But your audience needs to be insurance brokers who are brokering contracts for self-insured employers, because this is, the market is aware of this D P C D S C trend, and they are looking for bundle procedures at reasonable causes.

They're, they're looking for knees, they're looking for cardiac cats, they're looking for colonoscopies. You know, they're looking for anything that has a C P T code. They're looking for a cash pay price that is about, one insurance broker told me, I think it was 1.7 times Medicare allowable. Is like the golden number and Marielle.

I wanna go back and just say one more thing because you made me, you reminded me that I'm talking to future gastroenterologists. There is that hump of convincing someone who has insurance that they do wanna pay cash for you. And so I, you know, I lay awake at night, um, trying to figure out how to make my business more profitable.

And the latest thing that I have entered into is a contract with my endoscopy center to. Be an employee of theirs. So I am not opted in with any insurance companies, but I don't have to be, they can use their tax identification number to file the patient's insurance, and that makes it sort of a hybrid model.

But I'm not saddled with any of the administrative burden of dealing with the insurance. I still see the patient in my office for a cash fee. We schedule them with the endoscopy center, the endoscopy center on the backend bills, their insurance, and that's all their administrative people. I don't have to do any of it.

And the patient is happy because they were able to use their insurance.

Absolutely. And that's, I hope that people who are specialists listening to this podcast are really thinking about that in terms of primary care that that happens very frequently. Where, where we'll say like, you know, you can pay $2 and 62 cents for X lab, or you can choose to use your insurance and then if, if you choose to use your insurance, quest will bill you, LabCorp will bill you, they'll bill your insurance.

But for our services as a doctor, this is where you are getting relationship-based care, you know, in exchange for payment. So I think that that's really a great point that you're highlighting because. When it comes to primary care, you know, we're doing 80 to 95% of everyday things, but when it comes to procedural care, when it comes to specialty care that are not really thought of as, oh, I could choose insurance or cash pay, you're bringing that part into the conversation, which is so important.

It gives, when we talk about your dad, again, it's like this is a way to give a patient transparency as well as an option, and that is one thing that I feel more medical students and residents need to know about is you have the option of direct specialty care, direct primary care, and that this is a way that you have just educated the audience who.

Or potentially dreaming about being a gastroenterologist or already gastroenterologist. So, awesome. So when you made this transition, and you've already mentioned ways that your practice, your way of practicing your art of medicine has changed. One note on your website that I absolutely loved was, we limit our practice size, not our care.

So when you think about that copy on your website and you think about how you talk to your patients and how you treat your patients differently on the clinical side, how do you act differently as a doctor now in your practice?

My nothing has changed about what I wanna do and the kind of medicine that I want to deliver.

I just am able to do it. You know, I don't have to ask anyone permission if Lacey and I decide that something isn't working or we need to change up what we're doing. We just decide and then we try it. I spend plenty of time with people. I mean, I. I, I schedule people for an hour. You know, a new patient is an hour and, oh, I'll tell you one thing that changed that is, has made all the difference in the world.

I can talk to patients about their diet now, and it's this weird thing that GI fellows are not, we're not taught nutrition. I remember I was given a binder and taught, I had a three month self-study block. There was no tests or anything. I was just given this really dry binder with like a page that said zinc and all the things it does in the body are what a deficiency looks like.

And I, I didn't learn anything. It's never made any sense to me that we we're supposed to not talk about what goes in top. And we are supposed to think about what goes on in the middle and what comes out the end. It doesn't make any sense. So during that hour, I talk to people about, you know, what they're eating.

I talk to them about their microbiome and how they need to support it because it's, the microbiome is now considered an organ. It elaborates hormones and creates neuro neurotransmitters, and serotonin and dopamine are made in the gut. Most of it is made in the gut. So it's really important that people are feeding that organ correctly, and I never had time to do that in my own practice.

Never. So I, I like to say I nerd out all over people, and I love that. I mean, it's an area of interest for me, so I get to indulge my passion and stay up on the latest science in an area that I'm really passionate about, and patience, hopefully benefit from that. And we have time to do it.

It's so cool. And when you were talking about how, you know, previously you were like, oh, wait, does, does this person have ulcerative colitis or Crohn's?

How are your notes different now that you don't have to, you know, in 72 hours, finish your note for the insurance company, their narrative, you know, they're free texts and their narrative. There's none of that, I don't even know what you call it, but the macros, you know, where you click the endorses or denies thing and it's all just a bunch of generic texts.

It doesn't convey any real meaning or any hint of, of what the person is like, or now it's all narrative. And I, I don't know, that sticks in my brain better and I don't know, get into the person's, I don't know. I, I don't know. It gets me not into their head, but, It helps me to empathize. I understand what they're going through.

I'm writing the story up there. Life or their symptoms or whatever, much better.

I find that when, you know, people like yourself are sharing their stories, emotion comes with it, and then I connect emotionally with people whose story I hear. And so I definitely understand that. I mean, ev when I was a resident, that's how we were taught to write notes.

Like handwriting notes was actually a thing. Like, you know, you and I remember that, but it's so funny when I talk to residents who're like, I can't function. There's no, there's no power in the hospital. We don't have an emr. It's like there's a pen and paper. You, you can, you can do it. But, but yeah, we were taught to, you know, when we're doing notes, when we're doing especially on wards, um, especially in the ER that you write, so that if someone's picking up your note, they understand what your thoughts were and what your plan was.

And I think that in D P c, I mean like I totally empathize with you sharing about how your notes are, are more narrative because we are, are working for our patients. We are not working for magic codes. And you know, how many points can we rack up in a day? We are working to maintain the health of our patients.

And so when it comes to how you mentioned, you know, you, you nerd out and you, you use that mph h brain of yours and that MD brain of yours to treat your patients. What happens if a patient says something to you and you're like, oh, I don't know the answer to that. I would like to look that up. How does that, how, how does that work out in your practice?

Are your, are your patients then scheduled for a follow-up visit? Is there a membership option? How does it work when patients have multiple visits in your clinic?

You know, I haven't figured out a way to do subscriptions yet because it's a, you know, it's different in specialty care. Ideally, they come to me with a GI problem.

We spend some time together, which is maybe two or three visits and figure it out and, and, and fix 'em. And that's the idea. And I, I'm toying with the idea of doing a subscription service for I B D patients because they're, you know, they do have a chronic illness that they're gonna need to come back and see me for.

I'm toying with it, just haven't figured it out yet. But you can figure it out and you can change and pivot if it doesn't work out for you, just like you did on your opening day. So it is amazing. It is suffering. When we talk about this idea that you are toying around with the, the future, you know, would you have subscriptions or not in your practice?

Uh, can you summarize for the audience, how does it work? If a patient finds your website or finds Dr. Shul and wants to become a patient at your practice, what are the ways that they pay you?

Sure. Well, so one of the, one of the great things about my practice, I think. We really took direct care, literally.

So I carry around a cell phone, that's the first thing. I have a cell phone. If I, if I'm busy doing something, I forward it to my nurse or she carries it around. So when they call, they, they get a human being. They get one of us, one of the two people who know them and can get into their chart and answer their question.

And if we don't pick up, we call back. I mean, if you call my practice and, and I miss or call, I call you back. You don't even have to leave a, a voicemail. And you called me, I wanna talk to you. But when they call and they get me, they're always so surprised. And it's usually, oh my gosh, I'm so sorry. I don't know how I got this number.

I didn't mean to call your personal phone. And I'm like, no, no, no, it's okay. Gastro direct. You get to speak directly to the doctor. How can I help you again know? And that, that just floors people, they're, they're so amazed by that. But we also tried to make it very consumer facing. So I used to get complaints all the time at my practice.

People would say, I've called six times and nobody's calling me back, and I couldn't figure out where it was going wrong. And I know how frustrating that is. You've got something on your to-do list and you wanna get it done. And so we have, with Atlas, you're able to enroll yourself. You're able, so I have a button on my, on my website that you click to enroll and it takes you right to my emr and you build your own chart.

And, um, once you hit submit, you show up in my electronic medical record and we text you or we call you, or sometimes we email you to set you up for an appointment. I do also, sometimes I have the option for a discovery call if people want to call me and just kind of see if we're a good fit and it's free.

It's 15 minutes. And to be quite honest, I do it. If you schedule it and talk to me or if you just cold call me. You know, it's essentially the same thing. But this is a more structured way of just letting people know, Hey, I'm willing to talk to you for 15 minutes and figure out if you like me and if, and if I have a skillset that you need.

I think it's super important and on your website, just, you know, for the audience to know, you can go on Dr. Scholl's website and you can actually, as a patient, you know, pick the time that you want the meet and greet. You have the Acuity scheduler up there and you know, like my practice we have on our Google site, and I don't know if if yours is, is like this, but you can link your scheduling calendar, free meet and greets to your Google business site.

And the, the, it's just screaming. This is a place of accessibility, you know, so it's something that absolutely is not culturally normal in our society. I mean, we are making it more normal, but it is definitely not something so people are like, I'm laughing so hard when you, when you say that, people are like, oh my God, I'm, I am talking to the doctor.

Because even as a direct primary care doctor, when I had, uh, called my endodontist and I got her, I was like, oh, I'm so sorry to bother you. I'm like, What the heck, because culturally that's just not how we operate in America. So I just love that you know, you are shocking your patients in a great way with accessibility and answering the phone and talking to them, or you know, engaging with them one-on-one.

So I love that. Now you talk about how patients do the meet and greet. Can you tell us, you know, how do you manage the meet and greet? So it's limited to 15 minutes, and what are some of the things that you talk about with each patient during the meet and greet?

What I wanna know from them is kind of, you know, what they're struggling with and what their goals are out of my care, what their frustrations have been.

You know, it's so funny, Marielle, whenever I talk to other doctors about how, you know, patients can call and they can get me immediately, they're like, do, how do you do that? You know, because they just assume that doctors, uh, patients are gonna be calling you constantly and driving you nuts. It's funny when you give them permission, when you give freely, never feel like, okay, you know, you're taking advantage.

Here're almost never. And so it's not hard to keep people to 15 minutes. They're almost trying to get off the phone too soon. I'm always like, it, it's okay. It's all right. But yeah, I just wanna know what they're struggling with and I want to be able to convey, I wanna make sure they understand the practice model, because I don't want them signing up, you know, enrolling in the practice and then, and then having a nasty surprise.

Um, but yeah, it's, it's just what it sounds like. It's a meet and greet. It's, hi, this is me and this is what I'm about. And. Who are you and what are you looking for? Awesome. And in your practice, do you accept patients acutely for care? Like if somebody is having, you know, three months of bleeding and like, I think of the well male, you know, Probably early twenties that their wife made them come into the clinic.

And finally, you know, it was the wife who sat there and told the story of the husband. And this patient in particular had turned out to have ulcerative colitis. So I asked this question because in my practice, that's one thing that I will not do unless it's a very rare circumstance where I, I will not take an acutely a patient in acute needs.

Like, um, if somebody has a diagnosis of cancer and they need, you know, to have a connection to, they need a referral. Or if somebody has like an immune issue where their insurance dropped them so they can't go to their previous clinic and. I can help by getting the referral to the new clinic. Like that's the type of, uh, acute visit that I will typically take on.

But when it comes to people who are like, you know, my person, you know, is, is diagnosed with this acute issue and we, we want you cuz you do home visits. I have found in my practice that people who join like that don't understand the model. And so for me as a subscription based doctor, it's different than your practice that doesn't necessarily have subscriptions.

So that's why I asked the question, do you take acute patients or do you take patients with acute needs? And how do you handle them if you do I do. I'm often sorry. Um, when I do for exactly that reason. And in fact the, the I'll do you one better the patient who calls and has to be seen immediately. And then I make time.

I, I do a telehealth or something that day. I'm almost always sorry because it hasn't been, well, th thought through and I, I'm not sure what the ingredients are there, but I, uh, on their part. But I, I just, I find that it's usually not the best relationship.

That's it. I think that you hit it on the head.

It's not the relationship that they're looking for. It's, it's the desperate need for care and access. And while we provide that, what's driving us continuously going into the future is relationship-based care. So, you know, it, it's something for people to think about when they're, you know, thinking about, I, I will take anyone who comes in the door and then versus I do have the ability to practice autonomously and say who I can and cannot accept in the practice.

And that does not mean cherry picking, but it, it means, you know, making sure that you are sticking to your guardrails boundaries so that you can thrive as a doctor. I mean, when, when you talk about seeing 30 patients in a day and constantly working, going in earlier, what kind of care is that to you? And if there's no, you, you can't serve any of your patients.

So, although I, I do think that you can turn that on its head and get creative with the model if it's something that you wanna do. For instance, I heard a story somewhere about a young plumber and the area he was in was saturated with plumbers. And so instead of trying to compete with that, he only worked at night nights and weekends.

All the other guys worked during the day. He was only a nights and weekends plumber, and he killed it. Um, and he was happy. There was a time in my practice where I thought about doing urgent GI care because I thought, you know, trying to, trying to get this thing going and I thought there's a six, eight week wait everywhere in my area and it, there is this acute care needs, so maybe I wanna do that.

I ultimately decided not to for the reasons we're talking about, but you know, for an entrepreneurial person who likes that kind of urgent, acute stuff, I mean there's definitely, in my market there's there's room for it, for sure. And you do bring up a good point as you're mentioning that example, I think about Dr. Lisa Davidson who spoke about how when she's on vacation, there is a, uh, like an urgent care after hours concierge practice who will cover for her patients and other D p C doctors in the Denver area. So I am glad that you mentioned that, that point. It's, um, this is why I think, you know, hearing everyone's perspective is so helpful.

So I really, I, you know, I, that it's gonna probably be a challenge to someone out there who might love the acute situation care. So. Awesome. Now, in terms of the growth of your practice, even though you don't have subscriptions, your practice grew insanely well. So can you share about your growth and how did you and Lacey bring all of these people on and get them care as, you know, quote unquote beating the standard of care in your area in terms of that wait time?

I do not know how it happened. I, I'm still amazed by it, but she showed me, Lacey showed me a, a chart the other day of our growth, and it's been like this, we're like 20% quarter over quarter, and we have, we do one clinic day a week. We now need two. And my goal for my career actually, is I wanna do two clinic days and two scoping days, and then I wanna have three days at the beach.

That's my goal. And, and then I'm developing, um, well, we can talk about that later, but I'm developing this, this online course too that I can do from anywhere. But yeah, I don't know. I, I, I mean, I like to think that, I take care of mostly women. It's not, not all women, but I just naturally, I co-founded a women's center for GI Health 10, 12 years, something like that ago.

And it was really, really popular. Um, and, and that just happened naturally. 95% of my practice just naturally became women. And um, so when I started this practice, actually I started it as women's gastro and I decided to rebrand because I was having to explain all the time that yes, I do see men also.

It's just, you know, we were funny about it, you know, you've gotta wear a wig and man Monday and all that stuff. But ultimately I decided that I needed to change the name to, to communicate the model. And I also needed to not scare men off because, you know, I was trying to build a business. So we did that, but I don't know how we grew.

I, I like to think that women talk and, and they tell their girlfriends and they tell two friends and they tell, tell two friends and then, you know, here we are. I don't know. I think that getting reviews is really important. Google reviews, that seems to be really important for the algorithm and just people pay attention to those.

They truly do, they truly do consistently since probably, I don't know, maybe around month six up until now, the number one lead on my website is Google. And so it re really does make a difference. Dr. Dipti Munk was the one who told me, you know, don't take it for granted. Google really makes a difference.

And she absolutely was right. When we talk about branding, I, I am glad that you mentioned how you switched, uh, in terms of this is a business you were making your peel with gastro direct, more broad rather than, uh, only to women. So do you have any other tips for people when they're creating their business from the ground up?

They, they have no previous, you know, direct, special DEC care or direct primary care name. How would you approach branding if you could have gone back?

I think I would've approached social media earlier. I'm doing that a lot now, and I, I tried to do it myself. I took some coaching classes on it and it just was too, too stressful.

It's too much to do. So I hired, uh, a young woman who's very facile with, with all of that stuff and, and, um, I think that has helped a lot. I get, I don't know, a few new followers a week, and I think that that has the potential to explode eventually if you're offering, you know, relevant content. Well, I'll tell you things that did not work, that I tried advertising on the radio was ex incredibly expensive, and it did not help a bit.

I got one referral, I think I spent $13,000 and I got one referral.

Yeah, it's painful when that happens, but I'm glad that social media has really kicked it up a notch for you and 20% growth each quarter is flipping amazing. I will say that your social media is on point, so kudos to you and your social media person.

I mean, you know, the, you, you did one where you're talking about your course, which we will absolutely get to, but you're talking about i b s has 10 reasons, and you're like going one through two and then 10, and then it's like, you know, digestible, super informative. What are, what are the, it's engaging, educational and entertaining.

So I totally think you guys are on point when it comes to social media. So as you continue to grow your practice and as you work towards that goal of three days at the beach minimally, and then everything else comes after that, how would you know if your practice is full without subscription members?

I, I think if it gets to. Feeling the way that it did at my old practice where I don't have a handle on things and I'm not a super control freak, so that that could, you know, but when I feel like I'm losing that relationship when it feels like that, I'm probably going to hire a nurse practitioner. That's what I think I'm gonna do, because I do, I wanna build this out more.

I don't, I want it to be bigger than just me, but I don't want it to be so big that it, that people feel like a number. And I think you have to pick the right people, because I think culture in A D P C or A D S C practice is really important. You know? How many times have you heard people say that, you know, they really like the doctor, but they hate the office, you know, and they, and they don't wanna go back there.

Your office needs to be a place where they. It should be like, cheers. You remember that old show? You know, you walk in and everybody says, no, you know, it should be like that. And that is how our practice is. So you, you have to choose your people carefully. Lacey is a gem. I luck out. I actually, I got her drunk.

That's how I, she got the job. I took her to dinner and I said, we knew each other from, from my old practice. And she'd always been a superstar, super smart, great critical thinker, um, to sweetie pie. And I, I took her to dinner and I said, I'm thinking about doing this. And after her second glass of wine, she said, yes.

So, and we've been off and running, but I think that, you know, when I pick a, a nurse practitioner, it's gonna need to be the same thing. It's, it's gotta be somebody who really cares about people and cares about relationships.

Absolutely. And I love that you're thinking about future growth. Now there, I wanna ask, had you entertained the idea of hiring or bringing on another physician versus a nurse practitioner?

Uh, hall. I mean, I have a really good business consultant who that's, that was actually really important in the development of my model too, because I had no idea what I was doing. I had been racing captivity, you know, all my life. I mean, I was trained in academics and then I went straight into private practice and I never had to think about the business of things.

So actually, one of my patients has a master's in health administration, and I took care of him and his wife and their daughter, and, you know, he had become a friend. And, and I called him when this all happened and said, you know, I don't, what, what do I do? And so we have been exploring it together. So I pay him, gotta pay him a thousand dollars a month, and I have unlimited access to him.

And so I have him look over contracts and he, his contacts have been important for just figuring out the landscape and how to work within it. Um, the insurance broker thing and all of that. So, uh, I don't know how I'm gonna grow. I'm gonna ask Cam to help me figure out, and the reason that I think a nurse practitioner rather than another doctor is, um, because that seems more manageable to me.

I can look at those numbers when I know that I've got a certain demand and I know what that demand will, um, turn into financially. Then I can figure out if I can pay a nurse practitioner. And, and I also kind of feel like with a nurse practitioner, I can train them to be a mini-me. You know, I can have them shadow me around and see how I do medicine and how important a bedside manner is and how important the relationships are and mold them into the kind of person that I want taking care of my patients.

Absolutely. And we've heard so many examples of how people who are in love with the model and what the model allows us to do, those people. Really adapt well to you know, how to do the model and how to finesse the model going forward. So totally hear you on that. Now, when it comes to paying Lacey, when it comes to paying this, you know, potential future nurse practitioner, can you speak to how you opted out of insurances and how does that equal payment for yourself?

Sure. So I, I'm in a funny situation. So the whole first year of opening this practice, I have worked as a locums part-time and that, you know, was very lucrative and allowed me to build. I'll be honest, I, I take calls from my private practice phone, you know, while I'm doing locums. And that's given me the freedom to pay my nurse very well.

And I, that's really important. And I think when you're doing a small practice like this, you know, it's like making a very simple, cooking something very simple with just a few ingredients. Those few ingredients have to be really good, really quality ingredients. And so you have to pick the people around you really carefully.

And so I pay Lacey very well. I got her from a hospital system where she was making $31 an hour, and I, okay. I'd had a couple of glasses of wine too, and I said, I'll pay you 33. And that's what I pay her and she does everything and she's responsible like that, you know? So it was a good, it was a good investment.

How do you go about paying yourself, especially because you're not accepting medi like Medicare and, and other insurances. And then the other part was about like how you actively got out of insurances cuz like, that's a question that other doctors will have. Like, but you were in, you took insurance, how did you stop, how were you able to stop taking insurances?

Did you have to like, find those contracts and, and you know, discontinue them? Like how did you get out of, cuz you said you left quickly. Like how did you get out of accepting any insurance? That's a good question that I'm not sure I know the answer to. Again, I'm not the business mind here. I am still opted in with Medicare because I do logos or I have been doing logos and I had to make the decision recently whether to opt out or not.

And you know, I've got like 30 Medicare people who they call me and. They want me to take care of them and I have to tell them I can't because you have Medicare. But I kept 'em all on the list and I told them, I kept telling them, you know, I think it's gonna happen in February. I'm gonna give up locums and I'm gonna give up Medicare, and then I think it's gonna happen in April.

So my business consultant actually said, you know what? This, I'm telling you right now, you need to not listen to your big heart. And you need to listen to your brain and you should not be opting out of Medicare because that's gonna limit your ability to do locums work and to take care of yourself and your family.

So I made the hard decision to not opt out of Medicare, and what that means is that I can't see Medicare patients at all. I can't see them cuz you're not allowed to see Medicare patients if you offer a service that Medicare offers and not take their Medicare. And I don't wanna deal with Medicare. I don't wanna deal with any insurance company.

So I just, I just can't see them. And that's what I have to tell 'em. The business part of things is not that hard, actually. At least not in a day to day. And my business consultant had me go through an exercise where I listed all of the costs per patient. So like I know how much the table paper per patient costs, you know, and how much that patient's portion of the electric bill costs.

You know, because that's how I know what to bill and, and how I can be profitable. And so that morphs into, you know, how much your overhead is per month. And once you clear that reliably, you can start paying yourself. And I'm, I'm, I have hit that point now and you know, it costs so little. I think it cost me $5,000 to start my practice.

So it wasn't a big hole that I was trying to dig out of. I rent space, um, I sublet space just one day a week, going to two days. So my overhead is really low. But anyway, so yeah, you figure that out and once you start clearing that you realize, okay, now I can leave the locums world and start paying myself.

And that's just how you do it. So valuable for people to hear. And can you give them a timeline as to how many months you're in practice? Because you just said you're starting to pay yourself. So how many months are you in with that as the case? 11 months. Amazing. And I, I'm gonna guess that people who, especially other gastroenterologists who might be listening, did not guess that as the right answer.

So congratulations to you. Thank you. And you know, I will tell you, if I had known what I was doing a little bit more, like if I had listened to a podcast like this and knew, okay, I need to get this contract in place and that one, and I need to be marketing myself to insurance brokers, I, I could have made more money faster.

I just, I've been figuring this. I'm the only one of me I know, I'm the only GI doctor that I, I didn't know anybody to ask questions. And to figure it out. And I will put here, because this is very important given what you just shared and, and what you shared earlier about brokers is that, you know, especially if you are a doctor who is looking to, you know, get your specialty care bundled into healthcare plans centered around direct primary care, primary care doctors who are looking to work with employers.

I will put a shout out to the Health Rosetta Summit. The Health Rosetta Summit is going to be in Chicago, August 7th through ninth and Health Rosetta Summit is where. You will get an entire, an entire room of people who are looking to build direct primary care as a primary care model and as a business model with specialists into people's plans, small businesses, big businesses, national businesses.

So it's definitely something to check out that you, you can find that through the Health Rosetta website. I will be, I'm seeing, I will be co seeing that conference this year again. And it is a place where last year I was like, where are all the doctors? We have so many brokers who are asking where like, do you know a doctor in this area who does this?

And the answer is yes, except they don't necessarily know who the doctors are. So in terms of people who are very much. Aware of D P C as a business model, how it pairs beautifully with many, many types of businesses. That's a great place to go and to network and potentially build your services into a healthcare plan.

Now, I wanna highlight the fact that you are creating this course that I already sent an email to my patient about last night. I said, Hey, here's Dr. S Shell's website. Go and contact her. So the way that you describe your, you know, your, your perfect week, your three days at the beach, and being able to make passive income with a course, can you walk us through, you know, how that all happened and with, are you working with your business coach to develop this course as well?

No, um, this is my idea. And so the way that it came about is I do, you know, everybody's got their thing that they just really, really love and I really, really love talking about the microbiome. And I can do it for hours. And if we, you know, if we went out for, uh, dinner, we would end up talking about microbiome or another.

Bless your poor heart. I would make you listen to me. My kids just roll their eyes. Oh my God. This is your favorite word, mom. But I found that I was in clinic and I was saying kind of the same things over and over and over cuz it is foundational, you know, feeding your microbiome is foundational to not just gut health but whole body health and people don't know it.

And I feel like I need to tell them I'm serving them as their gastroenterologist best if I tell 'em at least a little something about it. So at the end of the day, I found I was exhausted. Cause I've been saying the same thing over and over and over. And sometimes people are really fascinated and they wanna hear more and they get on board and other times their eyes just glaze over, you know?

And they, they really don't wanna hear about it. And I thought, you know what? I need to, I could, and I should scale this because. I want to do, I'm saying the same thing. I wanna get all those people in the same room so I can just say it once. And then I wanna harness the power of community because I'm asking people to make big changes.

And if they can help each other and be accountable to each other and share wins and losses with each other, it's gonna make them more likely to be successful. And the third thing is, I only wanna be in a room with people who are as excited about this and, and receptive to it as I am, you know? And so that was the genesis of the online course, and it's a three month course and we cover everything, so it's right my first.

The first course that I'm offering is specifically for I B S D patients. And so these are people who are afraid of food or who have no idea what's triggering them. And I, you know, I gave that social media and I actually wrote a LinkedIn post too about how I b s is a bunch of b s because it is i b s is just telling you you have diarrhea.

Thanks a lot. Why? You know, why do you have? And we used to just shake our heads and say, ah, but we do know we, there're actually my list keeps getting longer, but there are about 10 to 12 things that cause i b s and now in my practice or in my course, I have the time to walk through that. And so anyway, in my course, it's I in the third and the first month is talking about i d s, what it is and how to check and make sure that you've had a good workup for it.

Look back through your medical records or go and ask your doctor to test you for this and let's figure out why you're having symptoms. And then the second part is teaching about the microbiome and how to build it. You know, how to kind of rewild yourself because we've all, especially with the pandemic, we've all been trying to get cleaner and avoid germs.

And that's the opposite of what we really should be doing. We should be trying to eat clean, but we should be living dirty and trying to get those organisms into our bodies so that they can do the heavy lifting of really creating health for us while we're not even not even aware of it. And then the third part is kind of putting that into action.

So how do you do that on a daily basis? And sometimes, you know, people need to be taught how to cook a little bit. They need to be encouraged to, uh, how to build more plants and fiber into their diet through things like compound foods, like granola that have extra things like chia seeds and pepitas in it that, that you don't get in a regular, regular recipe or, you know, smoothie bowls or, you know, grain salads and things like that.

So, And let me ask you here, because on your website on the, on the footer it notes that you are the Plant Fed Gut Masterclass certified. So did you have that certification before you opened your practice and has that drawn people to your practice?

I don't know if it's drawn people to my practice. I feel like if people are also aware of, of will Biz's work, then they, they're going to be looking for someone who shares the same philosophy locally.

And so that's why I put it on my website, but I. It is, uh, I, you know, one of the things about direct care is that I now have work-life balance and where before I got off work and I didn't wanna think about work. Now I do. I mean, I love medicine. That's why I got into it. So I got curious about the microbiome and, and, uh, will, B Seitz is a guy who trained at U n UNC as I did, and he wrote a book called Fiber Fueled.

And it's all about using you, using fiber to harness the power of the microbiome. And it passes the, the science test. It's not like a pop science book. It is very evidence based. And I had the, the luxury of time to take that class. And so that is something, you know, and so I just, I just followed my interests, my medical scientific interests, and I got masterclass certified, and I'm able to share that with patients.

I love it. And to me, when I saw it, it to me it highlighted that this isn't like you're just, you know, blogging about the microbiome. You're like actively doing things so that you're prepared with other information and other examples and, you know, in addition to your training as a gastroenterologist. And I love that as you develop this course and have it available that as people find you, it's another way for people to learn about you and learn about what you do and how you approach things.

And then for me, it, I could also see that making it easy for people to become your patients and talk about you. I know that that was your GI experience. Let me tell you about Dr. Schul and my GI experience because she's my doctor. So I think it, it really. It does play so well into a business plan to highlight you as, as an individual and all the things you're interested in.

And having a course I think is, is so awesome because it even goes beyond that hour visit that you have with your patients. So I think that's so cool. Yeah, and I kind of enjoy, you know, and this is part of direct care as well, I feel like I'm more, somehow, I have more permission to be myself and to bring my authentic self into my practice.

And so like on my social media, I have dogs and I have chickens in my backyard and I have a garden. And I show people that, you know, and they seem, they seem to like I do, I do try to bring more of myself so that they do know. It's just a less clinical, less sterile experience. I hope I am going for that. I want that.

And I, I find that people respond, they wanna know their doctor, they wanna know you're a person. I totally agree. And I, I love using the term, you know, the non-doctor doctor's office because when people talk about like the waiting room that's not actually used for waiting, it's for getting coffee or, you know, the waiting room is actually, you know, super luxurious.

Like it came out of, you know, some kind of H G T V episode. You know, it's not, it's not a typical, these are the chairs that you can wipe down easily with the standing wipe and not destroy them. So, love it. So when we talk about. You bringing you, you and all of your loves, uh, your academia of patient care to your practice.

Something else that I wanna highlight that is also highlighted on your website is your work with AI and gastroenterology. And so when it comes to the idea of practicing autonomously and being able to choose the tech and the tools that you have in your practice, can you share about your work with AI and how you were featured on this Samsung, Verizon collaboration?

Yeah, that was really cool. I had the opportunity to work with these really smart, um, Silicon Valley guys who were developing, uh, technology that would allow me to wear a mic. And talk to a computer that they program that they devise to teach it, to find polyps and to dictate my procedure note when I'm done.

So gastroenterologists know that whether you use probation or endos ot, there's a, a template, you know, macro and you just click through it. And so we were developing a project or, or um, a software product that would allow me to just dictate that in real time. It's pretty cool. It's pretty slick. And out of that, actually out of that project, cuz they had a monitor beside me that I was watching in addition to my monitor and it was a few milliseconds behind and I kept telling them, you have gotta speed it up.

I, you know, I can't look at two screens if they don't match. Exactly. It's way too distracting. So they developed this technology where instead of going like to some cloud in Atlanta or someplace, they just pinged right off the server in our, in our, um, endoscopy suite. And it got super fast and that has turned into the edge.

Verizon's 5G edge network, which is where the internet information is set up. Again, going to a cloud, it goes to a cell tower and back. So it's, it's being used for autonomous driving and super fast gaming and things like that. So it is pretty cool. Enjoyed that.

It, it was so incredible. And if you have not watched it, I definitely would say watch it.

There's a link to the YouTube video specifically in your blog accompanying this podcast. But you know, just the idea of. What is out there? We as direct primary care, direct specialty care doctors can really harness things quickly and we can pivot to incorporate those pieces of tech into our practices because it helps us do our job, you know, differently, better, whatever the, whatever term you wanna use.

I think about in rural America where I trained in rural Nebraska, they have a camera that is in the ER so that if something happens where they need, you know, support from a doctor who's not a family medicine physician from, you know, Lincoln or Omaha or elsewhere, that they can have a doctor, you know, visually be there.

And so I think that, especially how you were talking about in the video, if there's a tough case where you're like, I would appreciate and you know, another set of eyes to do the best work for this patient, that's a thing that's really a thing out there. So, you know, think about. What your needs are as my, my encouragement to the audience is to think about what your needs are as a doctor and is there a tech out there that allows you to do that thing that you wanna do.

So I definitely would, would encourage everyone to watch that video. It's super, super cool. So as you, you know, have shared your story and you've reflected on how you were practicing and how you're practicing now, what would you say to other gastroenterologists specifically or future gastroenterologists who are thinking about direct specialty care in the future?

Oh, it's, I wish I had done it straight outta medical school. It's so much better. I can't even tell you. I mean, quality of life, career enjoyment, gratification, I don't know. It's just that every day feels like a job well done and there are less headaches. It's all around better. You're giving better care.

Patients are happier. You're happier and you can make a living at it. You totally can. And I have to. I don't know if you will agree with this, but I tend to think that D P C docs are a little bit rebellious and there's something that just feels really good about disrupting the system and just kind of telling, you know, the insurance companies, no, I'm gonna come play that way.

I refuse. It feels really good. Amen. I mean, we're standing up like I'm totally on board with you. We're standing up for what's right. I literally told someone, people like you and I, we were not allowed to vote at one point in time and that was wrong. And so now we are. And so, you know, there's things in this world that are, you know, I think of Harry Potter and Star Wars.

Why do we, why are we so attracted to those? Because it's good against evil. And when it comes to the patient who can't get in, I mean, when you're talking eight weeks in your area, sister, it's eight months in my area. So when it comes to lack of access to care, that is completely.

Unacceptable for everyday Americans.

I mean, there's people in other countries who do care differently, but as we ha have seen, other countries are now taking the fee for service system and building it into their systems. And we are showing by the bankruptcy rates that we see due to healthcare bankruptcy, the burnout of physicians, people, you know, hating medicine and leaving.

And us as doctors losing that, that those skills, so future physicians can't train with them. There's so many downsides to insurance space medicine, and we are providing a solution. Yourself as a specialist, myself, as a primary care doctor, to give our patients the, the care that they deserve. So, amen. For being disruptors.

Um, I had to say this to, to a person that we're not disruptors violently, but we're disruptors innovatively. And so now that you have shared about your practice with other gastroenterologists and future gastroenterologists, do you have any dreams in particular about your practice or what gastroenterology looks like for you in the future?

Yeah, I do. Kind of part of my plan for world domination is I would like to own my own building and I mean that just makes good financial sense, but then have in it all the people that you know, you can refer to and who to create, um, almost like a medical mall for patients so they can just go there and get what they need.

So me cuz I started it. Primary care, obviously an ob, G Y n a psychiatrist or a psychologist and maybe a dermatologist, I don't know, or a pediatrician. It could be a pediatrician now. And I'm thinking about it, but you don't need that much space to be a D P C doc. I don't even use, I've got a thousand square feet, but we only use.

Two exam rooms and a workroom. That's the size of an exam room. That's all we need. So you need like little micro offices. That's been, that's one of the challenges when you're showing direct care practice is where to put your practice. You don't need that much. So yeah, that's one I'd like to make it easier for people coming behind me.

That is such an awesome and achievable goal. So thank you so much Dr. Schul for joining us today and being a fellow disruptor. Good luck on your and everyone's journey of world domination. Thank you.

Next week, look forward to hearing from Dr. Nitin Gupta of River Towns Pediatrics in Dobbs Ferry, New York. If you've enjoyed the podcast and you haven't yet done so, subscribe today and share the episode with a physician you may know. Who needs to hear about dpc? Leave a five star review on Apple Podcast and on Spotify now as well as it helps others to find all these DPC stories.

Lastly, be sure to follow us on social media. If you're wanting to continue learning more about dpc in the meantime, check out DPC and on next week, this is Marielle conception.

*Transcript generated by AI so please forgive errors.

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