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Episode 138: Dr. Emilie Scott and Dr. James Gaor (They/Them) of Halcyon Health DPC - Irvine, CA

Updated: Aug 21, 2023

Direct Primary Care Doctor

Dr. Emilie Scott and Dr. James Gaor of Halcyon Health DPC
Dr. Emilie Scott and Dr. James Gaor

Dr. Emilie Scott believes that the best health care comes from a meaningful partnership between her and her patients. She has found that direct primary care is a great way to facilitate this. She is originally from Orange County, Ca. She trained at the Mount Sinai Beth Israel Residency in Urban Family Medicine in New York, NY. She completed a fellowship in Integrative Medicine with Dr. Andrew Weil. She loves to teach and is an assistant professor at UCI, having won the teaching award in 2010. She enjoys spending time with her awesome husband and being a kid with her two kiddos.


Dr. James Gaor was born and raised in California, but ventured out to the East Coast to become board certified in Emergency Medicine after training at Albert Einstein College of Medicine in Bronx, NY. He is a self-described technology geek and enjoys the thrill of finding simplicity within chaos. James feels that Direct Primary Care is leading healthcare into the 21st century. In his spare time, James wishes he has more spare time, to trail run, cook and eat real food, and spend time with his wife and 2 kids.


They opened Halcyon Health in 2016.




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Transcript*


Direct Primary care is an innovative alternative path to insurance-driven healthcare. Typically, a patient pays their doctor a low monthly membership and in return builds a lasting relationship with their doctor and has their doctor available at their fingertips. Welcome to the My D P C story podcast, where each week you will hear the ever so relatable stories shared by physicians who have chosen.


To practice medicine in their individual communities through the direct primary care model. I'm your host, 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.


Hi, my name is Emily Scott and we are with Halcyon Health D P C. And to me D P C is a safe space to be a true doctor. Hi, my name is Dr. James Goor and to me Direct Primary Care is about being bold to find balance, and this is our D P C story.


Dr. Emily Scott believes that the best healthcare comes from a meaningful partnership between her and her patients. She has found that Direct Primary care is a great way to facilitate this. She's originally from Orange County, California and she trained at the Mount Sinai Beth Israel Residency in Urban Family Medicine in New York, New York.


She completed a fellowship in integrative medicine with Dr. Andrew Wheel as well. She loves to teach and is an assistant professor at uc Irvine. Having won the teaching award in 2010, she enjoys spending time with her awesome husband and being a kid with their two kiddos. Dr. James Goor was born and raised in California, but ventured out to the East coast.


To become board certified in emergency medicine. After training at Albert Einstein College of Medicine in the Bronx, New York, he is a self-described technology geek and enjoys the thrill of finding simplicity within chaos. He feels that direct primary care is leading healthcare into the 21st century.


In his spare time, which he always wishes he had more of, he likes to trail, run, cook, and eat real food, and spend time with his wife and two kiddos as well. They opened Halon Health D P C in 2016.


Welcome to the podcast, Dr. Scott and Dr. Gore. Hi. Thank you for having us. Thanks for having us. I will totally admit this. I'm totally fangirling out. These are my heroes people. These are when, when I learned about D P C back in 2019, it was Dr. Janine Roddas who opened in the same year as you guys up in Santa Cruz.


She said, oh, you're thinking of doing this with your husband. You got a contact, Emily Scott, you gotta contact James Goor. And I was like, great. I don't know how to contact them, but oh my gosh. When I saw you guys in person at hand Summit, it was just like, whoa, whoa. They're, they're right there in, in person.


And so this is such a treat to, you know, people to talk with you guys, you know, with a little bit of D P C under my belt also now, but again, to hear. Your guys' story at this time in my life where my husband is actively joining Bigtree md. So, and OLS also. I'm super excited for everyone who has not heard your story to hear it on the podcast.


So I wanna go back to how you guys both grew up in California and then ended up in New York for training. So how did that all happen? Can we, can we start by just saying when we first met you? Yes. When we first met Marielle, we were blown away. She was at the hint, uh, summit with a notebook and she had so much energy and so I, I'm also a fan girl, just Yes.


Wanted to start there and she has more energy now, so I don't know. We'll talk later about what you're drinking, but Yeah. There's a lot of energy. Yeah. So we're, we're grateful for what you've been doing for the D P C movement, so thank you.


Yes. That's awesome. So how do we get started? Yes. How did you guys get started?


Because California transplanted to New York, like Dr. Nittin Gupta was similar. Like I was transplanted to Nebraska. I couldn't, couldn't for some reason make it all the way to the East Coast. But how did you guys end up in the East Coast?


Well, that was a matter of medical school where we got in together 'cause we wanted to be in the same place 'cause we were.


Dating at the time, so, and we wanted to see something different.


Yeah. We were, we started dating in college, so we started off as friends and Yeah, both decided we wanted to go to med school together and yeah, so that was kind of where we ended up. I actually wanted to go to New York. I was, you know, I, I.


Was getting a little bored of California and got a little antsy. And so New York was one of the places where we both, um, were accepted.


That's awesome. And when you guys were practicing in New York, because very often, and this is more more so from residents that I hear this from, but people who have practiced in New York.


Again, from what I've heard is they get a lot of exposure to like full scope, practicing physicians practicing at the top of their game because there's so much need. So when you guys look at your exposure and your training in family medicine and emergency medicine, What did you aspire to do and be as a family doctor and er doctor given that you were exposed to training in New York?


Um, well, so when I trained, I was able to access an integrated medicine fellowship. I think that really helped form my sense that I wanted to, to look at the big picture. To me, integrative medicine was more of just being a really good primary care doctor, kind of learning about nutrition and, and all of these different things.


I think seeing, to your question, seeing a breadth of things in New York, I think also just exposed the healthcare system for its failings. So that was pretty powerful experience, just seeing people fall through the cracks and, uh, where we had to pick up as, as trainees and all of that. So,

yeah, I think I was a little more naive to how.


Broken the system is and was at the time. I think, you know, going back to, gosh, you know, we were, you know, this is 25 years ago thinking about, you know, where we wanted to go to medical school and, and train. I was still this, you know, old teenager, young adults, you know, wanting to do emergency medicine and it's cool, right?


Like you do all the fun things, the trauma, and you get like the wide breadth of clinical experience. You could be the cowboy. So yeah, New York was definitely amazing place to, to do that and have, you know, that, that experience of just learning all of these different skill sets and along the way, clearly as you can tell from where we are now, you know, all of the things, all of the failings of our healthcare system.


You know, they filter down to the emergency room, um, from my experience. And it impacts, yeah, the side as a whole. So it, it, it is, you know, incredibly humbling to, to have practiced there. And I'm still drawn to those, you know, those communities to serve those communities. And I think, you know, D P C specifically can address that moving forward.


I love it. I just literally came home from seeing a two month old in the office because their parent was worried about them and. Totally a reassurance visit, but it was like you didn't have to go down 30 minutes to the urgent care, wait the five hours in the urgent care, or better yet, on a Saturday, go to the er.


'cause the urgent care is not even an open option. So I love that we're all doing what we're doing. We're all part of this movement to really impact everyday Americans and not, you know, try to narrow down that the, the gaps where people would fall through healthcare in places like New York. So let me ask, how did you guys make it back to California and what were you looking for in terms of jobs in California?


Were you looking to be employed when you moved back or were you looking to be independently

practicing? So for me it's straightforward, like, you know, going to, and, you know, we could speak about this in length too. I mean, you know, our, our training traditionally is in the medical field, right? You go to college, you go to medical school, you go to residency, you get a job.


I mean, it's very linear, right? I mean, it's, if you really think about it, it's incredibly simple. The cookie crumbs are there. They're really delicious cookie crumbs 'cause mm-hmm. You know, you're gonna get paid well at the end of the, you know, end of the tunnel. So for me, you know, I, it was a simple, like, okay, I'm an ER doc, I'm gonna work for a hospital and yeah, I'm gonna do my, my my thing.


Interestingly, near the end of residency, I, I knew this, I already started feeling, okay, well this, this has a particular lifespan. Um, in terms of my career. Like, I just couldn't see myself sewing up a drunk person's lip laceration on a Friday at five in the morning forever, right? As fun as it was. So, yeah, there, there was already some like rumblings in my inner soul of like, there's.


Probably gonna be something more down the road. I didn't know what, but yeah, I mean, for me it was a very traditional look for a hospital-based ER position. Yeah.


Similarly, I, I was really, we were looking for location. Our family is in Orange County, so we moved back here to be with them, um, and have our kids and, and you know, we have primary care jobs, so we thought we could go anywhere.


So, and then it was just looking for the best fit of a job when we got here. So I ended up at academics at U C I and an F Q H C, which fit well with my desire to teach and work with the underserved. And so that's where we started. Yeah. And I actually ended up with a really now is a rare find a, a small democratic owns er group in Long Beach.


Um, which, you know, un unfortunately is they're getting bought out by private equity, but that's a whole nother conversation. But yeah, I mean all of these independent groups are, um, no longer existing. I.


It is sad and Emily, you hit it on the head. It's like we, we assumed when we graduated medical school and residency that like, we'll always be employed, we're physicians.


And unfortunately that's not the case. And you know, I don't know if medical students and residents are being told that, but I think it's very important to mention that on the podcast because there have been so many people in this, in this movement, my husband, you know, included in that the need for physician-led care is not the demand when, when people are looking for how do you see patients, right.


So when it comes to Emily, you're, you're talking about this F Q H C and also a position with U C I and being able to teach as well as work in a community that was by your family as well as in an underserved community. When you see underserved community, what was that demographic like? And James, were you seeing some a, a community that was similar?


Yeah, I mean it's, it's a federally qualified health center, so the, you know, the patients that go there are patients who cannot afford meaningful insurance, so people in need. So that was really the demographic, a pretty diverse group of people. When I got there, actually there was, seemed to be a lot of drug seeking patients, so that was quite a challenge.


And then a lot of very complex patients that, you know, communication could be a problem, people from lots of different backgrounds. So, um, it was, it was a, a wonderfully challenging job that I was not given the proper resources to pursue.


Similar with me. I mean, I was in downtown Long Beach, so I had two hospital groups, or two hospitals, same, um, group.


Yeah, downtown, long Beach, underserved, a lot of uninsured, underinsured, uh, patients there. Trauma, very inner city urban population, which I really enjoyed, was very challenging in different ways. And then another local community hospital, a little more diverse, um, working class population. So just such a great learning opportunity to just meet so many different people.

That's why I love being a physician, right? I mean, connecting with so many different people. It's been a great experience.


And when you, Emily specifically, you, you mentioned resources and you weren't able to be in a place where you had the resources that you needed to continue on there. What were some of those resources that you were probably asking for and not getting?


Yeah, even though you're asking for them, I mean, that's easy, right? I'm a fresh graduate from Family Medicine residency. I'm a, I have patients with, you know, 15 things on their problem list and 20 different medications and I have a paper chart and I have 10 minutes and I don't speak their language. And so like, I mean, you, we could go on and on about what you need and you need more time.


You need someone to help you translate. You need some, a mentor there to help you because you're a brand new grad, or you need more than enough time so you can read and learn. You know? I don't think 90 minutes per patient would've been enough time to really do an accurate job coordinating care there.


And then beyond that, it feels like the institution as a whole, the goal of it is to put space between you and your patients. So patients would call and they get a message center, and then I'd get these typed. That's changed, right? I mean, this is a while ago. Now they have an E M R, but I would get these typed papers in the morning.


Patient called, you know, this sort of like translation of what they asked for, but it was never really clear and then I never had time to call them back. And so, and then that time we had a newborn and I was pregnant and it was just awful. I. There was, it was not good. I was listening to one of my favorite podcasts, uh, 99% Invisible, and they were doing this, uh, episode on Breaking Bad News and how, uh, Dr. Bachman, who was in the same comedy group as a lot of the people in Monty Python, would had this, you know, this acronym for how to break bad news. And, and you know, they're not doctors talking on this podcast, but they were. Trying to, to describe how, you know, a doctor definitely needs the time to deliver bad news, specifically, uh, the topic of this episode.


And they were saying like the national average that they found was 21 minutes. And I was like, yeah, what study shows that? Like, 'cause that that ain't happening in primary care. And I, I mean all of those things that you say, I'm so glad you said them. 'cause it, you know, I'm sort of playing devil's advocate because all of us, like you, me and James have all been through this.


Like, what is this? Right? Like, this is not what we wrote about when we applied to medical school. This is not what we thought we would be doing in a lot of our cases. And when you talk about that, it's like, here are people who can't afford what you, like you said, you know, meaningful healthcare. But we're trying to provide that meaningful healthcare and fee for service.


And it's like, but I can't, like I really want to. Yeah. I'm trying to, and I can't do that. And when you talk about, especially like people might not know where Irvine is and you know, they might hear Orange County and think like, what the old, like, I'm so dating myself, but like Misha Barton on the OC or whatever, like, but when you guys are, you know, when you're talking about a culturally diverse population, economically, socioeconomically diverse population, it's like that is so complicated.


Like that's not, and, and that's even apart from the. 15 problems that the person might have or the 20 medications that they might be taking. It's just having the cultural competence to be like, this is totally normal for this culture. Or so not normal. Or like the fact that, you know, they're not emoting is like, not that they hate you as a doctor, but literally 'cause they don't emote as part of that family union or that culture.


And so I, I think it's so crazy how we, we just go from residency into these jobs and we're like, alright, I'm ready to start. It's like, no, this is not at all what I signed up for. And so, but it's interesting too because as you experience that, at what point did you think about like, there's gotta be a different way to do my job.


Yeah, I mean, I, I think having, I I, I have one experience that stood out in particular, I had a patient super complex and I'm running around and she's, she was having symptoms of, I don't remember the details, but she came back to me later and she's like, you know, you told me that I was withdrawing from my medication, but I was having a stroke and you missed it.


And I was just, at that moment I was like, my God, you know? This is not right. Right. The level of stress that I'm carrying with this and, uh, you know, reflecting on myself and my own health along with my sense of purpose. You know, what am I really doing here? I'm like standing into this terrible broken machine and just spitting out like not good care and what am I being trained to do as a doctor in my first job?


And that was when I was like, Nope, this is not, I, this is not gonna work. We can, I can't do this. And it, it's heartbreaking because those are the areas that need physicians with heart more than anything. And it seems that if you go in there and, and you got heart, you kind of get ripped up. You know, it's like, it's tough.


I hat off to people who stay there and work and, and they have great hearts and they do great things and they should be given, uh, just so much more to, to support them. So, absolutely. And James, as you see this transition that you mentioned in emergency care where, you know, there's, there's private physician groups that are being bought out and then, you know, there's some ERs now with no physicians which is insane.


And people don't believe me when I say that. I'm like, oh yeah, like, look at this hospital and look at that hospital. But for you, did you have similar experiences, you know, going into, as a new grad, outta residency, your first job working with physicians, you know, who are leading the group. And in that experience, did you also feel any, like, you know, I, I know you said like.


How you, you know, doing trauma according to the emergency room, not like taking them to the trauma surgery base, but like what you were doing in the ER acutely. Did you see yourself getting pressured to, you know, see more or do more or do things out of your scope or like do things under your scope because you were, you know, in the same healthcare world that Emily was in, in Irvine, in Long Beach.


It's so funny, you can make that a survey question and then you could put the last one, like all of the above. I would just circle that one. Yeah, it's pretty stunning, you know, coming from, you know, this the shelter world of residency, right? And academia, it's pretty simple. I mean, you're learning the medicine and there's, there were some logistics we had to learn in terms of, you know, a private attending and taking care of it.


But pretty much in the academic centers, you know, there were these bubbles of care, right? Where everyone was fairly taken care of. Um, outside of a few instances, you know, moving to California in a totally different HMO dominated world, it was flooring to me what I was having to do, like knowing which patient had what insurance was probably the biggest thing I had to learn and continue all the way until I left was the sticking point of.


The face sheet, the er face sheet, what insurance do they have? And not because like I would treat them differently, but like if, if they needed to be admitted or I needed a specialist, like it, it took it, it was just this convoluted system where I had to transfer them to a hospital 60 miles away and the patient had no idea.


And it's like, well that's 'cause that's your insurance. Like you can't be admitted here. It was just horrible. It was demoralizing, you know? And you know, at the end of the day, I'm the face of this care delivery, right? Like I'm the one at the bedside telling them these news. And, you know, it was just hard from a systemic perspective.


And then all of the other things, right? I mean, You know, hospital-based care, emergency medicine, it's R V U based. So clearly the more patients I saw and you know, the level of care that I documented clearly would bring my R V U up and, you know, profit sharing and all of those things. So it's all a silly game with our templates of review of systems and physical exam and none of it translates into better care for the patient at the end of the day, unfortunately.


So, coming from that experience, coming from the experience you had seen and you know, been through in New York, how did you, 'cause I actually don't know the answer to this, Emily, did you first learn about D B C or did you both learn about D P C? How did you guys find direct primary care? And then how did you choose direct primary care as your next venture into how to do medicine for our patients?


I remember the sequence of timing, so, and you could probably remember it better. So Dave Chase is definitely like probably the first, his articles in Forbes about direct primary care specifically, he wrote extensively about, it was definitely one of those first moments. And then also you were looking for a job with Crossover Health, who happened to be potentially opening something in the area at the time.


Well, so, and they coincided. I, I don't remember which speculation.


So I was at Optum. After U C I and that was interesting. They were, um, that's, it wasn't Optum at first, so it was Monarch Medical Group. It was a, um, yeah, yeah, it was, uh, it was AL one and then Local bought them, right? Yeah. Yep. And they were doing this whole RAF thing, this whole risk adjusted factor.


I don't know if you know about this. It was actually like really, I was surprised it wasn't fraud, what they were doing. Wow. And there's exposes in all the different news places about this whole practice, but they basically, Medicare pays you more if your patients are sicker, which makes sense, right? I mean, it's good intentions.


And so what they do is they set up a whole system to. Like farm the charts for codes to make your patients, you know, to, and they're not making your patients look sicker, but they are. I mean, you, you know, they're, they're trying to get different codes out to, to really beef up how much money they get. So it really was just so perverse and, and I was just like, this is, again, we're not taking care of patients and there has to be a different way.


So, and then as in the meantime, I'm buried in the clinic with 20 to 25 patients a day. So I'm like, okay, let's try group visits, you know, hand me a a pa and we're gonna work together and we're gonna be a team and, and try to do that. And that, you know, that there's no way to cut it differently when you have to see that many patients.


So it's like, there has to be a different way. And then we started reading Dave Chase and I was like, I have to work in this model where you get paid. You know, my dream was like, I'll be the doctor for this company and I'll be the doctor for all these employees and it'll be right, right? It'll be aligned because this is how it's supposed to be.


And so then I was like, that's what I want. I don't wanna do any more of these jobs that are broken. And then the company crossover was, was the first one that we found that was local. 'cause I didn't wanna start my own thing. I was terrified. And so I tried to get a job with them. They couldn't, they like, were not gonna be local.


They were like, you can move up to the Bay Area and go work at Facebook and we're not gonna move. So James is like, you know what, we're just gonna do our own thing. Let's, you can do this. Like, let's start our own business. And so that's, that's why we did it. Because I couldn't find somebody else doing it that would, I could just jump in on there wasn't like a turnkey solution.


Yeah. I mean, looking at a turnkey solution and nonexistent and, yeah. I mean, you know, we, we, and we've talked to countless people about this. I mean, at the end of the day, what's the worst that can happen, right? I mean, you know, you're not gonna end up homeless on the street 'cause you couldn't know your D P C didn't work.


Yeah. You could lose some money from, from cost of it and. You're still a physician that can be highly valued somewhere. So yeah, I feel like we're, we're scrappy in general, you know, or maybe I shouldn't say scrappy, but we're, we're survivors. Like we, there are some of us who are like, I'm gonna be done with medicine now if I don't find something else.


Like D P C and I, I mean, even with a physician degree, it's like you also realize that like, we are all, I mean, I'm not saying this to you personally, but it's like you, meaning like the, the person who I was even was thinking about like, well, maybe I should leave medicines. Like, you realize that, that you actually could be employed doing a lot of things.


Like you could be a marketing person or work at, you know, as a vice principal or work as a janitor. Like what are, there's a lot of. Being from a Filipino family, it was like doctor, teacher, lawyer. Like there actually are more jobs out there than those three. But you know, I, I feel that, you know, that mindset in it was like, yeah, like I'm not gonna do this and like, I don't care what it is, but it's not gonna be this job that I'm doing going forward.


So it's very interesting how we have similar, like, I'm done with this, this is nonsense experiences. Um, before, you know, in our cases choosing D P C, now when you guys are reading, Dave Chase's his, his work and what was it that made it like, this is, this is right, this is the model that I wanna be in. I just had this sense when I was trying, it was always about the money, right?


So it was when I was at U C I I was like, well if we can just bill every visit, 9, 9, 2 1 4 or like try to get these more complex codes in, 'cause these are really sick patients, then you guys will give us half as many patients on our schedule, right? They're like, oh no, no, no, no. Like you'll just make us more money, right?


So then it's like, okay, well no, that's not gonna work. And then we get to Optum and it's like, okay, well we're gonna make care team. And it's like, okay, well great. And now you need to find the RAF scores 'cause that's where the money's coming from. So to me, when it's reading Dave Chase, it's like, oh, the money's coming from the patient.


So like if the money's coming from the patient, uh, then that, then everything else will fall in line y. You know? Now the incentives are aligned. So that just was so obvious.


Yeah. It, it was really, it's interesting. It's not really reinventing any, I mean, it's not anything new. I mean, this is the way it was.


We just forgot. Right. So, you know, it took him to kind of bring that to light and, and bring it into the context of the modern era to describe how it could be again. And yeah, it's super simple. It's, it's incredibly different than what you traditionally see, but it's nothing new at the same time. And

as you found that crossover was not, you know, gonna be local to Irvine and you weren't gonna move to be a doctor at Facebook, how did you overcome the like, dude, I've never opened a business before.


What the heck am I gonna do? How did you get from there to welcome Toon Health?

Yeah, I mean, first I went and brought my boss lunch, which was interesting. There were lots of interesting moments there. My boss kind of, you know, patronizingly took the lunch and, and I was like, I'm gonna tell you about this great idea.


Like, you're gonna love it. We're gonna open a D P C here at Optum. Like I'll spearhead it. You just gimme the tools. I'm gonna make this awesome V P C 'cause I still didn't wanna take the risk 'cause that's who I am. And he was like, this is a terrible idea. He's like, these people go concierge and they always fail.


And it's like, no, you didn't hear anything I said, so I was completely sort of dismissed out of hand. And so then just, yeah, so it's him. So he did it. Why not?


Yeah, he, he's more a risk taker. He was like, oh yeah, we can do this.

Yeah. So, no. Yeah, I think, you know, we, you know, if you go to the nitty gritty, you wanna go to the nitty gritty, right?


I mean, you, you do your, you know, financials, your home and your personal, I should say, and figure out what you need. You know, we're in a very special, unique situation, right? We're both dual income physician families, so we could make it work. And I worked full-time in the ER for the first couple years while she ramped up her, her practice.


But yeah, and I think your question was like, in terms of being a business owner, like the steps to getting there. None of us have any training in business. Like we have no background in it whatsoever. So it really was just Googling things. And to be honest, the, the community that was out there, we spoke with, you know, new Hle, um, Rob Lamperts, Rob, I mean, you know, yeah.


We spent so much time with them and they were so gracious, just mentoring and just asking, you know, answering our questions. And really at the end of the day, It's incredibly simple, the steps to getting there, it's just, it's a different language and it's different, like stuff we, we never were trained in.


But really the steps, if you just take a little bit of time to go through it, it's, it's really not that

difficult. I think every doctor who's starting a D P C needs a James voice in their head because he has all the self-efficacy. This sense of like, oh yeah, well, it's simple. You just, you know, you just do it.


Like if he, you know, like the clean version or the explicit version, because there's two different voices that can happen anyway. There's only two. Like, who got James?


Come on. Well, there's more. That's fine.


Amazing routine of making coffee for a while where he'd like grind the beans by hand and then weigh them out and, and I'd be like, my gosh.


You'd be like, well, it's just really simple, you know? And he's right. It's like if you just take the steps, but if you, if you look at it from the outside and you watch him make a cup of coffee, you're like, that's insane. That takes up so much work. How are you doing that? And then I. But then it's done. And you think about, well, it actually was pretty simple, like, and our coffee's pretty good and I have some kick as coffee, so it's awesome.


Yeah, no, tell us about your strategy. 'cause I, I totally wanna call you out on this because I love it. I emulated it when I was getting ready to leave, um, after I'd given my, uh, my notice that I was, I was gonna quit. But what strategy did you use to. Not necessarily tell patients where you were gonna be, but how you could get them to follow you or find out more information about you by quote unquote opting in to what you had to say online.


Yeah. Yeah. So I, well, I had found many times just referring my patients to different websites for information at my old job. So then I was like, well, I'm gonna start my own blog. And in the blog I put why you should get a pap smear every three years instead of every year. And why you, you know, should put on sunscreen and here's different sunscreens.


So I would tell them to go check out my blog, and then when we switched over, we just turned the blog u r L to our company. So it just kind of like when they went to the blog, it all of a sudden was our company.


And this was a long time ago. So now there's all of these different channels now for like multimedia, right?


I mean like this for instance. So I can imagine any physician now, a young physician, I. With a voice can just be out there and, and having their voice independent technically of their employed position and being like, yeah, this is my, my personal thing. And whatever they do later, it's, you know, can be transferred.


Absolutely. And there's ways to do it. I know people are so worried with, you know, if they live in a state with non-competes that are enforceable or, you know, they, they need to practice outside of their certain radius or whatever. When you have, like, similar to what Emily did, when you have an option where the patient is the one choosing to follow you, rather than like, you giving out, this is my email address, let me sign you up to get my email later on.


I mean that you take that all away and if they're engaging with you, they could engage with the, you know, the people outside the marketplace who are like asking you to you to sign a petition. There's no. Like that's on the, the patient or the potential patient to be able to follow whoever they want to.


So, you know, I, I mention that because some people are thinking like, but how do I, how do I let my patients know? 'cause I'm not supposed to tell them. And it's like, well do something like Dr. Scott did and then look at them now and look at you and James like, you guys are super successful and we'll get to how you've grown.


But it's a great way to really, I think practicing also, like doing a blog to me is also practicing being a D P C owner because it's a way to like think about how you're going to engage with people on different levels, including how you can be their doctor when they're not necessarily in front of you face-to-face.


So I really love to get how you did the blog. Now, James, when you and Emily were, were having these discussions, you with your multiple voices and taking those next steps step by step, what was, or I guess, what were some of the first steps that you guys took or the most important steps in order to open the doors for day one?


Yeah. I think one was figuring out, I mean, we decided pretty early. I mean, we wanted a physical space. This wasn't gonna be remote or mobile necessarily, so we. We're looking for a physical space. I think that was probably the highest thing. In parallel to that, all of the things of registering, you know, your business, figuring out your business name, like going through that checklist was happening simultaneously.


But I think in terms of stress and importance, I think that was the highest stress in the beginning was deciding the physical location, how big, where we wanted it. You know, we got lucky. I think we found a place pretty quickly, but that was, I think, um, for me at least, the highest stress component was the location.


Um, yeah, I feel like a, a high stress component for a lot of people would be hiring. Like, do you know, again, this was James, right? I was like, I'm gonna be in the back of someone else's office and not hire anybody because it's, you know, I'm scared. And he was like, we're getting an office space and we're hiring somebody.


I was like, but, but, and we did, and we were so lucky to have one of the front office staff at my prior job at Optum was gonna quit. She was miserable and I knew she was great. So we snatched her up and she's still with us here now, so that could be potentially very stressful hiring somebody and. You know, we were paying her very little in the beginning, so she really made the leap, uh, you know, out of a, a just belief that we would succeed.


And then just knowing now you're responsible for somebody else's money and you haven't started yet. That, that was just a lot. Yeah. I mean, yeah, I guess you can frame it that way. Or

see, or the, or the, you know, the possibilities and just having the confidence like, hey, you know, you're gonna make this work.


Right. Mindset. I think this is an example of mindset and how, thinking of the potentials and, you know, for me, I'm always thinking like, what's, where's the exit? Like, where's the emergency exit? Right? Like, that's my emergency medicine hat on. Like, what are the bad things that can go wrong? I know where to go, but that's not what I'm thinking all the time, right?


I'm focusing on moving forward, but I'm also cognizant of like, okay, well this can happen. So I have these parachutes that we can deploy. And thinking, I mean, in that line of thought, did you prepare, like you said James, how you were working for two years straight in the er, um, so that Emily could do this, but is that how you primarily planned financially for whatever happens with the D P C?


Yeah, pretty much. I mean, yeah, we, we had, uh, we sold our condo That's true. And bought a house that cost less. That's true. Part of that, like, we moved to a different neighborhood and that money that we took from, that we put into the D P C, so that was our, like, investment money, and then I didn't have a salary, so we were living on just one salary for the, the time for like a year.


Yeah, for about a year. Yeah. And you know, for, you know, once again, this is a specific circumstance. I have the flexibility of asking for more shifts. So this was pre covid and, you know, I could work really hard if I needed to. So I felt I, there's all these levers I felt like, um, had the privilege of being able to, to, to manage financially, um, during that time.


And then going forward to Halcyon Health, d p C is opened and it's like, it's day one. Did you have patience on day one?


Yeah, we had an open house that I pushed really hard. I actually did get a list of patients and sent it out to them. And we had a good showing. And I remember one patient coming in who, who appreciated our relationship, but was, and that's why she showed up, but she was heavily skeptical.


She was like, I can't afford this. Like this is gonna be too much money. And then we told her the price. She's like, No, that's not it. And we're like, yeah, that's it. No, I'm not candid camera. I remember her saying that. I don't know if anybody knows what that show is anymore, but I remember that show and you know, we're like, no, this is real.


And so it was kind of like that experience. People were just shocked that that's it. That's all you're charging. And those pa, and she's still in our practice, right? Seven, eight years later. So we had, I think about 70 to 80 people in the first month sign up, month or two. Yeah, practice. And I remember we put up the website and I had three people sign up right away, two of which were my patients from before.


And I was like, oh my God. You know, just like so excited. And then one was this one patient and we were like, She, she made a mistake. Like she doesn't know what this is. Like, she, I was just not confident, right? Who, who's this person she doesn't know, just randomly found us and she's still in our practice like seven years later.


So I just, the, that like, just lack of thinking that you have something to offer is, was my biggest barrier. Right? It's like, You need that. Like you, you totally can offer something. So that's awesome. And I love that you said that because that voice, you know, I think we all have multiple voices in our head and when it comes to the self-doubt, it, it's a real thing.


Especially like James, how you were talking, you know, we are literally trained in this breadcrumb. You follow the next breadcrumb and then it's like, what am I actually worth? It's like you don't even think about that. 'cause you don't, that's not your right to think about that. You do what you're told, like this is the next breadcrumb that you follow is, is so ingrained in our training and just how medicine is done.


Like who's, there's a, there's a hierarchy of like, you are report to your second year, who reports to your third year, who reports to the attending, yada, yada, yada. So when you were thinking in that space, James, do you remember any conversations to counteract that when Emily was like, what? Like the, how is this even happening?


Any, any of those self doubts? Like how did you guys get through those conversations in that first year?


I mean, it was, it was pretty easy, right? I mean, it's, it's, what's nice is there's such this like, you know, simple like reward system, right? People just sign up and there's no like refuting that, right?

Like, you can have the doubt, but if they keep signing up, I mean, it's, it's just harder to doubt it once the numbers start coming up and yeah, they're, they're great patient experience and then you get to meet the patients and why, right? You learn the why they joined their practice. And then I think for her that probably, and I'll, I don't wanna speak on her behalf, but yeah, they, they appreciate what we're doing.


They get the alignment of, you know, how we're practicing and, and, and aligning with them from a, a patient perspective. And, you know, I, I don't feel like I needed to, to counteract it by, by actively doing anything outside of just like, just refocusing like, Hey, like patients are signing up. Like, it's, it's gonna be okay.


And Emily, as you, you know, built out halon, given that you had training like your integrative fellowship at, with, uh, the Andrew Wheel Institute. Did you specifically craft your clinic so that you had so many patients a day or so many, so many, so much per visit in terms of amount of time so that you could start incorporating things that you might not had the opportunity to in your previous jobs?


For sure. Yeah, absolutely. I mean, it was from the beginning, it was mood, sleep, nutrition, exercise, you know, hitting on those four points every time everybody got an hour at least. And we, we have a doctor who started with us a couple years ago who, you know, started with an hour per patient. It's like, you know what, now I need nine.


I had an hour. Not enough. I need 90 minutes. So certain patients we would give more time to, but I think, yeah, I mean that freedom is just amazing.


Yeah. I like you mentioned the breadcrumb thing and it's like, Instead of falling breadcrumbs, you get to be the baker, right? Like you're baking the bread and it's just so like, it's so gratifying.

Yeah. It's, it's nice.


I love it. Like, as you guys are talking about these, you know, even like how James, you, you're talking about how like this is not new. Like this is how medicine used to be. Like, it's like this is totally like, You know, you can, you can hear now that I am clearly the mom of like two young kids.


'cause I'm like, that's just like Ryan, the last dragon. Like the world is dead. And then it woke up when all, you know, when, when, what is the, the name of the dragon like came back to like, like I'm thinking of like random ex like weird thoughts over here. But like when you talk about that, I'm like envisioning the gingerbread man and like posing boots.


And so like, anyways, this is like not to do with D V C. It's totally to do with mom hood. So Emily, when you look back and James, when you look back on your guys' experience in this first two years, James, did you plan any specific ways to be able to transition over and Emily, did you plan in any way specifically to prepare for James to come on?


Our, our plan. So financially and, and Businesswise was a five year window. Like we, we give ourselves five years, five years for her to fill up her panel and then I will transition out and, and join the practice. I mean, we were super lucky, like a year in, you know, we're like, oh, I think, I think I'm ready now.


Like, I think, well, I was burned out and financially the growth was such in a place that, um, we could really start doing that. Me preparing clinically, you know, once again, this is a unique situation. I, I'm basically, you know, kind of in my mind an intern, right? Like, I'm asking her a lot of questions on things.


I just, it's just not part of my training. I mean, it's, it's two different, um, specialties and for me to sit like, oh, I'm just gonna do, you know, family medicine now is, um, yeah, it's, it's, that's not, that's not. Possible. So the one thing I can do, the one thing I love to do was like, you know, the patient p right.


Sitting down with a patient and, and interacting with patients. And that's regardless of the specialty. Yet, at the end of the day, that's the heart of a, a primary care relationship is just being able to listen and, and engage with people. You know, emergency medicine is different. I had 10 seconds to gain somebody's trust.


Right. So now I have a little bit longer, maybe 12 seconds, but you know, I, I, it's, it's the, the medicine part was, is, is still, you know, I'm still learning every day. Like, I don't know what's that rash can and, and so I'll pull it into rash. He's, he's reading so much, he's coming up to me and telling me how to manage things a lot of up to date.


So for me, a lot of UpToDate as well as, as her, you know, basically mentoring me in terms of the clinical care.


Um, yeah. I'm gonna put a shout out there. If you're a D P C Alliance member, definitely like check out that UpToDate discount. 'cause that's what my husband and I are using. Since we don't have access to it, they're here shaking their heads.


It's like, yes, there is a discount d c. So Emily, how about you in terms of preparing? 'cause like I asked this, especially again, going back to the, my husband and I are in this. Place where he's coming and joining on and I'm like, okay, I gotta get this ready now so that he can come on successfully. Like, given your experience being a D P C doctor exclusively, did you prepare the clinic in any particular way or would you advise to other people, you know, this is what I would do, or like, these are the things that don't really matter to be able to, to bring on James?


Yeah, I mean we, um, honestly bringing on James wasn't it, it's more like bringing out James from our financial, our home finances really. I mean, that's truly what we're preparing for. 'cause bringing James into the business is like, he's helping mail, so there's nothing to prepare for. He's, I took the mail just coming in to help.


So no, it not just getting your finances in line, like how, what, how expensive is your house? Did you buy a new car? Do you would like, Do you wanna go, like, do fancy things? So if so, and you gotta just make sure you can afford to be off that income. We, you know, as I got busier, I think more in the early years it was prepping when do we hire our, our next medical assistant.


So we hired a second medical assistant, uh, two years in. Uh, one year later. A year later. Okay. Yeah, a year later. So, and she was, 'cause I was doing all the blood draws and the shots, you know, I'm like googling like, what's an Im shot, you know? So cute. Like, how do I angle the needle? I mean, we don't learn this stuff.


So spinning the blood, right. Pipetting it. So all that stuff had, we needed to hand that off so I could work on growing my panel even more. But yeah, I mean, bringing James on was not. I don't know. He was just there. Yeah. I love it. That's, that's so like a spouse thing to say. Like, he's, he's just there. I love it.


I like, I, I will shamelessly say that, you know, when I was starting out, I was like, like I'd given injections before, like, you know, subq, but like, you know, I, that the, the inner voice in me that was like, oh my god, but you gotta make sure you review it, blah, blah, blah. It's like, I remember I bookmarked the like how to give a Prolia shot, like right on my Yes.


And I was like, right, I'm gonna watch it. I'm gonna watch it again and again. Again. Uh, what's another one? Shingrix. That's another one where I was like, okay, you take vial one and you take vial two. And I'm like, okay. Yeah. So I totally can relate. Oh my God. So, When you guys are talking about adding an ma, how did you, like what was happening at at Halon where you're like, now is the time that we need to start adding somebody on?


It was pretty quick. 'cause like she was saying, I mean she's did all the blood draws, all the clinical stuff, right? And I think you were just really busy. I think that must, it's so funny how, I don't remember. I feel like that must've been it. I must've been so busy and we could afford it. You know, we could afford to pay someone.


It was without, it was still not about me getting a salary, but we could afford to pay another

ma. And that's just in the background, seeing your growth curve, right? Like you're just seeing that just patients are, are continuing to sign up and, and you know, seeing that it was just made sense to invest.


We, we wanted her to start a certain time and she didn't come till like two months later and we were kind of losing our minds like we were busy.


Yeah, yeah. Yeah. That's awesome. That's, you know, it's busy is a good thing when, when it comes to D P C, especially when you can still practice the way you want to. Let me ask you there, because. As people have, have come on to the practice, especially in this early period, the first two years, what was your biggest way of marketing?


And if it was word of mouth, at what point did you feel like, whoa, okay, this was the magic number for us, and then going from there, did it explode? I asked that because in Irvine, given that you guys are in OC and there's, you know, U C I and all the, the major hospitals with the billboards and. I don't know if they had Super Bowl ads too.


But versus Halcyon Health, how did people find you and then what's been your biggest, uh, way that people have, have joined your, have learned about the practice?


I think it's word of mouth, honestly. And we did like some webinars, but primarily for mostly our patients. I joined the, um, you know, chamber of Commerce and kind of did my networking thing there.


Got some patients through their, you know, reflecting back on it. I think, and we've, I'm sure you've talked about it and people are talking, you know, there's these influencers, right? There's these inval, evangelic, you know, evangelists, not evangelicals and evangelists. Very different things, very different who happen to be real estate people who happen to know so many people.


And you know, we, we have those people in our practice that have just helped exponentially spread that by word of mouth and then along the way, so bus, some small businesses, like part of it is just luck. Like people just knocked on our door and said, Hey, we looked up D P C and you're one of the few in the area.


And yeah, it, it's been that. And then at a certain point, like, and I don't, I can't give you a number, but you know, after a couple hundred, it's this self-sustaining, you know, word of mouth after a, um, a particular point. And as people were joining, did you have a practice that was just, you know, like self-selecting to be a, a full scope family practice?


Or did you see more of a certain demographic, like older, younger pediatrics? How was your practice as you grew initially? Yeah.


I mean the, uh, I would say the, the real base demographic are people between 30 and 50 with kids.


Yeah, that's a big chunk of it. You know, it's interesting, it's people really investing in their health, if you think about it.


And that's how we, we frame it to our, our patients as well when we review their medical history. But, you know, people who are really, you know, that are people who are just traumatized right, by the, the system for various reasons. And so they're just looking for an alternative. I mean, those are the two kind of segments that we see.


But it's definitely the young families, the professionals, and you know, the convenience factor. So yeah. And then we have, yeah, and then they bring, it's interesting, you know, they bring their family members along the ride, right? So it's an interesting middle ground. You have these, you know, 30 to 50. You know, couples and they bring their kids and then they have their, their co work colleagues they spread to, and then they bring their parents and then their parents' friends.

And that's how that, that that kind of grows, uh, from that perspective that we've seen.


Awesome. And as you guys were doing this, you know, growing the practice, James coming onto the practice, and you had, you know, like you said, Emily, you had already a newborn and you were pregnant before you started D P C in the first few years of the practice, how old were the kids and how did you guys manage as a family to be doing family, you know, as husband and wife, as mom and dad, as well as doctor and doctor?


So they were, let's see, so they were seven and five when we opened our practice. So, and we were working on, you know, kind of the transition for about a year before then, you know, doing research maybe a little, yeah, more than that. So, um, yeah, from the ages of like, you know, three and five, the five to seven, we were starting to, to get this warmed up and, and ready to go.


You know, I, I, I said, you know, earlier about balance, right? I mean, part of this is, has been about finding this balance in our household, and that's really been important to us. It's actually been the focus of, you know, we have one practice and it's, it's an incredibly robust practice and we've chosen not to take in the, the time, personal time to make this 10 sites, right.


I mean, that's just a decision we've made. I'm incredibly happy to, yeah, just have a lot of time with our kids and, and with each other, and it's been been really amazing. I don't know if you talked to, you know, like some of your, I. Co-residents or you know, even people in medical school about like what, what their lives are and how they're spending or not spending time with their kids.


But it's, it's crazy how like, you know, you started with the kids being three and five and in that age group, and then now you know, they're almost teenagers or one is a teenager and it's like, what could life have been like had you not been able to. To do what you guys did, right? Like that's, I'm so, it is just so awesome and it makes me all emotional, right?


Just the last person I recorded with is Dr. Mina Jula Polli. And she was like making me all emotional too. But I just think that what a gift that you guys have for yourselves and what a gift you have for your entire family, especially your kids, that you're able to, to look back and say like, yeah, I was able to do these things with you.


So when you talk about James, going back to how, like the, one of the biggest decisions in the beginning was space. You guys have transitioned to a new space and the, the website's been flu up. It's, it's good. Was gorgeous then, but it's gorgeous now. How did you guys decide, you, you, Emily, you mentioned staffing, but like how did you guys decide.


We're not gonna do 10 practices, but we are gonna go into a new space.


Yeah. We were, I mean, I was literally running down the hall in our building asking the, like, sleep center next door if I could use their room. So it was time, like we were operating out of one room and it was not gonna work. So yeah. So we needed more space and we initially were just gonna blow a hole in the wall of the building where we were, and then we got a better offer for a much bigger place, more space than we needed.


And the price was really good. So here we are. And it was so worth it. I, I think that's one thing. It's like if you already have momentum, like, you know, channel your inner James making ground coffee and be like, well, you know, this seems like pretty simple, right? Like, things are moving forward, they're gonna keep moving forward.


So get a little bit more space if you can. Yeah, we, it, it felt like that pretty fast right? Early on. So we signed a three year lease in the first place. Um, we're currently in year three of the five year lease now. Um, but yeah, after year one we're like, oh, we need, you know, we're gonna need more space.


Really soon. So luckily it was a three year lease and yeah.


At this place. And can you describe your space for those people who haven't seen pictures on your website compared to your, like the one room situation, I guess doesn't really need comparing two, but how does your space look like now? And now you have Dr. Seymour and Dr. Suskin. So how does everybody work? Is everybody in the building at the same time or do you guys, uh, stagger? Yeah, there's one day a week where everybody's here and we, I we, I have a chiropractor friend who we met initially and then she subleased with me in our first space, which was a great idea too, to bring more traffic to your office.


And she is hugely supportive and so we would refer each other patients, so that, that was great. And so she's still subleasing from us here. So we, we have four rooms and five, five rooms. And a separate lab for Nancy, whereas before we had one room, so, and Nancy's the clinical ma, so she has our space where she can draw blood and, and all of that.


Before she was doing it in the waiting room. And so people would pass out and then they'd be laying on the floor in the waiting room and we'd just put like a screen in front of them and you'd just see their feet.


It was really just really like IKEA screen and it was like, it was great. Yeah, nothing to see here.

Don't worry about it. Welcome to Halcyon Health. If you need something, target can send that, deliver it to your door in about two hours. So you're good. Oh my God, that is, oh my, I have no words for words for that. I, I would not wanna be the patient being like watching the screen, being the patient. Oh my gosh.


Oh my. So let me ask you this, because as you have grown specifically, you have two MDs who have joined your practice. And so, whereas, you know, there's other clinics out there, there's other D P C clinics, excuse me, who are specifically looking for physicians to join, and it's quite difficult to find physicians.


How did Dr. Suskin and Dr. Seymour find you guys and decide, like, this is amazing. Like, I wanna work here.


How did that work? So it's, you know, the universe is funny. It's just, you know, it's such a small world and you know, there's this one person who contact me cold email just like, Hey, I'd love to meet you.


I'm heard about D P C. Great. My name's Jess. Yeah, my name's Jess. She's a physician. Yeah, pediatrician now in public health and super gong. She reminds me of you actually. Right. And she's just gong, oh, I just wanna learn about this. Like, what are you guys doing? I'd love to do this in pediatrics and serve like, you know, county population.


So we had, you know, she's amazing. Gone along well and she's like, you know, one of my best friends. She'd be perfect here. So we emailed her and she said, thanks, but no thanks. You know, I, this sounds nice, but not interested at the time, and I'll take it to you because I think, yeah, yeah. Then I was like, I wanna marry this girl.


So I kept emailing her. I think I emailed her two more times and, and I just, like, I, I was like, I'm just gonna email her again. And I was like, I just, every time I think about hiring someone, I just keep coming back to you. And she was like, okay, yes, yes. I'm gonna come over and talk to you guys now. So then she came like on her birthday and spent the day and just looked at our practice and then she was like, you know what, I'm gonna do this.


So that was, that was that. And then our, and then Dr. Seymour is super interesting. One of Shay's, Dr. Kin's patients said, you know, there's this doctor at U C I who I really love, who would be such a great fit, and Shay told me that. And I'm like, I'm calling right now. I. So I called over while she was in the middle of clinic and I was like, Hey, you know, I'm calling to recruit you.


Like, do you want a job? And she was like, what? And I guess she had been looking, actually, she looked at a couple of different practices. She was trying to figure out where to go because she didn't wanna do the grind anymore. And so I called it the right time. And she's a perfect fit for the culture of our practice.


And yeah. Yeah, I think, you know, the lesson that to me that, I guess just hearing this, you know, it's a mix of luck, right? Like just having, you know, people in your life that come into your life and these relationships and connections that you maintain and the work, right? Like, I mean, she, she hustled. She's just like, I'm gonna call, I don't know who this person is, but she sounds amazing, and her video's amazing.


Like, let's call her. And so instead of this passive like, you know, putting out like job opening, come find me. Like I, you know, that can work. I'm not saying that won't work, but I think there's just something more, especially when I. For us, the culture is the number one thing in our practice. It's, it's people and relationships.


So you know when, when that's the most important thing. You really have to rely on your network of people and to seek out those relationships. And we did put out ads and we did interview. Oh, we

did like a bunch of people. It was not good. Yeah, it's challenging. It's like Mary Poppins, man, this is crazy.


Yeah. Yes. That's a good one. Your mommy references. Yeah.


Also a Julie Andrews fan. But I just love that though. And you know, I think that the more and more people hear your story, people hear all the stories on the podcast, the more and more we talk to people about how like, wait a minute, you are telling me I can do that.


I could do exactly what I signed up to do when I became a doctor and like just dedicated my life to take care of other people. Like that's incredible. And I'm not having to do it for only people who have seven figure salaries. Like, that's incredible. So I think that the more and more this happens, the more and more we, we get the word out.


It's like I. Every time somebody hears about it. I mean like even just within your practice, like somebody had a friend who decided to be, you know, that this is, you know, a perfect fit and then they, their patient knew a person. You know, it's like, that's awesome. And so I think this is where the fact that you focus on relationships.


It's interesting. Dr. Shannon Schul, when I was talking to her, she's a gastroenterologist who was previously on the podcast in Raleigh. She said, live time, like, I didn't think about it. This is like relationship-based medicine. And it's like, yes. Like absolutely, because I've found that at Bigtree md two that like the patients who've joined, they will tell the people who, you know, value healthcare in the same way.


And so they are the people who then join after them. So I definitely would say, you know, also something that I love is that like you went from this place, Emily, of like. Oh my gosh. Like I don't, I don't necessarily have the best confidence in like, I'm gonna call my next work wife. Like, this is awesome.


Like, I love Exactly. Yeah. That's incredible. Now, how is it structured at Halcyon in terms of when you bring a physician on, are they a 10 99? Do they own part of the practice? How does

it work? No, it's a 10 and it's simple, straightforward. Yeah. And really, uh, you know, The arrangement is, you know, there isn't a set number of patients technically like they have to see.


Um, you asked earlier in terms of the logistics of the workflow, you know, there's no nine to five, like you have to be here nine to five kind of thing. It's, you know, it's the expectation, like you have to take care of your patients, right? If you're at home, if there's nobody on your schedule, like that's great, like, check your messages and take care of your patients.


So yeah, it's a straight 10 99. There's a, a percentage split in terms of they collect on the membership fees. The practice collects the rest for overhead. And yeah, that's it. Um, they're independent rock contractors, so technically they can work where, wherever else they want. And it gives them flexibility as well.


When we, um, hired Dr. Seymour, she was, I was trying to tell her, take one new patient a day, and she was like, well, I can do five. I mean, she's very experienced. I can do five. I, you know, I think I'll be okay with doing, you know, a bunch. And, and like, you know, and now three months later she's like, my gosh, you know, I, I thought an hour was gonna be so much time and now I'm just like, I don't understand, or, you know, it's just a very different lens on things.


So I think helping mentor people, even very experienced physicians who know medicine really well, to kind of understand, to take it slow. And I think I really like the idea of hiring people and not. Holding their feet to the flames. Like you have to take, you know, 600 patients. You know, I think it's really nice for them to be able to feel it out and see how they wanna balance it and what it feels like to them.


'cause they don't know. And I don't wanna hire someone who then becomes miserable and quits.

Definitely not, you know, especially if you go through all of that work mentally. Also preparing for like, we're gonna have another doctor join the practice. And then it's like it falls through that. It can definitely be, you know, one, one more thing that you don't necessarily need to have on your plate or think about if you prepare for it differently.


And that said, when you guys were talking with Dr. Siskin and Dr. Seymour to join, did you have any discussions because of 10 90 nines about like, you know, this is what we have on the waiting list in terms of people as you onboard them, or how did you, you know, have any financial discussions with them?


Because they're also going from, even though one of them was like about was looking for something else, like they're going from a fee for service model. To a different type of model where we work for our patients.


I mean, financially there's, there's risk involved, right? And so, you know, one of the things we value is just transparency.


So, you know, here's our wait list of patients, right? And here's when we first started collecting it up till now, here's how many, you know, I don't know how many are gonna follow through and actually sign up after we open up the panel. We're all hoping, I mean, the one thing that's reassuring is we're both aligned on this, right?


I mean, we both want you, the new physician to, to fill up. 'cause it benefits everybody. And so part of the discussion too is like, hey, you know, if, if it starts slowing down, you know, clearly we can rethink our marketing besides word of mouth. Like, are there things we need to do? But yeah, I mean it's, it's very transparent in terms of laying out, here's, here's what we have to potentially offer.


Here's clearly what potentially you can make if. You know, the tr here's the trajectory. So it's pretty clear the potential. I mean, they, they have to be, uh, comfortable with the risk that like, hey, maybe it slows down, maybe it might not pan out the way we're describing, it's not guaranteed. And you know, it's diversified and there's this whole nother discussion, right.


Employers and how does that play into account? I mean, that, that could be an opportunity to fill up somebody's panel momentarily and hopefully that would sustain itself as well. But Yeah.

Um, that's helpful. When we, when we hired Shay, we had a big employer contract that we had no idea what was coming, but they basically were like, oh, sorry, our thing dissolved and we're not our whatever benefits thing.


So we lost like, I don't know, 200 mm-hmm. Patients that we were gonna give to her. And luckily Shea is, you know, she wasn't angry and she grew really fast too. But you know, this was actually Covid. She started in Covid. She started in Covid. Yeah. So that was a good lesson learned though. I mean, you really, when you are bringing someone on that language of like, okay, well here's what we think is going to happen, and we're not making you any promises, right?

Like, you're still gonna have to hustle. Right?


And the way we structured it there, we have like a base, like, you know, um, it's, everybody's structured differently, but we have a base monthly compensation and then a certain amount after you reach that level. But once again, every D P C can structure it differently.


And James, how about this, when you came onto the practice, because I'm assuming you guys are an SS corp, just like Bigtree MD is. How did you join? Like did you guys split ownership of the business or are you a 10 99 as well?


Well, part like, we're split ownership from the beginning. From the beginning.


Gotcha. Okay. And did that have any, like, did that throw any complications with regards to your contracts? Because like for example, my favorite, my favorite, favorite portion about fee for service contracts that I don't see even and they don't hear from and in your guys' contracts is like exclusivity. And like you can only work for us and if you work anywhere else, we own your money.


Like that's one of my favorites. I have more. So for me it was an issue. I was a 10 99 so I had my own SS corp as an an ER doc in California. And then my, my insurance contracts through that group didn't resolve after I, or renew after I left. So it was pretty, it was pretty clean.


Love it. And how about you guys are actively, and you know, I cheated a little bit 'cause you told me this when we prepped for the call, but you guys are actively looking for a new physician, so.

How has hiring been? Like how has this process now changed now that you're on your third physician to be hired at the practice and what are you doing or how are you looking for that person, given how the, the last two physicians joined by this word of mouth, I. We're, you know, I'm anticipating it's likely gonna be the same once again, we just, I can't say enough, you know, the, the cultural fit is, it's gotta be dialed in, right?


I mean, and, and so we're not, we're actively looking in the sense that we understand it's gonna take time. Right? Like, if, if it happens tomorrow, we, we actually don't have a position today No. To, to offer, because Dr. Seymour still needs to fill up first, and we're seeing that she's probably gonna fill in 12 months, hopefully.


And so the whole process of meeting somebody or, or once again, developing relationships with multiple people to find that next fit is gonna take some time. So that's why we're openly putting it out there, that, yeah, we expect to, to hire another physician in the near term. And

what about residents? If people were like, in two years, I'm gonna be graduated from my residency program, and I would love to work at like your D P C or another D P C, what are your views on having someone coming out of residency to join at Halon?


I think like what we always say, if it's a good cultural fit, like if their values align with ours, like, I don't care about experience or, you know, I mean, none of like, none of that. I mean, of course, like hr, like age and gender and like all those things don't matter. What matters is, and it's, it's really true.


It's like, do they fit to the culture of our practice?


So yeah. And just taking care of patients you like, you're, yeah, I mean you're, you're good at building relationships and, and cultivating relationships and Yeah. The medicine is, you know, that, that's the base too. But at the end of the day, it's really gotta be, um, able to connect with people and, um, yeah, I, residents.


Great. That'd be awesome.


How do you guys go about, Like you said you interviewed multiple people. Like how do you guys go about your interview process in terms of like, the favorite questions that you like to answer or like you like to ask or the, you know, the, the theme of questions that you guys have to try to figure out like, oh my God, you're my next work wife.


Yeah. I think, you know, hearing a physician talk about how they want to take care of their patients. I, it's, you know, there are maybe some buzzwords that I hear, like with Dr. Seymour, for example. She had this video of her talking about what she was doing at U C I and it was like, yes, that, right? So I gotta figure out how to put into words what that is.


But the, it's really about what is your juju around the patients like, Who are you with? Your patients? Yeah. And, and does that make sense? Yeah. Yeah. And I, I think part of it is, it's kind of, gosh, it's hard to, to verbalize and there's a way to do it, but it is like when you meet somebody, right? There's, there's a chemistry, there's a body language, there's a, a sense of of purpose that's communicated to somebody.


And it's, it's really, it's, it's, it's not tangible. It's, you know, you can read the buzzwords and you mentioned the word buzzwords, like we can say the buzzwords and somebody could say those buzzwords to us, and it's like, I don't know, like, you know, you just feel it when, when you can see it in their eyes when they talk about certain patients or their experience or what they're looking for.

That's something that just pops out to us. I think that that's really valuable.


Yeah. I love that. Someone said to me the other day, they were like, oh yes, that's right. You, you speak in hugs. And I was like, yes, this is true. Like I do, I do like a hug. Oh my gosh. Now tell me about, we, we talked about the plans to, you know, potentially sign, resign the lease, or move into a new space.


If you were to go down the road of a a new space, would you guys ever consider having Halcyon health like, you know, in two locations? I know James, you said you didn't envision 10 locations, but like if it were harder to find a bigger space, would you ever envision going to two different spaces? Why or why not?


The short answer is yes, then, then it's just the financials after that. Right? It's just rejecting like growth. And then clearly at that point we probably have to take on capital with a, a loan and, and build that out. But yeah, I mean, you know, going back to how we started, we bootstrapped this. So this is, you know, at the end of the day, we own this and there's, you know, we don't own anything to anybody, which has been really nice.


But at some point, if we do wanna grow, that would be the next step. And that's something we're actively thinking about. Like, you know, the five year, the tenure, like what do we want as our kids grow, right? I talked about this balance and this balance is always recalibrating itself. So five years from now, our kids are, you know, they're gonna be going off to college, right?


So it's, it's kind of like a no, that can't be right. Or, or not, maybe they're just gonna travel the globe with a backpack. So either of the two. I'm very bearish on college, and that's a whole nother discussion. Yeah. I think, you know, whatever they choose to do, they're gonna be very different people than they are now, and their needs are different.


And so how do we see ourselves in that light professionally? And yeah, it's really fun, exciting questions that we haven't answered yet. I think we're more open now to growing faster than we have been in the past, just because we have this security of, of what we built here. And just that confidence. Like, I'm no longer like, terrified.


I mean, I'm still terrified, but, you know, it's different.


And one of the things, it's different. We haven't talked about this, you know, when the, the, the retail versus employer kind of group, we're incredibly diversified, right? We've built this practice, right, and we have employers and some employees, but, you know, it's just, it does feel very stable.


This stable core, just diversified patients and like, they're not all just gonna leave. So it, it's a, it's a nice place to be.


I think that's, Strategically a very smart way to approach your, your practice because I think it's, well, there's another doctor I'm hoping to get him on the podcast to share his story as well, but I believe he had 300 people in his employer group, and then the employer, you know, took all of those agreements away and then there were, you know, 300 to zero in, in one day.


And so, you know, people like. Uh, Dr. Ken Richter are working with other DPCs to, you know, have an employer send their employees to different DPCs, so that, that give and take is not so great. And I know we're recording this before and it'll air after, but like, I'm very excited and fortunate that I get to see you guys at the, uh, Rosetta Fest in Chicago because that is, you know, a a, a whole place of people who are, you know, they're associated with employers.


Their employers are having, you know, all of these employees looking for good healthcare. And there's not necessarily the knowledge of like, who's the D P C doctor who could take care of, you know, these, these patients. And so I'm glad that we're, you know, the three of us at least are, are joining the other doctors who are gonna be there to discuss like, oh, you're looking for that type of healthcare?


Like, that's the type of healthcare that we do. You know, and it's like, You know, there's ways to grow with employers that, you know, some people might be like, oh, I will never work with employers. 'cause that's how I was back in 2019. Like, I will never work with employers. 'cause what happens if, you know, 200 leave?


And it's like, and Dr. Scott is still alive today. Like, it's okay. You know? So, and Dr. Siskin is still at your practice and full, I mean, like on your website it says close to new patients. Yeah. So it's, it's like, it'll be Okay. So going forward, in terms of, you, you, you talked a little bit about your five 10 year plan for those doctors who are.


Thinking about D P C, whether they be in medical school or residency, or already attending physicians, what is, do you have any last words or advice for those people who are thinking about D P C or figuring out who would be a good practice to join? I have, I, I

just had a phone call a few days ago from this medical student who's like a dynamo.


Her name's Siri in case anybody wants to hire her in a few years. I might get to her first, but she is doing her family medicine residency in Utah and she worked with me here at, from U C I and she is gung-ho d p c. And she was called me and said, you know, oh my gosh, she just finished her intern year.


This is like, she's like, this is awful. She's like, you know, I can do it. I can do the 12 patients in a half day, um, and I'll finish my notes and I'll check all the boxes and I can play the game. She's like, but I don't like this. And, and she started asking me questions, which was so interesting about like, well, shouldn't I just take a job?


Like I can't just go straight out and do D P C. Like, I probably need to take a job because I need to like, make money before I can do my D P C and shouldn't I be like, you know, doing that first and what should I be doing? And, and I was, you know, I, I felt like. Oh my gosh. Like she's already getting, getting sort of like losing her confidence or getting, I don't know if brainwashed is the right word, but she's just not, she's losing her confidence that she could do this because she's so in the system.


So just that reminder to those people that you know, there. You can do this. People do this all the time when they come out of residency. And, and you can, you just have to have your James voice of like, you know, it's really just like you grind the beans, you put the, you know, you do the steps even though it's like, gotta weigh the beans, gotta weigh the beans first, okay.


See so much harder than just going to Starbucks. But like, you just take the steps and then you're gonna have a much better life. You know, things are gonna be so much better. And so, okay, so you give up, you know, $200,000 one year. So in a salary when you could be building this thing, that's gonna come back to you in spades.


If you own your own practice. And then if you have a D P C that's local to you and you really don't wanna be a business owner, then, then, oh my gosh, find that D P C and go talk to them and go see if it your cultural fit, because they really are different. Different DPCs feel different. And so what is the theme?


Like what's the flavor of that D P C, and is that what you want? And if it's not, then go start your own. Don't, don't be afraid. Don't let the system make you feel like you're not powerful.

Love it. And James, how about you? I use my water boy voice. You can do it.


Oh no. I feel like there might be something wrong there now.


Really? Like 2023 is waterproof.


No, you can do it. Um, no, I feel like there's things there that, that may not be okay. That movie's probably really bad, but that, that, that quote was, is not, no, I don't think that's offensive that you can do it. But, you know, in all honesty, I think the same as Emily. I think there's, there's a place for you, right?


I think wherever, whoever you are looking for something, whether you're a future business owner, whether you want to partner with a D P C. There are similar minded people who, um, yeah. Have created these spaces for both, you know, physicians and their patients where it's just, you know, this, you know, harmonious place where you can practice medicine and feel like a normal human being that's helping them, right?


And it's, it's a wonderful place to be and you can find it. I think, uh, one thing to also just highlight, you know, as simple as these things are, it also isn't necessarily easy, right? Mm-hmm. So I think, you know, Emily worked her butt off like in the very beginning, as you have, as every other D P C has. And I think, you know, to practice good medicine, it's not about it.


Being easy by any means just is rewarding, right? You put in the work and you just feel so rewarded for it. So, um, yeah, find a place where you feel like you're gonna put in a lot of work and feel great about it. Is, is all I have to say. Well thank you Dr. Scott and Dr. Gore as we have shared, you know, references to Candid Camera and the water voy, like now those people are like, what?


I gotta Google that movie. I've never heard of it. Camera. We will enjoy our eighties experiences and until Chicago. Thank you guys so much for joining us today. Thank you.


Thanks Maria. Appreciate it.


Next week, look forward to hearing from Dr. Michael Lovelace of Derby City D P C in Louisville, Kentucky. If you've enjoyed the podcast and you haven't yet done so, subscribe today and share the episode with a physician you may know who needs to hear about D P C. Leave a five star review on Apple Podcasts and on Spotify now as well as it helps others to find all these D P C stories.


Lastly, be sure to follow us on social media if you're wanting to continue learning more about D P C in the meantime. Time. Check out DPC news.com. Until next week, this is Marielle conception.




*Transcript generated by AI so please forgive errors.