Direct Specialty Care Doctor
Dr. Kapoor proudly founded Brooklyn Dermatology with a vision and a mission: to be the new standard of dermatology.
Dr. Kapoor has a loyal following of patients because of her approachable style of dermatology. She provides first-class care, practicing evidence-based medicine with integrity, and taking the time to explain conditions and treatment options thoroughly to her patients. She has an honest and straightforward approach to aesthetics - natural results that leave you looking like yourself but rested and refreshed. Dr. Kapoor is dedicated to her professional growth and engages in constant continuing medical education.
Dr. Kapoor is an accomplished and highly trained board-certified dermatologist. She completed her undergraduate studies at Northwestern University and enrolled in the inaugural class of Northwell School of Medicine. She graduated medical school at the top of her class as President of the Alpha Omega Alpha Honor Society with an additional Distinction in Research. During medical school, she spent a dedicated year at NYU studying dermoscopy of pigmented lesions. She completed her intern year and dermatology residency at the prestigious world-renowned Memorial Sloan Kettering Cancer Center and New York Presbyterian-Weill Cornell Hospital. After residency, Dr. Kapoor worked at one of the nation’s largest health systems, Northwell Health, practicing dermatology in an academic setting and actively teaching the next generation of dermatologists. She is sought after for her expertise in acne, melasma, hair loss, and ethnic skin and her cosmetic skills.
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Address: 61 Greenpoint Avenue Suite 219A, Brooklyn, NY 11222
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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 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.
Direct specialty care is the way medicine should be. I'm Dr. Remi Kapor of Brooklyn Dermatology in Greenpoint, Brooklyn, and this is my D P C story.
Dr. Remi Kaur proudly founded Brooklyn Dermatology with a vision and a mission to be the new standard of dermatology. Dr. Kaur has a loyal following of patients because of her approachable style to dermatology. She provides first class care p. Evidence-based medicine with integrity and taking the time to explain conditions and treatment options thoroughly to her patients.
She has an honest and straightforward approach to aesthetics, natural results that leave you looking like yourself, but rested and refreshed. Dr. Kapo is dedicated to her professional growth and engages in constant continuing medical education. Dr. Capor is an accomplished and highly trained board certified dermatologist.
She completed her undergraduate studies at Northwestern University and matriculated into the inaugural class of Northwell School of Medicine. She graduated medical school at the top of her class as president of the Alpha Omega Alpha Honor Society. With an additional distinction in research during medical school, she spent a dedicated year at N Y U studying oscopy of pigmented lesions.
She completed her intern year in dermatology residency at the prestigious world renowned of Memorial Sloan Kettering Cancer Center and New York Presbyterian Wheel, Cornell Hospital. After residency, Dr. Kaur worked at one of the nation's largest health systems. Northwell Health, practicing dermatology in an academic setting, and actively teaching the next generation of dermatologists she's sought after for her expertise in acne, melasma, hair loss, and ethnic skin, and her cosmetic skills.
Welcome to the podcast, Dr. Kapoor.
Thank you for having me. So this is on the heels of Dr. Amina Jula Polli, who is another dermatologist. She's a pediatric dermatologist. But I love that, you know, even just looking at your guys' websites, totally different. You guys are totally two different physicians and you shine by doing the things that you do for your patients in totally two next to the woods.
But I love that people can take a listen to your episode to Dr. Jula Poll's episode and see like, Whoa. Like they are totally independent, different dermatologists doing their thing. So let's start by Greenpoint in Brooklyn. We've heard people on the podcast, Dr. Dr. John and Ariba talking about Broadway, Dr. Nitin Gupta, talking about Rivertown. Tell us about Greenpoint. Tell us about Brooklyn, where you're at. What is the community like?
Oh my gosh. I love Greenpoint so much and it's actually moving to Greenpoint and of my love for the neighborhood in part inspired me to open a practice here because I saw a need.
It's such a, even though it's New York City, it's such a small community. There's a lot of local businesses and strong local business support. There's a lot of local moms in the neighborhood that own businesses. The themselves. So it felt like a very supportive community. Uh, there's like, we call ourselves green pointers and a lot of people live here for years, raise their families here.
It's a very insular neighborhood. It's beautiful, great restaurants, um, but not a lot of physicians. So I definitely saw a need to open a practice here. But I love working in the neighborhood that I live in. I love kind of meeting patients that are people that I run into on the street. It's very, feels like.
I think direct care is sort of like medicine in the old days, how we were told about medicine in the old days. So opening a practice in my neighborhood and having the community, I have kind of feels like that too. Sort of like the local, um, neighborhood dermatologist is what I aim to be and it's part of, um, my marketing as well to my community.
And it's boom right there in your mission. So that's awesome. That's amazing that in New York, when we think of New York, we think of clearly New York, New York, but I love that you have this local feeling in your community. I, I went to a k through eight school in the middle of Sacramento, but I only knew like 66 kids in their parents.
So I love that. I, I, I can relate to that and I think that, you know, when people think about that, you can have a small community within a larger community. That really, you know, makes the personability that we have of D P C as a business model, it clearly breaks down barriers as to understanding how so many people all over the country can love the model that we are working under.
So with that, I wanna go to now after residency you were working at Northwell Health. Mm-hmm. And you were quite involved with even teaching future dermatologists. The residents who are dermatology, who are in dermatology training. When you were there, I wanna ask first, what was your life like as a practicing doctor in such a big academic center?
Yeah, so I'm a little torn about this one because I did love working in academics, interacting with residents. Um, the camaraderie of working with colleagues and teaching are all passions of mine. And then, um, I saw a lot of complex patients. So with the high volume of patients we were seeing, um, there's a lot of complexity and delayed diagnosis, so I love that aspect of it, but, On a day-to-day basis, I felt something was missing.
I felt like I couldn't spend my time doing what I loved most, which was actually face-to-face time with patients. Because at the end of the day, like a lot of healthcare, and especially in dermatology, the priority is volume and number of patients, and that's not what I wanted to prioritize. So I was seeing maybe 30 to 35 patients a day, 10 minute visits, and often I think what frustrated me the most is that.
I had like a three month wait for patients to come in to see me, and then they'd come in for, uh, a skin cancer screening, let's say. But then they also wanted to talk about acne or hair loss, which is a whole visit in and of itself, but impossible to do within 10 minutes. But then if I said, you know, we have to reschedule, then they, it'd be another three months to.
Reschedule with me. So that's kind of when it hit for me that this just wasn't a sustainable model for me to practice in. I really enjoy educating patients and, uh, for example, if I'm seeing something as common as melasma, I like to spend my time to really go through the whole game plan for our treatment and talk about adjunct therapies, and I just wasn't able to do that.
So I was starting to feel frustrated on a day-to-day basis, even before I knew. The direct care model existed, and given that you were in a place where you were teaching future dermatologists, I wanna ask there, how did you interact with them so that you could help them understand like dermatology and you being a dermatologist, of which there are not a lot of, like you have to be, you know, going to medical school that weeds out a lot of people and then you have to apply for residency.
That weeds out a lot of people and then you have to be an actual board certified dermatologist that weeds out people. How did you talk with them and what were they saying when it came to like, Satisfaction with their careers, satisfaction with the way that health was done at
Northwell? Yeah, that's such a good question.
So I, it makes me think of when I was a resident, it's sort of, it's what I saw. So I saw dermatologists practicing that same model. I had exposure to private practice, dermatologists in the traditional model. And it came up even before I knew, I personally knew about the direct care model. We would talk about how it made no sense that insurance companies dictate the care that we give In dermatology, there's a lot of like, uh, medications that have, that we have trouble accessing because of insurance barriers or prior authorizations.
And obviously seeing patients for 10 minutes, it's sort of like, Everyone accepted it because that's what we know, but we question why is this the way that it is? Why does insurance dictate the care that we provide? So like it definitely came up as an existential question and an abstract question with my residents.
And I think once I decided to go. Then started exploring this model. Uh, but before I decided to open a practice, I educated the residents on this, the existence of like a separate model that I was learning about myself. Um, and then I think when I decided to open my own practice specifically with the direct care model, now they know that there is like the opportunity for that.
And I definitely think we're on the heels of a huge movement in dermatology where we're gonna see more direct care practices open. And it was definitely a little. I mean, some people have paved the way, and those were people I spoke to before opening, but I am feeling like that we're about to see a huge movement and a lot of practices transition to this.
I totally agree. And even just within this season, like we've had a pediatric dermatologist and now you're coming onto the podcast. Incredible. So when it comes to you learning about direct primary care as a business model, As you were realizing, like, this is so frustrating, I can't even do my job the way I want to do it.
How did you come to learn about D P C as a business model?
So I, there was a resident from the same program that I went to, um, Dr. Rachel Day, who opened one skin dermatology in Pennsylvania and I spoke to her. I, I forget exactly how I came across the model. Period. But once I read about it, I was like, whoa, this makes so much sense.
Let me just get so much more information on this. Um, I found your podcast, which was so helpful, and then I, there's some Facebook groups for both Direct Primary Care and also Direct Dermatology Care. So those were invaluable resources. I spoke to some physicians themselves who had opened derm practices, which there were only a handful of, but they were so helpful and so kind.
So once I started, Learning about the model, it was kind of like, there's no other way for me, like, I have to do this. And then the clock started ticking. I felt an urgency to open because it just made sense. I, I, I didn't understand why all of medicine wasn't this way.
I love it and. Again, like preaching to the choir and the audience I'm sure is just like, yeah, yeah.
Especially if they're already open. So let me ask you there, when you started talking to people like Dr. Day and you were like, okay, I'm coming from never having, you know, an M B A under my belt or opening a clinic by myself. What were the questions that you found most helpful to talk about when you were talking with Dr. Day and other people, and even just looking on the, the, the social media out there or whatever, what was most helpful to you that you would encourage other people to think about asking themselves when they're thinking about doing a direct care practice?
Definitely. So I think for me personally, just being the personality that I am, I had so many logistical questions and I would say that you will figure those out, but I kind of bombarded people with like a lot of logistical questions like, what do I need to do, do from like a legal standpoint, I, how do I set up, uh, supplies, et cetera.
All of that is. Figureoutable. I think one of the biggest questions is like, where should I open? So when I opened in Greenpoint, although I lived here, I have no patient base here because my practices were in different neighborhoods. But what drew me to the neighborhood was really the strong local community and the need.
So I definitely think just thinking about. I think direct care can sort of, uh, succeed in any market. I mean, New York City is an oversaturated market for dermatologists. There's lots of options, but I think definitely just thinking about where am I opening and kind of what is the audience I'm speaking to?
So like, what patient do I want to bring in? Um, I have a friend, she's a massage therapist by training and she has a very successful. Business model with like numerous locations in the city. And one of, uh, the pieces of advice she gives is like, who's your red carpet patient? Who's the patient? You want to come through your doors and sort of speak to that patient.
So I definitely think thinking about things from that at like the end game, like where do you want, what do you want your patient panel to look like is a good place to start. And then that'll help you decide location. 'cause that's gonna be one of the first things you decide on. And everything else will follow.
I love that. And it, it really like, you know, it takes some of those barriers in terms of what creates fear into going direct. It takes some of those and just knocks 'em outta the ballpark. 'cause it's like, remember you went to medical school, that's not an easy thing. Like you can figure out like, How do I order a lab?
So we'll get to more details of your practice 'cause I wanna hear how you're doing it. But when you talk about this acuity, when you're like, I need to open yesterday, I need to do this right away. What were some of the immediate changes that you made when you were like, I am on this path of, I needed to open yesterday?
I'm doing it. This is the next step I'm gonna take. So I opened, kind of, I signed my lease when I was still employed, and then I, um, gave my notice, uh, once that we were building out. So basically when I decided, I think I decided, I. I started researching this model maybe like June or July of 2021, and then it was all abstract in my head and I decided Greenpoint was my neighborhood.
I started looking for a lease, I think May, 2022, signed for July, 2022. Gave my notice July 22. So everything happened like kind of right after each other in a couple of months. So I think as soon as I decided and I found a place, I just hit the ground running with. I need to build a clinic. I have like an Excel sheet of all of the things that I needed to do.
So I sort of broke it down into like clinic, logistics, legal infrastructure, then marketing. And I like, I think marketing is sort of like the fun part, like deciding how to like expand my, my base. So I think it just became kind of like, it, it kind of felt like very urgent once I decided and signed a lease.
So, um, I sort of just took the leap. Love it. And when we talk leases, when you were, you know, First finding out which location in New York you wanted to practice in. Do you have any recollections that you'd like to share or advice for others who are looking for places, especially in, you know, a metropolitan area versus a suburban or rural area?
Yeah, so I mean, New York City's kinda a tough market because as I mentioned, it's very, um, oversaturated from the dermatology perspective and that's, It's true of my neighborhood ish as well, because patients can easily commute into the city. Um, however, what I noticed was that there was no independent dermatology practice in my neighborhood or the surrounding neighborhoods.
There's a lot of private equity groups, so I think kind of being strategic from that. Standpoint is important. So if a patient wants to see an MD dermatologist in my neighborhood, I'm sort of the only option. The other practices are staffed by mid-levels and they don't offer kind of like the advantages of direct care.
So that was kind of my selling point and uh, I think it's. Important to be strategic from that standpoint. And also think about like what other neighborhoods can come to you. Commercial real estate I think is a little tricky. In New York, I was lucky to be paired with a real estate broker that a friend of mine who's a dentist had used.
So he actually, I signed the first place he found me 'cause it just fit kind of my criteria, which was low overhead and a place that could be a medical office. So I think definitely reach out to colleagues and peers who are. More willing to help than not and kind of heed their advice and, um, be intentional about the neighborhood that you pick.
And, and although Greenpoint is amazing and I love it, I think one barrier I have is because there's not that many physicians, I don't have as much of a physician referral network, so I rely on other kind of strategies, which I can get into. But I think just having some kind of strategy with the place that you're picking is important.
And I love that you have the subway in your favor. So it's like that, you know, people, people can get to you when they, you know, they've decided they wanna see Dr. Kapur. Yes. So let me ask you there, when it came to planning, 'cause you mentioned a build out, you mentioned, you know, signing this lease right away while you were still employed, did you prepare financially to open or had you been, you know, thinking about it for long enough that you were like, I'm gonna do some extra shifts or whatever and put this squirrel, this money away in.
The preparation for opening my own clinic? That's a great question, and that's something that I had asked others as well. I had basically saved the income I made for my few years of employment post-residency, uh, for a potential like down payment for a home, but ended up investing it into the practice. So even though it wasn't necessarily intentional, For my practice, I was able to kind of divert it to this and my practice is really small, it's like 800 square feet.
So my buildout, my landlord was very helpful with my build out. So it was, it happens to be financially reasonable with what I had saved, but had I decided on a different place or a different clinic set up, I did look into, uh, small business loans from banks and there's lot there. It seems like there are good options for physicians.
So that was a route I explored, but ended up. Being within my budget to build out my small clinic with, um, what I had saved up.
Awesome. And 800 square feet, you know, compared to the, the one, the single bedrooms that people are opening with, or even, you know, telemedicine, no rooms whatsoever. 800 is a lot. So, you know, think about that.
Yeah. If you, if you really look out like. How much space does a couch take or whatever, you know, it's, it's definitely for the listeners. Think about you. You don't necessarily have to have, you know, like the multi-room clinic. So when you talk about the landlord helping you, how did your landlord help you specifically?
And like on your website, you can see shots of like your beautiful coffee table and like the, the. Totally branded, you know, colors and whatnot. Your beautiful lamp over the, the chair there where you're sitting. But walk us through the clinic. What does the patient experience when they walk into your clinic?
Sure. So, um, my, to answer your first question, my landlord helped because, um, I funded the build out, but he actually was basically the general contractor. So he's very particular about his building and who works in his building. And it's a conversation we had before I signed the lease. And basically I planned everything out and I Funded it, but he was the one directing like the electrician or the contractor, et cetera, for the build out. And we had a clause in my lease that my. I basically don't pay rent until it's built out, so I protected myself that way. And then he also had an urgency to build out my clinic so that I could become a rent payer.
He was helpful because had I had to manage all of that while being employed, it would've been very difficult. So that was really helpful for me. In terms of the clinic layout. So a patient basically walks in, they see my reception desk, and it's usually me checking them in. Um, I have a small waiting room, which honestly no one even waits in because I, there's no waiting time because it's such a, a low volume.
But it's there if I have a meeting or whatnot. And then I have two, um, exam rooms that look pretty similar to each other. And I do have occasions where I have a patient that's numbing for like a cosmetic procedure while I'm seeing a medical patient. So, For, I thought about how many rooms do I need. And actually to go back to your previous question, I did explore the option of, um, renting a room from an established medical CL clinic.
So I looked at renting a room for five days a week, but it ended up being financially the same price as paying rent for the place I ended up finding. Um, so I chose the latter. And I, I guess it was the cost of the build out that they had factored into their rent, but it made more sense, uh, amortized over like the 10 year lease that I signed to it, the way that I ended up doing it.
But when a patient walks through my clinic, they basically see my reception desk, which is usually me standing there to check them in. And then I have a small waiting room, which no one really even waits in 'cause we have minimal wait times. But I do use that for meetings with, you know, companies or reps.
And then I have two identical exam rooms that, uh, is like where I do all, all of my visits. And, um, I needed two because I often like am numbing a patient for a cosmetic procedure or while I'm seeing another one for a medical visit. So it made sense for me to have two, but if I had to work with one, I probably could have made that work.
And then I have a little nook, which is where I'm sitting, where I just like to sit by the window and, uh, write my notes. So, and then I have a little lab area where my autoclave is and where all my supplies are. So 800 square feet actually ended up being a ample room to run a full a practice. So, um, you don't need, I think living in New York City, you realize you don't need a lot of space period to do things, so ended up being perfect.
I love that. I, I just think back to, I think it was an Ellen episode where she was interviewing someone with like, I think the contest was like the smallest department in New York or something, and the PA person like stretched their arms out and they were touching the walls. So it's like that versus Dr. Kapoor's face. Like you, you got it going on. Love that. So when you talk about that, you designed the build out, and you talked about just now, like how you were gonna to use the space if you were, you know, growing so crazily that like you were to bring on a second physician. Have you thought about that in terms of your build out?
To be honest, I. So my lease is, uh, five plus five years. So I have, I am committed to five years and I can sign on for an additional five years. And based on everyone I spoke to, they estimated that it would take about two to three to potentially even five years in the saturated market to get, um, super busy.
So I sort of, Assumed that I wouldn't bring on another physician for the beginning. I think if I ended up doing it, it would be in a very flexible arrangement where maybe they worked somewhere else and worked at my practice one or two days a week on a day, on days that I didn't work. So I did think about it, but I don't know that I planned.
To expand in that way, but I could if I wanted to. I love that. And you know, just like River Town's peds, you know, they have River, river Town's, peds of Dobbs Ferry of Staten Island, I think. And now when it came to branding, I know that, you know, I, I mentioned a little bit about, you know, what potential patients see on your webpage, but tell us about the journey to brand your clinic, because you have awesome colors, super relaxing, super on point when it comes to.
Patients like, I'd be like, well, and not I, I'd be like, I was when I was looking at your website, like I'd love to go to Brooklyn Dermatology. So tell me about how you got to branding as to where it is
today. Thank you so much. I really appreciate that because I think I just had a lot of fun with it. I think.
I would've loved to be an interior designer of some sort different life. So, um, that was a really fun part for me. I, how I wish my home looked but doesn't because I have a three-year-old, so I sort of manifested that in my clinic and I love neutrals in general. And then it kind of also, You know, skin tones and dermatology.
I sort of had that in the back of my head when I was choosing colors for my website. So to be like very inclusive and to kind of fit with the fact that I'm a dermatology clinic as well. But yeah, I think I just love interior design, so I just use it as an opportunity to play with it. And I was very like frivolous with my build out.
So a lot of the things were bought like from Wayfair or Amazon or, um, I was really cost conscious. When it comes to branding, I wanna ask this 'cause it's super important. When you mentioned earlier how you know when patients are looking for physician dermatologist versus what else is out there in the neighborhood on your website, one of the biggest things that I love is you're representing your personal brand as well.
When you said 100% of your care is personally provided by our board certified dermatologist who graduated medical school and completed a dermatology residency. Don't settle for less. So when it comes to patients understanding that, I've posted about how like there's the large corporations who have the money and they, they say things like, Happy Doctor's Day.
Whether your doctor be a provider or a non-physician provider, like a nurse practitioner, pa, or another clinician, happy Doctor's Day, there's a lot of watering of the, an attempt to water, like what does it mean to be a physician. So when it comes to your care, And when patients are approaching you for, you know, learning more about your services, wanting to become a patient, interested in becoming a patient, how do you describe the care that you give as a physician versus what's out there in your neighborhood, especially.
I mean, fortunately a lot of patients have found me because they already saw a non-physician and didn't get the care that they were, uh, hoping to receive. So they were intentional about picking my practice because they knew that it would be an M D U or d o physician seeing them. And I've gotten that feedback a lot from patients that a lot of my patients are insured, but choose to pay out of pocket because they'll know they'll.
They know they'll see a physician that day and it's the same physician each time. So there's continuity of care. But I think, um, once they experience the care, they also sort of, uh, we, we, I, most of my patients have a conversation about the practice model because during my initial visits, I ask how they found me, and we kind of get to talking about the practice model.
So I have loved the feedback that I've gotten. Like a lot of my patients are educated who they're seeing because they've unfortunately had. Not so great experiences prior to seeing me. Um, so the feedback I'm getting is things like, this model makes sense. If it means I'm gonna see a physician or you know, I'm going to look at who I'm seeing in the future.
And I think the issue is that a lot of these groups intentionally, like you touched on, don't have transparency about who's seeing the patient, um, which is unfair to patients who are, you know, waiting weeks potentially to get a diagnosis. Then I'm often seeing. Unfortunately misdiagnoses are inadequate treatment.
So I am getting a lot of that feedback like, oh, I wish I'd known about this sooner or, or, I'm gonna, moving forward, I'm gonna see who's seeing me at whatever clinic I'm going to. So I'm definitely getting like direct feedback about that in particular.
I love it. And now they have somewhere to go to find a doctor who is a dermatologist born, certified.
All of the things that come with being a physician. So let me ask you there now, because again, you and I don't have MBAs, we don't have it degrees, but when it comes to branding, your website is also super on point. You have, I mean, even at the bottom, your accessibility policies, privacy, hipaa, privacy terms and conditions, all these things.
Did you design your own website? And if so, how did you do it? Oh, I did, um, Squarespace, which actually made it. Uh, definitely pretty straightforward. I watched a lot of YouTube videos on how to like do all of these, like other things, so I. Kind of learn how to code from YouTube, but Squarespace makes it pretty straightforward.
And then you can definitely learn how to add elements. I thought about like hiring a website designer. Definitely I got the feedback that it would just be easier to do it that way, but I'm just very, I was very specific about what I wanted. I didn't know how to kind of articulate it to someone else. And then I also wanted control of my website, like if I wanted to change.
One thing, and now I actually wanna start a blog. So I didn't wanna hire someone to do every step of the way or change minor things. I wanted control to do that myself. So Squarespace really made it pretty simple.
Love it. And how about SS e o when it comes to ss e o in your neighborhood? Because you talk about saturation of private dermatology, not necessarily direct dermatologists, but how did you optimize your SS e O?
So I'm still working on that. I definitely think asking for reviews has helped and then that's why I'm starting a blog to help with ss e o as well on my website. And then, um, I did some, you know, the tricks that, uh, Squarespace mentions, like putting ALT tags into your images so that you are categorized.
You know, by Google, because I kind of opened my practice after I finished my employee job. I noticed that it took a couple of months for Google to kind of recognize my site and for me to show up. But now that that's happened, I am more regularly showing up for all the search terms that I look for. But, um, I'm definitely still a work in progress, but I, there's a lot of resources online to help with things, and there are companies too, but again, I'd rather do it myself.
Awesome. And when it comes to, as you talked about, like you were. With Elise while you were still employed. You know, like you can be doing stuff like website design, creating a blog even, even if nobody knows the address, like you can still do that while you're, you're doing your thing, so, yeah. Yeah. I think there's more lead time than all of this can be done before, you know, and we can hit the ground running, but I kind of had to work with the timeline I had.
You've done awesome. So don't, don't, don't ever forget that. For sure. Now, when it comes to marketing, you talked about how, you know, there's lots of, there's lots of options out there. How did your patients come to find you specifically, and how has that changed since you've opened? I. Absolutely. So in the beginning I think it was just Google and a lot of my patients do come in from Google and reading reviews.
I have now have more word of mouth patients, and that's my, you know, end goal that most of my patients are probably hopefully going to be from word of mouth, um, which is the best SS e o, right? And then other things I've done is definitely local community things. So there, for example, I gave a hair loss talk to.
A, it's basically like a WeWork for hairstylists. So I gave a lecture on, uh, hair loss to a group of hairstylists and, um, they've actually referred me a good number of patients, so I plan to do more kinda on the ground, things like that. In Greenpoint, I mentioned it's like a very insular community.
There's Like an open airfare that happens on the waterfront every weekend. So I did a booth to promote like skin cancer awareness and sun protection, and I partnered with L'Oreal and we provided, um, sunscreen samples. So I think we like met like hundreds of people that day. So definitely very like community level things.
This week I'm going to, oh, the WeWork in Williamsburg and I am gonna have a little like meet and greet. Of your local neighborhood dermatologist. So I think just kind of meeting people and say, I did this at like my building too. So I'm just trying to find, you know, innovative ways to kind of. Let patients know that I'm here and I think that works best in the community that I'm in.
So I think definitely like honing your strategy to your community is also important.
I love it. Now when it comes to pricing, you have a pricing tab on your website and people can learn directly, you know from there. The transparency is, is obvious when it comes to pricing. How did you develop your pricing structure?
I definitely leaned heavily on existing DER director and practices, and especially ones in more urban areas with a similar like cost of doing business. So I modeled it based on that and I, there's a website that I'm blanking on now, but there's a website where you can actually look at. The price that each level visit reimburses out of network in your zip code.
So all my prices were actually set below that. So it kind of shows the advantage of not going through kinda insurance, insurance mediated pricing. So, but I would say my biggest resource was a fellow dermatologist and what their pricing model was to get a sense of what works. Love
it. And when it comes to the specific way you've separated your pricing, like you have medical and you have cosmetic options, um, that people can learn about, you also have descriptions.
Like for me, when people call the acute line, it's like if you need stitches, I had one person who needed stitches and didn't call the acute line. I was like, It, it says right there, like you, if you have stitches needs, if you have stitch needs, like that would be a great time to dial the acute one. But for you, has your messaging changed on the website?
Because you run your own website and you can change the copy whenever, based on patients coming in and understanding or not understanding what it means to have, you know, a, a follow-up visit, an initial visit, et cetera.
So, uh, I have had to change the wording a bit on my, uh, E M R scheduling because, uh, I mean, it's a little confusing for someone to go to my website and not, I, I guess like if you imagined it could be confusing.
So, um, but I do get some clarification calls so I have the opportunity. So a lot of patients will call and be like, I'm not sure what timing visit I should book. Um, so I definitely like, Changed my wording. So for example, my 30 minute visit used to say any chronic skin condition, and I used to list out examples, but I found that people weren't getting to that part.
So now I just have it delineated as like 30 minute visit, total skin cancer screening. Acme visit, melasma visit. So it's more clear cut. So I've had to, I've definitely had to rework some of the wording as I got feedback.
I love it because I also have that desire to like log into my Wix count and then be able to change it automatically.
Like I don't, you know, I don't like, I have to wait until somebody can get back to me about blah, blah blah. So, love it. Now, when it comes to medical services, uh, specifically you talk about, you know, actinic keratosis or eczema melasma issues that are, like you say, are chronic or ongoing. Had you thought about membership for those particular services versus one-off payments?
Yeah, I, I thought about it, but I think for most diagnoses, even if it's chronic or ongoing, I, I felt like the initial consultation is sort of the meat and potatoes of our visit, and then it's often check-ins, maybe like two or twice a year, and then once a year. So I, I don't think it made sense for the conditions that I anticipated seeing.
So as a specialist, I kind of, Felt like our visits are more annual sometimes, like for skin cancer screenings, it would just be one annual visit. So it didn't make sense for what I anticipated seeing, but I definitely see the value for primary care. Um, it just didn't make sense for what I anticipated
I love this question, especially for specialist to answer it because you know, Dr. Andy Burkowski, he's, he's doing sleep medicine and restless leg syndrome. It's like, He's telemedicine, so the way that people are pricing their things, I love that. You know, you had some models to go off of in terms of what people were asking, but also, you know, you referred to that website that you mentioned earlier, but does membership work for Direct Primary care as a business model plus specialty care?
Right. So I think that that's so important for people to hear and to think about as they're going into their own, into opening their own clinics. Now, when it comes to the cancellation policy, this is another thing that for somebody who's, you know, investing the time to. Do all the backend work for the patient, but also get them in, like you said, like you're the end all and be all like you are the person welcoming.
Welcoming them at the reception desk and bringing them back if there is a cancellation. What is your cancellation policy and how did you come to that cancellation policy? Again, I looked at a lot of kind of other established practices. So my cancellation policy is 48 hours, and then my E M R when they book an appointment requires credit card on file.
My, in the beginning had some patients call who didn't wanna give credit card on file, so I changed my wording. It was like, in order to book an appointment, we require credit card on file, and I looked at the policies of other services around town. So for example, nail salons and hair salons also require credit card on file.
So, Similar to hotels, restaurants, uh, every service industry essentially requires credit card and file. Like it should be no different. So, uh, it's just become a kind of blanket policy. We require credit card and file. So my policy is they reschedule or cancel within the 48 hour period. It's not the full cost of the visit, but it's like a charge, whether it's a hundred or $200.
And definitely for patients that don't contact me or just don't show up, and oftentimes I'm going in to see that particular patient. I stand by the policy. If it's a patient of mine that's established and they call the day before, so they still give me notice, I'll make an exception, like a one-time exception.
But overall, I pretty much stick to my cancellation policy because our time is valuable and they're aware of it, and there's. A policy doesn't mean anything if it's not enforced, in my opinion. So I have it for that reason. I love it. And it's being respectful of to yourself for, like you said, your time, but also you are running a business and if there's another person who can take that slot that is
Income is part of your business. And so it's definitely, you know, that's one way to think about it. And also, you know, when people are like, oh, I'll just book this appointment and don't put anything down. It's like there's no skin in the game. And so I think that that's also very important from the patient's perspective to say like, I'm sold.
I mean, you even have the, the, the button. This is book now. But like for those people who are like, I need to see Dr. Kapur here, it is like, I am invested and here is my, you know, investment so that I can see her that says a lot to like, oh, this person has sought me out in particular, and is investing, you know, if again, not everybody has.
Their EMRs and clinics set up like that. However, for you, I think it's great that you are sharing your experience so that other people can think about like, would that model work for me in my locale, in my specialty, whatever. Now, when it comes to tools, you mentioned how you have like your space, what the autoclave and whatnot.
How did you determine what tools to open with and have you added tools? Over
time. That's a great question. I, so there's a great resource on Facebook of dermatologists have open practices. So someone had made their start, OSHA had shared their startup list. So I sort of thought about what did I see the most or what do I see the most and what tools did I actually use the most?
And I made sort of the most. Bare bones list of tools to order, and I haven't had to order anything extra. And I ordered supplies and kind of tried to keep it as minimal as possible. And I would say my first order of supplies lasted me the first six months of my practice opening. So I definitely leaned on help for that.
Or had I not had that resource, I would've just thought about what does my day entail? Like I do punch biopsies, I do shave biopsies, I'm cleaning lesions. I. Do this and that. The Audi leave was new for me to figure out. 'cause typically, like, you know, we had a medical assistant help us with that. So, um, I just thought about my day and kind of wrote down everything that I would, all I needed.
I love it. And definitely if you're getting started and there is a list out there, also look for the details as to like, Which particular derm blade to use versus if you get the generic one and you're like, oh my gosh, I'm with a patient that this doesn't and this doesn't cut anything. Like, I've totally had that issue with punch biopsies off brands as well as derm blades.
And so, sorry. I was gonna say, if you were, if you're in residency or if you're working somewhere, I like started taking pictures of like, you know, the drawers and how they were laid out. Even the room layouts. 'cause it's not things that you consciously think of until you're planning like. Where is the sink in relation to like the sharps disposal?
And then I even took photos of like the storage room just so I could see how it was organized. And um, definitely brands is helpful. Like if it's not something that you're using on a daily basis, like what sutures do we wait, what sutures am I using on a daily basis? So things that are so second nature that you actually did start thinking about.
So I took a lot of photos and I started noticing things when I decided. Love it. And when it comes to things like pathology, how did you find a pathology service that would service your clinic? And how does it work? Do you take the sample into them? Do you FedEx it, uh, courier? How does it work so that you can use services like pathology?
I. Sure. So that, that's very important for my clinic. 'cause I, I do a lot of biopsies. So I use one pathology service called BridgePath and they, they have a courier come pick up specimens and then it's great because I have access to the Dermato pathologist. So if I have a question about a biopsy results where I wanna review something, they're very communicative.
So that was important to me. They do participate with a lot of insurances, so if the patient is insured, I, um, send them the insurance information and then they have a very, Reasonable cash pay rate for the uninsured patients or for patients who are not on their list of participating insurances. That was kind of my criteria for picking a pathology service.
Awesome. And Rishi, when it comes to other services, like if you were to need a surgeon and you needed a referral to that specific surgeon, or if you needed labs for, you know, a medical diagnosis that you were working up, how else have you built out your network in addition to pathology?
Yes. So I send labs to one lab provider in the neighborhood.
I will say it's more cumbersome than when I worked at a academic center where if I sent a lab, I got the results to my inbox. So I have to check a portal or I have to have the labs faxed to me, and then I enter them into the E M R. It works because I don't have to order labs that frequently, but I will say that part is a little bit more cumbersome.
And then similarly, I mean, I don't have the luxury of having like a. You know, a whole department dedicated to referrals and helping patients with appointments. But because my volume is lower, I can be more actively involved in that. So I have like a network of two or three surgeons that are either people that I trained with in residency or worked with prior that I'm able to communicate with directly.
So if I'm sending a patient to them, I give them a heads up and then they send me their notes. Oh back. Once they see the patients that I have, like they, we close the loop. So it's a little bit more work to establish that. And it's not as automatic as it is when you're working at like an academic center, but I mean, it's not a reason to not do direct care.
Of course. Um, and I think patients are actually really grateful that every time I refer to a surgeon, for example, that I'm reaching out to the surgeon and kind of telling them why, giving them a heads up and they see it as like, wow, I've never had a doctor do this for me before. So there's a lot of intentional.
Care, and I'm able to do it because my volume is lower that I can kind of take on that added work. But I've basically created my own network that I refer to. Love it. And in terms of advice for others who are building out their networks, do you have any advice as to like, you know, how to reach out to people if they're not practicing in an area where they know, you know, uh, surgeons or other people in medicine because of residency connections or whatnot?
Absolutely. So I definitely think just reaching out to any doctor that you might know in the area is helpful. 'cause they might know someone or a specialist, for example, like I don't have a, if I don't have an endocrinologist to refer to, I'll ask a primary care friend that I have to help me find someone.
So using whatever network you do have, and I think. Even some of the Facebook groups that, um, kind of connect physicians from all specialties. If you were to post there and say hi, are there any endocrinologists near Greenpoint? I'm sure people would offer. There's also any local networking that kind of brings different specialties together.
For example, so many docs, which is social doctors and social media has like local networking. Opportunities in New York City. So I try to take advantage of all of that. And then I also think asking patients, so anytime a patient's like, oh, I saw my G Y N, or I saw my P C P, I'll ask, who did you see? Like, are you having a good experience?
So I use my patients to help me find, um, referral sources as well. I. Love it. And I definitely love the, uh, especially the, the patient portion there because yes, like when, when a patient says like, the doctor spent time with me, the doctor did, you know, all the things that we would love to see in medicine in all clinics, it's like, awesome.
I'm gonna put that in my little Rolodex virtual these days, but still a network if it is being built out. And I will put in here like, There's a lot of direct primary care practicing doctors and direct specialty care doctors. So like, if you don't know, there's a lot of people to ask, even virtually, so love it.
Now when it comes to workflows, you mentioned, you know, the labs coming in when doctors send their notes after they've seen your patient back to you. Take me to the, the back office view, what it comes from or after a patient books on your website, a, a service or a visit. So I use a wonderful app called Jane for my E M R, which honestly works really well for the type of practice that I opened.
So after a patient books, they automatically get a link to fill out intake forms and to book their appointment, they have to put the credit card information, as I mentioned. So typically before they walk in, I've already reviewed their intake forms and I write out kind of the highlights for myself and I know why they're coming in.
And then they come in, I see them. The downsides of Jane is that there's no integrated, like prescription tools. So I have a separate app called MD Toolbox to send prescriptions. Um, so that's typically the visit. I see them. I document, I take photos, they pay with a credit card processor that's provided through Jane.
I send them a receipt. And then if a patient asks for a super bill, I have a, um, template that I fill out and provide so that if they have out-of-network benefits, they can submit that to reimbursement for a claim. But I make it very clear that I'm not involved. In that aspect of it. And then I send a prescription, and then if they have labs, which is infrequent for me personally, I'll give them a requisition form so they can walk to the lab.
And then if I'm referring to a surgeon, for example, I'll give them the surgeon's information, ask them to call, and then I'll give the surgeon a heads up. And then, uh, if I'm doing a biopsy, I do the biopsy and put it in the box outside my office, and the courier comes and picks it up, and then I get a fax a couple days later with the results.
If I get any results that are faxed to me, I do have to sort of transfer them into my E M R. Um, but I would say that's the bulk of like my admin work other than ke you know, other things like keeping supplies, stay on top of supplies, et cetera, and like practice, uh, related things. The patient workflow is pretty seed wfs.
Love it. And what about for you having two rooms and you, you know, you talked about how like if, if somebody's numbing for procedure and then you're in the other room doing another thing, how do you block your days? Do you have certain days where you only block certain procedures? How does this, the scheduling work for you?
Yeah. Right now it's kind of like, Whoever wants to see me come see me because I'm in the growth phase, so I'm very flexible and open. So I'm open five days a week. I kind of have it staggered. Two of the days. I'm nine to four. Two of the days I'm 11 to six. Just to give myself time to catch up and then give myself kind of a late evening for people that work, et cetera, to be able to see me, York, kids after school, teenagers after school.
So, and then on Fridays I'm open 10 to two. So I have a lot of just like built-in admin time and then eventually I can see myself. Like if someone is seeing me and I know that I'm doing a cosmetic procedure, I'm able to like walk out enough ample time to do something like P R P or microneedling. So I'm able to control that.
But right now I don't have like procedure days or non procedure days. I just kind of. Whenever you wanna see me is okay. And then eventually I think I might change things around a bit. Like I may might make Friday like a procedure day only, et cetera. But I love having flexibility to do what I want with my schedule, which is something that frustrated me prior.
So it's really nice to have that autonomy and total flexibility and control.
And especially how you mentioned like you have a little one who's not, you know, able to drive themselves or take themselves in the subway safely, uh, by the, you know, independently. Yeah. So I love that, you know, you can, you can do the things that you need to do to make your life the way it's supposed to be for you.
So, exactly. With that, and actually, so today, um, my nanny called out and, uh, so my husband stayed back, but he needed a break between patients. So I went to the park to play with her and then came back to see my next patient. So it's like been really beautiful to have. This flexibility of working where I live, because had that happened before, I mean it's like what can I do?
I can't move around 30 patients and then reschedule them for three months later. So it's just been like, it's obviously a balancing act, being a business owner and a mom and a physician, but it's made the balancing act a little easier being my own boss for sure.
Love it. And on that note, I want to ask one more question about how, you talked about loving logistics and knowing all the things, and you did figure them out.
But any other little tidbits of little nuggets of advice that you have for others when it comes to logistics and thinking about and planning workflows for a micro practitioner or a a, a solo
doc. So I think staying organized is really helpful. So I definitely think making a list for myself, because there's so many things swimming around in your brain.
So I kind of touched on this earlier, but having this like master plan list, uh, when I was opening the office so I could sort of refer to it, was helpful. And then I also think like, uh, one thing I've done is like, Oh, like important dates. So there's dates that, you know, the subscription renews or this is due or that is due.
So that's been helpful to, for me to just kind of stay organized. I think asking other people how they do things is so helpful. I mean, I had so many people that were so generous with their time. And sharing how their clinic works and answering my questions and kind of collecting different models of how people do things and how they do it differently.
But it all works is helpful. But I'll end with like, uh, so my father is a physician and he opened a practice kind of later in life, like in his fifties. And he's in the traditional model. But, um, I'm very inspired by him because all he knows all of his patients and all of his patients know him. And he's very much like the doctor from the old days that.
People like know and love. And when I was asking him all these logistical questions, he's like, why are you asking me this? Just open and practice and it'll happen. And that was so helpful for Type A me to hear because it's true. It's the, the hardest part was deciding to open. So just. Make the decision, take that like leap and like all of the other things will happen.
But I, for me, the hardest part was just deciding to open. There's a lot of fear associated with it, but also a lot of bravery in making that decision and then everything else just falls into place.
I love it. And one thing I wanna go to now is the fact that you, on your About Me page, you have. Like, contact me if you'd like to, you know, have me speak on your behalf or, or on your, uh, company's behalf or organization's behalf.
Or if you'd like me to engage in, you know, writing a thing about dermatology or whatever it is. You're able to have the time also to, you know, do things that are beyond clinical medicine, but that allow you to really highlight you as a person, your training, your personality, the way you approach things.
So tell us about, How you got that mind shift from being like, oh, I go to work, I see these patients, I get paid, do it again the next day. You mentioned how your dad just, you know, said like, why are you doing this? But how did you go from that person to, Hey, like I, my information's out there on the website if you'd like to work with me.
Here it is. Yeah. So when I was employed, obviously my job was seeing patients, but I just felt. Like not as inspired to do adjunct things that have to do with dermatology and being a physician. And I had this like extremely strong entrepreneurial itch. I was like thinking about other businesses to start.
I was like, could I do like something with like interior design? Could I do something like this? But then I was like, wait, but I'm a physician. I should use those entrepreneurial skills in what I'm an expert in already. So then that's when I decided to open a practice and I found the drug care model. But then, This whole other world of kind of opportunities arose.
I, I've been doing some like consulting for different companies that need like a dermatology expert. I've been like a media resource for different outlets, um, and giving quotes on kind of, uh, common dermatologic, uh, issues or treatments or products. And it's just kind of, It's fun. Like I, I, I guess that's what it is.
It's like I feel fulfilled by that. I love seeing patients, but I also like doing other things. And I think just opening and kind of changing to an entrepreneurial mindset, which is something I always wanted to tap into. And it just opened the doors. And it's sort of like anything that I do benefits my practice that I wholly believe in.
So I think that was a mind shift change too, where it's like, I really believe in my practice. I feel like the care I'm providing is a care that. Is the way medicine really should be. So I'm very inspired to like support that. So I think it kind of all fell into place that way.
Love it. And the next question is, I, I think about because, uh, talking with people like Dr. Kristin Coleman, who is definitely partnering with people left and right. You mentioned earlier that you partnered with L'Oreal to bring some awareness to your community. So when it comes to partnering with, with brands, um, especially national brands like that, What advice do you have for people who are looking to do that, especially if there's like a great product that they love, that they'd love to bring to their community?
Yeah, I think it's all about relationships. So the opportunity came about because my L'Oreal rep who provides me with samples for the office and I were talking about the community, she also lives in a, a neighboring community, and I brought up the fair to her and she said, we'd love to partner with you.
So I think it's just all about kind of opening up the relationships with reps and, um, members of companies. So, yeah. Awesome.
And how do you go about, again, we, we talked about how. Even with your cancellation policy, you have a policy to help respect your training and your time. But in, in terms of working with other companies, if there's a way that you're gonna work with them for multiple hours or a, a contractual agreement is on the table, how do you go about approaching.
You know, getting compensation for what you're doing.
Sure. So that's come up for me from a consulting standpoint. So some people have reached out to get kind of like expert opinion on, uh, running a practice or the E M R that I use or the pharmacies that I send to. So I start the conversation with like, I have a hourly compensation rate, this is it.
And if they agree, I have a contract that I have that I send out. So I think just kind of establishing. We're content experts and we deserve to be compensated for our time. I had someone mention that they had someone starting software for potentially a direct kind of care business. Can they reach out to me?
I said, sure, I do consulting for that. I'm happy to provide you with my hourly rate. So I think just like any other professional, our content, uh, and our expertise warrants compensation. So I sort of just start the conversation in, in that way. Love it. And I hope those words of advice help people get over their fears when it comes to like, I'm getting all of these, you know, people asking me things and I'm investing my time, but I'm not getting anything in return.
So I think that especially as you know, we see physicians on, like you said, social media, but also truly on social media being, uh, influencers when it comes to dermatology, project products especially, that is a way to envision a partnership and make sure that your autonomy is shining through even when it comes to something like that.
Yeah, there was definitely, um, Becoming a business owner and becoming an entrepreneur. I went through a, there's a period of uncomfortability with these conversations and even with patients and establishing boundaries with cancellation policies. And, uh, I had some patients, because my appointments are time-based, call and try to negotiate down the timing of an appointment.
And in the beginning it was uncomfortable, but I've, it's a practice, so I have just practiced. Kind of holding my boundaries and saying maybe this is not the right, like fit for you, or, you know, these are our expectations, this is our clinic policy. And I think I just wanna validate that there's this like period of like uncomfortability and getting used to being your own boss and setting the rules.
But with it comes like a lot of peace of mind when you're able to kind of, uh, do that.
I love that. And in closing, do you have any additional words for especially those looking to open a direct dermatology practice, whether they have fears or not, from your experience thus far?
Yes, if you're thinking about it and it speaks to you, do it because I really think it's the future.
I think we're gonna see, uh, like almost, I, I wouldn't be surprised if most private practices ended up being direct care in the next one or two decades, maybe even sooner. But if you have any, if you're inspired by it, if it's speaks to you, do it. Um, reach out to people that you know or don't know. I spoke to a lot of, Kind strangers that are germs that helped me and gave me so much advice.
Like everyone is willing to help. We're really more friends and competitors. So I definitely think reach out to your community. And my dad's advice really kind of was re resounding for me, which is just do it and you'll figure it out. I'm sitting here thinking that your dad's gonna give you a huge high five after, after hearing this.
Oh, he's gonna love this. So thank you so much Dr. Kapoor, for joining us today.
Thank you. Thank you so much for having me.
Next, we look forward to hearing from Dr. Peter Cashio of Code One Concierge in Austin, Texas. If you've enjoyed the podcast and you haven't yet done so, subscribe today and share the episode with a physician you may know who needs to hear about D P C. Leave a five star review on Apple Podcast and on Spotify now as well as it helps others to find all these D P C stories.
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*Transcript generated by AI so please forgive errors.