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Episode 148: Reflections on Year 3 With Dr. C. and Dr. J. Mutch, Dr. Mundkur & Dr. Hughes

Updated: Oct 31, 2023

Direct Primary Care Doctors

Year 3 In Review -  A Reunion Episode With Dr. C. and Dr. J. Mutch, Dr. Mundkur & Dr. Hughes
Dr. Christina Mutch and Dr. Jake Mutch, Dr. Mundkur & Dr. Hughes

Join us in celebrating another year of success and the latest updates from three distinct Direct Primary Care (DPC) practices: a family practice DPC, an internal medicine DPC, and a pediatric DPC. These dedicated physicians embarked on their DPC journey after completing their residencies, and over the years, they have generously shared valuable insights into the evolution of their practices, as well as the transformation of their roles as independent physicians and business owners.

For a comprehensive look at their journeys from the very beginning, you can explore our earlier interviews by following these links: 'Episode 51: A Year In Review' and 'Episode 105: Year 2 In Review.'

Dr. Christina Mutch and Dr. Jake Mutch, both family physicians in the group, are graduates of William and Mary. Their shared experience at the West Virginia School of Osteopathic Medicine revealed the limitations of rushed seven-minute patient visits, which often hindered meaningful lifestyle changes necessary for disease management. In August 2020, they took the bold step of establishing Defiant DPC in Williamsburg, Virginia. In September 2021, they joyfully welcomed their baby girl, Isla, into their family. As of this recording, they have also welcomed their baby Beckett, and both mother and baby are thriving.

Dr. Lauren Hughes, a board-certified pediatrician and IBCLC (International Board Certified Lactation Consultant), is the founder and owner of Bloom Pediatrics and Lactation in Kansas City, Kansas. Her practice offers a wide range of pediatric services, including expert breastfeeding support. Dr. Hughes holds the distinction of being the first in Kansas to hold both the title of IBCLC and MD. In addition to her medical career, she is a loving wife and a mother of three children—Calvin and twins, Nolan and Sloane.

Dr. Deepti Mundkur, an internal medicine graduate from the University of California, San Francisco School of Medicine, Fresno Medical Education Program, hails from a small coastal town in India. Recognizing the importance of personalized primary care, she initiated My Happy Doctor, her DPC in San Diego, California, in July 2020. Dr. Mankur continues to provide exceptional care to her patients through telemedicine and home visits, aligning with her mission to meet both personal and professional goals in healthcare.


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***A note about today's episode. There is some language that may be inappropriate for young listeners, so please consider this as you listen today. Thanks for tuning in.***

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 the time. their fingertips. Welcome to the My DPC Story podcast, where each week you will hear the ever so relatable stories shared by physicians who have chosen to practice medicine in their individual communities through the direct primary care model.

I'm your host, Marielle Concepcion, family physician, DPC 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.

Today, we celebrate with another year and another reunion update for three practices. One, a family practice DPC, one, an internal medicine DPC, and one, a pediatric DPC. Opening their DPCs after residency. Our guests have year after year provided insights on the creation and changes in their practices and also on how their confidence as independent physicians and business owners has changed as well.

If you're interested in their journeys from the beginning, you can access the earlier interviews by clicking on the links provided in the blog accompanying this episode at mydpcstory. com. The family physicians of the group, Dr. Christina much and Dr. Jake much both attended college at William and Mary, and then went on to attend the West Virginia School of Osteopathic Medicine with the realization that the rushed seven minute visit did not provide patients or doctors with adequate time to make meaningful lifestyle changes needed to control and reverse disease.

They started defiant DPC in Williamsburg, Virginia in August of 2020. In September of 2021, they welcomed baby girl Isla into their family. And as of the release of this recording, have welcomed baby Beckett now as well. Both mom and baby are doing great. Dr. Lauren Hughes is a board certified pediatrician and lactation consultant, or IBCLC, and founder and owner of Bloom Pediatrics and Lactation.

She provides all general pediatric services as well as breastfeeding services to her patients in Kansas City, Kansas, where she was the first to become a dual IBCLC and MD in the state of Kansas. Dr. Hughes is a wife and mother of Calvin and twins, Nolan and Sloan. Dr. Dipti Mankur is an internal medicine graduate from the University of California, San Francisco School of Medicine, Fresno Medical Education Program.

She hails from a small coastal town in India where her medical schooling was at Manipal University in India. To meet her personal and professional goals in primary care, she started her DPC, My Happy Doctor, in San Diego, California in July of 2020, where through telemedicine and home visits. She continues to care for her patients.

This is year three. This is how it is in real life. I'm podcasting from the car. Cause we're on a trip down to see my cousins, go to my cousin's wedding. Lauren's unpacking a delivery. Vaccines, the car doors opening. Uh, Jake and Christina are about to have their second kid and Ty's like loving life, doing all the Lego sets that I wish I could get.

So this is how it is, man. She just got gringotts, man. She got Gringotts so jealous.

and my favorites are like right next to me. Oh wow.

Oh my gosh. That's awesome. First for my, when are you gonna have your baby? Uh, any minute. On the podcast episode, I just saw, I just bear witness to my God. We are, we are having so much fun, just like, you know, Lauren, when you showed your update last year, you said that, you know, somebody who you had gone to, another physician had said to you, like, you're just so happy. And then they went into DPC and it's like, we're having this conversation as we're all technically working, getting paid.

And I'm like. In the car, enjoying, you know, time with you guys now, because this is where we're at. You guys are, you're three. I just celebrated my second year anniversary. And so let's get to some updates. So who wants to go first? You guys talked about lots of things last year, growth and boundaries and adding people to the clinic and workflows.

What are your guys updates? Yeah.

So we kind of continued on that same theme in the past couple of years. It was how to build an infrastructure and then how to hire people on that infrastructure. And now we're getting to the point where we've expanded both our operations as well as our clinical staff.

And so we've also had another growth here as well, too, Christina is ready to deliver in a week. Yeah, and so we are very excited. And 1 of the things that we wanted to do was to have the infrastructure to be able to take some time off, spend time with family. And so we hired on an additional operations assistant.

So we have operations and clinical staff. Our operations assistant, we currently have used the workflows that we developed to train her operations or another operations assistant who's worked with her, who's hospitality trained. And so we've doubled our work staff that way, because we also have our amazing clinical assistant is going to be going off to medical school next year.

And so we are also training an additional clinical assistant. All of that being put into place was actually really good timing because we, a friend of ours. From residency reached out and we're just getting a tour of the practice and DPC, that kind of thing. And at the end of the meeting where we were sitting down, she said, are you guys hiring?

And so we actually ended up starting that process and we're about to finalize the paperwork in the coming weeks. So we'll be bringing on another physician as well. So super excited, lots of growth. And that's been a big thing for us.

Love it. Love it. And how was it in terms of this idea of bringing somebody on and the process, when you talk about the process, how was that process?

I know like Lauren specifically had talked about that she didn't consider herself really good at hiring and she's had some awesome updates too. But for you guys, when you talk about this process, what are major things that you had to consider because it was going. You know, beyond the two of you and the partnership you guys have in business and in marriage and in friendship to add somebody into the fold who would fit.

Yeah, absolutely. I think the first thing for this was it had to be the right person. We don't want, I mean, like we spent a lot of time, energy, sweat, blood, tears, creating this little thing that feels like our baby. And so we wanted to make sure that if somebody is coming on and coming under our brand, that it was somebody we really jive with, we're going to be.

You know, maybe there's some cross coverage. They're going to be practicing the same kind of styles of medicine. We do a lot of like, lifestyle stuff, you know, that kind of thing. And so we wanted to make sure that that still made sense for patients who are seeing the practice and that we're kind of honoring that promise that we're giving those patients.

So it had to be the right fit from, um, uh, getting a long perspective as well. And I can tell you these positions. A phenomenon, I mean, like, she was a few years ahead of us, and we just really looked up to her. And so that was easy fit. The next 1 in terms of logistics, how to make it work. A lot of that has been video training series.

And so how to work with the, but then also a little bit of philosophy about how we approach common problems. How do we deal with hard conversations? That kind of thing. And then the final part of it is the logistics of actually hiring somebody, the contracts, the, you know, getting paid, the gusto, like arranging all of those logistics.

There's a lot of different ways to skin that cat in terms of bringing somebody on. Are they going to be a salaried employee? Are they going to be a partner? Are they going to be something in between? She's essentially the first person we've ever That's, you know, not us. And so. Because it's so early, we want to make sure that she shares in that growth a little bit, but also it makes sense for what her goals are.

She wants to practice medicine as opposed to being involved heavily in management decisions. And so we want to make sure that we've always got an open ear towards it and that we're making, we want to make it a job that nobody has to run away from and that basically a dream job. And so, in order to do that, we say, okay, why don't we, since we're starting out early, you know, X percentage of whatever the monthly memberships are, and we're just going to grow from there.

We'll do like a short 2 year or something contract and then reassess and see how you feel. What are the must haves or where the deal breakers. Thank you. And just make a short document and, you know, it doesn't have to be anything fancy here. You can use a rubric or a template, or, um, you know, this is not the first time somebody's hired someone this way.

So you can ask a lot of advice from, um, you know, other lawyers or friends to lean on a little bit there, and then just make sure everything is polished as you go back and forth. And then this is also the point where we're going to find what are the sticking points? What are the things that we're trying to that are really helpful to know the next time we consider hiring someone on.

So we're using this very much as a template and using her feedback as a guide for what we should be doing differently. So we're very excited about it so far. I love that. And I love, you know, how you said this is, you're trying to create a job that people are not going to run away from because we have all seen what we could have done if we hadn't done DVC.

So definitely creating things that are babies that are not recreating burnout for us, um, is definitely a good thing to always have your eye on. Christina, how about you? Because you know, this last year, you guys have both been parenting a baby girl who's now just passed her second birthday and now bringing another little one into the fold.

Can you guys, and especially Christina, can you speak to how it was to adjust to being a doctor and being a parent, especially with one who's so little and so, you know, needing of parents to be there to do all the things?

Yeah, no, I, I think that also played into our desire to hire and expand our support team because we realized if we could expand our support team here, then I could be at home a little bit more.

And then also the, the beautiful idea in the future to actually have full coverage for vacation and really be truly off would be nice to. And so being able to find the right people, it may have not been like the perfect timing or like, oh, we know exactly how we're going to do it. Or all logistics are in place before we, we seek out somebody, but we had, you know, this kind of serendipitous, you know, way of a lot of our pretty much all of our hires and the way they came into our kind of life really.

And being able to find those right people. We're like, we will. Figure out the logistics, because this is what we need as a family to not just as a business. And so it supports both things. And so that's been incredibly helpful, you know, not being strapped on both ends, but being able to kind of find balance on both sides, which is definitely work in progress still.

But I think about it all the time. I think, oh, my God, I don't, I don't know how people do it in fee for service. I don't, I don't think I would survive, you know, a week as a mother. In fee for service, because it's not supportive. There's no way would have been able to breastfeed as long as I did. There's no, I would be able to schedule everything so that I could see my patient run home, breastfeed her come back, put her down for a nap.

See another patient. Like, it was it's been incredible. I mean, there's no way I would be able to have that flexibility. If the weather's going to be really nice. I can be like, I'm going to take this morning off. And go to the beach with her and then do afternoon clinic. And it's just, it's been incredible to be able to have that time with her and kind of make my patient panel as big or little as I want or as busy as I want in order to accommodate that.

And then, you know, she grows, she goes to school for a full time. I can get busier in the clinic, but being able to have that autonomy to decide that is. I mean, it just wouldn't happen anywhere else. So it's, it's been a godsend. And I hope that that brings some, you know, some solace to some people's concerns about being a parent and opening DPC at the same time.

I really love that, you know, you guys have found a way to make it work for your family that allows you to be parents and be doctors at the same time. So with that, I want to turn the mic over to the master of working as a micro practitioner as well as, you know, exploring the world. At her whim, just got back from Italy.

Dipti, tell us about what has been going on at My Happy Doctor. Oh, this is so awesome. First of all, congratulations, Christina and Drake. The growth's awesome, professionally, personally, and also of your, you know, the, the number of, uh, You know, heads in your family, I am, you know, I probably the other extreme I really am more of an a micro is super minimalistic practice and I feel like.

Even though there's plenty of time on my hands to probably do a lot more work, I just realized that, you know what, we spend so much time working. That's all we know to do. And last podcast interview, I spoke about pottery and now I've been, you know. Pottering around with my husband and we do these, uh, couples pottery sessions and, um, we, now, now our instructor doesn't have to tell us how to, you know, center the clay and, you know, get your pot up.

And so we've, yeah, I made so many pots that now I finally watched one of her really tiny students, like really young students make this bowl into like a fish base. Which has like two eyes on top, like two balls of clay on as eyes and like, so it's a bowl that's like sitting up. So anyway, it was really funny that I chose that to be my last piece.

And that's still kind of, you know, in the kiln and hopefully will be ready for us today evening for our next pottery class. So, you know, essentially, I have found DPC to be my pottery class. Way to finally explore things I would have otherwise not been able to do if I was in FIFA service like this is so precious to me like this weekend.

My aunt wanted me to make a ringtone for her. You know, back in the day, you could like put these really basic tones as your ringtone and you could like put anything in there. And so she likes these really old Bollywood songs. And like, I sat down and played it and like, it's on my Facebook page and like people It's crazy.

I look like a headless person playing a piano because I couldn't, I couldn't manage to like get both my hands and the piano in the pictures of my head had to go. Anyway, so it was, it was really funny. So I think these are the things that make my life the way I always wanted it to be not really going, you know, like an assembly line of patients showing up at clinic and I'm just going back to back to back and no time to pee and like.

To be really honest about how things were, I really think it took a toll on my emotional and physical health and things have, things have improved significantly. But I do read books now, after like 10 years of not reading books, every evening I'm actually reading a book, you know, before going to bed, a physical book, not Kindle.

And all these awesome books, Atomic Habits, Essentialism, and I feel like Are you judging us Kindle users? Stop it. It's the night light. You know, no matter how much you try, it's a device and it's gonna, it's the whole melatonin thing. Anyway, I want to sleep well, Lauren.

I'll have you. I will murder someone over my Kindle.

Oh, man. All right. I love it. My Kindle is fine. My dad has a huge Kindle, um, you know. Addict. He, he has, he uses my Kindle ad limited subscription from India. So it's really fun. Yeah. He, he loves reading and there's something about the books though, Lauren, like you can like feel them.

Yeah. And my kids can rip them.

It's great. Okay. So you have reasons to keep the, I don't have, well, I keep it away from my doggies. So I have one of my kids. Well, any paper.

Yes. Anyway, but yeah, that's pretty much my life. I don't know if, you know, I have anything great in terms of like my DPC practice that has been a huge change, but right from the beginning, my DPC was exactly the way I wanted it to be.

I probably, you know, just the main thing with my practice, I think, is just going with the ever evolving things surrounding me. For example, the stuff with health insurance keeps changing or the stuff with, like, whatever's available in the community keeps changing. So I adapt as much as I can and try and find solutions that are still affordable for my patients for things that I can't do myself.

But yeah, it's growing. I got five new patients in the past week and it's, yeah, it's just, uh, the way I always wanted it to be. That's so awesome, and I just love how you guys all did really deep dives into what would you want your practice to be like, and I love how as your practices have continued to grow, you're still staying true to why you started DPC.

Dipti, one of the things that you mentioned in the last time we had the update was that in the beginning you felt like, you know, you were a fraud, that you were like, oh my gosh, I have to, like, Try to convince patients to join my practice, and I'm just going to put a story here. I had the amazing, amazing opportunity to actually see Dipti in person when I went to San Diego for a conference, and it was amazing that she was sitting there at the table, like, wearing her Dipti Monkhor, my happy, uh, my happy doctor.

And it was not, there's nothing but like pure pride when we were talking about DPC and the waitress like overheard us, came over, and then Dipti's like, oh yeah, just go to my happy doctor. Just add a dot com to that. She's like pointing to her scrub shirt. There was like no shame. There was amazing. And then all of a sudden, it's like, the people next to us who came from the nurses conference for us who went to DBC, the people next to us who were just a mom, dad, and their son, were asking about joining our practice.

So it was so incredible to hear, yeah, to have heard you say, you know, how you were in the beginning. Like, you know, you have to sell yourself to like, this is an amazing practice. Like, you should totally be a part of it. Come check it out. So, tell us how that shifted for you in terms of being from a place where you needed to get patients into the practice, so you had that feeling, that compulsion, versus you're just doing your pottery, your Legos, you're traveling, and you're still taking care of patients while taking care of yourself.

Yes, yes. And I think that kind of blending work into my life, the whole Italy trip that happened, right, there's going to be like urgent messages. Oh, I forgot to ask you for this prescription or something else. And the way you navigate all of that, and the way you're like prepared for all of it. As long as you know deep inside that having that little bit of work every day is not going to make a huge difference in your peace and happiness.

Really, I think that acceptance goes a long way. And it's funny, someone I know is a dean of a medical school. School also has to deal with this. He's going to keep getting emails, even if he's on vacation. Right. So some of us, we, we, we want to try and minimize how much actual time is spent working on vacation.

But I think if you have a nice workflow that kind of, you know, allows that to happen super seamlessly, then you wouldn't have to spend more than a few minutes every day. Also, I think in terms of like having my practice. You know, meet and greets in the beginning, just to answer your question, there was such really, really, really uncomfortable conversation sometimes, which felt like an hour, even where someone really wanted to, like, be 100 percent sure they're they really have the right doctor.

And I think it was partly the whole conversation went up to an hour because I wasn't prepared. I didn't know what meet and greets would be like, and it just went like. Whoa, I'm trying to, you know, prove myself and, and I'm sure if I heard myself talking, I'd probably not join my practice. Right? So it is a learning curve.

And there's absolutely going to be so much growth with each meet and greet you do, like, even though the patient doesn't join, I know that the meet and greet has taught me something for next time. It's taught me new questions for next time. And I think having that approach with anything in life, and especially with meet and greet, It has been a huge difference now when I start my meet and greet, I'm like, you know, I'm so and so and ask them to tell me what they're looking for.

And I think that made a huge difference because patients are then pouring out their heart. I'm so pressured in the five minutes. I don't even know what to ask my doctor. You don't even have to make for them, you know, about your clinic that they should like they're already sold to this model. You just have to tell them.

Yes, that is exactly what I do. This is not a dream come true for you. This is actually possible. Like, you know, this is not something you, you think is far fetched. It's actually happening. And then someone said, how do you have lab discounts? How do you get all these? Like, I said, I don't make these. This is how it should be.

This is the actual price. It's not Julia discount. Everything else is inflated. So I'm not doing any magic here. So I think being super honest. about why you started your practice, what it means in reality for healthcare. And honestly, now there's a big strike going to happen. I don't know if you guys are aware, right?

75, 000 employees at a hospital system. I'm not going to name it, but there's huge, huge outcry. There's two really top clinics out here that are not going to take Medicare insurance anymore. It's just ridiculously horrid. So all my patients now, bottom line. They're reaching out because they want something different.

They're not, most of the patients are not even asking me if I take insurance. So there's a huge shift happening. And I think that really has helped a lot that I don't feel like a fraud anymore.

I love this, you know, exuding of business confidence that I see has really grown over the, over the years from all of you.

And, you know, I love that as we're talking, you know, you guys are shaking, you're not, you're nodding your heads when Divti's talking about the meet and greets. So I will, I want to get to that, but I want to also just honor that you guys have talked a lot about so far your boundaries, like your boundaries where you need to set boundaries so that you know you need to protect your family time and grow.

boundaries so that you can protect your personal time as well as, you know, grow as a human being and not just processing patients throughout the day. And boundaries, Lauren, that was your, like, one of your big themes. Adaptation and boundaries were your big themes from last year that you wanted to, or that you were describing your year as and year two.

So when you look at your practice and boundaries and adaptation, how has Bloom Pediatrics and Lactation changed over the past year? So, Dr. Van Gundy, join. And so I think one of my biggest was I got really good at saying no to things. And I also did a lot more acceptance of like what D. P. was saying, of like, A five minute phone call where my kids don't like they're outside running around and I'm still out walking around the park with them does not interrupt my day, but it makes a world of difference for that patient.

And so I think it was just 1 adjusting my mindset that, like, I'm not going to have a day where I have no patient interaction. It's just not going to happen. But how can I make it work to. Instead of me bending over backwards, like, oh, I'll like make my kids go home early. I'm like, hey, we're at the park.

We'll, I'll text you when we're home or something like that. So like I adjusted and ever gotten zero pushback. But I think the other huge part of it was I stopped taking new patients. I take siblings of existing patients, but I, I am closed to new patients. And. I did not realize how draining meet and greets did get of like you just say the same thing over and over and you answer and you know it does feel repetitive and so I stopped doing those and I stopped doing networking meetings.

Those two things alone, massive change in my, in my mental load. And like, I didn't need to network anymore. I have good word of mouth. I have a good reputation. Like I don't need to do these networking meetings anymore. I was able to just like pull back. And then the hardest part for me now is not boundaries, but delegating and like being okay with like Dr. Van Gundy doing things around the office. Like that was. Super hard of adding, like adjusting my, it was a boundary for me to like, Hey, I don't have to do everything, but that was hard. So yeah, I think it's been great. And I read every day. I do some like craft thing every day. I go to my kid, I did, went and did secret reader, uh, at my son's school.

And I was able to like, you know, like. You get to just go. I went, I go and have lunch with him. I go and like do these things. I'm going to go to the pumpkin patch with my twins. Like I get to do things during the week. That I wouldn't because I will like, just go through and I block it and I don't feel bad about blocking off for my family.

And I've not had any pushback from it either, which is awesome. Love it when you hit on this. Sorry, I might like you hit on a really important part. Like, I think we set so much more pressure on ourselves to say yes. And then realize that when we say no and have like a very reasonable, like, oh, I can't see you now, but I can see you in 2 hours.

People are like, like, yeah, we're not upset. Yeah, it's like unbelievable. And I think part of that stems from just our, our breeding, right? Like, it's like undergrad med school, like, you never have the choice. You have to do everything the way somebody else tells you to do. You have to

sacrifice your own self care as it is.

It's always right. Yeah, and then, and then realizing, like, oh, it doesn't actually have to be that way and everybody's going to be okay. And the patients are like, and that's how I feel. I'm like, I can block out my morning because I'm still able to guarantee my same day. It's just going to be in the afternoon.

That's totally fine. Like, nobody is nobody cares. And so, like, changing our own mindset, like, you were saying is like, I think the biggest growth that we have had and like, questioning why we do things questioning. Thank you. Thank you. What makes us upset? Like, what like, give us feel like more anxiety or like, oh, we don't actually like doing X, Y, or Z.

Do we actually have to? So then I just stop doing it.

Yeah, exactly. And so I think that has been like, a huge shift. Um, and that that is a part of boundaries that I never really thought about. I always think of it as saying like, yes, no, but like, kind of rethinking what. Our own personal boundaries and comfort.

If I am, like, getting frustrated about, like, patient text, I just stopped responding to him for a while. I'm like, they will call me if it's an emergency and I give myself and so, like, I get exactly right that it doesn't have to be this all or nothing. Like, sometimes it's like, I'm not in the mood to talk about this.

Like, I'm going to give myself an hour and then I'm going to come back to it.


I feel like with. I don't know if this confidence has just come from growing the practice and we both kind of agreed that, hey, we want to keep this a small batch micro practice and bring in their position in. But there's a huge amount of, like, I don't know, people call, like, abundance mindset or competence or whatever it is from.

Saying enough, like, we, we have set out and we've done what we wanted to do and we're doing that. And that creates that optionality that that creates when someone. You know, we all have those hard conversations where maybe it's not the best fit that somebody's coming in, you're having a conversation with somebody and I don't, you know, I'm doing them a service.

If I acknowledge like, hey, you know, this, I don't think we drive it. I don't feel like this is working out. Let me, I know exactly. I can find somebody in the system. I know exactly who to go to go to this person. This is what you're looking for. And so it's just an acknowledgement and kind of a positioning that says, like, you know, that if we have, if we start this relationship right now, you're not going to be happy, we're not going to be jiving and then that's going to continue until somebody gets upset.

Let's not do that. Let me find somebody right for you because the PCP relationship is a wonderful thing. And the last thing that I want you to do is not have that. And so freeing to us, because it lets us say no, without having to say, no, I'm happy to do X and you can do Y. Like, it has been in terms of my stress levels, being able to say, this is what I'm about.

If you're, if you're into that, that's great. But if not, I wish you well, it's been very good for us and for our stress levels. And it's so interesting because, you know, in fee for service, especially, you know, I know you guys. Opened really after residency. So you didn't, you know, do the years of fee for service.

However, you still experienced that in residency where it was like, I don't know who's on my panel. I have who they handed me. That's who's on my panel. And like you were saying, like you, you know, you were in a place where you couldn't even choose who the patients were. And because of that, you were in a position where you felt unsafe, where people were like demanding medications that you didn't want to prescribe because of medical reasons.

And then. You felt unsafe as the doctor. That's crazy. And so I think it's so important to, you know, to hear what you guys have shared because when it comes to patients, you know, being a good fit, like Lauren, I think you mentioned this to last year or, you know, when you had. I think it's when you had closed your wait list, you had shared about how your families who were totally in alignment with, with how you practice medicine were telling their friends and that's how your practice quickly grew in that second year.

And so I think that, you know, that's definitely happened for our practice in Arnold where, you know, we have more and more people now like, Oh, I heard about how you're practicing from other people. And the culture feeds itself, I feel in. Yeah. When. You have those outliers. You can, you can feel them out during a meet and greet and I, I don't know how you guys feel, but how else have your meet and greets changed?

So, I, I don't do them anymore, but Dr. Van Gundy, in the initial, and everyone has this, you're like, oh my God, I'll say whatever because I, I'm terrified that no one's going to join, right? So. I think she had a little bit of that, but now she's like, Hey, this is who I am. This is how I practice. This is my philosophy.

Here you go. And people leave or they don't, or people join or they don't, and it is not as stressful. She also, it is a little easier because I have, it feels weird, but it is a brand. It is very much a brand and like our brand is becoming very well known. So we are also getting referrals of people who align with us.

I mean, it's getting just easier and easier to have the conversations because we're like, Hey, this is how we practice. This is what we do. This is what it is. No, we don't take insurance. And they're like, yeah, I already know. And or people will start like, you know, like, tell me why you're joy. And I do feel as though they're like, well, I can't reach my doctor and I want to be able to reach my doctor.

And I am rushed in mind five minutes and we have to use urgent care. And there's only. Like, no one sees kids. We have to go to the pediatric urgent care. So does everyone else. And I'm like,

yes, you don't have to do much of the talk. Yeah. And then exactly. Like, and they're like, so that's why we want to join because we just were tired of being of this point where we realize, like, we don't even need to do this.

I mean, our operations assistant does it. If there's any other further questions, it is so rare that after they talk to her. Bye. Bye. Bye. That they don't want to talk to us. So we're like, we really don't have any more time for this. We need to concentrate on our members. She does a phenomenal job and she's gotten to learn exactly what we're about and how we jive and things we do and do not do that.

I never thought in my because I'm not a good delegator. I never thought in my wildest years. That would be something that. I would feel comfortable. You'd hand off. Yeah. And, and it's been, she probably does a better job than than ever did. Um, and so like you said, it gets easier with time because people just understand it more now.

Yeah. Um, and then, and then you, they're just talking and, and you're like, that's great. That's what we do. And I'm like, I don't need to be part of that. And the other thing that I really think I feel like needs to be stressed more is like, You're not a concierge practice of asking for a whole year up front.

Like, there's like, it's a month. If you don't like it, you can leave. Like, there's, there's not, um, this huge bite, like literal buy in that they have to do. And so I feel like the main greet originally comes from like places like that, where it's like, oh, you need to pay us 3, 000 upfront for a year. And I'm like, It's month to month.

Like you don't like it, like no big deal. It's not a huge risk. So I don't, why am I giving a whole hour of a meet and greet when it's like, oh no, 15 minutes max. No, I know, but I'm just saying like, there's always ones where you're like, okay, gotta go. And so, so yeah, I just, I think we also put that pressure on ourselves to thinking that it was a hundred percent necessary.

Where like maybe, yeah, maybe when you're first opening up, people don't actually understand what it is. But then eventually I'm like, if you don't get it from our website by now, like, it's probably not a debate.

Like, yeah. Yeah. I think the commonest question I'm getting now is, why aren't more doctors doing this?

Oh yeah. Right. Like that's the new, that's a new question.

Yeah. Everybody now is like, I get Instagram DMs like, will you come to X, Y, Z city? Is there anyone like you in this place? Like, yeah. And so then I'm end up marketing. For other because I'm like, oh, yeah, let me send them to you or like they they figure it out.

Like, we just had somebody move from Tallahassee, Florida that they were seeing a dpc doc there and they're like, we can't go back and then they so they just automatically we know what it is. We know what we want. And I think a lot of people are also now discovering health sharing and moving off of health insurance.

And so that has been a huge shift to a lot of self employed or working for smaller companies or whatever, and they'll, they'll do health sharing. As opposed to health insurance and

then they're like, Oh, so I love though how Lauren, you're talking about, you know, like, where do you, you're getting people asking, like, is there somebody like that in my town?

I just wanted to point out Dr. Lisa Davidson at insight primary care in Denver. She started putting other people's practices links on her page as to like, Hey, we're closed, but go ahead and. You know, find these doctors who are also accepting new patients, and that's definitely a way to cut down on having to respond to, hey, where can I go, but also helping the community grow and bringing awareness to those around you, especially as we see more specialists coming into the fold, they might not need, you know, a primary care because they have you, but if they're looking for a specialty, cardiology, dermatology, whatever, Putting links to other people's websites can definitely be helpful, especially if there's no, you know, barrier to them accessing, you know, other people who are doing direct care.

They just go to their website and sign up, do meet and greet, whatever is required. So that reminded me, the specialty thing. So I, in addition, like with my growing, so I added Dr. Van Gundy. I also added Dr. Dilts, who is board certified in pediatrics. Headache medicine and medical acupuncture. And so she is here a couple days a week and so she is doing a direct specialty care and it is awesome.

Amazing. Let me ask you guys this. When, clearly, you know, word of mouth has helped grow your practices, what is the next strong lead generation after word of mouth for you guys? Obes and doulas.

Google search. At least in San Diego I think most of the patients who reach out they're like direct primary care in San Diego and they say you're the one that pops up and so that's been.

Good SEO. Organic and you do real stuff.

Amazing. So as we talk about patients and how they've been finding your practices, I want to ask here, what is a great patient story that happened over the past year that you can share about on the podcast?

Oh, I got one. So I had a patient that had some chronic.

Multiple diagnoses and she usually goes to a tertiary care tertiary like health center for her specialty care follow ups that kind of stuff. She was really upset because she was bracing herself because when she goes through this, eventually she gets this mystery bill and her labs were something to the tune of 900 dollars.

I said, 900, please send me which labs they got. She sent them to me. I looked them up in our list. And I sent her an email saying these were 27 dollars. Wow. She's coming to me for the laps from now on. Let me put it that way. And we can do that for anyone. Yeah, it's. I feel like sometimes we, you know, with all the other things that we do, I mean, there's just so many different ways that we can be of service to the community.

And 1 that I think sometimes doesn't get all of the attention deserves. Is cost savings labs, all of these things that we're always just need somebody to call, look it up or arrange and make it happen, like, connect those dots that nobody's going to do unless you kind of put in the front end work. And all these doctors have done that already just by being open and having access to those things.

And so it can make a huge difference of whether somebody goes to get checked up. Decides to get that work up if they know that it's not going to break the bank to do. So it's a, it's a huge barrier.

I thought of a good one. So it was like a weekday night. I was just finished putting my kids to bed. It was like 8 15 and a patient called me.

They were in the ER waiting room that their son had had an episode of syncope and they think he had a seizure. And the, but they were like, they just told us it's going to be about an eight hour wait. I was like, that's bullshit. Come to my house. So I have like pretty much everything in my clinic. I had to keep a home visit bag in my car, so brought him in.

Didn't, they came to my house in my living room. I was in my PJs and they like, the, uh, one of the kids played with my dog and had a snack. And then the other ones were like, I did a glucose check. I did a neuro exam. I kind of like went through this story and like, turns out, no, he had a vasovagal was non epileptic.

Had, like, not like, I can tell that this was not an emergency. He did not need to go get he did not need to go back to the ER. And so they were home and in bed by night and as opposed to hours in the ER, the bill that would have come sleep lost, like, all that stuff. And it was. Yeah, I

was kind of like, yeah, this is, this isn't normal.

Like, they, like, I'm like, full mom mode. Like, I just put everybody to bed. And something that I realize is probably abnormal, but I do it so much that it's not abnormal. It's kind of common practice. I have people come to my house all the time and I do ear checks in the driveway or whatever that it's so frequent that my kids, when they see a car pull up, they're like, mom's a patient's here and I run out into, and I like go out and I look in ears or I listen to lungs or I do a COVID test or an RSD test or whatever, and I just do it all in my driveway, then they head home and that is like A very typical Saturday for me.

I've done a lot of them at farmer's markets. I don't know why, but that's, that's where everybody runs into each other and I'm like, Hey, are you going too? Okay? Like, I'll be there in like an hour. , let take a look. I'm like sticking my hand in somebody's like tooth being like, no. Yeah, I think it's kind infected.

Like you got, I'll call it an antibiotic right now. But this goes back to the boundary thing that like, it doesn't really impair my life. Right? Yeah. Like I run out. Five minutes looking through the ears, Mike, and then my kids watch me do it. And they're like, Oh, cool. Mom's being a doctor. And then like, and then I go in and I send in an antibiotic or whatever.

And then I go back to my life and like saves them hours of time, money, all that stuff. And I do like, this is yes, definitely a cost savings part. And also like, I think that. The time portion is, is a massive thing that people don't realize.

Yeah, like in terms of their wait times.

Yeah, in terms of like, an eight hour wait for a syncable episode in the ER.

And especially as we're in October, so like, it's gonna be worse. And you have those things. I have people come over my house.

Yeah, no, I think that that that part is I feel that way to with, like, coordination of care with specialists and things like that. And so, like, I have been able to use her services for something that notoriously has an 8 month wait time give the patient an enormous amount of relief.

Luckily, in this in this situation, but something that I was super concerned about was very acute issue. And I could not get into multiple rheumatologist from Virginia up to Maryland and was able to get an answer a thorough advice and like, get a game plan together so that we could figure things out before their actual like appointments.

And so things like that are just like, there's no way this would happen in the system. Like there's no way there's nobody advocating. There's no one navigating for you. And all these things would take years often. And that's not an exaggeration. It's like, I've had people who are like, yeah, I've had this issue for years.

But it's like every follow up is like 3 to 4 months later and then something maybe minimally changes. And then it's another 3 to 4 months when they want to follow up with me. Whereas I'm like, okay, day 1, we're doing this tomorrow. We're doing this. I got the next week. We're doing this. So it's like, the speed of the workup is incredible to the point where I've had specialists be like, how, how did you end up with me so quickly?

And usually this diagnosis takes years and it's not because I'm doing anything special. It's just because I'm literally available. And so that's been like, 1 of the most satisfying things. Thank you. To me, it's just like seeing specialists be like, oh, wow, this is incredible. Like, I don't actually have a lot to add.

I'm like, yes, I just want your opinion and I need your expert opinion, or I need to know about what do you think about this management? So it's like, they don't have all this bullshit that they have to do come back to me 16 more times before I'm going to give that opinion. I'm like, I did everything. This is what I need.

This is my exact clinical question. Here you go. And then they can like, we can do it right then and there. So it's like being able to speed that up, hopefully, you know, in the grand scheme of life is making it, making a difference.

Guys, it was great seeing you all. My one o'clock patient is here. I will see you later.

Congrats to everyone, and good fortunes, and breastfeeding, and birth, and travel, and all the things. Bye, guys. Bye, Lauren.

Bye, Lauren. Thank you. Divti, how about you? So much stuff, Mariel. I mean, that's a loaded question. Because all the, all the stuff that you're trying to fix with the healthcare system, you are actually able to do it with this small, tiny practice of yours.

In, to whatever extent you can do it, you know, and some of the shocking stuff. Like, for example, I told you about this recently because it was really shocking. And you were, we, we met recently and This patient was told by a random, from a random phone call from her rheumatologist's office. She doesn't know who it was.

They just called her and said, our osteoarthritis protocol involves taking six 15 milligram Tylenol, eight tablets a day. Now, thankfully this, this patient actually reached out because it's so easy for them to just check with me about everything. I go, no. Did you get life threatening Tylenol toxicity?

It's just ridiculous. So I don't know what's happening with the healthcare system, you guys. It's just, I don't know who called her. And it's really disturbing, uh, that that's happening. So I, I, I think that's why Christina is mentioning these specialists that we really can trust. I obviously got her in touch with the on call rheumatology, Diana, Dr. Diana Guernita, because I was like, this is not okay. Like this practice is not going to work for me or my patient. And then just in terms of examples, like literally a lot of doctors are reaching out with either joining themselves or having their family members join with me because they really do think that it's time we take matters in our own hands and not count on insurance.

to take care of us. So I think literally this is the best example I can give you. I've been playing a lot of pickleball, so every evening I play pickleball. I thought it's like a game that you play when you're like in your 60s and 70s, but somehow, uh, I think it's gotten more popular among the younger people because tennis has lots of like injuries you can have, uh, tennis elbow, blah, blah.

And so now I've been playing a lot of pickleball. Anyway, I'm not making excuses for it. It's really fun. I burn like 1050 calories each session, which is awesome and I'm having fun and it's a team effort and all of that. So I got a text on my watch, notification that my patient has texted me, checked it and this patient was Is my 89 year old patient who was having hypoglycemia and the awesome thing is the daughter who is a doctor was able to coordinate so well with me and the patient to try and make sure that he eats a solid meal, despite eating a little bit of glucose or sugar for, you know, helping with the sugars.

But I think it's, it's invaluable this kind of access that you have. Where you can avoid going to an ER where you spend eight hours or like, end up having, you know, end up fainting when you live alone and, you know, you actually have access to a doctor who will tell you exactly what to do, uh, go eat a big meal right now.

So, you know, you obviously stop taking your medicines, but you, you need food, you need food to keep you going and it's not. The sugar that or the glucose that's going to last a long time. You need a solid meal. So I think it's small stuff like this that it doesn't even require me to like, go see the patient right away.

It's, it's going to be that advice that that's going to make all the difference between life and death for the patient. And I think that that access when I'm playing pickleball, I'm getting a text and I can actually. Excuse myself and say, Hey, you know, time out, I'm gonna, I'm gonna go and talk to my patient real quick.

So I think that is so precious to me in my practice. And one more thing I just want to point out because I think a lot of doctors who are listening also to this podcast, right? We neglect our health terribly. We neglect our health to the point that we actually not practicing what we preach. We don't follow what we tell our patients and that kind of imposter syndrome is the next level of imposter syndrome because you're actually a doctor, you are qualified to give all this advice, but you're not even following it yourself.

So, it's not because we don't want to, we're just in a system that doesn't allow us to take care of ourselves. So, I want to tell you, my recent patient, who's a doctor, was able to finish a hospital shift, go and sit in a car between going to her seven clinics. Right, seven clinics that he, he manages. She was able to sit in the car and have a full conversation with me about all her symptoms.

We got her health treatment started right away. The prescription that means she needed was thankfully delivered by our kit, who is my independent pharmacist friend actually dropped it off to my patient's home. And I think that beauty of me finally being able to help someone like myself who who's struggling who's, who's not at a place where they can start their own DPC for whatever reason.

Right? And yeah. have debt or something else that they haven't figured out how to navigate. So I really think that is also another pressure. So that was a loaded question. So you got a loaded answer.

These are such awesome stories though. And you know, stories that people need to hear about because there's so much talk about how, you know, DPC is not equitable because it's very, you know, it's very common that people can continue to confuse DPC with concierge medicine.

And When we talk about, you know, these everyday things that people need in primary care. I mean, that's what we went to medical school to do is take care of everyday primary care type of issues. And so, you know, when we, when we look at how our system you're talking about, like how, how did our healthcare system get like this?

Like there's so much, such a lack of access to doctors like ourselves that like you see people, you know, they go into the ER and they're like, you got to start dialysis because you're totally in kidney failure. It's like, How was that not caught? How did we get there? How did we get, you know, before Yes.

How did we get there? And you know, it's giving people access to direct primary care all over the nation in every single state. And if you don't know where one is, definitely like reach out to a D P C that's open, you know, in your state and ask them questions. There's so many resources now than there were before, but I think those stories are so important for people to hear.

I'm going to flip that and ask you guys, what is one of the biggest challenges or, you know, some of the biggest challenges that you've faced over this past year and how have you overcome them? I think, uh, I think our big thing, it kind of goes a little bit towards boundaries. It was realizing when we were full.

I think there's a lot of, well, because you've seen one DPC, you've seen one DPC, there's so much variability in patient numbers in terms of panel size. Um, and I think we had this idea of like, oh my God, you need to get to like 600 or 700 or like, you know, why do we feel so full right now? And so I think realizing that like, you are a unique practice and when you're full is going to be different than another practice.

And just realizing that you can tailor your day to what your priorities are. And so that may not be 600 patients. That may be more of a micro practice. And once we came to peace with being like, this is where we are right now. Like, that may change in a couple of years, but that's the whole point is like, we can change it.

Based on our needs and making sure that we are able to attend to the needs of our patients, too, and making that for ourselves and trying not to compare too much to do. We see, I think, you know, that's natural for us to do as humans in general. And so realizing that that's going to be unique to us and just honoring that, because once we.

Started a wait list and just got some breathing room, we were like, okay, this is more manageable. Our day to day is working a little bit better or personal life or business life. Like, all of that is a little bit more in balance. And so not being afraid to question things like that and realize what you need as well.

I think that was kind of our biggest challenge. And once we realized it, we could do something about it and tailor it.

Yeah, I would say that to add to that. There's always this struggle, and I think we all have gone through or hinted at it to some degree, the idea of boundaries and what it means to be okay with.

Communication in any form that it takes now that we're more accessible. And I know this is a concern that a lot of students and residents ask me about, like, how do you deal with all of that? And a lot of the framework of how you think about interactions with people will determine how you feel about it.

And so if you think of boundaries as I'm going to build up this wall and any text that comes through is like somebody trying to climb over that wall and get to me, then there may be a lot of agony that comes with how you view interactions with other people. Instead, I try to shift that a little bit by saying, like, we're trying to build walls to keep people out.

We're going to create walls to invite people in. We're going to in the same way that there are certain expectations for how to behave or how to interact when you're in a nice restaurant. It's dimly lit and there's music. People understand how to deal with that. They don't know how to interact with the DPC.

It's their 1st DPC for most of these people. And so by teaching them and giving them that grace of this is how we do things. All of a sudden that clarity removes the anxiety and with it comes, you know, all of the extra interactions that could have been forcing to be if the expectations were set. I found that once that system, you of guy, but once I put those systems in place, it made me feel a lot better because I knew that there was something a structure to fall back on.

And then anytime that a text comes in, or, you know, email or something like that. It's fine, it's not a big deal at all because it's worked into my life on the terms that I'm okay with. And so that has helped me a lot as somebody who likes things to kind of be neat and rank and file when life gets a little bit messy sometimes.

And that's okay.

I think the biggest challenge for me, I think, is navigating how my DPC can help my patients in situations where medicines are expensive and we absolutely need health insurance to cover for things. And like we were speaking just before the podcast interview started, I was not in a good mood because of a denial from health insurance for a patient who absolutely deserves to be on that medication.

Cannot afford that medication. I mean, if it was a cheap alternative, absolutely. I wouldn't have even asked health insurance if it was a 5 dollar alternative or even 100 dollar alternative, honestly, for that. But if it's if the medicine cost 17, 000 dollars. Or, you know, for that much supply, let's say for 3 months or something.

There's no way you can afford it except for using health insurance, and we are allowing health insurance to get away with not helping patients who need this in a timely manner, where tomorrow they will end up on dialysis, that same patient who ended up with dialysis in the emergency room, no matter how much I'm trying to help the patient, how much I text the patient, how much I email the patient, they're not getting anywhere if that medicine doesn't get approved.

And I think that huge challenge is a problem beyond DTC, but we all need to acknowledge it. We need to educate our patients about the way health insurance is denying them care. And I also think it's important to complain to insurance commissioners if it comes to a point where this is affecting your patient's safety and well being and you foresee them getting unhealthier and things getting downhill.

Despite being under your care, I really think those challenges are like the biggest ones in my practice right now.

Healthcare's not broken. It's working exactly like the insurance wants it to. Yep. It's not on purpose. It's designed on purpose. Stop it.

It's so interesting because this is coming around the time that, you know, Amazon is being investigated for Affecting the entire market for how it runs its business and how prime buttons appear, don't appear, how shipping is, is, uh, you know, being used by different sellers who use the platform.

And it's, it's so, you know, I was, I was hearing a report on this whole case about monopoly and Amazon, whatnot, and there's so many parallels that you can draw to the healthcare system in terms of. you know, choice. Do we have options to practice the way we want to as, as the physicians we train to be? Do patients have the options to get the care that they deserve?

You know, it's, it's so interesting how like you're saying, you know, it goes way beyond DPC, but as DPC physicians, you know, doing things like Christina last year, you went, you called in, I think on a phone visit when someone was at their oncology visit. And, you know, it's like, it's things like that, that they really make a difference.

Like if your patient hadn't. called you and asked about Tylenol, they would have probably been in a very different position, you know, in the ICU somewhere with liver failure, ridiculous, ridiculous,

crazy. So, you know, as, as we think here, you know, following your guy's episode, there's a physician who's coming on as a specialty care doctor who opened right out of fellowship.

And I just think about how like you guys opened out of residency. When you think about everything you've shared, You know, today, as well as on the previous recordings, I want to ask you guys, how would you talk to someone about DPC? Like, how would you define DPC to someone who's still learning about DPC?

And what advice would you have for these people with all the experience you have under your belt if they're also looking to do direct primary care? I think 1 of the benefits at this point of how the movement has grown is that there's this heterogeneity of opportunities available for people who want to start a DPC.

Not too long ago, it was if you want to be a DPC physician, get your business license, get all these logistics together, and you're going to bootstrap it from day 1. And. For some people that doesn't appeal to that doesn't that doesn't work, whether it's logistically financially, there's too many barriers.

That gap is closing and it's closing because of the practices that are starting to grow and who want to bring on other people who wants to experience that DPC lifestyle, that DPC interaction with their patients, but perhaps aren't in a position to engage on the business side of things. And so the 1st thing that I would want to know is what excites this person, like, what, what is bringing them to the table?

What are they or what are they most interested in? And then use that to build something that is of interest that really resonates with that. What is their ideal patient? What is, you know, what do they want their ideal day to look like? And then that way, we can say, okay, are you looking to go to conferences to start bootstrapping things?

Or are you interested in having a job here? So it very much depends on where they're at with their mindset and what they've heard. And then how do we close that gap? And that's why we have medical students that rotate here. And it's a wonderful thing to be able to interact with them because we want to see them and help them make those decisions as they're trying to figure out.

Are they even going into family medicine versus something else? Introduce some new ideas. That's why we talk to residents. We're going to see him tomorrow, actually, and give them some ideas about DPC in case they've gotten this far and perhaps haven't haven't heard it. And at each stage of that training, they're going to have different questions.

And if somebody is really ready to launch or they've been in fee for service for a while, those questions are going to be different, but knowing what really resonates with them, what they can close their eyes. Imagine what. An ideal day looks like and then back calculate what has to happen to make that.

That's how I tend to give that specific advice to people who are really looking to do something different with the type of care they provide with me. There were 2 questions, right? 1 for the patient and 1 for the doctor. So if a doctor, you know, is even considering, which I think a lot of doctors are burnt out and I'm sure everyone at 1 point or the other on a particularly stressful day will think about being that.

in their own practice. And even though it might seem overwhelming when you kind of look at other clinics and you feel like, okay, I need to have this and this and this and this and everything else to be ready to start my practice. I think it's important to remember that you can start bare bones, really simple, really, really mobile micro practice.

As long as you kind of just set up the initial, like, you know, corporation and stuff like that, and just do the bare bones stuff. You don't have to. And I think for me, also, this was a challenge, like, all the time, comparing myself to other DPCs and wondering, oh, do I have enough? Like, is this enough? And then all these success stories that happen with each patient over time, you realize that the relationship between the doctor and patient is all that matters, honestly, and everything else will fall in place over time.

Thank you. You will find solutions within the community that you, you know, for services that you don't offer and patients are happy to reach out to those people to get those things done and you can coordinate all of that. So, I feel like the problem often begins with this sense of overwhelm. Like, you know, Jake was saying, like, there's a ton of things and you might feel like, whoa, where do I start?

And so you want to go back to, like, Jake said, Think of the ideal day, close your eyes and, you know, your ikigai, like the reason for waking up every morning, like, what would make me happy? What kind of practice would make me happy? And go to the basic bare bones of it. And you will realize that there's no amount of legal back and forth about how you should run your practice that's going to make the biggest difference.

It's going to be. The actual wanting to have a practice that that, you know, and you, if you have the right intentions, which we all have in DPC, we want to do the best by our patients. There's no way you'll make a patient upset. They already have a. Shitty system to deal with, like, they, they already pleased with just that meet and greet on this.

Nobody gives them a meeting with the doctor.

Yeah, it's just it's just really I think for. For doctors, that's my advice. Don't look at like the challenges. Look at the good outcomes in your emotional health, your physical health. So much is going to change for you that you will be able to give more than what you're already giving to fee for service and burning out.

And for patients, I really think it's the mindset. It took 15 years to believe that insurance will take care of us for everything. We won't have to pay a penny for it, right? And now insurance is Honestly slapping everyone in the face with the most basic needs and it's only a matter of time that everyone's going to hop on the boat for DPC and choosing a DPC practice for their care.

It's like you go to a gym. Honestly, it's like you go to a gym for your physical health. Why don't you take care of your overall health with the DPC membership? Why do you have to only do dumbbells and you know what I mean? I think it's high time.

And Christina, how about you? I feel like I couldn't say it better.

I don't really have much to add. Honestly, I feel like that's that's the, the bare bones of it. It's just that it's, it's going to be unique to everyone. And so each person's journey is going to be different and you can make DPC what you want it to be and tailor it towards your values, your morals and your, your own personal mission.

And that's kind of the beauty of it. So I think there's. A lot of questions that we get about details and things like that from from doctors who are interested and kind of like, learning about it. But the truth is, it's like, you can do whatever you want. It is a blank template. And you can, you can make it and so that reverse engineering is kind of how we also do, you know, updates for ourselves.

Like, how are things going day to day? Like, what barriers are we seeing? What was upsetting this week? What worked well and reverse engineering that to to see where we can change things. And that's that's really the beauty of it. Because if you can do that, then. You're going to give an awesome experience because, you know, you're, you're happy and you're capable and you're not burned out.

So you're going to be able to pass that on to your patients experience. Absolutely. And I think that, you know, it's hearing you guys as physicians talk like this, that's really inspiring people, you know, in medical school, in residency to plan on opening DPC in their future. You know, it's, it's so. Lovely to hear, and this is my opinion, but when I hear, you know, program directors tell me that their whole class is going to go to be hospitalists because everybody wants to get out of outpatient care, and then to hear people say like, this is why, like the reason why I wanted to do that because I didn't know a model like DPC existed.

And if that exists, I need to know more about that because that's exactly what I wanted to do, but I didn't think that that was an option anymore because of insurance. And, you know, I want to put a plug in here, like, this is where making it known that DPC exists in your medical schools, your residencies, your state organizations, you know, whatever it is.

It matters because there's so many voices out there like, you know, I look at the leadership of some state chapters of the AFP. It's like these systems that are large and corporate and the people are leaving. That's not all that's out there.

And we are. Continuing to create these places of quality care for not only our patients, but also so that, you know, we as physicians know that this is a possibility and we are building this community where we're, we're working off of, you know, our first principles and what we went into medicine to do. So I love that now with that, talk to us about your goals for year 4.

I think at this point, I there are a lot of different directions that we can go. I think that right now, building the infrastructure for what it looks like to onboard a physician, since we built that structure for what it looks like to automate. Bringing in additional team members, that's going to be something that we're going to be working on and trying to systematize and really figure out all those how all the gears turn and make a plan.

And my hope is that as that grows, it will be a smooth process where anybody who's kind of curious and. Really motivated and interested in becoming a direct primary care physician. We can say, hey, if this is a good fit, like, let's bring your right on and really make that fairly seamless. And then with that growth.

Now that we can ask ourselves, okay, what are we looking to do in the next. 3, 5 years or so, how are we going to incorporate things like a teaching kitchen, like a community garden, like a space, you know, all of those questions that we're now in the position to ask. We can start thinking and planning for those and whether that's, you know, bringing on, um, health coach, or, you know, any other type of service psychology, what do our patients need?

And how do we respond to those needs? So, from my perspective, it's. Kind of seamlessly putting together this system so that it makes the next few years, um, smoother on the patient side of things. I feel like 1 of my biggest goals is to really try to find a way to kind of bring a sense of community among our members.

That's something that we've talked a lot about. There's like, Different, you know, places in the community where that exists, right? Like, people are so invested in their yoga studio. Like, they're there. It's this camaraderie. Right? And people have the support system. And so we were like, how can we bring that to our own patients?

Um, we're thinking about trying to do some quarterly workshops, or we've kind of started the walk with the doc thing, but it's so hard to, like. For people to always be on the same time and so being able to make things so it's like, is there a way to. You know, do other things throughout the year, or even like, we're kind of brainstorming, like, you know, closed Facebook group, just for our members or something so that they can interact and connect with each other.

So, finding some sort of way to kind of, like, bring our members together and have that support system and kind of, like, have like a little, like, defiant pride, right? Like, kind of just, you know, make it make it feel a little bit more like a family for the patients.

Yeah, and I think this is so on point with what I was thinking, except it was in terms of pickleball courts that I reserve.

So, come and play some pickleball because then I'm actually giving them an opportunity to be physically active. I'd like to talk to the doc and I think. You know, of course, if patients want to be private, they, they don't have to join, but if they, if they were to actually want to be, you know, part of this, my happy doctor family kind of thing.

Yeah, why not?

I love that. I really got to try pickleball. That's my goal.

I'm going to try pickleball. The best thing about pickleball is I think it gives that. The learning curve is not really, you know, steep and at the same time within three, so let's say within three or four times of playing pickleball, you're going to start enjoying it.

Like, no matter how good or bad you are at it, you're going to start enjoying it. Next, you actually have like, when you play doubles, you meet these people and you're like, We were deprived of this throughout COVID, like, we didn't have, like, more of these, like, social settings that, and now, now we have, like, it's funny, the banter and all of that.

It's just so amazing. Like, I really think, uh, the pickleball thingy, I need to, I need to, well, I'm going for a camp this upcoming weekend. It's called Level Up Pickleball. And it's like a 6 hour thing Saturday and 6 hour Sunday. I don't think I've ever done anything that physical in a long time. It's going to be fun.

A lot of my patients have loved it and they've they've lost weight. They feel better. They have every aspect of it. It was actually featured on. The Blue Zones documentary. Oh, yes.

That was like helping with longevity. So longevity, swimming, pickleball, community, um, staying away from electronics, one sort of way.

So I just gave a, you know, like a talk for employees, uh, a local, like San Diego based tech company, which has employees in India too. And here at India does not have the primary care concept. You guys like there's no pap smears, no mammos. Like it's really. It's actually really very hard because when I even talk to them, I don't even know who to send them to because there's these packages that companies make where they can have stress tests and this and that, but it's not individualized to patients like they could have family history of breast cancer and no one's telling them when to start getting screening.

It's just. Everyone gets, you know, stress tests and random things like that. So it was really eye opening. All these people were like, I don't have breakfast in the morning. I just like, I have to do a 2 hour commute to go to work. And everyone was opening up. All these employees were opening up and they wanted to talk about it.

And mostly I spoke about the blue zones. It was just awesome because I feel like. Is the basic sense of life like we are trying to use this supplement and that supplement and something else to like how quick fixes for our problems, but it's really what we eat. What is what we become or what how what we do every day and how we think is what we become.

Yeah, I think it's I think it's time. We look like 60 when we're 90. It's time. Oh, my

goodness with that. Congratulations again, guys on your 3rd of your practice. Can't wait to hear what's happening in your 4 and especially early. Congratulations to you, Jake and Christina and good luck with it.

Thank you guys so much. Thanks so much.

Next week, look forward to hearing from Dr. Lalene Kanji of Ethos Endocrinology in Houston, 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 DPC. We have a five star review on Apple Podcasts and on Spotify now as well, as it helps others to find all these DPC stories.

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

*Transcript generated by AI so please forgive errors.


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