Direct Specialty Care Doctor
Dr. Aleem Kanji was born in Chicago and moved to Houston at a young age and spent his formative years growing up in the suburb of Sugar Land. After graduating high school, Dr. Kanji attended Houston Baptist University where he completed a double major in Biology and Business. He ventured to West Texas where he earned his Doctor of Medicine (M.D.) degree from Texas Tech University Health Sciences Center.
He returned to his hometown of Houston where he completed 3 years of internal medicine residency at Baylor College of Medicine. He then pursued his passion for endocrinology by completing a 2-year fellowship in adult endocrinology also at Baylor College of Medicine, which included training at M.D. Anderson Cancer Center and Texas Children’s Hospital.
He is board-certified in Endocrinology, Diabetes, and Metabolism; Obesity Medicine and Internal Medicine.
In addition to working with patients and improving their experience, Dr. Kanji enjoys spending time with his family, reading, listening to podcasts, and playing basketball.
Watch the Episode Here:
Listen to the Episode Here:
Here's a glimpse of what you'll learn:
How Dr. Aleem Kanji uses Google as a tool for lead generation
The importance of having a meet and greet questionnaire to track how patients heard about the practice, including Google
The increasing reliance on Google for information even in rural areas
Building relationships in the medical community and the challenges of starting a practice from scratch
Tips for maximizing visibility and community understanding through Google My Business Page and positive reviews
Dr. Aleem Kanji's background and experience in endocrinology and patient care
The benefits and challenges of opening a medical practice, including the flexibility it provides for work-life balance
Incorporating telemedicine and adapting to the changes in healthcare delivery during the pandemic
Medication options and individualized treatment plans for conditions like weight loss and type 2 diabetes
The importance of seeking advice and insights from experienced DPC doctors and specialists in the field
Innovations in delivering care and improving accessibility to endocrinology services
Resources and guidelines for managing thyroid nodules and other endocrine conditions
Evaluating the need for direct specialty care and considering happiness, goals, and feasibility
The value of offering additional services like InBodyScan and the considerations of time and costs
The challenges of insurance coverage for certain medications and compounded medications.
In this episode...
Dr. Aleem Kanji of Ethos Endocrinology in Houston, TX, shares his experiences and insights. Dr. Kanji highlights the importance of utilizing Google as a tool for lead generation and shares how he uses a meet-and-greet questionnaire to track patient referrals. He discusses the challenges of starting a practice from scratch and emphasizes the need for building relationships in the medical community.
Dr. Kanji provides valuable advice on maximizing visibility and community understanding through the Google My Business Page and positive patient reviews. He also discusses the challenges in the field of endocrinology, including medication options for weight loss and managing thyroid nodules.
The episode also delves into the benefits of telemedicine, the culture shifts in healthcare delivery due to the pandemic, and the value of direct primary care. Dr. Kanji highlights the importance of finding happiness and achieving goals in clinical practice and explores the feasibility and business aspects of incorporating direct specialty care.
Overall, this episode offers valuable insights for healthcare professionals looking to establish a practice, navigate the challenges of endocrinology, and provide exceptional care to their patients.
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Address: 2500 Fondren Rd Suite 320, Houston, TX 77063
Telephone Number: (713) 804-8349
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Transcript*
Direct primary care is an innovative, alternative path to insurance driven healthcare. Typically, a patient pays their doctor a low monthly membership and, in return, builds a lasting relationship with their doctor and has their doctor available at 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.
Direct specialty care to me is restoring the patient doctor relationship. My entire path in medicine has been led by the belief that the patient doctor relationship has the power to transform that person's health. To me, the direct care model is the ultimate manifestation of that. I am Dr. Aleem Kandjian of Ethos Endocrinology and this is my DPC story.
Dr. Aleem Kanji was born in Chicago and moved to Houston at a young age. He was raised in Houston in the suburb of Sugar Land. After graduating high school, Dr. Kanji attended Houston Baptist University, where he completed a double major in biology and business. He ventured to West Texas, where he earned his doctor of medicine degree from Texas Tech University Health Sciences Center.
He returned to his hometown of Houston, where he completed three years of internal medicine residency at the highly ranked Baylor College of Medicine. He then pursued his passion for endocrinology by completing a two year fellowship in adult endocrinology at Baylor College of Medicine, which included training at MD Anderson Cancer Center and Texas Children's Hospital.
He is board certified in endocrinology, diabetes, and metabolism, obesity medicine, and internal medicine. In addition to working with patients and improving their experience, Dr. Kanji enjoys spending time with his family, being a girl dad, reading, listening to podcasts, and playing basketball.
Welcome to the podcast. Dr. Kanji. Thank you so much for having me. I'm super excited because we have been wanting to do this podcast for such a long time. And so, you know, we're going to be adding your practice to the mapper on my DPC story so that other people can find even yet another doctor in Houston.
And this time we're talking about endocrinology. So I love that when you talk about in your opening statement about transformative health care, you truly are doing that because the endocrine system affects a ton of stuff. So this is wonderful to have you and it's only been so far you and Dr Haley Miller who have talked about direct endocrinology on the podcast.
So I want to get started with a video you posted about a year ago. It was a video featuring your practice, a patient, you walking a patient down the hallway, your wife was in the video. And you talked a little bit about your why and you said that it's hard to take a risk like this referring to opening and direct care practice.
So tell us about what your life looked like before you decided to make this hard decision and open up Ethos Endocrinology.
Yeah, absolutely. A big part of reason why that was such a risk is I did that right out of fellowship. Right. And so coming out of fellowship, especially with the financial burden, we face that from medical school and so forth.
And so taking a risk on starting a new practice just in of itself, but especially a direct care model where perhaps that business model is not so tried and true. Compared to traditional insurance based private practice was quite a risk. And so I flip flopped on that decision for a long time in my last year of fellowship, but thankfully, uh, the situation just kind of ended up to where what I was looking to default to or the position I was looking for wasn't there.
Not surprisingly, it opened up after I committed to opening my practice, right? It's funny how life works. And so I feel like life was telling me to push in this direction. And so we took the
risk. I love it. And in part of that video, you also shared that your wife was the one you gave credit to your wife as the one who pushed you.
And so I'm wondering when you're talking about this flip flop area, what made you go to the flop rather than the flip? Yeah. Uh, so, you know, she, she was just encouraging saying, you know, we're in a position where we could. Take that risk. And if it works out, then great. You know that the upside is tremendous there.
Whereas if it doesn't work out, well, it's not a complete indefinite commitment. You know, there's availability for endocrinologists in the regular world, so to speak. Right. And so that combined with the ability to, to really practice medicine the way that I've always dreamed. That, that was the push. And so, and so we went for it.
And I just love that, you know, you guys went into this with, you know, your wife says this in the video that like, let's just try it. And what's the worst thing that can happen? You're still going to be board certified in endocrinology, obesity medicine, and internal medicine. So I love that. Now you guys also made the decision to start wearing all the hats yourselves.
And when you opened, and I don't know if this is, has changed, but when you opened, it was just you and your wife, Irina, who's a nurse practitioner. Doing all the things. So how did you guys decide to open your clinic with that as your model?
Actually, I drew inspiration from the DPC community there, right?
There's, there's a number of DPC docs that are really running kind of this micro practice, right? And they're, they're leveraging technology to be able to, to wear all the hats. And so I drew inspiration from that and, and kind of looked at some of those techniques. And between the two of us, that's what we do.
And we actually continue to do that as of now. We are probably right around the corner on getting some additional help. But one of the beauties of a direct care model is just that it allows for multiple hats to be worn if someone desires that, right? And that tremendous overhead that's in a typical practice isn't there.
Absolutely. When you talk about, uh, you know, other doctors who have really maximized micro practice, I definitely want to give a shout out to Dr. Lauren Hedy out in Rhode Island, who has demonstrated on the podcast, what they're doing and their practice continues to grow, um, while keeping overhead low. So we'll go ahead and attach her podcast also to your blog.
When you guys decided to, you know, wear all the hats and this is going to work for in decided this is going to work for you. How did you divvy up the particular roles? Like in terms of. Who does marketing? Who does answering a patient request to join the practice? Or does everybody do it? Do you and your wife do everything?
It is a little bit more split. So, for example, clinical care is all on me. And then the rest kind of depends on our schedule. So, we based on kind of our availability. So, for example, you know, she has a part time role as a family nurse practitioner with an academic institution. And so, on certain days, we may be kind of switching hats there, but certainly kind of the bigger picture items of clinical care more so fall into my lap.
And then the number of administrative things and these other things to kind of make the machine run that a lot of that falls on her. Got it.
And going back to that. We've been wanting to do this podcast for a while. One of those reasons is because we have kids. So tell us how did you bring family into the fold so that you could still be a dad, still be a husband and still be a doctor?
Yeah. So this is, this is a tremendous topic. My number one reason for opening this practice was Practicing medicine that I wait in a way that I felt like really did justice to our patients, right? And the way I like to phrase this phrase, it is restoring the patient doctor relationship right after that was having flexibility.
My schedule to be present for my daughter, right? And so I can't imagine another position where I'd be able to drop her to school every day and pick her up every day like I do, right? I have that flexibility and Granted, and I think we make we may go down this road a little bit later on in our conversation, which is it comes with with a level of sacrifice, oftentimes financially.
But when we were making the decision to do this or not, 1 of the things that I I was telling myself or framing was. Well, when I'm on my deathbed, am I going to miss X amount of money or will I want to have remembered those times that I spent with her when she was a child? And I felt like, I mean, that, that answer is quite easy.
And so absolutely. I mean, this was the second driving reason for this.
It's so interesting because as you talked about, like just after you decided to open up Ethos Endocrinology, your thought was your ideal role opened up. It's so interesting. If you had that ideal role open up while you were still deciding and you went that route, how many years it would have taken you to realize what you realize now.
And I wonder how do you. done that role, would you have thought about, you know, if you were on your deathbed, what would I be proud of at the same moment in time or later? So it's, it's so interesting to think about the shoulda, woulda, couldas, but in your case, so glad, and I'm sure your daughter and wife are also so glad that you chose this path.
When you talk about that you're on the cusp of maybe hiring someone, what is bringing you to that
point? Me, it's it's the additional administrative help. And also I do split my time between taking care of people either in person or virtually. And so having that additional help will actually open up a little bit more face to face time in the schedule.
And that's actually the larger driving factor. And, uh, to be very specific, it would be Mondays and Tuesdays, right? So I do quite a bit of virtual Monday and Tuesday, but being able to open up the face to face space or office visit space Mondays and Tuesdays, that extra help would allow for that. And so that's going to be the next step here in the near future.
Love it. And I have this question later on that I was going to ask you, but I want to ask now, when you talk about that you're available virtually, what states are you licensed in?
Yes. So right now, Texas and Florida, uh, that may potentially change. That's actually something that I'm looking, uh, looking into right now, but those two at the moment.
So you heard, you heard straight from Dr. Kanji's mouth, Texas and Florida for now. That's awesome. When you talk about your, you alluded to this a little bit, when you talk about the financial part of the risk, uh, opening your practice, how did you guys prepare financially to open up ethos endocrinology?
We're very blessed in that we, so during residency and fellowship, we stayed with family and having the opportunity to stay with family and those funds that would have otherwise gone to, let's say their mortgage or rent and everything that comes along with that. We shifted all of that to loans. So we aggressively paid that down to where when I graduated fellowship, actually we, we had no student loan debt and we'd built savings.
And those savings were utilized to, to start the practice.
Amazing. And I love that you had that experience because you're another person who, you know, is living by example of opening after, you know, fellowship money is still not a lot more than residency money. And so when you're talking about, or when you're talking to residents who are like, I can't do this out of residency, it's like you are definitely an example of how when you're bootstrapping it with the intention of paying off loans and you, you know, you never know most of the time out of residency what you're going to do next.
However, you know, knowing that you could go ahead in life with less debt because of how you budget is amazing. So I love that you guys were able to achieve that. When you decided that you were, you guys were going to open the practice, how did you decide it would open? Did you decide to have a physical space from the get go?
Did you start with telemedicine only? How did, how did you guys open?
Yes. So we did go, go forward with physical space. And so, uh, I'll backtrack a little bit here. You know, in the way I approached it is. Completely from scratch and not utilizing a consultant, so I kind of drew from some of these blueprints.
A lot of it from the DPC community again. I mean, it's so phenomenal how kind and resourceful the community is and so that that was really helpful. And so I piece these things together from scratch to try and avoid the cost that comes with a consultant to build it. Thank you. And for me, I did want a physical space.
Now, it's interesting retrospectively, the way things have evolved. And I think COVID made this push, right? Which is that there is a lot of feasibility in opening virtual first. Or if you do want a physical space, I think one piece that I could have done differently, and I hope this is helpful for someone who's looking into this, is subleasing, right?
We generally don't need a big space and if you could someplace you take that risk out, drop the overhead and then you can grow into that. And I think that was that would have been a fantastic route to go. It's not something that I ultimately executed though. I did lease out of space and we're fortunate that it worked out really well.
We, we found a space that worked perfectly for us with a landlord who's great to work with. And so that was kind of our, our approach, but certainly those one or two pieces, I would share with someone who is maybe kind of on the journey of opening, maybe thinking virtual first or a subleasing.
And especially, you know, because like you mentioned the pandemic, it really changed the whole culture of healthcare and how it's delivered in this country.
And lots of DPC doctors will tell you, like, we've always been doing telemedicine. However, I love that, you know, when people are. You know, hearing your story there, some people have not heard that history of like, oh, the DPC doctors have always done telemedicine, but you're really showing how, you know, Hey, like if 80 percent of our visits come from history, it does not need to be in person all the time.
So it's quite amazing and convenient. I feel for us to be able to do things virtually when we can, it was interesting because prior to your episode, Dr. Stephanie In, uh, Georgia does not cover telemedicine. So, you know, definitely something to check with, with your malpractice in your state, but super interesting.
And, you know, I hope that definitely changes for her, um, because telemedicine is so wonderful as a tool to have in your belt. So when you decided to open your practice, did you have any issues with non competes in your area? No, you know, coming right out of fellowship, I didn't have any, any prior employment that, uh, that hindered me geographically.
And so we really got, got to pick a location that we felt would work for us in terms of, let's say, population served as well as Kind of the other, other family logistics.
I love that and I'm so glad you have that experience. I didn't actually know if that was an issue with residency and fellowship contracts.
So I really love that that was the case. Do you know if non competes are an issue in Texas in general?
Yes, they are. Um, I know from colleagues that they are, especially with either academic institutions or hospital systems that, that those do come into play and they, they could be, they could be troublesome.
Definitely. And take a listen to, you can find them on the DPC mapper, but take a listen to other Texas doctors who have shared about their stories, including touching on non competes. When you were opening. And you were in your space, how did you decorate your space in terms of like, did you have somebody come in?
Did you guys do it yourself? Cause you have this amazing sign that, you know, if you're into the YouTube, you can definitely see in the background, but how did you guys make the space yours?
Yeah, we, we, we approached the design ourselves. And so the credit again, I have to give to Irina about that. I can't say that it's my forte, but we, we, you know, we, we utilized, uh, some of the, the colors, particularly the blue in our logo, and then kind of went, went through the space and again, I think, I think it, I think it turned out, turned out well, and so, uh, yeah, everything, everything was from scratch.
It was quite an experience to, to do this, but it was, I think ultimately what was the nice thing about it is. We really were able to create a space that we felt like was our own and welcoming and conducive to the experience. We want to give to our patients that come in and not to mention, we got to learn throughout the process to have kind of what it entails to get a space and then.
Having to kind of renovate it.
Awesome. And I love that, you know, as you're talking there, it's really getting it developing a space so that you can have a space for that doctor patient relationship that you yearn to have. So when you talk about doing construction, did you add some rooms to the space? And was that what did you get some help from your landlord?
In the build out. Yes. And so the prior tenant was a dentist who was in this space for over 20 years and that same carpet was there for over 20 years. And so we did have some changes to make. And we, we, we changed some of the structure, not significantly, but if someone were to join us and towards the back of the clinic, what they would see is that We have one room that's dedicated to consultation, and so we get to sit across from each other, have a conversation in a relaxed kind of setting on couches, and that room has a window with sunlight shining through.
It's really nice. And then when it's time for the exam. We moved to the next room and take care of our physical exam. And so that's how we've broken it down to kind of have that have that experience. And there are some other pieces involved as well. But that backroom structure was the biggest lift, if you will.
And then to answer the 2nd, part of the question. So, yes, our landlord has been great to to work with. And so for anyone who's going down this route, 1 thing to ask about is. Are there any tenant improvement funds available? And so in our situation, two thirds of the cost was covered through tenant improvement funds.
Amazing. And, you know, I'm assuming that's really, really good, especially for being in the Houston area. So that's, that's definitely wonderful and I would say when you're talking to landlords, you know, and you have, if you have multiple options, it's interesting because even if the, you know, no matter what they say could be covered as a tenant improvement amount, just the way that they talk about it, I'm sure would give you, you know, an inkling as to how that person values their tenants rather than, you know, treating you as a number.
So. Interesting. I just thought about that when you're talking now on your website, when you go to the first page and when we were scheduling this interview originally, I don't think your website was the same. I think it's, I think it's been changed, but when you, when you open your website, it's like there's your couches and there's you doing a consultation right there on the, on the front or at the very top of your page.
So you can definitely check out Dr. Kanji's website to see that. And another thing on your website is this, you know, right bold next to you doing the consultation. It says, Hormone and weight loss specialist in parentheses endocrinologist in Houston, Texas. So let's talk about that because when we talk about SEO and when we talk about people understanding who you are, if they're checking out your website at two o'clock in the morning or whenever they're, they're looking at it.
What made you change your copy to say that specifically?
It's a great question. The website is actually only or I should say that the revamped website is only a few weeks in you as of this recording. And so I would say every so often I try to learn a bit more about marketing and it's such a Big piece of what we do, right?
Even though it's not necessarily our favorite, I would say. And one of the things that I was reading about was, okay, as far as website structure goes, in particular to your point copy, the moment someone hits your homepage and they call that above the fold piece, right? So we're right above where they don't need to scroll what immediately hits them in the face.
They should be able to identify what you do. Within two, three seconds. And if they should be able to identify it, understand that. And if they can't, then a lot of times that they may leave. Right. And so I wanted to make it very clear that, yes, this is what I do, hormone and weight loss. I'm a specialist in it.
And again, for Google, that's kind of crawling the page. I also wanted them to realize, okay, endocrinologist, but that was the purpose behind that change. I love it. And, you know, I'm sure that There's a lot of people like making notes, like, Oh my gosh, I'm going to change my copy. Now I'm going to change my before the fold copy.
And you know, it's, it's interesting. I think I mentioned this on a previous podcast when I was working in St. Joe's in Phoenix, uh, during medical school, they had a change from the badges saying doctor to physician. And people were like, so what are you? And people were like, I'm a physician and they, that needed to be clarified for some people and, you know, in terms of if English was a second language, or if that word just wasn't familiar to them, but they knew the word doctor.
So copy does matter. I learned this when I was doing a. We had a county health summit, our very first county health summit, and I was talking to people about that we're full, that we're the only, my husband and I are the only full scope family physicians in the entire county, we're the only people offering obstetrics care in the county, and people were like, what's full scope mean?
And it was like light bulb moment for me because I was like, Well, there's lesson learned. So in the future, I will not be saying that because it's so familiar amongst full scope family physicians, but clearly not everyone is a full scope family physician in this county. So great points. Now, when you talk about your patients finding you, because especially your copy is so like clear.
Who has found your practice over time and has that changed? It has. We, over time, we have seen more people find us through Google search. And so that has grown some, but what's grown more so, uh, and this is just kind of, you know, time being around and trying to provide. The best service that we can, which is word of mouth from family and friends.
So that piece has probably grown the most over the time that we've been open, which is really nice, right? It lets us know that we're doing something well and people appreciate it. So certainly we're trying to continue to grow both aspects of that. I love it. And when you talk about copy, you talk about patients finding you and you mentioned Google.
How have you maximized your Google presence? Or how have you encouraged people to help you maximize your guys Google presence so that more people can find you? Absolutely. So one thing I would share with either, you know, current DPC or direct specialty care physicians or those that are looking to start a practices, get your Google My Business.
Page set up definitely and not only set it up, but complete the information. So there's a lot of different categories on there ranging from basic things like your hours, but add office pictures on their ad. As much information as you can and then ask for reviews, I don't hesitate to ask for reviews and in an ideal situation have a system for for reviews being asked and so that has helped us a lot because on several occasions we've had people reach out to us.
And say, oh, you know, we read your reviews, um, whether it's someone on the phone, uh, requesting a consultation or someone that has come in and we're asking them, how did you find us? And they're letting us know about the reviews. And so that's a big piece is definitely complete the Google my business information and and ask for reviews.
I love it. And just throwing something in here, especially if people are wanting to find, you know, what their lead generation is, what we do is when everybody goes through meet and greet, who wants to join the practice and part of our meet and greet questionnaire includes, how did you hear about us? And so when you talk about Google, I cannot.
mention the number of physicians who could agree with you or who do agree with you because we're finding it more and more even in rural America where I am, people are like, Google, Google, Google, you know, it's, it's crazy. So I definitely, you know, second what you say, and you can really, you know, use this tool to help maximize your visibility and people understanding, you know, what you do in your community.
So. What about on the bottom of your website, um, on the homepage, you have your reviews flashing. How did you make that happen? Yeah. So this is actually a plug into my website is WordPress based. And there is a I'm trying to think of the name of the plug in. I think it's called WP Reviews Pro. It's a very nominal cost.
I believe like 30 a year, maybe not much and you just plug it into to your WordPress website and then you can customize that slider to however you like as far as the number of reviews and how it displays. And again, this is another support for collecting reviews, right? And because people are looking for that evidence that, hey, I'm going to have a good experience.
And especially as a direct specialty care physician, you know, I feel like the value proposition that comes with direct primary care is so much more easily explained and understood for a reasonable monthly membership. And you're getting almost unlimited primary care. I mean, that's it. Like, that's so well understood.
As a direct specialty care physician. You know, that could be a little bit more challenging to come across, uh, to get across rather. And so any evidence that you have to support other people's experience, I think is really valuable. Love it. And with that said, I want to ask about your pricing because this is a conversation question that I have with If not all, most of our specialty care doctors who come onto the podcast going between membership, no membership, would a membership plan ever work in the future for your type of practice?
So for you being an endocrinologist doing obesity medicine, doing internal medicine as well, how did you determine your rates?
Yes. So I'll speak to a couple of different points. In the very early days, I did have a membership that I offered. And I think there's likely a number of factors being specialty only as opposed to including primary care.
And then just the population. It wasn't a very popular choice. And so, for me, kind of that fee for service type setting was more helpful. And I think people found that lack of commitment, if you will, to a specialist kind of more accessible and reasonable for them as far as pricing goes, I think 11 kind of benchmark that I looked at was, you know, what are the Medicare reimbursements for the codes that I would normally be be billing.
And so that was kind of a reasonable benchmark. But I would say. I definitely made the mistake of undercharging, uh, significantly. You could argue the amount of price still undercharging, but I think this is, again, this is one of those things where if I likely was in an employed position or had that other type of experience, perhaps I'd view the pricing a little bit differently, but certainly for specialty care physicians out there.
That are looking to start or, or grow their practice, I think that benchmark is helpful, but certainly don't, don't make the mistake that I did of, of undercharging, you know, I think this, the service and the quality we provide is, is incredibly valuable and, and there are a number of people that, that see that, and so one thing is certainly competing on prices is not the ideal scenario in my humble opinion.
And how about those people who join the practice? With a membership in mind, how did you transition them because you're no longer offering memberships? Yes. So in that situation, what actually happened is all of those individuals naturally kind of had an end to their membership in one format or the other.
Um, and so that, that really, really was an issue. And, and so whenever I did transition and for those that were remaining, I honored that, that contract because that's how it was stated. And so, and that, that wasn't a problem, but so it ended up being a relatively smooth transition. Awesome.
And one thing that I had noticed also between when we first were working to schedule this podcast and now is that your prices have increased.
So when you talk about just the standalone price for an initial visit, having increased and you said, you know, it's not, it might not be still reflective of what you're the value that you're bringing to your patients, but. How did it feel to increase your pricing and do you feel about increasing pricing differently now that you've been in practice for quite some time?
Yes, I definitely it's, it was, it was, it was a scary, scary thing, especially not so much increasing the console, the initial consultation price, but the follow up pricing while sending that email out was scary, but it wasn't necessary though. I do know the amount of. Thought and care that I put in for every single person that I take care of.
I mean, this is again the whole reason why I opened. And so I knew it was time to do that. And I was getting encouragement from colleagues, which was really nice. And I think one of the other nice things we find is that for all of our practices, we tend to have a certain population of people who maybe fit the best for us.
And when. Our prices can actually align with that value and population, right? And a lot of times that happens. And so I think what I found is that that alignment was a bit better and it's always a work in progress, but taking that initial step was scary, but it was, it was helpful. And something
that is so normal.
I just remember a dear friend, Dr. Krista Springsteen, who's in Georgia. Uh, she's also an internal medicine physician, but she, uh, took a selfie with her and her letters that were physically going out to her patients about increased pricing. And it's like, it is definitely something that can evoke fear in a lot of us.
We're still alive. Like it's amazing. So this is, this is a, you know, a word of support for those people who are like, I am coming to a point where I am realizing that I am undervaluing my own services while still trying to make a price point that is, you know, that is going to work in your community. So you also have an option for a separate fee for body composition.
So tell us about that offering part of your clinic.
Yes. The reason for the body composition is as part of medical weight loss or medical weight management. So one of my board certifications is obesity medicine. And my particular area of passion is the intersection of endocrinology and obesity medicine and to be a little bit more granular.
So a lot of us know the rising incidence of both say type two diabetes and obesity when we look at something like pre diabetes. And now something that is getting more and more attention, thankful and hopefully that grows is nonalcoholic fatty liver disease, right? Um, this quickly became the second leading cause of liver transplantation.
So these entities, especially in the earlier stages, have the ability to be reversed. And so when we look at something like weight loss that has data to show that we can. Reverse prediabetes or improve non alcoholic fatty liver disease or even Nash non alcoholic steatohepatitis to an extent. Uh, that's kind of where my, my passion lies.
And so we utilize body composition. To give us an idea regarding, okay, how much total body fat mass are we, are we looking at, or, or, or visceral adipose tissue and lean body mass and utilizing those metrics to to help guide how we take care of individuals.
Love it. And it's definitely something that I love that you have that because clearly it, it goes along with your practice and it, you know, arguably is a necessary thing to know to have baseline and trackable data for your patients beyond blood work.
But when it comes to other people who have scans, you know, in body scan is a, is an example. Dr. Adam Schulte has that in his clinic in Yorba Linda, California. But it is a service and so, you know, and I'm not, I'm not saying like everybody has to charge separate for everything, but if that works for you and that's another way that you can bring value to your practice, that's definitely something to consider because, you know, I, I think about the time that it takes to do these things, whether it be, you know, a composition, whether it be, you know, the tools you have to buy for a procedure, whatever it is, you get to decide whether that's included in a membership Or a service fee, or if that is a separate service fee or an additional charge to your membership.
So I think that's a good point to make. When it comes to, you know, this is a hot topic out there because there's so much news on the agonists and compounded medications and I can't get them, the insurance is, you know, denying unless the BMI is 40, it can't be 39. 5. How do you go about dealing with not only, you know, having come to a decision or recommendation for your patients, but how do you go about navigating this world of, you know, a ton of people are wanting these medications?
And we're getting kickback from the insurance companies to prevent people from getting medications that treat obesity.
This is, uh, not the million dollar question, but perhaps the billion dollar question, right? Okay, so the, the approach that I take is certainly the GLP and let's say, the newer generation, so Terzapatide or Munjaro, the kind of dual hormone agonist, excellent trial data for weight loss.
So certainly, These medications tend to be at the top of the list, but one of the approaches is that it's still individualized to each person. And so let me, let me give an example. There may be someone who comes in for medical weight loss and and going through that detailed history, we find out, well, for them, let's say they're contending with emotional eating.
Well, in that case, perhaps. Yes, the GLP 1 agonist certainly may be on the list, but perhaps a different medication that's better suited for that, for example, Contrave, as in this particular example, may work well for them. And so I think individualizing that treatment plan is helpful because not necessarily everyone is a right fit for those types of medications.
As far as navigating it otherwise, you know, I wish I had kind of this, this secret to share, but it's the same challenges that everyone faces. I think for those individuals that have a covered diagnosis, like type two diabetes, you know, certainly we, we utilize that again, if it's a good fit for them, something that's exciting is the relatively recent.
Cardiovascular data on week on week Ovi or mg. So perhaps if that FDA approval goes through for cardiovascular protection, that may be something that that helps us. But certainly the same challenges that everyone faces. Well, I'm guessing people are just like. You know, nodding their heads in agreement because I've had people text me like, Hey, do you do anything special to get, you know, blah, blah, blah.
And I'm like, because there's no way that I can, you know, I've no, I found no way to beat the system either. So this is where we are at. But I, I love that when you're talking about, you know, what are the foundations driving obesity? And in this case, we're talking about obesity. You have the time to ask those things to find out those questions like I can imagine, you know, if someone is just coming in and their BMI has been calculated by the EMR or whatever, and it's like, okay, the to get codes, we can talk about this BMI and here's your prescription.
We don't know if it's going to be covered, but here, let's write your prescription and, you know, I'm not, I'm saying that in a hypothetical example, who knows if that happens in fever service, but. Arguably, uh, when you have time to talk with your patients like you do and build that relationship, I'm sure not only can you find out that emotional eating is going on, but also you have time to like over time through follow up visits, make an impact in the mindset of your patients.
You know, I do. You're shaking your head. Can you speak to any HIPAA protected examples of how that has manifested in your clinic?
Yeah, I guess the 1st, the 1st example that that comes to mind is. Someone that was a good fit for a GLP one receptor agonist over time, what we realized is that was helpful and that weight loss trajectory and to be more specific, the fat loss trajectory was exactly what we wanted.
However, she was telling me that my brain just won't be quiet like regarding my appetite. I'm like, my appetite is like almost ravenous. Well, in that situation, then we discuss, well, do we need a second agent to help quiet that? And this is the beauty of establishing a relationship and carrying it over as we did that, right?
We added a second pharmacologic agent and it made a big difference for her. It quieted that hungry brain, so to speak. And so we're using those at the same time and it's, it's made a significant difference for her.
That's awesome. And I'm sure there are also people thinking about, you know, the conversations they've had with patients when it comes to just chronic illness in general, and how.
People are coping with chronic illness differently when they have a doctor who they can talk to who knows them. So when, you know, we're getting all excited about that, you're bringing this type of medicine to Houston or to the Houston area as well as Florida on your website, you have a button that drops down and says location.
So I'm wondering, there is a future location coming soon.
Uh, great question. So for now, not another physical space, perhaps maybe some, uh, some virtual space based on licensing, but for now, the physical spaces is working out well for us. And, um, you know, perhaps perhaps in the future.
Love it. Now, how about when a patient signs up for your practice, you have to manage them on the backend.
So in regards to choosing an EMR, how did you choose one that works for your brain as an endocrinologist?
Yeah, great question. I, so mentioned mentioning it again, just how helpful the DPC community has been, right? So when I was in that, in that phase. I was looking at, okay, what are the most commonly used by by colleagues and what they found helpful.
And so I had a list. And then from there, I just went through each and try to demo it, learn more and see what would be a good fit for what I perceive to be kind of my flow and my needs.
And I think that's another challenge when you're starting from scratch without, I guess, prior attending experience. Whereas I think for many coming from Position where they've had several years of experience that you can identify. Hey, this is what I want my flow to be. And so I definitely encourage demoing and asking colleagues as far as what's your experience been like?
Can can it do this in this particular flow?
I love it. And especially as you know, there's more and more products coming to market. I definitely would say. Something when you're talking about asking others, I definitely would ask people who have switched DMRs, what's their experience been, and I definitely would talk to people, especially in their, you know, 3 to 5 year, uh, time span for their DPC, because when I opened, I had all these, you know, I'm going to do this workflow, I'm going to do this workflow, and then it's like, Oh, that workflow doesn't actually work.
So I got to change the workflow. And then, so, you know, when it comes to people who are, you know, they're out there, they've been there, they've been out there a little bit more in terms of time from opening, you can learn a lot from these people. And so, you know, those are, those are great tips that you have.
And there's others who have shared on the podcast, but also people who are on the Facebook groups and whatnot, you know, just reach out to people. If you, if you, you know, pick up like, oh, they changed AMRs. Why? How was that process? What was the. What was the easy part? Difficult part? All those questions. So you mentioned earlier now that you are thinking about hiring a person to help with the administrative tasks so that you're able to have more in person time.
What does your everyday clinic look like right now, given that you are picking up and dropping off your daughter?
Absolutely. So for me, drop off, uh, occurs ideally around 8 a. m. I laugh because for those of us, uh, you know, contending with that traffic. Oh my goodness. So we'll keep it with the ideal time frame for now.
So 8 a. m., right? But so official start time is about 8. 30. And Mondays and Tuesdays, I'm predominantly virtual. Uh, Wednesday through Friday, most of our schedule ends up getting booked with. Either office follow ups or initial consultations, which are usually done, um, face to face, um, as well. And it is sprinkled in with some virtual as well.
And so that help, uh, on Monday and Tuesday particularly, would open up some, some of that, uh, kind of face to face follow up time. And so that, that's the thought process behind that.
Love it. And yeah, I'm just, uh, I'm laughing also because like... We have one lane in each direction. And so our, our traffic is very different than like where I grew up in Sacramento or Houston.
Cause I'm like, Oh, people are cutting down trees today. Or there's a deer crossing the road, like very different traffic situation, but traffic is real when you're dropping kids off at school. So I love that. And all the parents out there and guardians can totally relate. Let me ask you now that since you've been open a while, how are you making connections within the Houston area as well as in Florida so that other people are aware of your practice?
So I will say I haven't done much to build that Florida, those Florida relationships, so that's something on it on the to do list. But as far as the Houston community goes, there's a few different things. I think Part of the main, the main piece is just connecting with colleagues, right? So certainly here in Houston, uh, you know, we, we do have a nonprofit for, for direct care positions.
So just kind of collaborating with DPC colleagues has been wonderful. And then also reaching out to, to, to colleagues in the, in the fee for service world, right? Because there are, there are individuals who, depending on where you are, the wait time to see someone in a specialist can be significant on the order of months.
And that is not conducive to someone's health care, particularly for things that are more urgent. And I'll give a endocrine example, hyperthyroidism, right? So uncontrolled Graves disease, quite common. And so waiting two months is, that's not acceptable. So I think, you know, reaching out to two colleagues and just letting them know, Hey, I'm here.
They don't have to wait two months. I can see them in the next. A couple of days. I'll just, you know, just let me know. And I think that that's been, been, been my approach.
Amazing. And you know, that whether you're in direct care or not listening to this podcast, I'm sure you're shaking your head because like, I don't know where it's not months to see an endocrinologist.
Like if you're in that area, let me know. And if you're seeing an endocrinologist in fee for service or sending your patients to, because I don't know of a place that I can pull off the top of my head that the weight isn't months in fee for service. So, I love that you're there, you're accessible, this podcast exists now, so hopefully more people in Florida will be like, Hey, got to contact Dr. Kanji. So, yeah. So, what about when you look back, reflecting on your experience so far, what are some of your biggest challenges and how have you overcome them?
Biggest challenges. Certainly, I think for me, it would be from the business side of things, right? And I think many, many of us would agree.
Certainly, the marketing piece starting from scratch, it's a significant challenge. And so when I have colleagues that reach out and I've had the privilege of speaking to a number of different endocrinologists across the country about this type of model and them asking about my experience. One thing is having an established Patient base, right?
Even if it's in the insurance based kind of fee for service model that eventually gets converted or just having a reputation as an attending in a particular community with patients and perhaps even more significantly with colleagues that that makes things easier. And so that marketing piece for me was very challenging, literally starting with zero patients as a brand new attending.
And I continue to try to spend time to figure out what can I do to, to improve that piece. And that's a ongoing project, but I think that's certainly been biggest challenge for me in my particular situation.
And, you know, I love that as you say that, you know, your SEO has changed because of the way you've changed your before the fold, uh, copy on your website.
And the only way to go is up, right? Like even again, like, even if we don't decide to do direct care in the future, it's like, You still not lived life in a way that you would potentially regret it. So love that. Do you think that direct care doesn't work for any particular specialty?
Oh, good question. So certainly, I think specialties that Could be very procedure heavy.
I think that can be challenging, right? Sometimes the cost for that. However, I mean, we do see innovative things and and the name I'm blanking on the name. I don't know if it's the surgery center of Oklahoma. I mean, you see these these innovative models where now, I mean, there's there's surgeries that can be had for cash pay, right?
That's that's the model is referring to. But I think I think it is a little bit more challenging for for those types of specialties. Whereas I do see. That transition to direct specialty care being much easier for, let's say, psychiatry, endocrinology, I think neurology, I recall seeing a couple of episodes on your podcast with neurologists, right?
And then I think it also lends itself to dermatology as well, granted procedures in dermatology, but perhaps the scale is a bit different compared to, you know, let's say, interventional cardiologists, right? But I think for a number of subspecialists, it's certainly worth.
Definitely. And something that I'll put here.
Um, recently I was on a panel where we were talking about specialty care access in the direct care space. And there is a, an orthopedic surgeon in Florida. You should totally connect with this person. So he has a company. I think his focus right now is mainly orthopods. To help a person negotiate with hospitals and with procedure centers to, you know, bundle prices so that they're still able to do care and do care with a cash pay option.
Um, so definitely, like, you know, I, I think about what we're doing, you know, Dr. James Gore wouldn't argue that it's not necessarily innovative what we're doing, but what I do love is that when we have the freedom to think when we have. Less administrative burden when we're able to be at peace with our practices, we can do things to innovate how we deliver care.
individually to our patients. So I love that. Now going back to what we're talking about with endocrinology and especially in fee for service not being so accessible. If there were a primary care doctor, whether they be in pediatrics or adult medicine, I know your, you know, your realm is adult medicine, but do you have any resources that you recommend specifically for endocrinology references for people to go to if they're in primary care and they're Not necessarily get at the point that they need an endocrinologist to do a, you know, a consult for their patient, but they're still wanting to do a little bit more digging and potential adding something to their care plan for their patient. So for example, thyroid nodules, what do you do with thyroid nodules? How do you determine if something is concerning whether, like, especially in those cases where you get like an incidental Loma and you're like, what do I do with this? Where do I go to look for the best guidelines and the best advice?
Absolutely. And actually, I think you hit the nail on the head, which is that our guidelines are actually quite good. And so particular resources. So one would be the endocrine society guidelines, and they have very specific topics that would be helpful. And then when it comes to thyroid, then American thyroid Association, and some of those guidelines are.
Published further back, but they're but again, still, still very helpful and they're incredibly detailed. They can be overwhelming. However, the way I would approach it is what are the initial steps as far as risk stratifying goes right? And those those guidelines are helpful for that. Okay. Now, I have this diary nodule.
What what's that initial step and there it's quite helpful there. And so between the 2, I would say. Endocrine Society or ACE also has guidelines as well. American Association of Clinical Endocrinologists. Then thyroid focus would be ATA, American Thyroid Association. I think those are great resources without having to feel overwhelmed into the nitty gritty, but just starting that risk stratification or management piece.
Love it. And I'm going to ask this question just because, you know, in your bio, you say that you love listening to podcasts. So are there particular medical podcasts that you enjoy listening to?
Yes, certainly, uh, so one that I've this is I've been listening to for a while is the curbsiders, right? And this is also an opportunity for me.
Of course, the endocrine ones are devoured quite fast early, but there I have these other other areas that I certainly want to learn about just to give an example. So the ones that come up on hypertension, resistant hypertension, I'm certainly all over those as well. But yes, shout out to the curbsider podcast.
I do enjoy that. I love that you mentioned that because I was like, this is such a curbsider type question. Now they start their episodes is like, what's your, what book are you reading now? Like what's your hobby? So I love it that that is perfectly fitted for, for that part of the, of your interview. So I love it.
And then in terms of, so I love that throughout this whole podcast that we've, you know, really gotten who Dr. Kanji is, who, you know, Dr. Kanji is because he has ethos endocrinology. What I want to ask now is, What would you say to other people who are considering doing direct care specifically? Yes, so I will answer the question focused to direct specialty care.
So for me, again, touching back to what I mentioned earlier, which is I think that that value proposition for direct specialty care can be a little bit more challenging, but that's not to say it's not there, right? Certainly the time, the quality, the access, it's undeniable. The way that I would approach it when I'm asked this is.
I always let someone know, what is your goal? What are you wanting out of life? Which is seems like such a broad question. Almost seemingly almost unrelated, but it truly is the guiding piece, right? If someone is saying, you know, I'm pretty happy in my position. It gives me flexible hours and the pay is good.
Okay, that's that's great. I mean, are you getting what you need on a day to day to be happy and kind of achieving your goals? On the other hand. If you're not, then depending on what that barrier is, I think direct specialty care really should be considered. And from there, I think it gets a little bit more granular as far as, okay, are there particular problems in the current clinical setting that you feel like direct specialty care can address for you?
Secondly, if you feel like that, that's the case, then I would start evaluating your particular community or population and seeing is that population allowing for that type of care? And is there a specialist in the community that's already doing that over there and reaching out to them? In my experience, I think most people have been really receptive to that, and I think that's really helpful to get that experience.
And then from there, it's. I would say a bit of kind of running the numbers to see, okay, is this feasible to do? And then the last piece that I would also consider is whether it's DPC or direct specialty care, having the added task of the business aspect is something that I would want everyone to think about.
The last thing I'd want is for someone to transition over and then they'd think, Oh my goodness, the business part makes me more miserable than I was before. Again, it's very doable. I mean, on a consistent basis, you're interviewing docs that are doing it. So that's not to say that that it's not. But this just kind of harkens back to that 1st question that I asked, which is.
What makes you happy, right? Because I think if someone can drill down and say, okay, these are the things that would bring happiness to me, then it kind of makes the path more clear as far as, okay, can direct specialty care bring me that happiness that I'm looking for? And then it's just an execution of, is it feasible and going down that route?
Well, with that, thank you so much, Dr. Kanji for joining us today.
Uh, thank you so much for having me. It was a pleasure.
Next week, look forward to hearing from Dr. Ingrid Liu of Progressive Health Primary Care in Oak Park, Illinois. If you've enjoyed the podcast and you haven't yet done so, subscribe today and share the episode with a physician you may know who needs to hear about DPC. Leave a five star review on Apple 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. org. Until next week, this is Marielle Concepcion.
*Transcript generated by AI so please forgive errors.