Episode 38: Dr. Whitney Pack formerly of Cortez Pediatrics - Cortez, CO

DPC Doctor



Dr. Pack with her stethoscope
Dr. Whitney Pack

Dr. Pack is a board certified fellow of the American Academy of Pediatrics and enjoys all aspects of general pediatric care. She attended medical school at Case Western Reserve University in Cleveland, Ohio and completed her residency in pediatrics at Rainbow Babies and Children's hospital, part of the University Hospitals of Cleveland network.


She opened Cortez Pediatrics in Cortez, CO in 2017 as a solo doctor. Her practice continued providing pediatric care to infants, children and teens in the Four Corners area, the location she had been practicing in since 2010, until it’s closure in Jan 2021.


Dr. Pack has lived in Cortez since 2012. She enjoys spending time with her husband and three children and exploring the beauty of the Southwest.


In her interview she talks about her practice, Cortez Pediatrics. She shares about the unique laws in the State of Colorado that impacted the patient population of her practice. She goes into detail about the nuts and bolts of the practice she built from the ground up after deciding a situation where she was going to do DPC or leave medicine. Dr. Pack also shares about her experience closing her practice and why it was the best decision for her.



Resources Mentioned by Dr. Pack:

- Whole Health Family Practice - Dr. Schaefer & Karassa Yeomans-Schaefer, PAC

- DPC Docs Facebook Group (Physician-only DPC-focused group, MD and DO Residents included as well)


Tools Of The Trade:

- Bionix lighted ear currettes

- The Mother's Kiss (to remove things foreign bodies in the nose, here shown is the modified version with a straw but typically the "clear side" of the nose is occluded and the caregiver's mouth is placed over the child's mouth before exhaling into the child's mouth)




CONTACT:

cortezpediatrics@yahoo.com

Socials: @WhitneyWebsterPack on FB and IG

Phone (970) 403-5944 (call or text - as of 05.16.21 Dr. Pack still takes texts and calls to this number)


EPISODE TRANSCRIPT*:

COMING 05.16.21 - Dr. Whitney Pack

[00:00:00] Maryal: [00:00:00] Welcome to the podcast, Dr. Pak.

[00:00:01]Dr. Pack: [00:00:01] Thank you. I'm so happy to be here.

[00:00:03]Maryal: [00:00:03] Awesome. It is wonderful to speak with you and you are the first physician who's been on the podcast. Who's living in Colorado.

[00:00:10]Dr. Pack: [00:00:10] Oh, wow. That's cool. There's a lot of us here. So that surprises me. Yeah.

[00:00:14] Maryal: [00:00:14] Tell your friends so they can come and follow in your footsteps.

[00:00:18] So I wanted to point out just geographically for people. Not only are you in Colorado, but you're in the area of four corners. And so that's where Colorado, Utah, Arizona, and New Mexico all come together to form a quadrant point. And with that being the place where you opened Cortez pediatrics, I wanted to ask about your geography specifically.

[00:00:43] And were you able to see patients only in Colorado or were you able to see patients who were coming from other States as well?

[00:00:55] Dr. Pack: [00:00:55] Most of my patients are from Colorado, I would say. The areas, you know, in Arizona that I'm [00:01:00] close to are very rural and a lot of native lands. So, you know, they're seen by their own health system usually.

[00:01:07]And then New Mexico, you know, there's a larger community close to us in New Mexico, so they have medical care as well. So yeah, I would say a vast majority were from Colorado

[00:01:18]Maryal: [00:01:18] How did you come to learn about direct primary care.

[00:01:21] Dr. Pack: [00:01:22] . So I actually learned about DPC from a non-medical friend which was kind of interesting. She actually belonged to another DPC practice. That's fairly close to me. There in Durango, so about 50 miles from me and she mentioned that she was a patient there and really liked it.

[00:01:40] And that maybe I should look into that model. I thought, what is this? I've never heard of this. I'm going to find out what this is. So that's where it all started.

[00:01:51]Maryal: [00:01:51] That's, that's pretty incredible. But you know, it's a, it's a Testament to the movement growing in that somebody who was a patient of a [00:02:00] DPC was the one who .

[00:02:01] Helped inspire you to do your own DPC? Now, when, when that happened? What was your medical role at the time that you heard about DPC and learned about DPC?

[00:02:12]Dr. Pack: [00:02:12] So I graduated from residency in 2010 and I moved to this area in Southwest Colorado. Took a job with a private practice was a solo doctor at the time.

[00:02:25] And after about a year there we had some disagreements about compensation and other issues. And so I left that job and took a job here in Cortez at an FQHC. So that's where I was working when I heard about DPC. I was pretty frustrated at that time. I actually very frustrated with my job.

[00:02:45]I felt like the management was very poor, definitely didn't advocate for the physicians that worked for them. The turnover of providers there was crazy and is still crazy. And, you know, constantly I was getting like reviewed for how many [00:03:00] open charts I had. And then the final straw was I would occasionally go in on the weekend to see, you know, a patient that I was worried about.

[00:03:09]Whether it was a baby who was losing weight, a jaundice baby, a kid on oxygen, you know, we're at high altitude here. There's a lot of kids who go home on oxygen. And I was basically told that I could not do that. I could not go in on the weekend and see a patient. And when I asked, what am I supposed to do with those patients?

[00:03:28]I was told that they had to go to the ER for a quick wait follow-up or oxygen check. And that was just unacceptable to me. And I, yeah. I, as soon after I heard about DPC, I thought, yeah, this is my way out. I'm not going to do this anymore. And I was ready to actually leave medicine at that point.

[00:03:48]And I felt like it was just you know, just perfect timing for me to hear about DPC because I, I was no longer willing to work under the constraints that were being placed upon me by [00:04:00] management, not physicians. So,

[00:04:03] Maryal: [00:04:03] and you said it right. They're not positions. I think that, you know, hearing your words and I'm sure that a lot of the listeners are like this as well, but.

[00:04:13] I personally am thinking of the many examples of that frustration that I've had in my own practice. And so I'm sure that everybody can relate to, you know, there's no staff to, to cover you to see the patient. We, we won't get a test into this clinic because it costs too much money, and the idea that you are at high altitude and that there's a lot of babies who are on oxygen.

[00:04:37] It just breaks my heart as a mother to hear that, right.

[00:04:42] Dr. Pack: [00:04:42] Yeah. It's like a kid with, you know, uncomplicated pneumonia, RSV. They might go on oxygen and it's okay. You know, they're at home, they're doing fine, but you don't want to leave that kid for two or three days without just having a quick, , touch on them and check in.

[00:04:56] So

[00:04:56] Maryal: [00:04:56] yeah. Yeah. Absolutely. Medicine is not an eight to five job,

[00:04:59][00:05:00] Dr. Pack: [00:04:59] right?

[00:05:00]Maryal: [00:05:00] Now, when you had decided to. Create your own DPC. Walk me through the process that you went through between when you decided that you are going to do this and when you opened your doors.

[00:05:16]Dr. Pack: [00:05:16] Yeah. So I got in touch with the other DPC.

[00:05:20] That's near me. It's whole health family medicine, Dr. Schaefer, and his wife. And they're amazing. They were great support to me as I was starting up. I talked to them a little bit and I'm actually patients of theirs now. So we still stay in touch. I, and they added me to the DPC docs, Facebook group.

[00:05:37]So I learned most of, the stuff I needed to know to open from that Facebook group. Like so many other people. And I had never, ever wanted to. Be in charge of my own clinic. That was something I had told myself I was never going to take on. But when I heard that you could be a solo micropractice DPC, I thought, well, I could do that.

[00:05:56] I think I could handle it. As long as I don't have to be in charge [00:06:00] of staff, you know, other people. And so I just, read that DPC docs, Facebook group, all the time, just old posts going through what I needed to do. And I did attend a couple of conferences, which I loved and super, , motivating.

[00:06:17]And that was really fun too, to go to those conferences and just hear, hear the stories, get all the advice, that they have to give and just be in that group of people who were so passionate and excited about what they were doing. So that's kind of how I got started and I'm trying to remember.

[00:06:32] I think that I put my notice in, in January of 2017. And so I finished I have to give 90 days notice. So I finished in March and then I took the summer to kind of get everything in order and to start up. And then that fall is when I opened. So that was kind of the timeline for me.

[00:06:53]Maryal: [00:06:53] And when you opened Cortez, pediatrics, did you open with a brick and mortar?

[00:06:58]Dr. Pack: [00:06:58] Yes, I did. Most of [00:07:00] my patients I saw in my office, it was just a one-room building that I rented from a office building, it did have a little lab area with a sink, which was great. But my office was about 250 square feet, just one room.

[00:07:14]And the rent was super, super low. So very affordable. And yeah I opened with that space. I did do some home visits for newborns, but most of my patients, I saw . at my office.

[00:07:24]Maryal: [00:07:24] And were you also seeing little ones in the hospital?

[00:07:29]Dr. Pack: [00:07:29] Nope. I am not affiliated with our local community hospital at all. So you know, they would be seen in the hospital wherever they delivered some deliver here in Cortez, some delivery in Durango.

[00:07:40] And then, you know, I would just follow up with them after they were discharged.

[00:07:43]Maryal: [00:07:43] Gotcha. And in terms of developing your practice model, as you read things on the Facebook DPC docs group, and as you talkedwith other people, did you have a business plan when you started?

[00:07:57]Dr. Pack: [00:07:57] It wasn't, I didn't have a, like a [00:08:00] really concrete, formal business plan, you know, obviously I had like a checklist of stuff I had to do, like get a business license for my corporation and that sort of thing.

[00:08:09]And I'm sure there's actually things that I was supposed to do that I never did just because it was not a very formalized process. And that was okay. You know, I just had to kind of let that go, that I probably wasn't doing this perfectly and that was okay. But I didn't do a lot of market research.

[00:08:24]Like I said, I, this was kind of like my last ditch effort to stay in medicine. So I didn't waste my time, figuring out if this was gonna work in my area. And I know that that's probably different than a lot of people might approach it. I work very part-time I I basically worked one day a week is what I was doing, at my former employee jobs.

[00:08:47] So I planned on being, , in the office two half days a week. And I just thought that it was not going to be hard at all to find 80 to 120 kids in my area. To fill my [00:09:00] practice. I just did not think that that was going to be a problem. So as far as market research, I didn't do a lot of that. Yeah.

[00:09:07] And then just my business plan, other than that was just kind of checking off the boxes as far as how you set up a business that sort of thing.

[00:09:14]Maryal: [00:09:14] When people are talking about market research, because I looked at that particular topic myself on the DPC docs, Facebook group.

[00:09:21] I definitely would say, there's not a lot said about that particular subject. And I hadn't even reached out to you in terms of, on messenger, asking about your market research and what that looked like. And I hear you, when you say that you didn't necessarily do a lot of market research, but I want to ask.

[00:09:39]Now that you have gone through opening, you had patients. If you look back on the idea of market research, what types of things would you suggest to other people? In terms of, if you were to do market research, this is something you should consider.

[00:09:56]Dr. Pack: [00:09:56] Yeah, that's a hard question. I'm not really sure. Like you said, we have a [00:10:00] lot of direction in that right now. In Colorado we have, I have a, kind of a unique situation where as DPC doctors, we are not allowed to contract with Medicaid patients. And that's pretty specific to only a few States as my understanding.

[00:10:16] So I knew that in my area, there were a lot of kids on Medicaid. I didn't know exactly how many until later and when I actually took the time to find that number, it turns out about 85% of the kids in my County are on Medicaid eligible for Medicaid. And that's a huge number. And you know, that's kind of a huge number that just off the top, like I'm, I wouldn't be able to have in my DPC practice.

[00:10:43] So, you know, things like that are, are. Are good to know. Again, that's, there's something very specific to me like in my state, you know, in my area. I don't think knowing that exact number would have changed anything I did. But maybe it would've [00:11:00] made me a little less surprised when it was more difficult to find patients.

[00:11:04]So yeah, that's, that's just something that comes to mind.

[00:11:10]Maryal: [00:11:10] You mentioned earlier that in the other States around you there are other healthcare centers, especially like those who are living on native land. Are there any other restrictions if you were to have had medical licenses in Arizona, Utah, and New Mexico?

[00:11:27]Dr. Pack: [00:11:27] I am actually not sure about that. For those patients who are native and, could be seen through IHS if there would have been problems with that certainly a lot of those patients also have Medicaid, so that would have been an issue. But yeah, I'm not sure about that population,

[00:11:43] Maryal: [00:11:44] I think that's really valuable.

[00:11:45] I mean, just to even know the Medicaid restrictions, if there are any in one state, especially if they're looking to have a Medicaid population as part of their population that they're trying to attract.

[00:11:57]Dr. Pack: [00:11:57] Right?

[00:11:59]Maryal: [00:11:59] When you [00:12:00] were, opening and you got your very first patient, how did your first patient come to learn about your practice and how did that make you feel when you got your first patient?

[00:12:12] Dr. Pack: [00:12:12] My first patients were patients that came with me from my former position. , I did not have a non-compete in my contract, so You know, I didn't want to be like super flashy about bringing all these patients with me, but in the final months that I was there, I just made a little business card that had my email on it.

[00:12:32] And I told patients that I was leaving, that I was starting my own practice. And I actually took their email address as well. If they were interested, I gave them like a very brief spiel about what I was doing.

[00:12:43]And you know, when I was, when I was getting ready to open up, like July, August, I kind of send out an email to everybody whose address I'd collected. And so definitely my first few patients were patients that I was very familiar with because they came from my, you know, [00:13:00] Prior patient pool. And then the next patients that I got that were brand new to me were pretty much from word of mouth.

[00:13:08] I mean, you know, my former patients told them, you know, Hey , we have this doctor and she's doing this new practice and you should check it out. That was always really great when I, when I asked new people, Hey, where did you hear about me? And they would say, Oh, so-and-so told us about you.

[00:13:25] So that was always really fun because I, I do think that sort of organic word of mouth growth is so important to DPC. And so, you know, when that was happening, that made me really happy. Yeah.

[00:13:35]Maryal: [00:13:35] I agree with you and I think that that's so powerful when. Somebody is advertising for you.

[00:13:40]I had a conversation with Dr. Vance Lassey about how he has patients wearing his logo on shirts that he hands out to them. And when it's not only just, you know, a logo, it's, it's also a story that is personalized because it's a patient's experience. I think that there's [00:14:00] nothing like that. I mean, that's why, influencers exist is because that human experience is so irreplaceable, especially after the year we had last year.

[00:14:09]Dr. Pack: [00:14:09] Yeah.

[00:14:09] Maryal: [00:14:10] What was your patient population like?

[00:14:12]Dr. Pack: [00:14:12] So most of my patients did have private insurance, I would say. But not the majority. I had a lot of patients who have health shares as their catastrophic medical coverage.

[00:14:24]And they seem to kind of know each other. And so I would get a lot of people, telling their friends who had health shares, about the practice um, which was nice. I did take care of a couple Medicaid kids from my prior practice for free. Just because I felt that they were so medically complicated that.

[00:14:40]It was a disservice to them and the new physician to try to have to figure all that out. And so I did do some pro bono work. And then I had a few patients who were just uninsured so I had the whole spectrum as far as, , insurance coverage goes

[00:14:56]

[00:14:56]? I should say that my practice was definitely skewed [00:15:00] to very young children. I would say mostly infants and toddlers. And I think that that's because of the number of well visits . I think that people saw more value in a monthly membership where they knew they would be coming in a lot.

[00:15:14] The older kids that I took care of did almost always have a chronic medical condition, whether it was asthma that was hard to control ADHD, where they knew that they would, , be contacting me every month for their refill. So I definitely did see that, and that was not something that I was necessarily expecting.

[00:15:33] I thought that I would have a good mix of, kids who were more high needs versus kids who were healthy and lower needs. And I didn't find that that actually turned out that way. And I actually had a lot of first-time parents sign up as well. And I think that that was also because they knew that, the accessibility was not something they were going to get at a normal pediatric practice.

[00:15:56]And so I did have a lot of first-time parents with newborns sign up as well.

[00:15:59]Maryal: [00:15:59] [00:16:00] Did you experience churn during the years that you were open?

[00:16:04]Dr. Pack: [00:16:04] I did a little bit. Yeah. But not much. Pretty much the patients who signed up with me stayed with me unless they left the area that happened a few times.

[00:16:11]One patient, was a very high utilizer at first was a young toddler. And then kind of, as she got older, I think that her parents got more comfortable. Didn't need to see as see me as much. And she left and then I had an older teenager who turned 18 and went on Medicaid.

[00:16:27] So it wasn't able to see her. So I can count on one hand, what happened with the patients who left? Just because my overall population was pretty small. Yeah. So most of those people who signed up, ended up staying.

[00:16:39]Maryal: [00:16:39] That's really good to hear. And I definitely could see that, especially given what you just shared with regards to the accessibility being so valuable, especially when kids are that little as a mom with a four month old.

[00:16:50] I, I appreciate that accessibility, even as a doctor. I mean, when your mom brain takes over your doctor reign access to a medical doctor is just, so [00:17:00] key. Now I want to ask you some, some more technical things about your practice. How did you handle vaccinations?

[00:17:06]Dr. Pack: [00:17:06] So I was very lucky in that whole health family medicine, who I mentioned before the DPC practice in Durango pretty close to me ended up getting a VAX care account. And basically what they let me do just out of the kindness of their hearts is I was basically a provider under their VaxCare account.

[00:17:25] So VaxCare has, you know, a little tablet, they call a hub where you check out vaccines through. So I had one of those in my office and I would just go pick up vaccines from them as I needed and bring them back to my office. And then they were really kind, and at the end of the month, they would go through and figure out basically if if they owed me money for the vaccines I had administered, or if I owed them money for self pay patients, that sort of thing.

[00:17:52] So they were super kind and just did all that just to help me out, which was really, really awesome. So , I did use VaxCare [00:18:00] kind of under that arrangement.

[00:18:02] Maryal: [00:18:02] Because you were, a sub user, I guess, of, of their box care account. I'm guessing you didn't face any, what do I do with excess vaccines

[00:18:10]Dr. Pack: [00:18:10] issues?

[00:18:11] Yeah. If I was, if I had a vaccine that was going to expire in the next few months, I would just take it back to them because they had a higher volume than me and were more likely to use it before I did. I really tried to only pick up the vaccines that I knew that I would use you know, fairly, fairly quickly.