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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:

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


Tools Of The Trade:

- 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:

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.

[00:18:27] So I was going over there like once every one or two months to get vaccines,

[00:18:32]Maryal: [00:18:32] not bad at all. And what was your overhead? Like?

[00:18:35]Dr. Pack: [00:18:35] My overhead was super small. I had really low rent Basically my rent and my internet and my spruce health account were my only monthly charges that were coming out every month.

[00:18:46] And then, you know, every, every other month maybe I would put in an order for medications or supplies. I did dispense medications through my office. Not a lot because I'm a pediatrician, but yeah, so it was super low. [00:19:00] I didn't have an EMR. I used I basically used paper and then scan it into my computer.

[00:19:05] I didn't want to pay for an EMR. So yeah, it was very low.

[00:19:08] Maryal: [00:19:08] With you sharing about your overhead being so low, I want to backtrack a little bit and ask about your startup costs and your startup expenses what were your startup expenses and did you have your startup expenses right at the time that you were opening or did you plan your practice and have startup expenses before you actually opened?

[00:19:28]Dr. Pack: [00:19:28] Yeah, so I, I estimate that my startup costs were about $10,000.

[00:19:34]And. You know, my husband is a dentist who has a practice and we basically just finance that startup through our savings. And the vast majority of those costs went to lawyer fees. I was not comfortable with just making that my own patient agreement that did not feel okay to me. And I really wanted a lawyer to do that.

[00:19:55] And so I did have a lawyer who's very well known in the DPC world [00:20:00] has a flat fee for DBC doctors, you know, to kind of get that set up for them. I also paid a lot for my logo and some branding stuff and looking back, I should not have paid as much as I did. I was trying to stay local and, you know, give business to a local small business owner just like myself.

[00:20:15]But I ended up actually overpaying for that quite a bit. And then I did do, I did remodel my office. It was pretty sad shape when I when I rented the space. And so they let me, you know, painted and put in new flooring and of course all the furniture and everything. And then as far as supplies, I did not buy everything upfront.

[00:20:36] That cost was spread out over probably the first year of me being open. So. There were a couple of kids who needed sutures. And I just hadn't bought sutures yet because they're kind of expensive. And, you know, they went to the ER and they were fine with that, but you know, a few months in, I had sutures and sterile gloves and all that sort of stuff, but I did not start out with absolutely [00:21:00] everything that I needed, but that's kind of what my startup looked like.

[00:21:04]Maryal: [00:21:04] Gotcha. And what about procedures? Did you do procedures in your clinic?

[00:21:09]Dr. Pack: [00:21:09] I did a few. Yeah. The suturing was the one that I felt most nervous about in my prior years. After training and even in training, I did not suture that much.

[00:21:20] I just didn't. I, I'm not a procedure or procedure oriented person. I don't like them. I know that some doctors love them. Not me. So I mean, I've probably did. Oh, like two, maybe like in the seven years that I was out of residency. Maybe it might've been just one. But in DPC I did probably 10 in the three years that I was there and, you know, they probably weren't great, but the patients were super happy that they didn't have to go to the ER and it was totally fine, you know, it was, it was more than adequate.

[00:21:54] So and then of course, getting stuff out of kids has noses and ears, you know, that that's a lot of [00:22:00] procedures in pediatrics. But yeah, that was pretty much it, you know, I didn't do a lot of other stuff. I never had to freeze words and that sort of thing that never came up. I wasn't going to invest in that until I needed it and just turns out that I never needed it.

[00:22:12]

[00:22:12] Maryal: [00:22:12] In terms of. Foreign body removals with the kids. I know you said that you added your, your tools as you went. Do you have any that you swear by in terms of up the nose in the air type of tools that you used in loved?

[00:22:24]Dr. Pack: [00:22:24] I love the Bionics lighted ear curates, those things are just amazing. So they're great for getting out your wax and I, you know, I've tried, I've tried ear washes and Laval and stuff like that, and it just, I just never had great success. So I just would rather get a lighted curate and get it out.

[00:22:43] So for noses, I've had a lot of. Families just take care of those at home with the mother's kiss technique. I don't know if anybody's familiar with that, but it's just occluding the opposite nostril and then having mom blow in the mouth that works quite well. And then there's a [00:23:00] tool that I used in residency called just a right hook is just a right angle.

[00:23:03] That's really good for pulling out stuff, especially beads and things like that. I don't have one of those, but if I had extra money, I would buy one.

[00:23:11] Maryal: [00:23:11] And just, I think of BIA, the kid who I pulled kicks a piece of cereal out that had not gotten too soft that I couldn't, you know, deprived it completely, but I pulled it out with a very thin pair of tweezers.

[00:23:25] And so I, I just, I thank you for sharing that. I just, I asked because, you know, with medicine, it's like, we always find these tools that work for us and in different ways than they were initially created to work for us so that's awesome. Now I want to go back to your patient population.

[00:23:45], at what point did you notice that your patient population was plateauing?

[00:23:48] Dr. Pack: [00:23:48] So my first initial year was very slow growth and that was okay with me because I had a baby

[00:23:55]and then that was, so that was 2018 basically, you know, end of [00:24:00] 2017, 2018. And then in 2019, there were a few months where I was getting new patients every month. And that was You know, that was new and encouraging to me because I felt like I kind of reached that point where the word of mouth was picking up.

[00:24:16] You know, you hear about that, that inflection point or , that time where, you know, word of mouth kind of gets around enough that you get more interest. So I had several months like that in 2019, and then I noticed that that interest and the number of calls I was getting kind of dropped off at that point.

[00:24:33]So that's kinda, probably the early part of 20, 19 to summer, I was getting, you know, new patients and feeling pretty good about where I was and then going into fall winter, I kind of noticed that dropping off in 2019.

[00:24:48] Maryal: [00:24:48] And at that point, what did you do as a response to noticing that you were starting to plateau.

[00:24:55]Dr. Pack: [00:24:55] Well, I kind of went back to the drawing board and kind of thought, you know, what other [00:25:00] opportunities may I be missing as far as marketing or, or finding the people who would be interested in the service that I am providing. When I started up, I had contacted the local newspaper and radio station had basically absolutely no interest from them, which was kind of sad to me.

[00:25:17]Because I see a lot of, you know, local news, newspapers and radio stations really picking up on, on the movement. So that was surprising to me and disappointing. And I really tried to go to some high touch areas where I knew kids and families would be, , I talked to school nurses, I went to preschools and daycares, you know, kind of had rat cards out there.

[00:25:38]We have a really great family resource center in our community. And they have somebody there who helps patients sign up for insurance, especially Medicaid. And I talked to that person, you know, just let them know that if they have paid families who didn't qualify for Medicaid, but also didn't have private insurance to definitely let them know that I was in the community.

[00:25:58]I went to a few [00:26:00] community events. We have a early childhood fair every year here that I've participated in for a long time actually. And so I was at that, you know, I went to some local festivals, , music festivals, where booths would be that those were pretty much a waste of my time.

[00:26:14] I did not get a lot of interest from those types of things. I, you know, I kind of went back to the drawing board and was thinking you know, where else could I go? I know that a lot of DPC pediatricians. Network with the doula and the midwife community. And in my area, that's just not a patient population that I enjoy taking care of.

[00:26:31] So that was kind of off the table for me. But I know that in some communities that's very helpful. So I was kind of going back to the drawing board, of course, I'm doing this as I'm juggling my practice and I'm also filling in with my husband's practice a little bit and with my young kids.

[00:26:47] And so I didn't really do a lot. And then, and then we kind of went into the pandemic, you know, a few months later. And at that point I was just kinda like, okay, well, it's probably not the best time to be really out there marketing. [00:27:00] So that's kind of where I was going into last year.

[00:27:04] Maryal: [00:27:04] And did you incorporate telemedicine offerings at that point?

[00:27:09] Dr. Pack: [00:27:09] I text with my patients a lot that just works for me as mostly a stay at home parent. I, you know, I did a lot of medical care over text. I didn't do a lot of video but certainly could do that if it was needed.

[00:27:22]I did have, parents send me pictures of rashes or injuries or whatever . When, when the pandemic hit, I actually I did get set up to do more telemedicine. And I actually did some well visits where I had patients fill out like a questionnaire online before they came in. So when they came in, it was pretty much just review the questionnaire quickly, give any anticipatory guidance that I needed to give them, do the physical, and then we were done.

[00:27:48]I did a lot of car visits you know, kind of initially during the pandemic. It was pretty slow. Like I didn't have a lot of patient needs at that time. I was always willing to do telemedicine and that was kind of just [00:28:00] already set up in my practice. So I didn't really feel like marketing.

[00:28:03] That would be super helpful just because that was already part of what I was offering. As part of The practice.

[00:28:12] Maryal: [00:28:12] Gotcha. Reason I ask is because some people either during the pandemic or as they go into the future are thinking about, telemedicine only membership offerings, as well as the telemedicine incorporated with the membership where you see your doctor in-person. So that, that's where the question was coming from. But I, I hear you in terms of, you know, you were harnessing spruce and you were harnessing the tech that you had to maximize the value for your patients there.

[00:28:41]Dr. Pack: [00:28:41] Yeah. I'm fine with telemedicine to a point, but then at some point I just really like to see the patient in person. So , as far as offering a telemedicine only membership, I don't think I don't see myself, ever really doing that and that I know that works for some people, but I think that my comfort level with that [00:29:00] is pretty low.

[00:29:01]Maryal: [00:29:01] And what about pricing in terms of when you notice that you were plateauing, did you ever think at all about adjusting .

[00:29:09] Dr. Pack: [00:29:09] Yes. So I started out with pretty much a family pricing structure where first child in the family to sign up would be $50 a month. And then from there, there were discounts when initial kids signed up.

[00:29:22]So second kid would be 43rd could be 30. And then at some point, if you had tons of kids, you know, you would just, we would just be done. And I would take care of you for that, that maximum price. After I saw that my practice was becoming very skewed towards the younger population. And this was before the pandemic.

[00:29:43]I decided that I needed to raise prices. I had a newborn who I took care of for a year. So from the time she was born, until she turned a year old and then the family moved away and this was a healthy kid. I mean, she had some. Initial weight gain problems in the first couple [00:30:00] months. And I did 25 office visits for that family in a year.

[00:30:05] And like I said, healthy kid, first time, parents, young parents and that's not counting like the phone calls, the texts, all that sort of thing. So after that, I just thought, Kay. Yeah, I am not charging enough for the, for my time. I mean, I did 25 office visits for them for $600. So that's when I re I split into a tier based system.

[00:30:26] So I charged more for zero to two years old and then less for above two years. And I still did a family discount, but after that I did raise my prices. And again, that was before the pandemic And I actually didn't really keep track of this. I'm not sure if that's, when I noticed the, kind of the more flat-towing in 2019.

[00:30:47] That would be interesting for me to go back and try to look at that. But yeah, , I felt like I wasn't being compensated appropriately, so that's when I raised my prices and you'll get so many different opinions about [00:31:00] if you're not growing, you need to raise your prices.

[00:31:02]You need to not list your prices on your website. You know, there's so many opinions out there. And, and you do what you feel is right. I think with that, but But yes, I did raise my prices a couple of years in just because I felt like I wasn't being compensated appropriately for my time.

[00:31:17]Maryal: [00:31:17] And that is a lot of visits for sure.

[00:31:19] And, you, you highlight something that is ultimately true. If you've seen one DPC, you've seen one DPC. So you, you did what was right for you at the time and that's, that's awesome. I know that you have also been involved in your community through the four corners child advocacy center, as well, as you mentioned with your husband's practice covering there when needed, and then also you were formerly involved in the summer camp local to you.

[00:31:50] So can you share about how you were a pediatrician at Cortez pediatrics in addition to serving in those other roles.

[00:31:58]Dr. Pack: [00:31:58] Up until very recently, I was the only [00:32:00] pediatrician in my County. So yeah. And there was a family doctor here who retired a couple years ago and he had a lot of these roles actually.

[00:32:10] And so when he retired, he's actually the doctor who started our advocacy center in our County for children with suspected or confirmed maltreatment. And so. I think me being the only pediatrician in the County that was kind of a, a natural thing for him to ask me if I would take over that role.

[00:32:30]And I, I actually do have some interest in that area. When I was an undergrad, I was a volunteer at our child advocacy center in the County where I went to school. I did electives in residency, on child maltreatment. And so I did have some baseline knowledge of those things. And I just felt like that was something that I should do.

[00:32:51]In my role as, a kid doctor in our County. So I took over that role, you know, I did get a lot of, a lot of extra training for it. [00:33:00] And I'm still doing that now. And then he was also the medical consultant for the summer camp. The archeological summer camp that's nearby. And that really took very little of my time.

[00:33:11] Mostly it's, it's like a paperwork thing. Like they pay me a small retainer and, you know, usually the kid, if, if they have a kid who has a medical need, mostly they'll go to the ER cause they usually need an x-ray that sort of thing. So that didn't take too much of my time. , the other role that I've had is just as another medical consultant for a school-based health center.

[00:33:31] Here in town. It's four corners, youth clinics, and they have their own providers. They just kind of need somebody to touch base with every once in awhile. And they've had a lot of different medical consultants, sponsors. Who've been kind of flaky on them. Like our, our local hospital was one and then the FQHC was kind of doing it for a while and I just felt kind of bad that they, couldn't find somebody to be kind of stable for them.

[00:33:57] So again, that, that doesn't take too much of my [00:34:00] time. It's more of more of a volunteer opportunity, I do get paid, but it's, you know, not a lot of money.

[00:34:05] Maryal: [00:34:05] With you sharing what you just did it just breaks my heart that you are, able to address these situations. You are the only pediatrician in your County and you cannot see Medicaid patients. It just blows my mind. I just, the lack of access because of the way that the law is written.

[00:34:27] It just, that just breaks my heart. And, you know, I, I want to ask because. When it comes to health care, DPC and Colorado, there has been a lot of buzz recently about the idea of universal health care in Colorado.

[00:34:42] What is your take on how healthcare is delivered now? Versus if healthcare were to be delivered under a universal health care model in Colorado?

[00:34:52]Dr. Pack: [00:34:52] Yeah. So I, I am all for increasing access to care. You know, I live in a place where the access is poor and we [00:35:00] definitely see the impact on the health of, of the people in my area.

[00:35:05]I have concerns about either the state or federal government really being able to provide that quality care in a fiscally responsible way. I don't think that they do it right now with Medicaid or Medicare. So I, I really don't have a lot of confidence that they can do it under a universal healthcare plan.

[00:35:24] I, I'm not an expert on this, but I would, I would love to see, you know, some sort of, I've heard of people talk about a voucher system where, you know, you get your dollars and you decide where to spend them. You know, I would love to see that. Some sort of a system like that in place where patients could decide to spend their state funded health dollars on a DPC membership.

[00:35:49]I think that would be great. There's a lot of people in Colorado, who've worked pretty tirelessly over the past couple of years to get this law changed about the Medicaid patients [00:36:00] and they, unfortunately haven't had any success at this point, but people are working to change that. And, and luckily through my advocacy center role, like I can see any patient that comes through that door.

[00:36:10] It's not, it's not part of my DPC. That's not how I'm compensated. So I'm compensated through grant dollars for that position. So luckily I can see any kid who needs to be seen, but Yeah. And, and, and as far as universal health care goes I think that a lot of Americans don't understand what that means as far as how that will change the access to care that they have.

[00:36:31]And I don't think a lot of Americans are going to like it. We're not used to being told, no, you can't have that. You can't do that. And that's basically what happens under that sort of system. And I, I just don't think , that the, general public understands what that would change as far as their access to medical care and them being involved in their decision-making as far as what kind of medical care they receive. [00:37:00]

[00:37:00]Maryal: [00:37:00] I am personally all for. All Americans getting the quality that they deserve wherever they live. And so I hope that, you know, if there is a medical student or resident who, at some point we'll be opening a DPC or joining a DPC in Colorado someday, I hope that the part about you can't see Medicaid patients,

[00:37:22] I hope that there will be changed there.

[00:37:23]Dr. Pack: [00:37:23] Yeah, me too. Yep. I've had actually patients write letters to the legislature about it and that sort of thing. So hopefully at some point they'll see that it's in the best interest of everybody.

[00:37:34] Maryal: [00:37:34] now one of the things that you have mentioned, and it's also mentioned in your bio is that you have three little ones yourself.

[00:37:42] And so I want to ask about. Being a mom and a DPC doctor being a mom and a DPC doctor during the pandemic and being a mom and a TPC doctor after having closed a practice. How has this all been with regards to [00:38:00] balancing you professionally and you as a mom?

[00:38:04]

[00:38:04] Dr. Pack: [00:38:04] My husband and I had a plan, right? When we got out of training, we were each gonna work three days a week. And so we would only need childcare one day a week. This was our awesome plan that was totally going to happen. And we took jobs that worked with this plan that we had. And pretty soon after we moved to my husband's job did not work out at all.

[00:38:30] And so he bought a practice and became a full-time employee of himself. And then I was working three days a week and gradually as I had children that. Went down and down and down until I was one day a week. So I I've always honestly found it hard to find a family work balance even when I was not working a lot.

[00:38:51]And in my employed positions, it was because I would come home from work and spend hours charting and taking care of tasks. [00:39:00]In that regard, DPC was an absolute godsend. I mean, the flexibility that DPC affords is unparalleled. You're totally in charge of your schedule. And it was amazing. Like if, if I had to.

[00:39:15]Go to a parent-teacher conference or a school meeting, or if I had a church thing, you know, I could just not see patients that day and see patients on a different day of the week. So that was incredibly helpful. It was still kind of hard to be on call all the time, you know, quote unquote on call accessible to patients.

[00:39:32] But usually if it, if it can be taken care of via text, you know, not a big deal The occasional days that I did have to take my children into the office were not good. But you know, patient patients are understanding, you know, when they sign up for something like this, I think that they come to understand even more, that you are a human being, you have your own family , you have your own childcare struggles or whatever, and they're pretty understanding about that.

[00:39:58] It was nice [00:40:00] that I was my own boss. I didn't have administrators breathing down my neck as far as like when I did my charts or, and the other great thing that I, didn't foresee going in is that I was only charting for myself because I was the only provider seeing those patients in the past, I was charting for the five or six other providers who might see that patient when I wasn't there.

[00:40:28] And that included family physicians that included mid-levels. And so my, I felt like my notes had to be so specific just, just to provide the care that I wanted that patient to get. Right. And, and now that, that I didn't have to worry about that. You know, just the documentation and, forget the billing and the coding and all that. You know, it just got so much easier. So that was another thing that was really great is that I knew that every touch that that patient had was with me, , and of course that's a huge selling point [00:41:00] for DPC as well, is that you're not going to be passed around and see one of the 15 providers in this ginormous pediatric practice.

[00:41:10]Maryal: [00:41:10] Absolutely. And your youngest, your daughter was inside of you , when you were opening and you had her during, during your time at Cortez pediatrics. So what did you do with regards to those early days and maternity leave as a solo practitioner?

[00:41:29]Dr. Pack: [00:41:29] That was hard. I wasn't super worried about it because I knew that I would not have that many patients when I had her.

[00:41:35] So I opened in September , 2017 and then I had her she was born in January of 2018. So I had only been open about three months, ish. And I told the few patients that I had, that I was going to be available by phone only for two weeks. And then the two weeks after that, I would be able to come in for emergencies.

[00:41:58]And then after that, [00:42:00] hopefully I'd be back able to see them as needed in the clinic. and I unfortunately did get a phone call the day I got home from the hospital that was. You know, on a chronically ill patient that I had, and I wasn't super happy to be taking care of that 48 hours after I had a baby.

[00:42:16] But that was the only thing that came up in those first two weeks. And then the next two weeks, I think I had to go in one time to see a baby. And I, I had planned on taking my infant daughter to work with me, you know, and I was hoping that she would sleep nicely in her rock and play, but she did not, she was not one of those babies.

[00:42:35] And again, my patients, I didn't have very many, I probably had like five patients at that time. They were super, understanding but I did have to end up getting childcare for her. Earlier than I had wanted to. Just because it wasn't working out for her to come to work with me.

[00:42:49]But that's hard, you know, I see, I see a DPC doctors who are basically back at it, like two weeks after they have a baby. And I think that is a harder point, you know, if you're a woman and, and [00:43:00] you're a solo doc in DPC trying to figure that out. So I don't think it's for everybody to be, back at work, bringing their infant with them two weeks after they deliver, but it worked out fine.

[00:43:11] It was, not a big deal. And, and after my first, I, I took nine months off and after my second, I think I had two months off. So It was okay. It worked out.

[00:43:21]Maryal: [00:43:21] Yeah. And any parent can relate to it. It works out in the end. You just, go until you figure it out. But yeah.

[00:43:27] There's every, every situation, every child is different. And when you add multiple children to the mix, having more than one is, is a beast in and of itself

[00:43:37]now. You shared that your husband had his own practice and then you had your own practice. So what did you guys do for your family's health insurance? You said your patients, a lot of them had the health shares. Did you utilize one for your own family?

[00:43:50]Dr. Pack: [00:43:50] Yes, we did. I learned about a health share from, from a patient.

[00:43:55]So we signed up for a health share and then and then we're members [00:44:00] of a DPC practice whole health family medicine, like I mentioned in Durango. So we feel that we get really, really great medical care and for about half the costs that we were paying for traditional insurance. So it works great for us.

[00:44:12] We've, we've really enjoyed it. The healthshare paid for my entire pregnancy with my third daughter. And that was amazing. .

[00:44:19] Maryal: [00:44:19] Yeah, that's awesome. I, had posted, but just to, put this out on the airwaves my son in. November of last year, November of 2020 to deliver him at the hospital was over $2,000.

[00:44:32] But the the explanation of benefits listed over $85,000 to have my son via emergency C-section. But yeah, that's amazing. And I hope that anybody who's experienced a hospital bill can really take that to heart that your, health share covered the cost of your daughter to be born in this country.

[00:44:53]Dr. Pack: [00:44:53] Yeah. And, and, you know, we were on traditional and health insurance when I had my first two kids. So I was blown away with out-of-pocket [00:45:00] costs to have a baby. I wasn't aware right. That I would be paying five to $10,000 to have a baby with health insurance. So to go into, you know my health with my health share, covering a hundred percent of those cash prices.

[00:45:15]It was awesome. Super awesome.

[00:45:17]Wonderful.

[00:45:19]Maryal: [00:45:19] In terms of compensation, at what point did you start paying yourself?

[00:45:24] Dr. Pack: [00:45:24] So I started paying myself a little bit about 15 months into the practice.

[00:45:31]It was not a lot. I was only, I was only paying myself like 500 bucks a month probably. Because that was kind of over and above what my very small overhead was. And again, I only had about 30, 35 patients at my max, so never had a lot of patients. Again, I was only trying to get 80 to a hundred maybe.

[00:45:51]But yeah, so the, in 2019 I probably took home the most money from all of the medical, you know, kind of services I was [00:46:00] providing from my DPC and the other things I was doing in the community. And I took home about $10,000 that year. So it was not a lot of compensation for sure that I ever got from my DPC.

[00:46:12] And that was hard because I, I did feel like I was working, you know, For me and my family, I was putting in, , a significant amount of time every week, both seeing patients and then doing kind of admin stuff that I had to do to run the business.

[00:46:28]Maryal: [00:46:28] And thank you for sharing that because I I think that that's very useful for people to think about financially as they are planning their DPC.

[00:46:38]

[00:46:38] When you reach the point that you decided that you were going to close Cortez, pediatrics, can you share with us about that experience and what led ultimately to that decision?

[00:46:51]Dr. Pack: [00:46:51] Yes. In 2020 we had the pandemic which changed a lot of things and I, I didn't, it wasn't. [00:47:00] Surprising to me that my practice wasn't growing during that time in the fall of 2020 after talking with our financial advisors, he recommended that I take out on the IDL loan from the SBA, which is part of, kind of the coronavirus relief.

[00:47:16]Services that were available. And and my cost had gone up that year because I rented another room. I was kind of, like I said, I was working out of a one-room office and I was, I was uncomfortable having sick and well patients in that same room. So I rented another room for sick patients. I got, you know, a rapid coronavirus testing system, which took up a lot of funds.

[00:47:39]And so, you know, he said, you know, your, your costs have increased this year. Why don't you take out the super low interest loan, you know, and take advantage of that. So I actually did, and the application was incredibly short and easy. And most of that money I planned to put into a pretty big marketing campaign.

[00:47:59] I was going to [00:48:00] pay for the newspaper, the radio social media Just to try to get, get my name out there. Because I still, I still do believe that there are those patients in my community. I just never found out how to find them. At that point I had, I we've talked a little bit about how in 2019 and 2020, I did help out at my husband's office for a few weeks, each time because we've had some significant problems with turnover at his office, especially at the front desk business team, office manager position.

[00:48:34] And So I, I dipped my toe into that a little bit, but always, you know, always it was just going to be temporary until we found someone else. So in the summer of 2020, we hired some new folks for that position. We felt like they were going to be great. I got that loan in the fall and then at Christmas, both of his employees at the position quit.

[00:48:56] And in two years we've had [00:49:00] six people come through that position. So At that point, I was feeling very done with continuing to try to find people to fill this position and having it not work out. Because I, felt that the turnover was actually starting to damage his practice significantly.

[00:49:19]And certainly the people that we'd had up there, I didn't feel saw, saw the vision and the mission of his practice and didn't really buy into that. So they weren't really helping. And at this point, you know, for the past few years, my husband's income has been pretty much our, our family's sole income.

[00:49:38] So, you know, we have to do as much as we can to try to make his business successful. And With, with my DPC and no, not really providing me any income and feeling like I was not willing to continue to try to find the right person for his office. I decided that I was going to step into [00:50:00] that role full time and that I was going to close my practice.

[00:50:04]And like I said, you know, back a few years ago I was ready to leave medicine. So those thoughts have, have already kind of been through my head at this point. So it's not something that's totally new to me that I have to rehash through. But just as far as I was concerned, I felt like this was the best thing for our family going forward.

[00:50:24]And I felt, you know, I felt sad and regretful that I had to close, but I did feel. That I was the right person to step in to help him at this time. And that, that was the right thing for our family. So that's kind of what, what led up to that at the very end of 2020,

[00:50:44]

[00:50:44]Maryal: [00:50:44] One of the things that you had mentioned on Facebook previously was that during your time in the PICU, in residency, you had experienced major depressive disorder symptoms. And so I I want to go [00:51:00] into. You mentioning these feelings that happened as you were closing your practice because mental health and taking care of ourselves is so important because we are by profession caregivers.

[00:51:12] We, we literally take care of other people as our profession. And so I want to ask about how did you cope with those feelings and what would you share with others who might be in a similar situation?

[00:51:29]Dr. Pack: [00:51:29] Well, I feel fortunate in that in 2020, I started to get really involved with a 12 step program for some food addiction issues that I have. And I. Started, really working that program. And I had a really good sponsor, , and that people who are familiar with 12 step programs will know what a sponsor is, but it's basically just a third party that is able to objectively look at your problems and your feelings and help you [00:52:00] work through them.

[00:52:01] And so that has been really, really important to me. And she is not, , involved in the medical field. So she has a very objective viewpoint and was really able to help me work through all the feelings that I was having and, and helped me see the truth about what was having, you know, it's very easy to get into a downward spiral of thoughts about how.

[00:52:22]this practice that you've put so much work, sweat and tears into is a failure, which, you know, then might mean what, what does that say about me? You know, and, she was just able to really help me objectively see that, I had taken really good care of people, as , in my, in my entire career in medicine.

[00:52:41]And that certainly that wasn't a failure that I had really thought through carefully, you know, what I wanted to do and that this was going to be a great thing for my family for my husband's business. You know, having a background in healthcare really helps me in my position, in his office, you know?

[00:52:58] So I think just having [00:53:00] somebody who's, who's really able to empathize, but yet kind of help you see objectively and truthfully. What's really happening and not letting you tell yourself all these crazy stories in your mind that aren't true is what I would say. Try to find that person that can help you do that.

[00:53:18] I also, I have to say, , DPC takes care of so many problems that we face as physicians, but it doesn't take care of everything, you know? It's super nice for me now to be able to go camping and not have cell coverage and not worry, you know, that someone's going to try to get ahold of me.

[00:53:37] And then I, I won't answer. Right. It's super nice that I don't have to second guess, like, did I make the right call on that? You know, I hope that kids okay. I don't have to try to, you know, talk families into doing some intervention that I feel is really important that they don't want to do, you know?

[00:53:55]I don't have to worry about that sort of thing, , and, maybe I'm the, [00:54:00] I don't think I'm the only doctor who, you know, has these types of problems, but I got, especially in this, in the internet age, you know, it's, it's hard to be a doctor when there's Google, it's hard to be a doctor when the anti-vax movement seems really strong,

[00:54:15]and And yeah, so, so some things I won't miss and I think it's good to keep that in perspective as well. I think that most of my sadness comes from the years that I did spend in training and all of the money and time that I sacrificed and really the abuse that I feel like I did suffer. I do feel like medical education, you know, and training is, is an abusive environment and some ways and it was hard for me to, to not feel like I could have spent my time in something else.

[00:54:46]And it was hard for me to feel like I hadn't wasted my time. But again, you know, having, having that input, like, well, think of all the things , I learned, in that training, \ think of the confidence I gained, think of. The knowledge that I have, [00:55:00] even being a pediatrician and a mom, I mean, super helpful, right?

[00:55:03] Like, Oh my gosh, that is just the best. Right. I don't have to take them to the doctor all the time. So you know, just being able to see that, training that time in my life isn't, isn't a waste. You know, that's good for me. But, but dealing with all those feelings was hard , and it's still hard.

[00:55:20] Honestly, I still have times. I mean, it's pretty new that I've only been closed you know, not even three months now. So it's still hard for me to, to think about the things that I'll forget or the things that I'll miss. But I think that part of it is just Realizing that I don't have control over everything that happens to me.

[00:55:40] And some things may be for the best and I can't see them maybe in the moment, but you just having faith that, God has a plan for me and my family. And that something really good might come from something that seems kind of bad in the moment. I

[00:55:55] Maryal: [00:55:55] just really appreciate you sharing and being so honest about your [00:56:00] experience in training and also with your DPC and your DPC closing.

[00:56:04] I just, I feel, but as a community the idea of the number of people who are posting about closure and BPC is definitely not the majority and, you know, for the movement, that's a good thing. Great. But that aside, like, you're sharing, you know, we do not have control over everything in our lives.

[00:56:27] I mean, we, we put our best foot forward. We have the best intentions, but it's not always going to work out. And so I feel that you sharing about your experience is so valuable today and it will continue to be valuable as people go through similar experiences. And I just, I really applaud you for, sharing your experience because this is your story.

[00:56:54]Dr. Pack: [00:56:54] Yes. I'm really happy to, to do it. Like you said, it's, it's not something that [00:57:00] is talked about a lot in the DPC space. And I feel like when it is talked about, there's I don't know, judgment, I guess I feel in the DBC community for, , quote unquote failed practices. And I think that comes from so many people being so passionate about this movement.

[00:57:14] Right. Of course we want to make it work for everybody, you know, that tries it. And I think it can be easy for others to try to pinpoint or identify reasons why people fail, right? Like, Oh, you didn't do this. Oh, you didn't do this. You know, maybe you should have done this. And I think that's helpful to a point, but I also think that it can get very overwhelming because only you can know what your real situation is.

[00:57:42] And other people may come in and try to be like, The quarterback, like in the last, I don't know what that phrase is, but they can try to, decide what you should have done differently, but, but really they're making those decisions based on a small amount of knowledge of what you might've shared.

[00:57:58] So I [00:58:00] think, I think if somebody is thinking about closing, weigh pros and cons pretty carefully and, and think about, what you need and what your family needs. And maybe talk to if you a few trusted people in the space to get some feedback, but you know, it might not. And I think this is why people don't, don't go on our big communities and say, Hey, this isn't working, you know, because they're going to get so much feedback.

[00:58:25] It might be overwhelming. So I just think that , it's helpful to take the advice that you feel applies to you and your situation, and then leave the rest because only, you know exactly all of the circumstances that are going into, into what's happening.

[00:58:40] Maryal: [00:58:40] When you say that it makes you think of a couple of things.

[00:58:43]So my husband and I, we are very different in terms of I will use a thousand words and he will use one to describe the same thing. And when I am saying a lot of words, he literally asks, are you venting? Or are you [00:59:00] looking for advice? And that has helped us in so many situations because , I will clarify straight up in the beginning of the conversation, this is exactly what I'm needing.

[00:59:09] And that said the other thing that I was thinking when you were sharing about, the advice that may come from, posting about closure thinking about closing is when you have the time to build a relationship with your patients, I feel that while we network as DPC physicians, This is where building relationships with other people, like you said, trusted people can really help our, individual journeys because you're 110% correct in that, you read a post and that's just like, an eight minute visit.

[00:59:47] You're not going to know everything that went into that history. I mean, for example, this, this experience that you had in training, you know, if we were just [01:00:00] focusing on your DPC journey from the day you opened to the day that you closed, that would not have been incorporated. And we are humans at the end of the day, we have so many experiences that come into how we practice as doctors, how we function as people, how we are as parents.

[01:00:20] And so that is so important to highlight that everyone's story is their story. That's it there's no, there, there may be judgment. Should there be judgment? Probably not. And because if you want to give advice, that's great. But I feel that when you share about unwarranted advice, it is really important to also, like you pointed out that you might get all of this information and you have to choose what you're going to take in and what you're going to allow to impact your future.

[01:00:55]Dr. Pack: [01:00:55] Yes. It reminds me of a post that I saw a couple of years back on the [01:01:00] group about somebody who , had opened their DPC was really struggling. And he had, I mean, Certainly dozens, maybe hundreds of comments telling him what he needed to do. Right. And, and I, I just said, I see you, I hear you. This is really hard.

[01:01:17]And I was the only one who said that, sorry to get emotional. But yeah, I just, I think that that's really important to just keep at the forefront of, of the whole thing that we're human beings taking care of human beings and the movement is amazing. The movement is awesome. But it can't overshadow that fact that this may not work for everybody and that's okay.

[01:01:39] Yeah.

[01:01:40]Maryal: [01:01:40] And with you saying that though, I want to also point out that you are still very much a part of the DPC community. You might not be practicing in your practice right now, but your experience is so valuable for people to hear, especially those who are thinking about [01:02:00] closing, like we talked about, but just in general to, to remember, to take care of all of us.

[01:02:05] Right. Because , we can't just take care of things when they're happy. Thinking about in the kid world, you don't love your kids only when they're not crying. Like you love them, especially when they're crying. So, you know, I, I, again, I'm so grateful as I'm sure all the listeners are that you are sharing your story and I hope that it also.

[01:02:27] Makes people maybe stop when they see a person asking those types of questions and check in with that person or send them a private message to say, Hey, I'm wondering about your post wanting to hear some more would love to know that you're supported no matter what you're going through.

[01:02:45]Dr. Pack: [01:02:45] Yes. Yeah. And certainly I spent so much time learning about DPC.

[01:02:50] Like I would be happy to talk to anyone. And just last week I talked to a pediatrician, who's getting out of residency, starting in Colorado and I [01:03:00] just, answered his questions and I was super happy to spend that time, , and I've done that a few times, even since closing. So I would love for all that Facebook time not to go to waste.

[01:03:10] Yeah, so I, I love DPC. I love the movement. Like I said, I I just, I really do have a really, really tender place in my heart for it. , and especially pediatricians, you know there's not that many pediatric DPCs out there yet. , I'm sure they'll grow and flourish like the family medicine practices have, but yeah, so I'm super happy to talk to anybody.

[01:03:31]And

[01:03:32]Maryal: [01:03:32] As your kids, you said they're eight, six and three, as they get older and as the movement grows, would you ever consider doing another DPC or joining in with another pediatrician to do DPC again?

[01:03:47] Dr. Pack: [01:03:48] I would consider it if the right Opportunity came along, you know, or, you know, God forbid something were to happen to my husband or that sort of thing.

[01:03:56]Yeah, I would definitely consider it again. I'm not sure I would do it, you know, [01:04:00] in my area again. But yeah, I, I would consider it again.

[01:04:05]Maryal: [01:04:05] And on that note, if others wish to reach out to you, what is the best way to get ahold of you these days?

[01:04:11] Dr. Pack: [01:04:12] So you can find me on social media. I'm on Facebook and Instagram.

[01:04:15] Whitney Webster pack is, is my name on both of those platforms. You can also email me Cortez pediatrics@yahoo.com. If you Google Cortez pediatrics a Google listing will also come up and it will say that I'm closed, which I am, but there's a phone number there as well. It's a Google voice number.

[01:04:33]So they can call me or text me on that as well. So any of those, any of those ways is good.

[01:04:40]Maryal: [01:04:40] Wonderful. It has been an absolute pleasure to talk with you today, Dr. Pak,

[01:04:45]

[01:04:45] I really truly appreciate you sharing your story today.

[01:04:49]Dr. Pack: [01:04:49] Well, thank you so much , I'm really happy here doing this and I love that you're talking to so many different people, so thank you so much for giving me a platform to share.


*Tanscription performed by AI. There may be transcription errors.

 

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