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Episode 46: Dr. Thomas White (He/Him), Dr. Josh Carpenter (He/Him) & Dr. Brianna Buchanan (She/Her)

Together, they are the team at Hometown Direct Care - Cherryville and Shelby, NC

Direct Primary Care Doctors

The team of Physicians at Hometown Direct Care
Dr. White, Dr. Carpenter & Dr. Buchanan

Dr. Thomas White is a native of Cherryville, NC. He attended Duke University for his undergraduate and medical degrees then went on to complete a residency in Family Medicine at Charlotte Memorial Hospital. In 1988 he returned to Cherryville and established Cherryville Primary Care. In 2015 he opened Hometown Direct Care, the first direct primary care practice in the area, which now offers care in Both Cherryville and Shelby, NC. He is board-certified in Family Medicine and Clinical Lipidology. In 2015, he served as the President of the North Carolina Academy of Family Physicians. In 2020, he was selected as the Family Physician of the Year in North Carolina by his peers! He is married to Diana, and they have 2 children — Whitney, a hospice RN, and Daniel, also an MD who is in his fourth year of a surgical residency - and two grandchildren Lawson and Addy.

Dr. Joshua Carpenter is a native of Duncan's Creek in Rutherford County, North Carolina. He attended Burns High School, the University of North Carolina at Charlotte, and The Brody School of Medicine at East Carolina University before completing his Family Medicine Residency at Cabarrus / NorthEast Medical Center. He is married to Megan, and they have a daughter, Lucy and son Edison. Dr. Carpenter works primarily at the Shelby location, which was opened in August of 2017. He is board-certified in Family Medicine.

Dr. Brianna Buchanan is a family medicine physician originally from the Midwest, who has been settled in North Carolina for the last 7 years. After attending medical school at Campbell University School of Osteopathic Medicine, she completed Family Medicine residency at Harnett Health. Besides medicine, Brianna has sung and played acoustic guitar for over a decade and uses her love of music in the community. She loves to travel and has explored overseas on various medical mission trips, including Africa during the Ebola crisis. She chose family medicine to invest in the doctor-patient relationship. Brianna’s love for family health is what drew her to Direct Primary Care. She is married to Logan Buchanan. They enjoy backpacking/outdoor adventure, travel, and exploring the world of cuisine.

Resources Mentioned by the Team at Hometown Direct Care:

- Dr. Thomas White's feature in the Gaston Gazette as the NC 2020 Family Physician of the Year!




[00:00:00] Direct primary care is an innovative alternative path to insurance driven healthcare. Typically patients pay their doctor a low monthly membership and in return build a lasting relationship with their doctor and have their doctor available at their fingertips.

[00:00:29] Direct primary care to me means the intersection of a simple but brilliant business model characterized by lower overhead, full transparency and a manageable patient panel intersecting. With the opportunity to practice more independently with freedom from the tyranny of the large employer and the games play a third party payers, that's a win for both patient and doctor.

[00:00:58] But the real beauty of [00:01:00] direct primary care to me is that it is a means to an end. It in the end is a way of achieving why I chose medicine to begin with the incredible privilege to truly inadequately listen to the patient without time constraints, without metrics and without the usual rules of medicine and serve as that patient partner Bozar and advocate in this very confusing, complex thing.

[00:01:30] We call health care, direct primary care to me means serving my patients and community to the best of my ability while simultaneously maintaining my own personal, physical and mental wellbeing. Direct primary care to me means just returning to that patient focused medicine and getting back to the central [00:02:00] doctor patient relationship.

[00:02:01] I am Dr. Thomas White. I am Dr. Josh carpenter. I am Dr. Brianna Buchanan of hometown direct care, and this is our DPC story. Um,

[00:02:18] Dr. Thomas White is a native of Cherryville North Carolina. He attended duke university for his undergraduate and medical degrees, and then went on to complete a residency in family medicine at Charlotte Memorial hospital in 1988, he returned to Cherryville and established Cherryville primary care. And then in 2015, he opened hometown direct care.

[00:02:41] The first direct primary care practice in the area, which now offers care in both Cherryville and Shelby, North Carolina. He is board certified in family medicine and clinical hepatology. In 2015, he served as the president of the North Carolina academy of family physicians. And then last year in 2020. [00:03:00] He was selected as the family physician of the year in North Carolina, by his peers.

[00:03:05] He is married to Diana and they have two children, Whitney, a hospice nurse, and Daniel, also an MD who is in his fourth year of a surgical residency and two grandchildren Lawson and Natty. Dr. Joshua Carpenter is a native of Duncan's Creek in Rutherford county, North Carolina. He attended burns high school, the university of North Carolina at Charlotte and the Brody school of medicine at east Carolina university before completing his family medicine residency at caravan Northeast medical center, he is married to Megan and they have a daughter, Lucy and son Edison.

[00:03:40] Dr. Carpenter works primarily at the Shelby location, which was opened in August of 2017 and he is board certified in family medicine. Dr. Brianna Buchanan is a family medicine physician originally from the Midwest who has been settled in North Carolina for the last seven years after attending medical [00:04:00] school at Campbell university school of osteopathic medicine.

[00:04:03] She completed family medicine residency at Harnett health. Besides medicine, Brianna has sung and played acoustic guitar for over a decade and uses her love of music in the community. She loves to travel and has explored overseas on various medical mission trips, including Africa during the Ebola crisis.

[00:04:22] She chose family medicine to invest in the doctor, patient relationship and Brianna's love for family health is what drew her to direct primary care. She is married to Logan Buchanan and they enjoy backpacking and outdoor adventure traveling and exploring the world of cuisine together. They are hometown direct care.

[00:04:46] Welcome to the podcast, Dr. White, Dr. Carpenter and Dr. Buchanan. Thank you. Thanks for having me so excited to be here. This is such an honor, and I just love that you guys are [00:05:00] here on my DPC story just before the start of this year is AFP DPC summit, and I feel so excited to have you on because of the fact that there are three physicians in your practice, Dr.

[00:05:15] White, you started the practice, Dr. Carpenter. You've joined the practice a few years back and now Dr. Buchanan, you're joining. And I just think that hometown is showing how this movement has really grown over the years in that you are supporting three physicians coming in at different times. So thank you so much for being here, Dr.

[00:05:36] White. I would like to start off with your practice prior to 2015, because when you opened hometown direct care, it was after you had already had an established practice. And so I was wondering if you could share with the listeners, what was cherry hill primary care like in terms of demographics, in terms of your everyday experience as a [00:06:00] physician in your former model of practice?

[00:06:03] I started Cherryville primary care in 1988, came back to my hometown and it was initially a solo traditional practice. I had a partner over the years. I had several partners and ultimately became part of the, of large local hospital system. And by the, by the year 2000, my practice remained busy, probably had a panel of about 3000 patients.

[00:06:31] We had two physicians in the practice. We had two nurse practitioners was a very large busy practice. At one time, we were open seven days a week. And as I began to move into a little more administrative role, my panel diminished a little bit, but by the year 2013, I was, I was busy. A full panel plus administrative beauties.

[00:06:58] And I saw all [00:07:00] ages. It was not doing stat tricks, so it was not doing prenatal care, but I was doing nursing home care. I had done hospital care for many years. I had a somewhat shrinking pediatric practice because I'd been in practice myself for so long. But by the year 2013, I made the decision to leave that hospital system.

[00:07:21] And to go down another path I want to ask, because you mentioned an administrative portion of your practice after you would transition from taking care of patients solely. What was the reason for you to go into administrative positions? Because I'm wondering, did you start having a sense of what the buzzword is?

[00:07:44] The burnout. From patient care and the demands that the hospital system was putting on you, that you sought almost like a safe Haven in administrative practice to give you a little bit of a break from the demands of patient care. [00:08:00] Yeah. So I think it was a mix. It was a mixed bag. I think part of it was to try to get away from at least one or two days a week that seeing 30 plus patients and feeling under such pressure.

[00:08:14] And then part of it was a very naive, idealistic thought that I had that somehow I could help support primary care colleagues. If I got into a position of being a regional medical director, it was both selfish and altruistic, but probably more selfish because I just couldn't keep going at the pace that I was going.

[00:08:38] I quickly learned that sitting in meetings all day was also not what I want to do. Given what you've just shared. How did you come to learn about direct primary care as an alternative to the model that you were practicing? 2009, I began to hear lectures about direct primary care. Dr. Brian Forester, a colleague [00:09:00] of mine from apex, North Carolina was presenting lectures.

[00:09:04] I was intrigued. I really wasn't ready to make that decision, but by the time that I made the decision to resign from my employee job, and actually I took a year sabbatical, I didn't jump directly from my old practice to a new practice. I intentionally had wanted a year sabbatical and didn't. And so it was, I got into that sabbatical and looked at a lot of options.

[00:09:30] The one I kept coming back to was direct primary care. I made a lot of phone calls and made a lot of visits and studied it. And it was about six months into my sabbatical that I made the decision. The real epiphany for me was when I got a phone call, when I looked at my cell phone and it said Wichita, Kansas.

[00:09:50] And it was Josh. calling me back and I talked to him for two hours and my wife didn't know who was calling. All she could [00:10:00] hear was this conversation going on in the living room. And when I came back in after two hours, she said, I have not heard you that happy in many years. And I knew that night that I wanted to do direct primary.

[00:10:16] That's just incredible. That's just incredible. And no matter where a person is in their DPC journey, I feel that that epiphany feeling that you're describing that as a real, it's almost like a physical feeling. You literally can consense different portions of your body. Physically reacting to that DPC exists.

[00:10:36] DPC is real and you can do DPC. So that is amazing. That was your experience. Now I want to toss the same question to Dr. Carpenter and Dr. Buchanan, how did you guys learn about DPC? Yeah, so I was in medical school between 2010 and 2014. And I'm thinking it was, I think late [00:11:00] 2001 did, I guess it was late in medical school.

[00:11:02] So it was late in my fourth year, maybe early year, first year of residency. I remember reading an article about a doctor in Washington state doing DPC, and that of course was Garrison bliss. That most people in DPC are familiar with. And I remember seeing that and thinking, this is a really interesting concept that makes a lot of sense too.

[00:11:25] That was my first introduction to it. And then over the next couple of years, like Dr. Y had mentioned, I had heard a couple of lectures, I think at some annual AFP meetings about the model. And it always seemed like one of those things to me that was, this is what the outsiders are doing. This is very, very small group of doctors are doing, this is something that I'll never probably even have the chance of doing until until the third year of my residency.

[00:11:56] When I found out about a doctor in terrible North [00:12:00] Carolina, You're just very close to where I grew up doing direct primary care. And fortunately, one of my attendings, she, I think she recognized something, a little different in me that I was not made for the traditional fee for service model. And so she mentioned Dr.

[00:12:18] White and I had heard about Dr. White, because he was recently at that time, the North Carolina academy of family physicians, president. So I had seen him, I had heard him speak and I knew who he was. So that's when I built up the courage to send Dr. White an email and said, Hey, I'm from close. By growing up, uh, near charitable.

[00:12:40] I'm really interested in what you're doing. Can I come do a two-week elective rotation? So this was late in third year of residency. When I think everyone else in my class had decided what they were going to do. So I was one of the few that there still wasn't. Sure. So that's when I got my first up close and personal look at DPC and.

[00:13:00] [00:13:00] There was, there was no turning back after that. Josh, you had something a little bit incorrect about all that your attending actually told me that you were too good for a traditional, that you were perfect for direct primary care. So it wasn't that you weren't cut out to do traditional. It's just that you were a special, you were a special resident and she proved to be right.

[00:13:28] So I first heard about DPC during my residency. I learned about it late, later on than you Josh, but essentially Dr. Tammy waters, she came to talk at just a normal Friday didactics. We did every week and she was our guest speaker and she was just talking about setting up her practice in apex. And I was amazed at what she was doing.

[00:13:47] I remember her saying that it saved, saved my career, essentially. And I was just thinking, man, I don't want to have to go through that process. Can I preserve it before I need to save it? And for me, I just didn't. I [00:14:00] loved the idea. I just didn't think I could do it myself. I didn't think you know that I had the money that I could put into it upfront that I couldn't invest in my own practice.

[00:14:08] I didn't understand the nuts and bolts. I couldn't imagine drawing my own labs. What I do as staff, I just, there was just too many questions. I thought it wasn't for me. Until I went to the North Carolina AFP conference in Asheville where Dr. Carpenter was actually on a panel of folks and they were all, it was a, it was essentially a job fair.

[00:14:27] And so I was just a part of it, trying to learn about all these different places that could essentially get a job. And he was, he stuck out to me describing DPC again. So it comes the second time I'd heard about it. And just the way that he was describing it, it was every everything that I thought medicine really ought to be.

[00:14:44] And he pointed to Dr. White across the room. I had no idea who Dr. White was. That's fine, which I'm actually grateful. Cause I didn't know all of his accolades because I was able to talk to him later. He pulled me aside and said, you should really think about DPC as I walked through the hall. And there's just [00:15:00] something about those interactions.

[00:15:02] Initially, I reached out to Dr. Carpenter too. Just get connected to this DPC world. How do I get a job in DBC? Is there even a possibility? And I think what they showed me is that I, I could join up and I could be a part of this movement when I didn't realize that that was impossible for me. So they really opened this huge door.

[00:15:23] And then, and then it became, oh my goodness, my husband family lives right near you guys. I want to join you in particular. It wasn't just DPC world. It was them in particular. And so, yeah, that's the story of how that happened. I just love that. That was your experience. I hope more residents. And again, going back to the fact that next week is going to be the AFP DPC summit.

[00:15:46] I just love that. I'm hearing more and more of these positive stories about people wanting to do DPC in residency early or later in residency, and then being able to find avenues to actively do [00:16:00] DPC once they'd be residency now, even though, especially for Dr. Carpenter and Dr. McKinnon, you guys mentioned that DPC was really what you sought after residency.

[00:16:13] Did you guys have any hesitancies actually making the leap earlier that I wasn't locked into a plan, a latent third year of residency, but I did have a plan. I grew up knowing a couple of local doctors pretty well. My, my mother was a family nurse practitioner in a traditional fee for service family medicine office.

[00:16:36] So my plan for several years was I'll probably just end up at that practice as a fee for service family, doc. And it got to the point where I'd even sat down with them and talked through all the details. The only thing we didn't do was draw up a contract. So that, that was the plan that I was going to do.

[00:16:53] Fortunately, they were still an independent practice, but still very much fee for service. And then I encountered Dr. White [00:17:00] and we were assumed to be on the same wavelengths. And I saw DPC as, why not now coming out of residency. I thought if I'm going to take a risk and then now's the time to do it, as opposed to 10 years into a fee for service practice, where I'm used to making a certain amount of money, and then I give all that up.

[00:17:23] So yeah, I felt a little bit nervous going into it. It was anyone who want to come join to be my patient are enough people going to come join. If people join, are they going to stick around? How long is it going to take me to build up a panel? There are all these questions circulating, but at the end of the day, I.

[00:17:43] I did not see a future for me, at least not a sustainable future in a traditional fee for service model. Yeah. I had some nervousness and some hesitation, but it was very much overwhelmed by the excitement to, to pursue DPC. Wonderful. And [00:18:00] Dr. Buchanan have a chew. Yeah. So for me, it kind of came down for me to two of my.

[00:18:06] Top job choices. I would say one was of course, with Dr. Y and Dr. Carpenter. The other one would be my residency. They really wanted to grow their own and have me join us. Faculty would have been really comfortable choice because I knew them. I had a lot of backup if I needed to. And the offer was very comfortable income wise, but I just, I realized for me personally, I just really believed that there is more to life than money essentially.

[00:18:33] And what they wanted me to do was the very typical model of the 20 patients a day. I would be in a new practice to grow their new facility. Those could be on my own out there. And I really wanted a team that was important to me. And when I voiced some of the concerns I had about starting off like that and not really having a break after residency, Essentially sentence you'd get faster.

[00:18:54] And that's my problem is that I've been known to be slow because I enjoy talking about patients and [00:19:00] taking care of them and I'm always behind. I just stay on. That's probably why DPC is for me. Yeah. So that just, there were definite things as I went through that process of really thinking about that, it was, there were some things are very tempting about it, but it just, it wasn't the, I guess the fit that fit my personality, my needs and what I valued in my practice, what you guys are saying, it just, it really hits home.

[00:19:23] Dr. Buchanan, when you talk about always being behind, I had my first son while I was probably two and a half years into my fee for service practice after residency. Yeah. I remember that for me in my breastfeeding journey, I really feel that I have lost my supply because I was always running behind and I could never even make my pumping breaks.

[00:19:49] That's just a part that I, that comes to mind when you share the always being behind. And then the other part that comes to mind is that uncomfortable space of your patients are [00:20:00] angry at you when they have to wait an hour and a half. And you feel mortified when that happens. And you're mortified, but then you think about why am I feeling guilty about taking time with patients because that's the care that people deserve.

[00:20:15] So I totally hear you when you say that. And then Dr. Carpenter, reflecting on what you said about joining a doctor became, you mentioned this too, that, that comfort level, that what we're used to, what we know, and typically that is, we know fee for service. That can be a type of model that pulls us. I think that if there are folks who are in residency and who are thinking about DPC or those who have recently left residency, I think that that your sentiments are things that people can really relate to.

[00:20:46] Because for example, in my own residency, in all three classes, there was a huge pull for Kaiser, which is a fee for service corporation in California. So I think that you guys, your experience is very [00:21:00] relatable and thank you for sharing and. I want to go back to you in terms of when you decided to do DPC.

[00:21:07] W did you have any hesitancies in particular? I sure did on a number of levels, but let me address something that you've heard a little bit for me, and you heard it from both doctors, carpenter and Buchanan, and that is everyone's familiar with this notion of Stockholm syndrome, where folks in captivity began to identify and actually in Mar and support.

[00:21:32] And they think somehow after a while their captors are right, that happens in medicine a lot more than that, we begin to feel that we're inadequate, that we're an inadequate doctor when we can't meet the volume demands and expectations. And we start judging ourselves. We're not as good a doctor. Say our colleague or [00:22:00] our partner, the person that's putting more dollars on the books or the resident, and can see more people in a day.

[00:22:08] And that's really unfair for us to judge ourselves. I really want to stress that direct primary care is a way to share that guilt because that's not how we should be judged as doc to go to your question. I made it the decision I actually made the decision to from my employee job, the hospital system.

[00:22:29] And I didn't even tell my wife, I made the decision, uh, the North Carolina academy of family, physician, winter meeting that Dr. Buchanan referred to as years before the one she referred to. But I made the decision that week at that meeting because I realize I'm not the family physician that I wanted and I was turning 60.

[00:22:54] And I thought if this is how it's going to be, I'm either going to leave medicine or I'm going to [00:23:00] do something different. So I came home from that meeting, told my wife, put my notice in and resigned. Now for the first few months, like I mentioned, I wasn't sure what I was going to do. I looked at a lot of options, but when I began to think of direct primary care made the decision about six months or so before I opened, I was awake at 3:00 AM every morning, thanking fit times, even doubting myself.

[00:23:25] What about done? My crazy. I gave up this and that. I left this huge panel, busy practice, and I had a lot of colleagues in the state. Folks are served on boards with new who really questioned whether this would even succeed in a small community of 5,000 by cheering because they saw this is some type of concierge model something.

[00:23:52] Was really expensive and folks would not see the value in it. And so there were a lot of naysayers. I [00:24:00] just put my head down and listen to friends and colleagues who were already doing it. I put my trust in them planned and thought it through, I think pretty thoroughly, but yeah, a lot of anxieties and my wife sure.

[00:24:15] Had a lot of anxieties about as well. And that's natural. I think for our families, others have some doubts because this is, uh, it was bad and it's maybe a little less. Now it's a new concept. Patients get the concept pretty quickly, doctors. Maybe you're a little slower to grasp direct primary care is I think our significant others grasp what it is, but they're so worried that are we jumping into something that is not a very good idea.

[00:24:47] So I think it is important as folks make the decision to consider direct primary care, make sure your family, your significant others. Everyone is on the same page. This requires [00:25:00] education of everyone. It requires trust, but it also requires a little bit of just a jump and the net will appear and there's tons of people helping to hold the net.

[00:25:13] As you jump into this arena, tons. Collegial support. It's the most collegial environment I've ever been a part of in my medical career. There is so much truth behind that collegiality. It's just ridiculous. Like when people talk about drinking the DPC, Kool-Aid it is Dr. Haley Miller talked about this, but it's real.

[00:25:33] This is such a welcoming community, a community that is really wanting to push everybody to succeed because a rising tide floats all boats I feel is, is the overwhelming feeling that I get from the DPC movement. Dr. Carpenter and Dr. Buchanan, I would love to hear from you guys. What was your experience when you spoke with your families about.

[00:25:54] Hey, I'm going to go to hometown and be a DPC doctor. Yeah, I guess I'll start with [00:26:00] kind of what was going on. I was burned out as a resident and some experienced doctors may criticize that statement. How could you be burned out as a resident? But I mean, as a third year residency in 20 plus patients a day in clinic and having all the same nonsense, you have to deal with universal suffering within that setting.

[00:26:18] So I think I was in that setting and not being labeled as someone who was efficient, like Dr. Whitehead has spoken about earlier. And that really kind of got me down because I felt like I was doing a good job as far as taking care of patients. I'll get to the direct question in a second, but I've told this story several times that I have.

[00:26:40] An attending, give me an evaluation that basically said Josh is easily frustrated in clinic and he appears to be checked out. That's not a good evaluation. And yet, especially from one of your attendings that you respect the most. I just, I contacted that attending and said, I'm not checked out when it comes to patient care.

[00:26:57] I just really hate the way that we do things. [00:27:00] And in this traditional model, it just does not make sense. So, you know, my wife, she saw how frustrated I was. I think she knew that I was going to try to do whatever I could to make it work for us. So when I presented the idea to her of doing direct primary care, she was thankfully completely on board.

[00:27:23] Put her full trust in me and said, if this is what you think you should do, then you should do it. And I'm very thankful for her being that supportive because we spent a lot of years making very little money, eating a lot of eggs and bologna and bread. And then you give up the big fat signing bonus from the corporate medical entity.

[00:27:42] And you give up the nice big starting salary, but thankfully that wasn't important to her or to me, what was important to us. Building something that was sustainable for, for our future and for our mental wellbeing. And thankfully she was, she was completely on board that experience that you went [00:28:00] through, Dr.

[00:28:00] Carpenter, with regards to your attending, commenting that you were checked out, it's it is heartbreaking because as a family physician, when you're dedicated to your patients, and when you try to do your best for your patients, and that's the perception, I would feel disappointment as well because yeah.

[00:28:15] You look up to those people. Now, Dr. McCannon is following in your footsteps and you followed in Dr. White's footsteps. You guys are just building this community and this culture shift I'll tell, pay the interest in end to that story because he, the other part of that evaluation was that I was perceived to have lost my joy in medicine essentially, but fast forward to graduation, just a few months later.

[00:28:39] And this is not to toot my own horn, but I received an award for having the highest patient satisfaction ratings of any resident to come through that program. So that tells you the disconnect there. That I was still very much engaged with patients and doing the best I could for them, but I was miserable myself.

[00:28:59] So yeah, [00:29:00] it, there were, there was something didn't line up there. We shouldn't have to sacrifice our own wellbeing to, to give good patient care. You can be a very happy, joyful physician and take good care of your patients. That's awesome. And that is an amazing achievement and yeah, just totally highlighting the disconnect there in the way that paper services.

[00:29:24] Dr. Buchanan. How about you in terms of when you were discussing making the jump to DPC with your family? Yeah. I probably talked about it with all of them, but in particular, my older brother, who's a, he's an ER, physician in Georgia and that's a little bit different in his world, but he thought it was a cool idea and it made sense, but he told me to be very careful and that it did sound risky to him.

[00:29:45] The idea that almost too good to be true. So to just really learn about it and be sure. And my husband who was seeing me in residency, getting home tarting at night, maybe eating dinner, and then charting more, getting up in [00:30:00] the morning, charting more prepping. It was just, it's just wild. You guys know what I'm talking about.

[00:30:05] And I decided, I, I want to live. Like I want to get home. I want to have dinner with my family. I want to just have balance. And, and really my biggest worry going into trying to figure out a job was, man, what can I do for 30 years? And be well that entire time. And what can I, how do I not burn out? I was most worried about burnout and essentially he was so when he heard about it and when I was trying to explain to him, because he had seen me in how life was actually going in medicine, he was just so supportive.

[00:30:36] He doesn't have a business background. So I think it made a lot of sense to him business wise. And I think he saw that this is such a good way to take care of patients. This is, this, it's a new concept. I understand that people might think it's, especially my family. They did. They thought it was risky. I understand that feeling as well, but to me it is so worth that risk start to begin.

[00:30:59] And when [00:31:00] you mentioned what you just shared, I think about how Mr. Earl, he was a music teacher at my high school. He. Worked his tail off for decades at our high school. And he was all set to retire, go travel. And he passed away within the first year of his retirement and he never got the chance to do the things he wanted to do through the things he looked forward to after working so hard in so many years there to carpenter.

[00:31:29] When you talk about how you're taking care of patients and the idea of having your patient care be honored in terms of the way you do patient care, taking care of you. I go back to you then Dr. White, with regards to you chose to do this model at age 60. And you did, I think again, that this is such a powerful interview because all three of you are here talking and Dr.

[00:31:54] White, especially if there is a physician who has been in practice for decades in a fee for service model, and they're [00:32:00] hearing the story and they're hearing now you have two partners joining you. How powerful is that you can be. This is, does not have to only be a model that you can only do out of residency.

[00:32:12] Totally can be that you can do it after working in paper service for five years, 10 years, 20 years, whatever it is. So I appreciate you guys for sharing your experiences in terms of how you discussed it with your family and what the feelings were that motivated you to, you know, make the leap. Let me add a couple of comments here.

[00:32:30] And some of this is, I think it may be obvious to many people. You've had a number of guests on your podcast. I don't know if you've, I don't know that there's anyone doing this as old as me, but there may be. But one of the, one of the things that happens to us when we get so excited about direct primary care and we pursue it and we plan it and that is we start it and then we don't think about the future.

[00:32:57] Okay. What's my practice going to be like in five years, [00:33:00] 10 years, 20 years. But how has I started mine at age 60? I had to think about that. A little sooner than many people. I think it's really important to do that. Being in solo practice is challenging, but it's also risky in that if you are forced to quit or retire, then what happens to that practice?

[00:33:23] The other thought is that I think direct primary care is the perfect practice for that physician. Who's been in practice for many years and really doesn't want to retire at age 60 or 62 or 65 wants to continue practicing, but just doesn't want to do it the way they have been. I know a lot of family physicians who are, they can't wait until they can retire.

[00:33:50] They pay off their children's college education or they pay this or that, or they save up enough money. So they can [00:34:00] finally walk away from that, that practice that's burning them out. I think direct primary care is an option that ought to be considered more by the older physician as a way of extending their career.

[00:34:13] There's no doubt that it extended mine. I could have walked away from medicine, a little bitter and unhappy at age 60, but this has enabled me to continue practicing. So I think this direct primary care, I think it's a model for the doctor right out of residency. I think it's an excellent option for the mid-career physician, but it's also one for the physician that is frustrated and can't wait for the day to retire.

[00:34:44] Maybe they ought to rethink and can look at direct primary care. Wonderful. And I have a particular physician in mind that I'm going to be texting this podcast episode to when it comes out because. I have tried to plant that [00:35:00] seed in this particular position, beer that you know, that there is a beauty in continuing a practice, jumping from fee for service, into a direct primary care model and choosing how much of a patient panel you want to carry.

[00:35:14] How many hours do you want to work, but you still get to practice medicine. And that is so important for people to hear. So if there's anybody else who is a listener who knows a physician who's been in practice five years, 20 years, whatever it is and who could use Dr. White's words as a seed for themselves text, share it, share this episode with them.

[00:35:35] I totally encourage that because I think about when I've had attendings who have been in practice for decades, the value that comes from the amount of knowledge that they have because of the many years in practice, it's heartbreaking when that goes away because they retire. And so. I think that's really a good point, Dr.

[00:35:57] White, that you make that this is it. It is a [00:36:00] really perfect solution to cold Turkey retirement for our physicians. Let me add if I could, that someone may ask Dr. Wa why would you add another physician? Why would you add yet another physician? Why would you share your practice, your revenues of the practice?

[00:36:19] Why would you do that? And obviously the, the, I guess the cynical answer from some course, I'm just trying to prepare for my eventual slowing down or retirement or death, but it's more than that. And particularly in a small community like this, I want there to be a hometown direct care for many years. I want there to be an independent home-bound direct care for many years.

[00:36:45] I will this model in our communities here to, to, to have legs, to have a future. I think it's. Good for the community that I wanted to [00:37:00] find the very best doctors to work with. And just listening to Dr. Carpenter, Dr. Buchanan, I think you can pretty quickly surmise. I think I was incredibly lucky to find these two individuals and they're the future of hometown direct care and not feel really good about that.

[00:37:23] And Dr. White, with you mentioning the goal of longevity for the practice and for the quality of care that you as a clinic bring to your patients. I want to ask in terms of compensation, how was it set up at hometown in terms of when Dr. Carpenter and Dr. Cannon came on? Are you guys on salary? Are you guys paid because of the number of patients that have joined your panel and you've created your own income that way?

[00:37:54] How does it work at hometown? If it's okay. I'll take a stab at that first. And then [00:38:00] Dr. Carpenter, Dr. Can you guys can correct me on this? And I want to be really honest and address an elephant in the room here. And that is that there are a lot of ways to do this. There are a lot of ways to add a partner and I don't think any of them are really right or wrong, but I have my personal opinion.

[00:38:23] And that is that a, a young physician right out of training typically has debt. They have student loans, they have a mortgage, they have a family responsibilities and they can join a direct primary care practice, but to tell them that they have to eat what they kill. Is I think counterproductive to, to the growth and success of their practice and their happiness.

[00:38:52] So you can Moonlight, you can do ER shifts, you can do a variety of things. It can work. I just, [00:39:00] I philosophically just don't think that's how we grow direct primary care. My approach to it was look, I've had a very successful career. I wanted a Dr. Carpenter and I want Dr. Buchanan to throb. I left money on the table for them to be able to be salaried so they wouldn't have to Moonlight.

[00:39:22] So they wouldn't have to do a lot of extra. Certainly they're not making the salary. They could. If they had stayed with the big hospital system, it's a compromise, but I hope it strikes a sweet spot. And so their salary, Dr. Carpenter is now has done so well. He's now. Sort of an incentive phase where as he grows, he will actually be taking home more than his guaranteed salary.

[00:39:48] So that's been fun to watch. And I have no doubt Dr. Buchanan will in the next few years to come, you guys correct me on that? I may have misrepresented. Yeah, [00:40:00] no. When Dr. Wyatt and I were first kind of meeting talking about how can we make this work? Now I basically just said, Dr. White I've survived comfortably on a resident salary.

[00:40:10] And for the last three years, I don't really need a whole lot. So we informally came to an agreement, Hey, this is, we can make this work. And then we'll just see how it goes. And maybe probably 99% of lawyers and doctors out there or not be comfortable with that kind of agreement by handshake deal. But I think we were just so confident in.

[00:40:32] The relationship we were forming, we were confident in our, in the practice. I think we were confident in ourselves that we were going to make it work. I, I didn't need to buy the big house straight out of residency. I didn't need a big fancy cars. I was okay. Delay and delay in some of those lifestyle choices.

[00:40:53] That's basically how we worked it out. And I think it's worked out really well. And I'm thankful how it's worked out. [00:41:00] Yeah. I it's really cool to hear your perspectives on this. It can be difficult for people trying to make the jump like you were saying. And so, because you do, you start with zero, I'm starting zero patients.

[00:41:10] And how do I sustain that? How do I eventually I'm hoping in a few years I'll be having more of a full panel and pulling my weight and everything for our, our team that we have. And it's that problem of starting with zero patients, not making really much money for the practice and then that process of growth and.

[00:41:31] Yeah, no, I think it's worked out great. It may be for some who are considering doing something like this, it might the, yeah, the offer might not be as big or as shiny as others, but you do have to consider what the trade-off is and what your life will actually look like and what you value. I think those are just big things to figure out before you do take the leap.

[00:41:56] And I think this is a very amazing way, Dr. [00:42:00] Why, what you've done is phenomenal and I hope we'll extract some ideas with other people about the growth of DPC. I love that you're looking at that perspective as well, because it's one way to do it and you've done it. And we're both here to attest to it, hats off to you, Dr.

[00:42:15] White. That's amazing. And I think that's very, it's very responsible. It's very supportive. It's very sustainable because I think about the day that I created this podcast, I was so. Disappointed upset all the emotions, because I was in a position where I either had to sign an RVU contract or be terminated after more than five years in my position in a community of 4,000 people where the need for primary care is extremely great.

[00:42:45] And so I feel that with you developing that model that you did before Dr. Carpenter came on and now Dr. Buchanan, it is very much honoring the understanding of where people are coming from realistically in this country [00:43:00] when they graduate residency. So that's amazing. Now I want to ask you guys a more general question, not necessarily from your experience joining hometown, but what are the questions you wanted answers to when you decided to join and Dr.

[00:43:18] White, what were the questions that you wanted to. Of new potential partners that were going to join your practice. And the reason why I asked this is because if somebody is in the position listening that wants to hire a partner or somebody is a person looking to join on a practice, I would love to hear what your guys' thoughts were to potentially give food for others to, to feed off of, in terms of when they're seeking a partner or a partnership.

[00:43:45] My big question at the time was what are your plans, Dr. White? Because four years ago, I guess it's been four and a half years ago now, but yet you have a physician who's over 60. Again, traditionally, you [00:44:00] think how much longer is this person going to practice? So I guess I was curious what his goals were.

[00:44:04] How did he see the practice developing? And did you know, how was it going to look basically in the next few years, that was kind of my big question. And I had several other questions. If anybody knows Tom white, they know how generous he is and how open-ended he often is with his, with his responses. So he, he allowed a lot of freedom and extreme amount of freedom and kind of what I wanted to do and what goals I had.

[00:44:37] We entertained four or five different ways that we could design the practice with me coming on. I could be in the same office as him. I could, we could do a somewhat kind of urgent care situation. We could alternate days we could form a whole new practice. So we, we entertained all those questions and.

[00:44:56] That was, that was really nice because, [00:45:00] you know, again, at the end of the day, I think most physicians would agree. Like the number one cause of burnout is the lack of autonomy. So when you don't have any control over your, your situation, that can feel really claustrophobic and intimidating. And this was the complete opposite of that.

[00:45:18] I don't know if every established DPC who's looking to join a new physicians is that open to as Dr. White was, but that was really nice because we can design it in a way that was in line, I think with Dr. White's goals, but also mine as well. Yeah. Thinking back to some of those early conversations, some things that two things come to mind for me, one of them was.

[00:45:42] How do you all make decisions for the practice? I wanted to get a sense because I came from a system where I was just told what to do, and I followed the rules. Essentially. I had no voice. I had no say in how it worked with where I practiced and it just goes a little bit frustrating. I was just the cog in the [00:46:00] wheel.

[00:46:00] I was told by my system that my value, especially around monetary value was in the power that I had to refer to specialists. And I just couldn't stomach that because I believe that my value is me and my patients. And that's really not about the monetary value of specialists and the, I have more to offer as a family physician than that.

[00:46:24] And essentially. And I did. I wanted a team. That was my other question. Are, are you all team? How does it work? I didn't want to go out by myself and just try to be a hero on my own. I know I needed people around me to sharpen me and make me better and did I can learn from as well. And so during those early conversations, it was very clear to me that they had the freedom as running their own business, that they had the freedom to really create as they went.

[00:46:56] And Dr. Carpenter was mentioning, you could do whatever. It was [00:47:00] amazing, the innovation that went into it. And so I just, I couldn't believe it that again, I thought I'd be stuck in a system where I didn't have a voice. I wasn't able to make my own decisions or even put out my preferences and, and no one would really listen or care.

[00:47:15] And this was just so opposite as Dr. Carpenter was saying, they wanted to know what I thought and they wanted to bring me to the table. How me sit down and we talked about it and we'll figure out, figure it out together. And it's just been an incredible to be able to do that. I just, again, I never thought I'd be able to, and I can't believe that I am.

[00:47:36] It's surreal and definitely something that everybody in, whatever job they hold, whether it be in medicine or not, everybody deserves that. But especially in medicine, when we have the calling to take care of other people. And so if we're not working together as a team to really honor the people who are actually doing the care of people, then the system becomes a dinosaur.

[00:48:00] [00:47:59] I'm so glad that has been your guys' experience. Dr. Wait, what were some of the questions that you had productor carpenter before he joined your practice? All my many years in practice and most of them were in an employed situation where I really didn't have much choice about the partners. Join my practice, the ones that came and went, whether that was physicians or nurse practitioners or physician assistants, but there's many years of having some partners that would come and go.

[00:48:36] Uh, I think I learned a lot and I learned to trust my instincts. So rather than focus on things like, are you really good at reading EKG? Again? How fast are you? How many can you see a day? Those are the old metrics of the traditional practice. I think what I learned in my years of having partners is to, [00:49:00] again, trust my gut instinct, just like we do as good family physicians in the exam room with the patient.

[00:49:08] And I just applied that. I talked to. I've talked to a variety of positions and nurse practitioners and physician assistants over the past seven years when I met Dr. Carpenter and I had heard wonderfully nice things about him, but I knew in 30 minutes, this is a person I would want to be my doctor. And I would want to be my family's doctor and my community's doctor.

[00:49:37] And I didn't care how good he was reading EKG. I didn't care about those things. It was the tangibles. And I think the same thing happened with doctors. You can. And when I met her, it was like, I knew pretty quickly. This is a person that I would want to be my physician, my family's physician, my community's physician.

[00:50:00] [00:50:00] And I went on my gut instincts. I was absolutely correct about Dr. Carpenter and I have no idea. It will be the same. Dr. Buchanan. Yeah, I guess as I've gotten older, I've learned to trust my instincts. I think that's something you learn and hone and hopefully get better and better at the longer you're in the practice of medicine and you're dealing with individuals and you're in that exam room.

[00:50:26] And you're trying to assess things sometimes with very direct questions sometimes by instinct. I hope that answers your question. Absolutely. And I, I hope that people who are seeking partnerships or who are seeking partners, I hope that really gave them some food for thought as well. Dr. White, I want to ask you, because you've mentioned how you've had partners throughout your years of medicine and now working with Dr.

[00:50:53] Carpenter and Dr. Buchanan as your partners. When you were looking for partners [00:51:00] in for hometown, how did you go about advertising that you were looking for somebody to join? I did not. I didn't place ads. I didn't seek a recruiter. It was very much, very informal word of mouth. I think Dr. Carpenter, actually, he and I did place an ad once and it didn't get it.

[00:51:24] It didn't really get any traction, Josh and not at all. I think we, again, we realized that's probably not, that's not the physician that we wanted to attract anyway, because I think the person who reads, sees that help wanted pad traditionally, they're going to call and say, Hey, what's the salary? What are the hours?

[00:51:50] What's the buy-in, what's the deal. I own the practice. How much will that cost me? Plus the call schedule. That's all. Those are important [00:52:00] questions. I don't mean to say they're not. And we've addressed those Dr. Carpenter and Dr. Buchanan and myself cause they are important. But my approach was word of mouth.

[00:52:10] Talk to trusted colleagues and residency programs who is who's coming along. That may be a good fit. I probably did more background checking on these two folks than they realize. And I'll say too, when I came to do that rotation with, I came to, to do the rotation, to just see what DPC was. Cause I didn't really know.

[00:52:35] I wanted to the in-person it's an experience. And when I saw it, I said, this is amazing and this is how it should be done. Hopefully one day I can do it. And I was very surprised when Dr. Wyatt basically said, well, if you want to come do it now, come do it. So that's kind of how that happened. There wasn't really an advertisement from him [00:53:00] to hire another physician.

[00:53:02] I think we tried to be a little bit more before we thankfully attracted Dr. Buchanan, but even that formality did not yield a whole lot of good results to us. It very much happened naturally and patiently and at the right time. Yeah. So here's, this is another version and funny version of that story. Dr.

[00:53:22] Carpenter came and spent those two weeks with me. And I guess I was thinking then I really heard some great things about the sky and gosh, maybe he'd be a great partner, but because he said earlier, he already had his sights on another practice and I fully anticipated that. Um, that's where he would end up going.

[00:53:45] I was a little, I was a little nervous about it because that other practice, they were friends of mine. I didn't want to come across it. I was recruiting against them. And maybe that approach worked that I didn't, I wasn't in the recruiting mode, things just [00:54:00] click we're comfortable with each other. You knew what medical practice was about.

[00:54:04] You'd been around it your whole life. And, and so we ended the two weeks, basically it was a great two weeks, but I wasn't sure where it was going to go. I don't think I put on a big recruiting spill. I didn't put his name on the billboard or giving him a Jersey with his name on the back and handing money under the table, like a college recruit.

[00:54:28] We just ended the two weeks and it was all good. And then I like to say that it was on Christmas Eve. It may have been new year's Eve. It may have been neither, but I liked the Christmas. Version. Cause I don't remember. It was very close to Christmas and Josh sends me an email basically saying I really enjoyed my two weeks.

[00:54:51] I really love direct primary care. I want to do what you're doing. And I'm thinking, are you kidding me? I [00:55:00] mean, are you kidding me? What a Christmas present? And I think we both understood then that, okay, we'll work out the we'll work out the details, but our instincts and our chemistry and what we both wanted as physicians, it just clicked.

[00:55:17] So Josh, I'm going to stick with it being Christmas Eve and that was Santa Claus present outside. I'll hold that. That's fine. Great. That's awesome. I absolutely love that. And it just, it reminds me so much of how Dr. Katherine Agricola shared how, when she was joining all to care, primary medical care, the understanding that she had with Dr.

[00:55:43] Vasquez, Brian was very similar in that Dr. Carpenter, Hey, you mentioned that the lawyers would not necessarily be super proud of what happened with you guys nor was the case with Dr. Agricola, but the feeling that I get from how you guys are just reminiscing about what day it was, what time of the year, Christmas time, [00:56:00] it just makes me feel.

[00:56:02] It, it, it makes me, it reminds me of how there are certain attendings that I've had that I've worked with over the years that I, I value so much as not only attendings, but as colleagues. And I just love that you guys are in this together. It just, I just love it. As we're talking about employment and finding partnerships and partners, I want to throw out for the listeners.

[00:56:24] If you're not aware, Dr. Doug FRAGO has made a website, DPC And on that website is a list of DPC classifieds. So if you are seeking a partner, feel free and reach out on DPC to post your job listing. And if you are looking for a partnership, you can go search one out. So especially if there's residents who are listening to this podcast, it's a great resource to check out and it changes all the time.

[00:56:51] The next question I want to ask you guys is with regards to benefits. That's another Dr. Buchanan. When you talk about the jump [00:57:00] off that you had into DPC. I want to ask about what are you guys doing for your own family's health benefits, dental benefits, vision, what are you doing to cover yourselves? What I've decided, if I'm going to be a DPC doc, I'm probably out to see one.

[00:57:18] And not that I have to, I'm choosing intentionally that I do believe in this. And so I would like my own DPC doctor. That's what I'm going to do. My husband, he does have, we do have health insurance through his current job. However, he just got a new one that is better, and it's very exciting. And we're going to choose not to get health insurance through his job.

[00:57:39] That was an option for us initially, but we're probably going to do for health insurance, like a health share or a catastrophic plan because yeah, we really believe in this and we're doing it completely ourselves, but yes, similar I myself am a member of a DPC practice. My wife actually works [00:58:00] for a employer who pays for their employees to go to a DPC practice.

[00:58:04] So she and the kids are members at another. And then we are members of a health share that we essentially use it as like a catastrophic plan. Unfortunately, we're all healthy. And we looked into the traditional insurance and it was just, we couldn't justify the cost. So we went with what we think is probably the, one of the more reputable health share companies.

[00:58:28] And so far that's worked out really well for us. I will say too, just you mentioned dental and vision for me. I've not often had those benefits and I'm just going to seek out my own for that. And that is just fine because that's what I've always done. And I think it's very important to point out that you got to reach a certain critical mass of physicians and patients and revenue.

[00:58:54] In order to provide those kinds of benefits for your staff or your physicians considering it [00:59:00] doesn't come on day one. It's part of the growth of a practice, the growth of a business, the maturity of the practice. So I am, I regret that in direct primary care, including our own practice, we don't have all those benefits for our employees, but it's our goal.

[00:59:19] It's a reason for growth. And Dr. Buchanan alluded earlier to decision-making the, the discussion, the decision, how do you do this? How do you do this financially? I think that's part of the growth of the team is to discuss that and see how you make it work and not to sound too old fashion, but there isn't a dollar tree, whatever you do, it comes from somewhere.

[00:59:47] And so that's a growth opportunity for a group of physicians. To work toward being able to provide those things. I would bet that most, very small [01:00:00] DPC practices can do those, but I bet you're most, all of them are working towards that.

[01:00:08] And we've, and we have worked in other benefits. We work in CME, certain amounts that each of us are allocated. The practice pays for cell phones because they're big parts of how we interact with patients. So there's other, I guess you would call it in benefits that aren't the traditional health insurance or dental or vision.

[01:00:31] That's great. And Dr. Carpenter, thank you so much for mentioning that because I don't think anybody on the podcast has mentioned benefits that are, that are beyond insurance insurance for employees as well. Partners. So that's really great. And I hope that gives some people, some ideas, because if they're not at the point yet, like Dr.

[01:00:50] White was saying in their growth to add benefits on doing things like a cell phone, that's totally achievable for a lot of people at, especially with the [01:01:00] options that there are today. So that's wonderful. So thank you for mentioning that. And Dr. White, I wanted to ask you in terms of your own family's benefits, do you, what do you do for your own healthcare?

[01:01:14] When I left the hospital system, I, I, my wife and I got up a plan through the affordable care act. We had an exchange plan. It was crazy expensive per month with an incredibly hard deductible. It's like the worst of both worlds and it was very expensive. And of course, one of the things you most people don't think about, but as you get close to 65 and you're.

[01:01:41] Those kinds of premiums. Medicare begins to look pretty good. We're both on Medicare now, but we have chosen a physician nearby that is not a traditional position. And we we've learned for things like vision and dental. You can negotiate and seek cash [01:02:00] prices that are very reasonable going. The insurance route is not the most cost effective way to do things.

[01:02:09] I learned a lot of that when I had the very high deductible plan. I've learned it as a direct primary care doctor. I've learned it as a patient. I'm not sure now it's still at 8 67. A Medicare claim has been filed for me because I believe in seeking a stale affordable cash pricing for my care, my medications, my immunizations health screenings.

[01:02:36] And what have you. I look at my Medicare, my wife's Medicare as a catastrophic injury plan, not something we use on a day to day, month to month basis. I think we learned those lessons from direct primary care. That's awesome. And as I planned to open my own doors, every healthcare provider that I've seen [01:03:00] this, the last one was my optometrist.

[01:03:02] I have, I keep asking people. Okay. So if I switched to cash pricing, what would that look like? And it's amazing when you talk about how, if you ask, if you look into what cash pricing is. Necessarily a catastrophic amount that we have, but we, so I go to Costco for my optical needs. I have just glasses and not nothing fancy, but to have an exam every couple of years, and to have glasses made at Costco, it's totally affordable the things we need in direct primary care.

[01:03:37] And I understand there are a lot of hurdles. There are a lot of issues with going across state lines and brokers and who has a license, but wouldn't it be really cool in the direct primary care world. If we can offer a catastrophic health insurance to all direct primary care physicians and their practices.

[01:03:59] So [01:04:00] they all have that basic coverage in case something horrible happens. Wouldn't it be cool if we could do that across the entire country, but there are a lot of obstacles, but I'm just going to throw that out here on this podcast that I think we need to continue to explore that. And see how we can make it happen because it is a, it's a need of really everyone, not the day-to-day overpriced healthcare plan, but that kind of stroppy plan that most of us encourage our patients to carry if they can, if they're a DPC patient.

[01:04:36] And are you guys aware of any movements in that direction, in the movement in general, but the first group I think about is the health Rosetta. I don't know if you are aware of any discussions along those lines of getting to a point where that catastrophic coverage could be a real thing. Yeah. I think the [01:05:00] Alliance has talked about it, but again, there are there's issues about brokers and going across state lines and all those things that are above my head.

[01:05:11] But I know the Alliance has explored that. It's just, it's interesting because when we have groups, like nor Cal, that I know that they're disseminating, but doctors, medical, the doctors company, nor Cal that there are different companies that are able to provide malpractice coverage for positions in all states or different states.

[01:05:36] I should say. It seems to me that there's there has to, it is, it could be a real thing. Yeah. It could be, I think health insurance and life insurance and malpractice insurance. They're just all different animals. Sure. Sure. Now, when you guys look at your practices again, you [01:06:00] guys are coming from three different perspectives, but I want to ask in terms of.

[01:06:06] What does your practice look like now? Like, what is your everyday, what is your typical everyday experience as a physician doing DPC again, opened up our Shelby location in August of 2017. And I guess I didn't really go into it. Knowing what my hard cut off would be for patient number wise. I wanted to see how my patient panel would grow and how, what kind of patients I would attract and how complicated they would be.

[01:06:45] And then I would have a better idea as I went along. So I think now not quite four years into it, I think I'm probably getting close to about 80% full and I'm not looking to add, or I'm not looking to have a panel of 6, [01:07:00] 7, 800 patients. I think I'm probably going to be more in the 450. Maybe a little bit higher up to 500 patient panels.

[01:07:09] So I'm getting close to that. I was thinking I was already going to be there and then COVID happened. And there, thankfully we didn't lose any patients, but our growth basically stopped really went down quite a bit during COVID. So fortunately the past month or two it's taken off again, almost at an overwhelming pace.

[01:07:30] So I feel like I will be, my panel will be full by the end of the year currently, what that means on a day-to-day basis. I think I probably average four to five face-to-face visits a day. I think I probably average about that many and what we would call like tech visits, phone calls, texts, patient portal.

[01:07:50] I usually don't schedule a patient before 9:00 AM. I don't schedule any, usually after four o'clock, if I can help it, if sometimes a little bit later, I'm basically at [01:08:00] the office Monday through Thursday, all day, and then Friday until lunchtime. And I think currently I average maybe two after hours contacts a week that that needed to have something to be done about them at that point in time.

[01:08:17] So that's kind of what it looks like for me right now. Very manageable, a good balance. So I'm with the new panel. I haven't started quite yet, so I'm getting things set up. And to me, it's very exciting. I know I'm in a honeymoon phase because I just can't wait to get started. The difference between being told, I will not have a break after residency and you will start working ASAP versus my situation with this practice where they're making me take time off because I didn't want to, and I wanted to start right away because I'm so excited.

[01:08:47] I'm so ready to get going. So I think that I'll just throw that in there because the motivation and excitement is just so different in those two scenarios. And so I'm so [01:09:00] grateful to be in this one. I'll probably start off with just numbers wise. I'll probably start off with maybe a patient, any patient in the morning and in the afternoon, just initially to get my feet on the ground.

[01:09:12] And I'm going to try to grow at a rate of 25 a month or so, so wonderful. I wasn't sure how fast my practice would grow in the beginning. And I wasn't sure how big I wanted it to be. I knew that 600, which is a common number, thrown out, seemed a little big and busy for me. I need that many of my patients were going to be older.

[01:09:36] And so I thought, well, I'll get to 300, then I'll see how it feels. You get to 300 and before 400. So I'm still holding at about 400 adult patients about 30 dependents. I will say this about the growth. I think the first 150 patients are the most difficult. They're more [01:10:00] difficult than probably the next 300 or even the next 500 it's, especially when you're starting, you're learning, you're learning how to practice this way.

[01:10:10] Your staff is patients that they're new to this concept. I think it's pretty easy after 150 patients to say, oh my goodness, I don't think I can get any bigger, but it gets easier. So how would remind new DPC doctors to this realize that it's going to be a little tougher in the beginning? Not necessarily the growth part, just the new patients take more time.

[01:10:35] They will they'll need more visits about once you get folks settled in, they know that they can contact you. They know they can. See you when they need to life begins to calm down as Dr. Kissy Blackwell often talks about the, was it drinking water from the fire hose? I think everyone maybe feels a little like that in the beginning, but you can slow that down.

[01:10:58] So my typical day [01:11:00] is I see four to six patients a day. I love having an hour with my patients. I would be through earlier in the day, but I'm just not as fast. A documenter is Dr. Carpenter. And that four to six a day is the right number for me. And I haven't added many new patients at all. Recent years again, when I got through her about approaching 300, I tried to stop the growth, but it just wouldn't stop.

[01:11:31] So now I am, my practice is it's slowly going to shrink and we'll just have to see how that does over the next six to 12 months. Going back to the earlier discussion about that. At some point, if you decide to slow down and then retire from medicine, are you putting any strategies into place today in addition to not taking new patients slowing down the practice, but how do you envision today that [01:12:00] transition to retirement?

[01:12:01] I, I wonder because it's not too many DPC doctors who have retired like Dr. Doug Franco retired, but that that's not something that we really got into. And we were talking on the podcast, uh, remember from him talking publicly about it. He, someone purchased his practice. So you know where the DPC model.

[01:12:23] It's still young enough that this we've not had a lot of folks who've done this. So when I was setting up my practice, I could call 25 people and they could tell me how to set it up. I, can't not very many people I can call to say, how would you do this? And how did you do it? I don't have a lot of, I don't have a lot of role models out there who can show me the path.

[01:12:45] So I am, I'm feeling my way through it. I am, I want to, I want to educate my patients. I want to be prepared. Something unexpectedly happened to me. I want them to know they're going to be in good hands. I think [01:13:00] working a day list. So we trying to be more available to my grandchildren, but those are things that are important to me, but do I have a strategy I've got mapped out and I've got it tucked away in my back pocket.

[01:13:14] I'm going to feel my way through this with the help of my wife and children and my grandchildren and my two partners here, but I want to continue to practice medicine. I've got very long standing relationships with my patients. I think the beauty of direct primary care is you can continue to maintain those relationships without necessarily being in the office eight to five 50 weeks a year.

[01:13:43] So I'm optimistic. I've always been a very optimistic person that we'll figure this out. And I will, I won't be able to enjoy that time with grandchildren and my wife and make sure I do some of the things that I've always wanted to do, but [01:14:00] I don't feel deprived. I'm an incredibly fortunate person and I need to, if I need to take a vacation.

[01:14:07] Uh, carpenter's been great. We've covered each other. We've helped each other. And I'm not feeling desperate that I've got to make a decision about how I do this, but I hope how I do it will be helpful to some other direct primary care doctors is they approach the age I am. Now I was speaking with Dr. Ken Richter, who I believe is two years younger than you, Dr.

[01:14:31] White. And he is, I believe in a similar situation in terms of there. Isn't like you're saying there isn't a brick path to follow with regards to how to slow down and how to choose or when to choose I to retire. But I am hopeful that just as you entered the DPC space and you listened to your gut, like you're talking about that, like you said, you know, talking with your wife, thinking it over, talking with your partners about it, that it will work out for anybody who's in your [01:15:00] shoes now or in the future.

[01:15:02] So I want to ask, especially for Dr. White and Dr. Carpenter, as you've been at hometown, as you've been in practice. In addition to the challenges that you guys have mentioned, are there any other challenges that you've faced as a DPC doctor and how have you overcome those challenges? When I opened my practice and started seeing patients in March of 2015, but we actually started the practice in January of 2015.

[01:15:31] I started it with two employees that I had actually worked with for, uh, over 25 years each in my former practice. So two of those employees, a front office person and a clinical person came and joined me talk about a leap of faith. We started on January 2nd, 2015, and they knew what I was going to do, but they took a leap of faith.

[01:15:55] They, we had a lot of trust in each other. We'd worked together for many years, [01:16:00] obviously. So we knew each other and we trusted each other. One of those employees. We talked her out of retiring for a couple of years. She finally retired last year and, uh, we had to replace her. And that was a big change because in a traditional practice where you have 18 employees, employees come and go, when you're in a small practice where you have one or two employees, it is a critical decision who you hire.

[01:16:28] And so that was a challenge. That was, that was a worry, are we going to find the right person? Are they going to have the right people skills? Are they going to have the right technical skills? So I would say that was a, that was a challenge we had to work through. We certainly hired the right person. We hired a very different person, different personality, different skillset.

[01:16:52] Different backgrounds, but I think it worked out with Josh. Is that a good example? Yeah. Yeah. I think that's a perfect example. Yeah. I think [01:17:00] one other challenge that comes to mind is one that I think a lot of DPC practices have to face eventually if they've been in practice for awhile, but that's what do you charge your patients?

[01:17:13] The practice had been existence for several years, without any price changing. When I came on board, I was more interested in, in track attracting some younger patients and we had several discussions and meetings zone. She knows. Should we charge the younger patients last? Should we charge them the same?

[01:17:30] And ultimately we came up with a solution that worked for both of us. Dr. White's patients pay a price to see him, and then. The patients that come and join to be a part of my, part of the practice pay different rates and it's age, tiered. So that's, that was a challenge that we, we probably spent way more time thinking about than we, we had to, but we wanted to entertain all the possibilities and outcomes.

[01:17:55] And eventually we decided on that, what we would charge. And then we had to [01:18:00] decide again on when to increase our prices. So we had to do that as well. And it doesn't sound like huge challenges, but there's a lot of implications there. It worked out well, but it's probably because we took enough time. And then we're patient about how we made that decision.

[01:18:14] And I think another big challenge that comes to my mind, especially as a new physician coming out of residency is you come from a place that there's a ton of support. I was in a clinic with seven attendings in that clinic because it was basically covered almost an independent practice operating within a residency setting.

[01:18:37] So I had plenty of folks to lean on and Dr. Weitzman, great to lean on him when I came on and we started a new location. So it was kind of me. So I had to get comfortable with that really quick. Fortunately, I had attendings, I could still text every now and then we did have Rubicon that I used quite frequently.

[01:18:54] And then I developed some relationships with some of the physicians in town, some of the specialists, and that was [01:19:00] helpful as well. So that was a challenge that took some time, but now I'm much more comfortable being almost four years out of residency now. Yeah. Those are the ones that come to mind. Yeah.

[01:19:11] So just to echo what Dr. Carpenter said, we, I knew my target population was going to be. Primarily, it was people who had come to see me for so many years before. So it was older folks over 50. My target population to grow was not the younger folks. It made sense to come up with some icing that that made sense.

[01:19:34] We also came up with some pricing for employers who had a small number of employees. We chose some special pricing for that. Dr. Buchanan is I think, going to be seeking younger population than certainly myself. And so she's got some carrier pricing in there and her, if she starts her practice, I think one thing we did learn and I laugh about it now, but [01:20:00] we did, we worried a lot about increasing our prices and we didn't increase them much at all, but we agonized over that because I was just, I was fearful.

[01:20:12] All these people that I'd made this commitment to, it's going to be this much a month or this much a year. I just had these thoughts and maybe they're all going to just feel like I betrayed them. And we got virtually no resistance from increasing our prices of very small amounts. So I would say from our experience, Dr.

[01:20:34] Carpenter, you chime in on this, but you're providing good care. You're providing an incredible product with access and quality care. And when you do that by and large folks will appreciate it. And if you need to go up on your prices because of the cost of doing business, the cost of adding a partner, the cost of growth, my experience would say, don't spend as much [01:21:00] time worrying about it is idea, or we did.

[01:21:04] And Dr. White and myself have both had patients offer to pay us more than what we charge. We probably spend way too much time worrying about it, but I think naturally again, a lot of physicians have got out of that entrepreneur business mindset, those money decisions. Aren't always the ones that come naturally to us.

[01:21:27] I have been speaking with somebody who does marketing and I've been very comfortable and almost best friends with the term inaugural. So I love the idea of inaugural pricing to me. It sets the practice up for, okay, these are the inaugural fees. That does not mean they're the forever fees to me. That's the space I've been in terms of not feeling guilty about if that day happens, when prices have to increase, like you're seeing Dr.

[01:21:54] White because of the cost of doing business. But yeah, I'm really glad that you guys have shared this and [01:22:00] arguably those challenges, I feel could also be perceived as wins, but I wanted to ask you because since 2015, since there's been a direct primary care practice in your communities in both travel and Shelby, I want to ask what, when you guys talk about direct primary care to somebody who's not necessarily familiar with the model.

[01:22:22] From a patient's perspective. What is one of the biggest wins that you use as your example to help people understand? And I know Dr. White, you mentioned how it's easier somewhat for patients to understand compared to physicians, but what is that example or what is the major example that you guys use individually to educate others about DPC?

[01:22:45] In the beginning? I think I tried to express all the advantages of direct primary care, because I think there's so many, but I think I've learned since then, it really [01:23:00] boils down to one thing there's many, but there's one thing. And that is Tom. The time that you, as a patient will be able to spend with me and the time that I can devote to listening to you.

[01:23:13] There's there's email, there's texts, there's phone calls, same day appointments there. Keeping you out of urgent care, their medication dispensing procedures that we do at no or very little additional cost, but for me, it comes down to time. And if a patient says, look, I've got good insurance. And I have all the time I need with my physician or my provider.

[01:23:43] Then I say, great. If I don't know that I can make that better, but the vast majority I could make it. Awesome. And Dr. Carpenter. Yeah. So I think, I guess the biggest thing I try to advertise is access. I basically [01:24:00] tell prospective patients and new patients, like essentially what you're buying is access to a physician and what we believe to be access to high quality primary care physician.

[01:24:11] So that's what I usually stress at times. I'll try to throw out a little bit more real-world illustrations, as far as the advertisements on Facebook, Hey, we kept this patient out of the ER, because we did this and we likely saved them this amount of money. And maybe that gets some people's attention. But at this point in the game, it's kind of.

[01:24:33] Most of all my patients are coming word of mouth, but in the beginning it was doing a lecture at the rotary club. It was joining the chamber and telling the chamber folks about what we were doing and how different. And then they told people outside of kind of the patient experience, the residency program, I've had the opportunity to do that now several times.

[01:24:54] So it still always surprises me how many med [01:25:00] students and residents have never heard of DPC and there's quite a bit out there. So yeah, that's it. And Dr. Buchanan, you're definitely in that space right now with regards to onboarding new patients. And what do you find works the best when patients get excited about joining your practice?

[01:25:21] I've had just brief moments. There's sometimes you have about two seconds to share what I've found. Just coming out in those moments would be the patient focus. And this model allows us to really focus where we need to be putting our attention. Essentially I've worked in systems that are for-profit and it was very much money was the bottom line and also in systems that are not for profit.

[01:25:44] And that was still a pole. And unfortunately you, so this model. To me, the difference is that it's finally back to the patient where it ought to be. That's great. That's absolutely great. When you guys are mentioning time [01:26:00] with patients access it, it makes me think about, I had a recent conversation with somebody I randomly encountered in clubhouse.

[01:26:08] He is from Norway and he and I were speaking about neuro-marketing and the idea that when you are talking with somebody information like doctor, what you're talking about, the technical things, the, how the lab discounts, the imaging discounts, all of those things there, information which can educate people, but in the world of neuro-marketing and I'm no expert.

[01:26:31] But my understanding is that when you use things like how you guys are describing time and access, the idea that you are, that you are evoking emotion, In a person and that can lead to higher action, then information educating person. Like when you make somebody, when you remind somebody of the 15 minute visits or the eight minute visits, when you remind someone that there's no access after [01:27:00] a certain hour and you have to go to the urgent care, which might be 45 minutes plus away that evokes an emotion and a person.

[01:27:06] And so when Dr began, and when you talk about, you only have two seconds, I think you're using the time smartly when you are evoking emotion. When you talk about time and access and what you as a doctor give as value as your value proposition to your patients and your potential patients in terms of location, you guys mentioned how you have a location in Cherryville as well as Shelby.

[01:27:31] How did you guys decide to open up a second location? And what does it look like for hometown, with regards to future locations? So I was in Cherryville first, Dr. Carpenter described earlier, how he came and we, we contemplated a variety of scenarios. It really made sense to open a, an opposite Shelby because Dr.

[01:27:53] Carpenter had a history there. His parents had both worked there. He grew up very near there. [01:28:00] So for him it was, it was almost hometown dislike. Cherryville was hometown permeate. But before we finish tonight, I do want to mention how I chose the name, which might seem very obvious, but we chose the locations based on that.

[01:28:16] We chose it. We chose the specific locations because we wanted to be very much mainstream downtown. Hometown. And we settled on a, a schedule where Dr. Carpenter would come to Cherryville one day a week and he would be in Shelby the other days. And I have been in Cherryville inclusively. We open a third location at this time.

[01:28:39] Dr. Buchanan can certainly speak for herself, but the plan is she's going to be in Cherryvale and in the office there, but I don't think you'll see a ad in the classifieds from us, but are we gonna, are we going to add another position? We're going to have another location. [01:29:00] Very possibly or likely, but marketers speak to that.

[01:29:06] I think Dr. White built a very successful, great practice. I'm proud of what I've been able to add to it very much suspect Dr. Buchanan's going, gonna add even more. So yeah, I would looking down the road five to 10 years, I would love to see one or two more locations for hometown direct care with another one, two or three more doctors.

[01:29:29] I think it's very possible. It's funny, terrible. And Shelby are only about a 15 to 20 minute drive between them, but they might as well be on North Carolina and California. These small towns, it's like this across the country. People don't leave their small towns very much. So people in Shelby had never really heard of DPC or Dr.

[01:29:50] White's practice. When I came on board, I suspect the same as. The town down the road, Kings mountain or Lincolnton, or there a lot of these small towns, [01:30:00] there's still tons of positions. Who've never heard of DPC. So there's definitely tons of patients that don't know the benefits that it can provide. So I think if it's not, if it's not hometown direct care, there's going to be other DPC practices popping up pretty soon around our area.

[01:30:15] So I would love for us to continue to be the pioneers in our region of the state. Yeah, absolutely. We, I think that makes what, what hometown direct care is trying to do very unique is that growth is absolutely something that is very intentional. And yeah, we do want to grow. We want to. Provide care to the area.

[01:30:37] For sure. I love thinking about adding more locations, more doctors. I just probably in the sense to just, I want DPC to do well. I want baling medicine to do well. I want patients and doctors to do well, and I think this is one awesome way to do it. And so I think it's very much to Dr. White's credit that he not only looked to his, his own practice, [01:31:00] but he was looking for the legacy of the future and setting up me Dr.

[01:31:04] Carpenter, future physicians. This isn't just about Dr. White story. It's, it's bigger than that. And I feel that as well in the DPC world, that this is much bigger than me and it's so cool to be a part of it. And so I have that sense with our practice. With you guys mentioning growth. One of the things I always go back to in my head is what can we do as people in the DPC movement to inspire people who are not necessarily aware of DPC like medical students, pre-meds and residents, what are your guys' thoughts in terms of how to best effect the pipeline going into the future to help grow the movement takes, take students and take residents into your clinic.

[01:31:49] If you are like me, and don't think you're the best teacher just having that student or resident there, seeing it face to face or [01:32:00] DPC is a big deal. I despise public speaking, something else that I do not feel like I'm very good at, but when you're passionate about something, it makes it easier to speak about it.

[01:32:11] So that's why. You know, I, I try to take any opportunity that I can. If I get an invitation to go speak at a residency or in the past year, I've done a couple of zoom lectures for residency programs. Basically just getting the word out because a lot of folks still don't know, or they confuse us with concierge medicine.

[01:32:30] So yeah, I think please be willing to take students and residents into your clinic. Please be willing to speak to residents and students be willing to speak at conferences if they allow you. If it's not a DPC conference, see if they'll allow a DPC lecture. That's what me and Dr. White have been able to do in the past as well.

[01:32:50] Yeah, it's bigger than us and I want to see DPC continue to thrive. And 30 years from now, when I'm thinking about if I should retire, [01:33:00] I want to see the country for DPC doc. Awesome. And Dr. White or doctor. Dr governor. And I've talked about this, that if we can get the word out more to students and those residents that have never heard of it, which is remarkable, but I do think that family medicine also would be more attractive.

[01:33:19] I don't know about you and your experience, but I remember in med school, a lot of my friends were looking for something lifestyle balance. They wanted something that they're interested in. They wanted to be paid well and to earn their keep for their work. And I think that DPC offers that. And if we can get the word out and really explain that to students that maybe what they're looking for and striving so hard and worrying about and trying to do all this stuff, to get what they want in life and their goals and their values, it's there for the taking, especially for them and not only students and residents, but docs.

[01:33:56] Other doctors who've been practicing as well. I think this is [01:34:00] something they need to do. And Dr. White, do you have any input on how to affect the pipeline? Well, I think the, I think one thing to look at is let's look at medical students when they rotate through family medicine, clinics and offices, they're often extremely excited because it's, for many of them, maybe not the surgical types, but many folks who go to medical school, express a interest in family medicine or primary care.

[01:34:33] And they go visit a family medicine practice and they are just excited. They love the diversity. They love the relationship they see between the doctor and the patient. And, but then at the end of it, when it comes down to their decision, they start looking at a, they think about lifestyle. They think about hours, how many patients they're going to have to see.

[01:34:58] Did that family [01:35:00] doctor really seem happy, all those things. And then the medical students says aren't really loved family medicine, but emergency medicine kind of makes more sense or ENT or whatever. So I think if we could show medical students that family medicine can be practiced a different way and a DPC model.

[01:35:21] I think the number of students who seek to match in family medicine will go up dramatically. Now, what we've got to do for those AE positions is we've got to put these very tangible things in place like catastrophic health insurance, other benefits, ways that student loans will be paid off. We've got to address that and remove those hurdles.

[01:35:48] I don't think we can put in place these onerous buy-ins. But I've got this practice and yeah, in five years, here's what you're going to have to [01:36:00] fork out, to own a piece of it. Those are things that we're not going to grow DPC. If those obstacles remain for the young physicians. Now on the other end is the older physician.

[01:36:13] Like I was like, I am, it's less about benefits and money and all that. It's about, it's about sustainability and doing it. And is it real? And can I do this and truly feel like I've slowed down. So I think we've got different things we've got to convey. And it depends on the age of the perspective doctor.

[01:36:36] Again, I think this is a great model for the young position mid-career older, but each of those needs are different and we've got to be very realistic about that. And as a DPC movement, we've got. Talk very openly about those and try to solve those issues, or we're going to be a niche. We're going to grow very slowly and we're [01:37:00] going to be a very niche part of family medicine.

[01:37:03] And I don't think, I don't think that's what we should be. Absolutely not. And I hope that your, his words really resonate with people to start discussing that reality more in terms of, I see quite often people on the Facebook DBC docs group saying, I need a partner. Anyone want to come join me? And there's sometimes a struggle, especially like you guys mentioned, you're in a small community, sometimes moving to small community.

[01:37:31] It is, it's not the easiest thing for someone to leave the opportunity of a mortgage paid for seven year mortgage paid or whatever it is, the benefits of the bigger companies can offer. But if, if those fears are addressed, And everybody has a sense of as a community, that DPC community has a sense of how to answer that no matter where you're coming from.

[01:37:53] I think that thinking in that space of, if I talk to somebody who is interested in DPC, that I can [01:38:00] be armed with answers or creative solutions to fears that people might have, I think that's a great place to be in because then it makes it even more a reality that this movement is real. And it's not like you say, Dr.

[01:38:14] White, that it's not a niche type of medicine that said I absolutely have to recognize that Dr. White was voted as north Carolina's family physician of the year in 2020. And I just feel that it is so incredible on the Gaston Gazette news article that featured you winning the award. It pointed out your experience as an unsure intern.

[01:38:41] And now look at the full circle. Traveled in terms of you were this unsure intern, like we all were at some point, and now you are a physician who has two partners running a DPC since 2015. That's that is so incredible. But I want to ask in terms [01:39:00] of, again, the conferences coming up next week for DPC through the American academy of family practice, looking back now, why would you choose family medicine?

[01:39:08] If you could do it all over again. Thank you for mentioning that. I do tell people that I think the physician of the year award, I think they got down to the bottom of the alphabet. Mine sort of hit on the w they must not have any other W's. I was extremely grateful when I applied to medical school, I was undergraduate at duke.

[01:39:29] I applied to medical school there. Didn't think much of family medicine there, but at my medical school interview, they said, what do you want to do? They were, most of the answers were, I want to be an MD PhD. I want to be a thoracic surgeon. I want to be a immunologist. I want to be a pediatric infectious disease person.

[01:39:49] So they get me in there and I say, we want to be a family physician. And I want to go back to my hometown to practice. And there were like five people around the interview table and they [01:40:00] all cock their head, just like a dog who had heard of a funny sound or a whistle. Are you kidding me? So I left that interview thinking, there's no chance they're going to accept me for some reason they did.

[01:40:11] And, but I always felt committed to that, but that's what I said I was going to do. And I was going to do it and it worked out I've been incredibly lucky. And then I was incredibly lucky that when I decided to get out of that traditional practice, because I felt like. If it come, I become the doctor that I didn't intend to be in the hometown that I wanted to be, but just not feeling that it was right.

[01:40:38] I was so lucky to have colleagues and friends around the country who helped me choose direct primary care and helped me extend my career. And now I'm lucky that I have a staff and partners that I do, and just incredibly grateful to the patients who've made this possible. [01:41:00] I think sometimes we forget we're naming off all the things to be grateful for.

[01:41:05] We need to be grateful for our patients because we don't have, we don't have a job. We don't have a role if we don't have them. For those of us who believe that medicine is personal, that you don't want to just treat a certain age, certain gender, certain problems, certain issues that those of us who understand.

[01:41:28] Medicine's very contextual. You've got to, you can only understand an individual. If you understand their environment, you understand their family. However, they define their family. I think when you appreciate the personal nature of medicine, the fact that it's very contextual, as I said, then family medicine begins to make a whole lot of sense, but we need to make family medicine more attractive.

[01:41:55] And again, direct primary care is I think [01:42:00] the best way I've seen to do that. Amen. And Dr. Carpenter and Dr. Buchanan. Well, I went into med school thinking family medicine, and in my experience just confirmed it all along the way, the specialty of family medicine. And it is a specialty. Sometimes we don't get the credit.

[01:42:18] Oftentimes we don't get the credit that I think we deserve. I think it's the most challenging specialty. I think it's the most rewarding specialty. It's incredibly challenging from a, just a mental standpoint of trying to take a complicated situation and think through it and come up with a plan, not just for one issue, but several issues.

[01:42:42] I often tell folks the biggest luxury in the specialty world is the statement. You need to go talk to your primary care doctor about that. And we welcome that. So I think it's an incredible privilege to be as involved [01:43:00] and patients' lives as involved as we are. It's an incredible privilege to have the ability to help someone out in a time of need, regardless of what the issue is.

[01:43:10] So even if it's something that we can't directly help, we can often direct our patients to, to the person who can so. I definitely have no regrets at all. Choosing the specialty of family medicine. I think it's the purest form of medicine. I think it's when we need more good ones, we need more and more. So I like Dr.

[01:43:30] White says, I hope that we can build a more sustainable model. That's attractive to, I think the vast majority of folks who enter medical school. So yeah, that, I think that's it. I love what you guys said. I was thinking back to this first interviews that you've been referred to Dr. Watt when you're sitting there and there, and you're trying to get into med school, you've taken them cat and you're ready to go.

[01:43:54] Just hoping they'll take you. And they usually ask in that interview one medicine, why did you choose this? [01:44:00] And I think the, a lot of people say, I just, I want to help people. And I do believe that at the essence, that most folks go into medicine for wonderful reasons to, to help people to heal getting back to those essential oils right.

[01:44:16] Of what motivates. To do what we do. And why did we even get into this in the first place? And I think family medicine is such a unique privilege. As you guys were saying where patients they do, they trust you with such they're so vulnerable. And in sickness, as we all are, we are in a vulnerable state and they truly trust you.

[01:44:35] And it's just incredible. And so to be with patients in that setting, to walk years with them and help them figure out, uh, the system and get what they need when they need it. It is such an honor and such a privilege. And so if we, I, a hundred percent agree if we can make that more attractive to people coming into medicine as providers, if we can make it work and [01:45:00] function better just as a medical system to provide the best care we can while taking care of ourselves as well.

[01:45:06] That's what makes me so excited about this model and family medicine and the them happening together. I love what you guys have shared, and I could not agree more. And I feel that going into the DPC summit, this being the first conference national conference of the year that we've been able to have, I hope that people take your words to heart and as anybody in primary care or any specialists now, because specialists are joining the direct care movement.

[01:45:36] I hope people who are attending the conference will think about their own journeys as they interact with people virtually. And they might help inspire somebody with sharing their journey or with sharing knowledge about DPC that makes them so driven to doing direct care that, you know, Also affects the pipeline, just the, the idea that we keep sharing our [01:46:00] experiences and we keep making this a possibility for people.

[01:46:03] I think that's awesome. So on that note, I wanted to say, thank you so much, Dr. White, Dr. Carpenter and Dr. Buchanan for joining us today. And I hope to. Quote unquote, see everybody at the DPC summit next week. Thanks for having us. Thank you for what you're doing for the DPC movement. Getting the word out.

[01:46:22] I've enjoyed several of these episodes that you've had. Please keep doing what you're doing

[01:46:31] next week. Look forward to hearing from Dr. Ananda Metta of stand-up family medicine. If you'd like what you heard today, please leave a review and subscribe wherever you listen to your podcasts. Tell your friends to for more information on this episode and much more, please visit my DPC also for the latest in DPC news.

[01:46:50] Check out DPC until next week. This is Marielle conception.

*Transcript generated by AI so please excuse errors.

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