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!

- Rubicon MD

- DPC Alliance

- DPC News


CONTACT:

https://hometowndirectcare.com


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TRANSCRIPT*:

[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.