Episode 48: Dr. Marguerite Duane of Modern Mobile Medicine - Washington D.C.

Updated: Jul 31, 2021

Direct Primary Care Doctor

Dr. Marguerite Duane of Modern Mobile Medicine
Dr. Marguerite Duane

Dr. Marguerite Duane is a board-certified family physician who decided she would be a doctor when she was just 8 years old as she witnessed the birth of her baby sister at home! That transformative experience fueled her passion for family medicine and desire to one day do house-calls! Today, she is a physician with Modern Mobile Medicine, a direct primary care house-calls based practice serving patients in the DC metropolitan area.

Previously, Dr. Duane served as the medical director of the Spanish Catholic Center of Catholic Charities, a non-profit community health center that provides care for an almost exclusively poor and uninsured population in the DC metropolitan area through a direct pay model. Prior to that, Dr. Duane directed the Family Medicine clerkship at Georgetown University, and she still holds an appointment there as an Adjunct Associate Professor. Additionally, Dr. Duane is co-founder and Executive Director of FACTS – the Fertility Appreciation Collaborative to Teach the Science, a non-profit group dedicated to educating students and healthcare colleagues about fertility awareness based methods and their applications for women’s health and family planning. She is trained as a Medical Consultant in Creighton, FEMM and NeoFertility.

Dr. Duane received her M.D. degree with recognition in primary care from the State University of New York at Stony Brook and completed her Family Medicine residency at Lancaster General Hospital in Lancaster, PA. She received a Bachelor of Science with Honors degree and a Master of Health Administration degree from Cornell University. She has previously served on the boards of both the American Academy of Family Physicians (AAFP) and the Family Medicine Education Consortium (FMEC). Dr. Duane balances her career as a teacher and Family Physician, with her role as a mother and wife. She is proud to be accompanied on this life’s journey by her husband and fellow family physician, Dr. Kenny Lin, and they are delighted to be the parents of 4 young children.

In today's episode, she shares how she built her dream practice panel up after realizing she did not have to practice as a family medicine doctor full time! For an amazing example of how DPC can prevent churn, she shares how she went to do a research fellowship in Utah during the pandemic. During her fellowship, she was only available for in-person visits when she would be able to fly home and over 90% of her patients chose to continue on with her care despite being primarily cared for through telemedicine. Hear her incredible story today!

Articles written by Dr. Duane:

Why The Direct Primary Care Model Would Benefit Poor Patients (1 of 2)

Why The Direct Primary Care Model Would Benefit Poor Patients (2 of 2)

Resources mentioned by Dr. Duane:

- St. Luke's Family Practice (The "Robinhood" DPC in Modesto, CA. FYI: the Doctors who run St. Luke's will be on the pod in a couple of weeks!

- Dr. Brain Forest - featured on a Medical Economics interview here.

- Family Medicine Education Consortium

- DPCnews.com

- Surgery Center of Oklahoma

- Fertility Appreciation Collaborative To Teach The Facts





Coming 07.25.21

[00:00:00] Dr. Maryal Concepcion: [00:00:00] Welcome to the

[00:00:00] Dr. Marguerite Duane: [00:00:00] podcast, Dr. Dwayne, thank you so much.

[00:00:03] I'm thrilled to be here.

[00:00:04] Dr. Maryal Concepcion: [00:00:04] I wanted to start with your decision to become a doctor at such a young age, because I find that that story with you seeing the delivery of your sister is definitely not something that a lot of people experience.

[00:00:17] So what was that like for you and what grew in you that drove you to become a physician?

[00:00:22]Dr. Marguerite Duane: [00:00:22] I remember that fall day in 1979, like it was yesterday, it was November 2nd, 1979. And I was just eight years old. And my mother had decided willingly and knowingly to have her last child at home, basically because she had a bad experience with her previous delivery when she had my brother a couple of years earlier.

[00:00:43] And she also wanted us to be able to experience that. And so I can close my eyes now and I can still picture where is. Was in the room, whether it was my older sister timing, the time of the delivery, or my two year old brother who was out on the porch, looking in through the window, wondering why all of these people were around [00:01:00] his mommy.

[00:01:00] And I sat at my mother's feet next to my older sister Therese. And we both were in awe as we watched our baby sister come into the world. And I literally can remember in that moment, thinking, this is what I want to do with the rest of my life. Like I want to care for women and children and be a part of this miracle that is life that is caring for other human beings.

[00:01:26] And so I still pinpoint my decision to become a doctor to that day when I was just eight years old. And I never wavered from that. For me, my calling to be a physician was very clear. The ironic thing is I never actually met a family physician until I was in college. It was only a few years later that I realized I really wanted to be a family physician, because as much as I was in awe about the experience of labor and delivery, I knew that I loved children and I didn't want to give up [00:02:00] caring for children.

[00:02:01] And I actually need through my own experience as a child that suffered from severe asthma, that it was the support and the help of my family. When I would have an exacerbation that made it either much better or much worse, if they were there and supportive, it would make it so much easier to manage versus if I was alone and scared and isolated.

[00:02:22] So very soon after within a few years, I knew that I wanted to do family medicine. And like I said, I never wavered from that decision. And to me it's incredibly beautiful that after. Having that experience nearly 40 years ago, my practice today is an entirely housecalls based practice, where I go into people's homes and provide care for women and children and fathers and brothers and grandparents, people of all ages from before birth until natural death.

[00:02:53]It's just such an incredible honor and privilege to have a calling from a young age and to be able to [00:03:00] live out my calling through a direct primary care practice model,

[00:03:03]Dr. Maryal Concepcion: [00:03:03] in your practice currently, do you do any home

[00:03:06] Dr. Marguerite Duane: [00:03:06] deliveries? I wish that I could. I really do as a family physician, we are trained to do full spectrum family medicine, including prenatal care and deliveries.

[00:03:17] And for the first five years that I lived and worked in Washington, DC, I did do deliveries at Providence hospital, but Five years into practice. I became the medical director of two community health centers, where I oversaw a staff of 50 and primarily switched to more administrative work. So I cut back significantly on my clinical time and stopped doing deliveries.

[00:03:40] However, I have a passion now for reproductive health and in particular restorative reproductive medicine and helping couples who are trying to achieve pregnancy naturally by getting at the root cause of their infertility. So I work a lot with patients and helping them achieve pregnancy and monitoring their pregnancies [00:04:00] and attending sometimes more so to be there when the baby is born rather than to be the delivering physician.

[00:04:06] So I have a couple of patients that are due this summer. I'm really excited about, and they've already asked me, will I be there at the delivery? So when the baby is there, I can take care of the baby as well.

[00:04:15]Dr. Maryal Concepcion: [00:04:15] Even though, you're not actually doing the home deliveries, you're there, when that baby comes into the world and when a healthy baby comes into the world, it is so beautiful.

[00:04:25] Dr. Marguerite Duane: [00:04:25] Absolutely. It really is an incredible experience and it's wonderful to be able to work with our healthcare colleagues, certainly certified nurse midwives who are trained to do home births. It's encouraging that I don't have to bear the responsibility, but it's also nice to be able to be there, to be present and be a of that just awesome experience.

[00:04:45]Dr. Maryal Concepcion: [00:04:45] when you mentioned that you transitioned away from as much clinical medicine as you were previously doing, prior to opening your direct primary care practice, what was your clinical experience like in your professional experience?

[00:04:59] Like [00:05:00] before you opened your

[00:05:00] Dr. Marguerite Duane: [00:05:00] DPC? Sure. So I did my residency training at Lancaster general hospital in Lancaster, Pennsylvania, and absolutely loved it. I felt so well-prepared to practice medicine in rural settings and urban settings. And I actually spent a year after residency doing locums, where I worked in Western, Alaska and San Antonio, Texas.

[00:05:21] And, A normal sized suburban town in Pennsylvania. I did student health and I worked at a nursing home. So I got a lot of experience in a lot of different areas of the country. And then after I married my husband, who's also a family physician, Dr. Kenny Lin he's one of the associate deputy editors for the American family physician.

[00:05:41] He was accepted to do a medical editing fellowship at Georgetown. And we moved to Washington DC. And there, I initially started work at a community health center at where like most community health centers, you're expected to see eight to 12 patients in a half a day. So you're seeing like 16 to 24 [00:06:00] patients and a full day.

[00:06:01] And this is again, inner city DC. Most of the patients, are not necessarily English speaking and, or have multiple problems. So you're trying to deal with, as a family physician, patients with diabetes and depression and or patients with high blood pressure and high cholesterol and HIV. And there's so much that you're trying to deal with in such a short period of time.

[00:06:19]And it was at times overwhelming. I absolutely loved to doing the work, but I never felt like I was able to truly care for the patients the way that I think they deserve to be cared for. I can only do so much in a 15 minute visit and I would have to, so we need to come back, make a follow up appointment for this, knowing that for the patients that we serve.

[00:06:36] Taking time off for an appointment might mean not getting paid that day. So I always hesitated because I didn't want them to lose it, lose that funding. And then I did that for a few years before I became medical director, as I said, two community health centers in Washington, DC that were actually sponsored through Catholic charities.

[00:06:54] So through these health centers sponsored by Catholic charities, we actually saw an entirely [00:07:00] uninsured, poor population of people. And it was this experience that first opened my eyes to the whole concept of patients paying directly for services. Because even though our patients were a very limited means, we did ask patients to make a contribution to their care for their visit.

[00:07:18] And more importantly, we had negotiated with labs to be able to provide laboratory testing at significantly reduced costs. And a lot of the national laboratory chains were willing to work with us. If we ordered a lab, we pledged to pay that at the price that they quoted us. So I discovered that I could get a cholesterol panel for $4 or a complete blood count for $3 and 25 cents or a thyroid stimulating hormone test for $8.

[00:07:46] And I thought to myself, how is this possible? I remember when I went to the doctors and had a complete blood count done, it was $80. My father used to send me his labs and his bills and, a cholesterol test would cost him 60 or $75. So [00:08:00] this is the first time that I learned that when you pay directly for care, whether we as a clinic paid the lab directly or patients pay directly for their care, the cost was so much less.

[00:08:10] But the value is so much greater. So when patients would make, a small contribution to their care, they were investing in it, the knew they wanted to understand fully they wanted to get at the root cause. I'll never forget having a conversation with a patient once who had some early signs of liver disease and I had tested him for hepatitis and as it turns out, he was negative, which was fortunate, but he actually never been immunized for hepatitis B.

[00:08:38] And so I talked to him about the importance of giving him the hepatitis B immunization, because given his underlying liver disease, if he contracted the infection, it could significantly worse than this condition and result in much more severe healthcare consequences. And I remember having the conversation that the vaccine was going to cost him $80, which may not seem a lot of money to some people, but for this person [00:09:00] who lives paycheck to paycheck, it is a lot of money, but we have. The luxury of having 30 minute visits with patients. So I could take the time to explain like, yes, this is an investment now, but what, this could save you down the line could be dramatic.

[00:09:15] Like not only from a financial perspective, but this could literally save your life. And so he understood and was willing to make that investment in his health, on, in contrast, I remember seeing patients at my previous clinic who came in with insurance with a headache and they were like I need an MRI.

[00:09:31] I'm like, would go through you actually don't need an MRI, but will you just get it anyway? Because like my insurance is going to cover it. And so there's this mentality. If I don't have to pay for it it doesn't matter if I really need it or not. I want it because I'm already paying insurance.

[00:09:45] So I want to make the most of my insurance. And it's just a very different experience when patients are paying directly. Now, can I just make a comment about providing direct care to the poor? Because I think this is oftentimes seen [00:10:00] as one. The biggest, this was one of the biggest myths that direct primary care is concierge medicine, which to be very clear, direct primary care is not concierge medicine.

[00:10:11] They are distinctly different, but because of the association, a lot of people think that direct primary care is really limited to people of means people that would otherwise be able to have access to insurance and can afford to pay this out of pocket monthly expense for their additional luxury care.

[00:10:28] The reality is I'm sure you can link to this in your show notes. The average cost of direct primary care for a monthly basis is oftentimes less than $100 a month. And maybe even less than $50 a month, depending on, the age of the patient or the location, there's a lot of factors that go into it.

[00:10:46] But I learned through my work at Catholic charities. Even poor patients can benefit from this. And in fact, I wrote two blog posts about providing direct primary care for the poor. And these were published again, my husband, [00:11:00] Dr. Kenny Lin has a blog called common sense family doctor. And he posted these as guest posts on his blog.

[00:11:06] When I wrote them 7, 8, 9 years ago. And they were some of the most popular posts because I debunk the myth that direct primary care is for a limited selection of the population. Direct primary care really can be and should be for everyone.

[00:11:23]Dr. Maryal Concepcion: [00:11:23] I'm really glad that you brought that up because that is a big worry for some people when they are coming from a practice that's very heavily populated by Medi-Cal or Medicaid.

[00:11:34] And so it's really wonderful to hear you say that. When your patients in Catholic charities came to see a provider to see a doctor, did they pay cash for that visit because they had

[00:11:46] Dr. Marguerite Duane: [00:11:46] no interest.

[00:11:48] Yes. So all of the patients that we served were uninsured, and to be very clear, we did not charge them a visit fee. We asked them for a contribution for their care. We always, as a standard, ask them to contribute [00:12:00] $40 for a 30 minute visit. So at Catholic charities, it wasn't a true direct primary care membership practice because they did not pay a monthly membership fee, but they would make a contribution when they came.

[00:12:10] Now, if the person didn't have any money or they only had $10, we accepted whatever they were able to offer. And we never turned anyone anyone away. But what was astounding, what I found was amazing, like on average, we collected $32 per visit. So 80% of what we requested again for a 30 minute visit. Now, some people would argue that's terrible because you could get reimbursed from, insurances at a much higher.