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Episode 52: Dr. Julie Gunther (She/Her) of sparkMD - Boise, ID

Updated: Aug 25, 2021

Direct Primary Care Doctor

Dr. Gunther is the owner of sparkMD in Boise, ID
Dr. Julie Gunther

Dr. Julie Gunther earned her medical degree from the University of Washington School of Medicine in Seattle and completed her residency at Ball Memorial Hospital Family Medicine Residency. She is a dual board-certified family physician and American Academy of Family Physicians (AAFP) fellow who founded sparkMD, a direct primary care (DPC) clinic in downtown Boise, Idaho, in 2014. In her seven years in DPC, she has been featured in Forbes, National Public Radio, Bloomberg, Reason TV, Medical Economics, and several other news outlets. She is a DPC leader, current president of the DPC Alliance, and has spoken at the DPC Summit, Doctors 4 Patient Care Foundation, FMX, and many local and regional meetings since 2016.

She is a founding member of the DPC Alliance, a former Board member of the Direct Primary Care Coalition, and one of the minds behind the DPC Alliance Mastermind series.

Dr. Gunther loves challenges, entrepreneurship, working with people, and values all that DPC has done for her professional development, love of medicine, community, and health care as a whole.

DR. GUNTHER'S FIRST BOOK! Sparks Start Fires - A Guide for Dreamers Who Are Also Doctors (<-------BUY HERE! it's AMAZING!):

Dr. Julie Gunther at the 2019 DPC Summit

Dr. Gunther joins fellow DPC docs on the Reason TV Spot:

Other Resources Mentioned by Dr. Gunther:

- ANNUAL MEETING 10/8-10/2021will be in person

Jason Health - where patients can order their own labs and pay cash for them

Hint - Membership management & billing for healthcare innovators

- HINT SUMMIT 10/28 & 19th, 2021 will be virtual


Aesthetics Training By Dr. Gunther:


Good morning, Julie.

Oh my gosh. You're due soon. Yes.

Yeah. We we are 37 and one today.

It's unreal because I mean like yourself, you have to, and yeah. I have no idea. What I'll remember. The first one and my son is almost three.

He's actually going to be three on Monday. So we'll see. And then now it's different because with COVID masking in the hospital during labor, I'm like, Hm. that's what that'll be different.

Like they just don't need more drama during labor.

But in my very strong opinion I fully respect people who choose not to have children. I fully respect people who only want one kid, but I also, we only have two, I would have liked to have had four, but that probably wouldn't have been a great life situation as things have panned out. But I firmly believe having a second kiddo made us way better parents for the first kiddo.

It just, yeah. It just and to a certain extent, and then my brother, so I have a 15 year old and a 12 year old now, and my brother and his wife just had babies there actually one this weekend, they had twins. It's funny to see, because while it's been 12 years since we had a newborn um, I mean, we do newborn care at the practice too, but I'm just so much more comfortable with them than I was with my own babies.

And my brother is I think sometimes a little bit Florida. He's like, how do you know all this? How do you know to do all this? But you just learn it. It's awesome. Yeah. So it's actually, it's weird to say, but our experience it's actually easier with. cause like it's easier but harder if that makes sense.

But like the second, the first one just has to learn to get their stuff together. It's a perfect age in the sense that there's probably things your three-year-old should be pushed to start doing for himself that you're not doing because you're first time parents with him and yeah. And so there's some natural rhythm to it, I think.

I love to hear that. Especially from a mom of two who are three years apart too. It's, it's so different when you're taking care of kids in the clinic and then when it's your own, you're like, what do I do sometimes? Rob bras, bro.

He was saying the other day, he's it's okay. The second one will be feral and that's,

I can picture that. But at the same time, I think that my son is very much a helper, he's definitely in the, I do it stage, so I think it'll be nice. To have him. Help out so that he feels included. And I think that's one of the things I'm the most apprehensive about is how, how he, how he doesn't feel that he's any less important.

Yeah. But yeah, but he will be, and that's it sounds crazy, but that's the fun thing of parenting is it's a gift in my opinion, for a person to be raised, to understand that at times their needs have to be prioritized with other people's needs and and having a second child forces you to help him with that lesson, if you weren't going to do it anyway.

And then in hindsight, that's a really valuable lesson for him. And the other thing we talk about all the time and our house is just I believe in the infinite capacity for love or giving. So it's like when you and your partner married there, wasn't a discussion that maybe some people do, gosh, if we have a child, is that going to dilute our ability to care for each other and on now, I don't know what it would be like to have 21 kids.

I think there isn't bandwidth of ability to attend to anything. But I think I think love can be administered in very small increments and it can be very clear that it's true love in the sense of I'm a big proponent as a working parent that I'm a better, more loving, more capable.

When I'm able to be with my kids a small amount of time, then I when I'm with them a lot, like in illustrator when we have with COVID, there's a point where you're were like, I actually just want you to go away. My husband and I just celebrated our 20th anniversary. We still, it was together in Jackson hole and in the car. And I actually bet, I mean, I love this man. I miss spending a lot of high quality time with him, but there's also a point where I'm like I'm not my best me if I'm with anyone all the time, like I just can't, I need like some space.

by the last I want everyone to go away and want to do a craft. I'm so grateful that you are letting me talk to you about it, participate in this. And I meant what I said on online, which is this is something that is necessary. That is valuable. I wish some sensationalistic TV station would catch on and do a long documentary about all of us, because all of these individual stories are so important. There's a lot of discussion and non-movement about about when you to turn the focus on the patient and the discussion should be on the patient.

And actually I've always disagreed. And it's one of those things that that is, is hard to disagree with because clearly like the calling of medical care is about taking care of others. But it's actually, it's a completely perfect analogy. If there is no mechanism in place for you to take care of yourself.

And in fact your husband and your two children do nothing but just demand of you. And then on top of it, you have to answer to a landlord and the garbage man and the window cleaner, if every domain in our personal life was beyond our control, yet we were expected to answer to it. But then we're expecting your children to thrive.

It's not going to happen. Yeah. So it's not to say there's not a give and take. It's not to say someone has disproportionately bad or difficult days, but I've just, we keep we, while we talk about burnout and exhaustion it's been very hard for us as a culture to really talk about the privileged physician.

And we look at physicians as being of great privilege, but talking about how absolutely essential it is for the physician to thrive. And from that comes a thriving patient population.

It's a very weird way that I got introduced to that concept, but it's so absolutely true. We have a Filipino veteran focused clinic in Sacramento.

I went to UC Davis and we were doing a volunteer clinic for them through UC Davis and at this golf tournament there was a person who was one of the the players, took a golf cart and it slipped over the hill. Yes, baby. You okay. can you tell Dr. Julie what your name is?

Hi Asher. My name is Julie. How are you? Asher,

How are you doing?

Good. Good. Are you helping? Mommy? Does mommy have a baby in her tummy

and the baby brother? Are you excited?

But yeah this golf fell off of a, of the side of a, hill. And I was freaking out because I was like, oh my gosh this person is hurt. What do I do? And this is when I was an undergrad. So I, hadn't had any medical training and this doctor, he talked to me afterwards.

He's like, you have to take care of yourself before you are able to take care of others, because if you are freaking out, you cannot focus on what needs to get done. And so it's a very different way.

It's about

coming Hold onto mama's hand but yeah, the idea that w with this podcast, I love the idea that it can be. Timeless in that someone two years from now who's new to DPC or someone who's been in it for seven years is listening to somebody else's voice and reminding themselves about how like their own journey was or how, DPC can inspire people and how, it is important to take care of oneself because um, you eat when you can, you pee when you can mentality.

So it's not okay. And and your patients can totally feel that, right? You have patients who they know you well, and then they'll comment. Are you okay today? They'd like to check in with you because they can tell that you're stressed if you're running behind and stuff.

So it, I cannot agree with you more on that for sure. Julie I actually had read your, before your book, you had put out that um, yeah. A

tiny bit. Yeah. But yeah.

Yeah, but with the Holstee manifesto and with your comments, the things that I, that you added in your book though, that really just floored me. the first day I was reading it.

You talk about how let me turn to the page. One of the things that you mentioned was, your years in service, and then all of a sudden, they're basically saying as your employer, like you don't matter if you stay, you stay, if you don't, we don't really care.

And literally three days before I created this podcast, my husband and I had been given a, you either signed an RVU contractor, you get terminated letter. That similar situation of de-valuing your services as a doctor, I was just like, oh my gosh this is uncanny, you know? and then your note about you know, your patients and you offered them a same day visit, and then you didn't know that your staff told them the closest visit she has is two weeks from now. And you're like, if you had control over that, you would never have let that happen.

And you don't even know that happens sometimes. , I just, I, I really related to those, but so when similar situations happen to me, just as of September, I literally sat there and I was like, this is extra time on my plate.

Cause I spend four to six hours probably a week doing the podcasting and editing, but yeah, I never thought that I would ever do a podcast or ever find healing in a podcast, but it's totally because I'm hearing other people's stories.

Yeah. One of my biggest epiphany is I think I tried to say this in the document or the book and what I've loved about DPC.

At the beginning, it felt like I was really putting myself out there and exposing these things that I felt vulnerable about. And then you sit in a room and everyone's nodding and all of a sudden you've found that people, that people come up and they're crying because what you, they felt alone too.

And what you said, and those specific examples, all of a sudden, just like you are like Kapow and what's tragic is that this isn't a unique story, but what's so important is, and this is changing, which is good, but physicians really die in isolation and we're really ripe in the employed model to be one-off meaning like, you're the problem.

You're the trouble child. You're the one who can't get your note done on time. And all of a sudden, what I think of a lot is I haven't had a lot of bad relationships in my life, but I've had, I had one or two romantic relationships that I didn't realize how not good they were until I was out of them because I didn't work in them.

And I think many of us have that personal analogy. And so it's so hard to know how bad something is when you're in it, especially with all these other social things we're taught about, don't whine, don't cry, don't pee. What are you complaining about? You're making 150 K a year. So my big epiphany was realizing, like I was so mad at my employer and my big epiphany that I think is actually even more tragic was when I realized oh my God, it's not my employer.

This is the entirety of what's happening in our healthcare system. So for my little like examples of unsustainability touchpoints, like someone who is very close to me with strep throat, who just wanted to pop in and get his throat swab, and he's directed to an urgent care and an RV you paid and I'm like the whole thing's insanity.

And it just shows how the system is broken. When I share those stories and then 2015, a hundred whatever, or even one doctor is oh my God, that just happened today. We get to see that it's a failure of the structure of our healthcare system and the physician's role in it. I wish it was just me.

I wish I was just some profound problem child. And then everyone else's situation was great because then it wouldn't mean our healthcare system as a whole was more highly functional than it is. But without ego, without paternalism we have to get to a place in my opinion, where we respect that the physician is like a quarterback or the point guard or whatever you want to call it.

And then, yeah, while we're all on the same team, there are people who carry heavier weight and have bigger roles and are more accountable. Then what comes with that is, is the ability to have more authority. And that just is what is necessary to provide the highest quality and the safest patient care.

And the systems I worked in were not, in a phase where they accepted. My voice didn't matter. My opinion didn't matter. They said it did. But over time it didn't, and it was to the detriment of my health and my patient's health. And it took me a super long time to catch on to that.

Because I thought something was wrong with me.

And as sad as that is, it's not surprising though, because of the way that even our training is, like most of us have had experiences where attendings, no matter what specialty they were have been very patriarchal. And I think that the idea of opening your own clinic after residency is so foreign to people.

Like in my, so I graduated 2015 and in my residency there were 12 per year and 80, 90% of them went to Kaiser because that's what you do. You doesn't see. And then you go to Kaiser and it's and I I was also in that boat, like I wanted rural family Fullscope medicine. But what I envisioned was an employed model.

And, we know that CMS is going to make whatever changes are going to make, but like even in our local community, the specialists are the ones, ironically, just speaking up when you can't code until you fill up this screen or you can't pass go until you do this now.

And it's just, so painful. But one of the questions that I wanted to ask, especially if you, because with your involvement in CPC Alliance and the movement in general, like how do we affect the pipeline, how do we get people at an early age to think about the possibility of being the quarterback or the possibility of being empowered to run your own clinic. that's a huge. A question that I keep thinking over and over in my head I just w like we can't we can't get more people in the movement fast enough.

And one of the things I was thinking about too, is that a lot of DPCs are growing. And at some point, if like yourself, if you decide to open a second or third or fourth branch of spark MD who are you going to hire to do that? Like where's the pipeline coming in to feed new DPC doctors

I think this is a really great question. I think it's,

I will show you, I can show you her picture

here. I have very crazy black and white.

That's Dr. Julie, that's

me. Do I have my crazy black and white hair? Or do I have long brown hair in that. This one is

the, this one is the former with the black glasses in your black


and stuff. Okay. So that's what I have my, I think my black and white hair yeah. I used to have very long brown hair, but that's changed.

I think, the pipeline issue, it goes hand in hand with the scalability issue. And I don't know, my, my heart, my gut sinks things when this issue comes up. And I think it's because I know it's one of the hardest questions about where we're headed and I've long felt like I've long questioned.

So I'm the president of the direct primary care lions for the listeners and the direct primary care Alliance is a physician founded physician directed physician members. And it's all about advocacy, mentorship, and education around direct primary care and a large majority of the physician members in the direct primary Caroline's own their own what people would call micropractice.

So many of us have one, maybe two clinics and follow a model of, X number of patients, 500, 600 patients, 800 patients, 400 patients, whatever, and a doctor and with, and there's been some contention in the DPC movement, that what is true, quote unquote DPC. And I think that I personally think the healthcare system is so fundamentally broken, that there's massive amounts of room for all kinds of innovation in this space.

And they all drive down costs, improve transparency, improve patient care, improve the quality of the life of the provider or the physician. So I don't necessarily ascribe to one specific way to do this, but I own my own micropractice so to speak. And the fundamental challenge really is I think all of our pricing is a tiny bit too low to create a readily scalable solution within the micro-practice environment.

And so there's a bunch of conversations we have to have in this movement because I think there's a couple of things going on. One is our residents, our doctors, and training exposed to this version of primary care. And there are doctors out there who are young and who are just like we were when we were young, but the calling to primary care is the promise of long-term relationships and being embedded in a community and all these intangible things that really do make this job amazing.

And those things are really stripped away in, the I would say that employed model or the system model, you just don't get to see that. So I'm concerned the people who might have a native calling to some of the intangible benefits of primary care, if they don't, if they aren't exposed to DPC like boots on the ground, DPC that calling and that interest is not going to be reinforced.

We also layer in what we all know, which is we still have this problem of catastrophic debt for most people when they graduate medical school residency, which is a barrier to primary care period for everybody that debt level with no guaranteed income is a huge barrier to getting a loan and entrepreneurship and startup.

And so there's a lot of barriers or perceived barriers. But at the end of the day, I think most of us would say, and I do believe there's people out there who know, but still maybe need to have their own life lesson, that it doesn't matter if you earn a hundred fifty, two hundred fifty $300,000 a year, there's a point where your life can be made so miserable that there's no amount of financial security that makes a job worth it.

So in terms of the pipeline question, I think the place we're at right now is I do think people with a big heart for family medicine and some exposure or awareness to DPC are much more likely to spend their first three to five years employed because of the financial risk and because of the promise that systems make.

But I do think we're just going to continue to see people at that three to five-year mark, start to say, oh, heck, now I can do this so much better on my own. It would be much more ideal to actually have physicians come up from high school, college medical school and go straight into a cost transparent model.

And if we could do that in a way where those physicians didn't have the debt burden, that would be transformative. One thing I've worked on behind the scenes here and there with one of the groups I do some lobbying with, and it's more of a discussion than anything that's been actionable, but I've also applied twice to try to get sparking de designated as a basically health core service site.

And what would be super transformative in this movement is if, there was a cost threshold or price threshold under which clinics like the clinic you're going to start or clinics like the clinic. I have basically clinics that are driving down the cost of healthcare that are charging less than a thousand dollars a year for healthcare.

If we could readily qualify for debt reduction which I think is not only appropriate, but then mutually beneficial. And that might be something that then fills the pipeline, if you go into the military or you go work in the prisons or the national health service Corps or whatever, I think this innovative model of healthcare, I think there, we could put some parameters up and continue to push for DPC types to qualify.

And that would help with recruiting. A lot of physicians too, and a lot of our colleagues that are burnt out that don't want to take on the full responsibility entrepreneurship. They want a guaranteed salary and that's tricky. I need you to join me. I want you to take less income. I want you to take on some risks, but you're not going to be the owner.

That's a really difficult proposition. So we have a lot of hurdles. But I do fundamentally think that the more of us that just keep doing this and the more patients get exposed to this as an opportunity, the more patients get educated that a CBC is not $48 or $110. It can be $3 or $5. We get this groundswell that creates demand.

And then we're just going to continue to have this supply demand discussion for a long time.

There's two things that popped into my head. When you said that one, my last day before maternity leave my last patient, I spent 42 minutes discussing insurance and what is covered and what is not, and didn't even talk about medicine. And it, but it is draining emotionally when you have more of those patient visits than you do taking care of people because people are so not aware of the fact that medicine is not especially primary care is not that expensive.

And the other thing is that in terms of getting the word out about DPC, one of the strategies that I saw one of my friends who just opened up a DPC in Michigan lake shore MD Dr. Mehra she just made her website live yesterday and yeah. Yeah. So she had learned about this from another DPC doctor in Michigan, but they listed the mapper on as part of their website with notes about if your family is interested in this type of care, but they don't live in Michigan, check out this mapper and find someone.

So I think even by doing little things anything we can do to spread the word is definitely helped. And,

what's been strange to me and this is where I honestly think your podcast has an incredible opportunity. What's been really strange to me is with everything going on in our country right now, I feel like we see so much recycled news, so many rifts on the same stories or a little tweaking this bit of data or that bit of data and healthcare is an incredibly hot topic right now, for innumerable reasons. So what has been strange to me, some of our DPC colleagues have made it to the big stage Dr. Josh umber and Ryan new hospital have been on Hannity. A number of times I did a short bit on NPR talking about what, the pros and cons of Medicare for all kind of a situation.

But what's crazy to me. And what I hear from a lot of my patients is they're like, how have you been in this community seven years when we don't even know about you? And sometimes I feel like that's such a marketing failure on my part, or is it a marketing failure on the part of the island. But there's absolute clear data clear experience that the best way to grow your micro practice, your macro practice, or to grow this movement is just word of mouth.

So there's so much more out there than there was before, but I still, I'm not sure why we

don't have this massive like

CNN or MSNBC story, or like why does the whole world know about that? This is happening. And I don't have an answer for that, but I think this is a story that needs told. I say all the time, and I don't know if this is, if this feels like it's been my quote, but I'm sure it's not, nothing sells like authenticity.

And when people are starting their DPC adventure, and they're worried about how do I explain this business model to patients, or how do I deal with people? Suggesting that I'm abandoning them or whatever. I'm like, it's just be your authentic self and give your earnest and professional and brief explanation for why you have to do this.

And, I was thinking about some things and I don't know why I was thinking about this, but I was thinking about if you basically calculate the standard hourly wage for a family physician, last year, the average family physician in the U S made reportedly made about $208,000 a year.

And if you work 40 hours a week, that's $108 an hour, which most of us don't right. Most of us work 60 to 80 hours a week. So that gets you closer to $54 an hour, which is actually lower than the standard hourly wage for most NPS or PAs, not to mention plumbers and many other professionals, right?

Th the gentleman that helped redo my front yard, cause it was a shit show, excuse my language, just charge $60 an hour for labor. So when you said you spent 42 minutes on talking about insurance, you have someone with, up to 35 years of education, $400,000 of debt who's being paid at best, a hundred dollars an hour.

So you just spent three quarters of an hour someone just paid you $80 to talk about insurance in a scenario in which your training is actually to advance a person's health. So like the absolute we, you and I, and doctors, we may say, we're not doing well. We're not thriving.

There's more physician suicide or frustrated, but I like to always try to break this down to the most objective information we can. And what's absolutely insane about primary care is we actually, and I don't mean this is a smart Alec, but we actually have a job to do. Like we have being a doctor is a job and what I heard over and over and over again was okay.

When we we need to order the mammograms this way now the doctors can click on that. We need to get prior authorization. The doctors can help with that. We need to do more end of life discussions. That's the doctor's responsibility. And I just found like, were, we were like this endless expansive bucket.

But I'm like, but actually the bare bones of what we're supposed to do already actually has totally filled the capacity of the time that I have with this individual. So, you know, Not just DPC, but that, but healthcare transformation in general, I think requires physician and physician organizations to come back and start to say, actually we have a job.

Like the job that we do is hard, the job that we do matters, and we have a job. So adding onto that doesn't work. And I told my patients right before I started spark, I started to say, I actually started to think months before I said it, but I started to say to some patients, I was like, you need a doctor.

Like you need someone who can actually be a doctor. I have so many other criteria to have to fill to even just survive this 15 or 20 minutes that like, is there someone out there who can just be a doctor? And so what I love about direct care and our mission is healthcare simplified, but I have to remind everyone that works for me from the new counselor.

We have to our esthetician, to my nurse practitioner, to my nurse, anything that detracts from. Providing care of the patient. We are on constant hypervigilant. Watch of, is it necessary? And are we going to do it? And the beauty of DPC is you can start to say, no, we had a patient yesterday who's a nice gentlemen.

But he, and he's fairly affluent and hurt his knee four weeks ago, probably meniscal his buddy's a retired orthopedist. And he called in and said, Hey, my buddy's a retired orthopedist. He checked out my knee. He said, he thinks it's a meniscus. So I want a referral to this or the PUFAs orthopedist and not orthopedist.

Cause I want to get in with them. And I want you to do both referrals so I can see who's available first. And I called them and I said, no, we're not sending two simultaneous referrals. And we're not doing it on the, I haven't examined. And are you like, I want you to come in, I'll check out your knee and I can inject it.

If it needs that and we can order an x-ray if it needs and anyway, it's just the beauty of it DPC. And had he got mad or had he said, I want something else. We have the privilege of saying, gosh, this just isn't a good fit. At the end of the day, the guy was like, oh, I didn't know you could do all this, which is crazy.

Another part of the conversation. But I've had a patient, the demanded dermatology referral and a prioritization for rosacea and she wouldn't do any of the treatments I recommended. And what was so wonderful about DPC is I just said, no, I was like, you can come see me and do what I've prescribed. And then at that point, I'm happy to send you to Durham, but I'm actually not using my time to send a referral when you haven't even done what I've tried.

And always, I love being focused on my job.

This one here, if you want to see old, that's watch Posen because no, not all of um, okay. We don't have to watch all of in the wolves. How about we watch Olaf and the fire spirit? No,



funny the difference in three months you'll have this exact same conversation with Asher. And what will happen is you'll say you can either watch this or you can go hang out with dad, but that's your only choice right now because I've got to feed brother and then he'll be like, this is fine.

And all of a sudden you'll be like, what? That's fine. You know how many times, so I'm sitting here listening and I'm like, dude, Asher, you get that or you get nothing. And he'd be like, what? That's not how this works. You don't, he'll start to learn like your mom has mom. That's my aunt. That's a good show.

I'll watch it 42 times.

I can totally future self see that happening, but yeah. Not good at that right now. I was asking Neil, like, how in the heck do you get your five children to eat vegetables? And he literally said something like that. He's it's either vegetables or you don't eat.

And I was like, okay.

But yeah, the value that we have to always remind ourselves of I frequently get that comment, like your patient made to you about your orthopedic services.

You do that. You're a family doctor that I thought I have to see a specialist is the mentality that a lot of patients have. My patient population up here is about 50, 50 something percent Medicare. And it's ironic that those are the people who ask me that question. The most, even though in this community, there was a doctor who retired at 94 and who was doing home visits and fee for service model, but he was still like local to this community for decades.

And they went to him for everything. And

yeah, he represents all family physicians, not just GPC physicians. And I work with them and engage with them quite often. And I've thought about this before, and then just this conversation made me think of it again. I think one of the best things family physicians could do is push a RFP to rerun a massive national campaign about what a family doctor has and what they can do.

I'm going to bring that up with them. But just because, we need more PR in the sense of we primary care doctors, the more we've sped up the visit within the system, double booked. Some people elsewhere referred onward, filled up the subspecialty schedules. The more we've taught people about what we don't do or can't.

And I'm just a big believer that the number one ingredient for high quality primary care is time. And then that just educates our patients about what we're capable of. It's also the most efficient thing for the healthcare system. Ironically, slowing down primary care, allowing primary care physicians, the flexibility to spend a lot of time with people is the thing I think would transform the healthcare system the most.

But it has to, we have to change our compensation models and our revenue models and our billing models to accommodate that

When you said that it's like the idea of more people knowing that we're capable of what we are capable of. Or just even the idea of them patients asking us, Hey, could you do that before they ask for a specialist? It just makes me all super like bubbly inside because I'm like, yes, I can do that.

Where my husband and I are, where we chose to do rural medicine. That's what we wanted in, when we were at Creighton. That's what we wanted. When we were in training in superior Nebraska, where the only people in this town are family physicians. Other than the APS, and they're totally valued by their entire community because there's nobody else. Okay. So I'm going to, I'm going to try your tactic. So Asher, so we got to pick one movie or it's going to go off.

So which one would you like to pick? Here are options. Frozen

cars or no movie. Hi. Okay. So we're going to stick with cars. So remember. Cars or no movie are the options right now okay. Here we go. Cars or nothing, then try it. All right. Okay. Okay. Yeah, I, that would be amazing.

There's been quite a bit of of AFP and um, having worked with now, the highest official app NFP Sean Martin fairly extensively. I have to be, just being completely honest. I've been super impressed overall with what they're doing and what they're trying to do.

They're not perfect. They're a massive organization. There's a lot of business decisions that occur that I might not personally agree with. But I do think the AFP as an organization earnestly wants to represent family medicine. And the challenge is the DPC as a movement among family medicine. While I think it's where family medicine should go, I would like them to put even more time, money and energy behind us.

We are a microscopic fraction of the broader AFP membership. So the attention we get, so to speak the resources, we get to have our own conference. It's not enough. I want more, we all want more but if we again, try and distill it down to mathematics, as a percentage of the entire membership of the AFP, DPC physicians remain a minority.

And so to that end, we do have quite a voice with them. The other thing I think and physicians, we have so much to learn which is good. But I, we think about like Kubler-Ross or whatever, and.

Cause I, I heard that Bethany is like doing double duty now because she helps him out as well as doing the DPC stuff

that she was doing before. Stephanie has been an incredible DPC advocate, DPC representative, and I believe she's gradually moved up through the AFP's organizational ranks.

I'm not a hundred percent clear and I should be, which is funny because she and I interact and talk a lot. I'm not a hundred percent clear on all of her roles, but she's a very meaningful, very influential voice in DPC. And she and Sean have worked together for a long time. And they're both very strong advocates of DPC.

Although I do respect that Sean represents all family physicians now. So yeah, so there should but anyway, so I you have the questions you prepare for me were so thoughtful and I really appreciate that. Like you did a lot of reading. I wanted to see if there's any specific things you wanted me to touch on, whether it's like entrepreneurship or breast cancer or being a woman in this movement, or is there anything that you, that stuck out to you that is different about me than some other people you might interview that would be helpful to talk to.

Yeah. I definitely would say cause


and I'm grateful that you talked about the Alliance and just the pipeline there because what it and I don't know if you have any more to add on that. Cause I want to, I want people to have a clear just like we do about DPC, like that people understand that we can be Fullscope care doctors at an affordable price.

It's I want people to have more clarity on what the Alliance is and how it can help them become that doctor.


especially like interacting with people on DPC docs, Facebook group, who are newer thinking about they're like, what

is the no, and I'm thinking good.

So that's something, that the best thing about a movement and when it is when it starts to grow beyond itself. And one of the challenges I think of social media is there's answers to questions instantaneously, but it doesn't always mean those answers are fully informed and that may seem a little obtuse, but I think it's really what I would like.

I think personally is really important is for people who are entering DPC to understand DPCs history. And obviously there's like my own interpretation of DPCs history but, and I can give a quick run through in a minute but the Alliance. And my very strong opinion.

And obviously I'm president of the Alliance. I'm one of the founding members of the Alliance. The Alliance was born out of a need identified by a bunch of DPC physicians that just hung out at conferences and drank and got to know each other. And it literally was, a girls and boys club, so to speak, there was a small gaggle of us who were providing a lot of the speaking four or five years ago, and doing a lot of the, of answering questions on social media and starting the Facebook pages like DPC docs like DPC women.

There, there was a group, a core group of us who in, in interacting online and then interacting in person at these conferences started to become friends and connections and would recommend each other oh, Hey, I know Shane Purcell in South Carolina, you should get him involved here or whatever.

And so we evolved a friendship, but really the root of that for a lot of us was just the shared purpose of growing DPC. And so from that, we started to simultaneously there started to be more and more sort of tentacles in the DPC space of non-physicians. And not, four or five years ago, there weren't a lot of people interested in DPC for their own personal gain.

It was largely physicians trying to educate physicians, trying to figure things out, pushing the AFP or FMTC, or some of the broader organizations to give us a platform. And so about three or four years ago, the big players was FMTC, which you mentioned in conjunction with the AFP, which we've talked about, doctors for patient care foundation, which is an organization out of Florida.

Largely I believe founded by our, the president has Dr. Lee gross, who has a DPC doctor at each organization. And then hint came on the scene. And each organization had their own reasons for supporting DPC, advocating for DPC, and each organization had their own messaging. If that makes sense.

Each of the AFP FMTC doctors for patient care foundation, which kind of ultimately is also DPC action and hint are all of us are pushing the same rock up a hill but maybe in different ways than maybe for different reasons. And so what has happened though in the last couple of years, is the messaging or the understanding of what each organization stands for or what each organization's purpose is, has been less clear.

And so 20 19. I know a number of people went to doctors for patient care because, and they were marketing that they are the premier direct primary care organization. And some people express that they were quite astounded at the political undertones at that point.

The politics that were discussed or that came through there were completely appropriate. If you understand what doctors for patient care is, has been and their goals and what they do and where they get their funding. But that messaging is lost. As people are fighting to say, we are the premier voice in DPC.

So FMTC represents family medicine. Education consortium represents family physicians in a geographic region in the Northeast, largely north and middle Eastern states. The NFP represents all family physicians who are their members of which DPC physicians are a very small part. Maybe 3% doctors for patient care foundation is a free-market medicine organization that largely supports DPC is influenced by.

And a number of DPC docs have provided content for them, but their primary overarching mission is larger than just DPC. And there are political issues. He was really involved in that organization, which is fine. And then hint is, has a product to sell. And hen has always been super DPC supportive, but hint is more than like, let's look at tech transformation of healthcare across the board.

Let's hear about, healthcare transformation. So what the Alliance came from was a whole bunch of DPC doctors who were providing content for all of these places and all of these conferences recognizing like which one is the organization that actually is doctor founded, doctor driven and represents doctors.

And there is. So there's tons of overlap. And then you've got the direct primary care coalition that is a lobbying and advocacy group. And it is, that is its job. That is how it was founded. It was physicians out of Washington state that early in DPC, RQI and physicians led by Garrison and Erica bliss, Dr.

Garrick doctors, Garson haircut bliss who hired a lobbyist in Washington state so that they could practice in a DPC like model. And then they had to take that all the way in 2010 to Washington DC, because the ACA was being implemented and they tucked into the ACA some provisions to allow for physicians to charge a monthly fee to patients.

So that's the history of the landscape, but nowhere in that landscape is a all physician group that advocates for physicians who want to do this. And so the real challenge actually has become that. There's now more and more people across industry becoming super excited about this movement. And it opens up a very readily possibility for physicians, excuse me, again, to be taken advantage of.

And the landscape is becoming cloudy, particularly because of the direct primary care page on Facebook, which is completely unedited, completely unfettered. It's all comers and there's people not really showing their true colors there in terms of what their motivations or their expertise is. So while I am biased as president of the Alliance, I'm going to just say something very blunt, which is for physicians, particularly there is no safer, no more authentic and no.

Unbiased. And I'll qualify that organization out there to reach out to for your own development growth or education. So my strong advocacy would be that if you're a physician who is curious about DPC or wants to do DPC, Google get all the information you can, but do not spend a dollar until you've reached out to the Alliance and learn what we're about.

And look at looked at all the resources we have for free already, because truthfully, while I would love everyone to join the Alliance and strongly encouraged people to do so, and it is $500 a year to be a member of the Alliance. A vast majority of our educational content is free. Our masterminds are we're this year, we're $300 for 48 hours onsite at two to five clinics, just picking the brains of two to 10 DPC physicians in active practice.

It's like tens of thousands of dollars of just free knowledge, our vested interest and our entire membership, our physicians who are doing DPC. So we try to stay out of lobbying. We try, but we will issue statements occasionally on major political issues and say, here's what, where the Alliance, here's where our head is.

And that comes after much effort. We've been trying very hard to grow out of our people who drink together reputation and

we're getting more of a national footprint. We're getting more diversity of thought among our organization and leadership. But our goal and the purpose of this organization is to advocate, mentor and educate physicians about DPC period.

And I'm just going to be blunt, the page on Facebook DPC docs. The one that is DPC docs is a bit hidden and private and physician only. And if you look, if you could Google, if you Google direct primary care physicians in the U S and took the top 10 names that just came up, the people who we might argue have been more influential in this movement, virtually none of those physicians are on that Facebook forum anymore. And I respect the people who moderate that page. But I actually went toe to toe with two of the moderators of DPC docs, because I was marketing, the masterminds.

And they said, you can't list this here. And I said, I make no money off this. This is not about me. This is about the DPC movement. And let me remind you that one of the people to provide the vast majority of founding content on this Facebook page was me and the people who are sponsoring this. So what is this?

And it's a landing page for people to be DTC curious, but that is also not declared. So anyway, my, my number one advice, if anyone's made it this far, do not spend a dollar until you have Googled everything you possibly can about DPC. And then if you want to spend money first reach out to the DPC Alliance and ask questions because our goal is just transparency and guidance and we are DPC physicians only.

I get made fun of for doing that. I said this on stage and some people think I'm a little too heavy handed and again, authenticity, anything, but authenticity is often a waste of all of our times.

So about two and a half or three years ago, there was about 1200 people on DPC docs and the content got to a Nadir where it was really productive. And then what started happening is people started to use it to post medical cases or questions and a physician who's actually now a very capable UPC physician.

Who's actually killing it. Posted what kind of mop do you guys use and do you mock your own floor? And I lost it. Not lasted, but I basically responded and said, this is ridiculous. You are using the eyeballs of 1200 physicians to ask about a mop. If you're an entrepreneur and you own your own business man, or woman up make decisions, and don't use this forum for this, because what's going to happen is all the people who have something really productive to provide are gonna leave.

And I actually had two people behind the scenes say I was a disgrace to the DPC movement. How dare I say that? That who was I to say those kinds of things. And then I reached out to the moderator of that page and said what is really the purpose of this page? Is it education? Are we going to hold people accountable to constructive criticism?

And are we going to hold people accountable to, thoughtful questions or, and she said, basically you are off base, meaning I'm off base. This is for the DPC curious, all fit, all questions are safe here. And so when people reached out behind the scenes to me and were really rude and there was only two or three people, but it was enough for me to say, you know what?

And I said, respectfully, I said, I would like you to take down all content I've provided here for free. And I need to step back. And actually that was one of the origins for deciding to just publish an independent document or a book, but it's gotten a little bit better too, but you also see people ask the same questions over and over and over again.

And it's exhausting. And so the way that the site has been moderated has tailored it for people who are just in the introductory phases of DPC, then what happens is the rest of us. Just get tired and leave. Why is the Garrison not on there?

And I know he's retired and I love Garrison and he's fantastic. And he has so much to contribute, but because it's exhausting too. To stand up for something and to be a leader in the movement, but to have moved to a place in the movement where people don't even understand what your contribution has been so far and then to have a moderator not stand up for you.

but again, I don't mean this as a cut on the moderators for that site, although it is, I kind of them, but like we haven't figured out how to scale Facebook as a learning tool. It's just really hard to do. . So it's a great entry point, but it's hidden. So direct primary care becomes an entry point for almost everybody.

And that is completely un-moderated and that is where I worry if physicians are being taken advantage of. So it's buyer B where people need to need to do their own research in the beginning. And I would say if you go to, if you go to hint or the AFP or FMTC or doctors for patient care, all of those are robust and reliable resources and you can poke around and see if the undertones fit your personal politics or beliefs structure.

And then I would, I would go after one of those organizations or just start with the Alliance and because our attempt is to try to thread the needle and advocate for all of those spaces. But at the core of our mission is the DPC physician period.

We want people to find the place where they go, oh, I'm safe here. I'm not going to get ripped off. I can self-advocate I can navigate and I can hear the truth. That's what we are all about. And so then we did little member moments and things, but your podcast stands to be much more robust. The other thing I would say, we're not super, super open about this. We don't try to hide it, but there is a hardship discount. And I think the DPC Alliance membership has incredible value.

It has incredible value in your first year with the discounts. Like you're going to save way more than your membership fee and discounts with the vendors you're going to use to start your practice. So I would encourage you. And then we also, people can pay monthly it's 48 bucks a month. But in the first year, if there's a hardship discount, that's quite substantial.

I would totally be willing to do that to join the Alliance. It's just that, like I thought again, this imposter syndrome, because I'm like, I don't have my doors open and I've been like saying, I'm going to open

the door.

Actually. That's a really good point. Number one, everybody feels that way and you're going to feel that way forever. And you just totally, putting everything together in a way. And I don't mean this unkindly to our male colleagues, but I think women struggle with that more across the board. And some, one key to entrepreneurial success is you just fake it till you make it.

You don't lie. But I'm not good enough. I'm not smart enough. I don't know how to do this. I don't know what I'm doing. Excuse my language. That's all BS. You don't harm people. You don't do these egregious, I don't do knee replacements, but the, like you just put it together and you move forward and then you learn we just launched we're working with a, kind of a cool company called dear doc.

And so we just launched a bot on our website and I know my big barrier. I'm a very like chaotic, messy, wonderful creative. My brain is full of many ideas, a tornado. And I tend to surround myself with very orderly people. And I joke, there's no FEMA if there's no natural disaster.

But dear doc like needed all these deliverables from me. The clock was ticking and I'd already paid them. And I was like, look, I need you to embed this in my website and we need to just start. So we started and then yesterday one looked in and some things are going really well, but there's some really unplanned things happening, like patients using this bot to ask medical questions, right?

So it's oh crap. But literally yesterday, I now understand exactly how the bot needs to function. I understand the questions we needed to have and how we needed to change. The only reason I know how to do that now is because I launched it and saw what happened. Other people plan and organize and plan and organize, and then sure.

But so one awesome gift of entrepreneurship is, and same thing with parenting is. You get to become comfortable doing the best you can and flying by the city of your pants. But when you're your own boss, you can change your mind every day. It's not ideal, but you can. And yeah, so I tell people all the time, don't get into deep financially, especially in the beginning, don't take unnecessary risks if you don't have to, but don't be afraid to pivot the next day.

You might launch on your website that you're going to charge 50 bucks a month. And then within a week, you're like, that is the wrong number. In the beginning, you don't, you just fix it. And it's beautiful because that's not something we get to do when we're employed with the Alliance and specific to you and to all your listeners.

Look we want every single DPC interested, DPC motivated and DPC startup position to be our member. That's what we want. We need their voice. We need their questions. We need their passion. And we do not want money to be a barrier. And as a physician, I remember, and I still am very embarrassed when I have to say $500 is a lot of money, but it is.

And that's a Testament to what we're doing. So email our membership committee, say, I want to join. I'm in. I want to contribute. And here's my financial situation. And we have accommodations, especially in the first year, when you have your own quote login, we have over 47 minutes.

With discounts. The discount for Rubicon alone is more than the annual membership we are. Yeah. So like it's a no brainer. And the weird thing is like you say, you feel like an imposter. You're not open yet, so you're hesitant to join, but honestly, some of the greatest financial benefit is in the startup,

and then honestly, a lot of organizations pull their speaker panel from Alliance members now. So there's an infinite number of opportunities to have your voice heard, have your influence heard. We want to give platforms to things like this, to earnest things done by earnest physicians. So I just, it sounds cheesy, but I'm like, we want this to be the doctor club the dark DPC doctor club.

And we want everybody to feel everyone is passionate and pushing a rock up a hill. We want them to feel like that's their administrative home. And we need that. The movement needs that because we can, we want to be the premier voice of DPC. And the only way we can do that is if we have all the voices.

* Transcript gets cut off here and this is also generated by AI so please forgive errors.


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