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Episode 56: Dr. Shane Purcell of Direct Access - Anderson, SC

Direct Primary Care Doctor

Dr. Purcell is a seasoned DPC Doc who has worked with employers and brokers.
Dr. Shane Purcell of Direct Access - Anderson, SC

Dr. Shane Purcell was born in Athens, GA and is a true Bulldog by birth. He graduated Mercer University School of Medicine after completing Armstrong State College in Savannah, GA. He went on to finish a family medicine residency in Anderson, SC were he continues to reside.

After completing residency, Dr. Purcell worked in private group practice for 3 years before opening his own cash-only primary care clinic in 2005. As he built his cash-only clinic, he was also working part time in a local urgent care facility. In 2008, he purchased a dormant medical clinic on the “wrong side of the tracks” and opened an urgent care and primary care clinic.

After gaining his freedom from third party captives, Dr. Purcell along with a colleague formed the first direct primary care clinic in Anderson County in 2015. Since then, he has been operating both his walk in clinic and the direct care clinic third party free. The Direct Primary Care model has brought about a restoration of a relationship with patients broken by third party middlemen. Now, he can offer more access and more of his time to patients. Dr. Purcell firmly believes that the direct primary care model is the last hope for health care in America.

Dr. Purcell is an active member in several medical organizations including American Association of Physicians and Surgeons, Free Market Medical Association, DPC Alliance and American Academy of Family Physicians. He is the former Chair of the Direct Primary Care Member Interest Group for the AAFP and a founding member of the DPC Alliance and the Carolina’s Free Market Medical Association. He was elected onto the Advisory Committee for the DPC Alliance in the Fall of 2018 and current still serves there.

Dr. Purcell is the author of Magic, Pixie Dust, and Miracles: A guide to Direct Primary Care and Employers that shares how to connect DPC with employers of all sizes. He has spoken about this topic and DPC in general at the DPC Summit, DPC Nuts and Bolts conference, Hint Summit, AAFP FMX, Carolina’s Free Market Medical Association, TedexFurman (see Dr. Purcell's talk below) and DPC Alliance Mastermind sessions. He continues to speak to residents and student groups about DPC as well

In today's episode, Dr. Purcell shares how he began down the path of Direct Primary Care. Through working with employers and brokers who support and build plans with the DPC practice at the center of healthcare, Dr. Purcell shares how his practice ballooned overnight by taking care of Anderson County employees. If you are considering working with an employer in the DPC space, listen to today's episode.


Dr. Purcell's Book:

Dr. Purcell presenting at TEDx FurmanU

Dr. Purcell's Magic, Pixie Dust, and Miracles talk at the 2019 AAFP Summit

Resources Mentioned By Dr. Purcell

-Catastrophic Care by David Goldhill

-The CEO's Guide to Restoring the American Dream by Dave Chase (FREE PDF DOWNLOAD)

-Other helpful Health Rosetta-certified brokers: David Contorno, Cristy Gupton, Carl Schuessler (all are on LinkedIn)

-Hint Summit - October 28-29th virtual conference. Tickets: FREE for Med Students, $99 for Hint users, $199 for non-Hint users


Welcome to the podcast Dr. Purcell.

Thank you. Good to be here.

So I have recently been reading your book obviously to prepare for this podcast interview, but what I really wanted to say first and foremost is one, if you guys, the listeners haven't heard of it, the book is called magic pixie, Dustin miracles, a guide for direct primary care and employers, but you go into describing how to work with employers I felt that reading your book, I really understood generally who are the players and how they can come together in the world of DPC. So just wanted to say that first and foremost,

That's great.

I tried to make it basic and straightforward, on a DPC level because we're, we, simplicity is what we do in DPC. How do we make it easy for patients? How do we make it easy for each other? We want to help each other. And so I wanted to describe, the situation of how we got involved with employers a little bit about our story is in there, but also things and topics to think about as you move into working with employers and in just a lot of general Information about, what is it, benefit advisor and different kinds of types of insurance and that kind of stuff.

And so people can have a general understanding, which is helpful. Was able to have a really good benefits advisor to write rights part of the book with me to give us some tips. And really the book is it's written by me for DPC folks for direct care physicians, but also it is for employers and it is for benefits advisors who want to work with direct primary care physicians, so they can understand where we're coming from as physicians.

So they understand all of the baggage that we bring to the situation. And so we can all work together to make some miracles happen. If that makes sense.

Absolutely. I want to take a step back and I want to ask you about before you even got into the world of DPC you've said that you were doing urgent care and you also had a private practice. Is that correct?

Yes, I did. So I had. I was a little, a lot different than a lot of current DPC physicians, which usually go right out of training and they go right into an employed position somewhere for a hospital system.

I'll work for a private office for two years after residency just to learn some things get some income generating and it became very clear right away that was not going to be something I could do long term, just because of the same problems we all have with the billing, the coding, the insurance interference, the paperwork not being able to really help patients like you want.

And so I I left that office and just started doing primary urgent care as a staff physician at a local urgent care center. And it was basically a 10 99 type of job. And I could just work certain hours and have certain shifts and I could go and take care of patients and leave without a lot of the headache, but I still wanted to do primary care and there was still a huge need in our community for primary care.

And this was about 2005 really before DPC was a way before it was a thing. And there wasn't even the technology to do direct primary care that we have today, where you have hint and Atlas and some of the cool ways that you can do The ACH and the direct draft and all this stuff where you can really make it a system.

So in 2005, I started a cash only clinic in the back of a gym. So I was doing urgent care as a staff physician, and there was so much need in our community. No one had a cash office in our community and years. And so I started a cash only clinic with pulling a lot of referrals from the urgent care where I was working, I would give out my card and say, Hey, your blood pressure is terrible.

know you don't have insurance, but I charge $45 a visit. And, you just come in and I'll help you with your insurance, with your blood pressure and your diabetes. I can also help you with your the next time you have a sinus infection. I can help you and save you about 150 bucks instead of coming here to the urgent care.

So I started that in 2005 and built up six or 700 patients that were coming in just doing cash basically, and still doing urgent care. then in 2008 and nine, this is as the story goes, the housing market collapsed and our economy tanked. So when the economy tanked, nobody wanted to pay for healthcare at all.

Nobody had any money. Everybody only wanted to. Just call me, call him my medicine. I don't, I can't come pay you. We ran into the same similar kind of problem with what people had last year with COVID. Nobody could go to the doctor because doctors close or they couldn't get in, or it was all telemedicine.

But the beauty of what we do in DPC now is that they were on a monthly payment. So they didn't, they continued to pay monthly. When the economy collapsed in 2008 and nine, really before DBC was even started there was no mechanism for me to get paid unless people came in. So that sort of the travesty of fee for service last year with COVID, if people don't come in, you don't get paid.

And all of our colleagues lost a lot of money because they couldn't get people to get in and get paid. So in 2008 I left the urgent care and started doing my own inner to care. I bought a building and started doing my own urgent care while continuing to do my own direct patient care.

The name of that, my direct, family practice clinic was ideal family health, and it was just cash straight cash. So I opened up an urgent care, bought a clinic started doing urgent care and I still did my primary care inside that clinic. And as the urgent care built up more and more started to hire people to help work urgent care.

And I was doing primary care. So you got busier and so I got back into doing more insurance through the urgent care blue cross and some of the bigger insurance plans, just because of demand for the urgent care.

And in 2012, I closed, we were so busy in our urgent care. I closed down my primary care office and just integrated those people into the urgent care and they could still come and see me and pay cash if they wanted to, but it was all through the urgent care. About that time is when threat primary care was really starting to take off.

Atlas has started, some of these companies were starting to where you could really make an easy system where you could keep someone's credit card on file and do a monthly charge, which we didn't have the technology before that really do that. And so I was learning more and more about direct care and thinking that maybe I could get back into doing direct primary care the way I used to straight cash.

And that's when me and my current partner sorta started talking about, how do we do this together? She was, she had been working for the hospital system here in our community for 17, 18 years. She'd never worked on her own. She didn't know how to do an office as far as the management side, the business side.

So she sorta wanted help. And she reached out to me cause we had, we trained together. She knew I had a cash practice. She knew it had an urgent care that had ran some businesses. And she wanted to know how to go about doing that because she was getting in trouble at work for spending too much time with her patients, which is the thing that we all love to do and direct primary care.

So I told her about drip primary care and gave her a bunch of information about it. Cause it was still, this was in 2000 14, probably when she was thinking about it. And then she learned a little bit about it and finally ended up going to a conference, a P S conference and hearing Josh umber speak and heard Brian forest and Josh umber speak about direct care. And she took her husband with her, which was really important because he was on the fence and they were sold about direct care at the time.

And she came back from the conference and quit her job and opened up a direct primary care. And in two months, which I don't recommend people do. So she opened up in August of 2015. And we became full 50, 50 partners. And I joined her in January of 2016. So just a few minutes later, cause I was still terminating some insurance contracts, which you really got to do before you get into DPC.

You want to be out of those contracts. So you don't commit insurance fraud. So in, in our state blue cross blue shield, if you see someone in your clinic and charge them cash, they pay you cash. And you have a contract with blue cross blue shield. They will come after you. For fraud basically because their contract says, you have to follow her insurance if they have it.

So I got out all the insurance contracts and started DPC in 2016, but it was really for me going back to a cash type deal, which I had done already. It was just a different mechanism because I had a monthly way to process it, which was really good for me. It was just going back to what I had already done.

And so I was in urgent care. So I was pulling patients out of the urgent care that needed direct care services. They had high blood pressure. I had all these issues, thyroid problems, and I was building up my practice from my urgent care and I still had a small following of primary care patients. So it took me three years.

In urgent care to build up about 300 patients. Now, obviously I was still making some revenue, so I was like moonlighting in my own urgent care. So I was still making money in urgent care. My own practice that I built at the end of three years, I had built up to about 300 patients. And then that's when the mojo hit the fan, as I say with employers, and so we can go from there if you want to go down that road.

I definitely want to go down there because the things that you talk about in your book and the things that you've talked about at conferences there definitely must hears on the podcast, but I wanna interject a couple of questions here before we get to the employer part, when you were mentioning how you terminated the contracts with the insurance companies, because you were not an employed doctor by like a corporation, how did you go about terminating those contracts and finding out which companies you had actually contracted with?

That can be very difficult. Obviously. I was, they were all my contracts. I had signed them up. I did have, I had a consultant person that helped me try to set up the contracts cause there can be quite tricky as an individual going to get a contract with United and going to get one with Aetna and Cigna.

You don't have a whole lot of room. It basically, they're going to tell you, this is what we'll pay you. And you're just going to get what you get because you just don't have any power. If I was in a group of a hundred physicians, you'd have a lot more power. So basically they were standard straightforward contracts with blue cross blue shield with state health different insurers in our county and our state.

And I had maybe five or six contracts. And so in each of those contracts, unfortunately there is wording about how do you get out of them. And so you have to dig all those contracts out, find them and find the legal mumbo jumbo in there that tells you how to get out of the contract. And if if you've been in those contracts for 10 years which some of them, I was probably in seven or eight years the phone numbers that have listed the contact numbers or emails that have listed in those contracts are probably no longer good.

So it can take some time to find out, okay, who do I, where did I have to send this letter to get it? You have to some of them will only let you out of the contract in a 90 day window from when you signed it. So if you signed that agreement October 1st, you can only get out between September and November of that year.

So that's, I can, you can take six months to a year to get out of a contract. So that's one of the first things I tell. I tell folks when they're trying to leave a practice and go number one, what's in your contract with the organization, right? Is it in the hospital system? What does it say about getting out to you and have a 90 day out?

And do you have any signed agreement? Did you sign a contract with an insurance company? Most people who are pulled about hospital systems, don't sign agreements with insurance companies. They're, it's all through the hospital system. So they're not having to get out of anything, which is good. But if you have a signed agreement, if you're working for a, maybe it's a private office you're working with and you physically signed a contract with blue cross, you've got to get out of those contracts to do direct primary care correctly.

So that you have to get those contracts and look in there and see who to contact. What a ladder, what do you have to do to get out of them? And it can be quite tricky and time consuming.

And I don't know if there is the listener out there who is looking into starting his or her own practice.

Temporarily in signing those contracts. So it's it's words, it's wise words for those people to hear to, you know, make sure that they know where to find those papers. If they're doing something with insurance as a way to get funds to do DPC later.

Yes. If you're going to do hybrid, which is really difficult to do, keep those paper handy.

If you need to put them in a folder and know exactly where they're at and know exactly what you need to do to get out of them.

Did you work with a lawyer at all in terms of when you decided that you were going to make the leap and closed on your urgent care and leave those contracts?

We used Louann leads when we set up our DPC practice, she did our contracts for us and our Medicare opt-out our HIPAA those things. But I never did close down my urgent care. I did DPC on the side. What I did was, I canceled all my urgent care, all my contracts from urgent care for me personally.

So my urgent care went back to herself, pay all cash or to care which, really hurt urgent care because it went down from 60 or 70 people a day visits down to 20, 25 bucks. Anytime people hear you don't take insurance, they just won't come. Even though it was cheaper for them to pay us 90 bucks a visit than to go through insurance.

And that was one of the hugest, frustrating parts on a daily basis to deal with because urgent care really is primary care anyway, and people would have a $5,000 deductible and we would try to get them to understand, Hey, it's really cheaper for you to just pay $90 for this whole visit instead of me billing your insurance for 300, and I'm going to send you a bill in the mail for 150 later.

So it's really sad how come using it is and difficult for people to understand that. So it was easier in us in the long run just to say, Hey, it's $90 for everybody. And we were cheaper than everything in town. We were cheaper than the CVS minute clip. It was just easier to deal with. And stop my, I stopped the insurance with them and just went straight DPC and I continue to run or oversee my urgent care.

I had some PAs that were working there for me. And then in 2019, I sold my urgent care to end of 2019 by the grace of God, right before COVID. Cause it would have been a total nightmare Tran having to deal with COVID because the people who bought my clinic ended up being closed for two or three months during COVID, which would have been devastating.

So I sold it to the end of October and basically in October of 19, I sold it. And for the whole January, 2019 is when I went full DPC. I was that's all I did. And I had other people running my urgent care for me. And then I ended up selling the urgent care at the end of 2019. And so I've been for the last two years now, basically full DPC and that's all I've done and I'm not managing any other clinics, which has been really nice.

Wow. And

I, geez, I did not know that at all. And that's, that is quite incredible that you got out right before COVID hit. Oh my goodness. I'm so glad that was the case because I'm sure that the value proposition of your urgent care was nothing compared to what it was prior to the panel.

Oh, yeah, it's it. It was pretty devastating but it was really a blessing for us to be able to get out. Then when we did, of course we didn't know at the time nobody saw that coming, but 2020 would have been a devastating year if I'd had to manage that clinic. So it was really good to do that.

And I think the people who bought it were able to weather the storm and, they ended up doing a lot of COVID testing and stuff. So they made, they're made, they hurt their hay in other ways which was a good thing for them. And most as you probably know, most everybody in DPC really did well during COVID nobody really, almost nobody closed down.

We actually ended up hiring people in the middle of COVID. Nobody lost any hours in our clinic. Our patients, we had less than a handful of people that either paused or stopped their membership temporarily. So nobody really, it didn't really affect DPC community very much at all, because we were already doing everything that everybody needed.

I think that's so cool though, because it goes back to what you were saying at the beginning. How, when you were. With your cash based practice, and then the economy took a dive. That's what you're talking about. This idea that there was no way of protecting your income because people didn't want to pay cash.

And then with DPC, it's a membership model. So it's so ironic that you've really weathered two storms differently.

And it's also technology. The technology between 2008, 2009, when that economy tanked and last year when the economy tanked. So what does that like 12 year difference, basically for the technology, we had the technology to do all of these video visits

we could do a telephone visit in 2008, but we don't have the cool spruce and Atlas MD. We don't have the cool mechanisms to do it now or video all the different video mechanisms to do it now, or zoom and those kinds of things. We had so much better technology for us as DPC. Honestly the money issue of babies, basically doing a monthly charge and all that technology was in place.

So we were lucky that they had the technology and then a lot of people didn't know most traditional offices, fee for service offices. Weren't ready for that. They didn't have the technology. Of course, they, you couldn't get paid. You could do video visits all you want, but the insurance people, they wouldn't pay you for them.

So you had to come in to get seen for you to UTI, right? I don't get paid for giving your Bactrim over the phone. So it, it just made sense the success because of the technology was there.

Definitely. And when you talk about this idea that physicians in fee for service didn't get paid for certain things like telemedicine or just making a phone call.

It is so true. I mean, even though, you know, 12 years later, we have all this tech, even after telemedicine was somewhat covered, it's still not the same reimbursement as an in-person visit.

So definitely I saw that when the pandemic hit, especially in March, April, may, the numbers were down significantly and, there's dirty things that corporations are doing out there. you know, If you don't see a certain number of patients, you're going to have to owe us money while you hardly have any patients coming in.

Versus the idea of direct primary care where you have members paying you directly, when you compare the two models like that, there's just in my mind, there's no choice other than, of course DPC.

Right. So I want to ask, because you had this experience in 2005 and you went through the economy crashing in 2008, and then again, with COVID hitting, you were transitioning to full DPC, having that knowledge of what it was like to suffer without the technology that you're talking about has really helped you.

Now, did you talk with Amy or partner about, these are things we need to look out for, or these are things we need to build into our practice so that we can continue to weather storms in the future.

It wasn't so much about, Hey, here's some things we need to think about. Most of the things we were thinking about, Hey, is let's have a little bit of money on the side in case something does happen and we need to have extra resources.

Now, some of that, we had that the PPP money or whatever, that extra money that we could use in a lot of businesses took advantage of that. And so what we plan to have, Hey let's have some money on the side, $30,000 or something in a little sad bank account. If we need extra money, if we get, we go through troubled times or something happens.

So it was more of a financial backup, but really my focus when we saw the COVID train coming down the tracks, me and Amy sit down and I said, listen we're strategically placed to win this battle. We are aware of a lot here is ahead of everybody else, because we're already had the capabilities to do video.

We can do telemedicine, we can close our office where we don't see people in the office and still continue to take care of patients. We can see them in the parking lot. We can do the gout. We were blessed. The other big blessing we had was because nobody could get PPE equipment, right?

Nobody could get mass, nobody could get gowns and gloves. Because we had a relationship with our county taking care of half their employees. They got a ton of resources through the emergency services for all kinds of different stuff. And they were able to give us gloves and gowns and stuff, just so we could take care of their own employees.

So that was a huge win for us. We never really needed a ton of equipment. But our success was really basically just sitting down and just saying, Hey, take a deep breath. We're ready for this, where we already had the technology and just to share that with our patients to say, Hey, it's all good.

We're here. We're not going anywhere. We'll talk to you over the phone. We'll video chat with you. We'll meet with you in the parking lot if we have to. So even though there's, statewide closures, everybody's supposed to stay at home, we're still here for you.

And there were companies, there were organizations that we're talking to now, companies that we're talking to now that want the DPC service. That we're on a really good blue cross blue shield health plans. And they could not, their employees could not get in to see their doctors. They couldn't get their medicine refilled.

And so this company basically had to scramble and get an agreement with a telemedicine company, so their employees could get help basically. and now they're looking at we really just need to do the DPC thing because it just doesn't make sense to pay this other company to do telemedicine.

And when we can get all of the primary care done for the same low cost. It, it really messed up a lot of companies. And I, I thought, and many of us in the DPC Alliance community and who really are on the front lines, trying to build up what we're all doing, felt like code was an opportunity for us to really, to take DPC to the front and say, Hey, AASP Hey, big organizations, Hey, government, Medicare.

You need to stop what you're trying to Ram down people's throats, and really look at direct care as a real fundamental option for people to get the care they need. And so far, it hasn't turned out that way. They, the addiction to insurance and the old system is very strong as Jeff gold would say, it's a huge addiction.

It definitely is. When I went back to my fee for service clinic after maternity leave, it was just so I don't know if it's because of my whole maternity leave. I've been living in the DPC ecosystem, but when I went back and I would talk to people about, their health insurance, what does health insurance cover?

I had explained codes yet. Again, I just, I heard it from such a different perspective, having been in the DPC space day in and day out for four months. So I had a patient who needed a mammogram and I showed them the radiology center an hour and a half away is the closest place that I can get access to a cash pay pricing list.

And the mammogram is like $140 or something like that. And I said this is how much it costs cash. And the patient said, oh, I'm pretty sure it costs me way more than that last time. I don't even think that my mammogram was covered. And so I said, do you want me to send your referral for your mammo down to the cash price place?

And they said, I'm going to call my insurance, see if it's covered. And so they find out that the insurance covers 80% after they pay a $500 deductible for the mammogram. And I was just, I was sitting there thinking, so remember when I said that the cash price is really an expense for our area, that's a really cheap mammogram.

There's some times during the year that people can, you know, like breast cancer awareness month, you can get a cheaper mammogram, but generally $140 versus that. And this person is on a PPO, a good PPO through their company. So yeah, this addiction is real. And Jeff gold talks about how people use their insurance card.

Like it's a credit card and they don't ever see the bill. But in actuality, we all see the bill because of the number of insurance claims that go up. And so this is a perfect time to jump into employer world where employers and DPC can come together because other interviews, I've talked about how do you, as a DPC doctor say your elevator pitch to an individual, but you have on multiple occasions talked and now have written a book about how to do an elevator pitch for an employer. And so I want to ask first when you're talking with an employer, because if in the back of your book you have a great outline as to the timeline you should have with regards to, you know, getting your grit in place, and then working down the timeline to actually approaching employers.

But when you look at an an elevator pitch for an individual who you're trying to convince to join DPC versus an employer, what are some strategies that are different because you're dealing with, a small group or a larger employer group.

Yeah. Employers are a lot different than individuals because you had to have a lot of patients because it takes time.

And it took us three years to get the county in a municipality is going to be a lot harder because you have to have all these people to agree to it. Right. You know, The county manager has to agree to it. The county council has to agree to it. The CFO of the county, the lawyer for the county, all of these people have to be on board to make something happen.

A smaller company, let's say. A guy who owns his own company two or 300 employees, but it's his company. He's the CEO, he's the head of it. He can make the decision and say, no, we're going to leave our fully funded PPO, blue cross blue shield plan and go to a self-funded plan. And we're going to offer direct primary care as an option because that's the best thing to do for patients.

And that's the best thing to do for economic wise care wise. And tried to make that connection with whoever makes those decision as the critical part with employer. I frequently talk about that in a book. And when I try to chat with people is when you're talking to an employer, is do you have the right people in the room who is in the room?

And a discussion is frequently. You may be talking to the head of the HR, which is not going to make a decision. At most companies, the head of HR is just trying to get the five o'clock they're just trying to get through their day and switch. And insurance plans is so much work for them.

They do not want to do that. It's what can I do just to get the same contract so we can just move forward. And I don't have to worry about that. So changing insurance plans and going to a DPC or self-funded plan is a lot of work. And so it takes patience. I would say there, there's not an elevator pitch.

What you need is a slow boat to China pitch because it is going to be a lot of conversations that you have to take. Typically if you're working with a broker may bring someone to you and you can have that conversation. But typically, if it's us, like how we got with the county, and most of our employers is somebody who worked with the county was already our patient.

And they basically told the county administrator and all of these people, Hey, you guys really should look at this practice or this style of practice. And that's how we sorta got our in. And we basically had it. They called us, they invited us in to speak to the chief financial officer, the county administrator and the head of human resources.

And we sat down and just explained what DPC is, because nobody still today, nobody understands what drip primary care is and how it works. And once we explained it to them, they made this the same mistake that almost everybody makes all employers make is okay. How does me paying you and paying blue cross blue shield?

Save me money. And so they weren't catching the whole point of no, you've got to get away from blue cross blue shield and look at going to a self-funded or level funded, a different kind of plan. And you put the DPC in that together. And so it takes a lot of education and getting them to see that until you're just tickling their ears for the first time, that's part of my book.

When I talk about the pixie dust, you're throwing the pixie dust out there to giving them ideas and things that, that, where they could save money. You're telling them, Hey, our thyroid, our TSH tests at our office are $3. You guys you're paying $30 every time. One of your 2000 covered lives goes to the hospital is $30.

You're probably spending $50,000 a year on a TSH test. We're just telling them ways that they can save money. And so I'm trying to get in with the people who can make a difference, the top level people in your organization. And then sitting down with them, not so much, really even having a presentation, like a PowerPoint presentation we just went in and basically explained what we did and how we do it.

I think it's good if you have some brochures or general information, what you met charge and that kind of stuff. And in my book, I talk about that about having a, have an elevator pitch because you w when, if you run into a CEO or something, having a 32nd pitch that kind of opens her eyes, it's almost shocking.

I spent 45 minutes with every one of my patients and they don't, they get unlimited visits for $50 a month. That's just shocking. Or I do EKG and take off toenails in my office and I charge nothing more. Just trying to have a pitch that you can throw to them. It's helpful, but it's really about getting a longer meeting where you can sit down and really explain DPC and, find out who their broker or benefit person is because you a larger employer.

When I say larger references in my book, it's really anybody over 50 employees that has to have insurance. If you're more than 50 employees, you're required to have insurance of some kind according to the Obamacare, the ACA rules, basically. And so any of those people have a broker or advisor that they're using Who is that person?

Is that someone you can work with? Yes or no, or know how's that going to work? So that's sorta how things get started. Most of our smaller employers, we have, we had smaller employers, almost right from the get go. So like a local exterminator company, they have 10 employees and five of them signed up with us.

So we had probably 20 or 30 of those over the first couple of years, we started just small employers, like mom and pop places that just wanted their employees to have something because they couldn't afford regular insurance. And so you learn a lot from those small employers, you learn how, you know how to get people into your system, you know how to do the billing part of it.

You learn from that. And then as you grow larger employers begin to want your service to, and that can be the tricky part, do you have space for them? If like my, when I, when we added it the county, I had three, I had 300 employees, so basic I was half full. So I knew we could take at least 300 people.

And then we were hiring another physician and we knew she could take 300 people, three or 400. We had no idea how many we were going to get from the county. It was just a total guess. And so we ended up getting 800 patients. So I got full and our new physician was basically almost full right off the bat.

So we have, we went from two full physicians to four full physicians in a couple of weeks. That you gotta be really prepared for that. You need extra nursing staff or medical assistance. You need space to do that. You need equipment to do that. You need parking to do that.

There's all kinds of things you gotta think about as you move forward through that. And it's a guess because you don't, we could have got 200 patients and then you're kinda like, wow, okay, we got to back this thing up. And that's the danger, for some people they're like that makes me really nervous that, I don't really have anybody lined up or what if I get 500 and I can't take care of 500 people.

The other big danger is okay, you've got an agreement and in a year they cancel and you were full and now you're back down to only 200 patients. And there's, those are conversations to have with the employer, to try to get a loan contract, if he can, Hey, will y'all mind signing a three-year agreement with us, if you can, can you get that done?

Know, give us, if you're going to drop us, can you give us six months notice, can you give us four months, notice that kind of stuff, try to work through some of those things as best you can to prevent that, but what you, what we wanted to try to do and what most clinics try to do is, Hey, let's get them in and then let's wow.

Their socks off. So to make it so good, they're like you can't take this away from us. So it's one of those benefits, so good that the employees are going to just rebel against if they drop it. So that was hopefully the way we were going to try to attack it.

That's awesome. And those are great pearls for people to hear because the first time at the hint summit, when you and David Contorno were talking about this idea of how you and the county are teaming up to provide excellent health care for the county employees, I sat there in the audience.

And I was like, if I have a DPC, I would never have an employer because I, what happens if they have 50 people come and then 50 people leave. And those are the only 50 people I had in my clinic. And so what was so interesting, it was when you mentioned in your book that turn can actually be prevented by using certain strategies, like the strategies that you just suggested.

This is where, even if you have an opinion about something in DPC, I definitely would say it's always good to be open to hearing other ways to do things because that idea of having a six month leave agreement, if they're going to leave give you guys six months warning or having a three-year minimum agreement.

I mean, those are absolutely ways to protect yourself and to come up with a backup plan for if somebody leaves and have you, because like you mentioned earlier on there's another company who, during COVID was very frustrated with the care that their employees got. Have you teamed up with other DPCs around you or within the state to disperse employees?

Not necessarily in the county, but on a statewide basis so that the employer, has employees go to different DPCs

we haven't done that on a state level. The other employer that we've been talking to, they have local employees and they have I have another group of employees in the Southern part of the state, but they also have employees and other states as well.

And so they're looking at, trying to connect with other DPCs like us in other states and can we get something to work that would work in the Southern part of our state? They're kinda near the coast. And that can, that is tricky and trying to work through that can be difficult, but basically because of the connections we have through the Alliance and using other free market connections we try to try to reach out and see who's in certain areas to try to help that could do that.

Cause a lot of employers are really looking, they're really laser focused on direct care and how they can, they get that going, whether they're doing it on their own, setting up their own clinics to do it. And we're seeing more and more setting up their own clinics and they're putting the nurse practitioners or PA's in there to do it and not really physicians.

So we want to try to work with them as much as we can so we can have clinics. Where we can focus on doing as much care as we can. So the reduced amount of referrals. One thing that was really cool, that we did is we have our four physicians in our clinic. We had at the time, I don't know if you are aware of this, but there was a pediatrician that worked with us for awhile.

Dr. Hill who passed away suddenly last year, but he was a pediatrician, one of the first pediatricians doing DPC in the country. He spoke at the summit a few years ago and we basically worked together and we, he had his own individual plan with the county to take care of children under the age of 15.

And he basically had a contract with them and if people signed up and they wanted to do DPC, the parents could see us and the kids could see him. And they, we had it all in a package deal and he was doing back scenes and everything. And so it was working really great. He had probably 200 patients that were coming from the county PD patients.

And they, we also work with a a lady physician in one county over in a community in a county over. But our county is so big. And a lot of some of our employees live closer to a metropolitan area Greenville, which is a bigger metropolitan area. And her office is closer to Greenville.

And she basically, we offered that to the county employees. She agreed to same process. She did the same kind of DPC scope that we did. And so if there were people on the edge of the county or closer on that side, if they wanted to use her services and she ended up getting 40 or 50 patients, I met with her.

And over the course of the last couple of years, she's had even more sign up with her that, that are closer on that side of the county. And basically we she did her own individual agreement with the county. We did our agreement and Dr. Hill, his pediatric agreement each organization had their own agreement.

But we all, as far as the family medicine, we all tried to, we did the same pricing. We tried to offer the same benefits and that kind of stuff to make it which was good. And we didn't have any contracts between ourself and we didn't do anything like that. We just worked together to basically take care of all the patients and that we're in this community.

And so I think other people were trying to do stuff like that. I know there's some lady docs in Pennsylvania and they're doing seminars, stuff like that, or trying to work with other employers to try. Work together to have three or four different options. Like you got this clinic, you have this clinic, you have this clinic.

So a broad range, all the processes are saying, but they're all independent DPC clinics. So more of that collaboration would be helpful. I'd love to get more collaboration with pediatricians, which would be helpful. It's just been difficult on the pediatric front. We're having more and no Carolina, South Carolina, more and more pediatric folks are doing it because they're getting fed up with all the junk too.

So we need more of that for sure.

Definitely. And even as specialists or are exploring the direct primary care model, that would be awesome if you could, enroll, some of those as part of the plan in the future in your county and beyond.

Oh yeah. I think every it'd be great for every, if every state yeah.

California is big, so you'd probably have to have multiple ones, but in our state, we're such a small state. If we had one ambulatory surgery center, like surgery center, Oklahoma, if we had one of those in our state or right on the border between North Carolina, South Carolina. So we all could use that and we could partner with them would be an incredible.

Like if If Georgia had one of those and North Carolina, South Carolina had one, there was one, in the Tennessee Kentucky area, every little area had one of those. There was one in Florida somewhere that you could just, I think employers would love it because they could get a gallbladder surgery for $5,000 instead of 30,000.

There's just so much money. They could save on the surgeries that we do over in hernia surgeries, gallbladder, surgeries, cataract surgeries, tubes in the ears, all the common stuff that we do could save so much money that we could partner with. That would be helpful. The biggest thing we have in our state is a certificate or need is just so dominating and nobody, the hospital systems don't want any competition.

So if anybody tries to open up a surgery center, they'll shut it down. So it's very difficult.

in terms of an ideal world, talking with other brokers, talking with people who do other cash practices or DPCs, have you thought about any ways to overcome that? Especially because it is different in between states.

The certificate of need issue, you mean? Or? Yeah. The only way to overcome it really is to change the law and south Carolina's track. We're trying to change the law there's they there's a law right now, basically in the Senate where that our legislation is already over for the year and it'll take it back up next year, we do two year rotation.

So there's a bill in the Senate right now to discontinue certificate of need basically. And actually me and Don Rainey went last year. He came up last year and we went to the Senate hearing and spoke in favor of repealing it, doing away with certificate of need, and basically spoke to why while we saw it as a problem.

And every CEO of every major hospital in the state was there with their suits and ties on speaking in favor of keeping the certificate of need. So it's just very hard to overcome that. we had probably 10 physicians there saying it is it's very restricted for our patients. They can't get colonoscopies because.

In our community, there's only one place to get those and they can charge whatever they want for them and set people who were paying self pay. And the Senator looked at me and said but sir, those are covered by insurance. And I said, but sir, in our community, 30% of people don't have insurance. They don't have it.

Or if they do, it's a $5,000 deductible, it's not getting paid. They're not getting paid on top of that, which they don't understand is just think in your mind, how many people do you send for a colonoscopy? And they find a pilot, what immediately goes from screening to diagnostic, which means it's not paid, it's not covered.

And so they're getting a bill for $3,000. And they, they just don't get it and they just want the system to remain the way it is. And so that's the only way you can fix significant need in our state is to repeal the law. And we're trying, but it's obviously he'll battle because it's the same battle we have in DPC trying to get over the hump with insurance companies and good government, because there's the status quo, right?

The healthcare, with American hospital association, big pharma and all the insurance industries together are the biggest lobbying group in all of America, they spend hundreds and hundreds of millions of dollars every year, lobbying, aligning people's pockets more than any other groups out there.

And they just want to keep it the status quo.

Yeah, this is it's something that I heard Jeff gold say. And then recently I'd seen on LinkedIn this idea that the system isn't broken the system is built this way on purpose and on LinkedIn, when somebody had posted that I was incensed because there was a C, M O I think, CMO of a hospital in Sacramento that my dad had been to and had gotten atrocious care at.

And he said this, the CMO had said something about, oh my hospital has good ethics and he had said yeah, those who have the gold really drive the system or something like that. And I asked the CMO, are you saying that your hospital holds the gold and you're helping promote this system continuing in the fashion that it's in right now. And he had the audacity to say that no we're a very ethical hospital and having experienced the patient care from the hospital and knowing what Travis sees is hospitals causing multiple communities in the state.

And other states that it's located in, I was just a guest but it just this idea that you were in the legislature, trying to fight for patients and advocate for an everyday American and the money and the addiction to insurance.

And this assumption that, oh, anybody can just get a colonoscopy and it's all covered. It's absolutely ridiculous that those are the people who are making the laws.

Yep. So I would say two things to go and look at, if you haven't read David book, the catastrophic care, which is a really good book that goes into about all those things and how bad hospital systems are.

It's an incredible book. And then. To if you get a chance, go back. If you haven't seen it, if you can dig it up. Look at my Ted talk that I did a few years ago, Fermin university, Ted talk, where I specifically said the healthcare is working exactly the way they want it to work right now.

It's not broken. It's working exactly the way they want it to. It's just not working for us. It's not working for patients and it's not working for physicians to people taking care of patients. And as long as the majority of the hospital systems out there, non-for-profit like in our community, the nonprofit hub hospital system owned so much property here.

And they can do whatever they want to do. But it is frustrating and it is you're, we're pushing an uphill battle in DPC. We're swimming against the grain. And it's, we all love it because it's the right thing to do for our patients. And once you begin to do it, like you said earlier, there's no other way.

I don't know how any other way you fix primary care, other than what we're doing is making it direct care because. Insurance for what we do in direct primary care. It makes absolutely zero sense because you just can't. I just can't do anything in my office. That's worth more than a couple of hundred dollars.

So why are we paying $2,000 a month for insurance for something that I can't do any more than $200 for it just doesn't make any sense

completely. I tell my patients every time I do a AAA ultrasound with my butterfly IQ, I tell them, do you know how much this actually costs when you, when I put the code in that I did this 120 bucks.

And they're like, what? It took you minutes to do this and look exactly. It makes no sense whatsoever. So when you talk about the pixie dust and educating others, that's how I find people really understand is when I do procedures and I'm like, do you know how much it costs for me to clean out your ear?

And it these little examples, I find it almost starts the conversation of what else is happening? There's a hospital who changed out urine dipsticks. All of a sudden one day pops in a machine that automatically reads the urine. And this company said, oh yeah, it's only going to cost the patients a dollar more, but did you get the okay by the patients to do that?

Of course not. It's w any way to make money.

For sure. , everybody tries to do that. When you're sewing people up, when you're removing a toenail, when you're doing those little things, even the EKG, whether they were to charge you $90 for this at the hospital, and it literally cost 28 cents to do this, the tabs and the jail, and there, it just does it, it just doesn't cost enough money.

So it's just a stupid way to do healthcare primary care. So hopefully the message will get out, but it's very frustrating to continue to see organizations, national organizations continue to still look at non DBC ways to try to fix primary care. And it's just so simple, here it is, here's the fix.

It's like Dave Chase's, if you've heard or anything, he says we've already fixed healthcare. People just need to use it. They need to do it.


before we go on to advisors and the health Rosetta, I wanted to just mention that included in your blog, that's accompanying your podcast is your Ted talk link, as well as the link to purchase your book. And also your 2019 AFP summit talk that was entitled magic pixie, Destin miracles as well as hunter Schultz's interview that you did on winning healthcare, food fights without the mess.

So all of those links are included in the blog, but now I want to go on to Dave chase, the health, Rosetta, and Dave Contorno because one of my questions, as I have seen you talk with David Contorno a couple of times now is how did you even find each other?

So actually originally I was watching a video or reading something that Dave chase wrote about.

I don't know if it was one of his books or not. But I saw originally something from Dave chase that mentioned David, Contorno his name? And somehow it mentioned he was in North Carolina and where it was at. And I was like dude, that guy lives like two hours from us. I was like, I could literally drive and meet with him.

So I looked him up a little bit and gotten to know where he was at. And then Dave chase, his first book came out and David Contorno. I wrote a chapter in that book. And we, I ended up emailing Dave Contorno, and saying, Hey, what's going on? Let's chat sometime. And so we basically connected and then ended up meeting at a free market medical association gathering or somewhere we met at a conference.

And talk a little bit, I don't know if you've ever taught today. Contorno before that he's always wide open. Go. If you get a chance to talk to him, get your running shoes on, cause you're probably going to be running, but so he's got a lot of irons in the fire and basically just struck up a relationship or what they were doing there and what we were doing, he was invited to give a talk in Atlanta for a group of hospital executives from all over the state of Georgia. And they wanted someone in DPC to talk and I'm not sure why. And David Contorno had asked Jeff gold as Lee gross, and he asked me if any of us there's any way any of us could go.

And of course they all live so far away from Atlanta. There was no way that they were going to give us a wheel out. I don't mind going, I can drive. It's like an hour and a half drive for me to go down there. So he said, sure, let's do it. So they gave me, put me on this panel discussion panel and me and Contorno was there with me.

And we basically talked about connecting a direct care and how that works. And the talk was about how, what are the next innovative models of health care and primary care. And I talked about what we were doing in Anderson with the direct primary care, they've talked about how they were integrating primary care, a lot into insurance plans.

And uh, so we hit it off through that little event. And then when Anderson county really started pursuing it I gave the county folks, Dave Chase's book would actually have David Contorno section in there. I said, Hey, y'all you guys need to read this.

The restoring health care dreaming or something like that, American dream, this is her first book gay, a copy of that book and said you guys should read this, this is how you need to go about changing your whole program to integrate DPC and how to think about direct care and that kind of stuff.

And self-funded plans. And they were like, we don't know anybody who could help us do that. And I said, I know someone I knew help you. And so I said, if you want, I can get you connected with a guy who wrote this chapter right here. He knows all about it. And so they said, yeah, we'd love it. And so I called Dave

and so within a couple of weeks, he was down and did a three hour presentation for them to explain exactly what they needed to do. And so he basically really designed their plan. The whole plan for them to change was designed by David. Contorno not implemented by him, but it was designed by him and implemented by a local benefits agency.

And we haven't done other plans, but through David I've met other health Rosetta people in our area. There's a lady who actually is in my book Christy Gupton, who's also in the North Carolina area. And w frequently comes in the South Carolina has done a lot of smaller DPC deals.

And she is the DPC of benefits advisors. She does not participate with any insurance companies at all. She does everything self-funded and then she works with Sadara for smaller organizations. And she basically works with only direct care places that she can set up and small local pharmacies and that kind of stuff.

And so she's really good about really working with direct care people. She has her own DPC doctor. That's one of the main things I ask people is to find out if the company you're dealing with, if they're using a benefits advisor, ask them if they do, they who's their doctor.

And do they have a DPC doctor? If they're using a DPC doctor, you're probably in pretty good company. And so her daughter's a DPC physician, David Contorno his, daughter's a DPC physician. Another guy out of Atlanta who works with Lee gross, who did the big deal with Lee gross down in Florida?

Carl Schuessler, who's another, a benefits advisor, but he does a lot of his own stuff. He's got really good programs. And so just connected with them has been helpful. Those are the ones that I know they're in our area. And so I would encourage folks in there, Hey, go to hint summit, go to free market medical associations, go to these conferences and hear people speak.

And other DPC doctors who are working with employers, Hey, who's the benefits person for this? Is it somebody who understands BPC health, Rosetta website is somewhat helpful, but I can tell you just like all DPCs are not like everybody on DPC frontier is not really a DPC. Some of them are concierges are doing different stuff.

Some of those health Rosetta people are sheeps and wolves closing to, you have to vet all of them. You have to really say, okay, do you really have you done DPC plans before? Who's the doctors you work with? Do you use DPC yourself? You have to really get down on it and see if they really understand what you're trying to do.

When you talk about reaching out to other DPC physicians and looking on the health, Rosetta, trying to do your vetting as much as possible if you are in an area geographically where there's nobody by you, who's using a benefits advisor, what do you suggest to those DPC doctors?

So if you're like, like in, in a dead zone, you're something someplace where you don't really know if there's any advisor that's beneficial. One thing that I do now is if I'm talking to let's say I have a really good friend out in Kansas and he says, Hey, I got this benefit guy.

And he swears he's working this deal for me and with 300 employees. And do you know this guy? So I'll call up, I'll call up Dave. Contorno, I'll call up Carl Schuessler I'll call him. Christie Gupton and say, Hey, do you know this person? What do you know about them? Are they legit? Can they get this done or are they going to be jerking my friend around, that kind of stuff.

So that kind of, underground research I guess, gets done. Outside of the best tips I have outside of looking on help, presenta is really talking to other DBC physicians at least connecting with, a health Rosetta person. So even if you meet and hang out with Christy Gupton, who's his a one in a million top of benefits advisor that I know is going to do the right thing for you.

She may be able to get you where you need to be. And they have her and Carl Schuessler have a small, I don't know, 20 or so benefits advisors that all work together. They have a pretty good network.

So trying to build that network of their advisors is helpful. So continuing to talk to other people going to DPC summit, hopefully we'll get those live again. Going to the summits and talking to other people who are working with employers it's just really got to ask those questions of the advisors to really make sure, are they only, how do they get paid?

Are they getting paid all these under the table, money from blue cross blue shield to redo those contracts? Have they ever set up a DPC type plan before? What DPC doctors have they worked with? Those kinds of things. But if if you get someone like Christie, who is they have zero commission from, they have no connection with any kind of insurance, a person like David Contorno, it doesn't work with any insurance companies.

So Cigna blue cross Aetna, he's not contracted with any of them. So those folks are in it for real. They like what we do not easy to find, but it's all about just continuing to talk and network and try to find out who's who, and hopefully as time goes by, we can really build, we can work with some of these high-level advisors to build a network, either on the DPC Alliance.

all our website or something like that, we can have our own list. Health Rosetta has their list that you can see, but it's still about making sure even those people on the list are doing what we need them to do.

Absolutely. And a previous episode featured Dr.

Katrina and her husband near Patel. And I thought it was very interesting that he had seen as the office manager of his wife's practice, what the big PPO plans were doing to patients when they were using their insurances. And so he became a benefits advisor. So for anybody who's listening who may be a spouse or a relative, or somebody who's helping out a DPC doctor, you could even become a benefits advisor by, learning from other people and approach other people to see what kind of qualifications you need to become an advisor to PR to promote this. Just people are popping up every day is new DPC physicians, because they're all learning from each other.

So the same thing could happen in the advisor space.

Oh, yeah, for sure.

Now with regards to the plan that David helped set up in Anderson, South Carolina, I want to get into the details because for those people who have not listened to your 2019 AFP talk yet you guys talk about some of the details specifically, how you are using mail order pharmacy medicines that come from internationally into the states.

And also the fact that the prior offs that you have to do is addressed in the plan. So can you talk a little bit more about the details from your perspective as a DPC doctor with patients who are enrolled in the plan in your county?

Yeah. So the those are things that, I try to get people to talk about as really early in the process with the benefits of Azure.

Because if you're not careful, if they don't have a really good understanding of what you're doing in DPC and how you operate. You end up right back into working for an insurance company because they can create a self-funded insurance plan. That'll do just like blue cross blue shield which means you have to get everything preauthorized.

So any medicine has gotta have a PA. And the referral to a specialist has to have a PA to get, MRI's gotta get a PA any kind of referral or specialists. Some of them are using medical management programs, like a nurse Deb type of thing, where you have to call and talk to somebody before you get anything done.

And so you can imagine the frustration of doing everything we do to leave all that behind. And now you sign up an employer with six, 700 employees and you're right back doing all those things again. So we're just not, we're not set up in DPC where it's literally, for most of us, it's either we're working by ourself or it's just us and an ma we have two people taking care of 600 patients.

We can't do three prioritizations a day for medicines to get somebody to referral, to see a specialist. We just, we don't have the manpower to do it. And so having those discussions up front with both the employer and the benefits about it and say, Hey, here's how we operate. We can't, we don't have the manpower to do prior authorizations all day.

So if you are going to craft a plan where you want everything to be proud, or maybe this is not what we need to do, maybe this is not the system you need. When David Contorno first crafted our plan and he did an incredible job cutting a lot of that stuff out. No prior authorizations were needed.

Now that the tricky part was there still has to be a lot of education between the third party administrator who is doing the claims, the company that's doing the claims because they have to understand when we order an MRI, we are not required to do a profitization, but they don't know that. And so a lot education has to go on with that, that anybody else in the Anderson county plan, if they're not DPC, they have to get a privatization.

But if they're under DPC, they don't. So that was, that took them a long time to figure that out. Now, how are we going to know whether this is a DPC patient or not? So a lot of it has to be worked out ahead of time and he got a lot of that stuff worked out. They did have us initially. In the system, they were making us do the medical management, where we had to call this nurse hotline all the time.

And after about a month, we were like, David, this, we can't do this. We just cannot do this., if you're going to make us do this, then we're just not going to be able to help these patients. So basically we ended up saying is, look, David, you are putting your trust.

You believe in us. Do you, you stood up in front of all of these employees and told them, and you believe in direct care, you believe in what we're doing. That we're going to save them money. We're going to do the right thing. We're going to only order the labs that need to be ordered. The county, they agreed to pay any labs we do in our office, any meds we do in our office, we have our own dispensary.

They pay for all of those because they were getting such a good deal on them. So instead of paying $30 for TSH, they're paying our $3. So they were trusted in us to do the right labs, do the right meds, not over just randomly do tons of labs, right? So we can make more money. They were trusting us all with all that stuff.

I said, David, how come you can't trust us to order the right test? I said are you saying that you trust us with everything, but you don't trust them. To order the right referral or the right test that you want us to ask nurse damn how to do that. So he said, yeah, that didn't make sense.

So they just stopped it. And we've not been required to do prior authorizations for any kind of procedures or meds or any kind of medical management type stuff. Now they can do back end medical management. What I mean is if somebody has been admitted with an MRI or something like that, and they know the claims went through the ER, or they went through the hospital system if the medical management team wants to follow up and help them, outside of what we're doing, that's fine.

But they don't have any contact with us anyway, to tell us you're not prescribing this medicine or anything. They can help manage them at home, aside from what we're doing. But we have a great system. We have set up to continue to follow those patients.

Once they're out of the hospital, we will see them within two or three days of discharge, way faster than they get seen by a hospital system physicians plus our patients, Texas and email us and we're talking to them all the time anyway. Trying to work on those things right up front with the employer and the benefits first, and is going to be critical because if you don't figure that out, you'll be right back where you started, which a lot of people are afraid of that.

Hey, if I do employers, is it going to be just like taking blue cross blue shield again? And either you need to work that out or it's just not going to work out with that employer and that benefits person. And that's the miracles part of my book is when that all comes together, right?

The DPC, the benefits advisor understands, and the employer understands, and you have a right plan that doesn't make the DPC physician do a lot of extra work. It just lets us do what we need to do. That's when everything comes together and you had this nice package miracle, that just happened.

Amen to that.

I just hearing that is amazing that there are people like Dave Contorno like Dave chase who are able to work with you and listen to you and affect change because of what you are saying. And you are a physician and you're being. Asked to be a physician and not an administrative assistant and do these things because you have to do these things or else you don't get this Anderson South Carolina county to pay for the employees.

That literally does, it could sound like insurance, if you guys did not have dialogue and that ability to change the plan. I just think about how, anybody in fee for service can understand that on a different level in terms of, you just talked to Dave and you just changed it. So I think that's amazing. That is a true miracle. And I hope that, more miracles like that can happen. And your book is definitely a great guide as to how people can create those miracles or promote those miracles to happen.

Yes, hopefully it will can continue and hopefully we'll get more, talks, more live events where we can talk more about it and share more about it or more together.

But really to try to get more of the employers and the benefits people involved that really understand what we're trying to do. So we can do things together and create our own little teams around the country.


Absolutely. No shame. This is leaving the employer part of the ecosystem. I want to ask about your book, because I remember there was a time that I was looking for the book and you would post on Facebook, like Amazon still hasn't released more copies of my book.

So I wanted to ask you as a physician in DPC, having written a book of which there are not too many out there, how was your experience writing the book and would you have done anything differently for like your next book?

So the experience it was a cool thing, cause I've always wanted to do something unique like that.

And I'd been thinking about it for awhile and obviously working with employers, just thinking about this week, there's probably been 10 questions on our DPC Facebook page about employers. So constantly people are asking about that. And so I was like somebody we need, somebody needs to go ahead and let's talk about this and make an easy resource to go.

And we have some stuff on the DPC Alliance page that are some pretty easy resources, the original ones I wrote most of the original ones. They've been tweaked a little bit since then. But the basically just sat down with pen and paper and started jotting out the outlines, w what were things I would want to know about and our story, being able to weave our story, here's how it happened to us how we found this person and how we got connected with him, with the county and how this worked out and how do we onboard all those patients and that kind of stuff.

Not just a process of here's the process, but how did we physically do it in our office? So jotting all those down basically used a real heavy outline and then went through just typing it all out. I'm not the best typer, but I basically typed it all out on my own. And didn't dictate it or anything like that.

And then spent a lot of time going back through and re fixing stuff, moving stuff around and stuff to it. And it took probably about a year to get all the stuff done. And I had, I have a good friend in our community. Who's just a really good, solid all around guy. And he's wrote several books about finance and he's a big finance guru and connected with him and said, Hey man, I've written this book.

Can you help me out? He said, oh man, I'll give you a bunch of pointers. So we sat down and he said, here's how you need to do it. And he had a place where you can get the books, like if you wanted to sell, publish and all kinds of stuff, he had all kinds of tips and stuff. So my intent from the beginning was, Hey, I want to try to get 500 books, which would be, self-published basically send them to this publisher.

They just print them up for you. So there's a mechanism steps that you can go through. You have to get a library of Congress number. You have to get all these things that you have to do to make it a legitimate book. And so he helped me go step through strips through those. And then they get dried and all those things And then he had a, an editor who's a local lady and had her edit the book, went through it like two or three times, made a bunch of changes, mostly grammatical, little commas and stuff here and there to try to edit it.

And there's still mistakes in there. There's no book without a mistake in it, obviously, it was good because she wasn't in the healthcare industry, but I knew, if she was able to read it and understand it, it was going to be helpful.

And there were parts that she was like, this makes no sense. I'm not clear here that I would. I clean up a little bit. And then because I really wanted the book to be able to be read by an employer to be able to understand where we were coming from DPC physicians. So I she did the editing.

The cover photo is actually a real picture of me holding a black hat. And that my awesome office manager took, and I had a local, the same guy who helped me do the book his graphic design lady did the cover photos for us package that up. And we send all that to the printer and they printed the copy.

Then what you do is you do the same thing you would do at Amazon. If you're trying to sell something on Amazon, you send the books to Amazon and they hold them in a warehouse and they send them out. So if almost nobody I'll tell you almost nobody does that anymore. That's not the way to do a book anymore.

So anybody who's thinking about doing a book, don't do that, don't go have 500 copies printed and send them to Amazon, because what happens is they get lost. So my original, I sent like a hundred books and originally, and it works like a charm. I sent them in, they got put on the Amazon shelf and people ordered them.

And as they got bought you reship more and they just, they keep going my second shipment only the good Lord knows where it is. It never made it where it was supposed to be. And so I literally lost $400 worth of books that I never got back. And so what I learned was is most everybody who does books you use Kendall, basically Amazon they own Kindle, and so you can do a digital, you can, you digitally upload a document file basically through Kendall and when it goes on to Kendall, and now when you go to my. Find my book online. It says you can buy the Kindle version or you can buy a print version, but it's all digital. And so if you go buy my book now online, you click print and they physically Amazon prints it.

And so it takes, like a week for you to get it because they physically have to print the book and send it to you. Instead of a copy that I re I really made, getting sent to you. And so I sold them all for our own website for awhile, and I just shipped them to people. It was literally me putting them in a package in melanoma to people for awhile.

And it actually make a little more money doing it that way, but it's just a lot more headache. But now they're all just on Amazon and you can either get a printed copy or a kennel copy. I'll probably do an updated edition next year, which you know of how things have progressed with the employer and some extra tidbits to think about.

And then I can just upload a digital, new digital copy basically. And it should be pretty easy to do, but my advice is don't self-publish meaning don't go print out 500 because I still have probably two or 300 copies that my plan was at the time I was to take the books to the summit and I was going to give a bunch away and sell them and then COVID closed it down. We had no in-person meetings. So at some point I'll be able to carry those books to the in-person meeting and, try to sell some at a discount or give them away or something

really good tips though, especially because I feel that with the number of books that are out there you could have a bookshelf that has all the DPC books on there and it still wouldn't fill the shelf yet.

So I hope that changes, but in closing, I want to ask what is the best way for others to reach out to you after this podcast?

So probably emails is a really good way. So I think it's in the back of my book, if you have the back of my book, but it's the same way you contacted me, Dr. And so it was pretty straight forward. And then obviously I'm on Twitter for my animal on the face. a fair amount.

I think in the back of my book, it has all those links. I think it's dot Shane P Twitter is dot same P Facebook is dot same P and I'm on LinkedIn at direct access MD I think is what it is and LinkedIn. So you can catch me there pretty easy too. So people, Facebook message me a lot.

Occasionally Twitter message or people would just email too.

Perfect. Thank you so much, Dr. Purcell for joining us today.

Thanks a lot.

*Transcript generated by AI so please forgive any errors.

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