Direct Primary Care Doctor
Dr. Kenneth D. Qiu (pronounced Q like the letter or the Bond character) is a board certified family physician and the founder of EuDoc DPC. He received all his higher education locally in Virginia— graduating magna cum laude and as a Monroe Scholar from the College of William and Mary, receiving his medical degree from VCU School of Medicine (formerly Medical College of Virginia) where he was inducted into the Gold Humanism Honor Society, and completing his family medicine residency training at VCU affiliated Riverside Regional Medical Center. He is currently an assistant clinical professor at VCU School of Medicine and has previously served on the Board of Directors for the Medical Society of Virginia and has been an innovation consultant for the American Academy of Family Physicians.
Specifically in the DPC ecosystem, He has been instrumental in the AAFP co-cponsored DPC summits and for the past three years he has organized the Med Student and Resident Tracks.
Additionally, starting in residency up until now he has been a key contributor in local outreach and DPC-centered education of medical students and residents.
He’s been on the DPC Coalition since residency began and he runs the resident and student section of DPC news.com.
Hear how he is working through his opening days in his very own DPC! After years of planning it is so refreshing to listen to hear how things are going now that he's opened!
Check out more of his diary at https://dpcnews.com
----> Read Dr. Qiu's Original Rebuttle Post HERE
----> Dr. Qiu & Dr. Keener
Recommended Resource:
CONTACT:
kenneth.qiu@gmail.com
TRANSCRIPT*
Welcome to the podcast, Dr. Q,
thanks for
having
me.
This is such an exciting time to be talking with you because we've talked off air before, but this is the time that you are opening your DPC. And you have been in the DPC ecosystem for so many years. So I want to ask before we get into the details about your practice, what's your involvement been like?
And also what have you seen change over the years as you've continued to be in.
Yeah, for sure. So I first got plugged in at the 2017 DPC summit. It happened to be my fourth year of medical school and it was in DC. So I figured why. And I had heard about it from classmates and I just went for it cause I was on a rotation where I could, and I went with questions, a lot of questions, and I spent pretty much the entire conference, just staying behind and asking all the speakers questions, Brian forest, Josh umber, Ryan new Hafele, Julie Gunther, all of them.
And I left that conference just completely enamored with. Like I realized that was it. So prior to fourth year medical school, I'd always been interested in the business and the politics of medicine and nothing made sense. Everything just seemed to be bad and getting worse. And there seemed to be no way out of it.
And then I went to a conference, I was like, this is it. This is the way. And so that's how I got plugged in. And then I went to go visit Dr. Forest in apex, North Carolina afterwards. Cause he was the closest one out of the conference to me. And we talked and I started reading more about it, wrote some stuff about it.
And then I went on scholarship to the 2018 summit and there did the same thing. Talk to everyone, had a million questions, got super involved. And afterwards they were talking about that summit that year. It was when JAMA published that issue of the story called direct primary care. One step forward, two steps.
And so everybody was up in arms about that article. And one of the speakers, I believe it was Joel Bessemer of strata healthcare. He was talking about writing a rebuttal to it. And when I got back from the conference, I was like, you know what, I'm going to do it too. So I went out my blog and I wrote a rebuttal and unbeknownst to me as somebody in the DPC community shared it.
And it got like over a thousand views. And I think somebody reached out to me, they're like, Hey, there's this Facebook group you should join. So I joined the DPC docs, Facebook group, and they're like, oh my God, you're the guy that wrote the thing. And that's kind of how I got started after that. I just kept in touch with everybody, kept talking about it, my med school and my residency.
And then I attended every summit since then, and have gotten involved in a bunch of various ways.
And one of the ways that you've been involved is the DPC coalition. So can you share for the listeners, what is the DPC coalition? And what's been your involvement in the organization.
Yeah. So the DPC coalition started with Garrison bliss a while ago.
It was, I can't remember the specific date that Garrison told me, but it was sometime before the ACA, but it is a federally federal lobbying group that kind of represents DPC interests. In the last few years, there has been an all openly admit that some controversy with some of the bills and that's a detailed discussion for another time, because it can go for a long time.
But essentially it's a bunch of physicians who have gotten together who support DPC and want to see a VPC positive legislation passed both on the state and federal levels. And so Phil sq, I actually introduced me to Jakey S I believe it was the 2018 conference. And they've had me on as the, a resident member of the steering committee for the last three years.
And in terms of just how things have changed in the last four years, I guess it's been cool not having a DPC during this time, because it's allowed me to. They kind of movement as a whole, from a bird's eye view, rather than being embroiled in the details. Like I am now where I feel like I'm not as up-to-date with what's happening in the community as a whole, because I'm dealing with so many day-to-day things.
But in summary, I think just going back and having talked, all the people who've been doing DPC for a long time, there's definitely like, I call it three versions. So version zero is what I call the Bushwhackers. So these are people like Garrison bliss and Brian forest, and the Clinton Flanagan who had this idea of, Hey, I want to not do insurance.
I want to provide better care. How do I do that? This monthly thing? Sounds like it could work, but back then there wasn't a name, right? So they envisioned a world that didn't exist. And that's why they're the Bushwhackers. They just gave it a name, made it happen and laid down the foundation for the version one doc.
So the version one dog. So I would say are the people who currently are somewhere between six and 10 years. Into practice. They're the ones who saw the path that that was placed. And they went out and they were the pioneers. So version was the pioneers. They were very much the Jack of all trades, very independent spirited.
And they're like, we do everything ourselves. We don't need anybody else. This is us. And they created a lot of the dogma and a lot of the principles that we have in DPC about direct payment and everything of the sort. And now version two is what I call the settlers version two, the settlers are people like me and you who are starting to UPC now.
And I would say within the last year or two has been the start of the settler group. And what that means is a lot of people are coming in and realizing, Hey, it's nice to build houses and do everything ourselves, but there's quite a bit of us now. And I think we need to build some sort of infrastructure.
And so I think our group is a lot less dogmatic and a lot more open to looking at opportunities and possibilities of how we. Bro this how we can work with other people to grow this thing and get things really rolling, to get the snowball and growing even bigger. And then we're all going next version three.
I'm not sure because I never could have predicted version two, but I'd like to call them the city builders just to take whatever infrastructure is put into place and then create something amazing out of it. So, yeah, it's been neat watching it for the last four years and getting to be part of it as a suburban.
Wonderful. Throughout residency, you were instrumental in educating the local community by doing outreach about DPC and education about DBC.
When you were doing that outreach and when you were doing that education, what avenues did you look out for in terms of ways to get into medical student lectures or presentations and the same.
Yeah, so it was nice being a well, so most of it was during residency, but being a resident, I had connections to my cause I did residency about 45 minutes away from where I did med school.
And so it was easy getting back to my med school and just saying, Hey, I'm really into this thing called direct primary care. Can I come talk to the students? Because we have pretty strong family medicine, I guess family medicine, recruitment, VCU, Virginia Commonwealth university, where I went to med school.
And so I was able to talk to my old med school there. And then some of the surrounding ones I just found out who was in their family, made groups who ran them and just sent them emails saying, Hey, I'm a resident here I'm nearby. I'd love to talk to you about this thing. And then through the Virginia academy of family physicians as well, they were able to give us a platform to talk about direct primary care.
And for those who are interested in reaching out to their former medical schools or the residency programs, and especially getting involved in the statewide AFP chapter, how would you recommend people approach those opportunities in their own communities?
Yeah. So my big thing is connections and networking.
It's really all about maintaining relationships. So I always stayed very close to my med school and I've come back to this year and I teach at the med school now as well. And it's because I've kept in touch with the people there. And same with the AFP, the state one, I got to know them pretty much as soon as I started residency.
And I just kept in touch with some of the people there who are on the board or who are staff. And when you, when people know who you are and when you know them, then it's a lot easier to get in. Cause they're like, oh, this is the DPC guy. And he wants to talk again. So it makes it easier. I just think staying on.
With whoever you want to, I guess, not sell to, but present too. So if you're interested in medical student education about DBC, just stay in touch with the faculty or the staff there, get to know them. And if you're interested in speaking on the state level, just keep in touch with the staff, be a member who is active and doing some of the other things with them as well.
So people will know who you are, what you're about, and that just makes them going back in a lot easier.
So with you still being involved, like you said, at the school of medicine and with you being an assistant clinical professor now, are you opting out of Medicare or are you still opted in?
And if you are.
Yeah. So the clinical professorship doesn't have anything to do with opting in or out. I don't actually see patients and I'm not on the payroll of the school of medicine. It's almost closer to a 10 99 situation where for the classes I do teach, they do pay me. But as an independent person, I'm not like a W2 or anything in that sense.
I don't have to opt out of Medicare. It doesn't really matter, or I don't have to stay in or stay out. It doesn't matter, but I am still opted into Medicare. And the main reason is because I'm currently moonlighting at an urgent care, just to make sure I have some sort of income while my DPC is building.
I know a lot of people don't with loans and everything. I figured it would be the safer bet. And I hope to get out of there as soon as I get.
I want to focus on your clinic. Now it's so exciting, again, that you're on the podcast, talking about your experience as you're in the throws of opening your doors.
So I want to start by just acknowledging the fact that you are documenting your experience, not only here on the podcast, but also on DBC news, because you are running the resident and medical student section of DPC news.com. And so the clinical journal entries that you've done about your opening of your practice, they will be linked on the blog, accompanying this podcast, but I wanted to go through what your experience has been for the listeners as well.
Who've may have not seen these articles. So how are you feeling in this stage of your finally getting to after years? Learning and planning and dreaming about DPC. Finally opening your
doors. So I think first off, I just want to thank Doug FRAGO for making DPC news so that there could be one place where all this information could be.
And then also for asking me to come on and help work in the arrested and students section, he is also the guy I want to give credit for in having me publicly write out my journey as it happens. I actually call it a DPC diary, which I'm perfectly happy with that name. And yeah, it's been cool getting to week by week share what's been going on in real time.
And what my thoughts are, I think in terms of how does it feel to finally have one open? Because I've been so engaged with this community for so long. And I've been thinking about doing this for a little longer than I've than I was in residency. It almost feels like. The next natural step. Like to me, when I graduated residency, it didn't really feel like I graduated and I was starting a job and opening a business.
It felt like I was going from PGY three to PGY four. Like this is naturally the next thing that was going to happen. So in that sense, so there, there wasn't like a big moment where I was like, wow, I'm doing it. It was more like, all right, this is it. I'm doing it. And I'm still doing it and we're just going and we'll see where it goes.
And so that's largely what it's felt like. Everything's been building up to this and now it's finally here and I'm doing it and we'll see if it goes anywhere. I hope so.
Cool. So cool. And with you having completed your education in Virginia and now your clinic is open in Midlothian, how did you decide on your particular area and location??
Yeah. So just for spatial context, Midlothian is a suburb of Richmond, about 20 minutes Southwest of the city. And like I mentioned earlier, I went to med school in VCU at VCU, which is in Richmond city and then did residency east about 45 minutes east of Richmond city. And so I maintain a lot of connections with my med school.
So that's been helpful just having that partnership, but by also Midlothian itself, I know a lot of cities in the U S are booming, but Midlothian potentially is growing rapidly. And Richmond city is growing rapidly too. And I just felt like the suburbs were a much better place to start. I think the population of people definitely is higher than the population of physicians who can support them, especially with more people coming in.
So I felt like it was a good place in terms of demographics is a good place in terms of just connections I had. And also my family is nearby. All in all, it was just, I don't want to say the easy choice, but it was the, in my head, the most rational choice to start a business.
You've shared in the diary, posts, how the people around you are also cash based healthcare providers. So how did you come about your clinic space?
Yeah, there there's a lot of preparation and hard work that goes into starting a DPC, but there's just as much luck. And I would say this space was totally a stroke of luck.
That was during a time I was just looking anywhere and everywhere and running into a bunch of dead ends and places. I was like, yeah. But then I found this place, my realtor didn't even find this place. Actually, my mom helped me find this place. So shout out to her for that. And so I went, I got my realtor to bring me in.
I looked at it and that same day I was like, this is it. And it was totally just based on space. I didn't even really know how good the location was. And I know this sounds dumb because I should've been more prepared, but it seemed like a decent enough location, but basically the size of the rooms were.
Just there. And I was like, this is it. And so that same day I asked him to put in the bid to get a lease and all that. And it wasn't until after I had signed the lease and they had renovated the place, I started going around to talk to my neighbors. And then I found out that everybody in my strip hates and health hates health insurance.
And then there were like several other ancillary services. We didn't take insurance at all, including physical therapy and massage and chiropractor. So really just as a really good stroke of luck.
I'm chuckling a little bit because Dr. Anan Metta had shared that his mother also found his clinical space.
I feel that might have to be a future question for DPC doctors opening their clinics. Is, did your mother or father contribute to finding a space that that's incredible. , as you're opening, have you found patients of the chiropractor and have the physical therapist are asking about your practice because they already understand the value of having a person in health care that doesn't
take insurance.
So I guess to answer a question in a couple of ways, first of all, I would say it hasn't led to any signups just yet, because I think a lot of people who do go to physical therapy who do go chiropractor already have primary care docs. And for the most part, it takes time for them to have a need before they make the switch.
But it is helpful in that. The neighbors. They have been actively looking for patients who are good for us and talking us up. Like my brochure is in all their offices and every now and then we bumped into them and they're like, oh yeah, I told this patient or that patient about your practice. And they're looking at your website, they're looking at your brochures and your information.
So it is nice to have that extra touch point. I think in the world of marketing, what is that on average? It takes about. Five to six impressions before somebody makes a decision. I don't expect them to just because they're paying out of pocket for physical therapy to be like, oh yeah, totally. That's this new doc with this model, I'm going to do it.
The other, I think the other difficulty with primary care compared to physical therapy, being cash based, it's that the ancillary services people are used to paying money for, because it's like a quote, specialty or specialist who has primary care and is just your family doc. They're like why that's what my insurance is for you.
My insurance assigns me a PCP and that's who I go to and they're adequate. And they refer me to everyone. I need to, there is a little bit of a challenge there, but anyways, it's nice having the cash based people nearby because I think you're right. It does make it a little easier to get to their patients and get them to understand what I'm doing
in that space previously, on one of your diary journals, you talked about how being in this space of DPC for years.
And being educated on the movement and its mission and the way that it brings value to everyday Americans. How do you talk to community members when they're not familiar with a cash pay way of accessing healthcare?
Yeah, so I basically, well, we'll see if it works, but I've honed in on some of the more common pain points, especially working urgent care. A lot of it is I can't access my doctor there.
The next appointment is like two weeks out. Nobody calls me about anything and the doctors rushed, so they never listened to me. And so just based on those patients, I focus my pitch on, Hey, we have longer visits. So we actually listened to you and you feel like you have enough time with us. We guarantee same the next day appointments so that if you're injured or you're sick, you don't have to wait weeks and end up in an urgent care.
And then telemedicine, if for convenience, if you're away, you have a rash or maybe have a UTI, you can just shoot us a message or give us a call and we'll handle it over the phone. These are things that an insurance-based doctor wouldn't ever do. And then you go deeper based on their interests. I already pay for insurance.
Why do I pay for you? And then you talk about the difference in value and changing insurance plans potentially, or using a health share and how that could actually save the money. One. Pitches a little bit it's one of the minor ones is like the lab pricing because he just like many other DPC is I use a GPO that has great cash prices and I don't mark up much.
And I out-compete the nearby hospital systems by greater than 80%. So it's all the things that I think people expect from primary care, but aren't getting and things that they find important. So there, there is a lot of education. And so the highlight is based on what I think their pain point is. And just to do a little dance, if they ask some more questions
Do you ever feel any guilt about. This is my pricing, and this is my value proposition because I feel not as something that can go either way. Some people feel a lot of guilt with regards to talking about their practice. And then on the other side of the spectrum, you have people who are like, this is me, this I am valuable.
Take it or leave it. Where do you find yourself when you're talking to community members?
Yeah. So I've never really felt that guilt. Guilt necessarily as the right feeling other people have. It's probably more, one of just being a more like skittish about their pricing. They're like, oh my God, well, people pay for me.
So I've a couple of thoughts on that. The first one, the 2017 summit, there was a physician who was talking about discount versus value add and how she marketed. I think she was in somewhere in Georgia, maybe one of the suburbs of Atlanta. I can't remember exactly who it was or where she was, but she started her pitch off.
When she first opened saying that she was cheaper than everyone, she was able to give discounts and it was like, look how good my practice is and how cheap I am. And she just had a terrible time having people say, And then she realized, or I think somebody gave her the advice like, Hey, you need to really talk about your value rather than how much money you're saving people.
So she could turn it around and started talking about the value she was bringing. I believe she increased her price to the value she was bringing and all of these services she had and hers, her signups just drastically increased. And so from that I learned we're here not to. The discount docs for people and people don't want discount docs.
When it comes to their health, most people are like, I'm willing to pay what I can pay in order to stay healthy and make sure my doctor knows what they're doing. And it's just like how some people avoid the dollar store because of the stigma. Nobody wants to go to the super cheap doctor because they're probably cutting corners or doing something weird.
So that, that was the first thing. The second thing, my dad, who is private practice dentistry, he says, when people come out of school, they always think, oh, I'm charging too much. And then they start running up. And seeing how much everything costs and they realize, oh man, I'm really not charging enough. And that's definitely true.
Everything in business costs money. And so if you're starting out and you have this idea of, okay, this is what my PMPM per member per month is going to be before you start paying for everything, you might not have a good idea, or you should probably at least do some math. Just guess how much you're going to be.
Your overhead. Your monthly overhead is going to be your total startup costs is going to be, and then how many patients you want to have, and then do the division there to see how much your monthly should be, because you definitely don't want to be in a place where you're basically fee for service. And your monthly payment is so low that you end up having to have 600 patients before you cover for your monthly overhead.
And then the third thing is the physical therapist, actually two doors down from me. We had lunch a couple of months ago and I told her how much my pricing was. Oh God, big items. You're charging, not nearly enough, like your physician, what are you doing now? She said the massage therapist, a couple of doors down and charges a hundred dollars an hour.
You're charging $99 a month. Are you kidding me? And I think a lot of it, a lot of the reasons why we don't want to charge more is because it is mission driven, right? Like I mentioned at the beginning, DPC is more than just the practice model. We're trying to bring good primary care for everyone. And so we want to be at a price that's affordable.
I call concierge right now, the easy way out, because people will get concierge, you build their insurance, you charge them money. You're available to them. That's intuitive, but there's such a high price wall that the average person can't get to it. And that's not what we're about. We're about. Providing for our communities.
And you want to focus on that mission, but you also don't want to shortchange yourself by trying to be a discount doc, or just feeling guilty or skiddish about your pricing. Because at the end of the day, you're a physician. People do value that and you do have to run a viable business. And so I think in terms of pricing, really just look at what works for you, what salary you're comfortable with.
And then don't try to undercut yourself too much just because you don't feel like you deserve money. Okay.
It's so important because not everybody has an MBA at some point along their career before they graduate medical school or soon after medical school.
And so this idea of valuing yourself, the reason I bring this up is because what happened was that day I went to clinic and I had a young person say to me, wait a minute, you get all of that access. And then for my model, it's home visits, you get two home visits included a year. That's incredible. And when this patient said that I reminded myself of this idea that yes, you are a physician.
Yes, you are valuable. And what I feel is that when I talk with people like yourself and like other people who are starting out or who have started out recently is just hold your position. Don't waiver in terms of going down in price, they're going into, when you talk about. Physician who was talking about the value add versus the discount medicine.
It's the space is so important for us to sit in and potentially be uncomfortable in, but that's where I feel that like, when you talk about knowing the value proposition and the cost of the business, there's great tools out there that we can use. One of them is burden free md.com. That was a, that's a calculator.
It's a website that Dr. Lauren, he out of direct doctors in Rhode Island has put out where she's listing the bare minimum of what you need to open a practice and XL documents like that. Physicians who've opened their DPC. That's a good exercise to do with numbers. So it's more numbers based versus emotion-based when you're making these decisions.
Yeah, for sure. And my experience has been the same as yours in terms of just like prospective people, the people who get it, they're like, wow, that's it. That's how much you're charging. This is incredible. And then the people who don't get it just don't get it.
They're usually some of the people who are overpaying for their insurance anyways. They're like, why I don't see the doctor? Why would I ever pay for this? Meanwhile, they're paying for like a gold or silver level insurance plan and not understanding the irony. And I, as a corollary to that, it's just realized that people who get it and pursued them and don't let the people who don't get it bog you down.
Cause a lot of those people will waste a lot of your time asking questions with no intent to join and no intent to ever get it. So you do your best with education. You tell them what you're about, you understand your value and you price where you think is viable for you and is reasonable for the value you're providing your community.
And then the rest is up for is up to the right people to under.
With you mentioning honing in on those particular people who really get it or providing information quickly and accessibly and in an accessible manner. So other people who are like maybe on the fence, but more leaning towards understanding DBC can also understand it more.
Clearly. I want to highlight your FAQ section on your website because on that section, you have six questions. And I want to ask, how did you narrow down your FAQ to those six questions? And the questions on your FAQ are number one. Is this concierge medicine. Number two. Why do you not bill insurance?
Number three. Does a membership replace insurance. Number four. Why do I need a membership? If I don't really go to the doctor? Number five is membership a long-term commitment and number six, are there other practices we do member based primary care strategic.
Yeah, I would say the FAQ is always a work in progress.
I think I did it a little bit based off personal experience, but also when I was building my website, I visited a ton of other DPC websites to see what questions they had up and what seemed to be high yield. So the first one that is most common, because it's just the question that comes up when people, or at least it comes up a lot.
When you talk to doctors, you find a lot of patients in the general population don't know what concierge medicine is, but when you do describe it, it is still. For the people who do know concierge medicine, one of the most common questions. Cause you're like, oh yeah, I did this membership. Then they're like, oh yes.
So I concierge and that's when I get into that. And that's why that's number one recently, I've been a little more, I've tried to throw a little more shade. I concierge medicine with my language in person. I really harp on this. I tell the people, I'm like, well, they charge you money to see them. And then when you do see them, they charge you money again.
And so we call that double dipping. And I think that makes no sense. We just bill you monthly and all the services are included. It's a little more shade than I used to do, but I think it's warranted. So that's concierge medicine, and then insurance is always the next question. They're like, well, I have insurance.
Why don't you take insurance? Like all my other doctors take insurance. So that's question number two. And I break it down there as to why insurance just makes primary care worse. And why DPC makes sense and care is better. Does membership replace insurance? So because it's a monthly thing, and this has been an issue since like the Dawn of DPC with Dr.
Bliss in 97 is people are like, oh, I'm paying monthly for. Medical care. That means it's insurance. No, this is primary care. You still need insurance for the high casualty things. And so just really need to make that clear because when you say membership plan, people automatically think, oh, it's like a, it's a health insurance.
So that needs to be made very clear. And then the, why do I need membership of, I don't really go to the doctor again. It's just like the people who don't get it, right. I'm overpaying. They pay, they overpay for insurance. And then when they do need a doctor, they get terrible service versus why not just pay less for your insurance and then pay for a service, which even if you don't use you save money and then when you have to use it, it's much better.
I'm actually planning hopefully soon to write like a full-on blog post for my practice website in regards to this question. And then long-term commitment. A lot of people with gyms and stuff they're just used to signing 24 month, 36 months commitment. And it just doesn't make sense if it doesn't work for you, I don't want to be stuck in that arrangement.
And I'm sure they don't want to be stuck in the arrangement either. And I actually, so only recently that I really start promoting myself as direct primary care and explaining the model because before my thinking was, nobody knows the direct primary care is what is the point of using that language. But one, and I don't know if I should say this on the air, but one of the reasons I did start using direct primary care is one of the large concierge corporations around here calls themselves direct primary care and uses direct primary care language, which is why I've very like in an effort to push back.
I've become very blunt about this is direct primary care. This is concierge. This is what I do. This is what they do. So the last question was actually written back when I wasn't using the terminology as much. I'm like, oh yeah, primary care. I offer these services and I build differently, but I want people to know that I'm not.
Some rando doc, but the Rondo idea, but this is like a large community. A ton of people are doing this and it's something that's growing. So it lends some sort of legitimacy to what I'm doing. So
thank you for going through your FAQ's.
Have you thought about. Changing your FAQ's based on the reasons why people are joining your practice or the questions that you're getting more
commonly potentially right now, these are most of the questions I think, instead of replacing them, I would probably either reword them or just add on either blog posts or other documents.
Like I created this beginner sky document under my, on my pricing page that kind of compares the prices of the high deductible plan versus a gold level plan and annual costs with my membership versus without, and all the savings they could get. So I would probably just have add on things and just link those blog posts or documents to the FAQ so that people can read more if they were interested in that particular question.
But I think these FAQ's right now are pretty high yield and unless like I hear something over and I realize it's, it's not here, but for the most part, like I said, I visited a ton of websites. So research what questions to put and based on my experience of talking to lay people and other doctors or medicines and residents, these are the big question.
So
If you have not gone to Dr. Key's website, you doc EDU, doc dot M E is his website, and you can check them out. now I want to ask about the name of your clinic and your logo, because again, one of the things that you highlighted in your diary post is how. One of the most valuable tools you learned early on is Adobe Photoshop.
And so I want to ask you about the process that you went through, designing your logo and picking your name.
Yeah. So learning Photoshop, and now having learned illustrator and premiere pro I've been awesome. And I just, I really enjoy doing this stuff. It's fun. I get to spend hours on it. Just like tinkering with things, but the name it's one of those things that I was in, one of those moments in a Headspace where I want it to be too clever for my own.
Good. And the name comes from the Greek EU, meaning good. Or like you thyroid and then doc, obviously doctor, I wanted like a, a prefix suffix thing because. And this is me being more ambitious than I have any right to be. If I do branch out into something else, I can have you this, you that. So it'd be cool to have.
And also, I think I had just listened to podcasts on SOC doc and their founders were saying, yeah, the name means nothing. It's just, somebody wrote it down and we're like, yeah, this is it. So that was part of it. But no, my name has meaning and also you dark, it sounds like you and doctor, and since we stress the direct relationship, I thought that was just another cool thing that, that also fit in terms of the logo.
I wanted one of those clever logos to where there's something hidden in it. Like how FedEx has that arrow between the E and the X, whether that was intentional or not, it's still pretty cool. But you have all these like clever logos, Amazon. I wanted something like that. And so just playing around with everything, the closest thing that I could figure out was the staff of Asclepius, which is the actual symbol of medicine and Hermes staff with the double wings and the novel snakes.
It's a single staff with a single snake, and I figured I'd just make it look like an E and have it be the E in you doc. And I initially. I think I wrote about this in my diary. So I'll be brief, but it spins it's in like it's fourth, third or fourth form now. And I'm actually planning on updating it again this week, making it even cleaner and then having another version come out.
But yeah, that's essentially, it actually looks better separated from the word. So most of the time you'll see the E and then my practice name just written out in regular texts, but that's the origin. There's very few places. Like at the end of the videos I make where you'll see the E at the beginning of the word doc, but for the most part it's separated and you'll see the practice name all in just regular print
logos, like the FedEx and even Google FedEx and look at the logo, but you'll never unsee it once you've seen the arrow, but between the E and the ax, it's a very clear logo.
It's like the Amazon, the sushi underneath the Amazon logo. The idea that. Design intention behind the logo as a person who also has graphic design as a hobby. I just really, I love that story behind your logo.
Yeah. Thanks. Yeah. And you know, the in, in long form story, it's the version I have right now. I learned about golden circles and how like Pepsi and Twitter and Facebook all utilize golden circles.
I was like, I'm doing this. I spent like an entire evening figuring out golden circles and then making the snakes in the right proportions.
You are an LLC. And so I wanted to ask what are some of the unique things you had to go through being in Virginia, if any, and what are some of the challenges that you wish you would have had more advice on going into becoming an
LLC?
The process was actually pretty easy and super fast. The only thing was you had to have a real address. And I did a virtual address, which is still like shaky at best, because the reason why I have now my home address, because some people before they sign a lease price. So I filed my LLC, I think about two or three months before I had a space.
And so some people will just list their home address. The problem is whenever you file an LLC, that automatically becomes public right? On a lot of places and I just didn't want my home address to be that. So that's why I have to find a virtual address. They used to be able to do PO boxes, but apparently since COVID, there's been a lot of, a lot of people committing fraud with PO boxes somehow.
And so you have to have a real brick and mortar address. So that was the only thing. Other than that, I think Virginia has a pretty straightforward, easy process. I just filled out some paperwork and then got my LLC. And
did you have any business licenses that you had to apply for in your county?
Yes, Chesterfield county.
And that was also super easy. And for us, if you make less than $10,000, which being a new company in general, obviously my, my income is zero. Yeah. It's just free. And I think it's annual renewal, but that was actually something I didn't know about that somebody asked me later, they're like, Hey, have you gotten your Chesterfield bison, Chet?
I was like, what are you talking about? Yeah, that's I guess the general piece of advice I can give is just check with your local county or city and make sure you're getting the local license as well as your state filings.
I feel like this is the most ironic conversation that I've had in the last week, because as we are talking, that is the place that I am in myself.
I did not know that there was a county business license required until I filled out a form that asked for my county business license. So I had to Google Calaveras county business license and in the state of California and everywhere is different. Not every county requires a business license. This is where I would say if there are other DPCs in your area, talk to them specifically about what are the things that you had to do to open, even if it's a basic question that you've already done, the steps it helps.
And also just like literally Googling. Do I need a business license for such and such county? It can definitely save you some stress in the future. Now I want to ask, because you are opening your clinic with Dr. Mariana keener. Is she a co-owner?
Is she an independent contractor? How is it working for you?
Yeah. So Mariana is a friend of mine from residency. Well, I'm pretty lucky to have her on. She is currently an independent contractor only because that's just what I understand how to do right now. I hope to W2 her at some point within next year.
And she was interested in buying in as partner as well. So. Once I figure out how to do that. I think we, we will probably go that way, but this year, I think it just makes a lot more sense doing the 10 99 it's cleaner. So essentially she works for herself by herself, like everything in her office she paid for by herself.
But in terms of like medical supplies, it's mine and I pay for it under the LLC. I think the way we do it is it's, she keeps a percentage of what she brings in. And I keep a percentage for the overhead and functionally how it works is she just rents the space from me. So rent equipment and rent space runs the EMR because it would be an undue burden to make her pay for her own EMR and have it be separate from my system and pay for her own supplies and be, have it be separate from my supplies.
And so I think. Works out fine when you do it like that. And a lot of her, if it's specific to her recruitment and stuff, she pays for her own stuff. And then I pay for the practice stuff, but like I mentioned it in the next year, hopefully there'll be a, there'll be a W2.
And when you talk about purchases that you have in the LLC, what are your strategies for when you buy something or when you bought something prior to opening your doors, how did you go about recording it in terms of the accounting part so that you can get that money back as part of your opening costs?
Yeah, it's just spreadsheet and I'm writing everything down. I think I've tried to keep as many paper receipts as I can, but. At the same time, like the credit card, I use records, what I spent where, so that's nice. So, you know, my papers, I have my credit card statements and then I have the Excel spreadsheet and I should talk to an accountant that one of my neighbor, my business neighbors recommended.
And I walked him through my process and what I've been doing. And he's yeah. Sounds like you're doing everything right. So just keep doing that. And I'll talk to you at the end of the year. If you need me to help you file your taxes. I was like, all right, sounds good. That's about it. It's just regular Kibana.
Some people use like Xero or QuickBooks, zero where the next or QuickBooks or something like that. But I haven't found that I need it yet. And also for billing, I only have a couple patients so far, but it does a really good job of just showing reports and everything. And that's what I use. So I haven't had to use QuickBooks or anything yet, but I know a lot of people do or some sort of accounting software.
And if that's just helpful to how your brain works, then yeah. Do that. But other than that, you just need a record of everything. And I started out not having a. Credit card or account. So I bought a lot of stuff on my, with my own money and the way my accountant told me to do it was just to pay myself back at the end of the year with a check from my business account.
So it's actually funny cause it's really just like pushing money around. So I like have to use my own money to fund my business account and then push some of that money back into my account. Just so there's some paper trail showing that my business paid me back.
When you opened your LLC, how did you know that you were doing it correctly?
Yeah, I didn't, I think that's one of the things opening a business as a physician is like nothing in your training prepares you for this. And you just go with what you think is right. Filling out all the forms, doing all the things. And one of the things that's been helpful is having well, knowing a lot of DPCs in other states, but also having a good community of DPC.
People are here. And a couple of my good friends, shaking, Christina macho you've had on of a defined DPC days, started in Williamsburg. So they were in the residency class just ahead of me. So they're a year out now and I'm starting. And actually they visited earlier today, but they walked me through a lot of the startup stuff.
And I check in and be like, Hey, what am I missing? I've done this. Do I need to do anything else? And so I think, but just having friends and having a community and people who've gone before you helped a lot. Yeah. And that's pretty much it in the same vein of looking up the, the county license, I would just recommend like steps to.
Required steps to opening an LLC in Virginia or whatever state you're in and then talking to people. Who've done it before, just to make sure you haven't missed anything, because there's just so much that you don't know that you don't know when you start a business and you just figure it out along the way.
I haven't used this phrase in a while, but when I was first starting out, the first few weeks, people are like, oh, what's it like, how's it feel? I'm like, I'm literally just falling forward. That's just what it feels like constantly. There's just another thing happening. And I'm figuring something out as I go, I'm constantly falling and catching myself.
That's progress to me. Amazing
and so relatable. I think this idea though, of falling forward, it's just like how Dr. Julia Gunther talked about it. I think the 2019 DPC summit in Chicago, this idea that you make this leap. But that's so true that the more you go forward, you're just exploring the space and it's okay to make mistakes, but there's an amazing community of people. Like you're saying to network with who can help get you back on your track. So you keep falling into a successful future. Now you mentioned hint, and I want to ask about the other pieces of tech that you're utilizing for your practice.
How did you. Choose an EMR. And what were the thoughts that you had that helped narrow down your choice to ultimately choose the EMR you did?
Yeah. In terms of EMR, I use servo and servo has been a rising star in the DPC community recently. I think I will focus on why I chose serve both versus why not the other ones with servo.
It's just, it's a very clean user interface. It's very DPC friendly in that. Like you can tell, it's not a billing software, like there's codes and you can do charges and you can run insurance through it. But it was specifically made for cash based practices. And I think it got into the DPC world through the functional medicine world.
So you'll see on their platform. There's just a lot of. Like really intense questionnaires about things. I don't even know what to do with, but largely it's clean in that. It's now the big EMR is where there's all these funds and click things. And they're tracking this, tracking that running this code running back though, it's not a billing software, it's a true EMR.
And I like that it's clean and it's got a nice patient portal. Part of it for me was, was a patient portal too, because when you're DPC again, it's that idea of not looking like a discount doc. And so it just had a really clean patient interface. And I wanted that to reflect the practice like, Hey, clean patient portal, nice practice.
When the patient interacts with the portal, they think about your practice. So just from a psychological point, I like that too. And then before this didn't really contribute that much to it, but it's just a fun fact. The founder and CEO is from Virginia and his dad actually runs a time-based. So he charges per 30.
Uh, time-based practice up in Northern Virginia. And I got connected to him through another DPC, Dan Moore, who was opening in Glen Allen, which is about 30 minutes north of me. So yeah, just a random, cool connection. I like servo is a clean EMR. It integrates with everything and it's just easy to use. And I think it's a good patient experience as well.
What do you use for communication with your patients?
So for communication, I use spruce. I actually have a triple layer thing. It's probably more complex than it needs to be on my business card and any of my life front-facing advertisements, the phone number I give out is actually my Google number and I use it.
And the reason is because when somebody calls me from that number, I can set the color right. Just say like you doc number that way I know how to answer. Hey, is a darker queue rather than flow. And that way I can also wait out some spam. And then when patients enter the practice, there's the spruce number where they can call and the same deal with the caller ID.
Then I know, Hey, this is a member. And also I know EPC, we're not technically HIPAA bound, but it's still nice to be able to say that, Hey, I use a very secure method of communication. It is HIPAA compliant and all that stuff, just in case there is some issue with the patient privacy and whatnot. And then there's also just like a lot of good internal communication that you can do through spruce and they give you a fax line.
And so my practice currently, I hope to keep it this way is completely. And so the faxes that come in, I have already gotten faxes. They come into spruce, there's a, it generates a PDF. And that way I can move it directly onto my computer or into the EMR. And so that's also really nice and I can send digital faxes as well.
So, yeah, spruce. That's why I decided on spruce. And with hint. I think if you're planning to stay as a small DPC, it's fine. If you just use Stripe or bluefin yourself, because hint is powered through Stripe. Anyways, one DPC. Doctor. I talked to Oklahoma who runs a pretty big one.
It says any decision you'd make it to scale. And I took that advice because it is a little more costly upfront, but it's a very slick piece of software that works really well. When you start having a lot of patients, it gives you a lot of flexibility in changing your prices and adding charges and working with different groups, running promotions and everything.
And Zack does that called forth. Who is CEO of him? I've known him pretty much for all four years that I've been in the community and he's sponsored some of my resident and student events locally here, but he, I think he gets it right. He's been a huge supporter of the DPC community for a long time now.
And he's. Very exclusively with DPC docs to create this platform so that it works for us and it makes sense to us. And so part of it is it works really well. It's something that I think will help when, and if I get bigger, but also it's a token of appreciation that he's been helpful to me. And he's been very involved in the community and by using hints, hopefully this is a good show of me just supporting them back.
And I find that the hint summit specifically not only shows that
Zach and the whole company understands DPC, but that they are also very forward-thinking and that a lot of their speakers talk about the innovation and the DPC space. So that the movement can grow.
Yeah. Yeah. And it's cool because there's the AFC FMTC ACO, CFP DPC Alliance. There needs to be a quicker way to say all of those for that mega summit in the summer.
And hint, some is usually sometime in the fall, but it's nice because they don't really compete with each other. And ant is usually one of the sponsors of the summer summit as well. It's just, it's a very different crowd. It's a very different niche. Tech and larger DPC and employer focus. Whereas the summit tends to be like independent darts and really good for physicians to network and they're different.
They're unique. And I don't think they compete with each other. So it's just cool that they've been able to do that and put on an extra event for people who are interested.
What tools have you purchased for your DPC
so there's all this stuff that you need for a business, right? Like furniture, decorations, medical supplies. And of course with primary care you run the whole spectrum of chronic and acute care. That's definitely one of the bigger expenses, at least starting out the recurrently, because you don't have as many patients you're not burning like sutures and punches and stuff that quickly though, they do have expiration dates for some reason or another.
But yeah, that's big. It's just like preparing for the, what ifs having to buy all the beta tine and alcohol and suture kids and this, that, and the other. But in terms of, and then, sorry, back to the fundamental stuff also advertising you have to pay for advertising. And a lot of mine has been just community engagement advertising.
So being a sponsor of the farmer's market and joining the chamber of commerce, that kind of advertising costs. Value add why? The only thing that I've purchased that's extra is the EKG. So EKG, so you can send them to radiology centers and just get that done. But I have a smart heart, which they recently changed from a bi-model to rent model.
And I think it's reasonable. It makes sense. At least for start-up for me to use right now. And my EKG costs is a 10th or less of the nearby radiology center. So I think that's definitely a value add. And of course we have the lab for stuff. So drawing labs on site, a lot of people really don't want to go to Dr.
Price to lab. So I think that's another value add.
Wonderful. Now you're still involved in educating your community about DPC for those who are in medical school or in residency. What words of advice do you have for them?
As they explore the DPC world and figure out if DPCs is a good fit for them and when to make the jump into DPC.
Yeah. I think first of all, know the system, right? Because if you're going to buck the system, you got to be. At least aware of what you're getting out of. Don't just hear about DBC. Think it's a good thing and then go into it.
Because even though I probably knew the most about DPC clearly, but I also was in the top few of, in terms of knowledge about the billing system. I knew which codes I had to use. I knew how to generate those codes when to use modified. How the billing works prior odds, et cetera. You got to know all of that before you make the decision to do this, what we consider an alternate practice type right now.
And other than that, I would just say, just try to shadow people as much as possible. Get interested into the, in the business side of things, talk to fee for service stocks. When you're shadowing about how their billing works, how collections works, talk to business managers, find DPC doctors around you.
There are plenty of them out there. DPC docs are some of the nicest people in the medical community. And most of them are more than happy to have medical students and residents. So, yeah, really, there's a lot of resources out there. This podcast, DPC news day Alliance has a university, just a lot of stuff out there.
That's accessible nowadays podcasts, videos, and the summits are also a good places to come and meet people and ask questions. That's where I got my start. And then we do have scholarships as many. Can do every year to bring students in and teach them. So, yeah. Resources to get connected and just to learn as much as you can.
So I definitely would say if you have medical students who want to shadow or residents who want to shadow the cost of sending like personally sponsoring a person to go to the DPC summit, the AFP, we can just
call it the summer summit to
personally sponsor medical student or resident to go to the summer summit.
It's not the full cost of a physician attending the summit. So definitely check that out when hopefully we're in person in 2022,
it's a lot more when it's in person. And I can't remember how much it was because it's been two years now, which is unbelievable. There are a couple of ways you can sponsor a medical student or resident, and I've seen in the past that some doctors.
Bring on their own people. Like they'll just pay for the students' registration along with theirs and they just bring them along. I've seen it where the student happens to be lucky enough to be doing a fourth year or third year rotation with a position. They're like, you know what, I'm going to the summit and you're going to come with me.
I think just bring them. But there is also, if you don't have a student or a resident like that, if you're an attending physician, the AFP does have a foundation scholarship. The planning committee usually will vote on which students gets a scholarship. There's an application, but they just want to make sure that it's somebody who has invested and who will get a lot from it.
So, yeah, there's definitely two ways you can either sponsor somebody or contribute to the foundation and help sponsor somebody who is interested in, who could ultimately become a big, a great champion for the future of DPC.
Cool. So now after this podcast, what is the best way for others to reach out to you if they want to connect.
Yeah. So if after the show you want to reach me, you can send me an email. My email is Kenneth K E N N E T H dot D as in Delta dot Q I u@gmail.com. My last name is frequently misspelled. So I also have Kennesaw dealer TUI that email, that comment forwards to my actual email.
That's amazing. And with that, I want to say thank you so much, Dr.
Cooper joining us today.
Thanks for having me. It's been fun.
*Transcript prepared by AI so please forgive errors.