Updated: Mar 6
Direct Primary Care Doctor
Dr. Ken Rictor has been the founder, owner and physician for Scotland Family Medicine DPC. He graduated with honors from the University of Maryland Medical School in 1985 and completed his residency at the Washington Hospital in Washington, PA in 1988. Dr Rictor converted his practice of 25 years to a DPC model in 2014 in an effort to enhance the patient experience and reduce overall medical cost.
He is a Crossfit Level 1 trainer and may never retire because he loves his life as a DPC doc so much!
DPC and Insurance
Dr. Rictor at the 2019 Hint Summit with Dr. Garrison Bliss and Dr. Lisa Davidson
Resources recommended by Dr. Rictor:
- Hint Health - REMEMBER THE HINT SUMMIT IS OCTOBER 28-29th!
Welcome to the podcast, Dr. Rictor.
Thank you very much. Appreciate being here.
I wanted to start with your transition because you had been practicing already for 25 years with, at one time, 4,000 patients before you transformed Scotland family medicine into Scotland, family medicine, direct primary care.
So could you share about your transition?
Yeah. I started right out of residency and started my practice. And when I graduated from my residency in 19 88, 89, at that time, when you graduated from a family practice residency, it was pretty much expected that you would go to an area. You'd pop a sign out there and you'd have an instant practice.
And that's pretty much the way it went for me too. And it wasn't hard to quickly be full up seeing 37 to 40 people a day, having an active inpatient population doing enough as colonoscopies and procedures and on everything that you were trained in residency. And actually it was a pretty good deal. Fun.
It was busy. We were seeing patients in a good manner and the insurances were not an interference over time that eroded. And you started seeing more, a collective buying of practices by hospital systems. You started seeing more collections. Salary to physicians that lost control of that independence. And you started seeing more restrictions in the insurance industry requiring you to do more paperwork, more coding, more information that needed to be uploaded before you could even complete your evaluation of that patient.
So it was more time for paperwork, less time for patients. And you've heard all the story before. So with the affordable care act, that's when it really hit the skids where I really saw it really hype up very rapidly. And I recognize that it's going to reach a critical mass. It's going to be physically impossible for me to see as many patients as I would need to see in order to keep my business running.
I was an independent practitioner. We had a staff of about 11 people, my head, PAs nurse practitioners hired, and it was a big staff and we were seeing a lot of people and everything's going well, but I thought this is not going to last. And so I looked for alternate. And I discovered direct primary care.
Actually it was a TV broadcast and they were interviewing some doctors doing DPC. I called up the docs and they were more than willing to come out. And for me to go out to their office, see what's going on. I think I understood about 70% of it before I decided to pull the trigger. And this was in January of 2014.
I sent out letters to all my patients. At that point, it was about 4,500 patients and we sent about 2,700 letters, licking stamps, and I'm putting all out. And that letter. Was, as I have stayed in the past was unfortunately an apology. And I felt bad about asking someone to pay for their healthcare. Like it was almost like you shouldn't have to do this.
You shouldn't have to pay for your healthcare. I feel so bad about charging you for your healthcare. I'm so sorry, but I have to do this. I have to do this. If we stay in business, I have to do this. And I met with the community for every week for six weeks. Until the transition of March, the first 2014, we just celebrated, sent that seventh anniversary as a matter of fact.
And I went from one night to about 4,500 people to about 375. And that was a gut wrenching experience. I think I expected it, but I didn't expect it to be that much. And I thought, well, here we are. This is it. And I went all in. So as of February 28th, 2014, I was with Medicare. I was with all the insurances and March the first I was with nothing.
I was completely severed from all insurance companies and Medicare altogether and running this new model. And that's really, that's how that transition took place growing it. So that was the starting point. And then it became more of understanding what needed to be done. And that point I was learning new and new things.
I recognize how early I was into it. I really didn't understand that I was this young into it and an early adopter until I went to the DPC summit for the first time. And I said, wow, I'm a little ahead of the game here, which was nice to see. But also that there were shared experiences from the other doctors and knowing that what they were experiencing was what I experienced.
And so I knew, okay, there's definitely a light at the end of the tunnel. And I just got to keep going. And that was one of the biggest revelations to me is it's it wasn't a mistake. This was absolutely the right decision. It's going to be successful. You just got to figure out how to transition that thing until you can be financially successful in there.
amazing. You know, especially now that there are so many more DPCs I definitely would say that sense of community is alive and well, but I love that. Even back then, when there were few DPC doctors practicing, you were still able to find your kin and to build that confidence from even just a few people's experience.
Oh, very much. It's fascinating to me because the first DPC summit I went to, I opened up in March and there was a June DPC summit and it was in DC. So it's an hour from me. I said, the only reason I went is because I didn't have to pay for a hotel room or anything. And I went in there and it wasn't a lot of people in there, but the information coming was great.
And everybody in there was more than willing to tell their stories and to see what happened. I said, oh my gosh, this is different than any other medical meeting I've ever been to where everybody was turf battling this and quiet. And this was more of a cooperative effort. Everybody wants to see everybody successful.
I got a man, this is the right group of people. This is what I want to be. And you start getting to know the doctors and really, without exaggeration, every one of those doctors, I would want as my own physician, there was just a different sense of caring that you just noticed. And I think that also one thing that I think was interesting to me is originally when I went into this, I went into it because there's a different payment.
It wasn't a different care model. It was a different payment model. So it was strictly because the idea of, I can't do this any way, the way insurance is based, I have to do this with a different model, a membership model. You pay monthly. Now that I've transposed seven years, it is a completely different care model.
You can't compare fee for service with DPC. It's completely cared if mom and the doctors are different and their focuses is different. And I felt like I'm with my people. You know what I mean? When I went there, I'd go like, okay, this is who I can identify with. And they're feeling the same thing I'm feeling, and they're in it for the right reason.
I think they're in medicine for the right reasons. And they're, I think there is a right reason and there's a wrong reason to be in it. And we're in it for the right. Absolutely.
I want to ask when those 375 patients did decide to join in what were some common comments that you heard from those people in terms of why they decided to join into a brand new type of medicine in your community?
And why did they decide to stick with you as their physician?
I think the majority of was because they want to stick with me as their physician and that they didn't recognize the benefits of direct primary care. They did it because they had confidence in me. They liked me, they knew I wasn't gonna steer them wrong and they had the finances for it.
And they, as soon as they, at that point, they weren't looking at what ways can I adjust my insurances? So I'm more of a low premium, high deductible plan or whatever would be recommended with DPC. They had their own plans. And to them, this was extra money. Now I'm paying something extra. But then they started recognizing the benefits and then they started recognized the convenience.
And then they were coming back saying, oh my gosh, I would choose this fall over again. And literally then you started seeing them, tell their friends, and then it was more of me and you gotta try this out. So they were experiencing like I was, and they were coming back with positive report. Wow. But that initial step was just because they had confidence.
And just me, and I will tell you, the majority of the 300 pounds are still patients seven years out. And they're my favorite people on earth. And because they stuck with me when it was tight. And then they did that out of, I think, a love and a respect for me, which I greatly appreciate from them, but that was it.
But it was a risk for them to that. That's the way that those 3 75 or so jumped on board,
those patients valued you so much. And then they found out what DPC was. I think that's really good for people to hear because especially if someone is transitioning a practice and they're well-known in their community, it might give them a little.
Fear going into opening. I can't imagine going from a staff of 11 and 4,000 to the less than 400 in, as you're describing just a day,
it was scary, but I really felt confident. I have, I put a lot of confidence in my faith and I really felt this was a God directed thing and that I just felt that it was right thing to do.
And that it was more a matter of look, there's going to be better days. And if it's something that you need to do and you're doing it for the right reason, and that was my confidence going forward. And that's something that's interesting that I've noticed recently. And I definitely want to do you know what I want to do a video about this because I think it's important and it's fascinating to me because I still do once in a while, I'll go out to a urgent care.
And most of the time I do at urgent care is to spread cards around that. Here I am. And the most common question, the two questions I ask. Okay. One, why are you hearing instead of calling your family physician. And the answers cause I couldn't get an appointment. And then the second one is, what's the name of your family physician?
And they said, I don't know. And that's amazing, isn't it? That relationship has broken so far down. You can't even have somebody who identifies, who they see. They don't know, they know they're associated with the practice, but they can't tell you who it is. And I thought that's astounding because I can guarantee you every single DPC patient, you said, who's your doctor.
They would say Dr. Richter, Dr. Sq, Dr. Umber. They would say that right off the bat they'd know who you work, Dr. Whatever. And usually Dr. Kent, that they would know that right off the bat. And so that shows a differentiation to me right off the bat, that this is a relationship type of medicine. And it's very pivotal.
That is not a production-based, it's a relationship based. And that relationship based is what truly cements people into this way. And this model of medicine, more than anything else that.
In bigger practices. People might know where they physically go, but they might not know their provider also because every time they see a different provider and it might not even be a physician that they're seeing at that visit, the idea of relationship-based care is so powerful.
I was just sharing with a family member about how DPC doctors are so focused on the patient and not the codes. And my family member was her mind was blown because she was so used to, I go only when I'm sick. And I was speaking with Dr. Adam Sheltie, who is running his DPC out of a CrossFit gym. And he mentioned something similar where he is a CrossFit level, two trainer.
He opened in a CrossFit like how much do I need to do? Yeah, there you go. How much do I need to do to convince you guys that I'm here for you, but the perception was that you only go to the doctor when you're sick in terms of. Your number of patients changing drastically, your income must've changed at the same time.
So how did you handle that change in cash flow? When you switched from paper service
to DPC, I knew I was going to make the transition. And again, I started this process probably in September. I started saving money and I started putting money away and I said, I'm going to need definitely some different cashflow down there.
I knew also that my overhead was going to go down because of what I was doing, which is a hard thing. I had a bigger staff and I knew this was going to happen, but we were still having income coming in from a fee for service schedule. And it's a larger amount of income, but it's still a larger amount of expenses too.
So that transition of having those expenses still coming in and still getting that money to receive. Then having no staff was a booklet because I had that money coming in from a largest debt now, stuff that's coming in. And so that was a kind of a wave that, that hit in. We were getting those dollars in and we use those for that.
I also went out and got a loan from a bank and initially. Tried to make it more of a home equity loan or something, just put my house on the line for this as well to do that. And just to, to, to secure it that way. And I went and got a, what's going to interest only loan, which was again, just a temporary deal, so I could just pay bills back.
But the biggest thing I did was probably the moonlighting and I started moonlighting in an urgent care center and I was doing about eight shifts. And that's what really got us over the hump more than anything else. And that also was the secondary gain of we start growing the practice because I was attracting people from that.
And I made it clear that when I was at the beauty of DPC was that I could also manage my patients from. The urgent care. So I could pop over my laptop. I had my staff that was there. I have a receptionist, a nurse, they were there greeting the patients, talking to them with their substance. They need to do, I could actually even FaceTime that deal and talk to the patient directly into a backroom, or they would just handle it that.
And I'd be able to take care of those patients. So I could be at two places at one time that is ended up being pretty good. I, I don't do the, the urgent care half as much as I used to. I still keep my hand in it because I still want to attract people in. I also probably going to use that as almost a recruiting tool, that if I get a mid-level or another practitioner, they can get some shifts out there if they need and to keep them busy.
So that was probably the biggest thing that I did. And then it really didn't take too much time. I probably, I would say six to eight months before we started seeing the revenue coming back, that I could pay substantial loans back and debt backing, and we were doing much better that way. It didn't take long.
And again, we started with 3 75 and I would say we probably got up to the 5 5600 number probably within the first six to eight months of being open. But so within the year, Of that we were doing. Okay. And we were independent from that standpoint. And again, it was independent from what we're doing, but I was still paying back debt and doing those types of things.