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Episode 60: Dr. Ken Rictor (He/Him) of Scotland Family Medicine - Scotland, PA

Updated: Mar 5, 2022

Direct Primary Care Doctor

Dr. Ken Rictor portrait
Dr. Ken Rictor

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!

Nelli's Story

DPC and Insurance

Covid-19 Vaccination

Dr. Rictor at the 2019 Hint Summit with Dr. Garrison Bliss and Dr. Lisa Davidson

Resources recommended by Dr. Rictor:




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.

And that's been a real good. So we're at about, probably about 780 people right now. Which is a great number any more than I think it's going to start surpassing my capacity to take care of these folks. So right now we're good. And so any new people coming in, we'll look to expand, how did you

handle letting staff go that had worked with you for multiple years?

Yeah. What happened was that what I explained this as a huge group concept, met all with them and met them all together. And I said, this is what we're going to do. And I said, realistically, if I don't do this, nobody will have a job. I said, I have to make this transition. This was forced upon us by outside forces.

This was by the insurance market. This is by a lot of government regulations. This was nothing that I imagined when I went into practice at that point 25 years ago, I never would have imagined this would have happened ever, but it has. And so these are the changes that need to make. There were people, my building.

I had three people that do billing for me, that's no job anymore. So I said, here's what I'm going to do. I said, I'm going to help you guys get jobs and you will be employed here as long as we get you another job. So you will not be without a job. And that was a little hit financially. Cause I carry more people that I needed to, but I felt obligated to them to place them in places.

And that's exactly what all of them did. They got a placed in other places and there were really no hard feelings of sadness because a lot of them didn't want to go. But also they understood because they knew me and they knew the practice and we hung on to two people that are with me. It's really

decent that you did that.

And it's great that you were able to do it financially. Although it was like you said, it was harder for you, but I always think about that when you know, offices, especially those that are in, that have been in practice for years when they have to sever a relationship with a front office person or an ma, and that person that.

Has become a really good friend or an extension of the family. And so it's an uneasy situation I can imagine, but I love how you handled that. I think that's really decent. That the other thing that you said was the approach that you took in terms of making it a group discussion and saying how, if we don't make this transition, no, one's going to have a job.

It makes me think about how in Doug pregos book, in the very beginning chapters, there was a talk about a grouchy physician saying that mentioning comments, like by taking yourself out of. Healthcare. And in your fee for service clinic, isn't that going to impact the number of patients that you can see?

But it's very real. A lot of people who were searching out another way and finding DPC are at a point that it's either leave medicine or, and then fill in the blank and then they come across DPC. It's a very sad reality that you have. Fantastic doctors out there who want to continue practicing quality medicine and who can't because of the insurance driven healthcare


Yeah. And I think too, I transitioned when I was 55 years old. I am at the more than halfway through with my career and my peers were doing it. They were quitting. They were saying, I'm done I'm out there. This isn't worth it. I'm doing it. And I was nowhere near ready to do that. I thought, no, there's no way in the world.

I've wanted to do this my whole life. And there's no way I'm throwing in the towel. So I have to figure out another way to do it. And unfortunately I would love to take everybody with me, but I can't. And so this is the best approach that we're going to have to do with this. And like I said, it initially I drug my feet for a long period of time.

That was one of my delays. I knew I had to do this, but I hesitated as long as I could. 'cause I just didn't want to make, I didn't want to let people go. That was my hold back. And I tried other things and they just didn't work. So it came down that this was the right decision. There is no doubt. There is no doubt in my mind.

No doubt knowing what I know now, if I could start out my practice as a DPC, there is no doubt. That's the way I would go. This is by far the best way to practice medicine. And I think it is going to be a game changer. If we can get enough grassroots people in here, it's going to a game changer for everybody's healthcare that they're going to get better healthcare.

You're going to see more people engaged in what it is to be healthy. And knowing that physician is in your corner and that they're their coach with you and that they want it for you. And when you realize that they're asking you, I need for you to come and see me. It's not because I'm down in revenue, but it's because they really want to see me because they've already been paid.

It doesn't matter. And so the only reason they will see me is because they want to see me. That whole mindset is a big difference that people, somebody really cares about you and needs and wants to make sure you're okay. So yeah, it was an interesting transition time, but that was one that was tough. It was tough, but I applaud my staff.

They did a great job and there, we still stay in contact with each other. So it just

makes me think of how many diagnoses we can catch or prevent early on or treat better. I have patients who are smokers, they've never had a PFT, they can't afford a PFT. They can't take time off of work to get a PFT. And you know, if you have serial spirometry in your clinic and they can see you without having to worry about copays every single time, that's amazing.

And then a person who gets to talk about just with the lung example about tobacco for 500. Once every three years, when they see their doctor for their physical, it's just, it's not effective. It really speaks to the power of that relationship that you talk about with regards to, I care about you. I don't want you to be sick.

I'm here for your wellness and not your.

Right. I think too, there's another topic in, and this, this is what we've noticed from being in there is that if insurance was out there just to pay for your medical care, I don't think anybody would have any problems with it. But what insurance does is dictate the way that care is given it dictates the timing of.

It did take us. What's done at that office visit. It takes where it's done. It dictates how it's done because telemedicine was only approved cause COVID was out there and you couldn't do it any other way, but I know the time, no home visits or note, if do it within your office, you can't do certain things.

You've got to be able to vitals in order to be able to get a refill. These types of things. Wait a second. I should not have a benefit plan. Dictate how I practice medicine. It shouldn't happen that way. And it shouldn't be that if I go to get a prescription for somebody that they have to try two medicines, if they fail before they get the insurance to cover, and then the insurance covers it.

And I realized that the copays they're paying for the medications I want covered, I can get for them less expensively than their copay. So what good is the insurance? What good is it. And people have been. So customers and doctors in training are trained to be insurance-based physicians. They're trained how to see people fast.

They're trained to see how to code them. They're trained what you need to see at certain times and what the rules are with Medicare and what you can and cannot do with a Medicare patient. That's the way they're trained. And when you take a medical school tests, the medical school tests, how do you treat hypertension?

A, B, C, or D. And they're all medications. There's not talking about lifestyle changes and talk about nutrition and why? Because I can see somebody for hypertension and it takes me four minutes to be able to see them to write a prescription for a blood pressure pill and boot them out the door. But if I want to sit there and make a substantial change in their life and talk about what's going on right now, what are you doing?

Health wise? And I would sleep. Are you getting how much anxiety reducing in your word? How much quiet time do you have during a day? How much fluids are you taking in? What kind of foods are you eating and how much exercise are you getting? That's a 25 to 30 minute visit at least. And you are making such an impact on that person.

And yeah, I can get their blood pressure pills for two or three bucks, but that's not what they came in. And they came in to get healthcare, not to get a prescription. And yet that's what we've gone to doing a fee for service system. Because now you're saying, if you don't see this amount of people, you're not going to be in business, we will guide you.

We will govern how you do it because we're going to govern it with finances. And if you think about in our country today, we don't arrest people and we don't shoot. Well, what we do is we bankrupt them because if I want to make a mass people do something, what I'm going to do is I'm going to pull your budget out.

I'm going to, I'm going to find you or I'm going to criticize. So now we've got a group of doctors that are fee for service based doctors to sit at the end of the year and face a CFO, chief financial officer of the hospital system. And you're looking at Denison. Yes, sir. How did I do this year? You're a little bit down on your MRIs and you're a little bit down on your CT scans and we weren't really pleased with the consultations that this year.

So we're going to cut your salary back until you can bring those up to par. So I guarantee you, the next person that goes in there, it was raking leaves on a Sunday afternoon and comes in. Cause their shoulders sore is going to get an MRI to make sure they don't have a rotator cuff tear rather than saying you've got to be kidding me.

Let me give you some bands. Let me show you some stretching movements. Let me show you some things. If this is still bothering you down the road and then. And that is what is funneling and fueling the healthcare for this country. So that you've got twice as much expense for healthcare in this country.

And we ranked 13th or 14th and quality because you're spending it in the wrong places. And we know that as DPC doctors, we know that. And when you pull that plug, when you pull that insurance blood, it's not just, you're losing your reimbursement, you're losing the chains and you're gaining the freedom that you can then hand back to your patients and that freedom and that care isn't just to make things easier, it's to improve quality.

And then we see that we'll see a statistically now. So that's why I said earlier on is a different way of thinking. It's a totally different way of thinking for direct primary care than a fee for service model. And it fee for service model is faulted. It's bad. And I can say, cause I was in it and I saw it and now I see the other side of it.

So I know, and it's, this is a much better place to be. I want to ask

about employer groups. You've you've said in the past that you've worked with people from the health Rosetta, specifically, Craig Schirato, how did you come to work with Craig and the health Rosetta. And how has that benefited you with regards to explaining DPC?

As an alternative to what employers typically provide their employees, if they are providing health insurance.

Yeah. I think what helped me is I really did not understand anything about the insurance industry, nor did I want to. It was just not an interest of mine to, to be an insurance broker out there.

And so I understood direct primary care and understood how to do that outpatient care piece. When I initially approached businesses about saying, Hey, how about, or maybe we can take care of your employees. There will be the other part of it from the HR person. What do we do about if they have to be hospitalized?

What do we do about when they need procedures? What kind of assurance? And I was at a blank and we'll just use your other insurance. We already have outpatient care. And we realized that DPC stuck onto a health insurance plan just does not work individual basis. It might work, but not as a business concept in that.

So the health Rosetta team originated out of this dysfunctional insurance market to say, we've got a better way of doing this, and we've got a better way of doing this, that we can help businesses save money, the money that can then be turned around to fund a DPC market, to actually cover those lines.

And fun to DPC practice in there, which in turn saves more money that way. So Craig and I met at the very first DPC summit. He was flying from Kansas city. He's been a, he was an insurance broker benefits specialist and came in to see what is this all about? We sat at the same table, struck up a friendship that is a tight friendship until today.

And we talk frequently and Craig was learning the ropes as I was. And when Rosetta came out, he became a Rosetta person, got certified for Rosetta, and he's still involved in the benefits game in there, or the trouble is he's in Kansas city and I'm in Pennsylvania. So it's hard. But through that friendship, he's taught me a lot about what it is with the insurance market, what to go.

And most recently we've been working with gentleman by the name of Ben bono. It, so it was also a resented person who was just fantastic. And a bed has the same philosophy, the same understanding, the same love of DPC their drive is that they want direct primary care. Mark. To grow and to grow the, so it's a true partner.

The resilient team works with the business. As far as their benefits packages, which we couldn't touch, we don't know what's out there and we provide that DPC. So to me, that's what I want. I want a partnership. I don't, I don't want to work for somebody and I don't want to Lord over anybody either. I want to be a partnership that we go in there as a cooperative team.

This is what we can offer. And we work together. We recognize that there's going to be expensive. Parts of your care. You go into the hospital, that's a big bill. You get a big procedure done. So you've got to be protected that way. I can't cover that. I can't cover that into my DPC market at all. So I need this other arm.

I've got to have this to have complete care and to make this fully functional. So that DPC integrates rather than stuck on it actually integrates into that care. And so that's what we found with Rosetta. Their concepts are just phenomenal. I think keep them growing. More ways, more tricks, more ways of funding, things that just are very clever and clever ways of using dollars in a reasonable way.

Outside of the insurance market.

You started working with Craig and now with Ben, how has that impacted your practice specifically,

specifically with what we ended up doing was re realizing that I was never out to grab a business that had two or 300 employees and say, I'm the sole doctor for that? I kept on thinking if I do.

And that prac and that business pulls out. If they could just change their mind, I'm going to be in a heap of trouble because I'm going to have to scale up my practice to take care of this increased staff, maybe hire an extra person on there. They're gone. I that's going to hard to recoup. So how do I take care of a two or 300 employee business?

I got to share it and wonderful. That's all DPC is all sharing. So how do you share that? So we formed an organization called Genova. And Genova just groups, DPC doctors together. And we share the patients, basically every practice days, independent, they do whatever they need to do. But Genova handles the contracting with the business, handles all the disbursements of the checks out to the doctors as their affiliates.

And we govern what's done as far as a standard list of complimentary procedures, so that we're all on the same page, but we all have our independent practices. And so you take a business that has maybe 150 200 employees, and between your four and five physicians, you may have 20 or 30 a piece. So you've been able to cover that bigger practice, but each does not have that individual risk associate.

And I feel that when you do that, when you can attract a business that not only attracts the employees, but that attracts the spouses have parents and friends that tells more, and that's the way it innately grows from that one business contact. And so it just grows with inertia. That way. We've seen that with other business deals that we've done, where we gather other patients from that.

And even if they've been released from that business, they hang on as patients on their own because they love the concept of

it. That's nice. That is a built option where an employee, even if they're no longer employed by the original employer that provided them access to Genova, that they can still maintain with the DPC doctor out of their own choosing.

How did you develop your model when you were transitioning over and have you kept it the same since you transmit.

Yeah, we went up a little bit. We went up after my fifth year, we went up just a little bit, went up $10 a month. There's different price structures. And some people will do it as a tiered method.

They'll do it based off of age, certain age group, certain amounts, that type of thing. I did not want to do that because I thought it's just too complicated to realize. So I have one price for adults and I have price for your kids. The kids are really reduced. Most practices will do that. Really reduced price because you're helping the parents out as well.

I caught another DPC practice in Erie, Pennsylvania, that John is Vicky. Really nice guy. I said, Hey, what are you charging up there? But what, w w give me the flavor of what that is looked around, looked at some articles. What's kind the average price around there. And that's what I used my price. Just to average it out, just to see what would be a reasonable thing to do.

And then you financially, if you want to figure that out and say, okay, Here's my overhead. Here's how many people I have to have in my practice. That's X per that per month. How much money do you really need? Generally? How many people do you need to see? I think your rule of thumb and for your individual practice, you probably should use a number about 600 patients.

Is that what you should use as your number is that's the number you need to achieve, then go backwards from there. How much money do you need for your overhead? Are you renting? Are you buying? Are you taking a space? How much staff do you have? What are you paying them? What's your malpractice costs? How much do you want to get paid?

Put that all in there and use that 600 number. And how much do you charge per month? That per month, times 12 is what your annual income is and how's that broken down. So that's, uh, I think 600 is a good number to use

now in terms of your practice and your successful transition to now seven years, and congratulations by the way on that and reaching your happy number in terms of your maximum number of patients, what are some of the other aspects of your practice that you.

Proud to say, we're in place or that you put your effort towards in building your practice up to what it is today.

I think one of the biggest tools that you have to do when you build a direct primary care office is a communications tool. The communication is key and your communication is access to communication is how you get patients in and out.

And those tools. I specifically use spruce spruce communication tool. I don't know if there's others, half there to teacher. I think there are, but spruce is what we fell into and I love it. And just to tell you, and again, it's just the whole model is that all of our patients get an app and that spruce app allows them to text message, send emails.

They can do PDF back and forth of documents. They can take pictures of rashes or whatever's going on. We can video conference with that and we phone conferences and it's all HIPAA guided. It's HIPAA scrambled up. Our phones are now. Internet phones with spruce so that all of our documents get placed into their medical chart automatically.

So even a phone conversation is transcribed automatically for us. And so that communication tool that goes through our cell phones and my whole staff has a access to this, makes dealing with patients so much easier. And it's very simplistic to answer a text message on the fly. And you're answering a question that way.

And essentially you're caring for those individuals by just that information I can mass text out with that. They give you an example on that is that when the recent COVID vaccine, I made a video about COVID vaccines and I sent the YouTube link out to all of my patients through the spruce app and all of that access to it.

And all of them learned about the COVID vaccine at one time through a video in there. So I can mass communicate to people very easily through that. For DPC. One of the things I did write was a great communication tool. The other thing, and this is just all independent likes is you, you, I think you need a good medical record system, but it doesn't mean just because you're not doing insurance, that you can be sloppy on your medical records.

We're physicians. We have to keep good records. They use good records or a flat reflection of the quality of care, but we do not want to take loads of time in front of that computer transcribing a novel. So you want something that works with you and something. I use elation elation, EMR has been intuitive and great and a wonderful link for me.

It makes my job very easy to see patients and I can see them. So I don't have to spend time. I'm still sitting there looking at the patient and I can document it very quickly outside of the room or whatever, but my eyeballs are on the patient the whole time. So software system, communication system, probably the most important things for me early on the mistake.

I think the advertisement is overestimated. Personally. There are people that are. Social networkers. They're great. I am not, I know a lot of people love Facebook and Instagram and that's great. And do it continue. I'm not, and I was really bad at it. I'm great on the one-on-one I think, and a much better about just coming and talking about this to individual patients and let the patients be my advertisement tool that seems to have worked for me is that's worked out really well.

The other thing, just let you know, I partnered. With doing physicals for a nursing facility and all the new employees come over, we charge a separate fee for the, for the physical. So it's extra income coming to the practice, but every single plea comes in there. Here's about DPC. In fact, what I did is I made up of a little tag that every patient gets with a QR code and they sit there while they're waiting for me and they click on the QR code and they see a video that I came up about, welcome, and what we're doing here.

And then I said, you have any questions about the video? So I shortened my time when I'm in seeing the patients that way, but then that also has that direct link in as far as the advertisement tool, but basically we're advertising and we're getting paid for our advertising cause I'm doing the physical.

So those types of things I think were really beneficial early on with getting the practice up and running.

I think that's so innovative in terms of using a QR code to bring up a video having something in a visual format is definitely more effective, especially with our seven second attention spans compared to reading something.

So where did you come up with that idea to use a QR code? And how does your process work to get that QR code to direct your patients to the video that you're

mentioning? What I did specifically just for this one is, uh, and again, it's just more of a useful hobby, but I, I love doing a Photoshop and I love doing final cut pro and doing foodie videos.

And I have a green screen down in my basement and I like my videos and just have a fun time messing around with it. So for me, if it's any excuse to do a video, I'm doing it and we've looked at a topic. And so this was a perfect opportunity. So I recorded myself just talking about this, but I did it with the idea that.

Again, I, it was, I didn't want to keep, I'm giving this presentation every single time I walked into a room. So while they're getting everything done for the urine drug screens and everything else we needed to do, I thought what's best to get them associated with this video. So rather than everybody's carrying around a cell phone today, right.

I suppose everyone's got their cell phones. And it's easy enough, especially with COVID. People are getting very used to QR readers. You go into restaurants and your QR reading your menus now. So I thought, you know what I'll do. I'll just get alerted that as they're handed their paper into the room, I'll have that little tag there with the logo between the nursing facility and from my office linked together as it scan me as this code.

And they, I watch them come in, they're watching the video on their cell phones while they wait for me to walk in the door. And so sometimes I've had to take patients and said, do you know what that is? I've never used one before it, let me show you how to use a QR code. What kind of phone do you have? But that's why I just wanted an easy way for technology that they already have in their hands.

And not only that, but now they've got the link and so they can refer to that over and over again. And if they have any questions, they can show it to their friends because now they've got it on their phone. So that's not the idea of doing that. I need something that they could take with them, but it was also going to be instilled in their.

And I love that. And we'll definitely make sure to include your video so that people can see what people are watching from that video. And it makes me think about how, when you do strategically take urgent care, urgent care shifts, you're handing out that QR code as well. When you're handing that business.

To advertise for your practice. And in previous talks, you've mentioned how you are very passionate about educating much more than marketing. And so I want to ask specifically about videos. Like recently you came out with Nellie story and you create videos that are not only advertising what your practices and what direct primary care is, but you have also created features of people's actual stories.

So can you share for the listeners what that process is like for you and what have you been able to achieve with your. Passion for education. Over-marketing

sure. Yeah. I always feel that education is the key to any type of successful health care. If you can teach someone how to take care of themselves and what to expect and what to understand about themselves, you have a successful patient.

Obviously you have to have a patient on the other end. That's willing to understand. I view my relationship with my patients as a partnership. I'm the advisor, and I'm going to help you along and I'll educate you. You educate me, bring stuff to my attention too. We're gonna have a discussion. We'll talk about it.

So how do I do that on a mass? Basis. How do I get that out there? Oh my gosh. Once again, the technology today is videos are everywhere. And how do you direct people to the right video? Or just to say, I want to hear what, let me discuss what I'm talking about. Let me explain to you a little bit better. It's great to be able to illustration for it.

For instance, one of my videos I did was telemedicine and I have a special effect where I'm coming out of my phone and I have myself stepping out of my cell phone and I'm saying, how could you come with me? And I show scenes in the back. Like I can travel with you and I can go on vacation with you and they're there.

And it's just a fun way to get the ideas of, Hey, my doctor's in my back pocket. I never thought about that before, or it's a different way. They think when you can use healthcare and use analogies to them, you remember it a lot better. You had mentioned the restaurant insurance and the analogy between insurance and restaurant insurance.

People don't understand insurance, but they understand restaurants. And so you go, oh, okay. I understand that a little bit better. So if I can put something on there that shows real life issues, or I can show for instance, Nellie story. The reason I loved Nellie story was because you didn't. Almost everything in direct primary care.

In one story, how it was utilized, how she used license spruce system, how the offices that was utilized, how the communication was a reassurance to the patient, how it was utilized in that way, how the staff. So it's a nice picture because when people say what's direct primary care, I can say this is a sample of direct primary care.

This is how it's used all of us. If, if you think of anything that you want to do, what is it? Give me a trial run. Give me a sample. Let me try it out. How do you try out direct primary care short of going to the office, talking to somebody? Let me see a video of somebody who's actually using it. How did they use it?

Oh, okay. I got that. You look at all the DIY and YouTube videos that go on. What are you doing? You're watching somebody using the tool that you just purchased. So that's what I want to do. I want to show people using the tool that they just purchased. They just purchased DPC. They just purchased a DPC tool.

Now we'll show you how to use it, right? These are the videos, the do it, yourself videos. And how many of us today? How many of us today? Can't figure out how to open up the battery pack on a flashlight and you go, what type of flashlight? Let's see if I can find a YouTube about that. Oh yeah. Okay. I just want to screw this and pull this out.

And the doctor wrote how many of us, when we go to inject a carpal tunnel goat, man, I've done that in a while. Let me YouTube it so YouTube and those videos become educational tools. The video just makes it attractive. You can do it on your cell phone. You don't need a green screen. You don't need special effects.

You put your cell phone up there and say, Hey guys, I want to talk to you about better today. And that's just as effective anything. So people out there listening to this, you don't have to have all this equipment to do that. I did it because I liked doing it because it was a hobby for me. But if you want to do some videos, talk to your phone, like you would talk to your patients and basically put it down there, upload it to a YouTube channel that you have, get a code for that.

Put it in your spruce message and say, Hey, I want everybody to look at my video because this is the way you're going to use. This is what you can do for COVID vaccines. This is what we COVID is all about. I was doing interesting thing was when COVID hit, I would do a video on a Wednesday. Video would go out on Friday.

I would say, forget what I said on Wednesday. And then on Monday, I say, remember what I said on Wednesday, remember that and forget what I did on Friday. And then I said, I'm not doing these videos anymore until everything gets substantiated, because right now I'm changing it every time I turned around, but I had more positive feedback from anything that I had done, because there was such a general fear about that.

And that familiarity that Dr. Richter is talking to me even through a video, the feedback was doctor, thank you so much for this. I feel a lot better about this. Thank you so much. And in essence, You were caring for your group of 700 and some people through one video through an electronic means communicating all at one time and giving them value information and providing comfort to 700 people at one time.

What other tools can you do to do that? And it's you personally talking with your patients in a personalized way, Hey, just wanted to give you some updates on what we're doing right now. And that was amazing. The feedback was amazing to me. I didn't expect it. I think that's why I was just doing it to do it because I thought I needed to do it, but the feedback was great.

And I didn't realize the fear that was out there until I saw that. I thought, ah, I got to make more of an effort, gotta recognize what's out there. And what's frightening people. And what's the concerns of the day and be on top of this stuff. So it doesn't get to be much problems. So that's why I did the COVID vaccine.

New vaccinations were coming out and other people are going to be spooked that they were going to grow a third head from it. When I had to say, here's the fact here's one of them I'm getting mine. We'll help you. If you want to give us a call, we'll tell you where to go. That type of thing. So powerful.

Uh, patient comes and joins practice, and I know that you're approaching fall, but say a new patient would join your practice.

Do you have like a quote unquote drip campaign for videos in terms of they joined the practice? They initially are flagged in your system to get a video about how to use your services or how a reminder on how to use communication. And then later on they get different videos about laboratory services or imaging.

How do you onboard or do you use your videos to help you onboard new patients? Not

yet. And yet you honestly, in my list, and it's really funny that you say that because it was going to be how to use spruce. How do you spruce appropriately? Because he has a great communication tool. I had one time that I had a patient that texted me 10 30 at night with a picture of their husband's sitting in a recliner.

With a note saying Dr. Richter, he's listening to what you told him to do. And although I appreciate it. I don't want to see him in a recliner at 10 30 at night. Okay. We got to get some rules and regs or you'll get a text message at three o'clock in the morning saying, I need a refill on a medication.

Maybe that's the time you're gonna read it. So there's appropriate times that you use spruce in that. W how do I train patients to do that the right way videos and say, this is what you do, and when to call for an appointment. So that's all my laundry list of things to do. Recently. I've been doing videos basically, just, and the change that I've just seen for fee for service has been so.

Violent almost and so hard to swallow that it's been recently, the difference between fee for service and direct primary care, really driving people. I said, you really need to make this push to direct primary care, find a DPC physician. It's really going to be important for you. And I think more important down the road.

Cause I think we're going to really lose aspects of fee for service medicine, as it is now care aspects. It's just going to be, it's going to price itself out of the market and we're going to have to be there for direct primary care. So that's been my focus recently, but it's funny that you mentioned that because honestly I have this one, I have a separate reminder list of curbside consults that I want to do.

And that's a whole list of how to sew on

there. No. About your website. Did you develop your website yourself or did you have somebody develop it? And what were your goals that you had to affect your potential members, your website?

I did. I did out of just because I felt like I could have more control over it and I knew what I wanted the website.

Even probably be used a little bit better right now. It's a resource for people to go and it's, again, it's not as active as I would like it to be because of time constraints. I don't spend as much time on it. I can really see where that could be a valuable resource for a practice to say, you are responsible for the content in this website, but right now, patients can join our practice directly through the website.

It's an online deal for doing that. We have a lot of references for education. We have referral patterns that they can do for a nutrition, but if they want to do exercises type of things, we'll put those out there for them. Introduce the office, show what the office about. We have interactive videos to the what brick primary care is.

So you understand about what that is. So right now that's more just a presence on the internet that people can go, but it's not used as a communication tool. It's not really used to advertise for patients or to get patients in there. It's used as a tool to understand who, and if you have questions, you can write to us through that, but we have.

Other tools that we use for communications with patients. And we don't need that as a communication. So it's more of just that's our presence. That's who we are. We can refer back to the website. If they have any questions, we keep a handbook on there that they can open up and look at a handbook and kind of see, but to teach that it's not very useful, it's not utilized very much because most of our patients don't need it.

We do a pretty good job. In-house taking care of that when they're with us. So they don't need to go outside the practice to figure out how the practice. So to me, it's more of an introduction when somebody just has to take a look at it, see what you think if this is where you get ahold of us and contact us and these sort of hours and that type of stuff.

I think it's important. It's like with this podcast, I had heard somebody say, if a podcast doesn't have a webpage it's homeless and the same thing for a DPC practice in terms of, if you have people who, you know, had heard from somebody, oh yeah, Dr. Richter's practice doing DPC. What was that about again?

And at two o'clock in the morning, they literally can just go onto your website and learn more about direct primary care. So I think it's so important that, like you say, it's not necessarily a communication platform, especially for your active patients, but for the general public, it's a great way to just get a feel for what the differences between direct primary care and fee for service.

And I think it legitimizes it. How many of us have looked for you? Go to look for somebody, say, I want a porch build on the back of my house. It pops up for us. You're going to go to the ones with the websites so you can see pictures. You're not going to go with the one that says call me during business hours.

So, so it's almost, you have to have to have the necessary presence out there that, Hey, we're up to date. We're tech savvy and we're real. That's kinda what I wanted on there. And I think w I'm managing two websites now because I'm using the Genova health one as well. And so for both of those websites out there, but again, that it's most just a place to say who we are and what do we do?

And I'd love to expand them out eventually. I think it's, I just gotta learn how to do it. I gotta figure it out myself. And

another aspect of your practice is the clinical trial work component. And you had prior to transitioning to DPC, is it correct that you had already been involved in clinical


Yes. We've been doing that for about 25 years, a long period of time. And that was still such an active portion, that it was easy to keep that on the only deficit we've seen as we don't have large as large a population to draw from. But we're finding today that when an individual trial is created, there's more recruiters.

That'll get patients in your office and now we have more time to do it. So the trade-off is now we have plenty of time to do it because we don't have as much office time taken up with patients coming in and we're taking care of a lot of those things online or through telemedicine. So it's an easy data.

It's also supplemental money source. And

what does clinical trial work look like in your practice? And what are some examples? If you can give some clinical trials you've been involved in?

Yeah, basically what the clinical trial is in there's five phases to clinical trials. There's phase 1, 2, 3, 4, and five ones.

And twos are very early on. And generally as a clinical practice, you're not can get involved with them. Most of the practices are going to be faced threes and fours, where they're looking for patients with certain conditions, you can set yourself up, say, I want to do clinical trials, contact websites that will put you on guides and say, we're interested.

Sometimes you talk to the individual drug reps, it's their company say, put some interest of doing studies. You have this coming along and they can feed them your way. A lot of the clinical trials would look like. Private care offices because they found out that when they did it through subsets of populations, like inner city populations of college kids, they're getting skewed results.

They want real life data. So your practice might be a rural community would be a perfect combination. And then they say, okay, what can you provide? What type of equipment do you have in your office? Most equipment you need to refrigerator drug, or maybe some blood drawing ability, something that you need to do for a specific study, know what the study is?

Entailing. Do you have a population that could fill it or will you intake the patients that you need to do? They come out with a per person per rate that you get for person enrolled, and then it's paperwork that you fill out basically as they come in use, fill out and ask her to answer questions that they would need, but we're doing two studies and one that's on the way for the two studies we're doing right now is on testosterone.

And it's a double blind placebo controlled trial with men. And we're looking for low testosterone. Individuals that have had coronary artery disease, because the thought is that testosterone will prevent coronary artery disease. So it's an event driven trial that they're either on a topical testosterone or they're on a placebo.

And we follow them and say, who gets the events? And so basically you're supplying them with all the, the, the medications and you're tracking them with lab work and you're blinded to the lab work, whether you make those adjustments, the other we're doing as a phase four trial, which is a post-market trial on a drug called at NCI, which is for add.

And so we're taking patients that are attention deficit disorder. You wash them out of their present medications for two weeks, and then you get randomized, whether they're on headsy or they're on a Conserta and they're looking for what works best. And you're basically asking the patient like you would as a clinician, how are you feeling with this?

And go down a list. Are you having this? Are you having this right here and this and that data. So it's nice. It's nice ways to do that. It doesn't take a lot of your time. The paperwork is a little bit more involved in that, but it's a great source of extra revenue for the practice coming in outside of your DPP.

And with regards to patients who are involved in the clinical trial part of your clinic, do they have to be DPC patients as well? Or do you accept patients who are non-members?

No, you take anybody and again, there's your advertisement. They walk in the door and you can take them on as patients. If you like, most of these places that are doing the studies, we'll get patients in for you, they're recruiters and they're calling up people and they're taking their own advertisement.

They're doing everything they can to get pasted into your trial. So they'll just do locality. You're located in the zip code. Somebody calls in through a telephone advertisement and they'll connect you with that. Your office, give you a call and say, Hey, we got to send them over. We'll have them at nine o'clock, you know, we're one of them through a screening and that type of thing.

So it's pretty easy to recruit them that way.

When looking back and now that you've celebrated your seventh anniversary, If you were to talk to people about longevity and DPC, what do you see for your own practice in five, 10 years? And do you have any other words of advice for strategies that should be strengthened early on to promote longevity in the future?

I think the biggest thing about staying in practices and everybody will attest to this that has gone through residency programs. Is that it's what you did when you were in your twenties and thirties, you cannot do when you're in your fifties and sixties, there's just no way when you were on call and you were up getting up to go to the emergency room and admit somebody in there and then have a full day at the office.

That was great and exciting when you're in your young thirties and forties, it's not, when you're getting older, you go, I, I can't do that anymore. I don't want to do that anymore. So I think that longevity would be that you simplify. And you stick to that direct primary care market, because it becomes very simplistic taking care of patients.

You find that your days are extremely relaxed. You're not pushed to see a lot of people that you can, you don't feel the physical push of having run through a day. That my typical day at most, I see 12 people in a day. That's my maximum that I see. And that's not by construction. That's just the way it works out.

And we take care of probably another 10 to 12 through the phones and through arranging things. And that's a whole mix, whether it's a physical or whether I'm freezing off words or as a whole mix of things, keep me going. The conversations are great. I catch up with the kids and see what's going on. It's like a whole day of talking to friends and that is great.

I see patients from eight to about 3, 3 30 Monday through Thursday and Fridays, half a day. And I said, so I think the advice would be that's plenty enough time. That's good because your communication tools that you've. Are outside, you're accessible outside of that office. And when you lose the concept that I do not need my office to be productive, your life gets a whole lot more simplistic.

So you can be sitting there watching a movie with your family and answer a question for. And being serviceable to them that balances your life out a lot, probably the healthiest I've ever been because of direct primary care. I do CrossFit workouts. I do them in my home with my wife and we work out together at least four days a week.

We eat properly. We get good amount of sleep. It's all the things that I want patients to do that I'm doing myself, which was impossible to do. When you're a fee for service practice, you couldn't do it. You getting killed. So I think for longevity, you have to make that transition. If you want to do a fee for service from you would probably have to go part-time.

I think if you went to still stay with that, well, with direct primary care, you can take care of whole bunch of people. And although you really are there almost as a full-time basis, it doesn't feel that way. It really doesn't feel that way because the technology is so great that you got that accessibility now.

When you mentioned how telemedicine was so new for fee for service, because it was out of necessity, but a fever service doctors needed to pay for service clinics needed to use that technology DPC has been using telemedicine like spruce as it was developed.

The reason is because it's not financially driven, but that's the bottom line is that when you have services that are financially driven, They're going to get contaminated.

So the whole idea of a doctor, a fee for service not providing telemedicine is because there was no reimbursement scheme for it when they kept reimbursement scheme for it, all of a sudden it's a great new idea. What are you doing? It is a good idea whether you get paid for it or not. And when you take that, when you take that financial component out of it, which I told patients all along when I want to see you in my office, because I want to see you, not because I need to get you in here to put the cash register out there.

When I offer you medications here in the office, it's not to make a profit it's to save you money. When I facilitate labs for you it's so you can get a discount on that. We don't make any money off these labs. It's not financially driven, it's service driven. And that is the biggest component. I think again, it's a mind change when you, again, a fee for service office, that doctor is reimbursed penalized.

Rewarded for the amount of tests that he's ordered. So he is financially driven to give tests. The hospital system that owns that practice is financially driven to order testing to do procedures. So protocols are built. Standard operating procedures are built around ordering tests, which are not necessarily sound medically, but they're sound financially.

And so to me, that's, again, that's a division of how, like I said before, I thought, when I originally did this, it was a different way to get paid, but now it's a different way, and this is it. It's either financially driven or service driven and we're a service driven industry and that's why our quality's up.

Cause they're service driven.

Now with us talking about communications, spruce, your video productions, I want to ask, are there any other tech or tools that you just love using in your clinic or you're excited to use in the future?

Yeah, I think that what we're probably going to do in the future are going to be what are called bio-hack.

And these biohack tools for measuring people's metabolism for actually being able to regulate sleep and to be at help people asleep. And as these new tools become more available, more accessible, we're going to be able to utilize them right now. You can get an apple watch and you can tell if you're an ACE or hearing normal sinus rhythm.

So these tech tools where we're going to be able to utilize on live medical information, I think is going to help drive healthcare. But you've got to, again, you've got, gotta use it with communication. You gotta use it with utilization in the right direction as these things come out. I think we're going to take more availability of doing that for sure.

But, so that's about the only thing right off the bat that we're looking at actively to be able to see, how can we incorporate this into the. And

I think that it goes back to the idea of planning stuff ahead of actually implementing it. Because as you look to tech, you already have the communications platform to utilize that tech.

And so as a sole practitioner, at least right now, you're not making more work for

yourself. Exactly. Right. You're exactly right. And again, it's just whatever you can do to increase your services without increasing costs. And without increasing time,

As you have been in your own practice, as you've transitioned, as you've worked with brokers, are there any other resources that you have found so helpful to you as a DPC doctor or your practice that you would recommend to us?

Yeah, I wouldn't, this almost sounds like an advertisement, but it's really not. But when we got hooked up with hint, that does our billing system for us, hint has been really a terrific company. And I feel very lucky that I was very early on with hint as well. I was one of their first customers in there. I know Zach, who's the CEO of it very well, and we're good friends.

And I was able to see that company grow and they've grown because they believe in DPC. They're big endorses of it. And what they're doing is they're investing in direct primary care. So when you go on and you become a hit person, there's so many personnel that will help you so many different ways of how to grow your practice, what type of things you need to do, even with advertisement and help you do with website design and so many, which is free of charge that they're out there because they want to grow your practice.

When you have the hint summit, which you've been to in the past, they're very quality lectures out there of what we'll be able to do. The other tool that I would highly recommend for people's called Rubicon and. And Rubicon MD is another company. Once again, we were introduced this when they were just starting out.

We were one of their first customers, met all the leaders of this thing, and his turned out to be such a valuable tool to provide virtual consultations for your patients. So your practice pays a monthly fee to be able to do this. And then with that monthly fee, you're able to access almost any specialty that comes to mind, a pediatric ophthalmology.

If you need that, you upload the information to your patient from Rubicon generally within two to three hours, or dentally within that same day, you're going to get information back from that specialist. You could feed back to that patient. You save time and huge amounts of money for that individual patient by getting that consultation back and I've used it.

My gosh, I don't know if it's probably, but probably hundreds of times at this point, over a six or seven year span and it has saved. Thousands of dollars for patients and reassure them and put us on the right direction. It's a very valuable resource adds to the quality of your practice too. So those two, for sure, hint and Rubicon would be people that I would recommend that you go to, they do a great job and you just keep your eyes open.

You might find some other things out there, but they were really two big of resources.

And for the listeners, if you are able to wash Nelly's story, that is a great example of how you incorporated your, how you incorporated the Rubicon consult in

practice. Yes. Yes. I forgot. Actually, I was in there, but you're right.

That reassured the mom. Yeah. Put that out there and got that right back. And yeah,

you've mentioned so many. Tips in terms of how you developed your own practice and how you transitioned. Are there any other things to consider that you would impress upon those physicians who are considering jumping into DPC or who are actively planning a DPC practice?

Yeah, I mean there's, if one, I think in residency, for sure. I think you can look at that track early on. You can contact the American academy of family practice and talk to them about DPC and talk to doctors that would help you along trying to develop residency tracks all the way along for educational consortium's that'll do that, put that all together.

So. I think one attracting people right from a residency group would be very important for you. Start from the get go. I think if you have DPC, you can contact existing practices who may be looking for other DPC docs that want to come on board and hired directly into that. Most of those practice, how you want with the idea that you will become a partner within that practice and become an active member of that.

For sure. If you're going to start your practice on your own, it is a very simplistic process to do that. It is just really a matter of getting an office space of some people instead of off space, they'll use their home or they can make it all a telemedicine surface on that. There's so many different ways that you can do it.

That just fits your personality in there. I don't want somebody to be afraid of it. There's no doubt that coming out, you are going to have to get. And especially if you're coming out fresh from this and just starting out, you're going to have some other sources of income in there. And so those sources of income is going to be some type of moonlighting opportunity.

Once again. Urgent cares, ERs, different things. Just, you can be very creative about what you want to do to be able to get that income without killing yourself, doing that. And when you're starting your DPC practice, the drain on your time is not going to be that great that you're going to be able to use that time again, aside from another job, just to fund you, to build your website, to do, to learn about things, to try to talk to chamber of commerce.

Has, can I give a talk about what I'm doing right now to get the newspaper, to come out and do an article on you to get a TV show, to be able to come out the TV station and say, Hey, just open up DPC. That's what I'm doing is unique. And can we follow that? There's just a lot of ways to just get your name out there and just talk it up, talk it off.

When you belong to a church, he talked to your church group that comes in there. If you're new to town, they try to get established with people around friends and say, just coming up that night, it starts, it'll just keep on growing for you. It's like a ball that you just start going many times. There's practitioners that do that and they do everything on their own.

And it's not a hard thing to do once again, you can. Computer software do self scheduler. You don't need to hire people right off the bat. You might not want to do that. You might want to just say, let me just do this on my own right now. And as I get more money in here, I'm going to hire different PO time and step up.

Don't let fear be your factor in, and again, it's, I think personalities of people are a little bit different. We use the analogy all the time that there's a big ravine and you have to build an airplane to go across that ravine that some people would want to that airplane to be completely painted with patches and all the little decorations on it.

And they're manual they've gone through and they stick it in the driver's seat and read it two or three times before they take it across. Okay. It's going to take you some time, right? At the same time, you don't want to go, if you just have a propeller and jump off into the ravine, cause you're not flying out of it.

So at what point do you feel you can take the jump. You're going to go down a little bit, but your Gaso come right back up and fly out of that cabin. What do you have to build on the way down for me, it was about a 70%. I've realized that I knew about 70%. I said, okay, I got enough to get myself started.

I'll figure it out. The rest of the. As DPC matures, we're going to know more than that. 70%. The other thing that's going to change is that it's going to be a time where we're not going to have to educate people of a DPC. You're going to have people looking for DPCs. And so it is a matter of you just pop it up a sign saying I'm a DPC practice.

I've been looking for you, the certain areas of the country, Colorado, for instance, a practice tool open and be full. And three months in me is a south central Pennsylvania, a very stoic, very slowly progressive society. We have people that still curse the day the rotary phone went away. And so for us, it's a little bit more of a stretch on there of what we need to do, but I've still been able to grow, but maybe not as fast as other people, but still there because it's a good idea and good ideas are always going to grow.

So if somebody's convinced, that's the way we'll do practice again, there may be their practices that, that want to exist in a fee for service. Maybe they like the idea of a salary deal. They want to go and punch the clock and go home. Okay, well, maybe that's what you want. That's not what I bargained for.

And what I did when I trained in medical school and in residency was not what I was getting as a fee for service world. There's so much more satisfaction to my job now that I truthfully, I was actually talking with my daughter and talking to her about retirement. And I said, I don't see the day will I'll ever retire because DPC is such that I could cut back.

It's still going one or two days a week and just get all the fulfillment in the world, but I wouldn't have to do at that pace. But even now, it's not that hard to pay so ever see where I'd have to stop just to

stop. That's awesome advice for those people, for those listeners who. I have enjoyed listening and they want to know more or they want to reach out to you.

What is the best way for others to reach out to you? After

this podcast, you can go to the website, www Scotland, family, probably the best way we have a contact, or you can just email me to say her, the podcast, please email me and I'll respond back. Let me give you my other email. So if, when it's easy, it's Dr.

Ken D R K E N at Scotland, family And that's my direct email. So feel free. Just write to me, it's easy to do. Just introduce yourself and yeah. Include some links and some helps that we have along the line and other things I've shared with other physicians along that I thought was helpful for them or get you to the right people.

If I don't have the answers, I'll get to the right people for that. And I'm

sure there'll be a QR code for that in the future. Click on

this cure. Yeah, absolutely. For questions, contact me. Yeah.

Thank you so much, Dr. Richter for joining us today.

*Transcript generated by AI so please forgive errors.


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