John R. Jacobsen, M.D., a Board Certified Family Practice physician, is the founder and owner of Click Family Healthcare clinics in Kearney and Broken Bow, Nebraska.
John, who grew up in Merna, was an ag banker for 10+ years before applying to medical school. Coming from a small town, his desire was to practice family medicine in a more rural setting.
After finishing his residency, John was in private practice in Geneva, Nebraska for over 10 years caring for all ages including pediatric, adolescent, adult and geriatric patients. In addition, he provided obstetrical services including cesarean sections, upper and lower endoscopies, in-hospital and in-clinic minor surgical procedures, hospital in-patient care and emergency room services. John served as the hospital chief of staff, was medical director of a nursing home and was medical director of the hospital out-patient senior behavioral health program.
John moved to Omaha to become the Chief Medical Officer of a start-up primary care center, a role that was administrative in nature. After 3 1/2 years, the desire to provide direct patient care led him to decide to open Click Family Healthcare.
John has been active in family medicine organizations at both the state and national levels.
John credits his wife Janet for their success. They have 2 daughters and 3 grandchildren, the youngest being a few weeks old.
He opened Click Family Healthcare in Kearney, NE in 2017 and a second location in Broken Bow, NE in 2020.
Visit the website at Click Family Healthcare HERE
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Welcome to the podcast Dr. Jacob.
Thank you. I'm glad to be with
you. I've been to Carney. And what I thought was so amazing was that you had gone to medical school with one of my former attendings out in superior, Dr.
Julie Theis and so what a small world and what a way to celebrate, medicine and business and entrepreneurship, in Carney and now broken bow.
It's been a, it's been an adventure. I'll say that, you know, having gone from banking and then the medical school, and then into the fee for service world, where I own my own practice and then leaving that to become the chief medical officer of a, a new primary care startup center in Omaha, where.
Yeah, we had a 55 minute hour clinic, six story hundred 50,000 square feet where we wanted to be a one-stop shop. So we had our own pharmacy lab, all of the imaging you would want. We had, you know, behavioral health and optometry and physical therapy all within our building, just trying to improve the healthcare.
And it was mainly of people, 55 and older because we were going after the, the shared dollars, uh, you know, with the ACO and, you know, having done that for three, three and a half years and getting really, really burned out, coming back home, even the home is actually 70 miles from Carney, but coming back to central Nebraska, where it's a different pace, it's a different lifestyle, uh, was really, really good.
Let's delve into that a little bit more because you're from Myrna originally. So, can you please share a little bit about central Nebraska about, where Carney is in relation to big city centers and we're broken bow is in relation to those same places.
Myrna and broken bow are pretty much just geographically in the center of Nebraska. If you were to dissect north, south and east west, uh, we're right at the edge of the sand Hills. So people don't know what the sand Hills are. That's some of the best country, uh, for raising livestock and cattle that there are, is in the United States.
When you go south of broken bow towards the, what we call the Platte river valley, which kind of is what I interstate 80 runs. It becomes more farming. Central Nebraska really has a lot to offer, you know, from a tourism standpoint, uh, the cranes migrate through here, you know, we have the geese migrations, of course we have Nebraska football, which that's not anything to brag about the last few years, but overall there's so many things to do.
You know, a lot of people think Nebraska is just this desolate desert that you drive across when really there's a lot to do. And Carney is a, it's a college town. So there's, it's a university, it's a, it's a branch of the university of Nebraska. Um, and so they've got typically eight to 9,000 students. So there's always that those things that you can do if you want to go to college sports or college activities, but yeah.
Central Nebraska is, is unique in that it's just a little slower lifestyle for most people. Most people are very, very gracious. Most people are very humble and it makes it fun to be their friend and take care of them. Uh, when they come to see us in our clinics, broken bow specifically is a town of about 4,000.
Who or which has kind of gone through a resurgent the last number last few years. And we actually bought a old practice clinic building that had closed in July of 2016 and renovated it to fit direct primary care. Uh, you know, I always laugh. The rooms exam rooms are seven and a half feet by 11. So it was like a glorified closet.
So we took three rooms and made two, we opened it up. One thing I don't like coming from the banking industry is barrier. So you walk into a typical family practice clinic. And the first thing you see is this glass wall. And it's like, oh, I know you're sick. Come in, come in and come. We want to help you, but oh, stay back because we don't want you to close.
And so we removed all the barriers that were there and people who've come into our clinic that used to go to the broken bone clinic. Can't believe the transformation that we did. Carney itself is around 30,000 people. It's again in the center in central Nebraska. Carney is unique in that it one is a college town, but a two has a lot of small industry, uh, whether it be manufacturing driven from the ag economy, but the Carney economy is not directly tied to the ag economy like broken bow is so we get some diversity as far as not just seeing farmers, not just seeing ranchers.
We're also seeing people who are working in retail, people who are working in manufacturing, which, which makes it fun and adds stability to our business.
When you're mentioning direct primary care is a business model and you've so wonderfully highlighted the points of having value, accessibility, affordability, and having a product that's easy to use.
I want to delve into your history and your experience in banking. Can you share about your business background in ag banking and what lessons have you been able to pull from that have made you successful in DPC so far?
Well, I think banking in and of itself was a second career for me or what was the second thought process? I actually started pre-med right out of high school. Then I went to college for a semester and after a semester I quit because I went home and told my dad, I didn't know what I wanted to do. And I, you know, I just was struggling.
So I actually worked for a farmer for a year and a half and drove semi and planted crops and harvested crops. And in one of the, one of the best lessons I ever got life was I'd worked for him for about a year. And he was my best friend and my best friend's dad. And I said, you know, gosh, TYC, I've worked for for a year.
I really think I need to raise. One of the, the story about how he couldn't afford to give me a raise. And the next week drove up in a brand new pickup truck. So I knew right there where I was on the pecking order. And so that really motivated me to go back to school and I thought I always wanted to be a farmer, but I didn't marry it.
And then I'm not going to inherit it. So what a better way to work with farmers and get into banking. And that's really what I did. I started out in a small bank, up in the Sandhills, after about three, three and a half years though realized that's not what I wanted to do forever. And I had an uncle who was a physician in broken bow, and he actually got me connected with the Dean of admissions at the university of Nebraska medical center.
So my wife and I went down and talked to him and, you know, he said, you've been out of school for three, three and a half, four years. You've got two kids at home. There's no way you'd make it in. So, you know, we just put our head down and kept working in banking and kept working in banking. And the town I was living in with my last banking job, we, uh, had, uh, at a city owned hospital and they hired a physician and they guaranteed him.
I think it was 120,000 a year, but this was back in 19 89, 88 90. So that was really good money. And three days short of his contract, he left and I kept telling my wife that I'd really love to go back and be a family physician. I'd really love to be in a small town. And she finally, I always tell people, she gave me the ultimatum either put up or shut up.
And so we decided to move. I resigned from the bank effective on Friday. We loaded the UL on Saturday. We unloaded it Sunday. And I started classes at UNK here in Carney on Monday. And so through that two year process, that's what got me then where I applied and got admitted. But the thing about banking that I think has been so beneficial for me is one, it taught me the business side of things.
DPC as a business. Um, so you need to know the ins and outs. The what's a balance sheet, what's expenses, what's income, those kinds of things, too. I had got up to where I, when I resigned, I was the second in command to the vice president. So I got some experience managing people, you know, and I was, was able to attend courses on, on human resources and management.
Also, we were coming off the end of the ag crisis. So I actually had to deal with some, with customers who were financially insolvent and had to have hard, tough discussions with them about, you know, we may have to sell the farm or we have to sell equipment or livestock or assets in order to pay your loans back.
And that experience helped me, I think, become a better person. Being able to see both sides of the business, both the good and the bad of banking, both the good and the bad of people. And when I left banking to apply to med school, you know, I, my, some, a lot of my customers were kind of raspy. And I said, well, you know, I've told you, you should sell your corn above what we've put in the cashflow.
If you come see me as a doctor, and I tell you, you need to quit smoking. If you don't, you're going to die. So there's a correlation. You either go broke or you die. And so it was just, it was a blessing in disguise for me to go do something else for 10 years to learn people skills, to learn the financial skills.
When I got out of med school, And ended up in Geneva. There were three of us that own the bought two clinics immersion together. And I was the financial guy. Another one did the human resources and the other one did supplies and purchasing. So it allowed me to continue the financial side of things and kept me in the loop there.
Now there's a lot of things that I've forgotten about banking, uh, but it's allowed me to be and understand the business side of things.
what a rich history to bring to your clinic and to bring to your population because not only did you know. How to talk with people in difficult situations, whether it be healthcare or finances, but also the fact that you grew up in Myrna, that you are familiar with Nebraska, that, you know, the culture of Nebraska too.
Can you please share how you came to learn about DPC and how that transformed your, your plans in life into opening your DPC?
Sure. When I was in the P for service world, my first. Partner boss that I was with, I was 43. He was 83 and he got me involved with the politics, I guess, of healthcare. So he was a big advocate of the Nebraska academy of family physicians. So I started going through the leadership pass there, got to where I, I was on different committees.
And then I became president in 2014 and that allowed me then to go to a lot of American academy of family physician meetings, where I got to hear people from all over the United States, the so-called gurus talk about healthcare and. Then we had a guy actually from Nebraska, Bob Morgan, who was a family physician in Milford, got elected to the board of the American academy of family physicians.
And he prompted me to try to get onto the finance and insurance commission for the American academy. So I sat on that for four years and then I chaired it for a year. And so it allowed me to be exposed to a lot of different ideas. And I was at a meeting. It was, I think, around 2012, when I actually heard Josh umber and Doug nother maker talking about starting of direct primary care clinic or a cash pay clinic where they were just, they just got out of residency and they didn't want to work in the Obamacare type of clinic structure or reimbursement structure.
And at the time of that, yeah, that's kind of a cool niche market. You know, you could, you could move to Wichita or I could move to Lincoln or grand island or OMA. And I could probably do that, but at that time I was still had my head in the sand, I guess, about fee for service. And, you know, we've got to do this, we've got to do that.
And so that really was my initial exposure came about 2014 to 1516, somewhere in there. I, again, her Josh talking to meeting at an AFP meeting in the storyline, kind of changed that, you know, we now have small businesses coming to us asking us for how can we help you? Because we're paying so much for insurance or we can't provide a benefit to our employees that is limiting our growth.
And at that time, the bells kind of started to go off in the back of my mind that, Hey, this might be something that is growable or expandable. Not that you're going to be able to take care of every person in America. But at least it's no longer a niche market. And so I left Geneva in December of 2013. I moved to Omaha in our whole philosophy in Omaha was we wanted to get part of the ACO chairs, shared dollar saves savings dollars.
So that was our whole structure and did that for about three and a half years when I finally. Yeah. I mean, we, we decided to make the move in between there. My brother-in-law who is my best friend, uh, was diagnosed with a funky cancer to where they removed literally half of his skull, um, and said, you know, you do radiation, you've got a 10 to 15 year life expectancy and, and.
No 16 months, he was dead. And so my wife and I are driving home from the funeral and I looked at her, I said, all right, honey, where are we going? Because I quit my job the end of February of 17, because I was so burned out that I, I actually didn't work until August. I started doing some locums, but in may, the end of may is really when we decided that, you know, we're going to do direct primary care.
We started, we looked at Lincoln. Uh, we looked at Carney and we looked at broken bow and we ended up landing in Carney one because of the business environment there with small industry being ag, you know, an ag economy around it, But we also moved there because my youngest daughter lives there and that's where our grandkids are.
So that's really how we ended up, but the idea that coming from the business background of being able to talk to different people in their language. So I can talk to a farmer about their blood pressure, talking about the hydraulics and the tractor. I can talk to people who are in manufacturing. Based upon my experiences.
So it does, I think, make me a better physician because I can build that relationship, which I was able to do in Geneva because I inherited Dr. Ashlyn's population to where I, you know, I had mainly 30 minute appointments, but my population was actually 70 and over the bulk of them too. So. That whole background, listening to Josh.
And then, and, uh, and then when I decided that this is something I wanted to do, I actually went on the trail and I went and talked to shadow. Doug and Josh, I went to I'm drawing a blank. Ryan knew Hafele and I went to his clinic. I went to Jennifer hairdryers clinic. Uh, at that time, I didn't know Vance Lassies or I don't want to his clinic, but I made that loop down and spent two days just gathering information of how does this work, the ins and outs of it.
Um, I, you know, I, I I've always felt like I had the business sense to do it. It's just the other things and yeah. Direct primary care is not without stressors. It's just a different kind of stress.
Yeah, absolutely. Dr. Nestor Mohammed put it beautifully. He's never worked so hard in his life, but he loves every day of his work.
And it's very different than showing up in a fee for service clinic where you are, like you said, you're burned out and burned to a crisp, in some cases to the point of quitting.
I always ask my customers how you doing, or I ask friends how you're doing. And I always love it when they say, well, I'm living the dream.
Because most of the time when people say that they're being a little bit facetious and my, my immediate Lurie's response to that question, when they say that is, are you living your dream or somebody else's dream because if you're living your dream, it's not a job. You do you work? I mean, I work more hours.
I last night, the last three nights we've had our grandkids and we handed them off to my son-in-law's parents last night and at eight o'clock they called wondering if we forgot to bring over the kids' clothes. It's like, well, no, we're still at the clinic. I mean, I was finishing up notes yesterday, how to be a day.