Episode 73: Dr. Belen Amat (She/Her) of Direct Primary Care of West Michigan - Grand Rapids, MI

Updated: Apr 3

DPC Doctor

Dr. Amat in her white coat
Dr. Belen Amat

Dr. Belen Amat was born and raised in Mexico City, where she studied medicine at the Universidad Panamericana and graduated with honors. She decided to pursue a dual specialty in Internal Medicine and Pediatrics at GRMEP in Grand Rapids, Michigan, where she found wonderful people and a great city for her family.

Ever since she was a child, she wanted to be a doctor and help people, especially when they were sick and needed help the most. She put her life-long love of science to work figuring out complex medical issues and preventing illnesses.

After several years of working in large clinics and hospital networks such as Spectrum Health and St. Mary’s, she decided to start her own practice with the idea of reviving the personalized attention she believes is the basis of a quality medical service. Her research into the Direct Primary Care model showed high rates of patient satisfaction and improved medical and wellness outcomes through increased patient access and communication, so she decided to adopt this preventative model of care.

Dr. Amat believes in patient care that is based on a personal relationship between a doctor and a patient, a relationship based in trust and communication. She volunteers for medical mission trips to Honduras and offers service in Spanish for the Spanish-speaking community.

Dr. Amat is board-certified in Internal Medicine and Pediatrics. She is a member of the Michigan State Medical Society (MSMS), the American College of Physicians (ACP), the American Association for Physician Leadership (AAPL), and the American Academy of Pediatrics (AAP).

She opened Direct Primary Care of West Michigan July 2017.


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Welcome to the podcast

Dr. Amat

thank you for inviting me.

Bellin. It is so wonderful to talk with you today because prior to. This interview Dr. Clutter, Ryan had pointed out that you have run a successful DPC since 2017 and you every day in your practice are proving that DPC is not built for only the people who have more than enough means to, to pay for this access to quality care.

So with that said, I want to take a step back to your training. When you were training in medical school, you had a fifth year requirement to go out into the community and serve in a rural area. Can you tell us about that experience and how has that impacted you and your practice?

And so medical school in Mexico is six years.

So you do two years of basic science. Then you do two years old rotations, just regular rotations. And then one year of internships, if you pretty much the, you're in charge of the patients in the hospital for a whole year, and then you do a rural service. So you're actually done with medical school.

But they will not give you a license until you do this year, rural service. So you go out in my case, cause I was in that private university, we got to choose where to go based on our grades. We could choose where to go. And so that was good because as much as I wanted the rural experience, I did not want to go to that place where they drop you in a helicopter and see you later in your it.

So where I went was about three hours away from Mexico city in the mountains, it was. I was a little scared to go because I am a city girl. I grew up in Mexico city, which is 25 million people in them, all the services, and it's all fancy. And I travel all my life. So I had never lived in this kind of environment.

So when they got time to go, it's super fun because you, the town will give you the clinic. In most places, you live in the clinic in the town. I was saying we actually had a house. The town provided this house for us. As, if they didn't have power, I didn't have power. They didn't have water.

I didn't have water. And we had water once a week. So our cows had a what does that look? The collecting system. So I did have, we could fill it up. And for one week we had that water. But if for some reason there was no power. There, there was no water. So sometimes we didn't have water for a couple of weeks, which is pretty interesting.

You learn, you can live with almost anything except water. The water is the new power who cares. And we didn't have cable. It was just awesome. One of my favorite things to do, and this is obviously nothing to do with medicine, was to sit in my car and listen to the traffic report for Mexico city.

And just look at the mountains. It was just amazing. So for one year you are the town's doctor, then you are under the, the supervision of the government. A guy from the government and who you meet this public health person, not a doctor, but a public health person who you meet once a week. And they, and you just report the numbers to them of what you've seen in the week.

So diabetics pregnant people, they were the control of the pregnant people, all their follow up. And you do pretty much everything in the time when you are at the town's doctor for a whole year, we had, there were two of us, another let's go, let's do that. And me and we had 3,500 patients, let's say that lived in this town.

They're actually two towns, but they were so close together. The clinic was in the middle. So we actually have two towns. And that's what the two of us usually you're by yourself, which is found scary sometimes up in the two weeks with no security. The interesting thing too is you become part of their town.

You are, but in Mexico, the doctor's. The Dr. Wright is the priest and the doctor and whatever you say goes. So that says he was a very rich experience because it takes you out of the comfort zone of, you're double the supervision and then you're in this place that's gorgeous, but you have very little resources, there's no lab.

So you treat patients not knowing what their labs are. You take care of more complicated stuff that you would normally do where you refer people out. There's no referral. You deliver babies, which I so are the city, the closest city was a half hour away. And I would give the pregnant patients, my cell phone in new coli anytime of day and night.

And I would take them to the hospital to deliver the babies. I did not want that experience. I, that's why I met. The main reason is I did not want to be specific. Just get stuck in your head. And there's nothing you can, we didn't have a rescue box with an ambo bag. That's how bare it was by the end of the year.

We spruced up the clinic and make it better, but still you're so used to technology and exclusivity. The hospitals are pretty fancy and all of a sudden you're thrown into this and now you're practicing on your own and you don't have any supervision. You can call, your teachers from med school and ask questions, but it's not like real supervision where you could just say, Hey, can you look at this with me?

None of that.

When you're talking about resources like electricity and water, did you also have. Waxing and waning of resources that you needed to use in your clinic as well, like gloves

not so much because cause these clinics are stuck by the government.

So they actually stopped our pharmacy. It was a little like DPC. So this is a funny thing because it feels a lot, DPC feels a lot like that because we had a little pharmacy and the government gives you their formularies. So you have amoxicillin and were bacteria, a few antibiotics, a few blood pressure meds Metformin, and that's it.

You don't get anything fancy. Sometimes we would have missionary trips that were coming. From the U S which I've certain opinions about those, but they would leave medications with us. So sometimes we did have some fancy stuff that we'll use, but most times it was just what the government would provide for us.

And in general, like we did have everything in this clinic, in medical school, some of the hospitals in Mexico don't have resources. So yes, you have to bring your own gloves or you're doing an exam without gloves. So I'm like no, I am bringing my own gloves. Thank you very much. So yeah, some of the PR the public hospitals don't have resources and you just have to do your own, but the clinic was pretty well-stocked.

One of the benefits we had is it had a power like a backup generator. So even if the town didn't have electricity, we had electricity in the clinic, so we could use the shower. If a kid came in with a fever, the first thing we would have, they were nursing students also because the nursing students were also doing the rural service and we would have the nurse, okay.

Get the kid in the shower and try to bring them comparator down before we see them. It was so nice to make the kid comfortable. So in that sense, and we could ask for stuff because this clinic I was in had a foundation from a religious group that was in town. So sometimes we could ask for things.

We actually had a kid who was on peritoneal dialysis during our year. I know. So my student diagnosis kid with renal failure, he came in full nephrotic syndrome. He was as the whole thing and she had no labs and she diagnosed since this is renal failure. We were able to send him to Mexico city to get a catheter put in and the bags of solution.

And here you go through your dial system. So their house, they were very poor and their house had like dirt floor. And of course they had no power and of course they had nothing else. So the mom would bring the kid to the clinic every day and she learned how to do the bag exchange. And we had a microwave, so she could warm up the solution.

And we did prevail dialysis for a whole year for this kid. And he ended up getting a transplant for that. But it was a really great experience because of course you see all the complications from. The dialysis without labs. So he, once had seizures. And so they called us, somebody came running, let's like, you could make a movie out of this.

This person came running because their house, you couldn't get to their house with a car. So they came running and he's having he's something's wrong. He's not responding. So there I go in, they had a truck, like a a big fancy truck with four by four. So we drove as far as we could. And then we ran up the hill to get this kid out of his house and yeah, he was having a Kingston status of electric cars.

So we grabbed it. I This is I would never do this, like in a normal situation, but it's he's going to die. We put them in our, in the back of the truck with the mom and my friend. And we drove into the city into the hospital and ran into the hospital and just here's this kid, he did fine, but oh my God, that was scary.

So yeah, it was her. Oh my God. But I don't think I had any like bad experiences. Sometimes things can happen where patients die and there's nothing you can do. I didn't have any of those experiences. I did hear from some of my classmates, that maybe a baby will die in delivery or, maybe the town didn't like them and then, they will make your life miserable.

So my experience was really good and I loved it. It's a little bit like DPC because you really know the people because you're in the town, where they are. You see, When they're drunk, you see when they're like slipping around, you see all these things that, you know, the CPC to because you become part of the community, which is the way it shook me.

Even though, like you're saying the doctor and the priest are at the top of the social pyramid or whatever you want to call it you were still part of the community because you were there for a whole year living within those two villages.

So that's incredible. when you had transitioned, you finished your year doing this internship and you made your way to grand rapids. You did your training. At what point did you learn about.

So I, the first time I heard about DPC, I was already working. I was employed my a kind of a Catholic hospital that had an FQHC for Hispanic patients and also homeless clinics.

So I was working with them, loved working with them because that's what I wanted to do anyway. So I the first I was just remembering, cause I I just had this like flashback when I was looking at your podcasts and you'd interviewed, you talked to Garrison Bliss and so the first, my first contact with DPC was an article he wrote, and this was maybe a year or two into being employed.

When I already knew that employed was not for me. The difficult thing was you get sucked in back into this whirlwind of being exploited. And I did not have time to think about breaking through. Until I think my mental health and my health in general was a stake in my family and everything. But every few months I would get back out again and try and look.

And there wasn't a lot out. This is like 2011. Not a lot of GPCs were out there. So here and there, I would hear things. And eventually I went to the first nuts and bolts and that's how I jumped ship. I went to the conference and by the end of that conference, actually not even the end, we met first to socialize and I actually went up to my room and call my husband.

And I said, this is it. I'm jumping ship. And I got back from the conference. What, October? November, I quit in December. And six months later, I was opening, you know, that you have to work for six months as a penance after your quit. But that was how it was. So that was the first experience.

But then that's how I can keep looking for a way out and then would get stuck back in. And it happens when you're employed is things got a little better, so you're okay. And then you move it again down. And then you're done, it's done for six months. So then all of a sudden you can breathe a little.

And I think it's the way the system is designed to keep you on. Who wants to bring you on in first year is this, let's tighten it a little bit and then let go a little bit and the, a little work. So you get used to it too. You're like, it's not that bad anymore.

And the golden handcuffs of, oh, we'll give you the salary.

And then after so many years, we're going to take that salary away because you are so deep into the system that you have to keep working because we've given you money potentially for your mortgage and you've already purchased a home here. And so it's really hard to pick up and leave.

You're so deprived when you arrested ants. Maybe the difference in my experience to other physicians was I did not grow up here and I didn't have loans because I went to med school in Mexico. So then I can start my professional life with these horrible loans and this, all these restrictions, I was on a visa.

So I did have some restrictions. I couldn't just go on my own. So I did have to wait for me to be able to not have a sponsor working on my own, but I didn't have that many. You know, They'll set the golden cuffs of being stuck because now you have this mortgage and we actually, you probably know it. But what we did as a family is to plan to go to DPC is cut back on the lifestyle first, because the last thing you want is going your own, and then you can't keep up because your bills are horrible, right?

Your mortgage is terrible, your loans are terrible. And then you want to keep up with this lifestyle with this income, that doesn't work. So

definitely when you mentioned visa. So I want to go back and ask when you had transitioned from Mexico city and medical school and your internship, you were at St.

Mary's. Is that correct?

The first I was at St. Mary's yes. When I finished residency. Yeah.