Direct Primary Care Doctor
Dr. Garrick Baskerville is a board-certified Family Medicine physician and the Founder of METSI Care. He received a B.S. degree in Biology from the Pennsylvania State University. He then received his medical degree from the Pennsylvania State Hershey College of Medicine and completed his residency at Christiana Care Health System in Wilmington, DE. He has practiced in Primary Care, Urgent Care, Sports Medicine, and Occupational Health (Worker’s Compensation) for almost 15 years now. Dr. Garrick is a national speaker and has spoken at the SXSW Conference 2019, was a panelist for the American Academy of Family Practice DPC Summit in 2020 and 2021, and many other times at schools, churches, organizations, and community events.
Dr. Garrick is passionate about providing HIGH QUALITY care that addresses all aspects of what makes us human beings, including MIND, BODY, and SPIRIT. He believes that care should be AFFORDABLE for EVERYONE and that QUALITY CARE takes time. That said, he believes a patient should have time to address their issues and not feel rushed during a visit. At METSI Care, the visits are 30 - 60 minutes if needed. When he practiced in traditional, insurance, based models of care, he was scolded by administrators when he wanted to spend more than 15 minutes with his patients. That didn't sit right with Dr. Garrick and he told himself back in 2012 that he would eventually start his own practice where he could provide the care he believes in which EVERYONE should have ACCESS. With that, he founded METSI CARE.
Dr. Garrick is also a photographer where he enjoys capturing human expressions of joy and excitement. Dr. Garrick started photography using his dad's professional Minolta camera after losing his father to Multiple Myeloma in 1997. He used the camera as a way of healing and connecting with his father which he still does today. Dr. Garrick decided to attend medical school because he wanted to be the doctor for other people the way he would have been for is father if he could.
In his free time, he also enjoys creating and cooking healthy recipes as a freestyle cook, and attending live music events, comedy shows, art shows, and performance art/theatre events. He was an extra in Season 3 of House of Cards. He was fabled with learning the bass guitar and hopes to get good enough one day so he can start performing.
Dr. Garrick opened METSI Care in November of 2019.
CONTACT:
512-729-5575
info@metsicare.com
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SOCIALS:
Facebook: @metsicare.PLLC
Instagram: @metsicare
Twitter: @metsicare
LinkedIn: @garrickbaskerville
YouTube: @METSICare
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TRANSCRIPT*
Welcome to the podcast,
Dr. Garrick.
Thanks so much for having me.
You have been opened since 2019 and in the past, you've mentioned that your dad and the healthcare that he received when he was diagnosed with bone cancer really impacted your career choice and your journey into medicine.
So I wanted to start with asking what was that experience like with your dad and how. Actually end up in you choosing medicine as a career.
Yeah, thanks so much for asking that question. so first off, I've had interested in science and all that, and being a nerd, a science nerd, since I was a child I remember drifting off in my brain and thinking when my teacher, my third grade teacher, Mr.
Rothman was talking about rocks. I remember saying to myself in my head, oh my God, Really awesome and exciting to learn about science. And I said, I'm going to be a doctor one day. So that was the first time that I ever thought about becoming a doctor. And then after my father was diagnosed with cancer and I was his, one of his caretakers when I was 13, 14 years old.
And then I saw him, To his demise and his death. When I had just turned 16, I realized that, I was unable to help him. Of course I, I wasn't able to help him in the way that I re you know, that had a lasting effect on his life. And so I said, To myself this is going to be my career path.
There was nothing that was going to stop me from doing medicine. Previously I was, I had to come up with these other alternative careers that was going to be a little bit more of an easier path. I had thought about becoming a businessman if you will And I've. I had also thought about becoming an actor and playwright when I was in high school, but this it was solidified after my dad passed away that I was going to become a physician.
I am so sorry for your dad's passing and I cannot even imagine, losing your dad at 16. I lost mine in my twenties and just being a 16 year old and handling that is definitely something that not all kids can go through and then thrive afterwards.
So it is such a Testament to your dads impact on you as well that you have been able to use his experience to help fuel your passion for medicine. Because you bring up how you thought about being a business person, doing, acting and also thinking about being a doctor was in the mix.
And so by creating your own clinic, how have you been able to still do, to still be a creative and to still do things outside of medicine?
So the beauty of direct primary care is it frees up the physician to basically cater their own schedule to their lifestyle. And the patients that select that doctor is usually going to be okay with it and understand that the physician has a life outside of work but also wants to be there for their patients.
So with my direct primary care, Office hours while I'm available. But I also make sure in my evenings that I have the time to do the, my creative outlet outlets including, going to concerts and small music shows. With my other music, loving friends and hearing the local community musicians perform.
And some of them are my friends. Some of those performers are my. And then I love singing along or air drumming or air bass playing. Cause I, I do have an interest in learning the bass, I have a bass guitar so that's, it's fun to be able to attend music events. And that's one of the biggest things that I do as far as my creative outlet is to attend music and talk about music with.
Amazing. so when I want to go back to before you were a DPC doctor, before you opened up your practice, you had graduated from medical school at Hershey, and then you completed your residency at Christiana care and that life to now, what was your outlook on your career?
Like at the time, because I'm guessing you didn't have as much time back then to do these things that you just discussed.
Yeah that's true. As someone who loves to, what the wide scope of family medicine and do a whole lot, I. Aspirations to be a great family doctor and see patients, grow from birth to death and be a big impact in that.
And the unfortunate thing that happened after I graduated residency was the metrics of hospital organizations putting limits on actually connecting one-on-one to your patient. And. Having the ability to enjoy the moment of being with another human being. So I always, I felt the pressure of the organization that I worked for at the time that I was unable to connect and to get to know my patients on a human level.
And it was more about how quickly could I get the patients in and out. So frankly, I would meet the metrics. So I was not let go.
so many people listening to this podcast can absolutely relate to that. When you get so involved in how many are views, how many FTEs, how many, numbers of my worth as a physician?
It's not about care. It's not about quality of carrots. I mean, Yes. Like you can argue that, oh, by meeting that A1C of 7.1, you're actually doing patient. It's no, because 7.1 is a cookie cutter number and that doesn't fit everybody. So frustrating. And you've said this before, you said that in 2012, it just didn't sit right with you and you were scolded by your administrators in terms of.
Whenever you would take more than 15 minutes, you would be penalized for that. And that is definitely something that people don't believe that actually happens when they're not in medicine. And it definitely does affect people who are paid by RVU. It's an ugly truth about meadow.
It's horrible. And for those that are listening, that don't know what a RVU is, it's actually it means the relative value unit, and it's basically putting a value of a monetary value of what the physician is doing for you. And there's an incentive to basically have as many RBU's in the year as possible for the doctor to meet the metrics so they can actually maintain their employment with the organization.
That's paying them. Because that's linked to a salary. So if the doctor is not meeting their RVU requirement the administration can let the doctor go. They can fire them. And it's usually the really good doctors that are actually bringing in less RVU because they are actually spending time with the patients and they're not rushing them through.
Those are the ones considered by the organization as being ineffective. And they use these kind of business administration words to basically say they're inefficient or not effective or whatever, but it's, they're inefficient and bringing in money. But actually the care that they're providing is actually amazing care because the most important thing that a physician has with a patient is actually time.
And the time is needed to accurately diagnose a patient and to care for. And the way that they are meant to be cared for. And unfortunately with the way insurance based care is it's they take that time away. And I can share with you the first day of medical school. Or it was actually the day of our white coat ceremony.
I remember at Hershey medical school. The Dean has the Dean Davis amazing physician whom I learned a lot from, but he said students and parents, I want to tell you this one thing, but the most important thing. That you have and that will help you get to the right diagnosis with your patients is sitting down, listening to them, let them tell you the story.
And any additional time you have, you do a physical exam to confirm what you're thinking, but you already know what's going on because you listened to that. And then any lab testing is meant to support that diagnosis, but not to search for the diagnosis. You. Pretty much it I've already an understanding, an idea based on your history and your physical.
And this is something that has been unfortunately lost in medicine. Dr. Who shared that with um, the Hershey Penn state Hershey medical school students you know, and I'm sure he did this every year. You know, This is something that we, along with other physicians value is actually the time with our patients, listening to them, examining them and using labs as to support the diagnosis, but not to search for one because we should already have a good idea of what's going on.
And a lot of patients don't understand this. They think we need lab tests and imaging. to figure out everything. And unfortunately, the system of insurance-based healthcare and administration, they have an incentive for doctors to do a lot of lab testing and imaging testing, which may be unnecessary because it's bringing in.
Financial gain for that organization. And direct primary care doctors. We understand there's a problem with that. And that's why we've a lot of us have opened our own patient, clinics. So we can provide the care for our patients without doing a whole bunch of unnecessary lab tests, imaging tests, and referrals.
Definitely. It's so interesting because, partially because of the pandemic, but also because the system continues to be atrocious for our patients, is that it's not only physicians who are realizing. Time matters. And like you said, in your intro that it's a relationship based care that we all, want to provide and family medicine, internal medicine, pediatrics for primary care, as well as specialty care, but too frequently, you know, I hear the, no one's ever spent this much time with me.
And it's that is a tr I hate hearing that I really kills me when I hear that, because I'm like, Okay. I am so sorry that that has happened to you in the past. That should never be the case with anybody, but it's, I hear that so often. I want to ask there, when you had her Dr. Davis, when you had experienced these administrative slaps on the wrist, or, you know, the fear of being fired I want to ask, at what point did you see.
Thinking about, if I could do it differently, this is how I would do it. And how did that transition into Mitzi care?
The thought of it first came in 20 12, 2 years out of my residency graduation, but two years of practicing and having my first job working for a large hospital system.
So my first job out of residency was working for a federal cough at health center or FQHC. That was an amazing experience. We didn't have the same metrics, working basically for the government. And so they wanted us to provide good care for basically uh, uh, low income. Population who was either Medicaid level below Medicaid or just above Medicaid.
So we, we took care of people that had Medicaid or were uninsured or under-insured, and we provided really great care at that organization and I'm happy to have worked for them. And then I moved. On to working for a large hospital system in 2012. And then that's when I first learned about these metrics that we didn't have at the federal qualified health center.
And I knew that there was something wrong because these metrics were taken away from actually quality care, because it was taken away my ability to sit down and listen to my patients and connect with them. And then that is really the way to to have a good relationship doctor, patient relationship, which involves.
And the trust is broken to an extent when the patient feels unheard or unlistened to, or the doctor is standing up and standing by the door because they're trying to get out of the room because they don't want to get in trouble from the organization who keeps time on the physical. Um, And this is something that, many listeners may not know all the physicians know this, but the doctors through the electronic health system, every interaction you have with a doctor is recorded in a time basis by the organization that's paying adopter.
This is for. Insurance-based practices. And if the doctor spends more time than as allowed by that organization, their job is in jeopardy. And so in this is, I'm getting to in 2014, the organization I was working for. They had a meeting with me and my office in 2014. And they said to me, Hey doctor Garrick, your patients love you.
You have really high press Ganey scores, but your average time with the patients is 22 minutes. And they said the average time that the other physicians have in this network on average is 16. For that interaction and they said, we're going to have you decrease your time by six minutes. And they also said to me, that to help incentivize you to drop your time with your patients.
So you can be on par with the rest of the doctors and our network. They said, we're going to have you do a performance improvement plan to get down to. Time. So going from 22 minutes to 16 minutes and that involved, cutting out mental health treatments with my patients and I can share with you mental health is actually one of the number one things that I do currently.
And I did back then for my patients. I have a huge interest in and treating diseases such as depression anxiety. Bipolar disorder. And I've even treated schizophrenia effectively. And in my practice and the organization, I work for a hospital based organization in the suburban Philadelphia said to me, you have to stop doing.
All mental health treatments. And for those who may not know, but the number one place for actually patients in this country to get care from for mental health is from their primary care. Provider, whether it's a doctor or a nurse practitioner, physician assistant, but it's through primary care.
And that, that includes internal medicine, family medicine and pediatrics. And so they were telling me that I was unable to do the thing that I loved so much in medicine. And I thought. All of my patients that I was taking care of, that they were effectively being treated. And my patients in the community that I worked for, it was a blue collar community.
And they said doc, we're not going to get care for mental health at any other place other than seeing you. And so with this conversation I had with the administrators, from the organization, I worked for. I I was deeply saddened that I was no longer going to be able to care for them in the way that I had them.
And I didn't know how I was going to tell them that I could no longer provide mental health treatments for them. Because the organization said that six minutes mattered more than my patients did. And so the following week I quit that organization because I knew that I would not be effective anymore as a physician.
And then I transitioned into urgent care at that time. And because urgent care at that time in 2014 didn't have the metrics that they now have today, which is similar to the metrics of being an employed physician for a large health system. The quality of care throughout, my career has, in my opinion, decreased.
And the reason it has is because of the greed of administrators hospital administrators because of insurance companies and because of pharmacy benefit managers it's really ruined healthcare. And so the doctors that choose to do direct primary care, what, we're, what we're doing.
Effectively is restoring high quality care by not having these metrics or not, forcing the doctors to limit their time with the patients, because we know that's where you get the best bang for your buck. If you will. Spending a couple extra minutes and there's many studies to support this, but adding a couple extra minutes to a visit can have a profound effect on the cost and effectiveness of health care.
But unfortunately the shorter time the physician spends with the patient, the more costs down stream with. Occur. And it's better for the health system as far as cause they're going to make more money. The less time that the doctor spends with the patient. And they know this and this is why they trying to force employ doctors to spend less time with them, because that means there's more referrals.
There's more unnecessary lab testing. There's more imaging studies just because the doctor didn't have enough time to sit with them, with their patients.
Too many physicians who have transitioned or not transitioned to DPC have told me similar scenarios in terms of, I, I totally could do the workup.
Like I have the training to do the workup, but I don't have the time to do it. So I'm just gonna refer. I'm just gonna, do this lab. Cause I like, that's what I have time to do. And just prior to our chat, I the California academy of family practice offered this test your interviewing skills
and I was like, sure, I'll sign up for that. It was a 15 minute visit that I did with a standardized patient. And. I was so uncomfortable because I felt like I was looking at the clock the whole time I had to rush rush, and I am so not used to 15 minute visits
and so I was extremely uncomfortable because just that life of you literally have to then tell them. You can only do one problem today. You're going to have to make another appointment.
I'm sorry if you still have that pressing issue. But my next appointment is in four months from now, and there's so many problems with the time centered care, rather than it's not even care the time centered visits versus relationship-based care. So thank you so much for highlighting that. And I thank you for sharing your experience.
It's also atrocious that when you talk about relationship based care, Yes. This in this country, where do people have to go? When therapy is not covered by insurance as a lot of time, or maybe one or two visits are covered and then the cost of therapy, can be very restrictive for patients because it can be over a hundred dollars per visit.
And when you look at direct primary care, when you have your physician who you can text, email, call, whatever. Who costs that price per month. It's just crazy to think about how you as a primary care doctor were asked to not be that physician who could care for the whole person.
So just thank you so much for sharing that.
Thank you for allowing me to share it. Now,
When you had started in 2012, developing this plan to open up a clinic that was run the way you wanted to run the clinic and the way you wanted to take care of patients and designed around the way you wanted to take care of patients.
How did that end up into actual steps to open MSCI care?
Yeah, thanks for asking that. So back then, it was really just a dream. I didn't really know how to get there. I didn't, I did not know about direct primary care. Back in 2012 when I was first unhappy and then 2014, when I consider. Quitting medicine completely because of where I saw healthcare going.
And the shift was shifting from patient focus to to profit focus. And that's what I was going to leave. Thank God I transitioned to urgent care where it allowed me to stay happy for a couple more years. And then when I was doing an urgent care I. Somehow learned about direct primary care.
And I don't remember how I first learned about that. There was another model, but when I was getting unhappy with working at urgent care, cause it had, it started to have a similar problem of the care, the family medicine I was doing previously. I originally was just going to open up a cash based business and just charge per visit because I didn't know anything about direct primary care.
And then when I learned about. Direct primary care that it made sense. It's simple and easy. It makes access very easy for patients. There's no more, five to 60 day waiting period to see a family physician, which depending on your area, it could be the time that it takes to see your doctor.
And the time was actually restored back where the physician could have time with their patient. And as soon as I learned about that, I'm like that's exactly what I want to do. And so. i, I wasn't ready to leave my, the job that I had when I first learned about direct primary care, but the conditions of my work my work environment continued to worsen whether it was more stress on.
Bringing in revenue billing for things that I didn't agree with me I didn't agree with what I was asked to do. And I got to a point where my ethics had to tell me that I can no longer work for the organization that was paying me because the care that they wanted me to do I believed was, did not match with my ethics.
And so that. Was what forced me to say, Hey, listen if I don't, if I'm not working with this company and they're trying to push me to do things, I didn't think that any other employed position would allow me to practice the medicine. The way that I felt should be best practice. So I said, if if I'm going to still be a doctor, then I'm going to have to start my own practice and practice medicine.
The way that I was taught and the way that I. Wanting to care for my own father who had passed away many years before. That's what drove me to start my own direct primary care concierge practice.
when you were deciding to open, did you have steps that you took in terms of looking at your budget in terms of scoping out a location?
What were that? The steps that you made before opening day for your.
Yeah. Just to share with those who are listening and interested in starting their own direct primary care practice for me from concept. To opening was about a year. And some people might say that's a long time.
But it was necessary for me to, I still actually had another job. So I was doing locums locum tenens work. And that involved Flying to other areas to work um, where I'm licensed. I, I was doing as much reading as I could read the direct primary care books that are out there.
I read different Facebook. uh, Groups to learn more about direct primary care. And you know, I got as much knowledge as I could about direct primary care. I came up with a logo. I created my business entity EIN, got my bank account. Started doing a little bit of marketing through Instagram.
Just so people knew that I was coming. And then I found a location which was took a while. That was one of the things that took really the longest time. The fine was my actually physical location. Cause I knew I wanted a physical location. And it was hard for me to find one that was affordable.
A lot of the physical locations in Austin was. Running about six from six to $8,000 a month for about a thousand. So just so people some of the direct primary care doctors that are outside of Austin, they may not know this, but that's what I was quoted for. The places that I was looking at back in, in 2019.
So it was very expensive. Thank God. I was able to find a location that was not that expensive. It's still expensive, but it was a little bit better than 6,000 per month for. But yeah, so once I found the location, we did some construction to make it fit the needs, of my clinic and my patients.
And then we opened in November of 2019.
Amazing. And before we go onto, after you opened, when you're sharing about your urgent care experience, was that also in Texas or in the Austin area, or was that in a totally separate location?
Yeah. So I worked for three different urgent cares. After I stopped working for hospital-based family medicine clinics, but I first had urgent care experience in Philadelphia and surrounding Philadelphia areas where I'm originally from.
And then I was recruited to come to Austin, Texas for another urgent care. And I worked for them. And then. They actually they actually let go of every physician because of money and they rehired nurse practitioners to replace the physicians. And so I had to find another job. So I found another urgent care job and I was the medical director for the for that urgent care.
And I did that until I couldn't anymore
the reason I was asking that was because recently Dr. Erica bliss we talked about non-competes and Dr. Doug Frigo had put this on DPC news that this terrible story of a physician who was planning on doing DPC, but then the company that she worked for is now, she's now facing legal action, basically because of a non-compete.
So I want to ask in Texas, Is there, are there enforceable non-compete centers?
You know,
To, to the best of my knowledge the non-competes are hard to enforce. And also to my knowledge, because we're not necessarily competing with the same clientele because we're cash based and we're not taking insurance.
So the organizations that we have left are insurance-based and most of the patients were in. Customers. That's my understanding of Texas that we don't have the same kind of issue with starting direct primary care here and with enforceable noncompetes, because they're really not enforceable.
The good news about the company that I worked for. Because we did a lot of work injury care. The, my boss told me that, when I opened my clinic that they wouldn't enforce a non-compete. So that was actually good for me because w what we did most of his work injury and not family medicine.
Gotcha. I want to jump back to you shared how you found your space. Thankfully, you found a space with a lower price tag on it. And you had designed your logo during your opening time. You had a ribbon cutting ceremony. I really want to highlight that because you had Congressman chip, Roy attend your ribbon cutting ceremony.
And so for those people who are doing. In-person ribbon cutting ceremonies. How did you end up getting a Congressman to come to your event and as a result, get a lot of media attention because of it?
Yeah, so it w it was kind of, um, kind of funny how that all happened, so the media found out that I was starting so originally Medicare.
Was a company exclusively for creatives. Now, the pandemic changed all of that. But when I started out, I was an affordable assessable doctor's office that was tailored towards the creative community. And there was spectrum news, local spectrum news here in Austin. They learned about that. They sent a reporter to do a story on me.
It aired. Congressman chip Roy was actually at home and he saw it. He watched it in its entirety, and then he had his chief of staff reach out to me and said, Hey, I want to talk to this guy. Because he was intrigued and he actually supports direct primary care and the model um, very much. And he believes that this is the way the care should be to create competition, to provide, to help bring costs down of care, because you have competition and to improve access of care.
Because the barrier to assessing a doctor is less than if you need to have insurance. So he, he actually sent his chief of staff to my office. We create, we had a time and I spoke with with his team and told them what I, what I'm doing and what my, how I envisioned growing as a company and how I wanted to help even more and more people.
And then when it came time to want to do a ribbon cutting a couple months after I opened, I reached out to his office and said, Hey, do you mind having the congressmen come to the office? And they immediately responded and said, absolutely. What data are you thinking? And just so happened. Coming to have a meeting later that day in Austin with a distinguished general.
And he said before he, he met with the general, he was going to come and stop and do the ribbon cutting with me and my family and other community leaders here in Austin. And so that's what happened. So he came, he showed up. It was beautiful. And I'm very happy that to have had Congressman chip Roy come to my, my, my ribbon ceremony, cutting ceremony.
I just love that, that, you, it's just you never know who's going to listen to your story. You never know who's going to value DPC as a patient or as another physician. And so the fact that you were just featured on a news story and you were seen by a Congressman who cares about DPC, it just fantastic.
Just so serendipitous. I love that.
Yeah, definitely serendipitous, but it was a great experience.
So now you alluded to that initially your exclusive focus was the entertainment and arts community and creatives. And so now Metzi care has. evolved in terms of not necessarily being exclusive to, but including the arts community.
Um, Can you share about how your clinic has transitioned and how you've transitioned since opening?
Absolutely. So you know, so we just talked about the ribbon cutting ceremony, which was February 20. Of 2020. Now that day was very significant to me because that was on my father's 92nd birthday. And in my, so my father was born to 20.
Of 28. The twos are very important and that was on his 92nd birthday. So I wanted to have, or would have been as 92nd bites. So I wanted to have that ribbon cutting ceremony on that date. So two 20 and three weeks later. The pandemic hit. Okay. Everything shut down March the 16th of 2020.
Now March the 16th is a significant date, which is also a little serendipitous, but that's actually the day my father passed away. So the day that everything shut down was actually the same day that my father had passed away in 1997. The dates our numbers to me are profound. And, it's kinda crazy how the whole world shut down on the day that my father passed away.
But that date also started to really affect my clinic and the ability of my patient. To continue to afford access to me, even though my prices were very low, they were well under market rate, about 31% under market rate Um, But I started to lose my patients one by one, and then another day I would lose five and next day I might lose 10.
The next dial is 15. And I'm hemorrhaging patients because my patients were no longer employed. They were food service workers musicians they worked for venues. Everything was shut. And my, my clinic was hemorrhaging patients and those who were still trying to afford to continue paying for access to me, they would call me and say, Hey, doc, I still want to stay with you.
But I'm really having a hard time staying with you. So then I had to start allowing them to be free. And unfortunately I can't provide, I couldn't provide care for free, cause I still had a lot of bills that I stopped at my medical school loans, my mortgage and my rent. And so I had to figure out how to continue to have the business survive.
And for me to do that, I realized that I had to branch out to the people that were actually thriving during the pandemic. And those had to do with high net worth individuals were thriving. They were able to. Things as people needed to sell, they buy low and then they're buying more property stocks at a lower number and doing very well.
And one of my friends encouraged me to add concierge services to my direct primary. And he, he shared with me, he said doc, you want to help people. And if you have no company, you can no longer help people. And he said the only way for you to continue your business, because he knew that I was losing patients every day, he said, was to start taking care of people.
And he said, you have to start taking care of people like me, who have the money to pay for your service. And so he encouraged me to start doing a year yearly concierge plans to help get some revenue back in the business and provide concierge level services where I actually go to my patients' homes, I sent phlebotomist to my patients.
If they need anything, I go to their home and they appreciate the access that they have with me, including the weekends, but also the privacy that they get. Because things aren't being billed through insurance, that adds an extra level of privacy to their health data, and they really value that.
And so, I'm very happy that I've been able to do concierge medicine. And get compensated for the value that I'm bringing to my patients.
And, it brings up this like how your friend shared with you. If you don't have a business, you can't help anybody.
It's like that old adage. You have to take care of yourself before you're able to take care of others. Because if you are burned out, stressed out, you're, emotionally depressed, whatever it is, where you. Being your best in front of your patients or with your patients? I mean that's an unhealthy relationship.
So I thank you so much for sharing that. In terms of pricing on your website, you have featured pricing that's specifically geared towards the creative community as well as this concierge level of DPC. So can you talk about pricing and how that's working out for you in terms of billing? Cause you mentioned. Th the concierge patients aren't necessarily using their insurance.
So how does that all work for you in terms of pricing and billing?
Yeah so I have different levels of service to meet my patients where they are and to provide the level of care that they. Requested and require. So I have still, I'm still doing I still have monthly plans. Unfortunately, currently my monthly plans are full for for subscription.
But the monthly plans are still catered towards the creative industry including service industry workers. But um, I'm still losing those patients that are paying me monthly. And then that's where I'm getting the most attrition. So as I lose patients from that, my patients are on the waiting list to join a Medicare as a monthly member, because they're in the service industry.
I'm still able to add patients fairly regularly because the there's attrition with the creative industry. Yeah. Hi Patricia. Unfortunately, and it always goes back to finances, which is unfortunate. And then I have my yearly plans and I have three different yearly plans.
They're not all on the website, but I have a yearly plan for access during regular hours. So it's not a concierge it's access during regular hours. And that's an office only. And then I have a a plan that is concierge. It's an office only, but it's every day. So they get me on the weekends as well.
And then I have a plan where it's home visits exclusively, if they weren't. So I, I don't have requirements that they need to have a certain thing for me to go to their home. So it's home visits exclusively, including the weekends after hours. And then get me pretty much whenever they need me for that highest level of concierge.
And yeah, so I have four different plans.
And, I'm such a huge fan of the, if you've seen one DPC, you've seen one DPC phrase. But with this way that you've set it up I want to highlight the word of concierge because definitely there, there are some in the community that have opinions as to whether or not somebody should, muddy the waters with concierge or not.
But in terms of, in your community, When it comes to marketing, when it comes to opening a new practice where a direct primary care might not exist. Can you tell us a little bit about your thoughts using concierge as a phrase in your pricing and in your offerings?
Yeah. Great question. And I'm sure a lot of the listeners want to know the difference between direct primary care and concierge medicine.
There's technical differences and there's what the patients really care about. And so for me, I don't use concierge in that verbiage on the technical side, because technically concierge medicine is doctors to take a retainer basically for access to them, but they still bill insurance for everything.
I do not do that. I do not bill insurance at all for anything. But concierge is a word that the patients value in my community. We have millionaires, lots of millionaires in Austin. And we have a lot of billionaires in Austin, Texas. So they, the, that clientele wants an exclusive doctor. And so they're looking for concierge doctors.
They don't really care whether they take insurance or not because the money really doesn't matter to them, but they want a concierge doctor. And if you do direct primary care, you're really doing concierge level of service, whether you want to call it concierge or direct primary care, but. With marketing and trying to talk to folks about what I do when I use direct primary care, they were very confused and anyone who is trying to do sales, which, as a direct primary care doctor, we are sales men and women.
But I was having a hard time selling direct primary care because people didn't know what it. Okay. And I would explain it to them and they were still confused. I said, doc, you've explained to me, I'm still confused. And then I say, Hey, I'm a concierge doctor. They're like, oh my gosh, tell me more. I want a concierge doctor.
So just with the using different terminology. There was a greater interest. When I said I'm a concierge doctor, as opposed to I'm a direct primary care doctor. So I just stopped using the concierge. I'm sorry, the direct primary care verbiage, because it was confusing patients. And so now I use that I'm a concierge doctor, even for my monthly direct primary care patients.
But they understand now what I do instead of being
gotcha. And now looking back at that, medically trained, employed physician in 2012 to now, I want to ask as your practice has developed, as it's opened, as it's transitioned and evolved to including creatives, as well as this concierge offering in your practice. I want to ask, are you happy? Are you happy that you chose this life and why?
Yeah. Thank you for asking that I can share with you when I was employed.
I was not happy because I was not able to provide the level of care and service to my patients, the new. The way that I knew that I could, if I was working under different circumstances. And I can share with you as a direct primary care slash concierge physician. I am happy now because I actually am able to do amazing things for my patients that I would not have been able to do.
And I can share with you many of my peers. Are shocked that I am saying, Hey, I can take care of that. Cause they, they're so used to being asked to be referred out for so many things. And when they learn that I'm able to care for. A lot of times easily in my clinic because I have the time to do so. they're like, oh my gosh, I didn't know you did that. Like I have one patient that thought that I needed to refer her to a psychiatrist for her the treatment of her anxiety, depression. And I was like, no, I actually. Or I had another patient who thought she had to be referred out to a dermatologist for treatment of her acne and a mole she had on her back.
And I was like, no, I actually do that. I can biopsy your mall. I can treat your acne, and actually she's doing great. So these are the things that family medicine physicians can do if we're given the time to do so. yeah, so I'm very happy because I have the time to take care of my patients and actually.
Able to treat my patients as humans and connect with them on a higher level than I was ever able to do as an employed physician. And then the last thing is the autonomy. So I can, I have the time to create my schedule the way that I would like. So if I know that I wanted to block my schedule for a time that I want to do something, whether it's listened to an educational seminar that might be during the day.
And I might not have been able to do that previously. Now I can do that. It's a beautiful. Model of care that I'm so happy to be part of. And
is that happiness? Does it have anything to do with the fact that you prefer to be called Dr. Garrick rather than Dr. Baskerville?
Yes. So when I was an employed, a physician that took insurance, I was called doctor Baskerville.
And through my. Feeling beat up by the organizations that I worked for. Doctor Baskerville had to go away and metamorphosize into I really am. And that's Dr. Garrick. And for me, I love being Dr. Garrick because Garrick is who I am. That's my name.
That's who I am. And I felt like Dr. Basketball was someone who had to rush to see patients, to keep his employer happy to keep his job. And that's not something that I would. To be anymore. So I'm so happy to be Dr. Garrick because I'm able to spend two hours if I need to, with my patients. And I've done that many times specifically for my depressed and suicidal patients I spend a long time with them and I've been able to effectively help suicidal patients specifically I've helped at least I would say.
Over the last two years and they were on the brink of suicide attempt some of them and also thoughts seriously, and I was able to help them. So you can't put a value on saving a life and actually having them become part of the workforce again. So some of my depressed patients, they were no longer working now.
They're effectively working in our in our system. Again, because they were able to have access to a doctor that they were not able to previously because they didn't have insurance. So those are the kinds of things that we do. As direct primary care doctors we literally save lives.
One thing I definitely want to include is back in 2019, on a social media post, you had written this quote that I thought was incredible, especially for people who are brave enough and have the network and are making this decision to do DPC. But your quote was when you were facing self doubt fears or other setbacks.
Nothing can get in the way of your vision as you are in control of your own destiny. Remember your why when times get rough, you feel too tired or just got off your current day job. So I want to ask in terms of when you wrote that quote, what was going on, and as you reflect on your DPC life thus far, what's been your worst day and what's been your best day that keeps you going.
Thanks for asking. And I distinctly remember, writing that. I remember I in a healthy food store. that was about to close, uh, in Pittsburgh, Pennsylvania. I had just gotten off my 12 hour urgent care shifts. I was extremely tired. I was extremely hungry. I hadn't had a chance to eat at all that day.
And I had my computer on and I was on their wifi. and I was about to, you know, work, on my business. Cause I hadn't, I hadn't launched Medicare yet. I was just a couple of weeks away from launching when I wrote that quote. and you know, I was feeling tired and I was feeling exhausted, but that quote,
reaffirmed to myself, why I was doing what I was doing. And, you know, the why for me, um, has, has been from the beginning of when I entered medical school, was to be able to provide the highest level of care to folks. The way that I would have for my father had keep it, we still living. Um, and so that's the kind of care that.
give to my patients and I believe everyone should have access to that. Um, so I really, you know, wanted to tell myself that I could keep going to, even though I'm tired, even though I needed to still figure out ways to, make money because I had quit my job. Um, as I had said earlier, so I was, I was doing, you know, um, traveling.
Gig work, you know, as a physician. And I was exhausted and that working for that urgent care was a experience to push me into the DPC. Um, and then as far as my worst, days in and direct primary care, really has to do with, when I lose patients due to, them being unable to afford my services anymore. Or when I lose them because they are no longer to afford to live in Austin and they have to move away.
And it hurts me because I, my goal was to make the, the model that I have affordable for everyone, including. the creative industry, but unfortunately, a lot of them still weren't able to afford Austin prices and have had to leave Austin.
And we've, we've lost a lot of patients because they had to move, from living in the city of Austin, because it's so expensive now. so those are my, have been my saddest days, um, in direct primary care, because I'm losing that relation. You know, with, with patients that I truly care, and value. and my best days in direct primary care really what I know that I've made a profound difference on, on someone.
And I can share with you the, the last one, cause I had them regular. you know, but the last one, um, is, is a patient who I've been treating, for the last couple of weeks, with multiple abscesses that he has in his abdomen from injecting, growth, hormone and testosterone that he got off the street.
he used dirty needles. he reused used needles and now he has. had, cause I'm treating them and he's getting better, but he had six abscesses, and his abdomen, that had to be drained. he had to be given, I am antibiotics and oral antibiotics to help him heal. And each of the, the wounds have been seasoned.
They've been drained, they're packed. and he comes every two or three days back to my office for me to care for these wounds and he's getting better. And, He was trying to deal with this at home. but for weeks and, um, because he was uninsured and then his wife actually told him that she, remembered that I had started my direct primary care practices.
She referred him to me and I'm so happy that I've been able to take care of him because he is so grateful that, for a low monthly. Huh, you know, he's paying me a hundred dollars a month, but he's been able to get care that would've cost thousands and thousands of dollars, for the care that I've been able to provide for him.
and you know, he's been back in my office now four times, and this is his first month of being a member, and he's only paid a hundred dollars and that, that would never happen in insurance-based practice. So I'm, I'm so appreciative of what I'm able to do and how I'm able to make a difference to patients.
every day,
It's so clear that you have your why, and what keeps you going so awesome.
Thank you so much, Dr. Garrick for joining us.
*Transcript generated by AI so please forgive errors.