Direct Primary Care Doctor
Dr. Clodagh Ryan is a board certified family medicine physician. She grew up in Ireland and graduated from Trinity College Dublin Medical School in 1999. After working in primary care in Ireland for a few years, she moved to the western suburbs of Chicago where she completed family medicine residency at Adventist La Grange Memorial hospital and spent 8 years in private insurance-based practice. As the medical landscape became more difficult for the independent family physician, her disillusionment with medicine grew. She switched to direct primary care (DPC), opening Cara (pronounced CAR-UH) Direct Care in 2017.
Ryan also serves as adjunct faculty and preceptor at Chicago College of Osteopathic Medicine. Her roles include course director, lecturer and preceptor of medical students.In 2020, she developed the virtual elective, “Introduction to Clinical Practice with Telemedicine.” The elective includes instruction on the U.S. health care system, health insurance, and the corporatization of medicine.
Dr. Ryan spends her free time playing Irish music on the concertina and fiddle, with her husband and four children who are also musicians. Her other hobbies include running and reading. KEEP READING TO SEE DR. RYAN PLAYING TRADITIONAL IRISH MUSIC!
Dr. Ryan will be speaking at this year's DPC Summit in Kansas City, MO
Dr. Ryan Is Featured on NBC News in Chicago - Oct. 17th, 2018
Read About Dr. Ryan in the Chicago Tribune - October 20, 2017
Watch Dr. Ryan at the 2019 DPC Summit in Chicago
Watch Dr. Ryan In This Traditional Irish Band
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Welcome to the podcast
Dr. Ryan. Thank you, Dr. It's such
a pleasure to talk with you and you and I have, have seen each other in person once, but we've talked many times apart from this podcast. And one of the things that you have said publicly is that
"DPC is the most fulfilling way I've been able to practice medicine in my 20 year career while being a wife, mom, and musician DPC allows me to have a life while still being the best physician that I can be. And so, you know, just tagging along with your intro statement, I wanted to start with your journey into medicine. So can you please tell us about how it was growing up in Ireland in terms of your care, your family's healthcare and what pushed you into becoming a doctor?
So I grew up on a farm in the north of Ireland on item number six of seven children. My dad left school at 14. He was taken out of school when his father died and had to run the farm. So, my mom did go to college. She was a kindergarten teacher for 40 years. On the big thing for us as kids, we were pretty smart, you know, Booksmart was that my parents wanted us to go to college.
There was no expectation of becoming anything in particular, but my dad did always have this idealized version of Madison because his father, his GRA I'm sorry, his father, his brother, Dr. Daniel Boylan was a family doctor in the early 19 hundreds to 1920s or so, very close to this bridge that I have in the picture behind me here on the north coast of Ireland.
And my dad would tell stories about Dr. Dan doing highs calls and getting paid and. Chickens or eggs or whatever. On, he also would go out on the boat to Rosalyn island, which is about five miles off the coast, where you're sitting in my picture behind me here to deliver babies in the middle of the night and stuff like that.
So, so that was the idealized version of medicine that I saw. And to be honest, I didn't really want to do medicine because I didn't want to work that hard. I tried to find something in science that would fulfill me, but medicine just, you know, seemed like it would keep me interested for as you know, for a long, longer and longer.
And I still, I'm really glad that I did because there's always a fresh challenge and there's always something new to look up and to be interested in. So I was the. One who went into medicine. Uh, and I ended up, uh, I, as a kid, I was part of the NHS system, the healthcare system, they are Northern Ireland because that's part of the United Kingdom and still is.
So we had socialized healthcare. We could see our doctor pretty quickly. It was very, very short visits. Oftentimes you would see the nurse. Oftentimes the doctor wouldn't even see you that just calling antibiotics to the pharmacy those days. So I do remember a few, a few, we were pretty healthy kids, so we didn't have that many trips to the hospital or anything like that.
But I do remember, you know, having to go in the hospital when I fell and hit my head at a concussion overnight, and there was access to care for, for, you know, for the most part. What I find is that the access to care does get a little harder as you become an adult with larger problems. And those long-term less urgent problems can sometimes take a long time to get on the list to get treated.
So I hear those stories from my parents and my siblings over. I went to medical school in Trinity college in Dublin, which is actually a different healthcare system. It's the Irish healthcare system, which is pretty, still, mostly socialized, but there is a larger private area. Wing to it. So it creates a two tier system.
Those who have enough money will have a health insurance, and then when they do get sick and they have to be in the hospital, they'll get more likely to get a private room in a private floor versus, you know, the public floor that might have six beds in one, one room. And so that's where I did my training.
I went from high school right into medical school and a six-year program in Dublin. And so, we saw the gamut. I mean, a lot of it was pretty similar to what you'd see here, but it a lot of volume and a lot of people waiting for things, uh, ER, is, we're always chock-a-block full.
And when I did work for a few years after med school in Ireland, before I moved here and the big thing I always remember is that I had to affect three-minute visits. I would see, I dunno, 40 patients in a day. And I, but I would have 1, 1, 1 line. I mean, I, it was short and sweet. We have screen, we had little sheets of paper and we'd write down three lines, the pertinent stuff.
And that was it. But if you got somebody who came in the door and they had a, you know, a particularly bad story, I would be way behind with my patients. So that was incredibly stressful as well. And the other thing was that if we have somebody who we thought we needed to send to the ER, you really wanted to make sure that it wasn't something treatable as an outpatient because they would be going and they might still spend 12 to 18 hours waiting to receive no chest pain.
For example, if it was an anxiety, almost like an anxiety, chest pain, you'd be like, okay, is it really, I mean, what are the risk factors here? Do they, do we really need to send them? So I didn't like that either. And At that time, I was also playing in a bond. And so I was doing mostly moonlighting to pay the rent.
But for after a few years, I was like, this kinda stinks too. So, uh, when I met my husband I had met him years ago prior to that playing Irish music. But when we decided to move here, I was kind of, eh, you know, I'm looking forward to a fresh start to see if something, you know, high I would to try a different healthcare system where it wasn't so overloaded on access to care.
I felt like it was a little bit easier to achieve. So that's, that's what led me here. In the early two thousands after I got.
And it's amazing. And, you know, it's, you come from such a wealth of knowledge, your experience in a different healthcare system, as a kid, but also, you know, in private practice prior to moving here.
So I want to ask, especially for those people who might be, coming over to the U S too, start residency, even though they're already a fully practicing physician in another country. What was that transition like to. Chicago area. When you started in your residency program here
that was it. I was one of the toughest times of my life, even though I was a newlywed. And I think that it's, it actually took me about two and a half years to fully, fully, fully transition into medicine here.
Some of it was those darn us Emily steps that I had, I was going back to like early med school biochem, et cetera. And that was really tough. So it took me a long time. I took a Kaplan course. I ended up having my first baby in that time on them trying to get the externships, getting the experience, the work, the letters of recommendation, et cetera.
And one, I feel like my first three months of, of residency were absolutely insane because I was learning a totally new system and a totally new system of charting and everything. But I also felt that. Those two and a half years were time. I would never, I never stopped working again because of that.
I always worked part time through having babies, et cetera, because I felt like that time out of medicine was very difficult to transition back into. But I, on day one of residency, I was lucky enough to have a great grip, a great class who were still in touch and were best friends. And I, so I feel like once I got my, my group I was on the same footing ban as everybody else.
And, and to that point, I think that I also had a little bit of head start because I'd had so much experience. And so a lot of the patient interaction, et cetera, wasn't hard for me. A lot of the differential, et cetera. It was more the system learning that was difficult. I'll never forget. I tell my med students this.
My first day of residency, my nurse handed me a blue sheet with like all the CPT codes on the criminal level, one level sire. I was like, what's this your billing sheet? I was like, okay, what do I do with it? So my nurse teres Jeddah to Teresa from residency she took me under her wing and she, she taught me all that stuff.
I just always thought it was so, superfluous to what I was supposed to be doing. And you know, that's, that, that was just it. We never had any of that in my old, you know, in Ireland at all. It's just, you get the, get the, get the patient visit done. You take care of them, you get the medicine prescribed and then you move on.
This is, this is exactly what I was gonna ask you next was, when you moved and you went through residency, were there other things that you were like, you know, I was really hoping that this would be how the us healthcare system would be like, and did you find anything that you are glad to see in the U S healthcare system that you didn't see in Ireland?
So I feel like, you know, the story changed in Mike between beginning of residency. By the time I started my DPC practice, because as a teaching, the course that we're going to talk about later for the med students, you know, Ababa care, ACA affordable care act happened right in the middle of that time.
And that changed it for a lot of us working docs at the beginning of residency, I would say, I, you know, we didn't see as many. I love the the ability to be able to really get into the story. I did have a lot more freedom to be able to get patients to the specialist or, you know, the care that they deserved or have them come back for follow-ups or even just getting into the therapist at our residency program.
But you know, in the first three years you start to see a lot more patients. So by the end of it, and then private practice, you start like, you know, just knocking them might, you know, hon Hondo on the door handle trying to get to the next patient. And the patient, you know, has got three more things to ask for you.
And then it became more and more tricky to get what they needed. The prescriptions at the pharmacy were denied. And you had to write a prior authorization for, you know, an SSRI that costs one to one 50 a month, or, you know, there, you couldn't get them in to see a specialist for three months, but you, you know, so we had to make calls.
And that was that, but that, that was not the case at the beginning of my American career. But it was by the time I started DPC, it was very much a huge time waster for us. When you just wanted to take, you know, to do the clinical medicine part. I do. I do like the fact that I don't have to really think of it, sending people to the ER for the most part.
Not that I do for a cash reason, for a pricing reason, I try really hard not to send them to the ER. But I know they can get the care that they need when they need it at the ER, too. So, so that part is really nice. And I also have made it a huge goal since I started my DPC to, to have connections with a lot of independent specialists in the area.
so I'm able to get most patients the care they need in specialties because I've developed those connections um, on most of the time cash pricing. So for example, I have a new, a new patient who, who pretty much ripped a hole in a shoulder and uh, he needs surgery. He's, uh, he's a, uh, hardworking gentlemen on his employer called me his employee as my patient.
On, we did an MRI on his shoulder assist, you know, he had an accident at work and it's just ripped to pieces. So the surgeon that I know in the area, I texted him on. I sent him the MRI report in Friday and he sent me. He w he, uh, a whole list of all the pricing on he's going to see them for free for the first visit.