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Episode 79: Dr. Natalie Gentile & Dr. Kirsten Lin of Direct Care Physicians of Pittsburgh - PA

Updated: May 7, 2022

Direct Primary Care Doctors, Managed Services Organization

The Doctors of Direct Care Physicians of Pittsburgh
Dr. Kirsten Lin & Dr. Natalie Gentile

Dr. Kirsten Lin was born and raised in the Pittsburgh area and currently lives in the North Hills with her family. She graduated from Penn State University with a B.S. in Biochemistry and Molecular Biology, as well as a minor in Human Development and Family Studies. She went on to receive her M.D. from the University of Pittsburgh School of Medicine and then completed her internship and residency in Family Medicine at UPMC St. Margaret Hospital.

Dr. Lin previously practiced medicine in Western PA for 12 years as an employee of large health systems, where she did not feel able to provide the best possible care for her patients. As a result, in October 2017, Dr. Lin opened Family Matters Direct Primary Care (Family Matters DPC) in Hampton Township, where she provides affordable, personalized healthcare without all the red tape.

Dr. Lin is also a regional lecturer and has been featured on various radio programs, educating healthcare workers as well as the general public about Direct Primary Care services and care options.

Dr. Natalie Gentile (she/her) is board-certified in both Family Medicine and Lifestyle Medicine. She is a proud Pittsburgh native from Mt. Lebanon and is grateful to serve the community through the direct primary care model. As an attending physician at Mayo Clinic in Rochester, MN, she saw that the current primary care model in the US lacks continuity, access, and time with patients. Therefore, when she moved back to Pittsburgh, she opened Gentile Family Direct Primary Care, and is now a co-founder, with Dr. Kirsten Lin, of the Direct Care Physicians of Pittsburgh.

She enjoys the work-life balance that being a DPC doc allows, and loves spending time with her husband and their two young children. Dr. G is a yoga and fitness instructor who works closely with the Walk at Home program as an instructor and now teaches at the Walk Run Lift® Studio in the Strip District. Through her work with Walk with a Doc, she leads the Highland Park chapter that has been active since Spring 2020. She is also a member of the Community Advisory Board for the Carlow College Occupational Therapy program and is on the Board for Plant Based Pittsburgh.

Dr. G is regularly engaged in educating the community through social media and was nominated as one of City Paper's Best Changemakers in 2021.

The opened the nation’s first DPC specific MSO and a celebration of the doctor-patient relationship and physician autonomy.

They started Direct Care Physicians of Pittsburgh in Jan 2022.


The Direct Care Physicians of Pittsburgh




- Dr. Gentile's Season 1 My DPC Story Interview HERE


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Welcome to the podcast Dr. Gentilly

and Dr. Lynn, thanks so much.

This is so exciting. It's wonderful. Dr. Gentilly to welcome you back to the podcast and Dr. Lynn, it's wonderful to hear a new voice and another story out there on the airwaves for everyone to hear and appreciate.

So, Dr. Genteel, they wanted to start with you for those who have not yet listened to your podcast from last season, when you shared your story. It was so powerful because as a family medicine physician, I really related to , somebody telling you that family medicine, wasn't really the way to go if if you wanted to really have a, a really good medical career.

So could you please share for the listeners who may or may have not have heard your previous interview a little bit about your history and how you ended up opening your DBC in Pittsburgh?

Yeah. So thanks so much for having us back I never knew much about family medicine. So I grew up in Pittsburgh and around here, family med is not really celebrated as much as specialists and internists and going to Pitt med was an amazing experience.

But again, there wasn't a lot of experience in family medicine through our training. So I fortunately had some wonderful mentors there who really supported me through that journey when I fell in love with family medicine and kind of helped me get through that and sludge through that. But there were a lot of pushback along the way.

And what I found so incredible and still do every single day about family med is we can do so much, but I did a recent post on social media about what a family doc can do if we're given the time to do it because our scope is so broad, our training is so broad and there's so much we can do. But in the traditional system, unfortunately with limited time and a referral heavy model, you don't get to do the things that you've been trained in.

So I went to Mayo clinic for my residency and family med was really celebrated out in the Midwest, which was cool. I was able to be in kind of a different environment where family docs are doing C-sections, you know, a couple hours north of where I was a resident. And so it was definitely something I wasn't used to seeing, but then, you know, now back in Pittsburgh and really just, you know, educating the community about what all a family doc can do takes regular work.

It takes regular community education. So after I was on staff at Mayo clinic for a couple of years it was time to move home back to Pittsburgh. And I was offered a couple of different jobs by the bigger systems. That seemed like dream job on paper, especially like doing lifestyle medicine and some bigger settings that would have been really cool.

But I fortunately had a mentor who said, you know, I don't think that you're going to be able to practice the way. I want to practice with that continuity with that time with patients and really talking a lot about one lifestyle and preventative care as well. So that's when I learned about direct primary care.

And it was so funny. I went to the DPC summit and was like, this is amazing. This is amazing. And it's sitting in front of me was a, there was a table of a few different docs and I could see over one of their shoulders, like what looked like an emblem for, I think it was Allegheny health network.

Like it was an implement I was familiar with. I was like, if that person from Pittsburgh, then I super awkwardly after was like, are you guys from Pittsburgh? And it turns out that Dr. Kiersten Lynn was one of the people sitting at that table right in front of me. So, you know, we connected then, and for that following year, actually from Minnesota, I formed by DPC so that when we moved back home to Pittsburgh, I hit the ground running and open Gentilly family director.

Incredible. And yeah, but when you talk about the time, the time that we are limited by in fee for service, it's amazing. I was just listening to the American family physician podcast the other day, and they were talking about HPV and HPV vaccines and how to advise your patients. And one of the, one of the hosts made a joke.

Yeah. Like we're supposed to do that in a 20 minute visit. And it's it really highlighted, you know, on a, on a major podcast about family medicine, how ridiculous it is to try to build a relationship with your patients, where you have the time and the patients have the time to ask questions and to feel, that the doctors really looking out for them, on a continuous basis, Just incredible that you, that you have that journey.

And thankfully you, you know, you, you did notice Dr. Lynn at that conference, so wonderful. Thank you so much again for sharing your story and, you know, Dr. Lynn, I'd love to hear, your story as to how you even ended up at that conference that you met. Dr. Jensen.

Yeah, absolutely. So, I went to the same medical school as Dr. Gentilly which was at university of Pittsburgh, but I was there about 10 years before she was. And so I, I graduated from there.

There were four of us that went into family medicine out of 150. So that kind of gives you some idea of the family medicine culture there at in the city of Pittsburgh. But in any case, I did stay in Pittsburgh to do my residency at St. Margaret, which was a wonderful place. It was completely run by family medicine docs, and we were the only residents there except for some surgery residents that came in.

So it was a very great experience and. Then after that I stayed in the Pittsburgh area and I practiced for about 12 years. And what you have to understand about Pittsburgh is that we have two major health systems and they're both owned by health insurance covers. So, you know, the conflict of interest there is just at a, at a grand scale.

And it's very difficult to practice medicine in that context. So I was there for about 12 years, like I said, practicing medicine and you know, just like everybody else, it's the, it's the 10 minute appointments seeing 25 patients a day, not having time for my own lunch, you know, those kinds of things, not seeing your kids at night because you're, you're writing your notes and all that.

But the straw that really broke the camel's back for me was that I looked at my schedule one. And I noticed that there was a patient who was a pretty elderly patient with a new cancer diagnosis. And I wanted to add some additional time for that patient. And I found out that I was unable to do that through my own software.

So I went to the office manager. She was unable to do it. So I kind of went up the ranks and I ended up speaking with the vice president of that health system who said to me, actual quote from this woman physicians, can't be trusted to manage their own schedules. And it was at that moment that in my head, I'm thinking, okay, so physicians can be trusted to save your life.

If you're in a car accident, physicians can be trusted to manage your diabetes and all kinds of other things, but can't be, they can't be trusted to manage our own schedules. And it was that moment that I said something is the matter here. And as it turned out, a friend of mine was familiar with direct primary care model.

I had never heard of it, of course and encouraged me to look into it. And the more I read about it and learned about it I realized this is, this is what I need to do. I can't, I can't stay in this other model anymore. So I opened my DPC practice in 2017 and I think I was. Almost a year into it. When I had met Natalie at that DPC summit, the following summer and I was loving life.

I mean, it's, it's like a, it's like a light switch where you, you know, the light turns on and you, you have time to be with your patients, you have the autonomy, you can really have that doctor patient relationship. And it was awesome. And it hasn't been for the past five plus years.

Incredible. And I just, I know that some people listening are still just in disbelief, that that is what that administrator told you, you know, for the people that are listening, just to give you a clue like Natalie and I are just like, are you freaking kidding me?

We have that look on our face. That's just, it's disgusting. It's absolutely disgusting. Cause I'm sorry. You were the one who went to medical school, you know, that's, that's where this whole. Issue with autonomy and physicians having the ability to practice medicine, the way we went to medical school to practice medicine it, it really truly matters.

And so congratulations to both of you for realizing that and for being part of this amazing ecosystem. So I want to jump from there to early in the pandemic, when vaccinations were hard to find who was to be vaccinated was, you know, very, was very restrictive and access to vaccines as independent doctors versus a big healthcare system was also limiting access for your patients.

So, that's at least the first time that I had seen the two of you together in terms of coming together and a call to action on social media. But can you bring us back to that time and share with the audience about how you guys started collaborating?

So just to give a little bit of background at, at that time Kiersten practice is maybe 15 minutes up the road from mine. And we, up to that point definitely had met several times and knew each other and collide, you know, collaborated in a leaning on each other, like running cases by each other kind of thing.

And you know, we're starting to work occasionally together, I would say. And then we really, the vaccine debacle, I think we'll call it really unfolded, but the rollout in our states was incredibly Rocky and it came to be about late November, early December of 2020 when we were. I know fortunate enough to, to have the ability to apply, to get vaccine and Kiersten applied on behalf of her practice, but to include all of us, other DPC docs, if possible, to have access to the vaccine so we could give people vaccines.

Well, what was going on in our city with the restrictions on who could get it is you could be working in a major health system and by virtue of being an employee there, like maybe an accountant working from home at that time, you had access to the vaccine. But for those of us who were physically seeing patients face to face with them are independent physical therapists mental health counselors, anybody who was seeing patients, if you were independent, though, you didn't qualify.

And so Pearson and I, as to, you know, classic Italians, we just became very enraged and it was on like right then it was on,

well, I, yeah, I mean, you, you nailed it. We just, we just got riled up by this whole situation. And we said, wow, you know, it's, it's really not fair that the only people who have access to this vaccine are, you know, people who are affiliated with the large health systems.

So, we, you know, started collaborating in earnest together towards the end of that December 20, 20 and early 2021. And we just started opening up clinics. Our offices are tiny, tiny office. But you know, we would run a hundred people through the office in a day. And then we ended up collaborating with our local Allegheny county medical society because they had access to a ballroom.

And so we kicked it up a notch by holding our vaccination events there. So we were able to get a couple of hundred people through and we pretty much devoted every weekend for a good, I would say about six months to vaccinating you know, first, the phase one. So we wanted to make sure we got all the dentists and physical therapists and mental health counselors, and you know, that anybody that has that face-to-face interaction.

And then towards the end, we started getting messages from folks about home-bound people. And so we then launched that whole campaign to get the home-bound people, their vaccine. So we we had a lot of volunteers, physicians, retired, physicians, nurses, nurse practitioners, who wanted to help us.

And we would just kind of assign patients based on neighborhoods. So we deployed all these volunteers to go out into the neighborhoods and do the bound vaccination. So it was a pretty big project. It took up a lot of time. I I didn't see my kids for about six months except for the oldest one who helped us do some of the, you know, data entry and things like that.

So, it wasn't experienced, but it feels good to know that we were able to do that for. Community.

Absolutely. And that's, that's exactly it. That is community medicine right there. So I really love that. And, you know, I think, I think actually on not only on your blog from the last interview, I think I have that up that post up where you, you know, said by certain time in the early evening you were headed out to do vaccines with your son.

I think it was. And then by five 30, you guys were home and one more person was vaccinated. So that's absolutely an incredible story and it's highlighting what you can do when you have the autonomy to be a physician and to serve your community. So now I want to get into how you guys went from being in two separate autonomous practices to still being able to practice autonomously under direct care physicians of Pittsburgh.

So first, could you guys tell us a little bit more about, you know, this definition of an MSO and how you guys went from collaborating around COVID to collaborating around your patients?

So, 2021 was, was certainly an interesting year, you know, starting with that grassroots effort. It really, I think highlighted for us quickly, how well we work together.

And it's, and we always say even to this day, like it's not often that you have two strong-willed women very busy work together this quickly, this. You know, so it felt pretty unusual and magical pretty quickly. And I think that's putting it lightly because it's rare. And so, because we had that connection and we're in a city that we are incredibly passionate about in, in a field that we're incredibly passionate about, we thought, how can we take this map?

You know, this magic to a different level and how can we, how can we do this on a larger scale so that we can inspire and help other docs? We, we say, you know, Shawshank than out of the system, how can we help them get to a better place so that they can experience this same kind of like fulfillment that we have that gets us up every morning, you know?

Because it's not, it's not easy going out on your own. It's not easy going it and starting your own DPC on our own. It's scary. And for some people that's not their jam, so how can we help them be autonomous, but also be there like a shoulder to lean on and help them, you know, do it in a way that is that's successful in a very challenging city.

So in about a year ago Kiersten and I, we just talked multiple times, like, man, it'd be cool if we work together, how would we work together? I wonder what that would look like and just kind of a toilet, you know, batted around like a cat with yarn. And then it got to a point where we thought, you know what?

I think we really need to think about this and what could it look like? You want to take it from there. Kiersten.

So that was the question. And then it came down to, okay, well, do we merge our practices? But then we thought, well, if, if this is just a merger of our two practices, it's still not meeting our goal of helping many other physicians to, you know, to do what they want to do.

So what we decided to do instead of merging our practices was to create an MSO. It's a managed services organization. So MSLs are widely used in healthcare around the country. But I don't believe that they, that there has been any MSO that's specific to direct primary care until now. And, you know, managed services organization just means that we share.

The cost of different services and we share, you know, some administrative functions and that way we can make things easier for physicians. A lot of times though, that's code for, taking over and, ruling with an iron fist. And that's absolutely not what we want it to do, because we've seen a lot of those corporate DPC models fail, or just turn back into what the physician was trying to flee from in the first place.

So, in our minds, the physician autonomy and the sacredness of the doctor, patient relationship. Is at the top of our mind. So what we've done is we've created this MSOE. So each physician that we help can actually start their own independent and autonomous DPC practice, but we're assisting them with things like, you know, marketing or, you know, business information.

How do you, how do you get a business off the ground? How do you get patients in the door? So those kinds of things and so far so good, it's been a great journey. We've had to lay a lot of the groundwork and you know, that's, that's been a process, but I think we're in a good place at this point.

And I can just imagine. You know, when not only when you're talking about that Pittsburgh and Kiersten, you brought it up too, that it's dominated by two big healthcare systems owned by insurance companies. What a way to gather forces to really hit your community hard with a collaborative marketing strategy,

so, Natalie, please, I know , you were chomping at the bit there, so please '

that's exactly, exactly what you just said. It's for us, it was a name recognition too. And I think it really became highlighted when you're going to talk to small businesses, for example, and you say like, well, I've got my practice here, but you could also go to Dr.

Lynn's practice or this other practice, and you're going to be contracting with each of them. We, yeah, we do all have different names. And then like, you're just starting to kind of dig into this. Like, it doesn't feel cold, you know, it doesn't feel collaborative cause it's not. And a small business with employees and a geographic footprint.

That's not just one small neighbor. Might want something more collaborative and in one place to contract with. So that also informed our decision to go this route. But really that name recognition where my practice, for example, changed its name to direct care physicians, to Pittsburgh, Highland park, you know, and like each of our practices is a DCPP practice, but with the neighborhood where they're located and we are all autonomous businesses that we own, nobody owns us.

Like, and I think that's, what's so interesting about it is that Kiersten and I are the owning partners of this managed services organization. And we are practices that are part that are members of this managed services organization. So we don't want anybody telling us what to do. You know, this matters just as much to us as it does to any of the docs that are joining.

And, the difference when you see physician run physician led organizations versus something that is run by an N and an administrator at any level is just very different from the core, because you have that understanding as a physician. You know, the idea that a physician would say to another physician, you, I can't trust you to manage your own schedule.

It's like, oh, wait a minute. Do you remember those days when you were , on the front lines, taking care of the family who just walked in with this, you know, we're here for the ultrasound results. Oh my gosh, it says cancer. Like you can't, you have to be able to pivot and you have to be able to be flexible to do those things.

And so for the, the idea that you guys are coming together collaboratively, but yet still being able to pivot within your own practices, I just love it. I love it. So Kiersten, when you were talking about how you're helping other physicians come to, you know, to join DCPP how have you guys grown already since January of this year?

Well, it's one of those field of dreams, moments where if you build it, they will come. Right. So we actually have. Reached out to anyone ourselves, people have, have reached out to us and said, Hey, I'm, you know, in X, Y, Z situation. And I'm interested in opening a DPC practice in the Pittsburgh area.

Can you help me? The answer is always, yes, we can, we can, we can help you in some way. And so we look at okay, what, what neighborhoods are in need. And for example, right now, Natalie people are bursting down her door. She's got a waiting list, like crazy. So, uh, the next physician that's coming aboard will actually be practicing at her location.

So w we just kind of plug people in where they want to be. And and again, you know, of course their input is important. If somebody tells me I want to be in this neighborhood, I want to serve this particular type of community or whatever it is, you know, we're just, we're just here to support your.

Gotcha. And then in terms of when you were mentioning how, as part of the the ability to help physicians, you, you mentioned marketing. And so I want to ask about, the details on the backend. What, what does it look like in terms of when a physician is joining DCPP? How does it look like in terms of how do they get their marketing strategy started and how do they get, you know, on your collaborative website, but yet they still have their independent practice.

Yeah, we've got a really wonderful marketing and PR team that has, has helped meet us all where we are. And as individuals and, and comfort levels with, you know, put it cause with DPC, it's so much about putting yourself out there and kind of shouting from the rooftops and not everybody's there. And that's okay.

And so, you know, marketing for us has really looked like helping each doc express who they are and tell their own story in a way that helps them feel comfortable in genuine because that's what patients really respond best to. So we any doc that's part of DCPP is going to be on our website as a, as a member, you know, practice.

But each doc is highlighted as their own self, you know, as their own practicing physician and the things that they like to do that patients can know. And then we still do all of the same things that we always used to like three meet and greets, you know, so any doc can run their own practice, how they want to, if they want to do meet and greets.

So patients can know about them and get to know them all the power to them.

And how about in terms of EMR is because you guys are your individual practices, you still choose what EMR that you would like to use.

Yeah, everything is very autonomous. So, we have four physicians right now using three different EMR.

It's a physician thing. It's whatever works with your particular brain and that's what matters. So, you know, there's, there's no way that I'm going to dictate to somebody, you know, what their office should look like, what kind of EMR they have, who they should hire as a staff, or whether should they should have staff at all.

That's not for me to decide that's for them to decide. And I'm here to help with things like you know, vaccinations lab contracts, you know, things like that, that we can be doing in the backend, you know? And one of the interesting things about marketing going back to that is I find that talking to DPC docs you know, a lot of times they'll say.

Well marketing, you know, really isn't necessary and so on and so forth. But I think it's important to realize that each market is different in the Pittsburgh area. If we didn't do marketing and PR we would have no patients walking through the door because we have these you know, large health systems and insurance companies that have every billboard, every scoreboard you know, every PTA directory.

I mean, they are stamped on everything and this is what, you know, people in our community are seeing just constantly, constantly, constantly. So for us to have a presence, it really, we do have to have a marketing effort that may not be the case in other areas of the country, but in Pittsburgh, it is. And so I think it's important to let docs out there.

Know it's not a one size fits all sort of situation. You have to gauge your own. Region and see what is appropriate for, for your region.

I'm sitting here laughing because I just pinned business cards to the bulletin board outside of the local grocery store. So I just stopped.

I love that is so true. If you,

if you've seen one DPC, you've seen one DBC.

So I want to ask there, you know, if, if there are listeners in, in larger cities, larger than the town of Arnold closer to Pittsburgh, what are some of the marketing strategies that you guys have found extremely effective that, you know, might be out of the box for other people that they hadn't haven't thought of yet?

So I would say the biggest strategy that is timeless is telling stories. Um, So whether it be your own story as the doc and the why behind why you're doing what you're doing and the how, and then patient stories, of course, and it goes so much further than Google reviews are wonderful and those kinds of testimonials are huge, but then telling the story of here's the picture of the laceration that I just repaired tonight, this patient came in and we saved them an urgent care visit.

It's those kinds of things where I think that is so genuine and people pick up on what we're doing is real human community medicine. And when you, when you tell that story, you just have to keep telling it over and over.

Yeah, I agree with that. I always say the DPC is a story about stories because it's, and the thing is it's telling your story and, and finding the opportunities to do that.

So, one thing that Natalie did when she first started her DPC was to get a table at farmer's markets. And now we all do. And that has been just a beautiful way to connect with people who are buying produce on a weekend in the summertime. So just finding those little opportunities to meet people where they are.

My my practice partner, Dr. Leila Daugherty gives talks at the local community center. She and Natalie also do walk with a doc. So they'll meet patients once a month and in the neighborhood that they practice in and, and go for a walk with the patients. And so all of those things are just ways to connect one-on-one with people and tell those stories.

And, you know, the next thing, you know, I mean, we were contacted by the local major newspaper asking us well, why do you think that patients in Pennsylvania haven't all been flocking to get the COVID vaccine. And we were able through that story, which just came out recently to tell about how, you know, when I can bond with my patient and spend 45 minutes with them, I can help them understand why I think the vaccine is important or you know, a lay their fears or look at whatever they were looking at on Google and try to figure out why that may or may not be correct information and so on.

You know? So, the more you tell your story, the more you have the opportunity to tell it again.

I love that. And I think that, especially in DPC, when people share their stories, I mean, clearly I'm, I'm very, I'm obsessed with hearing people's stories because of this podcast, but you can see how genuine and how affected people are by what they've been through, who they've been able to help in this model.

It's just so powerful. So I love that. Take home message, you know, have your story as your calling card, have your patient stories as your, your marketing platform to build off of. Wonderful. So now I wanna jump back a little bit into when I went to your guys's website, there's a common branching point, and then you go into your own practices, say a patient wants to join, one of your guys's practices or your partners.

How does that work for that patient? Does the patient register and then you have a staff member who filters it into your own practices. How does it work on the backend?

So everybody is on their own with their own practice. So, a patient may come to our website and know nothing about any of us, but they want direct primary care, for example.

So they might look through each of the physician profile pages. And then what they'll do in the end is click to make an appointment for a meet and greet, which with whatever physician they want and those meet and greet appointments are through our own appointment schedulers. So truly everything has its own pathway for each practice.

When Kiersten, and I might have a meet and greet with a patient and we are tapped and not taking more patients, we will likely direct them to have a meet and greet with one of the other practices and meet some of the other doctors.

And so we do funnel them in that way, just by our own word of mouth, you know, doctor to doctor. But there is no central type of scheduling or central type of filtering.

Gotcha. Yeah. I just, it's very different than, you know, who's the doctor magically assigned to you on the back of your insurance card?

I know a physician who had a doctor assigned to them. Three hours away and then call the insurance company and put their own name on the, in their insurance card, because that's how ridiculous it was. So that's wonderful that your patients experience that autonomy to choose just from the get-go love it.

And then in terms of when you guys are able to, and Natalie, you talked about that, that you guys were running cases by each other and whatnot. One of the things that that Dr. Vance Lassey noted in the summit preview to the DPC summit in Kansas city was that, you know, it can be lonely out there once you go into practice, especially being a micro-practice.

So how are you guys able to come together potentially on a regular basis to check in with each other? And do you have any things like, you know, weekly balance or anything like that where you guys, harness that collaborative environment and community to help each other be better at medicine?

Yeah, we're, we're all about that. I, I believe that I had the first DPC practice in our county and so the first year or two, I was very, very isolated, never went on a vacation. I think my family was just ready to disown me. So there was some hard things about that startup process. And as a result, I think, you know, one of our primary aims in having this managed services organization is to create a group of physicians that can support each other.

And so we do that in many ways. You know, we present cases to each other. We will have an opportunity for something like a balanced group where we'll get together and talk about any difficult interpersonal interactions that have occurred. We have a quarterly administrative meeting so that physicians can provide their input as to.

Okay. Hey, I noticed that the flu shot process isn't working very well. Can we see if we can troubleshoot that? Because we of course want to have input from the member, physician practices? Something that we're planning coming up in the fall is a kind of a hybrid retreat slash CME. So we'll be able to get physically together in the same room and do some some procedural training.

Some learning, hopefully catch a baseball game together, you know, so all those good things. And then of course, coverage for vacation because I want to go on vacation and I want my colleagues to be able to go on vacation and just recharge and rejuvenate themselves. So, vacation coverage is, is an important thing for us as well.

Awesome. And in terms of the strength that you guys have collectively, I want to ask there about employers, because like you guys talked about how, if there is a, an employer who might have employees that are not necessarily in the same geographic neighborhood, you are able to appeal to those employers who have employees all over Pittsburgh.

So how do you guys interact with employers? But especially if there's, employers who have patients in different practices in DCPS,

So part of being a member practice of DCPP means that you go and contract, as you want with employers, if you'd like to, but you also know that Kiersten and I are going out to bat for the group as a whole.

So Kiersten and I already in the, you know, couple of months of, of having DCP P live have been pitching to businesses, not so small. Some of them and, and really working as a United front to represent DCPP as a whole, and then all of the individual practices as well. And what will end up happening is when we have a business that wants to contract with us, they will contract with DCPP the managed services organization itself.

And then the patients can see whatever doc they want. They'll be presented with all of the member practices and they can see whichever doctor that they'd like to go to. And then Kiersten and I are in a sense. Acting as a middleman between the practices and the employer so that the employers can contract with one place, but the docs and individual practices get to see their patients and get paid accordingly to do so.

And no one is taking away from them. No one's taking cuts away from the docs and no one's telling them how to see these patients.

And in terms of, if an employer is wanting to just check in on the savings that they've had because of their employees, seeing the physicians in DCPP how would that like report so to speak, look like on the employer's end.

We actually, haven't been asked to create a report like that, which is surprising because you know, a lot of people want to crunch those numbers, but I think what, what we can do that's manageable in a DPC situation is compare year to year, you know, cost of claims last year versus this year. There are some other DPC practices that will do things like create ghost claims and do a side-by-side comparison and that's possible to do, except that it requires a lot more time and a lot more administrators, so that's money.

So we want to really be true to DPC and be as pure as we possibly can. So we're not going to utilize a lot of resources and time to that. But I think we can do it in a reasonable way by just comparing year to year.

Because you guys are, you know, creating best for your community. I want to ask about community collaborations.

You guys, you guys have highlighted about, you know, programs like walk with a doc, but can you talk about other professionals that you're collaborating with in the, in the community like Natalie, you mentioned blueberry pharmacy on your previous interview, and I know that that continues to be a collaboration.

That's helping your patients immensely. So who do you guys also work with in your community to help grow , this amazing healthcare point of access for people.

Yeah, we're still, we're still with blueberry pharmacy. So all of our member DPC practices you know, the, the patients are automatically members of blueberry pharmacies. So they get you know, the, the cost plus pharmacy, which everybody has been hearing about lately on the. Plus the nice thing about it being a local pharmacy is that our patients have gotten to know the pharmacists there.

They have a relationship with them and they can also do consultations for the higher priced, you know, medications and they'll help them navigate those types of things with manufacturer coupons and financial assistance. So that's been very helpful. The other collaboration that we have done is with a local dietician group called case specific nutrition.

And we've been working with them all along, just patient by patient. But what was really neat is that we received a grant from the Pennsylvania medical society last year, and that allowed us to formalize our collaboration. And we had a series called dinner with a dietician, which was a what was that?

Natalie, a zoom webinar, kind of a thing that we did once a month with um, one of their dieticians going over different things like, you know, how can you maintain a healthy diet over the holidays type of things like that. And that has been an awesome collaboration as well.

Some other collaborations that you could call collaborations.

Kiersten is on the board of our Allegheny county medical society. And then I teach for the university of Pittsburgh school of medicine. So we've got work, you know, we're, we're trying to do. Teach medical students, and then also get involved with residents to to help spread the word about DPC and then through Kiersten's work with HCMS representing independent docs and representing, you know, and giving us the voice

so important, especially because, you know, in like in my county, there's no more medical society.

And so we got thrown in with the larger central California group. And so representation is huge. And so it definitely food for thought for people, no matter where you live. I know Dr. Wendy Malacca, who became recently the president elect of the Wisconsin medical society. So whether it be your county, whether it be your state, just keep at it, especially if that's something that calls to you to be an advocate for independent physicians.

Now Natalie, when you talk about, you know, educating residents, as you're educating medical students, I want to ask, do you guys also have medical students and residents rotating with you at this time?

So we've had in our own separate practices over the past few years, occasional medical students they're also heavily involved in the flu shot clinics that we do and the COVID vaccine clinics that we did.

And then this year we've formally put our information to the medical school, to have them come for formal rotations. So I have two coming in January and March already signed up for those. And they can choose amongst all of our sites, which is really exciting. And then kind of, you know, bring a bunch of docs together.

They can go to one site for a couple of days and another site for a couple of days, just so we can all give them different perspectives. And then currently I'm in discussion with the family medicine residency about being a lifestyle medicine, elective, and direct primary care elective for their residents.

So, you know, we're, we do appreciate how challenging it is to. Teach while running a DPC. You know, it's a, it's a very unique situation because we're not seeing one patient and then have another in a waiting room at the same time. Right. So we can't say, Hey, like you go take the history on that patient philosophy, those other one, that's just not a thing.

So it's definitely a very unique situation. And Kiersten, I have really thought long and hard about how much we want to engage. And so that we can really do it well. And I think what we ended up agreeing on for at least this year, for example, this academic year was, yeah, they can come maybe once or twice for, you know, a month, a month or two months just to see how it goes and, and fill it out.

So we don't over commit, but so that we can really start to inspire these students, that there are other ways.

I was talking to a reporter for the AFP. He does interviews of positions for their blog. He was asking me how I got started in superior, Nebraska of all places.

And I'm like, because of all the stories that my husband told when he went out there, it was like, I needed to be there. And , when we all look back to our medical lectures and we remember the people who are so amazing and they told those stories like you guys are talking about, and, you know, we had one lecture who who played rollercoaster videos.

I kid you not at the beginning of each lecture. You remember those people and you remember, you know, how it felt to be in those practices and to be in those lectures. And so for you guys to be involved in the pipeline at such a, it's such an impactful level, I think that's amazing. And I definitely would say that's also food for thought for other people to think about, especially in terms of if they are around medical schools or residencies, or they can collaborate with them virtually.

I know that I had seen a job offer for a pediatric virtual job opportunity that I thought was so interesting that I thought could be applied to D DPC in general, was medical students and residents could, you would be paid to have them shadow on your visits to learn basically how to be a good doctor.

And I was like, oh my gosh, that's amazing. Because then when you talk about the time commitment, that is so true, especially if you're growing DPC, but when you have the ability to, you know, after hours have take questions about that particular patient or, you know, ahead of time, because you're in a DPC relationship with these patients, like this would be an incredible patient for you to take a listen to you because this is extremely complicated, or, you know, we're dealing with a family situation where you could learn a lot from, and there's ways to harness teaching and being involved.

Whilst. Respecting your guys's patients and the time you need with your patients.

Now one of the things that I, that also was amazing just learning about and preparing for this interview with was the fact that not only your practice has 86, 5 star Google reviews. And so I want to ask for those people who are especially growing their DPC and getting, you know, credibility on the internet world, how did you approach your patients or how did you achieve 86, 5 star.

So I think something that Kiersten and I have done really well in our individual practices and the reason why each of our individual practices has a really nice chunk of reviews. But we're so grateful for, I would say over the past four Kiersten five years and me three years is we, we don't always ask for Google reviews.

Right. But we I think word of mouth goes a long way. And what we try to do is just have so many touch points with patients, whether that's physically asking them at a, at an appointment, like, how is this going for you? You know, what do you appreciate about DPC? But there are also those touch points after an appointment where you reach back out and say, how did it go?

You know, how are you doing, let me follow up on this issue. And there might be a slot at the bottom of your email that says, like, leave us a review. And I think those. They do, you know, people want to talk about when they're really happy with an experience. We also do a lot of clinics and like when we've done flu shot clinics and COVID clinics, you know, the appointment follow-ups, we'll have things like leave us a review.

And so I think I can speak on behalf of both of us. We're really grateful for the people that wanted to shout from the rooftops, you know, about their experiences and those kinds of reviews. Just keep fueling the fire, you know, cause you, you always want to deliver that kind of care. And I think that type of always wanting to deliver that kind of care informs your decision to cap your practice too, because there comes a point where you, you can feel as a DPC doc, like that's a good metric.

Am I still that person who, who get, you know, that person who gave me a five star review two years ago? Am I still that person, am I still delivering that kind of quality or giving them that experience? And that's a great metric to always go by and, you know, check yourself as the years go by. Yeah,

I think one interesting thing that I found is that along the way, one of the reasons my appointment times are so long is because the patients wants to talk about the healthcare system, not just their own.

But they want to tell me their gripes about the healthcare system. So he ended up having, you know, 10 or 15 minutes of a conversation about that. And I've had patients that will say, like recently I was talking to a patient of mine. Who's a retired physician. And, you know, we end every conversation with her saying, you know, I really want to help you somehow.

You know, you use me in whatever way that you need to use me to help you continue this vision around the Pittsburgh area. And so these patients are just so motivated just by having experienced this model of care and unlike the usual thing in social media, where people only want to report the negatives in DPC somehow people want to report the positives because they're so shocked by what they found in a good way.

You know,

I love that. I want to put this out there because this is something that I learned from Dr. Clutter Ryan, who was featured last week, but she had the strategy about like, Hey, happy St. Patty's day. Wish your doctor happy St. Patty's day by Livi, leaving it an awesome Google review.

And when you have patients who love you as much as you love them, they're like, yes. Where do I go? Like, I, I did that strategy on Valentine's day and it worked. So I definitely would say, you know, there's, there's ways to go about it, but definitely like when you talk about, you don't even know that they're leaving you five star reviews because you don't necessarily have the time to think about it.

That's, that's a good problem to have. Now I want to ask you guys. Shared incredible information about how, you know, your histories. We're starting our DPCs in Pittsburgh, how you guys collaboratively came together.

And so I want to ask looking back on the creation of the MSO creation of your DPCs in general, would you have done anything different?

I think for me I would have done something collaborative sooner, and this whole thing, actually, wasn't my idea. It was Natalie's idea in the first place, because I had been relying on myself so much that it was making me crazy and I never even thought, Hey, maybe if I collaborated with someone, we could share the load.

So I'm actually really grateful that Natalie approached me that that one day and said, Hey, you know, do you think we could do this together? And it's really amazing to have help, you know, and it's, it's a lot of work, but it's really nice that I can now, you know, in some ways, sit back and appreciate my DPC practice and spend more time with my family.

And I've made a friend, you know, it's all, it's all good stuff. So if I had to go back, I would've collaborated sooner.

Natalie. How about you?

So I tend to bite off more than I can chew and Kiersten. I have it in common where when we do something we're diving in the a hundred percent and we also happen to dive in a hundred percent with every other realm of our lives in our families and our social lives and our, you know, the commitments that we have outside of the practice of medicine.

So it was, I think coming off of such an insane time after the COVID vaccine uh, rollout and kind of everything we went through with that and how it truly, I don't think we can really do. Reiterate enough how exhausting that process was. And then we dove right in to starting DCPP and it was exciting, but extremely challenging and exhausting.

And so here's one and I kind of keep joking like 20, 22, we're gonna, we're going to have like about a week or two of like status quo. I know it's coming. Like there's going to have a day where things are going to be easy and we're not going to be like, you know, having an agenda with 20 items on it that we need to figure out.

And, and as my husband just said, finishing through tax season, he goes maybe in 20, 23, could you not open another business? Maybe you just pick a year off. So I think if I had to do things differently, I would maybe reign myself in just a couple of months and have had a little bit of a buffer just to have some reserve.

But you know, hindsight's 2020 and we did it and we're doing.

Amazing. And for those, especially for those listeners who are thinking like, Hey, you know, I wonder if I could do this in my own community. What would you say to those people who are, taking your guys's words and planting them as a seeds in their own minds and hearts and how would you advise them to go about reaching out to , other physicians in their communities to look to do an MSO or something.

Yeah. I mean, I think that this could be replicated anywhere. And it's, it's a really neat idea too, to have the the shared services that everybody can, can be a part of and the collaboration. So, yeah, I, I think it's, it's possible to do it. If you want to figure out who to work with, you know, if you want to start something like this you, you have to start off with, especially if it's a two-person partnership, you know, making sure that you work well with that person.

So if it's somebody that, you know, already somebody that you've worked with maybe somebody that you went to residency with somebody that you really click with, because this is going to be. Your, you know, they call it a work wife or work partner, right? So you may spend more time with this person than you do with your actual spouse or other people.

So that's it's important to pick the right person. And I'll also say this one of the pieces of advice that we received early on in the process from actually a family member of my husband's who's in the business world is to read the book called the partnership charter by David gage. And that was actually really a pivotal step for us because we, we each read the book individually and then we came together one day and had just like, Major powwow.

And that really helped us to nail down, you know, like who are we as individuals who are we as a team, what's our mission statement. And that was, that was really amazing, but we're always happy to, to share our experiences. One-on-one with folks. So, you know, people are welcome to reach out to us if they'd like as well.


powwow that I had forgotten that we had done very early on was we brought together a few different people that we trust that have business sense, medical you know, practicing medicine, history, people that we really trust from a couple of different realms and sat down and essentially said like, we want to get married.

Is this a good idea? Like, that's really what it felt like, you know, Is this the worst idea ever, and just had them start asking us questions. They started poking holes in ideas, asking us a lot about the why. And really from that meeting, I think we realized like, oh crap, this is not a bad idea. So now we're doing it, but that was super helpful as well.

Fantastic. And are there any, in addition to the partnership charter book, which I'll include a link to on your guys as a company blog, are there any other resources that you guys would recommend for others looking into DPC or developing an MSO?

Well, I, I think one of the, as crazy as it sounds, one of the greatest resources for me has been social media and, you know, A little on the older side. So, you know, hopping on a computer and making technology work, Natalie will tell you, you know, she's the, she's the tech brains in this operation, but on social media, you can find someone who has done something before you have done it and has paved the pathway and that you can reach out to sometimes those people have written books, sometimes they're coaches and you can pay for their services or whatever, but sometimes you can just DM them and, you know, start a conversation and, and reach out.

And that has been just an incredible resource to me. And also we were talking before we actually officially started the podcast about the the DPC conferences, the summit and having gone to a couple of those and met people you know, meet for drinks and just talk DPC. I mean, that has been incredible.

And those have been lasting friendships and collaborations to this day.

You guys are at an example of that.

Exactly. Yeah. I, I still, I just got off the phone with Jeff gold a couple of days ago, and it's been four years since I was at that conference. And I still feel like he's a big brother, you know, that we can still collaborate and bounce ideas off of, and now, you know, he's someone that I can talk to about what Kiersten and I are doing, and I can, you know, have a sounding board there and get different ideas from someone in a different city.

It's, it's really amazing.

Wonderful. And for those of you who might not have heard the DPC summit preview he's going to be doing the dark side of DPC talk at the DVC summit this year in Kansas city. So definitely check that out if you are in attendance there. Well, thank you guys so much for being on the podcast and sharing your DCPP story.

Thanks so much.

*Transcript generated by AI so please forgive errors.


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