Direct Primary Care Doctor
Dr. Christina Doll is a board certified Family Medicine and Lifestyle Medicine physician and the owner of Revival Direct Primary Care in York, Pennsylvania. She grew up in Prince George’s County, Maryland, just outside of Washington, D.C., where she first developed an interest in medicine during a high school internship at Children’s National Medical Center. Dr. Doll moved to Pennsylvania for undergraduate school at Dickinson College, where she earned a B.S. in Biochemistry and Molecular Biology. While at Dickinson, she also played varsity volleyball and met her now-husband, Travis. She returned to Maryland for medical school, attending the University of Maryland School of Medicine in downtown Baltimore. After medical school, Dr. Doll headed back to Pennsylvania to complete her residency training at WellSpan York Hospital, where she served as chief resident in her final year. She graduated in 2017 and became board-certified by the American Board of Family Medicine shortly thereafter. In 2020, Dr. Doll decided to pursue additional training in Lifestyle Medicine, becoming board-certified by the American Board of Lifestyle Medicine later that same year. Dr. Doll opened the doors to Revival Direct Primary Care in September 2021. When not seeing patients, she can often be found in her garden, with a toddler on her hip and a pre-schooler running around by her side.
Dr. Doll Is An Amber Grant Recipient of $10,000.00
Dr. Doll Amber Grant Interview
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Welcome to the podcast, Dr. Doll.
Thank you. I'm so excited to be here.
It's so funny because you and I have interacted so much in social media before, and yet I still haven't met you in person.
So I'm so looking forward to that, but I'm definitely looking forward to talking with you today, too. It's
nice to see you.
I wanted to start with when COVID hit and your realization your job is not guaranteed in fee for service, as many people.
Right. So, yeah, I mean, before I opened my practice, I think that my path was really similar to many young family physicians. Right.
I took all of the usual steps, went through medical school, residency training, and then I found myself sort of, you know, middle of my chief year looking at the horizon, thinking like, okay, you know, what's next? What's my next step. And I remember feeling like I really only had a few options. Like I could work as an employed physician for one of the large hospital system, affiliated medical groups.
I could have. You know, look into private practice, maybe a partnership track, or I could stay in academia. And I really wrestled with my decision because none of those things necessarily felt like quite the right fit for me. I had also just had my first child and I wanted to make sure that whatever position I chose to sort of start my life as an attending that I would, it would allow me to have some sort of balance as a physician mother, which I think all of us are looking for.
And it's really hard to find. Right. Ultimately I decided that I would join one of the local medical groups in hope of getting some additional experience in outpatient setting. I thought it would give me sort of a predictable schedule, provide some of the support that I was used to medical assistant administrative support, steady income, all the, all the good things.
But a few years into practice. I became pregnant with my second child. And unfortunately I had a really difficult pregnancy. I had severe, severe hyperemesis gravidarum. I, it was resistant to every medication in the books and ultimately I needed continuous Ivy fluids for 30 consecutive weeks. So I had this little backpack that held two and a half liters of fluid and a pump.
And I wore it 24 7 and tried to keep up and try to function, but it really became clear pretty quickly. Like I was going to have to temporarily step back from seeing patients. I was just too sick. So I had my daughter in early 20, 20. And as luck would have it, of course just as I was starting to feel better, I was like coming out of that fourth trimester Hayes you know, getting ready to return, to work, getting my groove back.
That's when COVID came to town. I actually remember I was in the parking lot after my six week postpartum checkup and I got an alert on my iPhone about going into lockdown. Wow. So it was like in an instant, everything changed. Right. And over the next few weeks, it became really clear that the job I had stepped away from during pregnancy was going to look very different.
By the time I was scheduled to return. Just like practices all over the country here in York, you know, people were putting off preventative care. They weren't coming into the office. So visits were down. Offices were closing, you know, providers were being shuffled all over the place to kind of meet to changing needs.
So I sort of found myself in this really strange spot where I had to decide, do I stick this out and kind of wait until patient volumes recover. See if I needed again in the same capacity is when I left. Or do I sort of take this moment when the world is clearly changing and just make a big change for myself?
Do I, you know, just take a leap of faith and ultimately I think that's what gave me the push and I decided to leap.
Yeah. Amazing. And just, you know, especially for the parents out there just hearing that and I'm sure there's lots of people who also were affected heavily with regards to, you know, how do you balance young children as well as a practice?
And so I want to ask there when you decided, you know, Hey, this is the perfect moment for me to make a change. How did you learn about direct primary?
I had been interested in direct primary care for quite a while. And it was kind of a lurking in some of the Facebook groups and things like that. I had not heard of it as a resident, so it wasn't until it was making my second year in practice that I heard about it a little bit and got invited to those Facebook groups and started kind of more and more delving into the world of it.
And, you know, considering it, but it felt very, for some reason, even though I knew so many doctors were doing it, it felt very unreachable for me. Definitely.
And I want to go into depth there because, uh, before you've said, and this is when, and we'll talk about this in a little bit bit, your Amber Grant interview, you mentioned how you would tell yourself that you weren't good enough.
I, you didn't have formal business training. You didn't have this sort of panel of patients ready to support a new practice in DPC. And so I want to go back to those days where you had those thoughts, yet you were able to overcome those, you know, those doubts and those fears and open up revival DPC.
So can you tell us what was going on in your mind that brought you to the point where you're at today?
I think that I, I want to acknowledge that. I think the reasons I had and honestly still have on occasion, those sorts of thoughts, those hesitancies, I think it's sort of complex. I think that in part, the way that we're trained as physicians sort of predisposes us to developing fear of failure, right?
So we go through this intensive competitive training and we're expected by others, but certainly by ourselves to be perfect, failure's not an option. Failure is something that really is presented as a source of shame. And so we'd never want to fall off track. We're right. We don't want to do anything wrong.
We stick to this very clear well-defined path in medicine. So intentionally choosing to stray from that path. It's really scary. And I think that that's a valid feeling and also just sort of logistically opening a new business is risky, right? Like if we spend years of our life studying medicine and anatomy, physiology, pharmacology, we learn all these things, but the business of medicine is not part of our curriculum, you know, probably a little intentionally.
Right. So to decide, you know, you're finally in a position where you feel comfortable with the medical side of things. Now I'm going to delve into the business of medicine and open up a whole new can of worms, right. Is really overwhelming. And I think really hard. But at the end of the day, I think what helped me is this idea that you have to sort of choose your heart, right?
So for me being an employed physician lacking autonomous. Seeing patients, you know, every, whatever it was, 15 minutes, 20 minutes taking home piles of paperwork, all of that was hard. Starting a DPC from scratch and sacrificing all the comforts of steady income and benefits is really hard. So you just have to choose your heart.
And for me, I think the more I learned about DPC and the more I kind of dipped my toe into the water, it just became really clear. Which heart I wanted to choose. If that makes sense.
It definitely doesn't. I love that. And I really appreciate, and I know the listeners do too, that you're so transparent and that you admit that it is still hard.
I agree with that every single day. Like we, you know, you, you hit those, those bumps in the road and you're like, oh, I know this feeling, but you, you have continued to push through. And I really love that. Choose your heart because it really it highlights how resilient we are as people who choose to go into medicine.
I mean, we have to deal with so many. Very complicated situations, whether it be medical or whether it be social or emotional with our patients. And we still are able to, you know, show up for our families, be there and continue to be business owners and DPC. So I absolutely love that. And you know, one of the things that When, when you mentioned choose your hard I really think that, you know, the, it should be on a mug or something like that because, uh, it's a, it's a good succinct reminder as to you have a choice.
Right. And, and that is so, it speaks to autonomy. It speaks to the ability to pivot all the, all of the things that we're so happy about in DPC that we're not allowed to do in fee for service as easily school. I wanna, I wanna go into, and I mentioned this earlier, the Amber Grant, because , as you mentioned, you explored and you found that this is really your passion, you were able to apply and you won the Amber Grant.
So I was wondering if you could tell people what is the immigrant and how did you find out.
for me, you know, because the timing of making the decision to open my practice was sort of unexpected. I had not been financially preparing for a startup, right?
I had not been like squirreling away money or factoring the cost of launching a new business into our family budget. So I knew right away when I made the decision, I'm going to have to be really financially savvy and really cautious if I want to make this thing happen. And I had no prior experience with grants or grant writing.
I quite literally went to Google and started just looking, just searching for opportunities locally, nationally, whatever I could find, just to see if I could get some additional funding for the practice. I really wanted to avoid taking out a loan. I have plenty of them from medical school as I'm sure most of us do.
So at all costs if possible, I wanted to avoid signing up for more of that. So when I came across the. I was really excited first because it's a grant for women which was neat. And second, because it was unique in that you did not have to be at a certain stage of your business to apply. Um, You don't need to be open for X number of years or anything like that.
So essentially the Amber Grant is a national grant program for women owned businesses. You can apply on a monthly, so every month they take applicants and they select a monthly recipient. And then at the end of the year, all of those monthly winners are considered for sort of like an end of year grand prize.
So I was the winner in June. When I found out, I, let me tell you, I just about fell apart because it was just such a shock and such a blessing and really helped me bring my practice to life. So I'm very grateful and I, I will say that one of the things that helped, I think, in my application process, because for the Amber Grant, at least the, the process was actually relatively open-ended.
It was like, tell us about your business, tell us about your plans. You know, it w it was not a nitpicky application. But I approached it incredibly seriously. I took it very seriously. I spent a lot of time thinking through my responses, calculating every cent I had spent already, and really, you know, how could I stretch any funds?
They would give me to make them go as far as possible. Really sort of honing in on my vision for the practice so that I could verbalize it. And truly, in addition to obviously being incredible to be a grant recipient, it was a really wonderful exercise in business development because it sort of forced me right away to get down to the nitty gritty and, and really you know, make some serious plans.
Yeah. I love that. And let me ask you there, because you were able to benefit from the Sandberg grant, what, and going also back to the fact that, you know, initially you weren't so sure about how do I open a business. I want to ask there if other people are listening and they're, you know, not the most financial savvy person, but they're wanting to be able to open up their DPC.
What are some tools or tips that you have for those people in terms of where do you get started? If you don't have any idea how to start a business.
I think it can be really overwhelming and that's okay. So the first step I think is just saying, this feels really overwhelming and that's all right. For those of us in medicine, we are used to knowing the answer, right?
We'd like to know the answer. We want to know it bothers us when we don't. So it's really uncomfortable to step into a world that is foreign to you. And to feel like you are certainly not the smartest one in the room when it comes to these things, it's real, it's intimidating and it's hard. But that's also okay.
I think knowing that getting started is the hardest part and chipping away at things little by little, instead of looking at this big, like if you just wake up and think I'm going to start a business today, it's a huge task, right? There's so many pieces. So I did my best to make lists, stay organized, break it down, and then really take advantages of, take advantage of the resources you have.
And in DPC, there are so many, you know, there are online guides for starting a practice. There are so many experienced physicians who will walk you through the steps you can spend for me. I spent months on the Facebook page, quite literally reading every post and just gathering what I could, you know. So I think just taking the time to learn and being, you know, cautious in your steps and being mindful the whole time little by little, it just starts to come together.
Awesome. And when you talked about stretching every penny to the maximal effect I want to ask when you were playing around with your budget, how did you look at, you know, certain pieces of equipment or, you know, certain investments differently than you would have if you know, you inherited a million dollars?
Yeah, I was pretty Frugal with everything that I did in opening and that included equipment. And I think there are different schools of thought, you know, some people go into DPC and don't have a brick and mortar office at all. Right. So, and do just beautifully that way. Some folks will get a really small space and outfit it with just very basic things and build as they go.
Some people go full tilt boogie, and just, you know, their clinics look like a dream from the minute that they open and. It can be challenging to figure out what the best situation is for you, if especially if you don't have the, you know, pockets to, to make any of those options happen. So what I did was I tried to think what things do I need to be immediately available to be a good doctor and to offer the level of care that I want to offer.
And there are certain things that, you know, you just feel like I should be able to do this. I should be able to obviously do, you know, take all of the vital signs and do thorough exams, but I should also maybe be able to do basic women's health biopsies, you know, and I, I just truly went through all of the things that I wanted to be able to offer, priced them out and then sort of set goals for down the road.
You know, I already have a list of like when I make X amount and when I get to a certain point, this purchase is going to be next. And I, I think it's okay to not open with everything.
Yeah. I love that. You know, you're, you're building your dream clinic from day one. And that's really, you know, it's really something to help keep that focus on the next step.
And so I love that. Like you have, you know, once I achieve this, this is the next purchase I'm going to make.
When you talk about. Spaces. And you talk about people who potentially have their dream space. I am totally fan girling over your space. So, you know, if you haven't already yet, please go to revival, dpc.com, check out Dr. Dahl's amazing space. But I want to ask about how did you find your location and how did you decorate it?
Finding my location was tough and I found it there just aren't. So first of all, there aren't that many spaces kind of, of the size I was looking for. Cause I was looking to stay small. I was being frugal, as I mentioned. There weren't that many on the market and it was really tough. There were some old medical buildings that would have needed a full gut, but again would have been a huge investment and I was looking to stay small.
So I found myself. Much much earlier than I needed it. So, I was able luckily to kind of work out a deal where I didn't have to start paying on this space until it was time for me to be closer to, to moving in. And I also got in right when they were doing the renovations and that was wonderful because it allowed me to say to them like, Hey, before you lay down flooring, can we put some cabinetry and a sink in here?
Can we do, can you give me you know, Vinyl flooring instead of carpet, that sort of thing. It allowed me to have a little bit of an early participation in those decisions. So that was really nice. And when it comes to just the branding and design, truthfully, that for me is like been some of the most enjoyable part of the process, which I think you can tell.
Um, So, you know, when I was starting everything and I was looking at all the tasks in front of me and trying to be financially savvy, I thought if I can do it myself, I'm doing it myself. And that is how I approached the whole practice. So whether it was working on logo, design, choosing brand colors, choosing fonts, building the website, doing the whole site, myself, doing manual labor to get the office ready, anything I could do with my two hands I was going to do.
There were things that I knew I should outsource. When it came to, I need a lawyer. I need an accountant people to make sure that the business structure finances are safe and sound great, but I really wanted to tap into my own skillset as much as I could. So for branding and for kind of decorating and the feel of the space, I just wanted my brand to feel a certain way.
I wanted it to reflect sort of the experience that I hoped patients would have here in the office. So I wanted it to feel calm and unhurried and detail oriented. And I also wanted it to stand apart from the local health systems. So I was really careful to avoid, you know, they're bright colors and they're more sort of the cartoony elements that they use in their branding.
And I just focused as much as I could on making every single touch point, whether it was my presence on social media, my website, the physical office, I wanted it to feel elevated and I wanted everything to feel really consistent and authentic to me. And my practice. What's really neat is when I launched my site, which is such a big moment.
Particularly when you make it um, you're, you know, you've never done that before. I, I, you know, I showed it to one of my friends and she said, you know, Christina, I would know that this was your site. If your name was nowhere on it, it looks like you. And then recently I had, when, uh, I had a reporter here at the office doing an article and when she came into my practice, she goes, wow.
I feel like I just stepped into your brand. And I'm like, those actually mean a lot to me because I feel like it means that consistency is there. And that it's coming through to people.
I love that. And I really hope that, you know, especially for those people who are looking to rebrand or the people who are, you know, thinking about their future DPC practice or they're actively planning it.
Just, like you mentioned, every touch point that you could potentially have in your community, whether that be, flyers, the local library, or, social media, a post coming up with your color brands, knowing your, , even down to your color codes for your practice, those things will.
You know, you can park those facts in the back of your head. So as you continue to build your brand, you can always reference back to, you know, does this go with everything else I've done already. Right.
And I think that it's also okay to be a little bit different. I cannot tell you how many people, when I showed them the first inner iteration of my logo that I had, you know, made in Canva.
So many people said to me that doesn't look like a medical practice. You know, it, this looks like you're it's, doesn't, it doesn't look like you're an MD. This doesn't look medical enough. I got a lot of feedback that things were, maybe it was too feminine or it was too. And I get all of that and I, I took the feedback and I listened to it and there were changes that I made because of it.
But ultimately I think. Your brand needs to speak to who you are and what you're offering and what your niche is. And it's okay if it feels a little bit different. It's okay. If every medical logo, you know, doesn't have medical symbols in it and stuff like that. So I think it's neat and it helps set us apart.
And the whole idea to me of direct primary care is being different. So I don't, I feel like to, to let those, your branding be different is okay. Awesome.
And when we're talking about branding, and when we're talking about being different, I want to highlight your social media.
So especially on platforms like Instagram, you have been very active in doing reels and doing posts that are definitely on brand. So I want to ask, when you think about your social media and the impact it's made in your community, can you speak to what types of calls to action really make the biggest impact for your practice and your patients who join your. Sure.
So I would say, you know, I'm the most active on Instagram and kind of share those posts to fake Facebook. I do my best to post regularly and I try to present sort of a mixture of content that's educational, informational about direct primary care, and then a little bit sort of behind the scenes.
I will say absolutely that I have noticed much, much more engagement when I show my face, whether that's in a static photo, whether that's in videos or reels. And I think that that makes perfect sense. When I think about the accounts that I love to follow the common thread, no matter what sort of it's about whether it's a medical account or a fashion account, you know, whatever it is.
They're run by someone personable. Yeah. Who is engaging, who's active on stories who you sort of get to know. I'm trying to be better about. Live stories and about reels, but I have to be honest. I mean, they make me super nervous. They make me like, it's a little awkward to make those. I recently had a real get about 10,000 views and just the thought of that many people, which in the scheme of social media is no one, but the thought of that many people looking at me doing a cheesy video just gives me a belly ache.
I don't know how people do it, but I think that staying active is, is obviously a wonderful way to just get more engagement, let people know you're there. But I do want to say that while social media is wonderful, can be a great way to just grow your audience, grow awareness for direct primary care.
It's free advertising. It isn't everything. And one thing that I have to remind myself sometimes is you are growing a practice. You are not growing an Instagram following and the numbers don't always translate. So, I try to always remember that the two, you know, they're separate, they're not the same.
So I try not to get too, too caught up in the numbers and things like that. I try to take advantage of it, but not let it get me stressed if that makes
sense. Absolutely. And I love, love, love that you said that the numbers are not reflective of growth of your practice. So when you talk about the difference there, I want to ask for your practice, how have you seen people find your clinic and find your services valuable
You know, people have found. So many different ways. They've found me just searching for direct primary care, like on the frontier mapper. I've gotten folks from there. People I have gotten people from, I would say Facebook probably more than Instagram. And then I'm finally at that point where word of mouth I think is starting to take off, which is wonderful.
That's probably cause everyone in DPC will tell you that word of mouth is everything. But it takes a little while to get there. And that can be painful when you're in the beginning. And no one's heard of your practice before and you're just trying to get the word out there. Uh, it can be tough to be patient.
So what I do is just really try to be intentional about planting seeds and it can be hard to know that they might not come right back with a membership, but all you can do is sort of keep planting these seeds. And I've been open long enough now that people that I reached out to in December or, you know, months ago, They are enrolling LA this week, you know, so it really is a slow process sometimes, but you just kind of have to stick with it.
And one of the things locally that you've been able to do, you know, most recently, especially with the pandemic numbers being different than they were, you know, say at the height of the pandemic is you've been able to inter interact with your community in a local outfit market. So I want to ask a couple of questions there.
How was that experience and you know, what was, what was interacting at that table? Like, but also what sorts of questions do people have now that could potentially be different than the questions people might've had pre pandemic.
That's a great question. So, I was so excited to participate in that event.
It was an outdoor festival that was sort of focused on healthy living and green living. It had over 50 vendors. So it drew thousands of people, which was incredible. It was a wonderful opportunity. And I got hundreds of visitors to my booth, which was just such a incredible way to bring awareness, not just to the practice, but like you said, to direct primary care for me it was extra special because, you know, when you launch your practice during a pandemic, you miss out on a lot of the typical opportunities to let people know that you're open.
We didn't get to have a ribbon cutting, you know, or, or big grand opening celebrations. So that was really my first time. Being in front of a large group to get my name out there. In my area, I would say direct primary care is still relatively unknown. Uh, so most of the questions I got were just clarifying what direct primary care is, how it works for patients with and without insurance and sort of what sets it apart from what people can expect from the large local medical systems.
So people asked really thoughtful questions and definitely were interested in, I would say the personal nature of direct primary care. It seems that, you know, small business is making a little bit of a comeback. I think people are appreciating what small business owners have gone through during the pandemic and.
Getting out there and interacting with people, let them see, wow, this is a doctor, who's a small business. And I think that, you know, those concepts have been so separated for so long. When you talk to people about owning a practice, they don't think of you as a small business. They think, you know, you've got, you know, all of these things on your side, you know, you've got like farm on your side and insurance on your side and all of this support.
And I think being able to stand there and be like, Hey. This is a small business. You're looking at her like this is the whole business standing here at this booth. Really resonated with people because they're like, you know, wow, that's what we do too. We're hard working people too. And people were really excited about the concept.
And for me, that was just a wonderful way to sort of fill my cup and motivate me to keep doing that. So over the next three weeks, I have three more vendor events. And all I can hope is that by being out there and being present, you know, people start to think about it and maybe the first time they just think about it and okay, neat concept.
And the second time they see you a little bit more and you just keep planting those.
Awesome. And in terms of the events that you just mentioned, you're going to be at, and this one that you already mentioned, how did you find out about these events?
So I have found that probably the best way to find events and just kind of get engaged.
The community is by forming relationships with other small businesses and other entrepreneurs that are local. So I make it a point to follow and support other small businesses on social media. And I'm always looking for ways to sort of collaborate, to support each other and to draw in, you know, maybe potential customers for them, patients for me.
So you kind of have to put yourself out there, which can be really uncomfortable. I have done it all. I've cold emailed. I follow them on social media. I engage with their content on social media. You just kind of want people to know like, Hey, I'm out here, I'm doing this. I think what you're doing is great, you know, is there a way we can work together?
And I think that not only does that help with word of mouth marketing it's also just really nice to build a little circle of support with other entrepreneurs. It's, it's nice to feel like you have a little. Community yourself.
Definitely. And I love that way of also amplifying your seed planting because when you talk to these people who are business owners themselves, and they have clients or patients or whoever you know, customers at their businesses.
You know, the F the interactions that you might have with them, they will talk to their clientele about your interactions and that your business exists. And so there's that word of mouth. And so I definitely think that's a great way to engage with the community. And you, like you talk about, you know, so, following local social media events you know, if, if people are not sure how to do that, a simple way is to go on to Instagram, for example, and you can actually search by hashtag and not necessarily by account.
And then you can see all of the hashtags, you know, York, Pennsylvania, and your example, or Arnold, California in mind and see who are all of those people in businesses who follow those accounts or those hashtags. And, if you're on the bus or if you're.
You don't have a patient cause it's DPC and you don't have to work every 15 minutes with a new patient. You can sit there and, you know, follow accounts. It's a great way to get engagement for free. Um, But yeah, I love that. You've also been reaching out to your community on a one-to-one basis.
And you kind of just have to be willing to take your shot. You know, like this festival that I just did there were no other medical vendors. It was not meant to be, you know, a medical or a health fair. And I think so often, like when I started, I was looking for what health fairs I could sign up for.
And there just weren't many, or they were so expensive to have a booth that I was like, I don't know that there's going to be a return on this for a little practice like me. So, you know, this was about healthy living and I was like, you know, okay, I'm a lifestyle medicine, you know, I'll take my shot.
And I sent a message and said, listen, this is what I do in my practice. And I think I am a good fit for this. And they welcomed me right in. So you kind of just have to, you know, have the guts to go.
And one more question there in terms of, when we talk about budget, when we talk about going to events, do you have to pay to participate in these local events? Or is this a come one, come all it's free and you just provide your own table and, and, uh, flyers.
So they vary. I have been really fortunate, a lot of the local events that I've done have either, either been free or they've been very affordable, like less than a hundred dollars. And so what I have tried to do when I started buying sort of the, the basics that you would need for a booth, you know, uh, a tent, a table you know, a tablecloth that's branded those sort of things.
I tried to buy good, affordable quality pieces there. And then when it comes to getting people to your booth, I try to pick things that again, are engaging and. You know, cost-effective so, so many people will buy all of this branded stuff, but it's not necessarily stuff that people want. Like how many, you know, I guess pens are great, but how many likes of those like stress balls do we need?
Right. And so at this festival, I was like, what can I do to bring people in isn't expensive, but we'll get people interested in the booth. So I actually ended up giving away seed packets and had a little station to plant your own seeds. So I provided the little pot, little peat, pots, and potting soil.
And I took every seed packet and put a little paperclip with my card on the back. So people could come up and pick what they wanted to plant. They got a card, they would talk to me about the practice and then they would do their little activity. And all of it for was probably less than a dollar per person, you know?
So it was affordable but really effective.
And what a way to tie that into lifestyle medicine. So I want to, I want to delve into that because you are a diplomat of the American board of lifestyle medicine, and, you know, for people, especially during this pandemic prevention and preventative care have really been highlighted as to how necessary it is to be well, to prevent illness later on.
Especially like for those people who couldn't make it to the doctor during the pandemic. So as a diplomat of the American board of lifestyle medicine, can you share with the audience, what does that mean to be an, a diplomat as well as a DPC.
Sure. So, I made the decision while I was setting up my practice and sort of in those early stages where I was doing some of the backend business planning, I made the decision to pursue board certification in lifestyle medicine, because I think. All of us in primary care, make these recommendations every day.
Right? We counsel people every single day on nutrition and movement. And I don't think that you necessarily need to be board certified in lifestyle medicine to do that. Of course. But personally, I just wanted to be a little bit. Uh, more well-versed in what I had to offer people. And I wanted to make sure that what I was offering was evidence-based and was sort of real useful, detailed information.
So, I studied and took the boards for lifestyle medicine in 2020, knowing that when I opened, I would be able to offer it not only to my DPC patients who are there for primary care, but that I would also be able to create a membership specific for lifestyle medicine. So I offer both every patient. Of course, if they have chronic illness, we talk about ways we can prevent it, treat it, reverse it with lifestyle changes, but I also offer a specific lifestyle medicine.
And what that means is that patients get a monthly visit with me. It's 90 minutes long. So it's a long visit and it comes with pre-visit work for the patient to do so. An assessment of whatever topic we're going to be talking about. That might be physical activity. It might be nutrition, it might be sleep.
They go through this these sort of worksheets and we look at their habits and then we spend 90 minutes talking through where they are now, what changes they can make goal-setting together. So it's a really thorough, uh, dedicated, personalized visit. And they leave with a plan that is something that they're ready to implement.
So it's not sort of this very vague, like, okay, you know, your blood, pressure's a little high avoid salt, which is a great, that's great advice. But what does it mean? Like on a very, you know, realistic level for that patient going home? What does that mean? And I wanted to be able to tell people exactly what to do, what steps to take.
And then there's pretty intensive. Follow-up where I check in, you know, how is that goal going? What barriers are we running into? How do we work around those things? And so on a monthly basis, they're getting a thorough check-in and they get to choose what topic they want to talk about. So some folks, if they have one area they really need help with like, I really need help with getting my nutrition together.
We might spend months on nutrition, checking in again and again, I've had other people who just kind of want to spend one month on nutrition one month on activity one. And we kind of go through all the different realms of lifestyle medicine. So it's really tailored to the patient. And it's something that is time-intensive on my behalf, but I really truly enjoy because.
Lifestyle changes work. They're just hard, right? They're hard for all of us. So it's, it's a wonderful way to really get in a little bit deeper with the lifestyle change.
And do you see those patients who may be in that, separate carved out lifestyle medicine, focused part of your practice?
Do you see those patients then converting to members of your practice because they see how amazing of a physician you are?
I have no one that that is only lifestyle medicine, I will say anymore. I had people start lifestyle medicine, and all of them are now DPC patients as well.
Incredible, incredible to have all of those patients transitioned to your practices members.
I absolutely, I'm so excited for you. I want to ask there, how do you manage that financially in terms of, you know, when a person signs on they have their own primary care physician, but they find your practice valuable to pay out of pocket and then they want to transition to your practice. Does that happen?
At the next month visit, how do you manage the transition between, uh, a all a cart service to a membership,
Patient. So I think that because the lifestyle medicine sessions include sort of pre-visit work, extended visits, lots of follow-up also a print I didn't mention before, but print materials.
So they get a binder. There's, there's a lot for them to work with what I do. If a patient who's a lifestyle medicine patient wants to join the practice for, you know, the, the standard DPC care is we kind of talk about what their needs are going forward, and if they want to continue having those monthly in-depth appointments what I do is I.
They still pay for the lifestyle medicine membership and the DPC, but they get the lifestyle medicine membership at a reduced cost. So there's a little bit of like kind of a bundling that goes on. If they say I've loved lifestyle medicine, I feel like I'm good. And I just want to transition to DPC.
Then we just make that change and they go from one membership to another. So again, it's really tailored to the patient. And so far folks have been really understanding where no one has started lifestyle medicine with these intensive visits and then transitioned to DPC and expected the same. If that, if that makes sense, they've all been really understanding that this is an additional service and it takes a lot of time and it takes time on their part as well.
You know? So I think everyone sees it as just an added, an added service. Love that.
Can you tell us more about the demographics of who you're taking care of?
Sure. I actually am so surprised by my patient panel, which is, has been really neat. I thought because of my branding and because of my interest in sort of the intersection of motherhood and medicine my emphasis on lifestyle medicine, I thought I would have.
Predominantly female patients and a lot of young families, that's where I thought the practice was headed. And much to my surprise. I have really gotten quite an even mix. I have an even mix of men, women, and children, and I'm also really spread out in terms of ages and insurance status. So I'm all over the map which is welcome, which is really, really neat.
And we'll see how that sort of grows and evolves. But it is not what I expected. And one ne. And unexpected thing about my panel is that I've developed this little niche in taking care of other physicians, which has been just an incredible honor to tell you the truth. It makes perfect sense when you think about the accessibility and the flexibility, and even the privacy that we offer.
But I just wasn't expecting it. So to have the chance to be the doctor's doctor and to have my practice sort of gain that reputation in the community has been humbling and just really fun, really.
That's so awesome. I'm so happy for you because it's, you know, doctors sometimes for the worst patients, the worst, when you have the time and a relationship with your physician who actually knows you and who has the time to spend with you, I just, you know, you can, you can call those doctors out.
Cause I think that's sometimes what we need. So that's amazing. And when you talk about the intersection between motherhood and medicine and the fact that there are kids and little kids in your practice, I want to ask about how your services as a physician extend to newborns in their home environment.
Sure. So, you know, when, when I made. The decision to transition to direct primary care. As I mentioned in 2020, it's when the world was totally shut down. So like so many other parents shut down for me, didn't just mean career changes. It meant changes in my family support system. So for example, you know, we lost all childcare.
So I had a newborn and a two year old. And as I started making steps towards building this business, I was also carrying the workload of a full-time caregiver and just the mental load of motherhood, which I think is often under recognized and under appreciated. So when I was dreaming up this practice and starting this practice, I was doing it all through the lens of a mom.
Babies. Right. And so I wanted the practice to serve that community. So when I chose an office space, I wanted somewhere with parking. I wanted somewhere that was stroller accessible. I wanted somewhere with bathrooms that were single bathrooms, not just stalls because it's hard to reign kids in. And I wanted an environment that parents not just mothers, all parents could feel good about bringing their children to.
And I think all of us have that our parents we've lived this experience where you'd go to the doctor's office. And the first thing your kid does is they're like on the floor and touching the equipment and like all the germs, right. They find all the gross stuff. So I wanted the environment to be really welcoming and families to feel like we're good.
We can let the kids run around this office. It's, it's clean, it's family friendly, all those things. And then in terms of services, I just wanted parents to feel well supported. I think the pandemic has been obviously so hard in so many ways. But on parents of little kids who are juggling work and childcare and just the, also the constant nature of it, all the no breaks, the no time away, the no breathing room, I really wanted to offer them some support.
So I started thinking like, what, what can I do? What do parents really need? And how can I offload some of those burdens for my families? So, I offer newborn home visits. Uh, so when patients of mine are expecting we start talking about their birth plan a little bit, and I try to be a source even in pregnancy, throughout pregnancy.
And then I'm the first to be excited for them. I'm the first, you know, I say, let me know when that baby comes. If I'm allowed, I'll do a social visit at the hospital, just because I think it's such a big moment for families. And that means a lot to them. And then I want care to be really easy for mom.
Like I don't want these ladies to have to pack up and haul to the office. So I go out and do visits at home which is really special. And I think is wonderful from a just old school medicine perspective. But it's also really great as a physician. I mean, you get to see the environment, the sleep environment you get to watch the parents kind of in their.
Natural comfortable place. I have an area of interest in breastfeeding medicine. So moms can feel comfortable doing that when they're in their own space. So I just wanted to make it as welcoming and easy as possible. And here in the office, I also make a point of those things. So I have everything you could need for breastfeeding here in the office.
I've got backup diapers, kids' snacks, all of those things, because I think when you have walked that path and you know how hard it is, anything I can do to make that better for people, you know, that's the goal.
Incredible. And I love, love, love the, you know, the ability to take your own experiences and put that into your everyday practice.
So on that note, I want to ask with the lifestyle medicine visits with you taking care of newborns, whether it be in your clinic or at home, what is your weekly schedule like on a typical.
Uh, you know, I don't even know how to answer that yet. I don't feel like my schedule has sort of declared itself because I'm so new.
Some weeks are full of patient care and it's, you know, just patient after patient, whether that's in person, whether it's virtual, whether it's home visits, whatever. But other weeks it feels like there's no one in the office and I'm doing all of the backend stuff. I'm doing the admin work, the marketing and trying to dig into that side.
So, right now it's a pretty solid mix of meet and greets, onboarding new patients keeping up with current patients and then trying to make sure that the business is tucked in, it's all over the map. So to be continued, love
it. Only way to go only way to go.
And with that said no, I want to ask you opened in September of 2021 and you have, you know, been through all these different patient types of visits.
What types of workflows did you build out in the beginning to make sure that you were able to support patients right away and how have those workflows changed?
Yeah, that's something I honestly truly am still working on. And it's that part is harder than I anticipated to tell you the truth. I think when you spend years working in a system where the workflows are laid out for you for better, for worse it can feel a little disorienting when suddenly you're on your own and you have to make the rules and define the processes.
It can be really challenging and particularly in a micro-practice environment where you don't have staff. So you're not really forced to lay these things out, but you should, you should think through them, it can be a little bit tricky. So. I essentially tried to batch my work right now. And so I tried to have dedicated time for patient care, dedicated time for administrative work dedicated time for things like inventory and stocking and ordering and things like that to keep myself as efficient and accountable as possible.
But really I think that I'll be working out workflow kinks and refining processes for years. You know, at the moment I try to do a lot of list-making. I try to really be as organized as I can, but there's some trial and error there, you know, and trying to sort out what, what worked in, you know, an employed or fee for service system and what works in DPC can be really, really different.
So it takes a little trial and error,
definitely something that I want to ask in terms of going into depth on workflows is one of the most crucial. Workflows I feel is the onboarding process. So when a patient doesn't meet and greet with you and they say, yes, Dr. Dahl is a doctor for me, I'm going to run revival, DPC, we dance.
I can picture that. In addition to dancing, how do you bring those people, you know, on the backend as well as face-to-face into your practice as they're planning
for their first. Sure. So, after meet and greet, if a patient reaches out and says, yes, I have a really sort of a standardized and what I think and hope is a pretty slick, easy process for them.
So my EMR allows for onboarding and all of the forms and paperwork to be in the patient portal. So I have an, a sort of a welcome to the practice email that goes out to the patient and it includes instructions for them on setting up their portal account. And then once they're in that portal, it gives them instructions on sort of step-by-step how to do the enrollment paperwork.
And on my end, once I see that the enrollment paperwork is done, I take a quick, at least a quick peek at it and make sure everything is sort of, as it should be, that we haven't missed anything. And then I reach out and we get our first appointment on the calendar. And then before that appointment, Is when I'm reviewing the records, I'm really kind of delving into that paperwork and making sure that I'm prepared to actually meet with the patient.
I, as much as possible, make a point to, as soon as they've submitted their enrollment paperwork, which includes records, releases, I get right on those and try to get that information as soon as possible, because whenever I can, I really like to come well-prepared to these visits. I think it makes a big impact to a patient.
It's a very different experience for them to walk into an appointment for the first time and have a doctor sit with them calmly and know their history that is such a shift from what most of them have experienced. That, that first appointment makes a big difference, a big impact. I also for every patient that joins make a little folder that has a sheet with my contact information and preferences, kind of how to contact me in different scenarios.
It's got a, I've got a list of local labs in there, a copy of their patient agreements. So I really have a pretty standardized process that makes it easier for me. It's a lot, but it's it's, since it's standardized, I just kind of go through those motions on every patient and make sure that everybody's sort of tucked in of it.
Between visits, how do you continue to engage with your patients?
So that also is something that I'm learning, I'm trying to figure out. And there have been some interesting discussions in some of our DPC physician groups about this, right? About, do you reach out to your patients in between visits if they're not having needs?
Because I think often in direct primary care, we know the importance of the doctor patient relationship, and we want to emphasize to our patients that that's there. And so sometimes even if they don't need us, we bug them. Which when you think about it is crazy and nobody in the system is doing this because who has the time.
Right. So at this point I really I'll send myself tasks to check in. And usually after that first appointment, because it's long and in depth, we've got at least a few things that we need to tackle. And so, I try to really work on those things as quickly as I can. Start to really get people feeling taken care of.
And then we sort of space it out. I feel it out a little bit, you know, depending on the patient, depending on what they need, when it's another physician who is terrible at taking care of themselves, I hound them like, you know, I'm like white on rice, on these people because they, they're not paying attention to their own health.
So it just depends on the scenario. Oh, I love
it. I love it. And if you've seen one DBC, you've seen one to BC. If you've seen one patient, you've seen one patient, everyone is an individual. So I love that. That kind of personalization. And in terms of looking back, because you know, it's already at this, by this recording, you know, you've been open over half of a year.
It's crazy. Uh, I want to ask, you know, what, when you look back to those days where you were like, I am at a branching point, I'm either going to go down this pathway or I'm going to go down this pathway and you chose DPC. Is one of the toughest days you've experienced and what's one of the best days you've experienced.
Ooh, good one. I think toughest days, there have been a few, I think, early on when I was trying to do this early in the pandemic and I was essentially stay at home mom by day and entrepreneur by night. Those were long, hard demanding days because I, you know, by the end of the day, when you're taking care of a newborn and a toddler, you're pretty beat.
And only when the kids were in bed, did I open my laptop and start building this practice? So it felt very like a 24, 7 job for a long time, took me a long time. And, and that was really hard once I opened I think there's a little bit of a. Uh, hi, a great feeling, you know, that comes a rush of endorphins that comes when you open.
And you're like, all right, we're doing it. It's happening. You know, people are coming in. I had a really tough experience, you know, I had opened sort of like a soft opening in August end of August for pre enrolled patients. And then the plan was to really kind of formally open in September and on September 1st, just days after I saw some of those patients soft open in mid August, hurricane Ida came to town and my office is on the lower level basement level of an old brick building that was renovated.
And when we got all the heavy rain, it flooded and it was awful. We did everything we could. My husband swooped in, in the middle of the night with a sub pump and we were literally taking buckets of water and carrying them upstairs and dumping them out. Like it was truly that dramatic just trying to fight the water as important, but there was a lot of damage.
And, you know, from the time that I sort of, you know, filed for my LLC and opened my doors, it took me a year. It took me a year to set up this practice because I was kind of in the thick of it with a newborn and to have spent a full year. Juggling babies and building this beautiful office only to have days into it.
Furniture, flooring, equipment just destroyed. It was heartbreaking. I mean, there, there were some big tears, you know, shed over that, but I think the lesson there is truly, what can you do? It's sort of like parenthood, like things are out of your control in business. And the only thing you can do is adapt.
So the building was without bathrooms for weeks, there were fans running to dry it out for weeks. It was a mess and I had these people who had pre enrolled and I had set this expectation and it felt like a lot, there was a lot of weight on my chest to try to feel it, you know, how can I navigate this?
But I did what I could. I offered home visits. I was really honest about what happened and tried to kind of lean in to the patients who were already supporting me. And when all was said and done, I didn't lose anybody. So it was tough to navigate. And when things like that happen, of course, it feels like the rug was pulled from under your feet, but you kind of just have to persist and keep trying.
That's all you can really do is get up and try again. And in terms of best moment moments, truly whenever a patient enrolls, it's the best moment, because I think that when I went into this, like I said before, you just feel so unsure, like who's going to join my practice. Who's going to care about this little office when there's, I am surrounded here in York, I am surrounded by big medical systems and I'm sure that's true for a lot of us.
So you've got some imposter syndrome and some feelings of like, Is anyone even going to ever sign up? Is this even gonna be a thing? You know? And so every time someone makes the decision to choose me for their care, it just kind of lights me up and I feel like, okay, let's keep going. We've got another patient.
Let's do our best by this patient. And I think all you can really do is devote that energy to every single patient and give them the best experience they can have. And then little by little. You grow, you know,
I feel that to my bones, not only just the 24 7 bit that you mentioned, but it also, you know, when you're in DPC and you have the time, you really can concentrate all of your efforts on that one patient.
And you don't even know that you're making a difference sometimes until after a patient says, you know, thank you. Or I've never had an experience like that. It is, The, the returns on that, on your ability to give that care are just amazing.
And I want to ask there in closing, when you look back on your experience as this person who had self doubts you know, no business skills to start with looking back and looking now at where you are. I want to highlight that you have said, see one, do one, teach one, and we've all heard that, that, that phrase.
But now that you are in this position that you are now, how have you been able to really embody that phrase?
So I think for me, when I look at sort of where I am now, where I started, where I am now, I am cautiously optimistic, I will say as someone who has. Risk averse and a worrier by nature. It can be really challenging to be optimistic all the time.
And the reality is, you know, owning your own business is a roller coaster. And some days I feel like everything is going according to plan and I am knocking out tasks and I am crushing it. And then moments later the littlest thing, right. I think we've all been here and the littlest thing can just knock you on your butt and make you feel like, nevermind, I don't have a chance.
Like I may as well close up shop. And sometimes that happens like in over the period of minutes to an hour. Right. And we have these, these waves of emotion. So I think it's all about recognizing that yes, owning your own practice can be tough and yes, it's valid to have those worries and that's okay.
But taking a step back to remind yourself that like, this is possible and you're doing. And I, I think in my experience, so many of us as physicians are really bad at celebrating our success. I know I am, I'm terrible at it. I will focus on the things that have gone wrong or the things that could be better rather than any one thing going well.
That's just kind of my nature. So I'm doing my best to make a shift there and learn to take pride in the progress, even if it's little progress and celebrate those little wins. And when it comes to. You know, see one, do one, teach one and kind of spreading the DPC movement. I try not to be too forceful because although I know what an incredible community of doctors we have I also know that making that leap that first step is really hard.
And I respect that and I have so many colleagues that are in the traditional system. And they're thriving. They're doing incredible work and incredible things. And the last thing I want is for any of them to think that my admiration or respect for them has changed, right. Because it hasn't like I said, you know, you choose your heart and that might be different for different people and that's okay.
That being said, when someone reaches out to me and says like, Hey, and it's always the ones you don't expect, Hey, you know, I hear you're doing DPC. Like how can I get into it? I get super excited. And I love being a resource for them and I will do absolutely whatever I can to help move them forward. I was blown away by the generosity of this community.
I would absolutely 110% not be where I am at my practice without other DPC physicians giving me advice, lifting me up, dragging me along, you know, um, being so willing to share their experiences and their secrets. So I want to pay it forward. So I tend to I'll I'll answer any specific questions. I'll invite people to the Facebook groups because they're so active and such a wonderful way to gain knowledge.
I will recommend books. I really like Dr. Gunther's books, uh, sparks start fires, and then I recommend the pod, this very podcast that it's kind of a, a full circle moment for me. I'll tell you to even be talking to you today because it feels a little surreal. Like, what am I doing here? This is what I listened to.
Right. It feels surreal to be someone who would ever give advice about it, but I'm happy. I'm happy to be here.
Absolutely. And we're so happy to have you. And again, here you are, you have chosen your heart and you have succeeded, and I wish you all the best in the future. Thank you so much, doctor at all for joining us today.
Thanks so much for having me
*Transcript is generated by AI, so please forgive errors.