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Episode 83: Dr. John Sanders (He/Him) of - Voyage DPC in Orem, UT

Direct Primary Care Doctor


Dr. Sanders of Voyage DPC
Dr. John Sanders

Dr. John Sanders is a board-certified family physician with a passion for pickleball and relationship-driven care.


He attended medical school at Nova Southeastern College of Osteopathic Medicine in Ft. Lauderdale, FL and attended the dual-accredited Family Medicine Residency in Jacksonville, FL.


After practicing rural family medicine in Moab, UT for 6 years, he built Voyage Direct Primary Care. Now he is able to offer excellent, innovative and friendly medical care for a low monthly fee and, as a result, is liberating patients and clinicians from the outrageous cost and undue burdens of the current medical system.


Voyage DPC opened in June of 2018.


 

Dr. Sanders & Voyage DPC in the news




ADDITIONAL ARTICLES:

How small businesses can provide employees with healthcare —without insurance

Have a high deductible or health share plan? You need to check out this clinic

Local doctor's unique no-insurance approach is drawing rave reviews from patients



 

PODCASTS Featuring Dr. Sanders:


“Why Doctor’s don’t listen”



 

“Fixing a broken healthcare system”



 

CONTACT:

Website: Voyage DPC


SOCIALS:

IG: @voyage_dpc

 

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Listen to the Episode Here:



 

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Transcript*


Welcome Dr. Sanders to the podcast.


Hi.


I actually have never seen your face lifetime before we talked on the phone once at the very early days of when I was planning my DPC.


So it's, it's wonderful to actually see your face and be able to chat with you. So I wanted to start with your journey from where you were practicing in Moab to your DPC today. So can you please bring us back to what were you doing before opening voyage DPC?


Um, yeah, it was a rural family medicine doc in Moab, Utah, um, doing full scope of family medicine with OB and C-sections and busy outpatient clinic and running an inpatient clinic and pulling some shifts in the ER here and there.


And, um, so yeah, just traditional family medicine, um, trained in Florida med school and residency, and went directly from there to the rural setting for six years.


When you were doing Fullscope care, how was your autonomy level there?


So rural settings, I think are unique to the autonomy piece, um, because you have like a little baby administrative arm and they're, they're less, I don't know, it's less functional because they're not always the best of the best in the rural settings.


Um, most of those people go onto the 50 and 75 and a hundred and a hundred twenty five hundred fifty bed hospitals. They just kind of scale up the CEO people. Um, but I felt like I had a reasonable amount of autonomy. I ran a little clinic and I was the medical director for a multi-specialty clinic.


It included anesthesia surgery, ortho and family medicine. Um, so I felt like it was okay. Um, I could, I could give some pushback if I wanted to take more time with patients and see, see more, more people and. Kind of control the quality of care that I provided the autonomy from the, the system was difficult, right?


Because I saw all these things rolling downhill to the family medicine docs, like these PQRS pay for performance, you know, all these things that just required more of my time, energy and effort, and took away from my ability to really provide beautiful care to people. Um, just, I call it bureaucratic box-checking bull crap, the triple BS.


And, uh, and that was tough, you know, that was tough to have to do that. And, you know, I had to have people do it and, uh, stacks of paperwork and, you know, the whole gig from the fee for service space.


And even though, you know, the administrators were arguably not as, I'm not coming down on you, as hard as they would have potentially in a larger system, larger city, what was it that made you want to leave Moab?


Yeah, so, so interesting. Um, when I was in Moab, I went through 60 different CEOs in my six years. And, uh, I quickly developed an allergy to administrators cause, cause I was in, I had this contract and they weren't executing it well because they were just incompetent. And so, and they were unable to really produce what they said.


They were able to like as far as numbers and things. And so I didn't get another CEO and I talked to them and another one I talked to them, but, uh, it was really challenging because each one of them were like the same person, just a different body. Like they thought the same. They they're, they're just the same.


Um, so I developed honestly, an allergy I'd get hives and like almost anaphylaxis to anything had been really tough. Um, but, uh, but yeah, the thing that actually moved us because I don't know, I felt like I was willing to continue to muscle there. I was on babies, number three and four. And so instead of having a bunch of primates styles on multi at time, it's, you know, it's just like six to eight hour deliveries instead of 24 to 48 hour laborers.


And, um, and so I felt like I was, I was really happy. Like I was firing all 16 cylinders of a good country doc, and I grew up in a small town and I don't know, you just know your people, you have good relationships. And so that was a, it was really hard for me to leave actually. Um, but I left because my wife, uh, she wanted to go to law school.


And, um, she, when I married her many moons ago, she was in a master's program at university Nevada, Las Vegas, where I was doing sports medicine, undergrad. And, uh, and she was actually finishing her master's and she was looking at law school and she was teaching the L sat prep course. And she had scored in like the 99th percentile and, uh, was, was fixing on going to law school.


And, uh, and so. She decided she wanted to just go and made a med school and have a family. And so she did just have a family. That's like a lot of work. We had four kids along the journey of med school residency. And, uh, and, and it was wonderful. But, but now, you know, our kids were getting older. She homeschooled them for a bit, which was fun for her, but then she recognized like, oh, you know, I'm thinking they're ready to get into high school and get into some of those junior highs and, and, and get more involved in the extracurriculars and things.


And, and so she says, well, I'll be bored. So I think I should probably go to law school. So, so we've been here four years and she, uh, she tacked on an MBA just cause she's, she's a voracious academic, she's a total genius. And so she just finished and she just found out last year that she passed the bar. So that's awesome.


Congratulations to her. That's so amazing. And no, no want to ask, because that's such a unique perspective to have a doctor and now a lawyer in the family when opening DPC. So I want to ask first does I'll take a step back when you talked about, you know, the opportunities are going to be different for your wife and that's mostly what prompted your move one.


Did you learn about DPC? Because I wonder why did you open an open voyage DPC versus joining another group?


Yeah, this is a great question. So we moved here and I didn't really know what DBC was. I had no idea. I just have a core value in my core value is really good care for my people. I love them like family.


Right. Um, and I joined a multi-specialty group, a very large multi-specialty group. And, you know, you hear about the solo docs and then the group docs, and then the large, large group docs. And, and I looked at this organization and I actually met with several of the different family medicine clinics to small groups, to bigger groups into this massive group.


Um, and this massive group was. Very bureaucratically, administratively heavy, but, but very transparent and sounded like a good gig. Like the CEO is like, don't worry. It actually, I was like, we have administrators here, but we all work for the docs. It's positioned, owned and operated. It's got a board of physicians.


And so I was like, oh, it sounds like a pretty functional type situation that I might be cool with. Um, so I joined and, uh, I, I quit after two months it was rubbish care and they were cranking and family medicine space. I had a family doc with me seeing like 40 to 45 patients a day. And, and, you know, it's just very much like crank, you know?


And, um, I just didn't, I it's just some of my style and I just wanted to spend more time with people and get to know them and deliver great care to them. And the other administrative part, I was still doing OB at the time and, uh, I just wanted to get an ultrasound, like a little baby ultrasound machine with, uh, with numbers on it.


She had given me, they bought one without the numbers. And so I'd have to count for 10 seconds and multiply that whatever. And then I'm like, what do I look like an engineer? Like, I don't like to do math. Like just give me the damn one with them as a thing. They, they all overhead pieces like that. They take out of my paycheck anyway.


So I'm like, Hey, just take this back and give me the one with the numbers. It's like 10 bucks more. And, uh, and I actually found it. I actually found it online and I found one for like half the price that you bought this one for. Oh no, we can't do that. Blah, blah, blah. And we were kind of blah, blah, blah.


Anyways, this big fiasco. And I'm like, are you kidding me? Like, like this is not a hard thing. And it's super, super easy. And by the way you worked for me, that's what, that's what the CEO said. So then a week goes by still no ultrasound. And they hold another meeting with me with another administrator and, , another colleague like, Hey, you can just like, relax about this and just use the ultrasound.


Right. What, why are we having a meeting about a demo? I'm like, this is so stupid. And, uh, But I looked at that pattern and I looked at their administrative thing and, and I said, you know what? This is not sustainable for me for 20 years.


This is, this is just going to get worse. And I have zero ability to make any change in this organization I'm out. So I, uh, at around that time, I have a buddy in Florida, Jeffrey Johns, and he was messing with DPC a little bit. And he's a colleague from, from med school, good friend of mine. And, uh, and he told me about DPC and I'm like, oh, that sounds really cool.


That's uh, that that's really cool. All through med school, all through residency. I'm the 1% of the docs. Knows business I would spend a day with the business of the office manager, every single rotation. I'm like, Hey, you mind if I just hang out with it, they're like, totally, that's super smart.


You should do that. So I would do that. And so I had my head around the business of medicine, super tight. And in fact, in, in Moab, I fixed a bunch of their processes. They were so broken and help their revenues and help all these things. Um, they weren't even negotiating contracts with payers zero. There's like, okay.


So I didn't just give them back. They were getting paid like so poorly and I'm like, you're in a rural gig. You're the only gig in town. You should be killing it there. Anyway. So the, the key was, um, for me, I saw, I knew, I know the big business of medicine and I saw what it was doing, but, and I, and I saw the opportunity there, but in the fee for service space, but I, I also saw all the bureaucratic box-checking bullcrap, the triple BS.


And I saw those as they were rolling down to me and I said, Hmm, this is only going to get worse. And it is like now, like it's worse, it's worse. And so I said, it's not, they don't have any business coming into my relationship with my patients and telling me what I needed to do and not do. And, and I saw this as a freedom from that, from the bureaucracy of administrators, but also from the bureaucracy of the fee for service payers, government insurance, et cetera, as they rolled down those protocols and guidelines that they necessitated from us and prior authorizations and, you know, the whole gamut, um, just really hard to take care of patients in an efficient way.


And so my buddy told me about, about a DPC and I was like, Hmm, that, that fixes a lot of the things. And my brain just went right to it and saw like all of the cool things that it fixes in healthcare. And I'm like, Hmm, really good incentives. All the incentives aligned with patients and doctors and nobody else.


And, um, and.


I love that. And I, I really love, you know, just highlighting what you said about that. You couldn't see yourself doing that for 20 years. And so I really think that that's a great space to be in when somebody is considering, you know, let me reflect on my job. Am I happy? Why am I happy? Why am I not happy?


And so I, again, I really am grateful that you mentioned that now, when it comes to the business side of things, now, this is where I want to bring your wife Shawna Sanders into the picture, because with her being a lawyer and with you being a doctor, how did you guys take your business knowledge, take her legal knowledge and create voyage DPC.


I want to answer that question, but I also want to talk about, cause we just moved here and I quit my fee for service gig after two months. And we don't know anybody. We're starting at GPC from scratch and, and that was a real challenge and she has just barely in law school and a.


And she's so funny. She's like, you're always like three years ahead of me and true to form, true to form. Right. She's not a lawyer. She can't help me with contracts. She can't help me with any of these things. Um, but, but she had professors at the university and she was able to pick their brains and say, Hey, help me out with this.


You know, my last boss was started, I'll see. Or he wants to get an operations agreement and he needs to get, you know, all of these pieces in place. And so we kind of leveraged her, lawyer, teachers and professors so that was really cool. Um, but starting a DPC from scratch in a new community where you don't know anybody, um, there's a whole bunch of challenges there.


And, and, and we did it, like I put, put myself, what do they say, business, like put yourself in a position where you can't afford to lose. Um, and that's the position I was at. And I was literally free falling. And I have four kids and a wife in law school and rent on a home.


And, um, and so I just worked really, really hard and prayed a lot and struggled a lot. And, and then some tears, I mean, I just, some hard things in that first little bit, you know, or you don't know anybody and you're disconnected and it's really tough. Um, but yeah, that was a whole, that was a whole challenging.


And when you mentioned those challenges, especially the people who are listening, who are in the early days, or they're struggling, you know, they might be in a six, seven months, two years into DPC and they're still struggling. What are some of those challenges that you went through in terms of specific examples and how did you get through those?


I think the, the first challenge was like, just understanding like business and like, I got to get a business license and I have to, you know, chart a course towards opening a practice and find a lease and all these little, um, snafoos along the way you have to, it's not just handed to you have to go out and get it.


And so there were just challenges. Each, each one was, uh, was a, a hurdle that you have to overcome and not be afraid of and go at it and fix it and find it. It's interesting the whole time. I never doubted, or I just didn't have a ton of doubt. I had, I played a lot of sports. I just got done playing pickleball.


That's why I'm a little sweaty in my car, but I changed my shirt for this. Now I put on, but, but I, I just went forward with like a positive attitude and courage, like fear is the opposite of faith. Right. And I was like, I kind of lean my head this way. And that the mental space was the biggest challenge for me.


Like just staying on an upbeat success trajectory, um, instead of getting on down on myself and fear and doubt and all that other bull crap. And so, um, fixing your brain space is probably step number one. Um, and there's a lot, I think there's a lot that happens in the fee for service space that breaks our brains.


As doctors, as family doctors, It's hard for us to re calibrate to DPC. Um, but, uh, but that was, I took some time off. I took like a month off of taking care of people and, just kind of worked on the, on all those pain points, but also it was good for me to kind of reset my, my circuits a little bit and just get back in touch with my why and loving and care for people.


And by the time that was over, I was like, ready to go volunteer at a free health clinic because I wanted to take care of people. Um, and if you put out that vibe to the universe, I think people start coming in and you, you get to know people and every opportunity to tell somebody about your shop and how innovative and different it is is you're on that upbeat vibe, you know, and it's not to be too like crystal hippy with, but there is a lot to be said for maintaining that good Headspace.


Absolutely. I totally agree with you. And you know, when you're in that head space that you're describing, especially, you know, you're pumped about being able to provide the care you want to provide. You're pumped about your clinic, you're pumped about your offerings, whatever it is, your attitude absolutely changes.


You know, like if you're, thinking about something and you're, you know, , half-heartedly talking about your practice, it's very different than if you're coming at it from a enthusiastic, like, I am so excited. Everyone needs this and I have it to offer. Are you going to be one of the lucky people that can benefit from my services?


So I absolutely agree with you agree with that and love it.


There was a time in my journey where I was getting full probably about 18 to 24 months in. And I was, you know, I was like, you know, I can, I can, I've got a, I've got a decision to make. And I have to either just stay the course with my lifestyle practice where I'm at or, grow it.


Right. And, and I thought my core value is taking really good care of people. Um, and then I developed another core value and that is helping my colleagues into this space as well in a sustainable and equitable way. And I think for those docs that are considering and thinking about it I think what we need to do better is, trust and like your colleagues are not trying to screw you.


Admins, you never know. Right? Like probably 90% of the time they are. Um, but because we come from that space, the docs that I've talked to, I've talked to like more than 10 docs as I've, as I've moved towards growing. Right. And helping them into this space, they're all like, dude, that sounds amazing. I'm going to do that, blah, blah, blah.


But then when we get into discussions about it, they're like, I don't know if I trust you. And I don't know if I'm getting screwed and XYZ and, and I think it comes from a lack of understanding of business. But, but my point is that that I think if we can culturally change our brains to trust our colleagues in that, that they really are trying to help us like, um, like the doc that I brought on a year ago, Infinitely more momentum and growth potential than I did when I started out and I showed them the numbers and I was like, look like at a year in, I was negative, like 20 grand plus, right.


And at a year, and you're positive 60 grand, like that's dope, man. And, and, uh, and at year two, like check it out. Like you're going to make triple digits this year. Like, that's awesome. And I was barely making double digit at year two other that year at year three. Like you're going to be making more than me right now.


Like, dig it man. And like, love it. And, and I, and then when I talked to other docs about that, they, they can't put their head around that. And what is fair? Right? Like my objective is, is to be hyper fair with my docs and, um, in business, most of the time. Their business makes money. Uh, somebody brings in money to the business or whatever.


It's a 30, 30, 30, right. So 33, 33 33, and they'll pay 33 to the person that brought in the bread. And then 33 to the goes to overhead and 33% to like the owners or whatever. And I'm like, I'm not going to do that. Like, I just want to be super fair with the docs. I'm not worried about making money on these docs.


And so like 50% of gross revenue split is like super damn reasonable. And in fact, go try to find that anywhere else, no one will do that with you. Um, I know I'm going off track, but I just want this said, because I think our colleagues have an opportunity to join existing practices and ramp up in a way more sustainable way.


What we can't do is pay them 250 or 300,000 or whatever. We can't do that. We don't make 2 million on ancillary revenue streams like the hospitals do. Right. But we can help you build your own DPC, sustainable practice. And when it's full, you're going to be. Super happy and like making, you know, reasonable living and it's going to be awesome.


And, and so I think, I think that space needs to be spoken to if these docs are trepidatious to do it themselves, to pioneer a practice from scratch, that's really damn hard. Join a practice like mine where I'm like super willing to bring you on. As long as you understand how, how fair it is and that it's a good gig and come talk to me and let's trust each other and let's work on it.


And, um, I think that's the, that's a space that we don't talk enough about, uh, fairness of business and numbers. And what is that firehouse subs franchise almost quit medicine and just bought a franchise. And, uh, and it's, uh, it's $385,000 upfront to buy into this franchise. And then it slowly over about two years will become profitable.


And it'll make you maybe, maybe 180 to two 20 a year. That's DPC without the $385,000. Buy-in right. Like, you're going to get there. You'll get there in two years, but you don't have to pay like 385,000 subway. Go look at these franchises, look at what, what those look like. The benefit of joining an existing dock is they have momentum.


I've done a boatload of things to get the word out in my community. It's not joining, uh, joining a practice from scratch anymore. Right. So I can bring in 35 to 50 patients a month. Right. And, and that's awesome. Right? That's what you need. And if you already have a clinic that's already doing that, then they can bring you on and you can ramp up in a sustainable reasonable way and you can get paid in a sustainable reasonable way.


Awesome. Now I want to delve into that even more because you hit on a hugely hot topic, especially in this world where we're seeing growth and people wanting to do DPC, but the, the business part is intimidating for them. And I, you know, I, that's great that you talk about trust because it is so true.


Especially if someone is coming from a, an environment that is really administrative heavy or pro administration pro money versus pro patient. So I want to ask there when Dr. Brandon Mitchell joined your practice about a year ago, the recruitment process is what I want to ask about, because, , when you talk about putting, your attitude into the world about that, this is amazing.


Everyone should come join it. Everyone should be benefiting from it. We see hospitals, big hospitals, try recruiting over 2, 3, 5 years. So when you were looking for someone to join your practice, how did you decide that the time was right to pick somebody or to have someone join your practice?


And how long did it take for Dr. Mitchell to think about DPC, learn about DBC and then join your practice.


Okay. So this is tricky, because COVID was like kind of instrumental in this process, but, I was still putting the vibe out to the universe about like, Hey, you know, do I want to grow or do I want to just lifestyle it?


And I was still undecided on that. I was like, I kinda like my gig. I don't want to manage docs. I don't want to fuss at them and I don't want to hurt them or screw them in any way. I just. I just want to keep on doing my why and loving my life. And, um, and he kinda just fell into my lap, honestly. So COVID hit, uh, they were in Tillamook, Oregon and Oregon was in clinched mode and that was not sustainable or reasonable for his teenagers and his wife just like, literally, she's like, you know what?


My kids are at home on their computers all day doing school and screw this I'm out. Utah seems more reasonable. Like their, their kids are still in school, I'm moving. So she literally like, and he was four. He was working for events as health in Tillamook and, uh, and you know, the typical brutality, fatigue thing and all that jazz.


Um, he's got some powerful stories. He should, he should talk to you sometime. Um, But she just moved. And so he's like, well, maybe I got to give like, you know, 90 to 120 day heads up on this stuff. And so he puts in his like resignation and then he's hustling in this neck of the woods trying to find a gig.


So here you have like this big hospital system and then you have that multi-specialty group. And then you've got like this family medicine group, that's pretty big as well. And a couple of those. Um, but they're all fee for service and they're all like, trying to figure out how to operate with COVID.


Right? Because they don't have tele-health video chat set up. They don't have any of these things dialed in. And I was already in function for a couple of years prior to, to any of that stuff. So it was no big deal for me. My growth just continued to kind of move forward. Whereas there, they were kind of reeling with all this, you know, oh my gosh, we just took a 70% hit on our profits.


And none of them were hiring and, uh, he's got a wife that lives here, so he would've kind of put in a little bit of a pickle. Um, and, and he came in chatted with me and he's, he's like, you know, this is kind of cool. And, you know, I, I thought about this and this, this would be a great way to take care of people.


And I'm like, well, awesome. So we talked a bunch and, uh, he's very similar to me, like similar in age and similar and like his why. And, and so we hit it off really well. And so it was really kind of a blessing, I guess, like just the universe provides. And, uh, then he came in and he has been awesome. He's been a great partner and we've talked a lot and we joke a lot and have a lot of fun.


And, um, and it's been really cool. It's been really cool. It's been, it was hard for him and over the past year, I could see some of those same things that I had coming off the fee for service space. Right. And I had to like reroute the brain cells and stuff. And I was just patient with the process. Like one of the interesting things that like, I didn't realize I was doing, I was a little bit sarcastic and pessimistic a little bit like, uh, it was, it was, I think it was honestly just, uh, just like a coping mechanism for, for the brutality that we were all under.


And so, uh, so it took me almost a year. I recognized it. I'm like, I don't like the way I am now with my kids, with my patients, with like life, I need to not be that way. Be more kind and sincere and direct. And, um, and that was really helpful. And it shouldn't have Dr. Mitchell had some of the same stuff and I'm like, oh, I've seen that before.


I've actually done that. And, uh, and so we talked about it a little bit and he's been awesome. He's he's so great. And it's been really fun to kind of deal with some of those things that the fee for service space brings to all family docs. It's like, it's like trauma for frankly. I mean, it's, it's, it's traumatizing and, and we have to like deal with the baggage, right?


If we're bringing on colleagues and we're helping them grow, like we have to deal with that. And or if we're, if we're doing it ourselves, we have to address those things too. And we have to look inward and we have to say, I need to be nicer. Or, you know, I need to, I need to change some things, you know? And, and I'm just recognizing that that is a thing that, that it's from us, uh, a really dysfunction.


Process of becoming a physician and then working as a physician in a very broken model. And, uh, it's healed me like it's healed my family. It's healed my brain and I'm a nicer person and a better person now before and stuff. So it's been nice. I love


that. Now, when you talked about the 50% revenue split, I want to ask a little bit more there because when Dr.


Mitchell was saying yes, I want to join the practice, how was it set up in terms of, did he have revenue coming in because you guys had started a pre enrollment list and then is that 50% split is that going into the future, non-stop or is there a change at some point, uh, depending on how many patients Dr.


Mitchell carries versus you carry?


this is kind of a, uh, uh, an equation that may change and continues to change. And that's the beauty of having a JD MBA on your back? Like, she's, she crunches the numbers and she's a spreadsheet wizard, and she actually shot off and talking about Sean, my wife, and, uh, I've been, so she's been awesome to kind of help us, um, figure out the equation and then keep working that equation and make sure that it's fair to everybody.


Like, again, our core value is fairness to our colleagues and let's keep looking at that. And so, right now it will be 50% moving forward and going on into the future and, um, Zero profit. Right. And, um, and it's not my objective to make money on my colleagues. Like that's not my objective. I, my objective is to continue to grow the model and continue to help my colleagues from this very demoralizing model, to this really beautiful model for caring for people.


And I think families deserve that kind of care in our community. And so we can continue to do that. Um, but making sure that we're fiscally viable makes sense too. And so, uh, so I, you know, I just continue to crunch the numbers and make sure that 50 50 split is reasonable. I've talked to a boatload of my colleagues that are doing stuff, and some of them are 60, 40, uh, 45, 65.


Some of them are, are even, you know, leaning more towards the dock, you know, and leaning away from that. It just depends on, there's a bunch of variables that go into that. And I think you just have to keep looking at, at your numbers and making sure that they're real. Um, I use Atlas MD and it's not the best for backend number crunching goodness.


And, um, and so we've created actually our own. Shawna can actually create a software that engages with Atlas. So she can, she knows the, codes for, um, spreadsheets for Excel. And so she can create a program, an Excel program that engage us with Atlas, pulls all this data and does really cool things and gives you actual real numbers.


And, uh, it's been really cool to have it like a super nerd in the background with me and making sure that that 50 50 split is hyper fair. And what I've done, I've looked at the numbers and I said, you know what? The 50 50 split actually gets you to make more than I do. And that's where I want you like, look guys Hyperfair, um, it, it, uh, it is a process, a ramp up process, but, but it is super duper fair.


if they do it themselves, right. They do it themselves. They might make 10 to 20,000 more maybe, maybe. Um, but probably not because their ramp up is going to, you know, and I, and I actually have a little graph that shows like my first year negative, his first year, super positive, like 60 grand second year, I was like reasonable.


Anyway, it just, my ramp up versus his ramp up, he's saving like hundreds of thousands of dollars in like maybe not a hundred thousand, but like probably like 60 to $80,000 in that whole process, because I can get money to him quicker because I have a system in place that actually brings patients through the door, like right away.


And, and so. So that, that's how I was able to get money to them quickly. I think, um, there are different practices that do that somewhat differently. Some of them do like a hundred percent goes to them. And then after a certain number of patients, then a hundred percent comes to us. And I was just not willing to do that.


I just said, let's just do a 50 50 split and make sure that, that, and just keep looking at that and make sure that that's fair and, uh, turns out to be super fair. And in fact, more, more, maybe not so fair to me, maybe. I don't know. I just keep looking at that and I'm like, oh, there's like, no, like, you know, and as long as like it's a seamless, good process where the doctors.


Great and fun to work with home run. But if it's like a fussy process where the ducks are like difficult to work with, it's not worth my time. Right? Like, why am I, why am I doing this for you? Like, you gotta be grateful and you gotta understand like this, this is a good gig for you. And, and so, um, so that's like the challenge is, um, again, it's in the minds of the docs that we, that we are talking to.


And as long as they can understand what is fair and perceive that as fair and, and recognize that as fair, because if they perceive it as unfair or, oh, but overhead is only here. Once I get to this many patients, overhead must be met and therefore, blah, blah, blah, blah. Nope. You just, Nope. You got to keep thinking back to fairness and, and you got to keep you just, it's a ma it's a mind thing.


If you can put your mind into like, oh, this my colleague is being super fair with me. I can, I can be happy about that. Like, but we come from a system that, that creates a brain that is not that in the docs. Right. A super distrustful, super, like you're trying to screw me brain. And, and so it creates difficulty in me trying to fairly help my colleagues.


Right. Like, I'm like, Hey guys, I want to help you. Um, cause they come from a very like trepidatious, like culture where everybody's trying to screw them. And so, um, so that's the challenge, I think.


And then when you have this agreement in place with the 50% split, how do you guys take care of marketing, overhead?


All of the practice costs.


Yeah, I do it all.


So none of that comes out of Dr. Mitchell's, revenue from the patients.


Correct. And that's why it's hyper fair because, because I'm not charging him overhead, right. It's not 50 50 split net. Right. If it were an in fact that might be more fair to me if it were 50, 50 split after, you know, net, but I'm doing like gross, which is like, put your head around that, like, gotcha.


That's incredible. That's incredible. And I take on the malpractice, I take on all those other pieces, cause I want to make it smooth. And frankly, I want to get money to these docs because I feel like man, well, let's, let's help them right. In a, in a less, less painful way than I had to go through. And so my objective is to be, as pain-free as possible, helping them ramp up in a way that's reasonable.


And uh, and I'll, I'll assume some of that risk and that's okay with me. Cause, cause again, my wife. Is like fairness to my docs and let me, and really good care to my community. And, and so that's the, that's the challenge is helping the docs perceive that as fair and understand that as fair, because it's gross 50% gross and no worries about overhead.


No worries about any of that other stuff, those create tug of war matches. If you create a contract that like is contingent upon overhead, and they're like, Hey, you're spending too much money marketing, like, blah, blah, blah. I don't want to blah, blah, blah. Nope. I don't want any of those little fussy matches.


Right. I'll take all that risk on and I'll do all those things and, and, and we don't need to play tug of war. Like that's what you did with your administrators at your hospitals and your clinics and all that crap. Like we don't, it is super not worth it for me. Like I'm not making money here. Like, you know, I'm actually losing a bunch of money.


Um, and so if it becomes a fuss match, like very quickly, I'm like I'm out based. I don't want to manage docks. It's too fussy. And, and, and I hear a lot of my colleagues Nash. Are trying to do this or have hired a doc and then it didn't work out. And I never want to do that again. And it's because they're hiring a physician who's traumatized by a system that demoralizes them, beats them up by administrators and, and screws the crap out of them, squeezes them for all they're worth. And when they come into a clinic, that's like, Hey man, just trying to be fair. They're still have all that baggage.


And they still act that way. And it's really tough. It's really, really tough. I totally get it. I just muscle it. I'm like, Hey man, I'll just keep showing you how fair it is. But I hope that you perceive it as fair at some point. And, and these docs that come in, I'm talking with them and helping them understand.


And they, they, they're still all, like, I don't know, like, is there a blah, blah, blah. And I'm like, no, like my margins aren't there for that. And it's just not how it works and go start your own and you'll make, maybe you'll make less than they made with me and that's okay, go do it, go do it yourself. And when I don't know, and maybe you'll fail, maybe will maybe a win.


I don't know, but I've got systems in place trying to help you guys with. And I just want you to be happy


when you talk about systems, you mentioned that you have a system even for bringing patients in. So can you touch on how does that system work for voyage and does that, uh, does that pertain to how you market it in your area?


Yeah, so, so really honestly, and this is, this is national trends. Um, there are like outreach systems that we have. We have meetings. We have like once a once a month, like, like doc talk things and we have all these little, like, you know, get the doc out in the community and get their face out there and get them to know people.


And those are all very good for, for that physician, but, but really like most DPC growth nationally comes from word of mouth. And so, so if you have a bunch of raving clients, they just keep telling their friends. Right. And so, so, um, I'd say even now, like 90% of Dr. Mitchell's growth over the last year has just been.


Having the patient clientele that I have and them telling their friends and, and I'll, I'll send an email out to all my clients and say, Hey, w w w we brought on Dr. Mitchell, let me give you his bio. He's a fantastic doc. He looks like me basically. And we're super happy. And we love people and keep telling your friends and family about, about Dr.


Mitchell. I'm going to cap my practice at this time. And all new growth is going to go to him. If you have friends, family, or relatives that you feel would, would benefit from this beautiful model of caring for people, please let them know. And, and then all that growth just goes to Dr. Mitchell and it's been awesome.


We continue to do other things. You know, the KSL articles, KSL is like a news, like a newspaper digital media thing locally here. Um, so we do some of those things and we meet with the mayors and we do townhouse town halls, and we do all those things too, but. Maybe they help us grow a little bit. Um, I I've, I've, uh, I've hired somebody to take on some of the networking marketing thing and go out and meet in these groups and do you know, the BNIs and do, you know, a bunch of little networking groups and stuff and, you know, to hopefully continue to some more growth.


Um, we've done a little bit more on the B2B space as well. And, um, and that's been, that's been pretty cool. Um, I've mixed feelings about that. And we can probably this, a whole nother question, but, but we can go there another time. I'll pause out the table that for later


one of the things that you've mentioned, um, and I'd love to hear more on this is your why. And so I want to ask about when you have your wife, Dr. Mitchell has his wife, they're very similar. And then you add staff to the picture.


I want to ask, how do you have your staff, whether they're new to DPC, whether they're new to, you know, being a medical assistant or whatnot, how do you get your staff to understand your guys's? Why and the why of DPC and how do they, you know, how do they get that Y out to the.


Yeah, this is such a great question.


Having a very strong why, and then recalibrating that why, and then staying on that, why I think is super important. Um, you have to have a vision and in that vision has to be a very clear expression of your why. And each staff meeting that we have. We always read our, our vision. Here's our vision guys, beautiful healthcare to the community in a cost-effective way.


And, and that's really it. And, and so, um, we will sometimes at staff meeting, ask someone to share a story on how there was beautiful health care delivered to a family in the community. And I'll, I'll assign it ahead of time. So they have a quick prep thing. And, uh, and I'll ask, I'll ask the front desk people because they hear right.


They hear the patients saying things, and then I'll ask Dr. Mitchell, the sheriff, or I'll ask, you know, and I say, guys, you're part of this team that is doing something very. To our community. And it's lovely. And, and, and you want to feel a part of this social. If there's like a, I don't know what they call that, what do they call that?


A, when you give back to your community, it's like social capital or something, but you want, you want to feel that, right? Like, could a pack see like 10% of your stuff goes to the blah, blah, blah, people and over whatever. Um, we are that, that is our mission. And we are, we give back so much to these families and they have an abundance mindset around healthcare now instead of a scarcity mindset where they just don't go in and, and, and we just, we just talk a lot.


We, and it's my job to continue that. Remember, we talked about vibe and frequency. Like I gotta stay on that positive frequency and then, and then be contagious about it. Right. So, and, and if a problem comes up, which inevitably does staff meeting is about discussing other ways to improve the system, to deliver this care to people.


Um, I'm, I'm, uh, I'm still positive. Let's, let's talk about that. And how can we fix that? And what solutions do you have? And, um, just maintaining that upbeat, positive frequency, I think is the key as the doc to spread that to the rest of your staff and give them assignments to, you know, maybe post something or create something or, you know, something along the lines of what we're, we're trying to accomplish.


It's a, it's a challenge, you know, I think everyone, you can't control people's brains. Right? And, and so, so to stay on a contagious, positive frequency, um, is tough. And, and to spread that to staff members, here's our. Let's stay. Let's make sure that we're still on our core value. Um, along the journey, uh, we're all going to be faced with temptations, to deviate from our why.


And I want to talk about this briefly because I've had to recalibrate several times because I have an entrepreneurial brain and my brain can go in all kinds of really entrepreneurial directions and that's cool. Um, and those could be sweet revenue streams, um, but do they maintain your core value? And, and as I've rolled back off of some of those temptations, um, I've had more fulfillment and more peace and I tend to overextended and turtle back and overextended turtle back.


And, and, uh, and as long as your sound with your core value of your, why I think your extensions will be sustainable and reasonable. And, and stay in line with who you are. Um, I live in a community with a whole lot of, uh, healthcare practitioners, chiros, and NPS, and PAs and people. And they're doing things that are outside of good care for people.


Why they're there? Why is calibrated with let's make a boatload of money and, and how can we create a system that puts on an air of expertise in this area and charge $3,000 for this thyroid thing? And I'm a, I'm a thyroid expert, cause I'm a chiropractor who went to like six weeks of a thyroid course.


And I put together this really cool package. That's, uh, you know how to fix Hashimoto's and we have tons of those in our community. And, um, and so I think, I think those people have gotten off kilter with a reasonable Y, which is we went into healthcare to take care of people and we got to stay on that vibe.


And so, you know, whether it's it's dabbling in, oh, do I want to, do I want to branch out into like aesthetics or maybe just some hormone stuff or maybe do some whatever's like, you gotta like, keep looking at that and say, okay, is that, is that in, does that, does that align well with my core values? And is it ethical and, or am I just milking my clientele for more money?


And, and so I think, I think we just have to continue to like assess our why, make sure that we're calibrated and then say, it's okay to leave money out of the picture and say, yeah, I can make a boatload of money if I did that thing, but it doesn't line up with my why. So I'm going to leave you alone. And, um, and that's an okay thing to do.


And it's hard sometimes, but, but it's actually great.


The model of DPC just helps us have the space to. Look at our Y evaluate our, why, you know, reevaluate, recalibrate, like you're saying, because of the monthly membership in typical, DBCs like when you're having a patient or their family join your practice, that is income coming in every month versus the fee for service, you know, eat what you kill mentality.


And so when you talk about that, DPC allows you the time to have space to recalibrate. Um, and I think that, you know, people have their schedules, they do, you know, financial Fridays or admin Mondays or whatever it is, but that definitely can be something to help your yourself, your team, whoever is in your DPC, um, really continue to follow the dream and your why as you go into the future.


So I think that's really smart. So can you give us some more demographics about voyage DPC?


Yeah. Um, we have patients from just about every socioeconomic status, um, outside of Medicaid because we can't do too much Medicaid stuff, but, um, we have people that are more wealthy people that are less wealthy. We have people with insurance, people without insurance.


Um, I'd say most of our people have insurance of some kind. And as you know, insurance is too. Copays deductibles, often confusion and, um, and not real care the way that we do it. And, and so, um, so to me, that's the broken piece of the equation. And people here would, when they go to a doc who sees 40 patients a day and they see what that product is.


And at that same organization, the doc per mid-level ratio is about one to four or five. And so half the time I see mid-level and the other half of the time, it's a hurry up visit with the doc. And so they're just disenchanted with that product. And so, as we're seeking clients, I think you just speak to the pain points in your community and, and our communities are all very similar.


We all have similar, similar people that have similar pain points with the current healthcare system. And, and so as far as demographics, I think, uh, I think it's more. People who have had enough pain points with that system to recognize that and appreciate what we're trying to accomplish. Um, most of them are like, at least in their like late twenties plus, because they've had enough run ins with the current system to recognize all the broken pieces.


Um, the younger couples, we've had a few of those signup too. They're so sweet. Um, but then they're like, well, we just don't go to the doctor and we don't have a good, so they haven't gone enough. They haven't had enough of those run-ins with the system to really appreciate it. So I'd say the young couples are less, um, and they're the ones that.


That we have insurance now. So we're going to fly away. They're the ones that apply away on you and that's okay. That's fine. They're going to go have insurance for three to five years and figure out how broken it is. And then they'll come back, um, when they're like 30 or 35 and they're like, okay, well, super happy about that.


Um, so that's our target target people mostly that we're trying to let let know, um, about our, our plan, um, usually like in their thirties to like sixties and, um, and they want something different as far as a healthcare product. I think as far as family medicine, we're chopping our own legs off in the fee for service space, by delivering a product that is, sub-par using 2% of our brain cells to have a five to 10 minute visit.


And, uh, and understandably, so people are being disenchanted with that service product because it's not real service. And so, um, so I think we're hurting our own profession by continuing in that model. Whereas in this model, we have an opportunity to distill our brand as family dot. Use 90% of our brain cells in helping to figure out and solve these these issues and, uh, and bring something different as far as a service to our communities.


Um, that's, that's key. I think DPC fixes our profession in so many ways, whereas the fee for service model, uh, why am I hiring docs when I can hire nurse practitioners and PA's to spend these five to 10 minute visits on folks. And, and so, so it's understandable why the CEOs and CFOs and administrators of the world wants to just scale with NPS and PAs, Utah last year passed a law, allowing PA's to practice.


Um, like dumbstruck, I, that they're never designed to even do that. Or even like, it's, it's, it's the quality of care and the service base will continue to diminish and in the DPC space will continue to improve. As we have the bandwidth to, to sharpen our, our family medicine brains, you know, Yeah, sorry. I went down another rabbit hole.


That wasn't your question, but you're welcome.


No, I want to ask about, um, a little bit more about your patients, because, and I know this just from our previous conversations, your marketing strategy is also involving patients who are part of your practice. So can you please talk to us about how you made the connection with somebody who helps you with marketing at wedge DPC, who happens to be a patient?


Because some doctors are like, eh, not too comfortable with that idea. And some doctors are very open to that idea. So how did you wrap your head around? Look, here's a patient who's doing marketing. They understand my practice. I'm totally on board with them helping us grow at voyage DPC.


Yeah. Um, I could see what docs would be trepidatious about this.


I'm hesitant. I could see that, um, I think you have to be careful and have boundaries and stuff, but, um, I think some of that is fear minded, right? Fear, mindedness, and fear mindedness is, is the exact opposite of abundance mindedness. And, and it's, it's the it's, it's not the frequency of success. Um, it's so, so I I'm just like, Hey, you have a video, uh, business, and you're an entrepreneur in the community and you support voice rec primary care.


Let me support you. How much is it for like videos? And, and can we put something together, a package that works for me and works for you? And he's like, totally, here it is. This is how much it is, blah, blah, blah. And I'm like, cool, that's way more expensive than I charge you, but sweet. Let's do it. And, uh, and so, so it's great.


Yeah. And, uh, and I think leveraging those kinds of people in a professional way, and just saying, I would be a little bit, um, cautious with trades because in, in direct primary care where we charge like this much money, we don't charge a ton. We're not MD VIP, we're not concierge. They charge five, you know, two to five times more than we charge.


And, and so when you're talking trades like, Hm, it's probably, it's not dollar for dollar because our goal is 20 years of caring for your family. And your goal is like one or two sales. Right. And so you're trying to make a bunch of money right now, whereas I'm just trying to be sustainable for everybody longterm.


And so, um, be careful with trades, but, uh, I wouldn't be afraid to use use clients. So, um, I have, uh, I have a lady who manages my Instagram. She's a client and she's. She has some ideas. She's like, you guys kind of suck on Instagram and it's like, yeah, we do. Thanks for your help. And so she has some ideas and she tells me, and I'm like, great. W w what does reasonable pace sound for you?


And she's like this much per hour or whatever. And I'm like, sweet. Let's do it. And, uh, and it's been great. Um, I think it has to do with just being, um, abundance minded and being willing to, to take folks. And if they see a way to kind of help you then be like, yeah, let's do that. And, and it's been, it's been great for us.


We don't have any qualms doing that kind of stuff. And on the professional side, hasn't interfered with our ability to care for them or anything like that. It doesn't get weird or anything.


And, one way to really address upfront the position that you might be in, especially if you're a physician looking to hire somebody who is, a patient would be to say, Hey, look, this is not going to affect the way I care for you because you're my patient at the end of the day.


But one of the things that, you can also think about with that potential patient who might be doing work for you is to say like, Hey, let's try this out. Let's see how it works. And at the end of the day, your decision is based on business, not by emotions. And so I think that that's something that can help in entrepreneurship when we are in a altruistic profession when we switched to altruism, but we're also a business owner.


It really comes down to, you know, is this person doing the job that needs to be done no matter if they're a patient or not. So,


oh yeah, sure. Yeah. Yeah. Thank you for chiming in on some tips and tricks too. I don't have all the answers and I love it when you, when you have some cool ideas, too. And, and I would, I would love to have think tanks with our colleagues, you know, like ways for them to comment on, on our conversation and give me some advice too.


Cause I'm, I'm all ears, man. We're all just kind of figuring these things out and it's helpful to have brilliant minds. Our, our colleagues are brilliant, right? They're brilliant people. And, and it's fun to hear, hear their stories and hear their solutions behind some of the things that we talk about. Put it in the comments maybe in, and let's talk about it for me.


Definitely. People can feel free to comment on, , the, my DPC story website, um, all of the blogs that are accompanying each interview. I believe there's a comment section there. And then also my DVC story has a voicemail. So if people are familiar with other podcasts, like radio lab, where, you know, people read the credits, you can actually call in and we have a question of the week going now, what's your biggest DPC challenge.


And so people can call in and those questions can be answered by future guests. So definitely we are open to comments and questions because that's how we grow this movement. We learn from each other. So , you, you know, came to this community that you're living in with no real base to start from, you're looking into, you know, do I continue in a fever service job?


Do I open DPC? You decided to open DBC, and now you're going from a space that you've been renting to a space that you now own. So can you tell us a little bit about that journey as to, you know, when did you decide that you needed to go into a bigger space and what made you decide to buy this new space versus rent?


Yeah, so starting out, it's all about being scrappy and efficient. And so I like had a doc colleague who is a neurosurgeon and he has, he just built a new office that happened to be outside of the non-compete from that I was having with the fee for service gig. And so I just like, no problem. I just office up there.


And, uh, and he's there literally like once a week and it's, so he's got space, it's like a 4,000 square foot office. Yeah. And he's like, I'd love to sublease some, some examiners to you and I'm like, sweet. Let's do that. And, and so at first I had one exam room and then I was like, oh, I need to, and then I, I grabbed two, he just has the flexibility to do that.


And that was awesome. Um, it's in a super nice building right across from the hospital. So rent was not cheap, per square foot, you know, and, but, uh, but I just rented a teeny little bit of square footage. And so having a nice office like that honestly was, I was like, I could probably rent cheaper somewhere else, blah, blah, blah.


But that, that was actually great for me. Like the clients would come in and like, well, we can wrap this a nicest waiting room I've ever seen. It looks like a spot. It's incredible. Neurosurgeons are a different animal than we are. Um, but, but it was great, like for the repeatability of the practice and they knew that it was docs and you know, it was fine.


but then I came to a point where I was like, man, I'm ready to go. Um, I brought on another doc and like three and four years in, I was, I said, I probably need more space. And I'd like to roll out a health book program and, and get more equipment and do some different things. And, um, and so I just need a little bit more space and, and I started looking into purchasing, uh, that's a whole nother challenge.


the commercial real estate does not have a centralized database, like MLS, like for the residential real estate. And so, that was really tricky trying to figure that out. And it's honestly better for almost like a you or a staff member to start, like looking into that because, um, brokers don't have your back.


, they have their properties that they're listing and they'll show you those. And then, then they, they don't go bird dog for you, right? Like you need to be your own bird dog there. Um, you need to be looking at your newspapers, looking at your local everything, and try to find something.


And so, yeah, so that's that, that's, that's, that's the key. I found it, I was able to find a place that was within my budget and kept my mortgage reasonable. And, uh, and so in as much as we're into continuity of care, like we want to grow for the longterm and we don't take care of these families for 20 years.


I think it makes sense to have your own office, if you can. And at some point in your, in your journey to start looking at that and say, oh, you know, my revenue streams are here. They're very solid. And I've got my patient panels pool, and boy, it should be nice not to pay, lease anymore and to have my own shop.


And from a tax standpoint, you, you can write off your lease, but you can't as a, as a doc. And so there's some, there's some pieces there that you have to look at and, um, and make sure that that makes sense, you know, with your business accountant and stuff like that. But, uh, but for me, it's a, it's a, it's another investment for us.


And so we're going to pay you do it under a real estate holding company. And then, um, it's been awesome to have Shauna to just set that up for me. Like, well, let's just set up a real estate holding company. She's like sure. Um, so one of the luxuries of having a lawyer in the family. Um, and so, so yeah, so we've got that dialed in and then we just pay leads back to that.


And can we win? Gotcha.


And yeah. When with you having Shauna on board, I definitely want to ask when you guys were even looking at, um, the contract to purchase, were there any points of contention where you're like, I would like to negotiate best? And what were those negotiations?


, it wasn't, it wasn't a huge ticket.


Um, the biggest thing right now is that that commercial real estate is, is always tenuous. And it's tricky, like in my neck of the woods, it's very expensive. Um, COVID like actually made it worse. I don't know why it doesn't make any sense. Um, I think realtors are always pumping the market, like, cause they make percentage of whatever it is.


And so they're always trying to push you north. And so that's super infuriating for me. Like, ah, man, I can't deal with those people. I'm like find me a deal, man. Don't try to push me into, convince me to buy, you know, spend more than I can budget. Like that's dumb. but uh, yeah, it's, uh, it, I didn't have any issues with like, Hey, you shouldn't negotiate this or that.


I felt like the contracts were good. And, and we, they were like, we, we made sure that we did a quick evaluation, just like you, when buying a home it's similar steps. You want to make sure you have a home inspector come out and take a look at it and make sure there's no wonky things that need to be fixed before you move in type stuff.


One of the things I want to ask about specifically is your recent trip to Kenya because you have a panel, but yet you were still able to go to Kenya and you've been able to, like recently you were in California in the redwoods, um, you've been able to take family vacations.


So can you touch on balance in DPC when it comes to being able to take time off to do the things that you know are speaking to your why as a person?


Yeah. This is such a good question. We come from a culture and a space of, um, work harder, make more money, work harder. Don't be a pansy work harder. And literally it took.


Uh, years after residency to take more than two days off, I couldn't, I would start twitching, you know, the Twitch stuff, I gotta go work. Um, and then I, I got to where I could take three days off and four days off and, and, and find time for play. Um, I want to speak to that just for a moment, like finding time for play, like, as, as docs, we have to have interests and things that we enjoy in life.


And, and whether it's, whether it's like, like walking or jogging or running or working out or playing pickleball or arts or whatever it is, um, it's hard to, to show up your best self, if you haven't had play time, right? Like I need to go play and have fun and smile and laugh and have a good time and do something fun.


Um, I think if you, if you have play incorporated into your life consistently, um, it, it helps you stay on your why it helps. Be the best person you can be. And, um, and my play has always been sports. I played a lot of sports. I played basketball and football and soccer, and I played rugby in college. And, and so, um, it's good for, that's my Prozac or whatever.


Um, and my wife has been really patient with that over the last 20 years. She's been really kind of, um, so like even now she's like, I just got home and, you know, anyway, so, so, so it's nice having somebody who understands that your need replay. But taking that time to honestly play and pickleball is the answer.


Guys, if you're not playing pickleball, your dummies, like you're, you should be playing pickleball. It it's just an incredible sport. Uh, it's super fun. And the entry point is a low and you can just take it to whatever level I play at a really high level now. Um, but, uh, but it is a blast. It is so fun and it's technical and it's very brainy and then you sweat a bunch and it's fantastic.


Um, so that's my player for pickleball. Um, but, but having that those times and taking that time to relax our brain and not be so transactionally driven, cause the fee for service space creates our transactional brain, right? Like if I'm not working, I'm generating less RV use, which are, which are counted against my bonus.


And so cash, this vacation cost me 20 grand, you know, like don't think that way, like we can't think that way DPC fixes that because we just have a membership model and, and so it's great. I take some time off and. I get time off and it's okay. Like my revenues aren't like, I gotta be worried about whatevers.


Um, you always gotta be thinking about patient care and stuff, but, but, but always, I always give my patients a heads up and they they're totally cool with it. And, um, and it, and it works out just fine. Um, we did Kenya, um, this last August, uh, I have a son going, he went off to college and, uh, and that's hard for me cause I, I, you know, you think back as a dad, you're like, you know, med school, residency, rural medicine, like I could have been around more like, you know, I don't know.


So, so I was like, let's go do a thing to Kenya. And, um, and, uh, and so we did, and it was awesome. We had a cool ma medical mission trip. We were on, uh, in the slums of Nairobi, a little place called . And, uh, and we hung out there is low birth center and a clinic and it had a couple of docs and it was really a special experience and it was fun to take my son.


And just show him like the world is big and there's all kinds of really cool people and really cool cultures. And, um, and they all need good care and it's really fun. And, um, and I come from a rural family, so I did lots of OB and stuff. And so we were able to just talk about some things and I didn't, I didn't go, I didn't go in like trying to fix anything cause that's kinda silly cause I'm only there for a minute.


And um, I just went in and just try to listen and understand where their challenges were and understand their system. Cause it's totally different than our system. And, and then understand like, and then make some, maybe some ideas for innovation and some ideas for improvement on these, these little spaces and stuff.


And, I can give you a quick example if you want, if you want to go there. So, um, so in, in family medicine residency, I was in Jacksonville and, and I had neonatology in house. I had. MFM and house I had, I had, I had all these access to all these specialists like right now. And so I could sit on some strips for a little bit longer.


So some babies that weren't doing so well, or maybe have maybe some variables, maybe not limits us to sit on this for a bit. Um, and so I could take those risks because my time for baby to C-section was much less. I could, I could get a baby out in less than 10 minutes, um, or, you know, or, or time for a consultation was less, all those things were much less.


And so as I moved to Moab, I had to recalibrate because, well, I don't have these people in house. Right. And, and so I had to, and it took time because I was like, whoa, like I sat on that too long, took a little bit too much risk there. And so I had to rethink that and roll some of that thinking back. And, uh, and while I was there in Kenya, they they're in this little, like, literally like the upgrade was that they have cement on their floors now and before it was just dirt and, and they've got like, they have a new.


They have some oxygen, but it's not mixed and it's dangerous and they're doing some stuff. I'm like, whoa, this is like not okay. Um, but, but we talked about, like I said, okay, so how long does it take, uh, a mama and baby in trouble to get from here to a tertiary care center? And they're like, and it's not far, it's only like a mile and a half, two miles away.


And it was two hours on average. And I said, okay, well then you have to think four hours ahead in managing these situations. And if you see something that could potentially go south, you play good defense and you get that mom and baby ship, don't sit on it. Right. Because then you end up with dead babies, dead mamas, and that's not cool.


Um, and so, so that was, it was just, uh, it was just like clinical disposition training basically. And so I was like, okay, I had to check, I had to fix my clinical disposition. Cause it was different in the city than the rural setting. And it's even more different here. And I shared with them, my, my experience in doing that as well.


And they're like, oh, that makes sense. You know, they have like probably 15 midwives that deliver in that community. And then they have a couple of docs that kind of help them as well. And, and so, um, yeah, that was, that was fun.


When you moved to voyage DPC, you've, you've mentioned this also Social platforms, not only have you seen birth, but you've also seen Fullscope care, including death. And so one of the patients that you had done fundraising for, you know, it clearly came out that you treated his family as if he were your family, but your patient, Ethan, was a patient who passed away recently at a young age from rhabdomyosarcoma.


So can you touch on how your practice, how voyage DPC has allowed you to not only view and value life differently, but what has DPC allowed you to do that you couldn't do in fee for service, especially with, patients like Ethan and his family?


Yeah. Um, this has been a journey and you know, our initial diagnosis was.


Was tricky. He was lifting a box of books and threw his back out. Right. I hurt my back. It was listen to that really heavy box of books. And he's a 17 year old kiddo and he's pretty thin. Right. But he's always been, and I've known him for a few years now. Um, and so I thought that's really odd. That's really odd.


Um, but, uh, but it, what does it feel like? And he kind of talked to me and I was like, okay, well, let's just say common things are most common. Let's say you threw your back out. And I asked him a few more questions, and this is why this is the difference at DPC time to ask more questions. Right. Anywhere else, if you went to urgent care, you went to anywhere else, it would have been five minutes.


You throw your back out living Bible books, man, here's the stuff. Right. So I said, Hmm, I asked a few more questions. And he gave me some responses that just red flags, right. Just a little bit, little bit. And I said, okay, that's really odd. So let me just, probably not necessary, but let me just check it out.


So I check an x-ray and the x-ray comes back normal, no lytic lesions. I was like, okay, so we're safe. We're going to do this. And, and so plan of care, pretty good. Pretty standard threw my back out. Um, a few like a, like a week later, mom texted me DPC difference. Right? She can just text me. She gets through, she says, Hey, you know, uh, it's not doing better as a lot worse actually.


And he's, he's got some numbness in his growing I'm like, what? No. So then I'm like, spidey senses are like on, you know, 10 out of 10. I said, we got to get a stat MRI. So we get a stat MRI. And, uh, and th and it shows this giant cancer in his spine. And, uh, and I called immediately, I got the results and I call immediately to he and his aunt to the mom and dad.


And I said, Hey guys, this is a serious situation. We need to get him to primary children's hospital up north right away. And the fact that he wasn't caught Aquinas. He wasn't totally, but he was starting to have some of those symptoms. And so we got him there right away and, uh, and they did surgery on him that night to decompress some of that area, giant tumor in his spine.


And, um, and then they kept him and worked him up for all these other things and figured out what it was and tried to find the origin pet scans. I mean, it was, it was the whole, the whole gamut. Well then we've got, you know, 99% of his cares. Hem-onc right. And so, um, so I'm, I'm there. And one time he was up there and, um, just shortly after his diagnosis and I drove up and I visited with he and his family and, and, uh, we talked a little bit and, uh, and just, just kind of was, uh, there with them.


And, and I was able to just be present and not have solutions or anything, but just be there with them as they endured some of the initial diagnosis process. And then as time went by, he was doing awesome. He got lots of chemo and lots of radiation, and it was really tough on him. Um, ended up with a JPEG, just for feedings and stuff.


Um, just to be a source of, of support for them. And they could reach out any time. probably several months in, um, we were able to have a pickleball tournament for him, like a benefit pickleball tournament and, and that was really special. And, uh, we raised like six grand for his family to help him with copays and deductibles.


Right. Um, it had been the end of last year and then into the new year. So a whole new set of copays and deductibles. And, um, and I, and knowing like the morbidity mortality rate with this is like, you know, survival was maybe 7%, you know, if he's lucky and, um, and so, you know, just anything that we can do to help this family is, is great.


and then. I was able to do some house calls and just check in and see how things are going and, and talk to mom and dad, anything and, and visit with them and just spend time and, and see how things just check in. And, and that was really great. Um, and then, uh, and then after he died, you know, um, being able to attend the, uh, the funeral and, and to be a part of that whole it's real life, right.


It's it's real life. It's, it's it's, as I think it's special. I think these moments are very poignant. Um, they're as pointed as birth, right. And, and those two spaces of the spectrum are really challenging, but they're really beautiful. And, um, the whole time he was pretty positive and he was. Always upbeat.


And he was never discouraged. And I was like amazed at his resilience. Right. And even into death, he knew he was dying and he, he still was like, you know, cracking jokes and, and, and he was just an awesome kid. And, and to be, um, to be involved in such a way with their lives, as their, as their family doc was really, really special to me.


, and really, , in a fee for service space had been really difficult to do some of those things.


Absolutely. And when you talk about the beauty of life and the peace that comes with death, that it definitely is gut wrenching at times, but at the same time, the fact that you were able to.


Give your expertise, your support as a physician and as a person who is a physician treating their patients like family, what a special thing that it's, it is really hard to do in fee for service. I remember times, you know, too many times where I just called people after hours because they didn't have the time to do it during clinic.


And I'm sure listeners are, you know, thinking about the times that they've done similar things to be able to be there for their patients. And that was that's what matters. And that's, you know, your why that's my, why, that's why we go into DPC. So, on that note, Are there any other words that you want to share with the audience?


Definitely go play pickleball, definitely find your play, whatever it is, find your play and do that. Consistently. When I started out, I was stressed. It's stressful, starting something. So I played a boatload of pickleball and, and guess what? I met all kinds of cool people in the community, and I told them about my shop and it was great.


I write off all my pickleball expenses, this hat, I wrote it off because I use, I use all that stuff to help grow my practice, find your play, go get involved in the community and play, uh, preferably pickleball. But, but that would be my thing is, is stay true to your why and go play and, and that'll help you stay on your wide track.


And, thanks for your questions. I think they're very insightful and they create really great talking points and I just want to see this, I want to see direct primary care move forward. I want to see my colleagues, taking the risk themselves, that they, if they're thinking about it , or consider joining practices like mine, where you've got a, you've got a doc or two that are, that have pretty good momentum and willing to share that momentum with you in a very fair and equitable way, I think is lovely.


And, there's no gimmicks. We're just trying to help each other out. And, and you've got great culture here in the DPC space. That's exactly the opposite of the culture in, in the insurance space and in the admin is different and all that is different.


And so it's been lovely. It's been really fun to continue to grow. And I'm looking forward to talking to you again. This is really fun.




Thank you, Dr. Sanders so much for, for being on the podcast




*Transcript generated by AI, so please forgive errors.

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