Direct Primary Care Doctor
Dr. Vicky Borgia is a board-certified family medicine physician with over twenty years of experience. She practices ‘womb to tomb’ medicine with special interests and training in reproductive health, LGBTQIA health, and integrative medicine.
She earned a BA in Women’s Studies from Columbia University at the dawn of intersectionality, and an MD from SUNY Brooklyn (aka Downstate). She completed her residency at UCSF Sutter Medical Center in Santa Rosa, CA and attended a faculty development fellowship in Addressing the Health Needs of the Underserved at UCSD. She holds her board certification from the American Board of Family Medicine and the American Board of Integrative Holistic Medicine.
She opened Radiance Medical Group in the Fall of 2019.
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Transcript*
*** TODAY'S EPISODE CONTAINS EXPLICIT CONTENT***
Welcome to the podcast Dr. Borgia thanks. Thanks for having me. So I wanted to start off our interview with this quote that you had said during a TV interview that you had, for a local TV station during the pandemic.
And it just really hit home given, your clinic and where it is. And we'll talk about that. But the quote was, we are part of the community and in times like this, referring to the pandemic, the community has to come together to take care of each other. I wanted to, frame this whole interview with that quote and start with asking how you ended up being a community direct primary care physician, opening up radiance medical group
in Philly.
So I've always been a community physician, not always a direct primary care community physician. Um, most of my career has been in federally qualified help centers or lookalikes or, um, things like that. And I actually went into medicine thinking that that would be how my activism came to fruition by empowering communities to take control of their health.
That was naive and a little. Caught up in the medicalization of the time. But, um, so my goal has always been to be part of the community and to be, you know, in that old fashioned way that, oh yeah, we can call or we can drop by or we can talk. Um, and I did have the interesting experience of opening up basically two months before a pandemic.
So , you know, it changed a lot of how I do things. Um, And at that time, the reason I'm on there is I actually had a ton of little hand sanitizer swag. And there was no hand sanitizer anywhere then. and I was giving it away.
I gave it to the rec center near me, the schools, people who needed it. My neighbors came by. So. Once that came out. I, I basically like had a distribution center for little tiny, you know, whatever, two ounce bottles of hands sanitizer. . That's
awesome though. I mean, you know, that is completely an unexpected way to use swag.
Able to, yeah. And to be able to have swag, be your marketing, reach in the community and the fact that, you know, they even showed you in the,, the news feature, which is also on Dr. Borg's blog on my DPC story.com um, handing out that sanitizer to a woman on the street. So that's amazing.
Never underestimate the power of swag.
Exactly. I had a recent experience just like that too, at pride in Philly where I gave out probably 500 things of sunscreen, all gone. Every single one of them gone.
I'm sure all the listeners can relate to being handed some kind of swag, but what makes your swag stand out?
well, I guess timing right. A, um, my swag stuck out at pride because I realized I, I tabled with Elise who's, um, a physical therapist that I work with quite a bit, and we had sunscreen lip balm. Condoms and water. And I was like, oh my God. We're like the protection station.
awesome. I think about that, that's way more fun swag than, you know, you see on. Physician appreciation day or whatever , the huge systems have. So, you know, mentioning that. I wanna go back to your early days before you opened radiance. what was life like when you had, you know, graduated from medical school and were working as an employed physician?
So, um, you know, I've been in medicine for a long time. I've had a lot of jobs. I'm basically unemployable at this stage. I started working right outta residency at a FQHC that I did locums or, you know, filled in moonlet for when I was a resident. Um, and that was amazing. That was mostly, um, I. Farm workers in the LAA, cuz it was Sonoma county mm-hmm and um, So I started there and then I wanted to move back east.
So I moved to Philadelphia after a few years out in Sonoma county and started working also for an FQHC here. Um, but honestly, By that point, I had sort of had it with the disempowering nature of all FQHCs. I was joking about one of them. There was a plaque and I was like, we should change this system, disempowering patients and providers since 1975.
Um, So I have been in many, many situations. Lots of them are FQHCs, mostly the churn and having to see so many patients just wore me out. Um, you go in with great ideals and thinking, this is what I'm gonna do, and I'm gonna change the world. And then you're basically beaten down by the volume of patients you need to see.
Um, one day I actually saw, I think, 30 patients before lunch. Um, Yeah. And I thought to myself, and this was, these were, this was my neighborhood in my neighborhood. So the FQHC, like I've seen these people at the park and at the store and they'd be like, oh, Hey, Dr. Blah, blah, blah. And I thought like, I could run them over and not remember them and just seen them, you know? Oh. I absolutely thought that I was like, oh yeah, I wouldn't know who you were. And that made me think I have to leave there.
Basically.
so interesting to hear. You shared earlier about how you've always been a community physician and then recently a DPC community physician. And it makes me think about how yourself, myself, many physicians on this podcast have shared that common thread of, we had that naivety that desire to change the world in our own local communities.
And then we get into employed practice insurance based practice, and we realized that that's not an alignment with what our initial goals were. Mm-hmm . So I wanna ask there, when you left, you know, the, the Sonoma area, when you left this FQHC in the east coast, how did you start reflecting on that, your positions that you were hired and were not in alignment with your desire to as
community physician
Um, I learned it painfully time and time again. Um, yeah, I did the whole, I'm gonna change jobs business. So after that, FQ H a actually worked at a residency, which I found very fulfilling, um, but also insane, you know, as it is. Um, and then I had a ton of. Director titles there with no extra time to do any of it.
And the final straw there was actually, when I was like, okay, you have me as a director of resident wellness, but you give me zero time to do this. And so I am not actually modeling anything. Great. So, um, and they're like, yeah, we can't do that. I'm like, all right, bye. So, um, I think, you know, moral injury became a term how many years ago?
Um, I was doing a lot of work with myself on compassion, fatigue on trauma stewardship, um, secondary trauma, things like that. Trying to keep myself sane. Mm-hmm um, you know, spoiler alert. It didn't work. Um so then I. I had an opportunity after the internship to work at the local, um, L G B T help center.
Um, and then very shortly after starting there, I realized that things were very not right there. And that's kind of when I started making my plans for exit of the system, And I really just like when I was there, I was like, okay, if this is really not gonna work, then probably none of this is gonna work.
When you were making your exit strategy, had you already learned about DPC at that?
So, yes and no. So I did read that article so long ago in the a, a F P about the DPC that was, you know, half.
I find the terms they used and still due to this day, extremely problematic as I do a lot of that clinic. However, the idea's good. Right. Um, that it was half sponsor, half whatever they call it. Mm-hmm um, and I thought, okay, this might be something that I can do, and I could. You know, do things on my own terms.
Right. And then I found God, who knows, what year is it been? I don't remember what year, because I hate social media, but I went on, I learned about DPC more, um, went to a few of the CME things and then I had to get over a lot of my own fear. About starting a business, learning those things. And also I had a huge burnout and divorce and all of that stuff in the meantime.
So part of me was just surviving and making money to pay for the divorce lawyers and keep my kids in their sports equipment and shit like that. So that took a lot of time out, but then once I really realized I just can't do this anymore, then I said, I, I have to do something different.
And honestly, my choices were leave medicine, leave the world. or do DPC. Wow. And my mom, who is an amazing person, who's 90 now who worked in advertising in the fifties and went to college, had to leave, um, is super smart. She, she said too, like, just do it, do it if you fail. So what you'll never regret failing.
You'll always regret not trying. And she was gonna like, Take out home equity on her house and things like that. But I was like, no, I'm not gonna have you do that. So I just busted my ass in urgent care instead. . Yeah.
when you talk about that fear that you had overcome, especially with this, you know, new, new proposition, it's either you, you try or you regret not trying.
What were the steps you took financially in addition to urgent care and also, educating yourself in all of the business about being a CEO to run your own clinic, how did you go from that place of fear to then putting actionable steps in.
So part of me did not have a choice cuz honestly I would leave medicine otherwise mm-hmm so that's where it was like, okay, learn it. Don't horn it. And then I thought about all those things we learned in med school and residency that I never wanted to know. I still really don't wanna know. I learned it and I know how to do it.
Right. So medicine and being a parent, you get really good at doing a lot of shit you don't wanna do and learning things you don't wanna learn and doing all that. I was like, alright, I can learn this. I don't want to, but whatever, I can figure it out. And if I can't figure it out, I can hire people to sure.
Figure it out for me. Right. So I don't have a lot of business. Experience or sense. Um, but I do have friends, you know, and they have practices. I have a lot of therapists, friends, and they figured out how to do it themselves. And I just assumed I'll, I'm still figuring it out. You know, like I just started paying myself last.
October. I honestly did not know how to pay myself. I didn't know how to do quarterly taxes. I was like, you know what? I'll just do it and what's gonna happen. You know, like if I get fined or caught or anything, I'll pay fees, what are gonna do right.
It makes me think of the phrase, it takes a village mm-hmm because it really, it really represents that what you've shared.
Really represents how there is a community of people who have gone before us. Right. And that if you don't know something, you can hire someone. I love that you can also ask. Um, and you can learn. We definitely are learners because of the fact that we are able to, uh, go to me medical school. Graduate medical school, graduate residency, right.
And become physicians. So I love that. Think
about how like, and I am so old, we didn't look things up on up to date. We looked things up in, when I was working at a, in. We had so many people coming from Mexico with meds and things like that. We had this raggedy old, I don't even think it had to cover Mexican PBR.
Yeah. That we were always like leaping through and trying to figure out what this med was. So I go back to those sorts of things and be like, yeah, if I can do that. I could do this, you know? Yeah. I still don't know how to do a lot of things. And I have a new like accountant person and I did some business coaching this year.
It gets the other thing about being a position, we know how to triage, right? like, I know how to do the things that need to be done because they need to be done. Yeah. It might be the last minute, whatever, but I can do it cuz I know that those are the things that I absolutely need to do.
Right. Yeah. I
love that. And it's very, very true. Yeah. Now, when you were, when you were realizing like, this is it's it's this, this is what, what I'm going to do next and this is what I'm gonna try. did you envision your practice in Philly? Um, what, what were the parameters that you wanted to build out as you were dreaming your, your DPC?
so yes, I never wanted to go anywhere, but Philly. I wanted a place I could walk to or take public transportation. I wanted to actually have a place. So my initial target body target populations were queer and trans folk. Um, fat people who have been abused by the system, activists, immigrants. And then I joke, I say wealthy white liberals who are wealthy, guilty, white liberals who can pay for everybody.
Honestly, that is what my patient population is gotta say. So it really worked out.
when I went to nuts and bolt, I felt really excluded really not a part of that really thought like, oh my God, DPC, this is not for me because this is not a community that I feel safe in.
Um, there was so much white bro action going on. I was shamed on social media for pointing that out, um, by people who were, you know, got power from being pro close proximity to white male power. Right. We know how that goes in the world. and I really thought like, I'm not gonna do this, cuz I can't. And at the same time, like such a generous group of people give all their resources, but I really didn't feel safe, but I did find my people there and I thought like, okay, I can still do this.
And I knew in my heart. That this is, these are populations that need to be served and need to be served in much better ways than the, you know, standard corporate medical tournament churn 'em out is doing
absolutely. And for me, You know, I, I see when we look at the marginalized populations, whether that be Q I a plus, whether that be immigrants who are undocumented, for me, I look at.
What we are lacking in their healthcare. Mm-hmm, , that's where we need to fix, because clearly those are the most broken parts of the system sometimes. Yeah. And so when we fix those pieces of access to quality, healthcare, timeliness of care, when we look at. How those things are broken and how to fix that.
The, the people who have the mediocre care can definitely benefit, but especially those people who are, who are marginalized, they can especially benefit. Absolutely. I think that's. Yeah. And I think that's wonderful the margins were your core, you know?
Yes. Oh, absolutely. I absolutely targeted medically disenfranchised people.
I mean, I have the privilege of. You know, living in this place for a while, having worked in, um, many different settings here, the settings, all the settings that I was aiming for and, um, you know, having done activism too. So like, there is ways that I didn't need to do a lot of advertising and things like that.
Cuz I saw what the need was. .
And you. became, you know, like you said, that community DPC physician who built your practice around your community, so wonderful. Now when you opened radiance medical group,
camille Thompson was with you. So did you open the practice together or did you open it and hire.
No, we opened together and we were co-owners, um, split in different ways because I had more money from busting my ass in urgent care. Um, so we did open together and. At the time we opened that's when she was working in student health.
And then there was so much turmoil with conmen closing and Drexel and tower and whatever the hell it is now. Um, and she could not stay at that job and she had to get another job and it just, it couldn't work out for her. At that point, I was working urgent care. So. Had much more available time in the office and to do outreach and things like that.
She did a little bit, but I mean, you couldn't go anywhere. So
we all, we all remember what that, that those lockdown times are like. And I wanna ask, so there. When you talk about opening with Camille, um, and how even just the finances were different because of what you brought to the table.
You know, I, I think about my conversation with your neighbors in Pennsylvania, out in Pittsburgh, about how they, Dr. Lynn and Dr. Gentil were talking about how to evaluate. A relationship, just like a marriage. Um, mm-hmm, when you're entering into a business relationship. So I wonder when you guys were having the conversation about opening radiance, what it would look like, how the would, do you have any words of wisdom for those people in the audience who might be thinking about a partnership at the initial opening of a DPC?
Right. So we opened. Like originally, we thought it would be 50 50. Um, and then in, in terms of how. Like the seed money we needed and what we needed to do. And our time in the office, it turned out to be much different than that. So we changed it. You know, we were able to look at like what we each contributed and changed for that.
Um, You know, I was fine doing 50 50 to be quite honest with you Uhhuh because I come from a place of much more financial privilege than Camille and, you know, doing equity in the company. It it's fine by me because I a, because I come from. You know, a white middle class family who were able to in our country have intergenerational wealth.
I say that in quote, cuz you know, wealth is, is quite different than what we talk about with intergenerational wealth. But I did have, I had a mother who was gonna do a whole equity loan. Like that is something that not everyone has. The reason I have that is because my parents were able to move out to long island from New York city in the sixties where it was redlined.
Right? Like there was things that happened that I was able to do because of my privilege, economic, racial privilege that Camille is not able to do. And so that. Which doesn't mean that we are not equal partners in this. It just means that I had more privilege going into it. Right. She didn't feel great about that, whatever we changed it, according to that.
But I really, the thing that made me change it more in terms of changing, like our shareholder agreement mm-hmm was the time because I was putting in so much time here. Um, And so I would think, think about all of those factors, right? Like it's not just the amount of money you have, but how did you get that money?
How did other people get it? Right? You don't wanna continue the same injustices, like perpetuate that same injustice, especially if you're trying to build something that is working towards more equality in the world. Right. um, so yeah, but you know, it was hard. And honestly the fact that she couldn't work as much as I could, I did start to resent it, cuz I was just like, I'm drowning and I need help.
And she was unable to help me. And in the end we were like, if we wanna be friends. I was like, just, you can stop. And when your life is at a better place where you can start building a panel or seeing patients then come back.
How did you guys work contractually or, legal wise to be able to allow that freedom for her to come, if you needed to take time, how did you work that.
Well, we did, we, we had a shareholder's agreement that was done through the lawyer. But the. I don't know if this is a good example, though, because really the pandemic happened. I was working care. She was working palliative care. Our lives sucked, right? Like both of our lives were terrible. It just depended when, at what point, which one was worse.
Um, and so we had very little bandwidth for things, you know, so we were just like running, running, running, doing what we need to, and then when we reevaluated. That's when I said, do you think you could do anything? Like, do you wanna do any part, do you wanna sh change the percentages that we have going on?
And you know, she wasn't able to do it at this point in her life right now. Yeah.
Gotcha. Gotcha. And in terms of when she stepped away from radiance medical group, what happened to her patients? Did they all transfer to you?
She had a few patients and they did transfer to me, but it wasn't so much that it was like a burden or anything. Mm-hmm we would've had a different conversation if that was the case.
Gotcha. And in terms of the patients that she did have were any of those employer groups?
No, but that was gonna be her job because she is much more extroverted than I am. I live in an amazing part of Philly, right? Full of immigrant populations, very diverse, lots of restaurants, really great stuff.
Right. And we were in the fall of 20 in the spring of 2020, we're gonna go and go to restaurants and pitch employee benefits for that. And that just did not happen.
definitely. And what about now? Um, with you being with you, refocusing on you as the solo practitioner. Mm-hmm did you, do you now plan on going back out to, you know, south street or all of the restaurants that are around you guys and
from point yes mm-hmm but I have a very large wedding list.
Okay. So I don't feel like I should go out and pitch things right now. Yeah. Um, my, my actual struggle is to grow in a way that's sustainable and doesn't make me crazy, you know? Um, but I do think it's, I think it's a great option. It's an amazing option for places around here too. Right. Um, it's a great option for people who.
Possibly are undocumented. Their only healthcare option is we're sitting for 12 hours in the FQHC, you know, half of them I already know because I worked there. . Yeah. Um, and then, um, so that is one option, um, that I think is, is good and I'm willing to do, and now I have like word of mouth about nonprofits and things like that.
So businesses kind of come to me and I have to decide. Like how we're gonna do things.
Yeah. So let's ask let's, let's go into that a little bit more with regards to you opened in October of 19 mm-hmm and
when you mention you have a very long wait list I'm so happy for you. in terms of that must, you know, alleviate and heal some of those fears that you had initially, like you talked about, but when you were open October of your growth?
Did you grow quickly early on? And when did you reach your number that you wanted to create the wait list? Yeah, so, no, I grew okay. Early on. Like I could pay my rent and overhead probably by. Oh, my God time is so weird. my urgent care job was cutting all our hours, all that stuff. And so I did a two week stint at the border refugee camp in Matamoros.
So when was that? May I was in Mexico when I covered my, when I realized I covered my overhead. Wow. So that was probably like may of 2020, but I have a very low overhead. Cause I was so excited about that. I remember sending people texts and stuff like, oh look, I just hint. And I made my rent, get my this.
So that was easy. And then I grew, there were a lot of things that I did at the beginning that I don't do now, but that also helped. So when the pandemic hit, I did pay what you can visits. And I did get a lot of members from that also, but I got like, just money and I was doing, uh, medical, marijuana certifications also pay what you can honestly.
And so those helped out at that point. And. I was actually at that moment, I wasn't living in fear, like in a fear based model. Later I did a little bit, cause I was just doing some locums and things like that before getting another job. So I hired these marketer people that my friend used.
That's how I got to be in like one of the finalists for be well Philly, because nice do it. Yeah. Terrible.
Do all this and put myself out on social media all the time and say vote for me, which was terrible. Um, So that, that happened. So I did have, and then I grew again and then I started working for different urgent care and I was growing in a nice clip. And mm-hmm when was it? Last year? May. I had to do my, I had to start a wait list because I could not sustain that.
Working two full jobs. One was, terrible. I wanted to keep my practice open and growing because it is actually what kept me going. Right. My, my vaccination rate in my clinic is yeah, 99.9% probably. And that was very helpful at that time. So, I did have to, I stopped because I couldn't actually grow in a way that I could take care of people.
The point of my vaccination rate being 99% was I was working at, in urgent care in central Pennsylvania where I was basically harassed and by people all day wow. Who were being tested for a disease, they did not believe in and were telling me how they refused to be vaccinated.
So my own practice of very community minded activists who were eager to get vaccinated and protect each other. Yeah. That's the thing that actually kept me going. It's and I can totally see that because where childhood vaccination rates and support for vaccines for preventative illnesses is one thing I definitely can say that the stress of COVID and the politics and the personal beliefs we've seen is it definitely brought a different level of stress to physicians that we hadn't seen in a very long time.
Absolutely. Yeah, absolutely. I think the thing that got to me, cuz we were talking about being the community doctor. Yeah. What's that, these things are available and yeah. Maybe you won't get sick and maybe you won't be hospitalized and maybe you won't die. But the person who is doing chemo, who lives on your block or the HIV positive person who lives on your block or the otherwise immunosuppressed or sick person, if they get it.
Yeah. So I think it's, it's an incredibly ableist view we have now that we should all just go live life because only the sick are gonna get it. The sick count, right. They're part of our community and they count. There's extreme poverty and extreme segregation in Philadelphia. Right. So, and I worked in places where people were desperately poor and did not have access to things. I mean, some of my patients right now are desperately poor and it changes how you practice and it changes what you do.
And so I think that never, never actually losing sight of that is very important,
I wanna ask there, how you had pivoted in your own practice to be able to offer, pay what you can.
So can you talk about how that works into the DPC business model during this amazing pandemic where everything goes. As long as your patients are safe and you're safe and you're able to continue keeping the lights on how that's that's the utmost importance, but it also matters as to how, the money does come in so that you're able to take care of those bills and your other patients.
So how did that all work in your membership and your DPC? So that's an interesting question because I opened really right before the pandemic, right? Mm. So, I had a nice patient panel as a pandemic started and they were pretty diverse. Right? Economically, a lot of my patients actually were sex workers.
Because it got out through some, I don't know, Lister or whatever that I was a place to go and I was sex worker affirming, and I could give them care without judgment, things like that. So mm-hmm, when the pandemic hit, even before we roll on lockdown and travel stopped. Sex workers actually lost a ton of their income.
Right? So service industry, sex workers, but sex workers were actually probably the first people to that. We noticed that their income would just like ground to a halt. So I had sent out something to my patient panel saying, okay, like unprecedented times, just let me know what you wanna do. If you need to change your membership rate or things like that, please let me know.
I also didn't know it was gonna grind on for so long. So that actually restored my faith in humanity because a, some people did ask to go down, but I actually got a ton of money from my other patients. Like people just gave me money. I was like, okay, great, thanks. Wow. Take your money.
Right. I also, at that point was still working in my urgent care job. Mm-hmm so I had the privilege of doing these things because I had an income that was coming in. I mean, I still do it now, and this is my only job, but I've worked it out in a different way. So like my fee structure originally was sort of like that we would, the people who could pay the full fee would always supplement the people who couldn't pay mm-hmm
Um, and so there was some of that, but a lot of this was I, I was able to do this because I also had another, like full time paying job that I was getting a paycheck. , I love that you mentioned this experience because one of the most common things I get from people outside of the DPC community is, oh, that's still for rich people.
I mean, just like you're how you're sharing about how the people with more means can also contribute on a normal basis to the people who might not have the financial means, this month or for a few months, mm-hmm to be able to pay for your services. I think that's so important because for those people, especially who are wanting a practice designed with the core of their patient panel, the similar to yours, that's a way to strategize how to do pricing from the get go.
Yeah, actually, that's interesting because I am about to send out something about raising my rapes mm-hmm and I am working very hard to figure out I'm gonna have a mutual aid. Part of this mm-hmm right. So I'm a big believer in mutual aid, actually mutual aid is the only thing that got a lot of communities by, during the pandemic.
It still is. Right? Well it just, it's just like the, formula shortages, I mean, people are coming together. Exactly. Mutual aid is a longstanding tradition in activists and, marginalized communities. Right. We've always done it. I had a community fridge outside of my office for a long time and you could really see, like, that was a great example of mutual aid done.
Right, right. Yeah. And even my thing, even though I didn't set it up as this is mutual aid people got it. Mm-hmm . And so for every person who said, oh, I do need a reduction in my fees. I did have people who gave me more money. I did have people who did that and. My patients who maybe were furloughed at the beginning of the, a pandemic who then got, got re-employed and things like that wrote to me and were like, okay, I can go back up.
And I was like, okay, great. Yeah. Yeah. like that totally restored my faith in humanity. So like, I went into this thinking like, I am not like I don't wanna do a sliding scale because I don't wanna be the person who looks at people's W2 S and bills. And sure. We all know that your income does not necessarily say whether or not you are financially struggling or not.
Right. All of us who graduate med school with whatever, 300, $400,000 in loans, we know that that's not necessarily the case. You could be making a lot of money, but not actually have a lot of. . So that I never wanted to do that. So my, my philosophy has always been, you can tell me what you can do, and I'm also just gonna be okay with that and assume that you are telling me to the best of your knowledge, what you think is affordable.
Mm-hmm when that changes, you will also tell me, right. I don't wanna go into this thinking like, oh, somebody's so rich and they're gonna try to lowball me on that. I, I mean, I could, but you know, I don't wanna live in a world as that's true. So, I have found that I, it really has been true that people, especially during the pandemic, they were laid off, they weren't making money.
Then they got a new job. And then some people who got new jobs were so grateful that we held them through. During that time. Now they're sponsoring somebody else, like all of that. It's just really clear just with you, sharing up to this point. How, when you have said that your faith in humanity was restored, I can clearly feel that just from envisioning your patients, helping each other out, you helping your patients out.
And it's just amazing because I don't necessarily hear that from my fee for service colleagues. Oh God. No, because we're not involved in it either, right? Yeah. But at the same time, like you, you just mentioned, the, the price, the, the upping and price is going to come and.
Have you have you mentioned this to people in the DBC community and have been made to feel guilty about raising prices. I do not go on those ones, those groups anymore. I limit my social media in DPC for that reason. I do not need somebody telling me that my prices do high or you can't raise prices or things like that.
Because trust me, I grew up Catholic and I have a lot of guilt to begin with. So I don't need outside people doing that. I have a lifetime of growing up in the Catholic church that helps me with that. Right. So, they can say all they want, I am going to raise my prices to reflect what I do and actually give a formal mutual aid option.
Right. So right now I do it on like a, I don't know, these people are paying more of these people are paying less. And part of that has to do with the fact that I really did just quit urgent care in November. So I haven't had like a good look at things. But I think that, that an actual. Mutual aid option that I could track in my books and things like that would be very helpful.
Like I was so , this is another naive thing I thought like, okay, I'll mark up my meds, and that will go into a fund for people who can't pay for meds, but like marking up wholesale meds is. Whatever one, penny, I'm not doing that. Like, I don't have the brain power to do that. It's a, that's some office space stuff.
Right. That movie oh yeah. Make a million dollars off of like percentages of pennies, but I'm not working at that volume. So there was like, I was like my labor of figuring that out is so worth so much more than actually doing that. So now I'm just like, all right, I'll just hope that washes out.
Right. But for memberships, I am gonna do it to see like, if people wanna pay an extra mutual aid part of that, I have to tuck the, in about this to see how I do this. But um, and that's, that's actually where my next question was going because when you have membership plus mutual aid, mm-hmm how do you manage that?
Do you manage it all through hint or are you doing a mutual aid through one, uh, option and membership through hint? No, I wanna, I wanna do it all through hint right now. I do it all through hint and I just increase family's memberships or people's memberships. But that doesn't help me in terms of like breaking it out and looking at how much of it is up.
Right. So that's my, that's my goal. Sure. And I wonder if in hint, because you're able to process individual charges, , that could be, durable medical equipment that could be medication, whatever. I wonder if it's just added on as an extra fee for however long, the family wishes to, to add that to their membership.
Right? Like that's how I'm doing it now, but I don't have it in as that. And I want people to be able to choose that. Without me doing it, Uhhuh, which just the issue. So like pay what you can visit through hint originally I could do them and then they got rid of that. So like, they'd have to tell me, and it was weird.
I just want people to do it and then I could see it later. Yeah, no, it totally makes sense, especially. So you could be able to track that because I, I assume that, you know, today or in the future might be listening to this podcast and saying, I wanna read, reach out to Dr. Boria so people are listening to this and they wanna ask me about it.
Give two good months and I'll tell you what I figured out. love it. I wanna shift a little bit and get more into the tech of your practice with you mentioning that, time is, is valuable. Your time is valuable and you value your time.
I wanna ask what, what were the thoughts around tech in your clinic? Uh, we're talking EMR, we're talking, onboarding. What was your strategy in terms of harnessing tech to make your practice work for you and your patients? OK. I like that though, because it really does come back to the sticky note I have on my dime center that says I respect my time, which was my mission statement.
That's great. That's great. So, sorry. We, I totally tangented. No worries. My tech, here's what I do. Mm-hmm I have I use hint to register. The reason I use hint is actually because they had much better SOGI type things when you registered for it. So, I used cebo as my EMR and at the time I started, the way you would register in that was very clunky.
And it was almost like, what is your sex? And that's defined at birth, or what is your gender? And that was defined at birth. And we need this because of labs. And I was like, oh, that sounds terrible. So I'm not gonna use that. Hint had a much, much more fluid option. So I used that to register I did not use spruce until this last year, probably in the summer of last year.
But I think spruce is actually something that is really pays for itself and more the idea that people can text me and call me and not be on my personal cell phone and I can put tags on it and I can the most important. And the thing I am not that great on is to put my out of office memo on. I'm, I'm gonna upgrade to the other premium.
To actually have that happen without me remembering to have to do it. But that has been one of the best things I recently learned through DPC women about how to in the future, which I embarrassed to say. I didn't know. So that actually been pretty good. I've tried it twice. I still think I need to not look at spruce because my message clearly says, if this is a medical emergency or urge, like emergency go to the ER, a medical urgency call on the phone because it will bring through, but I won't have notifications at night or, on the weekends.
So I still wanna not look at it to protect my time, but I do obviously. So that I think is amazing. And then I use cebo. I like their intake forms. There are some things I would like to change about it, but I honestly have not had the time to sit down and try to figure that out. And then most of my patients honestly are pretty tech savvy mm-hmm so I do a lot online.
I do have to talk to people, as much as I don't like people , but there's some people who can't actually get themselves to make the appointments or they wanna talk when they get a, get on the wait list, they have questions and things like that. And that's fine. Now, when you mention your tech and how you added on how you're even currently still building out your, your ways of harnessing the tech to work for you and your patients, did you have a, this is what I want my tech to do, uh, roadmap before you opened? Not exactly.
Mm-hmm I had a Google voice when I opened. And that is so and I did know that I wanted to have people to be able to reach me, but because of Google voice was so unstable, I wound up giving out. Cell phone, my personal cell phone which is fine, but I don't necessarily always turn off my notifications.
So people would text me in the middle of the night, like the pandemic really messed with everyone's circadian rhythm. So like, I'll get, I'll see screw messages from people that are, it's like a three and it's like a random thought. Right. So I don't feel the need to answer that at all.
And I'm like, okay. Note to sell, talk about their sleep wake cycle but you know, like I. I just wanted people to have access. Right. I have a ton of patients in my practice, like most DPC docs. Do I think that have been traumatized by our medical system. Right. Who feel like they can't ask questions, they can't get, when they're anxious about things, they can't have someone to talk to.
And so I want those people to know that they can access me. Right. I tell people , this is an interesting experiments on my part, that my boundaries are mine to protect, like their boundaries are theirs to protect. Right. And not to stereotype, but most of these people are therapists or in other helping professions.
So they would do the opposite and not talk to you or call you or ask you things. And so, I want people to be able to get to me and then I'll tell them, like, in the middle of the night, if you call me, because you're really anxious about something, I will either say, oh yeah, you're neurotic, go back to bed.
Or, oh, that's something we need to deal with tomorrow the next day. Or you have to go to the ER. Right. And I have no filter. So I tell them exactly in that same way and like that it is a relief to a lot of people. I do not get a lot of phone calls at night. I do get a lot of like random hint messages that could wait till the morning, except people are up 3:00 AM.
Right. But I did want people to feel like they could access me, like your tagline on the podcast is at the, like their, at their fingertips. Like I do not wanna be at people's fingertips. Yep. But I want them to know that if there is something that they're worried about, I can be there and I will triage them appropriately.
I love that. And in terms of the fingertips, literally when I wrote that I was envisioning my actual fingertips on a keyboard because for me, amen to boundaries and amen to being able to be there for your patients and bring that sense of security to them. I mean, a lot of DPC patients, if not, most of them really understand the value proposition when it comes to accessing their physician.
So I absolutely love that, but yes, even in my own practice, I, I tell my patients if it takes more than two lines of text on spruce, we will move this conversation to Serbo. Or I will answer your message through the portal because the boundaries, especially when I'm so used to, as I'm sure you are texting on our phones all the time for families, right.
And, for our, our personal stuff, it can be very. The, there can be a very big gray area when it comes to, and now we're gonna add 300, 601,000 patients to that. I totally think that that is so important to. To think about though, in terms of how you're saying access is so valuable, especially to marginalized communities might have, have had preventative care for decades because they, they could not access it or they could not.
And so that, that complete opposite experience of, I know Dr. Borja, I love Dr. Borja, Dr. Borja is available and literally I will send her a message and knowing also that it won. Affect your ability to live your life and get sleep, et cetera. But there's a beautiful, balanced ground that we can find by using tech and making it work for us.
Exactly. So here's an interesting story. My implants, when they failed, I went. To the oral surgeon, whatever. And she was like, okay, well we have to redo this. Can you do it Friday? Okay, fine. I had a patient who is a therapist. I have a lot of therapists, a patient. So I was going to talk to her about, I don't know, follow up labs, whatever.
And like 10 and I, so I wrote a portal message and I was like, look, I can't do this at 10 cuz now I have to go back to the oral surgeon. It does open up my afternoon though. And not in the afternoon. You need of yourself. Oh
my goodness. And just I'll, I'll put a little bit of a backstory here. Dr. Borja was on a scooter. Am I correct? When you were on a scooter having the time of your life, and then you had an accident happen yes. I blew out my two front crowns on a scooter in Washington, DC visiting our last of all of the MLB stadiums I might add. So this that's awesome. AOUS occasion for me and my kids. And. This is the thing that drives people crazy. So I fell, I took a header off the scooter, broke both those front crowns to the point where there was no returning them to crowns.
And I need to get implants and one of they failed, blah, blah, blah. So I'm not gonna have teeth for a long time, but it was one of the most fun things I've done in a so long. And I listened to my children who are always telling me, oh, you should do this with us. And I always spur things like that. And I was like, yeah, sure.
I'll do it. It was so fun. Five minutes before the calamity happened, I thought to myself, oh my God, this is so fun. I should do more of what the kids are saying. Don't regret this day and not regret it. It was so fun. Oh man. What a, what a story that's gonna be passed on for generations? Oh my goodness.
Totally. Oh my goodness. I never freaked out because I stayed down for a long time and I was doing like a little survey, trauma survey. Oh my wrist. How was my how's that? They were like, oh my God. I'm glad that you're in good spirits about it though. Cuz that's that is, the way we frame things is it can be challenging sometimes. So now on that note, I wanna ask about as you've been open, what are some other challenges that you didn't foresee when you were planning your DPC that you, you had to cope with and overcome.
So I am a very socially anxious introvert and marketing myself is horrible. I can advocate the hell out of anything for anyone else, but doing it for myself is terrible.
So when I started, that was one of my biggest, biggest challenges. I did not wanna write blog posts. I did not want to put myself out on things. When I hired those marketers They made me do that be well Philly challenge. And I hated every moment of it, but I was able to actually make some money for a cause I truly, truly believe in the abortion liberation fund of PA mm-hmm and so doing, like having it, having it framed like that, made it a little bit easier.
And I have fiercely loyal patients who told everyone to vote for me. Right. So I made it to the finals. I did not win. But that was terrible. So marketing myself, I thought was one of the worst things in the world. Right. Luckily I did not have to do it for long and I don't need to necessarily do it now.
Because I hit that magical point where it's all word of but that was the biggest for me. When you talk about this magic point where it was word of mouth, as you were getting there, even before this marketing came on, did you start changing how you approached marketing?
I mean, even, even with that, thread of being an introvert, did you, continue to say certain things that were an alignment with your mission and your DPC that just came out easier? The more you said them? Yes. So the thing that came out easier for me was asking for money. And telling people like this is what this
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costs and not Heming in high. And so even things I did that I still do is pay what you can. So like I'll do medical, marijuana certifications, and now I'll just be like, so my usual fee for this is whatever. I do just pay what you can, because I believe this is an interesting, weird gatekeeping thing that we do.
And I do believe it's harm reduction. So you can tell me what you think that is right. In the old days, hint would just tell people and they could put the number in. So now I have to do it and make an invoice for them. So I've gotten very good at that. I've gotten really good at, I didn't have to do business because the pandemic happens and I didn't market to business, but I'm good at even talking to people about what their rate should be, This is what my normal rate is.
And I want to make this something that is doable for you. And what I really don't want you to do is ghost me and not get care. So I want you to tell me a reasonable amount for you, right. That took a lot of practice. And it took a lot of like saying it over and over again, instead of like, oh, well, if you wanna pay me, this, So that was, that was difficult and challenging. And I did it. And the other thing that was very challenging, but I do it and I still do it is doing networking things, Oh,
I hate those things, but that's what my, I go with the lease. So I actually, for pride, I got a table at Philly pride, right. There was a first Philly pride for two years. And I wrote in it. I was like, I would like to share my table with ally wellness because we are both very introverted, socially anxious people, and we must sit next to a class so we push ourselves to do this and we go to things and I have a good friend who hypes me up for things.
So I won a thing at the Phillies. The Phillies had this like hometown hero thing. And a friend of mine did it and sent a video in. And so he's really good at that. So I sort of am his date for things. So one of the things that's important is I do not go as selling myself.
Like, I'm me. I'm, I'm, I'm in a good place. Cuz I'm like, look I'm me. I'm not for everyone. Whatever. I don't care. Right. I am who I am. I'm a fat, loud, cranky, Dyke, whatever. Like me, don't like me. I don't care at this point. But I am here to serve a community and to advocate for community. And I know how to do that really well.
I have had years and decades of. Activism experience for that. So , I can network because I'm like, look here I am. And all these people have trauma. All these people have medical trauma and if they wanna come to me, I can help hear that my office is not like other offices, things like that.
And so if I put, take myself out of the equation, like I'm not selling me, I'm selling my services. And that I can do. So clearly your practice has found its community niche. And you have done this pride event in Philly.
When you had as part of your ideal patient, as part of your core members of your practice, those who are in the LGBTQ, a plus community how did you come to have members of the LGBTQ I, a community as part of your core, , avatar, your core, ideal patients. So I've been queer for a long time, right? Mm-hmm probably lifelong as they say. And I have been out since college med school. Right. Mm-hmm my activism in med school was queer and reproductive justice focused.
So I have been out out for a long time. Right. I do not have any issues with that. Although I get where a lot of people could. And I'm very fortunate, Come from fairly liberal place. I went to a very liberal, liberal arts college. I lived in New York, so I did not have struggles like other people have.
Right. So being out has never been an issue for me. Being someone who queer people could flock to has also never been an issue to me because I'm out. Right? And so people will come to see me. I've done transcare since I started in medicine in various different ways. And that has never been, there's never been a problem or anything like that.
So in Philly, part of how this became, one of my target populations was I did work at one of the major Philly LGBTQ health centers. And I was, I did activism with a lot of other people to bring down some not great actors in that sphere. Yeah, it was very traumatic and it's traumatic to this day because things are still going on.
But I was known actually, one of my , one of my patients was like, of course I trust you. You're the person who took down, blah, blah, blah. So like I had a following before, right? So for me it wasn't a big deal. There was a very active sort of social group, social like social media group, queer exchange Philly.
And when I was even thinking about this, I put out feelers, I said like, would you pay for this? Would you pay for people who couldn't do this? Things like that. So being competent in queer health was never like an issue for me. being competent in Transhealth was there really an issue for me?
It's getting those people to come in. And because it's a sort of oftentimes double or triple marginalized group, it's more an issue of access. Right? Mm-hmm so, that has been a challenge, but it has not been an, an issue in terms of like bringing people on. In fact, I got someone on my wait list who was like, I was referred to you by said, large LGBTQ center health centers because their wait list was too long.
And I sent it out to everyone was like, oh my God, did they have a full turnover of staff? Or am I no longer persona on grata? It speaks to the brokenness of our system. And then you add. A marginalized population to that. It's just, it's just crazy. Especially in, in Philly. Like, I mean, I practice in a very rural community, so to have access problems, even in a large city, uh, it, it just speaks volumes as to how broken equal access to car is in the country.
We're absolutely broken. Yeah. And also it speaks to how corrupt, so many nonprofit, industrial complex places are amen to that. All I have to say is amen to that. I, I trained at a for-profit hospital which blows my mind that for-profit and hospital, uh, go together. But then when I see the margins, the financial margins for the nonnprofit hospitals.
Oh, absolutely. Blows my mind. Now what about in terms of when you mentioned, like Hannaman closing, Drexels changing the, this patient comes from the LGBTQ, uh, clinic, because can't get in, there goes to your practice. What type of access do you guys have locally, uh, in terms of like hormone therapy, in terms of mental health, you said that you have a lot of therapists as your own patients, but I wanna ask for the, for your patient population, what's it like around Philly behavioral health is one of the most challenging things, right? Every single person who's in medicine, who's in primary care, who's in DPC knows that we have no behavioral health care in our country. Right. That's actually one of the biggest challenges I have now where my. Business coach came in really well.
So a very, very long time ago, is it a Garrison Institute? Retreat. Garrison is like a it's on the Hudson. It does meditation retreats and things like that. And I heard someone, I think from Bellevue in New York saying I practice impossible psychiatry. And that really struck with me cuz I was like a lot of times I practice impossible medicine and that is where you are taking on these things that.
They are not ours to take on like the absolute, terrible lack of behavioral health in our country cannot be my responsibility. Although of course we all feel that it is because we see these people suffering in front of us. So, I, I do not have an answer to that. It sucks here just like it sucked in California when I worked there.
Mm-hmm it is inequitable and there is so much systemic racism bias and by poverty going on in that I try really hard to get people into places that are sliding scale, but now I have the other side too, where I have all these therapists in my practice and they cannot go on, like they are also . So, yeah, I, yeah, I don't have an answer to that because that's a way bigger systemic issue than I can handle.
That's actually where my business coach was pretty awesome. And we, there was a time we were talking whatever, and she sends out these little like newsletters for things mm-hmm . And one of them was about time management, because part of what I was doing was like, well, what do I do? And I was particularly vulnerable because it was at a big COVID surge.
I believe it was So she, we were talking about that and I was like, I just don't know what to do because everyone is urgent. Right. Like I have it, there were weeks I had, I did not have a week where there wasn't a person in crisis. Right. So she, we were talking about that and she sent me this thing out.
She's like, I'm gonna use you for my newsletter. And then things happened. I think it was Ukraine and Texas banning gender affirming healthcare or gender affirming treatment. And she changed the whole newsletter. And she said, time management is grief work. Swear to God that has stuck with me. Like you would not believe.
So, like when you have impossible choices, what you are doing is grief work. Right. I'm not gonna fix everyone. Cause I can't, cuz I don't have the resources to fix everyone. That's not all of my problem, but it is my grief. It just makes me think. It makes you think about how coming off of hint summit, just thinking about talking with people about how their communities are so broken when it comes to healthcare, the, $60 ibuprofen tablets, the bankruptcy mm-hmm it, it, and then when you paint that picture and then add it to what you just said about that time management is, is grief management.
It's, it's very, it really hits home. Yeah. For me when I hear that. Yeah, it was so funny cuz she sent me the first draft that was like, I want, you know, look at this and see. And I was like, well I made little edits. And then the actual thing was, because all those terrible things happen, time management is grief work.
And I was like, oh my God, you punched me in the gut. cause that is exactly what we're doing. And I try to think of that all the time now. Like I have a lot of impossibly, terrible choices to make for me and for patients. Right? So our job is to make the least terrible choice or to support people, to get through to a place where they can make better sustainable choices.
And that's hard. That's really difficult. And we need to acknowledge sort of the secondary trauma that happens to us or holding that for us. Mm-hmm so that we don't burn out right. We all burned out in corporate medicine. That's why we're all doing DPC, but it's very easy to burn out in DPC too, because you are practicing impossible medicine a lot of times.
One of the things I wanna highlight especially in your practice was that you were quoted in a magazine. Where they were talking about how somebody like during the pandemic, this was during the pandemic where they were sharing the story of patients who were affected by, dysphoria and mood changes and other changes because of not having consistent access to their gender affirming hormone therapies.
So can you touch on when you talk about, you, you have harder decisions on the table and you have to choose, what's going to be the best decision when you're dealt with a, a bad, set of cards. How did your patients receiving hormone therapy get affected in your practice and how did you guys navigate those waters during the pandemic up to up till now?
Well, people who were already members of my practice did not have an issue. Right. Cause we were together and we can do yeah. Telemedicine and all those things. It were P it was people who were going to one of the big systems. So, one of the beauty of DPCs is being able to shift quickly. You can pivot, you can decide what's needed in the situation.
So, doing even telehealth right at the beginning of the pandemic my pay, what you can, people, I swear to God, it was all people who could not get into their primaries or the people who were doing their gender affirming hormone on therapy for refills of those and Zoloft, like Zoloft was the same.
No one could get in. They had no refills on their Zoloft. Right. And it was amazing to me to see. so, like gender affirming hormone therapy, and this is important to be said, it is not difficult, right? It's not complicated. Medically speaking. It's one of the most upfront least complicated things that we do.
Like the idea of doing gender affirming care for someone, it is medically speaking, not even difficult, right? We do so many more difficult things and making so many more complicated risk benefit analysis for like someone who has diabetes. Right? Mm-hmm the thing that happened during the pandemic was big systems were not able to pivot quickly, did not know how to do telemedicine did not know how to do other things were so used to doing things in the way that they did things.
That people called, tried to get refills, things like that. And they just couldn't understand how to do it. Right. So a lot of my pay what you can, people were people who needed Zoloft or other segment and people who were unable to get their gender forming care. Mm-hmm , and not difficult. Right.
I can look up their labs. I could do that. I could see what they're doing. And we're able to fulfill that need. Right. And when you think about it, so. Someone who say is not trans does not have gender dysphoria, things like that. Like the pandemic sucked, right. We all get that sucked in different ways for different people.
And we all had a lot of stress and everything else was terrible, but we did not have that added stress of like, oh my God, this thing that has been changing my life is now gone and I don't know how to get it. And, you know, we all know how terrible it is to navigate the healthcare system even as physicians.
Right? Yeah. So, that was, it was pretty fulfilling actually to see that you couldn't fulfill this need for people that they thought was insurmountable, but we know is actually not that difficult. And have those things happen. The next thing that I think about is when. We have, who knows what's gonna come in the future, but clearly access to care matters.
Access to care is a huge value proposition to DPC physicians and their patients. But when we talk about the LGBTQ I plus community one of the things I think about that I've mentioned to other physicians during this month of pride is that when a person is wanting to find affirming care and they're looking on a website, they're looking, you know, cuz that's our calling card for most of most of our patients or social media.
How do you look at painting primary care? Which includes. Affirming care, hormone treatment for those people who are doing it. And how do you, how do you frame that visually? Like if a patient is looking for somebody and they're in the LGBTQ I a plus community, and they're wanting to find somebody who is affirming, what are, what are things that a person should think about if they're developing their website to say, whether it be, using the LGBTQ I a plus term or something else to say, this is a safe place to come.
Because if, if you only have a, a moment where the social media crosses the feed or a person visits the website for three seconds, how would you encourage other people to think about how they're being presented in the public eye to create an affirming presence?
Okay. So there's two answers to that. One is the, how you appear to create affirming presence. And the second is, are you actually creating an affirming presence? Right? So the first one is like we say, for everything, make your office look inviting, right? Mm-hmm so like, I have a thing on my door. That's like the, the progress pride flag And I have things on my website that are pretty specific right up.
Yes. Than when you see it. Yes. It's easier for me though, cause I'm a queer Wolf person, all that stuff. But if you're not saying that, you, this is something that you provide. I think saying that gender affirming care is primary care because it really is primary care, right? Yes. That is very important.
And so being very upfront in your website and all of your social media that you believe it is primary care, not in a passive voice saying like we accept everyone, we don't discriminate things like that. Being like. We affirm you, we believe this is primary care. We wanna be the person you come to. In places that are really in danger, Of people and trans people who fear for their lives and their healthcare and all of that, putting something up there, being brave about it, saying like, we support you, we believe in you.
We want you to succeed and we believe you are just as worthy of healthcare as everyone else. And we wanna be that person for you. I think that would go a long, long way for people. Right. I like, I see a lot of queer people, right. But I'm in Philadelphia. There's a lot of queer access in Philadelphia.
The people that I think I affirm the most are actually fat queer people. . And so being upfront about that has really taught me how people who wanna be affirming to queer people in other places, a country could be right. Like you wanna be like, this is your home. I am your home. I'm your primary care home.
I am the person that you can go to. It's all good.
I'm telling you this, I hate social media. I hate all that. I let other people do it for me. Like I have unbelievably fantastic patients. A lot of whom are authors also, who just like one of my patients just wrote a piece for Philly mag.
So it's like in my feed and stuff. But like awesome. Yeah. I know get to that point and then you have to join any marketing. Thank God. But like, you wanna be the person that people think of when they see that, oh, there's a person I can go and I can trust. And I know that it's okay. And what about, like I went to Creighton, uh, Creighton did not have that to my recollection.
Training in the LGBTQ I medicine. And so when people are looking to learn more or, uh, or like learn about how to strengthen their position as an ally whether they're in the community or not, mm-hmm, how, where, what are, what are resources that you like to share to with others?
Okay. So let's talk about the word ally first. Okay. Mm-hmm ally is a term that allies use for themselves, right? Mm-hmm it is not ne like people who wanna be allies. That's great. And you should, but what you wanna actually try to be as an accomplice or a co-conspirator is actually the new words though.
But that means that you are actively, always trying to support a community or a cause. Right. So mm-hmm, , ally at some point is like, oh, you want ally cookies, whatever it's performative in some ways. So, Yes, I do want people to be allies, but I want it to be allies as a burb. It's not an app, right?
If you wanna learn more and I recommend everyone learns more because gender affirming, hormone treatment and gender affirming care is one of the most satisfying things you can do in medicine. It's also way less complicated than a lot of other things we do in medicine. really, really is all of this stuff that people get like upset about and like confused about things like that are social things.
Medically speaking. If you can handle a britle diabetic, you will be overjoyed when you have a trans person come in, who you are doing their gender affirming hormone therapy, honestly. It's awesome. It's so lovely. It's so affirming patients are so happy. So I would recommend at the first thing I would do, if you have no knowledge whatsoever about queer health or gender affirming health is going to the Fenway site.
Mm-hmm I think I put a link to this, but they have an educational site too, and they have, like you can get CME even. They have webinars, they have things like that, that you could go from the most basic to very complicated. Right. I personally use a lot, uh, I use the Fenway guidelines. I used the U CSF guidelines, which I sent you the link and then the the world professional association for transgender health, they are having their conference in 2022 in Montreal in the fall. I am going, I think it'll be great. If you wanted to go to one of those things you could glam or if the gay lesbian medical association also has lots of great educational things you could go to.
But I would start if you are not doing anything at all, I would start with and then I also use surprisingly a lot, the Boston university guidelines. I sent you that link to there's it's so like clean and. Simple and easy to look at so if you wanna see something that's not gonna overwhelm you, I would start with that because it's just like such a nice entree into everything.
And the links that you've mentioned will be on your blog, uh, accompanying this podcast. So thank you so much for sharing those and even sharing about the conference in Montreal. Because it, that that's the first time that I've heard of it.
So I'm sure that there are other people like myself in the audience listening that I have, have not heard of it before and might wanna go. So that's wonderful. That'll be great. Now in closing, I wanna just round back to you being a DPC physician, having experienced fee for service, having chosen DPC because of the community, focus, you can build into your practice for your patients and yourself.
But when you do, talk to future DPC physicians, or just being aware that there could be a medical student or resident listing in the audience who is very much enamored with the idea. Is still in that place. Similar to you were in the beginning when you had that fear before your mom talked with you about, just at least try.
Um, So you don't have the regret of not trying. What would you say to those people just try. And if you fail, you fail. Right? So, a very important thing in my life, a very important person in my life has been or ward, right?
People I don't DPC people probably don't know, or your Lord, unless you did women's studies or are queer. Right. But one of the very important things that or your Lord said was basically your silence will not protect you. Right. So the point of your silence will not protect you, is like for everything that you speak, you speak those truths and you do it for yourself.
Right. And like this is a seminal essay by or Lord a extremely influential lesbian black lesbian feminist Pope, right?
And because I did women's studies in the 1990s she was one of the core person, people that we listened to. Right? So, this essay is actually, I think the transformation of silence into language and accent, right? You hear this and you see it on book stickers and things exact, it says your silence won't protect you.
And that has been a guiding principle for my life. It's gotten me in a lot of trouble. But you speak out for yourself. You do not speak out for other people, right? Like you. Your being silent when injustices are happening is never gonna protect you as a person. Right. And we know that history shows us that.
So like she had said something to paraphrase, like your, my silences had never protected me. Your sciences have never protected you. We protecting you. You're never going to. Go anywhere. If you stay silent about things, but if you speak out, you will find connection and you will find people. And even if you don't, you speaking out will be the thing that some other person hears.
Right. And so in queer communities, we know that intrinsically mm-hmm, your coming out may not be for you, but it might be for the people who come out after you going to pride this year really brought that home to me. Cause I was like, oh my God, I'm an old lady. And this is super event. And I don't saw these young people with
things like that. And I just was like, oh my God, pride and so much. And I was, so there was this community, right? So like you. You're speaking out and doing what you need to do. Even if you fail, you are setting an example for other people, you're setting the example to be brave. You're setting the example that marginalized communities and medically disenfranchised communities count.
And you are setting this example that you are gonna live your life, how you want it to be. Right. So think about it in any terms of that way. If you are queer, I'm gonna live my life with integrity and authenticity. If I'm a doctor, I'm gonna live my life in a way that I know I make a difference in the world and I am also making a difference in other people.
And I am not someone who just clicks buttons and does weird metric things. That don't mean anything. And then you continue on with that. So like, it seems very trite to say this. But be brave. Find your people know that there are people out there. Like when I went to nuts and bolts, I really didn't think there was anyone out there like me who wanted to do DPC.
And I found my people, right. They're my biggest support right now. And, queer people know this from the get go because we have our family and we have our chosen family and find your chosen DPC family. It might not be in the big DPC group. It might not even be in one of the side groups. It might be a super sponsor group, like where I found people, you'll find your people and you will get support and you will have people that help you so powerful.
Thank you so much, Dr. Bojo for joining us today.
You're welcome. 📍
*Transcript generated by AI, so please forgive errors.
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