Direct Primary Care Doctor
Dr. Allison Edwards aims to change the manner in which healthcare is delivered, putting the emphasis on keeping people well rather than solely stepping in and treating the sick.
Originally from Lawrence, Dr. Edwards spent her undergraduate years at Drake University in Des Moines, IA before returning to Kansas City for medical school at the University of Kansas. From there, she completed her residency and served as Chief Resident at the University of Colorado in Denver, CO where she also was awarded the Larry Green Award for Leadership, Scholarship and Vision. In addition to her role at KCDPC (now merged with Health Suite 101), she provides locum tenens coverage for rural hospitals and ERs across the Midwest as a board-certified family physician and serves as a Volunteer Clinical Assistant Professor for the University of Kansas and a Volunteer Clinical Instructor for the University of Colorado, allowing her to continue to educate the next generation of healers. She also provides consulting services for healthcare technology startups (Sesame is a proud example), writes for the American Academy of Family Physicians, and is a nationally featured speaker on the subject of healthcare reform.
In her free time, she loves spending time with family and pursuing hobbies including travel, gardening, cooking, being outdoors (backcountry camping and skiing are top choices), and enjoying a cup of coffee, ideally while reading the (real! printed!) newspaper.
FEATURED VIDEOS:
FEATURED ARTICLE:
The AAFP National Conference for Residents & Medical Students
Many Maps, One Aim: Charting a Course to Family Medicine
The Larry A. Green Center Person-Centered Primary Care Measure
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TRANSCRIPT*
Welcome to the podcast Dr.
Edwards. Hi, thanks for having
me. Your journey has definitely taken you very far from Lawrence, Kansas, where you grew up.
And so I wanted to start with something that was really, really impactful. Last year in Forbes magazine, you were quoted. Around sesames raising 24 million for, their venture, but the quote that you said was the insurance system is so opaque and full of hopes to jump through.
It's no different on the doctor's side than on the patient's side. We are equally frustrated with how poor of an experience working with insurance is. So given that DPC is your why, as you explained in your opening statement, this is so appropriate. And so, you saying how the doctors, as well as the patients are experiencing frustration, really highlights, , the, the why of this movement.
So I wanna ask, can you give us a little bit of a picture of your history and medicine and beyond so we can understand where you came from and how you came to this.
Absolutely. and thank you for having me. This is absolute joy. I'm so excited to be here. So I I went into medicine because I wanted to help people.
I think that a lot of people, especially those who are drawn to primary care are drawn into medicine probably for that reason. And I'd actually grown up like, like you mentioned in Lawrence, Kansas, it's a relatively small college town in the Northeast part of Kansas. And I had always worked for small businesses.
Like I'd worked for a hardware store and ice cream shop. And I, I was a server and I was a barista and everything. And, you know, I, I like to share this story one day. I was I was 16 and my boss who was not the kindest person asked me. I was a server at the time. Uh, He goes, you know, who do you work for?
And I was 16 and I'm talking to my boss. So I was like, obviously you, I work for you. And he laughed. And he said, no, no, you work for the person who signed your paycheck. and what he meant by that was that if you you know, at least when I was 16 in Kansas if you were a server, your paycheck was zero, your literal paycheck was nothing, cuz it kind of got all eaten up by taxes and, and whatnot.
And his point was that the person I worked for was my customer at the table, the one who was giving me the tip, the one who I was paying attention to to make sure they had a good experience and a great meal. That was the person who I worked for. Cause they were the ones who were ultimately paying.
And so that sort of ethos and mentality and small business mindset and relationship based like small, personal touch was, you know, what I grew up with culturally, so that when I finally gotten into residency and was working for a large healthcare system, it was the first time I'd actually worked for any sort of a corporation and a bureaucracy.
Not to mention the fact that it was, you know, we're, we're steeped in insurance reimbursements and all of those constraints. It, it really hit home that if I was. Gonna work for somebody in healthcare. I didn't wanna work for the large corporation and I didn't certainly didn't wanna work for the insurance companies.
I wanted to work for my patient. And so DPC is the way that you achieve that, right? Like they're the ones, your patients are the ones that sign your paycheck, so to speak. They're the ones that pay you. And so they're the ones that matter. And so I think, you know, that's why that's, that's my history.
Like that's, that's where I come from. And that's, that's how I arrived at, at direct primary.
That's incredible. I was talking with a person today, a medical student he's in fourth year and he was, talking about how, how could he go through residency now knowing DPC exists and how can he go through. The everyday clinics, especially knowing that he's going to enter into fee for service, And I told him, similar to how you said, this is your history. I, I said, and I challenged him about. Your mindset, that your mindset in residency can be very jaded, but like Lauren Hughes, who is, you're also your neighbor.
Yeah. At bloom, pediatrics and lactation, she pointed out how during residency, when she knew that she was going to do DPC. She thought about things differently. She collected attending's phone numbers. She operated differently so that she was ready to open DPC and already had that network and plan and, you know, the, the business plan and everything prepared.
So I really
love that. Absolutely. Yeah. It's all in all in your mindset.
Now, something that was very interesting, that I did not know about is that before opening DPC, you were a research intern for ABC and you were an intern specifically for the news medical unit. And so I wanted to ask because.
You know, DPC is a grassroots, so to speak, you know, movement, but at the same time it's growing like wildfire, right. And when we're working with, groups, employers, et cetera, the community around us, because our culture is so ingrained in fee for service medicine, they wanna know data.
And so, I wanna ask when you are working as a DPC physician, when you understand DPC from, from your perspective, and you've also been involved in, you know, doing research I wanna ask, what type of research would you like to see done in DPC to help push this movement forward?
Oh, oh, I, this is just such a fun question to, to think about you know, I, I have to tip my cap to a couple things.
So number one, anytime you measure something, you change it. Right? So, that's, that's part of the paradox of like gathering data and, and trying to make sense of things is that inevitably when you start to, you know, mess with things, you, you mess with things. But I think that what I would. To see, and this is a pipe dream and I don't necessarily have the path laid out for it as to how we get here.
But what I would like to see is sort of that longitudinal data that very directly ties DPC membership to better health outcomes, right? Decrease morbidity, decrease mortality. Because those are obviously those, those patient centered outcomes that we actually care about. And then maybe on like a less grandiose scale, like do our patients like us, you know, do our patients have a good experience?
Do our patients feel like they're listened to you know, do our patients feel like they can rely us when they're going through something fairly significant? I think that the patient centered primary care measurement tool. Is out of the Larry Green center. Isn't, it's a phenomenal tool.
And for those DPC doctors who are out there listening it's a, it's a free resource. It's I believe it's 10 questions, maybe 11. And we have administered that to the patients in our practice annually. And it's, it's, it's validated across cultures. Um, It's available in a couple different languages, but it, it, it measures the things that make sense in primary care.
And so I think they're on the right track there because ultimately from a research perspective and going back to, you know, you, you mentioned the, my time with ABC news when, when you're trying to. Sort of tell us, tell a story, if you will, when you're trying to change, somebody's mind someone's behavior, someone's culture, you alluded to, you know, our, our society's stuck in fee for service.
Everybody thinks health insurance is healthcare, right? So when you think globally about, you know, how do we change a culture? Nobody gets jazzed about, you know, data and statistics and like, according to our statistical, you know, survey and this, this, you know, tool that we have people get just about anecdotes.
And so I think that. That's the other side of it is like, how do we continue to collect stories? Which is what you do here. How do we continue to have that narrative of like, this is how impactful a, a good direct primary care a good primary care relationship can be. But then when somebody wants to get all wonky about it.
So if you're talking to an employer or a politician, or maybe just a, a. Overly eager potential patient . You can, you know, flip to the other side and say, Hey, look, we've got survey data that, you know, our relationships are more meaningful. Our NPS scores are better than, you know, almost any other industry, you know?
So I think there's, there's kind of two sides to that, you know, data and research thing. And they're both, they're equally important.
And on that note, because you have, been in practice for so many years at Kansas city DPC, you, you founded it, you opened it, you made it thrive. I wanna ask because we have the upcoming DPC summit in Kansas city and it's going to have three different tracks, the 1 0 1, the 2 0 1 and the 3 0 1.
And so that's really allowing people to go to content that is pertinent to people starting out in DPC, people who are in those first few years and the people who are looking to, you know, potentially add more services or get into specific types of offerings more in depth.
So I wanna ask in your practice, could you highlight Your 1 0 1, 2 0 1 and 3 0 1 tips for those people who might be listening to this podcast today and five years from now.
I think uh, anybody who started a DPC practice could like just go on and on about all the mistakes you've made.
I think my, my 1 0 1 advice is Kind of like a pep talk, right? You are a doctor you're smart. You can learn anything. And as long as you apply yourself, like it's like hunker down, like network, get out there, learn um, get mentors, uh, learn from, from some of those, you know, flashy business books and things like that.
Like. Develop your marketing strategy, you know, all that stuff like it's out there. People are willing to help you. There are small business development centers that are that are federally funded. There there's no cost. You, you don't have to pay for a business coach. And you can learn a lot. But you do have to dive in and you have to, you have to dive in head first and you gotta, you gotta be able to swim.
You can't just kind of wait and put your toes in and just expect to, to be good at DPC it's it's when done, right? A DPC practice is a, is. Thriving small business. And so you really have to have that mindset that you are opening up a small business. So I think that would be, that's sort of my 1 0 1, like rah, rah, go get him.
You've got it. And then of course, as time goes on, like, I show when I give a lecture to the fourth year med students about direct primary care, there's this point on my growth. Like I would actually pencil in on a weekly basis. I would pencil it. It saw this printed. Graph paper, like how many patients I had every Monday for the entirety of my business until I left for maternity leave last fall and then I priorities changed.
I don't have time to pencil it but anyway I should. Show these fourth year students, there's this inflection point that I point to on the chart about six months into my venture where I was like, oh no, I'm a small business owner and this is working and we're growing and I'm gonna have to figure out a lot of stuff to make these systems work.
And so I think that's sort of the 2 0 1 advice I would give is. When you're in 1 0 1 mindset. That's so important because if you can't, you know, take flight doesn't 2 0 1 doesn't matter. Yeah. But in 2 0 1, you also have to like set your boundaries, set you know, start thinking about like what practice.
Can I sustain and what behaviors can I sustain? And what expectations can I set for myself? What expectations should I set for my patients? so that I can have a long and fulfilling career and that needs to happen right after lift off. Right? Like you gotta get, get your plane off the ground. You got business off the ground then immediately like.
This is working and, and that's a good thing, but it also has to work for the long run, right? Yeah. I think a lot of times in residency, your intern year, your attends are like, don't spend an hour with your patient, cuz they're gonna expect that when you're a third year and it's like same thing in DPC, like, like really be clear about what you're gonna be able to do in the long run and not, not burnout.
Cuz burnout is just, you know, is an over extension of yourself. Right. So think about that in your 2 0 1. My 3 0 1 is kind of thinking about.
Like the longitudinal, like how do you, how do you create that adolescent business that, that can kind of run without your explicit involvement on a minute by minute, day by day, you know, week by week basis, how do you get the processes in place to have robust staff and thinking about.
You know, cultivating a, a great culture within your practice. Mm-hmm, through the, the clinicians that you involve, whether that's MDs PAs MPS, you know, how do you build that? Do you have MAs, do you have LPNs nurses? You know, who do you, what, what ancillary staff do you have to support you? And then also you really do.
And I know that this is kind of a. A third rail, I guess, and DPC, but you have to think about benefits and, you know, people actually do care about health insurance . And so like, think about are, you know, are you going to provide, you know, DPC coverage, you know, maybe at another clinic or, or find some way to ethically provide it for your staff.
And then encourage them to do a health share industry. Are you gonna encourage them to go on the exchange? Are you You know, how do you think about that? Because in today's climate with hiring, it's really, really tough to compete if you aren't thinking about those things. And then because it's fresh on my mind should probably think about what to do if everybody in your clinic gets pregnant at the same time.
because. that's that's hard how to small, this is, especially if you wanna, if you wanna provide for any sort of a parental leave. Yeah, so things like that, like short term disability you know, medical benefits and, healthcare and stuff like that. So that's, that's all important retirement, all that stuff.
That's that that's like, that's when you got your, your big boss pants on, you know, you guys start thinking about these things
such great tips though. And especially, you know, in this, in this climate where we're seeing DPC grow. Exponentially. It's really wonderful to hear those words from someone who is so experienced, so other people can think about what they would do if they had, you know, everybody pregnant at the same time, or, if they want to really provide some kind of healthcare coverage or 401k, et cetera for their employees.
Oh yeah.
You mentioned , the Larry Green tool, but when you talk about culture in your own practice, how did you specifically work on building culture? Especially for those people who are like, I sort of get DPC, but they're not really necessarily all in as much as the founders of clinics are.
Oh, my I'm, I am not probably the right person to speak to this because I don't know if I've cracked the code mm-hmm . I think there are a lot of really, really great clinicians out there who have developed a great culture.
And I, I have to tip my cap to my, my current business partner, Kylie Vanneman. She is has done an amazing job with the growth of her clinic in developing a beautiful culture. But. You know, part of it is is, is being intentional. Mm-hmm, about it. And I, and I see this in what she does and you knows glimmers of it and kind of what we were trying to develop And I I'm like I'm spoiler alert.
We're, we've merged with health suite one 10, and Dr. Kylie Vanneman is now kind of my business colleague. So, I'm gonna sing her praises a little bit because I think her culture is beautiful and that's, that's partly why, why we've merged with them. But you know, there's an intentionality to it.
They have a, a weekly meeting with the staff. There's, there's three nurses four physicians. And it's, you know, phones off for an hour lunch, you know, on Tuesdays, everybody sits down and make sure that we're all on the same page at the beginning of it. Everybody practices a, a gratitude exercise, a centering to exercise.
Mm-hmm the centering exercise. That's important. They and you know, we did this too at KC DBC, like having a fund where if a patient couldn't pay, you know, we could personally you know, cover their costs or for their medicines or whatnot and, and be intentional about being empathetic for our patients.
And then, I mean, ultimately there are some people who just are not good culture fits mm-hmm and when you become somebody who is in the position of hiring. To a certain extent, you kind of have to be okay with getting good at firing people. And that's hard and there's, there's a lot of different ways to think about that.
And and whatnot, and having fired a, my share of people. I'm, I'm happy to grab a beer with anybody who wants to talk, talk about it about, you know, the things I've learned, how to, how to, you know, do it well and how not to do it. And of course there's also legal aspects to that that I, I won't get into, but It's it's tough.
I'm sorry, I don't have a great answer for that, but it's it. I would say it's work, you know, it's, it's a concerted.
I think that that's a very fair answer, especially given your 1 0 1, 2 0 1 and 3 0 1, you know, high, high level thoughts there, because your business is not an autopilot.
Your culture is not an auto autopilot. So I think that's really, really a total fair answer. and I think that other people can really relate to that as they're trying to, face that challenge and, , make strides in the cultures, in their own practices.
So, well, I have, I have to say one more thing on that.
Yeah. I moderated a panel, I think it was in last year's AFP. I've lost track of time. COVID has really distorted my perception of time. Anyway, it was with Rob robs, furrow and Amy Walsh. On opposite coasts. And we talked about culture. We talked about this subject. It's like, well, how do you find great people?
And Rob was like, well, I don't know. I've I've had my gal for, you know, 20 years. I just took her from my last clinic. And Amy was like, oh yeah, we've had our LPNs. We trained him up. We've kept him, you know, we're, we're a solid team, you know? I'm like, guys, this is that's great for you, but there are dozens of not like hundreds of people out there listening to this who hate you.
Right. that is like, you know, essentially what they were saying is, oh, you know, I hit the jackpot, you know, I found a great person and I've stuck with them. So, I think that the, the big lesson that I took from them in, in that comment on developing culture and, and building a, you know, beautiful workplaces that if you find people who are great, keep.
You know, figure out how to make it, how to make it work and keep up. Yeah.
I love that. And not necessarily delving into specific examples in your practice, but when you talk about when a person does not, level up to the culture that you need them to, or that your patients need them to, how do you.
Mentally and emotionally go through the process of firing someone or letting someone go, because I know that that is a, place of, of difficulty when it comes to being a business owner, because we're trained to be physicians and even letting a patient go can be uncomfortable, but mm-hmm, a lot of the times there we.
Like actionable reasons. When it comes to a staff member, right. What words of advice do you have for people who were, in that? Do I keep them on or do I not, how do I go about this? Because some people say, you know, just rip the bandaid and this is business is money and you can't, you can't afford any more days of, Subpar care or subpar service. So I just wonder on your thoughts there.
As, as any good clinician, I have to give a caveat. You should get a lawyer on your side to make sure cause every, every state has different really specific laws regarding employment. So like, Do not do not go into this process without consulting sound legal advice.
But from just sort of a higher level perspective, if you do not feel bad about firing somebody. You need, you need to check, check your pulse, right? Cause like you're taking away somebody's income. Like we identify in the us so much with our careers and where we work that it, it is a big, big, big deal to take that away from somebody.
And so it's it, this is not to be taken lightly. That being said, you know, you're not walking into the office one day guns blazing. Right. And like, gimme your keys and turn off your laptop. Get outta here. Right? Like. To a certain extent, your point of like somebody mentioning, like rip the bandit off, you can't tolerate it other day.
Like if there is somebody who is actually dangerous and a threat to your patients, or is a potential to cause harm, like that is something that needs to be addressed immediately. Mm-hmm and that needs a quicker time course. But if it's somebody who is not actually you're, you're not worried about, you know, perhaps patient harm or something like that.
My. Ethos is one of like, you've got good people like you, you hired 'em for a reason, you know, sit down and be very clear with them. Because to be clear is I think a, a fantastic attribute of a leader. And to say clearly, like, I, you know, I love this about you and I also, I need this for, you know, from your performance in order for us to continue this relationship be explicit, you know, I.
This needs to be something that's tangible. It needs to be a benchmark. It needs to have a timeframe. You're gonna check in with them again in, in so much time. And I think a lot of employees or, you know, people listening might roll their eyes and say, oh, this is just a pathway. So you can fire them. And that's not the case.
Right? You should be doing this with the intentionality of. growing this person and developing this person and supporting them in becoming a great player on a DPC team, right? Yeah. That you're not, this is not punitive. It's for growth. And if you approach it in that way of, I'm not angry at this person, I want them to grow and I need this out of them.
And they see it that way and they, they receive that you are supporting them as a leader and as, as their boss that has great potential. And there's a lot of work there. Alternatively, it can also be a great opening to have that really Frank conversation where they're like, you know, maybe this, these aren't the benchmarks that I, derive meaning from in my job.
And you know, maybe this isn't the right fit for me. And maybe, you know, I should be looking at another career or another position, I think being honest and Frank about expectations and, and again, without any punitive Behavior behind it is really important.
Very Sage comments with regards to employment of others.
Especially because, we saw how many people really did suffer, losing their jobs and losing their health insurance with this pandemic. So, yeah. When you talk about culture, I wanna shift a little bit towards your impact on. Future primary care physicians and the fact that you are still involved in the residency in Colorado as well as in Kansas city.
You have been writing for the American academy family, physicians' new physicians blog and.
You know, the articles that you've written in there just really, really highlight the, the culture that you put forth in medicine. You were even on the main stage in 2019 at the national conference for residents and medical students.
And you spoke about a particular resident you had been assigned to work with. Yeah. And that In the uh, summary of that presentation, you were talking about how that resident was, if not fully burned out crispy and on his way there. So, when you are talking with other.
Future family physicians, future DPC physicians. What do you, in addition to, you know, that graph, that you talked about penciling and how many people you see on Mondays? Yes. What do you talk with them about in terms of, potential as a physician?
I think it's really interesting cuz We live in this bubble right. Where we're like, of course DPC. And of course, everybody knows about it.
And of course, you know, this is the right answer and it's so, invigorating to, to, to tell students and residents about direct primary care when, when they haven't heard about it before, cuz man, you can just see their eyes. Like they get like the thousand miles stare and like the gears start going in their head and they're just like, wait I feel like you.
Wait, no one should, what? Like people will just pay what, and you could just see this. And and so, and I think you, you, you already brought this up, but like just, it's a matter of thinking about your mindset, right? Like, you know, Here's somebody at the beginning of their career, they can do anything mm-hmm and I even talk to students too, about how you can be a specialist, you know, you don't have to be primary care to really understand and get behind the principles of, of a direct primary care relationship.
you can think about things in just a simple, like. Let's peel all the layers off the onion and just have a transparent price at, you know, at, at which you can provide really high quality healthcare. Right. Nobody's asking any physician to. Commoditize themselves down to the basement. That's not what we want.
And, and that's not good for our profession, which ultimately is not good for patients if you know, if, if we're not able to repair our loans and you don't get sort of the, the smartest and most driven people to be actually providing healthcare services. Right. But it doesn't have to be as expensive as it is.
And so, You know, it's, you know, it's, I try and light that fire of like, you guys can think outside the box, like you can make your career what you want, you can push back. And if we all, as physicians start to become empowered, to behave a little bit more entrepreneurial and a little bit more as advocates for our profession and, and ultimately for our patients mm-hmm and push back against these huge mergers and like big corporate influences and big insurance pressures.
You know, if we all stop signing contracts with crazy stuff in it, The crazy stuff would disappear. Cuz there would be no physicians. And so, I try just and empower, you know, students to just think and push back.
In terms of you know, your involvement with these residency programs, do you do any clinical work with them as well?
Or do you do remote sessions on just what you shared.
Yeah. So, for the university of Colorado, I am a volunteer clinical professor for the residency program. And so, i, I generally actually try and structure it as a conversation of with a kind of an open question, you know, how would you change healthcare? You know? Yeah. What is your, what would ideal healthcare be like for you? And it's really amazing to see where the residents take that conversation because ultimately, obviously it all could be solved by DPC
But yeah, that's how we kind of, frame things with the university of Colorado. Here at the university of Kansas here in Kansas city, it's more of a clinical relationship where at the clinic we've brought in students in their first, or excuse me, in their third year clerkship and some kind of, elective weeks in the first and second year.
But mostly the third year clerkship. And then I also help I'm on the board of trustees for the student run free clinic which is also really fun because it that really gets students thinking about like operationally, like how does really run? Like how do we provide care? And at what cost and you know, the unit economics of.
Of, of actual provision of healthcare. So, it's, it's a wide variety of different ways and I encourage anybody who's listening. Medical schools are always looking for volunteer clinical preceptors and it's a really, really rewarding thing to give back to students. And they also ask really good questions which means that you have to be at the top of your game.
So it keeps you really sharp. So, I highly recommend staying involved or, or getting involved in your local med school or re.
Yeah, and I think it, it also adds a layer of thinking about your business differently because when you have people who, you know, are very, just like our patients, sometimes very, new to the world of, of direct pay and direct pay models.
They have very basic questions and you can really, you know, like you are every day impacting the, , future DPC doctors, hopefully. When you talk with the residents, You can really think about your business in, in those high level. Like what would a basic question be about, you know, my marketing, my my workflows, et cetera.
And so it, really helps you also think about your own business and how it's run and how you can improve based on their questions. So I wanna ask there, and you, you mentioned how you have recently merged KC DPC with dr. Van's clinic. I wanna ask how do you even merge a clinic?
Because , that is definitely something that as we go into the future, you know, like Dr. Doug FGO has retired, he sold his practice, but definitely mergers are something that are bound to happen with physicians in the future of VPC. So how, how would you start explaining how to merge a clinic?
Oh, this is oh, who knows?
And it feels like, you know, the answer is always, you know, if you've seen one DPC clinic, you've seen one, if you've seen one merger, you've seen one . I do wanna back up just to say, cuz I, I know that it kind of, I, I had said on some of the message boards and in some of the social media groups that like I'm selling the clinic and, and it kind of raised flags people like, oh my God, what are you doing?
The reason I'm selling the clinic is because my passion in medicine is not necessarily in the provision of like one on one primary care every day. Mm-hmm . Yeah. I, I derive a lot of joy and pleasure from thinking about systems, levels of care, healthcare provision, health policy, you know, how, how do we provide, how do we, as doctors like provide outstanding healthcare to, to our, our community, to our neighborhood, to our state, to our nation, right?
Like that's what gets me jazzed. And so I really wanted to make sure that my patients were well cared for. Yes. Without, you know, me getting in the way of their care, basically it actually, it made for an easy transition because I, as I alluded to everybody at my clinic got pregnant last year.
We had we had two physicians, myself and my partner. My nurse also got pregnant. We, we were spaced about eight weeks apart. Everybody was, you know, delivering eight weeks apart and um, Just the, our poor patients, the transitions, and like, training up new staff to cover for everybody paying for my nurses, turn or parental leave trying to figure out how to work through my partner's parental leave.
And then eventually he decided, you know, he, he had a 45 minute community way. This was a second kid, his wife's in law school. He was just. He wanted to prioritize family. When my nurse came back from her parental leave, she wanted to prioritize family. So she decided she was like, I, you know, she left and went part-time.
And so it was just, it was a really interesting. Position to be in where I'm you know, , I think I was three weeks postpartum. When my nurse told me she wasn't gonna come back oh. And my partner had left and I had hired an NP to kind of cover things. It was this crazy paradox where I have a highly successful clinic with we, we were full great location, generating revenue, growing by word of mouth.
Not really spending much on marketing. And, and I had. Lost, you know, all like my, my culture, I'd lost my people for really, really joyful reasons, right? Like who can get upset about people having children and wanting to spend time with their family. And so, essentially that was when I was like, you know, I.
I want to make sure that our patients are well cared for mm-hmm . And, and that's kind of where the conversation started with Dr. Vanneman about bringing our patients into the fold of their clinic. They had two physicians who still were not full. I am gonna step away from day to day patient care, so I kind of transition my patients into their care.
Obviously we've had churn and drop off. It's fascinating with all the, with all the pregnancies of like the changes of the last year. We have a ridiculously resilient patient population, cuz they've stuck around through just an insane amount of chaos. And I, I bless them for that. Cause it's, it's amazing that they've stuck around.
But when we changed locations, we moved about eight miles south. Like that was some people were like, whoa, like. You left my neighborhood I'm done, which was interesting. Like it we, I think we all, as, as doctors, like to think that it's us, you know, the person that people are sticking around for, but I've also found that it is the address that people stick around for.
So, just, it's interesting. So I very nice. I'm happy if anybody's listening and wants to, to hear more, I'm an open book. But it's essentially as far as like, the, the price and like how we've negotiated all of that. We did it very differently than I understand Dr. FRAGO did in that I'm, I'm basically sticking around to help transition patients.
Mm-hmm and we're gonna figure out kind of how many people stick around for how long and kind of, come up with sort of the financials behind it in the end. So we'll and Kylie and I have a, have a great working relationship, so that, that works for us. And so that's kind of how we're. Take things from here on out.
Gotcha. And going a little bit further into that. Yeah. When there is a merger happening and potentially there's different tech like one EMR to a different EMR. Yeah. How, and just even adjusting to a new. Physician or a new primary care provider. How do you prepare your patients to transition over to a new way of doing direct primary care?
Yeah. In terms of the tech and in terms of, this is who is going to be taking care of you in the future.
You do it very carefully. I was listening to a podcast earlier today, reminds me like they were looking at death certificates from the 18 hundreds and like the reason for death on a, on a good handful of them or, or like the, how did the person die?
Section was filled out. It said. Suddenly that makes sense. Like, how do you transition your patients carefully? You do it carefully. It's like, did I do it right? I have no idea. I have. So. Stumbled through the last year of these poor patients being like, oh, Dr.
Short's leaving to be with this kid, like, oh, Lauren's leaving to go out a maternity leave my nurse. Oh, Lauren has decided to stay home with her kid and, oh, I'm pregnant. I actually didn't tell my patients. I was pregnant because I was so overwhelmed with, Everything that like, the last thing I wanted was for them to be like, and how are you?
Cause I was gonna be like that. Good. Please, not that. But anyway, what we tried to do is we tried to be really explicit And like anything in indirect primary care, we really tried to put the relationship at the center of, of the transition and just saying like, you know, we are here for you.
Like there's no need to panic. I am you call my number. I'm still gonna answer you email me. And my, my usual email addresses, I'm still gonna respond. You know, we changed addresses. It's updated on Google, on our website, on our footer. Like I'm gonna, when. You're gonna hear very explicitly we're at a new location, just like oversharing and over communicating.
At the same time, like we're also trying to not scare people because when Dr. Short left, I, I sent out an email and immediately people like, well, I need to find a new physician and they quit. Mm-hmm . I was like, well, that's interesting because like, with him leaving regardless, you're gonna have to find a new physician.
If you stuck with us, you wouldn't have to find a new clinic also, so you don't need to leave, but you know, people have their reasons. And I think sometimes it's a, it was a, a convenient excuse for them to move on. But I don't know, give people love, just give a little love, give 'em a little respect.
They're gonna be scared. They're gonna reach out like with, with different emotions, but ultimately they're just scared that they're losing something and, and you sort of have to T see that a little bit.
Yeah. Especially, I can see that with, the patients, especially in DPC having a relationship with their doctor and not, the typical like, oh, I haven't seen you in three years.
Cause every time I wanted to come in, you weren't, it wasn't your shift or, you know, whatever the reason is. So I can definitely see that. Now. Going off of that, if a person were looking to Futureproof their business, because that's, that's a big question in entrepreneurship. When you talk about going from like the teen years of a business to really, really being in that place of my business is working.
My model is working. How do I Finese that? How do I take it to the next level? Even if a person, you know, at, at some point closes their business, how do you think about future proofing one's business so that it could potentially be ready to merge or to close or to expand? I, I think about that as a business owner.
Yeah. In DPC, especially with this movement growing as it is.
Yeah. I think I mean, this kind of goes back to the, the DPC 1 0 1 concept mm-hmm you're, you're a business owner and. Every business owner from the very beginning, from the moment you open your doors, you need to think about what the end looks like.
And that's not a negative thing. It could be because like, like what we're going through, you're merging with another clinic. It could be because you have to close. It could be because you are brilliant and successful and you are selling to Google. I don't know who sell to Walmart who knows?
It could be because you know, life transitions. Kids come along and you need to do something different and you just wanna close the doors. It could be because God forbid you die. Like, there are so many reasons why a business ends. And, and most, most DPCs are probably set up as, you know, LLCs like sole proprietorships.
And so it's very much on your shoulders as to, as to where this business goes and how it succeeds fails, et cetera. And so from the very beginning, You sort of have to build your business to think about what sort of resiliency do I need to build? Should I, I always said this to my staff. If I get hit by a bus tomorrow, y'all need to know how to run this business without me.
Yeah. And so that became the the beginning of we have a really, really. Big policies and procedures. Mm-hmm I think it's like 90 pages. Last time I checked, which I know sounds probably small for some people. I dunno. But it has, it literally has everything. It has our vendor, you know, relations.
It has our Our like macros, it has, you know, weird contact information. It has like the state rules about, you know, reporting. And we tried to make it a living document mm-hmm so that if it was something really specific, we'd link out to a different document. So it's like, this is how we handle vaccines.
And we have a vaccine policy. Like this is how we handle controlled substances. We have a controlled substance policy so that our, our PMP always links out to the more editable live document. So it never, it never got sta. Awesome. And then there's a lot of SA you know, best in class software solutions that you can use to make sure that you retain control over like the communications of your business.
So, V O I P phones, for example where you can port numbers and you can take that anywhere you need to go, you can port that into a different system. You know, evacing making sure that that things can be forwarded. Obviously everybody's hopefully, well, maybe not everybody, but electronic record storage, things like that.
Like, I know this sounds kind of morbid, like you're gonna close your business, but, but, but truly, like, if you think about a transition in a business, like these are the little things you need to think about, like, do you have control over your. Email address like, or, you know, are your clinicians, you see all, you know, different email addresses, like, do you have, you know, control over the information in there?
Like business is about control. But then the like, but, but future proofing can also be a good thing cuz you're like really you're growing and really successful. And those things are still true. Right? Mm-hmm make sure your policies and procedures are clear. Make sure that people know where to find them.
Maybe they don't have to have 'em memorized, but they need to know where to find them so that they can operate. I.
Yeah. I mean, we, especially in primary care are always talking to our patients about, well, especially older patients or people who are ill about, you know, post forms about About in my case, I use the five wishes packet, but definitely I think that, you know, thinking about the future, like we say to our patients, when they're.
You know well, and talking about these things, it's not the most comfortable conversation, but it's so important to preserve what you've built. And so, you know, when we talk about culture, it's preserving your culture, it's preserving what, you know, your, your patients are used to whether that be it's still you in 10 years, or whether that be it, it looks different.
And so, this idea of future proofing it, it's not just pertinent to DPC. It's just, it's pertinent to all businesses. So I really appreciate that.
Also. Don't let all your employees get pregnant at the same time. no, I'm kidding. I'm kidding. That that is a hundred percent joke.
Like I, that was, I just, that was a, that was a tough . That was a tough go last year. Oh my goodness. I cannot
imagine. I cannot imagine. No. When you talked about, you know, working on this higher level of how to make an impact, in bigger societies, nationally, hopefully you work with Sesame.
And so I wanna ask, how did you get into this role and what advice do you have for those looking into, potentially nonclinical roles? Or consulting work. Sure. Because , when people get that entrepreneur bug, it opens a lot of doors. And so I, I love that you have different, pots on the, on the stove.
Oh, gotcha. And this is, this is definitely one of them.
Yes. I, when I have been telling people who don't know me very well, that I've, you know, I'm selling my clinic and moving away from patient care, they're like, oh, what are you gonna do?
And I'm like, you have no idea how many jobs I currently have. And I have trying to get rid of one of my many jobs because I am overworked right now. Yeah. So, I, I. I guess the, an, the short answer to your question is just yell loudly and people will hear you and pay attention to you. And, and eventually they'll be like, oh, well, you seem interested in this, like here, why don't you take this job?
And if you're just dating, you'll be like, oh yeah, sure. I'll take that job. But I, I think that being a DPC doc, to your point, you become entrepreneurial. You also become really independent, right? So like you're not beholden to any employer or non-compete, or like your benefits, aren't tied to somebody or your malpractice.
You know, you also have a lot of flexibility as to what opportunities you can pursue, what risks you want to take. And so, and, and if you have an idea pursue it during COVID one of my entrepreneurial friends, who's, who's not in healthcare, he's kind of in social justice. we had testing, he was like, we have a community need.
We got together pitched to a local non-profit about providing testing for the community. And basically just created this hodgepodge of. An effort. And I'm still the clinician on record for all of their vaccination and testing efforts here in, in the Metro. And that just came out of like a, a spur of the moment, like, Hey, this is a need that we've identified.
I have the malpractice, I have the business, I have the vendor relationships. Mm-hmm, like, all I need is a, a nonprofit partner. Cuz obviously I don't want people donating to me in my clinic, but I don't want that financial obligation. Like we, we needed a partner. And so, that was just, it was seizing an opportunity.
And. Creating one and going out there and finding it as far as Sesame, it was a similar thing, you know, networking, talking out loud, mm-hmm, , discussing with my DPC colleagues, like, you know, what's going on out there, like, just, just being out there in present. And then speaking up, like, when I heard about the opportunity, I was like, I, I wanna get involved in this.
Like how can I help? Sure. You gotta be careful, cuz if you collect jobs like me eventually you'll have too many jobs but but it's great. I still do locums too, like in the ER, in the inpatient world, like, because I, I actually really like that, that realm. And it keeps me really sharp.
And so I, I, I don't know. I just, you just do what you wanna do. It's fine guys. Like be explorers and, and be brave and, and things will come.
And on that note, one of the, one of the big things that I keep seeing in the DPC women's Facebook group is how do you learn to value yourself and how do you put a number on how much your time is worth?
It's a really important point to actually think about that because our like per unit value like, you know, how much, you know, dollars per hour can kind of get lost in the DPC world.
Right. Mm-hmm because. You can work 16 hour days in BPC, you know, five days a week. You can, you can work long days if you don't put some clear boundaries on, on what, again, going back to what I said earlier, like what can you do to sustain a career? Cuz that's not gonna work in the long run. And, and I think that goes to, to valuing yourself kind of in air quotes, not, not in an explicit, like I am worth X amount per hour, but rather.
you know, I am worth taking time to spend with my family and like at, you know, four 30 or F five, when I say I'm done working, I'm literally done working mm-hmm . And if patients don't get responded to until the next day, guess what, that's the business I'm gonna run. And that's how I'm going to value my time, because I value being with my family.
I value being on with my family and not multitasking and not, you know, having the computer open over dinner and, you know, responding to emails like. Here's the deal half the time. People, if you don't respond right away, like they're either gonna figure it out on their own or they're gonna get better by tomorrow, or they're gonna be fine getting your advice the next day.
It's like, it's not actually gonna matter if you respond, you know, or, or, or do whatever. In that moment. I was talking to Phil ESCU one time. It was fantastic. He said He was like, you know, the more emails I respond to, the more emails I get I was just like, oh, that's fantastic. So the, the answer is just like, right.
Fewer emails that you get fewer emails. Yeah. That's it like? So essentially like, you know, sometimes , we are the ones overworking ourselves because we're essentially, we' being a little bit too. Too responsive to we're too giving, you know, I think and I mean that like kind of collectively is like, I think family physicians give a lot without being explicitly compensated.
But at a certain point, you know, I, I'm happy to talk numbers with anybody who wants to talk numbers as to like what I actually think monetarily our time is worth But it's, it depends. And it kind of depends on, you know, your, your level of expertise and what you're doing and who you're doing it for.
And ultimately. How, how badly do you want to do it? You know, lower price that you might wanna command or like how much do you not wanna do it? Charge way more. There's always a number and you can always come to a number, but I think we tend to undervalue ourselves as, as family physicians.
I
definitely would agree with that. I mean, when, especially when we talk about consulting work I frequently see people talking about MGMA data equals my worth in any realm of business. and that's definitely not the case.
So I encourage people to reach out to you to reach out to yeah. Each other to, to talk about like, if you're doing consulting work,, if you're working beyond your DPC have that conversation about how much is my time worth and experiment with it.
Oh,
absolutely. I mean, in the worst, if you're consulting fees are, are too high, you know, somebody will say, no, I'm not gonna pay him, but that's not the worst thing that they could say. Right. It always, it always kind of feels bad when you, you put out a price and people are like, oh yeah, absolutely.
Like, dang it. Like I could have asked for more. But um, I don't know. It just, I think that the, the thing to hammer home is like, you're a professional and you spent a long time getting to where you are and you have an immense amount of knowledge. Not just from the medical side to your point. But also, I mean, you're a DPC doctor, you're a business owner.
You understand like the economics of healthcare, you understand. You know, consumer demand, you, you understand a lot more than people are probably gonna give you credit for mm-hmm , right off the cuff. But it's, it's worth quite a bit. And that's what people are paying you for when, when they're paying you for consulting, is, is that sort of like the secret sauce, right?
That that's not really quantifiable, but is so important to what, whatever. They're trying to accomplish or whatever effort they're bringing you in for. So don't, you know, don't devalue yourself cause you got secret sauce. I
love that. And in closing, I wanna highlight an interview that you had done on the fun podcast, because you spoke about, you got about two years at a residency, you got used to the idea of free time in self care. And now that you have been a resident, you've been chief resident, you've opened your DPC.
You've merged your DPC. You've had a baby. You've had people pregnant all at the same time in your clinic. I, I wanna ask what does self care look. For you these days.
Oh, so, this is very important when I, when I did that podcast interview, I was just far enough out of residency. Yeah. That I was like, just absolutely bamboozled by the idea of free time.
I was like this weekend, like, what am I doing? I, I have a free weekend. So like any pathological doctor, I definitely filled it up with all these jobs that I collected. And so, you know, so self care is like. I am working from home today and I definitely took my child into, to daycare, cuz I, I, I know that to be a better mom.
I need the time to, to get my work done and to process. And you know, I went on a walk earlier this morning and got a coffee and actually got on a, a group call with my mom and my sister. And we call it our, our weekly walk and talk and just making sure that, you know, that that happens in prioritizing it.
And ultimately this, this is gonna sound like a cliche, but it's, I guess it's a cliche cuz it's true. And it gets said a lot saying no. And, and that goes back to valuing your time, right? Like, making sure that you are maximizing the hours, you know, the economic Impact of the hours that you are working mm-hmm so that you can maximize that time to do do the things that, that, that fill your cup.
And that's not to say that, like, I, I think sitting with a patient and talking with a patient is actually a really fulfilling thing. Probably too much. So like, that's actually part of my problem is that I really enjoy today and talking with people. And so then at the end of the day, I'm like, oh crap.
You know, now I need to do my refills and my notes and everything like that. So, so I don't mean to say that. Work equals bad. That's that's absolutely not it. But rather to like, to, to make sure you say no to the things that are not fulfilling, right. Mm-hmm , there was a really good exercise that I did with my women's entrepreneurship group, where you kind of, you take set a timer for, you know, two minutes and without overthinking it, you just sort of like write down everything you do in a day.
Just EV like just whatever, everything When the timer off, you know, put your pencil down, look over it. And on that list, you know, see what you can either cross out or outsource. That's not fulfilling. And like, what are the things that you're pressuring yourself to do for no good reason? Like, like, be honest with yourself, like, are you doing things out of guilt?
Are you doing things because you feel like you should, are you doing things out of pride, you know, who knows why you're doing them, but like ultimately they could, you know, like get a frozen meal. If, if cooking is something that's like really hard for you, there's nothing wrong with that. Nobody's gonna give you a gold star for like making a meal if it's really exhausting for you.
You know, I know a lot of women I've spoken with have a hard time with some of the domestic duties, like in the household, like cleaning and stuff like that. Like, dude, there are people who will do that. Hire that out. and so, you know, it, it's not something that you have to own or be, or be proud about, you know, if it's if it's a commute.
You know, think about like, how do you change that? Do you redesign your practice so that you're doing maybe more telehealth, you know, doing some days where you're at home, so you don't have that commute. There's there's there are options. And so self-care is sometimes not about like, adding like yoga, right?
Like it's not necessarily about adding more. Sometimes it's about the minuses.
And definitely going back to valuing yourself and valuing your time. If you know that, you know, you need something to happen and like you have to hire someone to help clean your house and your overhead for life goes up, then your pricing can also go up to adjust to that.
That's right. That's exactly right. It all I mean, hashtag first world problems. Right. but like, but that's, I mean, that's the truth. You sort of have to think about it globally. It's like, what is my time worth literally? And if I can find somebody else to do this for. Less of a cost than it is worth my time to pay them and then continue doing that thing that I do that generates more revenue.
Love it.
Thank you so much, Dr. Edwards for joining us today.
Thank you for having me. I absolutely absolutely enjoy this conversation. Thank you so much.
*Transcript generated by AI, so please forgive errors.