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Episode 94: Dr. Amy Mechley (She/Her) of Integrated Family Care - Cincinnati, OH

Updated: Dec 13, 2023

Direct Primary Care Doctor, Lifestyle Medicine Physician

Dr. Mechley is a Family Physician in Cincinnati
Dr. Amy Mechley

Dr. Amy Mechley loves being a physician.

She attended Saint Louis University for her undergrad years and then earned her MD from the University of Cincinnati College of Medicine and then went on to the University of Utah Family Practice Residency at McKay-Dee Hospital. After residency she completed advanced clinical training in cardiac wellness at Harvard’s Henry Benson Institute in Mind Body Medicine Massachusetts General Hospital.

She has been practicing medicine in Cincinnati, her hometown, since 1998. She married a native Cincinnatian, and they are the parents of three fantastic children.

Dr. Mechley takes innovative approaches to some of the most challenging concerns in healthcare today.

She is a recognized physician executive in primary care which gained her national recognition.

Dr. Mechley has worked with all the regional Cincinnati healthcare systems. At the beginning of her 20+year career, she began a relationship with the University of Cincinnati/The Christ Hospital Family Medicine Residency, and today continues to guide and teach the residents, our future primary care physicians. Dr. Mechley feels strongly that primary care physicians need to be independent in order to serve as true patient advocates. Primary care doctors can work fully in the best interest of their patients, fostering a deep caring relationship to help improve health and promote wellness.

She became the first doctor in the region to be board certified in Lifestyle Medicine, which focuses on a partnership with the patient to improve their health. This is done by understanding the root cause of the issue and not just treating the symptoms. She has been awarded many teaching awards, local Best Doctors yearly since 2010 and to Best Doctors in America. Her favorite award is still a hug from her patients.

Dr. Mechley and her DPC partner, Dr. Glass, have been crossing paths through the years as they both moved to fully embrace a more holistic approach to medicine. This synergy and aligned missions brought them together to open Integrated Family Care in 2017. The practice embodies all the learnings from many years of work as a caring doctor, along with an executive understanding of the business of medicine. She feels this practice is a culmination of her calling as a healer.


Watch a virtual Integrated Family Health information session:


Learn About Tri-DPC, a DPC Network for Self-Funded Employers


Dr. Mechley presenting with Dr. Glass at the

2019 DPC AAFP Summit in Chicago


Hear Dr. Mechley & Dr. Glass on an IFC patient's podcast!


Hear Dr. Mechley speaking on the podcast hosted by medical students of the University of Cincinnati Medical School



- My DPC Story PODCAST Episode: Dr. Garrison Bliss


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Welcome to the podcast, Dr. Mackley.

Thank you, Mary. It is always good to talk with you always.

Your opening statement really, really speaks to all of us in the direct primary care movement in that we, if we don't realize it, when we're learning about DPC, we really truly understand that this is true patient centered medicine when we have our first DPC patient.

So can you please share with us, uh, as we open here, the story of integrated family care and how you and your partner in DPC, Dr. Glass became not only outstanding family physicians doing family medicine, but under the direct primary care model.

Oh, I love it. Yes. I I'll be happy to share that.

Happy to, to talk about my journey. Um, and hopefully it pertains to a lot of other people's journey and gives them the courage to take that step. so I would say my journey started before 2015, but 2015 is when things got real. And I was working, um, in a large healthcare system in Cincinnati, Ohio. I was the medical director.

working under CMMI, which is the centers for Medicare and Medicaid innovation. One of their innovation projects called CPCI. I know a lot of jumbled, terms there, but that was, , an advanced primary care, movement or advanced primary care, model that they were testing out. And it is, was essentially a progression from maybe a patient centered medical home.

You know, that, that concept first started maybe about 15, 16 years ago saying, gosh, we really do need to be patient centered. Um, we're we're in my mind losing our way. Um, and that was a, a very much a nod to that. And that turned out in my, uh, opinion to be much of, much more of an administrative move than it was true outcomes that we saw from that the, the, um, ideals were good, but how it was executed.

And we see that all the time, especially when a lot of these models come from payers and CMMI is essentially a payer and I'll actually stop right there. Cause you'll see, my background is also in a lot of healthcare reform. I still use the term payers, but if, if we think about it and I think this is critical to understand in the large macroeconomics of healthcare payers are the people that are actually paying for healthcare.

And those are you me, the individual, because we pay taxes and we also pay directly for healthcare. And then the employers, those are the only two bodies in the United States that really pay for healthcare. Even though we consider the BCAs and the government payers, they really it's transactional. They're just passing things through.

So I was in that world. I was a medical director for CPCI, and I kept thinking, this has gotta be more simpler than we're making it. This is just too cumbersome. There are so many different, additional needs that are being placed on the, the physicians on the administration. And they're basically saying, we want you to perform and then we'll pay you later.

And we're like, we can't do that. That's not primary care. We don't have this large margin. Like some of the specialists do to hire three nurses and then see how our outcomes go. So we really were pushing for some direct monies or some, some early, uh, monies investment monies that we would then have to, um, true up in the end.

And that's where CPCI kind of came from. So when I was looking at a lot of these different models, I was looking at something called micro practices and those have been around for a while. And Garrison bless again. He, he, we always consider him one of our, our fathers of DPC and he practiced in, in, uh, a format that again became what I think is the current DPC model.

So I was investigating some of these and I thought this makes a ton of sense. The thing that I think makes the most sense is to take third party payment out of primary care. Primary care is not expensive. It is foundational. It is budgetable, it's predictable, and everybody needs it. And we know from the, the, um, Research that everybody's healthier when they have routine and regular care by an individual by, by a physician.

So I was like, okay, this to me. And it's the whole adage that we use now in DPC. Why would you use your insurance to your car insurance to pay for gasoline? Why would you use, you know, that was kind of that click like ding, ding, ding, because we're already caught up in this, I, this, this thought that you have to use medical insurance and you'll see it, you know, our patients run around, like I have a card don't I get that for free or I have a card I'm like, well, that's unfortunately not how this insurance thing works.

Just because you have a card, especially as a transition from the 1970s through the eighties. And that, that, you know, has all had some significant impacts on what that means to have insurance. So that was, so I was like, this has gotta be a lot simpler. And obviously there was some burnout, there was frustration with large.

healthcare economics, and then seeing the suffering of my colleagues. Um, you know, I'm, I'm the medical director. I'm supposed to be staying up there with my pompoms in rah, going, come on primary care, we got this and it, it, it, it was crushing me. And in a lot of ways, my heart, cause I'm seeing these great doctors, um, doing things that, uh, aren't, aren't consistent with where they thought they should be at all.

So I had considered making a change and, um, went to an early DPC conference. I think it was 20 13, 20 14. I can't, I honestly can't remember which one came back and was like, this is great. So I, I spent in the next probably two years putting together a business model, so I don't mind risk, but I, my husband will laugh at that because he, he doesn't think I like risk a lot, but I like a calculated risk I like to say.

Okay. So, then I thought if I'm gonna ask a partner, which I was always my plan from the beginning, and we can talk about that, cuz there's different ways of doing this. I wanna make sure I de-risk it as much. As I can, if I'm gonna bring somebody else in, in, cause I'm, I'm willing to, to understand what I'm, I'm taking out as a risk.

So I created this business plan and we'll talk a little bit, if you want to about my design thinking background, because in the media time I went and got a certificate in design thinking, which blew my mind, did this thing called business model. Canvas really took the DPC concept and pushed it out on this big.

I had a white wall that was about eight foot by four foot. And just, I mean, you know, the, the typical sticky notes, everything else, and you look at who all the stakeholders are and what is your value proposition for those stakeholders? And I took it back to one of the, my mentors at, at, at XR university for design thinking.

He's like, okay, when you've a business model that meets the needs of all your stakeholders, he goes, I don't. He goes, I rarely see. And I'm like, yes, I'm like, okay, it's this is not gonna be easy, but it's pretty simple. And that's what I kept coming. You know, it's not easy, but it's simple. So long story again.

And so that's where I, I, again, attacked it from that perspective. Then I was all excited. Dr. Glass, ER, glass. We had met because I was on faculty. I, I taught at the university of Cincinnati for a very long time in my career. I was on faculty. She was one of my residents. She then joined faculty. So she, we were co-faculty members at the time.

And I was recognizing in her burnout and she was getting crispy and she is an amazing, an amazing person, an amazing physician. So I remember when I went to her one day, I'm like, can we have lunch? I said, I have this idea. And I started talking to her about it and she was kind of like, and she's, she's brilliant.

She's very headstrong. And I could tell she was like struggling with it. And I said, I, I know. I said, why don't you go to one of these conferences, see what you think. She went to a conference, came back on fire, and then the rest is history. So we opened in 2017. Um, she, I came from Originally a faculty position.

And I did some consulting in between, try it because I didn't have a full practice at the time I, I had, last saw my own patient panel probably four years prior to that. Cause I came on full-time back to be, medical director and do all these other administrative things. So I long I, well, my point is I didn't have a patient panel at the time.

I was seeing the patients with the residents, but she did. So we started with 50 patients between the two of us and they were her patients they were my patients. And that's how we started. And I can tell you now it's been five years. We've had a wait list for two plus years and we are, you know, having a great.

Absolutely incredible. And I love that you highlighted your experience at Xavier and your experience with the design thinking and the, and the business canvas, because, you know, when I had done my research about DPC, I did not know that the business canvas existed until I took a score class. And so I wanna, I wanna ask if you can share a little bit about what is design thinking, what is the business canvas when you, have it as your architecture to build, , your clinic off of, and did your original business model look like?

What it does today?

Yeah, those are, are great question. So the business model canvas is something out of, and actually, I, I look over here, my, my I've got a bookshelf to the left and it is, I had a lot of these like lean startup change. You know, a lot of these business books switch that I was like, just this whole idea of how do you innovate?

Um, and, and again, you have to be just not different, but you have to be different and better. And what's that value proposition. It gave me a lot of language to start understanding some of these concepts, cuz I didn't take a business course, zero Zippo all the way through college. You know, I was science all the way.

So this whole idea of economics and understanding these, uh, models started to intrigue me cuz I thought if we have to find an answer to healthcare, we need to do it with understanding all the stakeholders, all the people that are involved and, and how to make that change. And what's the, what are the needs of all those different people?

And if we can meet those needs, whether they're, our, patients or, the payers, like we talked about cetera. So. The business model canvas, and I keep coming and I apologize. This might not be correct, but stargazer is, I can't remember if they were the founded cause I would love to give credit, but there's an actual process called a business model, canvas, and then the value proposition and it, it again, and I like, I'm a visual person, so it breaks it down into these, um, eight boxes, these stakeholders.

And you have to think about what are the pains or the gains of each of these people that are involved in your ecosystem. So that was kind of, um, the model that I learned in design thinking, but design thinking itself, that was just a tool that I had design thinking the way I describe it. It's human-centered design.

So you, you literally have to keep this human in the middle of your design. So you're not designing a product. You're not designing a solution. You're designing for humans. And the thing that it made me do, which made me crazy at the time is I could not think like a doctor anymore. I, I, it made you stop thinking, like I got this like, oh, I've taken care of diabetics.

I understand that you have. Really stay. I don't know anything about this human being. And then you have to discover what you need to discover about the person you are designing for. And that's where we kind of talked about personas and you would, you would understand different personas and different needs.

And it was so frustrating because you feel like I've been training for this. I'm doing this. This is what I do for a living. And you know, this is why we keep coming up with the same stuff. You really have to go back and say, what am I doing? So to answer your question design thinking to me is that very strict human-centered design model.

And that like a lot of the key phrases are how, how might I, how might we, um, and you're just doing all you're doing, there's multiple rotations where you go through design thinking and you question what you did and you have to go back and then you have to, so it's, um, it takes a lot of time in the beginning, but once you start doing it, it gets you to the places you wanna be quicker.

If that makes sense. So

absolutely. So with that said, you and Dr. Glass have shared before. I believe this is the 2019, uh, DPC summit in Chicago. Um, the link to that video will be in your accompanying blog. So definitely go check it out, but you guys share how. Even during your week, you continue to work on that avatar and making sure that your value proposition is continually, you know, um, appealing to your population.

And clearly it is with your wait list being as it is. So can you, um, share a little bit about what that looks like and how you're able to build that time into your daily routine, even though you guys are a full practice?

Sure. Yeah. And I give a lot of credit to, to Eleanor Dr. Glass, my partner, she, again, I, I have a, a huge amount of respect for her as a person, but her mind her she's she just has this, this beautiful intellectual mind.

And she's extremely compassionate. I mean, she's like this, you know, wonderful. Person and packaged from a physician. But so her and I were working on, um, different things when we were in the residency program with what's called T I or training with an industry. And it has to do with what was before the lean model.

So have you heard of the Toyota model, the lean model, , that that really took off? , I think it was probably the 1990s, maybe early two thousands. I, I can't remember, but what that was based on is something called T WWI, which is training with an industry. And those were concepts that really helped, , keep businesses focused, organized, , but more specifically how to, train people coming on.

So you've got a consistent standardization, so it was along those lines. So from that, she's got these great concepts about how to do that and maintain a workflow. That's a continuous quality improvement workflow. So we both have that language. Um, and she continues to work in. Area in that field. Um, she was actually just at AWI conference.

She's like, I think probably one of the first physicians to be at a T I conference. Um, and speaking, uh, so we've come up with ways of, of continuing to embed that because you can get stale pretty quickly, uh, or think, you know, what everybody around you is needing from you. So just some of the things we do, I mean, we do the huddles, um, and you know, we're looking at those on a, on a regular daily basis.

We do a, a Tuesday meeting with our, all of our staff and what we have one of the key components. And again, we've grown over this first, last five years. So I'll just talk about where we are and if there's anything I can remember for people just starting like, Hey, this was important. Um, but we had an area in our office and we, we do definitely have the, the kind of the do act plan, you know, do we need to, to be looking at different things?

And like, one of our modules is safety. Are we doing well with safety? You know, just cause we decided here's, here's our vision statement. Here's our priorities. So let's make sure we're putting these out there. So we'll we'll we used to huddle in front of that wall. And then when we went virtual from COVID, it was, it was not virtual, but some of the, our, our staff members weren't right there on site.

But we still have that kind of mantra in our mind. And then what we have is this, you know, those big, huge white post-it wall notes. So we keep one of those in our back room and we, we have a thousand square feet. So our back room is. A beautiful converted closet and anybody at any time we have markers right there.

You just scratch a note, not a complete sentence, not anything like, Hey, I just thought of something. Why don't we do it this way? Or I just, why am I doing this? Or I'm a little frustrated here. So it's in the midst of your workflow. You are just scratching what you want up there. So it's really nice that you don't have to say, oh, let me put together an email to the office manager to talk to her about this, this and this.

And it's everybody, everybody. And we have a lean staff. There's not a lot of people there, but everybody can do it. And then on our Tuesday meetings, we just take it like I have it behind me, or Eleanor has it behind her. And we're like, okay, who wrote this? What did you mean? Oh my gosh, what a great idea.

Okay. Who's gonna take that on. Do we need to, and then if it's too much to discuss there, we have something called, it's from a book called traction, which we, we literally like is one of our, our latest business books that we've read. And again, Eleanor, um, and the book traction, we talk about rocks. So every 90 days we set no more than seven rocks.

And these are the things that we feel like we have to. The rocks that have to be moved. And then we assign those rocks and that's between El and I, and then everything below that should be pushing towards that rock. So we don't get distracted by the tiny penny or so it's resource allocation and thought, and those all have to point up to our vision.

So once a year we have a retreat, we relook at our vision, is this correct? Then we do this quarterly, um, rock resetting, and then we have 90 days to work those rocks. And it's okay if you didn't finish that rock, we just then say, is it important enough to continue to go for the next 90 days? So it's just a really, it sounds a little complex, but it's not, it's a really good way of keeping things moving and quick and efficient and making sure we're all yo yoed and rowing in the same direction.

And, we're getting feedback hopefully from a 360 to make sure that we're doing that. So maybe more detail than you needed, but that's kind of how we've embedded that in a day to day regular, Quality improvement type of thing just for our small office.

We can easily as DBC doctors because we're doing everything and wearing all the hat. Sometimes it's very easy to get into the weeds. So I really love that. And as a result, you guys have also continually worked on your culture.

And I think that that's a big thing that a lot of people have, you know, questions about how do you maintain culture? How do you bring somebody on and have them understand what you're doing even though they're not the creator of the clinic. So I think those are really valuable tips.

And that's actually one of our vision.

So we have those, you know, we have no more than seven cuz you can't do more than seven and we decide, so sometimes there's five, et cetera, but one is usually around culture. I love how you picked up on that. Or you, you pointed that out because I, I agree. We can look at finances. We can look at, marketing, we can look at, the stuff that maybe keeps us up at night.

But if you don't have culture and you don't foster that, it's gonna really start to erode your day to day and then it'll come out in all different ways. So I, I spot on.

Awesome. Now I wanna go back to the root of your guys' culture, because one of the things that you mentioned was that you were intentionally wanting to open DPC with a partner mm-hmm

And so you talked a little bit about Dr. Glass and her personality and her abilities as a physician and as a person and her, complimentary skills that, that go along with yours. But in terms of, if a person is listening and they're thinking about, you know, who would be the person to go into business with me, what are some tips you would say to them when they're thinking about who to choose to open DPC with?

Yeah, that's a great question. I think the first thing, and this comes from like some Steven cubby work is know yourself. Be really honest with yourself, know why are you doing this?

And then what is your personal skillset? Like I like the business end and I would not have said that 15 years ago, but I really like, I don't mind doing the numbers. I don't mind looking at contracts. I don't mind. And I think as I, I, you know, it's, to me, it's like a challenge or not a game, but, you know, it's like, um, one of S so we, we funny when we first opened it, it was literally the two of us in an office manager.

It was three people. And we, we were coming up with titles. I'm like, okay, you're chief, this I'm chief that, you know, just for the fun of it, cuz we could we're the owners. So one of her titles was chief label officer because she got a label maker in her hand and she was off. So I'm like. Fabulous. That is not intrinsic me.

That is not me. So I think coming to this and saying, okay, know what your why is and make sure your whys are, are connected. Like I said, Eleanor uses a lot. We're yod, we are definitely yolked and we wanna make sure that doesn't mean that we have to be in step with everything. And we dis respectfully disagree.

Plenty. So good communicator. I would say that's really important. Know that you're yolked. If somebody's saying I wanna make $2 million in the first year, and you're like, I really wanna help people who can't afford to pay. You're not yolked, you know? And it doesn't mean that you can't be financially successful by doing this.

But just kind of hearing that saying, here's why, why here's what I wanna do. And then here's my skillset. Here's what I love. I need somebody complimentary to that because in the beginning we were both doing everything cuz we wanted our fingers on everything. Cuz we were learning. And then about six months in we're like, we need to divide and conquer.

We need to separate this. You're obviously much better at this. I'm obviously much better at that. And for us, we were both really conscious about this 50 50 thing. So it was like, we wanted to be sure that we're not asking more of another person than we were giving in. And, what's interesting as I talk, I said that the, probably the biggest thing is to look for somebody who you can communicate with, because if you can't have critical conversations or speak your heart, as well as your mind it's gonna be challenging.

And then, you know, I'm 54 and it's fun. I love my life, but this is where a friend of mine, who's a business person and I'll be careful here I'll make a G-rated. But I was talking to him once and we were, I was doing some consulting work and he goes, he goes, Amy, I'm gonna the point in my life.

I don't have to work with blank holes anymore. And it hit me and I was like, Hey, that's really great. If you don't get along with somebody or you don't respect them, you don't have to do that. You don't have to work. So just being thoughtful about who you wanna spend your time with, and how they're gonna influence you and you're gonna influence them and we should be building each other.

So, , I think looking for those, characteristics, qualities that you really respect

amazing. I wanna go back now to your opening days, because once you guys decided that it was gonna be the two of you, you were gonna open, what were the first actionable steps that you guys made with that business?

Canvas, in place and with the goal of your ideal DPC, on the future horizon,

it's funny, cuz I, it, it, you think, oh gosh, I remember this forever, but it was, you know, five years ago and I'm thinking, where was I? What was I doing? I think that, again, a lot, I mean, we just did a lot of planning. It's different now.

We didn't have the resources that we, that everybody I think has now. I mean, AFP didn't even know what we were, you know, there was no, there was, I think maybe 400 people at that conference or 300 people at the first DPC conference. And there wasn't, we were, it was kind of like buy it or build it. There was no buy it.

You had to build it. You know? So, so I, I leaned in really hard and this is a advice I've given to a lot of people leaned in really hard on the people that are around you that you trust. So I had an accountant that I knew really well. I had a, a banker that I knew I had somebody in the family, uh, my husband's cousin who was in commercial real estate, cuz I was like, what do I look for in a lease?

You know, what are, what are the things I can trip up on? So I did a lot of self education and now, again, it's lean on us, you know, lean, we we're in a, a big, much bigger sharing community. so. What I did probably about three years ago is I went back and wrote the business. What I, I actually have it, I, I have it on my screen up here, but it's a direct primary care business outlined.

And I've shared this in a lot of my talks. And I wrote, I actually ended up writing like a, the skeleton for like a 60 hour curriculum on how to start your own DPC. And it hit right when I think a lot of the people coming out with a lot of this stuff. So I, then I realized you. The world doesn't need another one of these , which is fine, cuz I'm not great.

I, I already have two businesses. I don't one, a third, but I was like, if anybody's entering this, here's a lot of the, the think stuff. And I give this out at, at when I talk about DPC because I, I broke it down and I'm just gonna kind of read, I broke down to six modules and I have found over the years. One of your questions was, has we changed that much?

We really haven't, which I was ready to pivot. Like we had pivot kind of points in place and it's been fun to look back and think we really haven't had to. And I think it's cuz we did a lot of due diligence. So that's why I try to give this as, as a, um, here are those six things, make sure you're thinking of these six and again, the first is the, creating a sustainable business.

Choosing an organizational system. If you got sheets of paper in three notebooks and six places on your computer, keeping this. You're gonna too many resources. So making sure you're organized, I put the business model canvas in there have a financial analysis, basically called a proforma.

So, and this is the one thing that people are kinda like, ah, I think it's gonna be right around 50 patients or say I'm like, no, no, no, no, you can do this on paper. And you will know when you're able to hire somebody new when you're able to buy more toilet paper. I mean, you know, like, you can kind of predict these things with fixed costs and variable costs.

So then looking up your capital assets, your financing. So that's kind of all in just creating a sustainable business, setting your price. What are your revenue streams? What, what do you wanna do? And then module two was you actually have to run your practice like a business. And so that was HR, accounting, real estate compliance, that kind of stuff's under there.

Module three is protecting what you build. And that has to do with contracting legal business legal, and then all the insurances, cuz you think, okay, Mount malpractice, but then you have business insurance and cyber insurance, breach insurance, stuff like that. So what's really necessary. What's not, um, module four was technology cuz again, one of our taglines, we don't use it as much anymore was early.

Tagline is old fashioned medicine on a high tech platform cuz we're your doctor and the family kind of, you know, the doctor down the street, but we're leveraging all this tech so that the access is there and the simplicity is there. And I know that we've all been able to do that. Most of our, , practices, especially with the newer EMRs that are coming out that are more designed for us.

So again, under that module is EMR evaluation. Just, I have a spreadsheet that I give people just, here's all the six EMRs you wanna look at here are the probably 12 things you wanna make sure you have in an EMR. And then are you paying for extra for bells and whistles because are you do really need that?

What do you really need for your EMR? Um, and I, I, I love that. Cause when I used to be the medical director at the health system, I'd have so many vendors come to me and they're like, oh, we're gonna sell you this. I'm like, I need you. Here's my problem statement. Here's this thing. I, it is almost like a, a pitch for me personally, it's personalized medicine, here's the problems I want you to solve.

And they were like, well, no, we're solving this, this and this. I'm like, uh, we're gonna try this again. Here are my issues. Cause I don't want you to sell me something that is a piece of software that does what you thought I needed to do. I want you to sell me something that you understand this situation.

So it was out of that work that I kind of came up with those things, interoperability that's tech, five was get your practice notice. So that's like website branding, marketing, logo, design, social media , and it's fun. Some people, this is natural to them. This is like, okay, this. The world they live in.

So it's no big deal for me. It was like, what is marketing? I mean, I know what market what's branding, you know, I had to learn a lot of that. It was fun. and then the last thing was just filling your practice. So, you know, making sure you're getting the kickoff and we get, I think we'll cover some of those.

If we, you know, the ones that we wanna highlight, like what has worked for us or what hasn't. But anyway, that was where, because you were like, where did you start? How to do it? I luckily. Had most of that and then went back and really organized it. But that was what I think we didn't have to pivot a whole lot because we had thought through, we understood our market, um, and kind of had an idea of what to expect.

Even if, if somebody has read resources and whatnot on business entrepreneurship or direct primary care, just to hear those words again and to hear your highlights, it never hurts to hear and, you know, think about things in a different light or, oh, in the, in the context of this conversation.

, I, so I think that it, it, this is just super helpful to hear that. Now, when you mention marketing, I wanna go there next, because you're in Cincinnati, you're not an Arnold, California. Like I am, you are in a big city. And so when you guys were opening. And you were keeping lean, but having this amazing, you know, tagline of old fashioned medicine on a high tech platform, how were you going about filling your practice with what marketing with a particular marketing strategy?

Yeah. I'll tell you a few that we did that didn't work. Cause I think it's important. And I'll tell you the things that I think worked now that you know, there's a little bit in the rear view mirror. So I, I literally remember, and this was Eleanor's idea. We printed out a one sheet thing. This is who we are, this is what we do.

And I think we made a hundred copies and we literally walked the streets around our building. I mean, we figured out like, there's a, a five mile radius. You go this way, I'll go this way. And we knocked on doors. I mean, it was, and, and then again, like you said, big city, this isn't like, people are like, who are you?


[Why are you? You know, at my accounting firm, I'm like, well, we're right down the street. We're a doctor's office. And they were just like, . What are doctors doing here? We met a lot of people. I do not think we got one person from that. Directly, but I do believe people started hearing our name and they started hearing what was going on.

So again, I think that was good still. We're great neighbors. We're in this community called east Walnut Hills, which is right up like it's we sit on top of the hill looking down into downtown Cincinnati, so we're really close to being urban. And it's a really wonderful eclectic neighborhood

, so again, getting involved in your, in your neighborhood , and to us, that just really meant really going out and walking and people are like, seriously, you did that. I'm like, oh yeah. So that, that was one. Um, another one, I think Instagram has been great for us. And again, we have to think where we're marketing locally.

I don't need somebody in Indiana to know who we are per se. Um, until the second business we can talk about in a second, which is our network. But for our practice, it was, very local. I'm trying to think what else we did. I went to a bunch of HR benefits. I, I talked to a lot of, , benefits managers.

I talked at to a lot of brokers. Some of that was my consulting work before. So I was kept pitching what we were doing a little bit as I was doing some healthcare spend consulting work for some, benefit managers in town, talked to a lot of CBAs, cuz you were thinking about who else is like-minded that might understand we are here to take better care of people and oh, by the way, brilliant, we're saving money for people, especially when you combine it with my lifestyle medicine, which, you know, we can, we can hit on a little bit, cause that's just such a huge value proposition.

So that's what we kind of did early on. I think what was really successful is our info, sessions. So. We started cuz we thought, you know what? Most of the time in old fashioned medicine, it wasn't you're necessarily going to a health system or a component. You were wanting to see a doctor. You wanted to see that personal doctor.

And that was one of our things that we knew we could be valuable with. Like you were gonna come to see Dr. Glass or Dr. Meley. Cause we don't share patients. We cover for each other, but we don't share patients cause we really wanted that long-term relationship. So meet the doctor. So as, Karen or our office manager were getting calls and she had a great pitch down, cause we had to work on that for our first six months.

Like what does she say? How do you answer those questions? Like, why don't you take my insurance? And you know, just those, the similar questions that we would get, she got Her sayings down that were really good. And then she'd say, well, would you like to come meet the doctors? And people were like, oh, well, yeah.

And so instead of us doing the half an hour of the 10 minute, you know, phone interview, we decided we'll do this. And so we were holding them, I wanna say twice a month. I think at one point we did it once a week, but we backed off to twice a month. And we said, this is when you can come.

They actually physically came to the, office so they could see the space. We kept it really simple within an hour. We started on time. We ended on time, cuz again, we were like, we're building our culture here. We each took little tidbits of these five things that we knew that people tend to have questions on after we introduce ourselves.

And then we left last half an hour open for just open-end questions. Like what questions do you guys have for us? And then we gave a tour that lasted about two and a half minutes. It's 1100 square feet. And, and again, we kind of explained, this is why this is your medical dollars. We wanna make sure one of my jokes always was you'll never see a chandelier in my office because that's not gonna make you feel better.

It's not gonna be helpful, but you're gonna see a really nice autoclave because that's important, you know? So, I think again, it was just them seeing us as people and then that I think really struck a chord and then word of mouth started within a year after that, then the Instagram. So for us, the word of mouth, the in info sessions, and then the Instagram post were, were I think the most that hit for us the most valuable.

And during the pandemic, you guys transitioned and pivoted so that you had these info sessions online. And one of those examples is actually on your blog. , so if you haven't seen Dr. Ley and Dr. Glass's, info sessions taken a look at it at their example. But let me ask you there, when you guys had to pivot and go virtual, did it make an impact?

Did you still see the same interest in the practice?

We continued to see growth. So one of the things we did again, and this was, we just, we were actually talking about this with my office manager yesterday. We were like, you know what, because it's after COVID, you know, not after COVID, we're still in COVID, but you know, after the urgency of COVID and we're sitting here and wasn't, we, we looked at each other, like, we're really proud of ourselves.

Like, like we did good , you know, and all of that, it was a, quite a challenge. So we already had telemedicine cuz we started with telemedicine five years ago, so that didn't change. But we had to message to our patients. You can still see us. You can still, we're still seeing patients in the office, but we're not doing well visits.

Like we shut down, well visits, we shut down the stuff like it's just for urgent, emergent, but. A non-urgent emergent. We can still do video calls. So yes, when the message from the, the rest of the healthcare community was like, you can't come in and we can't see you. And most of the healthcare systems around here didn't have telehealth because of the whole well insurance doesn't pay for.

So therefore we don't do it kind of issues. We actually ended up, I, I called the lawyer that we worked with and I'm like, I need a contract, a quick contract that people can sign that if they're not my patients, I'm still gonna see 'em on telehealth, but they don't have a long term relationship with me, which is very different than our current DPC, contract.

And she was like, what? I said, there's so many people that are not being seen that the, the, their choices are emergency emergent care or nothing. And I'm like, we are fully set up on telehealth. So we ended up very quickly pivoting. And so we saw patients that were not our patients, um, just for a quick 15 minute.

And most of them were, can you explain this COVID virus to me? Can you explain, you know, what do I have to do to be careful? Um, you know, or I have a cold, or I, you know, um, I mean, there were sprains ankles and the typical stuff. And it was all virtual. And so then I would say, okay, if you're not my patient, we could bring you in, but you have to do a little bit of a different thing or you're correct.

You should go to urgent care for this. So it was really, it was our way in the community of keeping people out of urgent care and out of emergency rooms during that time period. And that worked really well. And then we were one of the first people to give COVID vaccines in our office because they weren't giving them to primary care.

And I'm sure you've heard that before. That was a, a really big thing for DPCs. I mean, we were, had already started doing vaccines and so we were like, yeah, we've got everything. So it, it worked out again, those were two big shifts that I think were really important during that time period. So I think because of that, we, we continued to do a lot of word of mouth and we continue to grow.

Now we slowed a few things down. So to make sure that we could cover the patients that we were caring for, but we continued to take new patients

incredible and definitely a Testament to how the value proposition, even during a pandemic really doesn't change. In your case, even for non-members because they still understand the access to a physician,


I wanna go back to the fact that you guys are in Cincinnati and you guys have created tri DPC within your area.

So can you share with the audience, what is tri DPC and how do you guys. Exponentially affect more people with your guys' collective value proposition within TRID.

Yeah, no, I would love to talk about it because this is something where we started probably in our second year, we were working with employers cuz we really understood, like we talked a little bit about the payers before, like where is the value proposition?

Employers are getting much more savvy, their understanding their healthcare spend. So we love the niche of, five employees, three employees probably up to about. No more than 500 employees. but with ele and I just being the only two physicians, we were doing like hair salons and, real estate companies, small businesses like that, who they were like, you know, we don't have to give benefits to our patient, but really want to, so those, those companies are, are pretty easy to work with.

But then as we got into larger companies, we thought, first of all, They don't wanna sell all their employees by the way, you have to choose between Dr. Glass and Dr. Meley because choice is really important, especially when it comes to primary care and they, they had this, gosh, we need more geography and we also need to be compliant with the rest of our, what we call an an S P D or wraparound product. So I, I, like I said, I did some consulting earlier in the healthcare economics field, but mainly in, um, healthcare benefits, like where's your spend going? So I would look at a company spend and say, here's where you're maybe, you know, you need to be thinking about your benefits changing because your spend is here and here's a high value, provider in the area because of their cost and quality, et cetera.

So I have a, I had a little bit of a background in that. So I started talking to employers and I was like, there's an absolute need for us to be able to bring these companies in simply and with compliance and then allow and facilitate their employees to go to any of the DPC doctors around. So we were able to coordinate, we started the company called try DPC.

And I did it with the McGill MD practice. Another practice here in Cincinnati. And, um, we've had the company now for about two years and we have, multiple doctors. So there are affiliates and it doesn't cost the doctor to become affiliate, but you do have to qualify, meaning we want high quality doctors who are gonna say yes, this is how I'm gonna treat these patients.

Because we have to go to the employers and say, this is what you're purchasing. This is what you're buying for your primary care. Doctors, you know, they're gonna do well visits. They're gonna do sick visits, , so all of those things are very clearly laid out. , and then it's a simple administration with a single contract with that employer.

And then in the background, we do all the hard work. We all do all the disbursement of the employees. We make sure that everything's compliant. Um, so we put a lot of work in this from a legal perspective, from a document perspective, from understanding the risk law and the DOL law, because there's a lot that goes into that.

So again, we're making it simple for the employer to say, yes, I want this, I get the value proposition. So I take, by 10 questions that I, I asked the employers 10, 10 financial questions. I can create a whole business performer. This is what they would look like if your company used DPC during this time period.

and it's really important for the CFO to see that because they're like why we call it penciling out. It has to pencil out. It has to look right financially on paper. Like, what am I getting for this? I'm making a change. How is this gonna affect most employers? I love it. Understand that they're getting better medical care.

And some employers are like, I pay more for that. But what I usually can show them is based upon what I know about your spend, you're actually gonna spend less and you're gonna get better care through our DPC docs because they are doing relationship based care. So it's awesome. So we do all that in the background for them.

And then for the docs, you know, we'll, we'll help them with vaccines. We kind of talked about that. We, we kind, we work with a, a little bit as an MSO somewhat, but you know, helping them procure things, but it's always like, what's. For us, we get together quarterly to talk and share information, but then we help infuse the stabilization to the practice of all these employee, based patients.

And, it's worked really well and we can expand anywhere in the nation if we wanted to. Oh, I like staying local. But it, it is really nice that we kind of have this umbrella to help facilitate that, which is again, getting this DPC model out. To more people, more doctors in a way that is, simple and compliant.

Amazing. And like Garrison bliss has famously.

People like him, the pioneers of DPC have built this movement and it's up to us to determine what happens with it. And so I think that doing things collectively, locally , so that everybody wins is awesome. So I wanna ask there, when, if. , a physician or DPC practice is wanting to join trade DPC.

What happens? Is there a fee to join? Is there a shared marketing fee? How do you guys work it so that everybody, , is involved in benefiting?

Yeah, ours is really simple and it's designed really for the independent physicians, the physicians that own their own practice. So we're really not set up right now for somebody to come.

It, it is for each individual practice, but you couldn't come and say, I, I want. Try DBC to pay me a salary and I'm gonna go open a DPC practice. What tri DBC helps are the physicians that are independently owned by themselves, by the physicians and they wanna get into the employer space. So to become an affiliate, we just have a protocol that you look at and you say, do you meet these.

Qualities. , we obviously do background checks, make sure they have a license to practice in the state, you know, all the, all those things like that. And then we, we add, we do we ask questions because we want people to be of a certain quality and make sure that they are, gonna follow through with taking good care of patients.

So, you know, do you have afterhours coverage? Who, what is your after hours coverage? You know, what is your sign out? If you do go on vacation, things like that. And we can help with that. But again, we wanna make sure that we're, , really bringing together this community.

So it keeps that legitimacy and the respect of what we're doing. Cuz what I think you, there was something called a Dino, uh, which is DPC and name only. I love that you, you had said that earlier and, or we were talking earlier. And there's a lot of, yeah. Oh yeah, me too. We do that. Oh yeah. I do that.

And I can call myself that and I'm like, you're not doing primary care. How can you call yourself, you know, a direct primary care. And what you're doing is cash based medicine, which is okay. But it's, it's not that encompassing thing that people are looking for when it comes to the true primary care. So we vet the affiliates, but there's no fee.

We think that's really important and they could be part of us and, and say, you know, I just wanna hang out and see what you guys are doing. That's perfectly fine. I mean, and so there's not a, a big leap to come in, but then what they would be open for is when I get more employers, can I then use, or, market your practice as available for these employers.

And it's a, win-win it makes. It makes the employees wanna come in more, the employers wanna come in more because they see more doctors, so they have more choice. And it really helps the doctors to say, yes, I've got all these different streams of, , people coming in. So It's that same business model, canvas, the stakeholders that they, that the value is there for both.

And so it works really well. And I'm bringing on a, a pretty significant employer. they're gonna come on in October is when they come on, it's been a three year discussion. There is a long. Relationship building that comes with a lot of the employers. Cause they were they're like, this is different. This is new. So I do a lot of that because I, I can really talk the talk with the broker and with the CFO and with the human resources person and the benefits design.

So that I think is a, is a value to help. People feel trusted when they, when that comes through, they know everything's been vetted. And so, um, uh, it it's, it's just been exciting to put that to work and to be able to do that and help, like you said, push things up the hill and keep things moving forward so we can scale it.

When an employer joins and has coverage of their employees, , through multiple direct primary care physicians in your area, or wherever in the nation, how does it work? When you're developing those performers, do you incorporate the existing prices of the independent practices themselves, or is there a, a set fee per employee, that is shared, amongst the different DPC doctors?

Yeah, it's a great question. We decided to keep it, cuz some of our foundational pieces are transparent and simple. So everything we do is is, is transparent. So you really see this is the money coming in. This is what's what's happening. So we set the price and then we make sure our doctors are okay with that price.

Like, would you be okay taking care of our patient and getting this much money for it because then it's consistent. The employer knows what they're paying and what they're getting the docs, know what they're getting and they're hopefully, you know, are comfortable with that. So again, it's, it's very transparent and then it really helps from a Arisa law, which you have to really understand benefits law.

It's, there's a lot of technicalities. You cannot offer different things to, to different people. You have to be very consistent and standardized in your offerings to benefits for employees. So it's very consistent as far as what is offered and at what price point.


Now in terms of lifestyle medicine, now, I it's so funny because you were mentioning how you guys like took, you know, this five mile radius song I'm gonna go and that family I'm ready.

You you're gonna go. And it's so like lifestyle medicine of you to, to just do the, the, , the, yeah. walking the pavement. So I wanna, I wanna ask now, can you share with us about how you got into lifestyle medicine and how, and this is why one of the big reasons why I reached out to you to be on this podcast is how do you integrate it into your practice?


Yeah. I, I, again, this is, it's gonna be so much fun to talk about. Cause I, I, obviously this is kind of the heart and soul of, of why we practice the way we do and DPC was the mechanism so that we could bring lifestyle medicine in cause lifestyle medicine is not currently supported very well in a fee for service environment.

You know why I always say we really took a wrong turn when we started paying doctors to do and not to think. , and that's, it became transactional. So we're going back to relationship based medicine and, and lifestyle medicine. I mean, what it is just where people don't, they're like, what the heck are you talking about?

Cause a lot of people are like, oh, that's an alternative medicine, et cetera. It's really evidence based scientifically sound. Interventions that prevent treat and potentially reverse disease. So it is, if you look at any of your, JNC eight, any of your, , endocrine guidelines for diabetes care, et cetera, the number one intervention is lifestyle treatment, lifestyle intervention, and people kind of glaze through that because they're going to the pharma and you're like, no, no, no.

There's a reason. There's a total evidence based scientifically sound reason that we need to pause and stop there. And then it becomes a yes. And with any other or any other interventions, you know, pharmacological surgical, et cetera. So we talk about the six, six pillars of lifestyle medicine. And it's nutrition movement, sleep, stress, substance abuse,

a connectedness social interaction. Cause we know these are those foundational pieces that if we are not putting resources to those in our own health and wellbeing, things are gonna happen. And the way I like describe it is so again, and I'm not sure how much visual that, that, um, our readers are gonna see, but if I'm holding up my, my Palm in my hand and I'm saying, okay, here's the root cause of disease.

Here's what's going on down here. All my fingers are these symptoms. So I've got, high blood pressure. I've got, muscle aches or joint pain, arthritis, et cetera. If I don't come down here and just figure out if somebody's not sleeping well, or if they're eating very poor nutrition, then these things are gonna continue.

But if we start to correct those and again, the lifestyle medicine is, is, I'm not telling you what to do. I am kind of helping you on this path and you are choosing to do that, which is huge because again, it's patient oriented goals, patient focused, it works beautifully, and everybody's like, I'm not, I'm like we, and that's the thing about, well, we'll talk about the conferences coming up, but we're literally gonna be teaching family medicine, doctors, how to do this well and integrate it.

So this is where I get super, super excited, cuz it's not like you have to have this special sub sub sub so special. The whole idea is we wanna infuse lifestyle medicine back into primary care because it is truly the medicine that we thought we were gonna be practicing before we went to med school. And, and before we went to residency and we got into these, this.

Dural trap thing. So if you start taking away or starting to actually transition the diseases or the, the, the issues here, all of a sudden it's like, Bing B, B, and you still might have one thing that we need pharma before. So it's not saying not medicine, but again, you're saying, okay, but now I'm treating this.

And the resiliency of the patient and health of patient is profoundly different than before. So it is absolutely foundational. And again, that's why I get so excited about it. And it's not, it's not sexy. It's not, I have a lot of people will ask me, like, there's a lot of alternative or a lot of different types of medicine out there.

And there's a lot of noise. Cause I always talk about the noise to signal ratio. And this is the issue that I have with a lot of people with the wellness and all this, all the other, you know, diet fat of the month kind of thing. We can distract our patients horribly and people can get distracted significantly with influencers or to people that are pseudo.

Scientific or pseudo, et cetera, but the signals there, and if you're spending time out here, you're not getting to the thing, that's gonna make you the healthiest. So we really try to clear that up and say, really, we wanna focus on this and it's not. Sexy. It's not like I have a secret, nobody else has, and you have to pay me to come get this secret.

It's broccoli, you know, , it's broccoli is not sexy. It's it's, apples it's it's movement. It's thinking about what you're doing with your fingers, your feet, your hands, you know, your voice, um, and being, you know, thoughtful and intentional about that. and again, DPC is that business foundation that allows me to practice medicine that is the most pertinent and most valuable for my patients.

Cause I work directly for my patients and I do it in a relationship based so that once I get to know that patient, I can say, here's what I'm thinking. Here's, uh, why I'm gonna take the time and talk to you about your sleep as opposed to writing three prescriptions for you. And it, it just, it absolutely proves itself in statistically in, um, improvement of health, which if you think about healthcare reform in the big picture, it is much less expensive to take care of a healthy person than it is somebody with disease.

So, and, and then the ROI is, is. So I went off on a little tangent. I'm not sure if I actually answered your question,

you, you totally did. The, the second part of that is the integration into your actual practice. When a, when a patient is coming in expecting, you know, like to fill out the forms and to, you know, get their vital signs and then get their seven minute visit, and then they experience something completely different at your practice.

How do you guys develop the workflow? So that you're from the get, go from the initial intake already, like you said, you know, trickling in that lifestyle medicine and incorporating it into

their care. Yeah, I love this cuz it's so funny. We were talking about some things. I took notes and this is how, how we know this is real.

I haven't looked at my notes the whole time. We're we're I'm like, yep. Yep. We're this is just it's just so, um, fun and easy to talk to you Maryelle cuz you, you, you really deeply understand these, these critical concepts in caring for patients. , and obviously this is, you know, why we're both excited about this, this lifestyle medicine stuff.

So how we infuse it and it, it is it's from it's from the moment from, from the moment we have contact with our patients. So one of the things we decided to do is we do a 30 minute, uh, patient intake and we've started doing it virtually because of COVID two and a half years ago. And we're keeping that, so my brand new patients, I do a 30 minute video call with and all I do is review their medical history review, good, everything that I've come in through various electronic means.

And when we have them fill out, we have, we do have them fill out that one form to say, can you tell us? But as you know, that's like. 70% accurate. Cause people are like, oh, I forgot about that surgery. Oh, I didn't even think about that. You know, I, oh yeah. I have asthma. Is that a disease? And I'm like, well, yeah.

You know, when they say, but what's your medical history, none. And you all of a sudden you're like, okay. So that 30 minutes really helps me. And I tell patients, I said, for the next 20 minutes, I'm gonna ask you questions. But the information you gave me, because not only do I wanna make sure I have the details so I can be a better doctor for you.

I wanna understand what that means to you and how important that is to you. And then based upon that, we're gonna make a plan of what, what we wanna do next. And it's really fun because most of the patients are just like, oh, and their shoulders go down. Cause they're used to doing the, I'm gonna fill all these forms.

Nobody's gonna look at me the eyes, they're gonna glance at the forms and put 'em to the side. They're gonna click on all this stuff. And then, you know, I, I, I'm not even sure if I really got any questions answered. So that sets up this basis of relationship. And I get, we get so much feedback. Like people are.

This was lovely. Thank you so much. And, and I'm like, well, this is really important for our medical care. So that, and, and inside of that, inside of our, our medical history, there are questions about sleep nutrition, and there are real specific ways about asking this. And that's why I, I, I wanna, when we talk about lifestyle medicine, I wanna make sure people get trained because once you get trained, it will just flow and it's not gonna be like, oh my gosh.

Now I have to think about doing this. It, it becomes just, a natural part of integration, into how to ask these questions and how to get the answers that you need quickly. And that's motivational interviewing, you know, when we really talk about how to help, , guide people through a discussion. So in the beginning we get some of that going.

And then based upon that, I say, here's what I wanna do. And usually it's, I wanna get laed I wanna do this. Then I'll bring you in for a physical exam. But in the meantime, I might send you some information on things that were important. So if you told me you had sleep issues, I'm like, Hey, I want you to read this and then we're gonna talk about it.

So we're planting seeds to say, yes, these are things that you can start to consider to do. Not that your doctor told you to do. And so we're just starting to plant seeds in different ways. And that's the, the nice thing about lifestyle medicine is you can come at it from a lot of different ways because we're all different.

So if you are an engineer and I say, I want you to, um, so for movement goals, and I'm expecting you to go walk in, in, in the woods and look at the butterflies, you're gonna be like, what do I wanna get on treadmill? I wanna be on for 24 minutes and I wanna have my heart rate here. Cause you're an engineer.

You're like an analytical. And so I can approach somebody who maybe is a, um, violinist for the symphony and they have a larger creative side. And I'm gonna say, I want you to get on treadmill and they're. You know, I go, I don't that you've taken my joy away. So again, it's, it's just understanding where people are and what they wanna do.

So it's working that way in the beginning. And then as they come in, we just do some small goal setting or I talk to them, I just kind of came up with this, this thing called anchors and you listen. And I really feel that people have two or three important anchors. And if they don't resource this, their lives just are not flowing very well.

So some of those anchors could be exercise. Like when I get up and exercise four days a week, my life gets into order. Or when I'm able to food prep, I can do this. Or when I get my sleep, I can do this. When I pray in the morning, I feel like my, my life , gets better when I spend time with friends and family.

So I'll listen for their struggles and their stress. And then I'll, I'll bring up this concept of anchors and that is really hit with people. And they're like, yeah. So I said, don't, we don't wanna do too much at once. But let's really get these anchors going and then you can build on that. So those are just kind of some little ways.

And then I have, like I think about, the lifestyle medicine, vital signs. I always tell if I get a temperature on somebody who's not sick, what a waste of resources and people are like, wait, you just take a temperature. I'm like, no, I would much rather have a finger stick possible lipid level, because I know that that's gonna be a, an really important driver for, for lifestyle medicine.

You know, where you are with your health, or I would much rather have the blood pressure's important or what's your sleep log, so where

we put our resources and what we do again, being thoughtful, not just saying I'm in this medical model, I need to have these to check my boxes.

Like I don't care if I have a temperature on somebody who's coming in to talk for their well visit. I'm like, I don't really want that. Or, Paul sock is interesting because that's become much more important in the last two years. but a lot of times you had points for getting all this stuff. And I was like, Ugh.

So the lifestyle medicine, vital signs, I think is important. And then having people follow up in different ways saying, yes, you can follow up through a synchronous means by sending in a log, I can have you work with a health coach. I can have you work with, community resources.

These are the people that I really like, and I can recommend you working with them. So as physicians, we don't have to do it all at all, but we're the person there that might be the trusted resource to say, here's what I'm recognizing. Let's talk about this. How do you wanna, you know, what are your next steps?

How do you wanna handle that? What are your first things that make you might make, make you feel better? So just kind of discovering those things. And then, you know, with our telehealth too, it can be a quick 15 minute video visit. They don't have to leave work. They don't have to do it, but we're doing a check in to say, Hey, you set goals that you said you were gonna add another vegetable per day.

And that was important to you. But if I never follow up on it, then obviously it wasn't important to the two of us. And it wasn't an important plan. So creating that accountability and follow up in very simple ways. So those are just some quick examples and of how we can infuse that. So you're not thinking, oh my gosh, I'm, I'm, I'm redoing my whole office setting.

No, I'm allowing this to kind of come in and it is so important. And the patients recognize that they're like, you listen to me, you get me. Yes. Now I trust you. Now I'm gonna keep listening to you about some other things that might be even bigger drivers that I'm not ready to deal with yet. Yeah.

And it's so relationship, patient focused medicine, just like, the core of what you were trying to do before you opened DPC and now in your DPC.

Another resource that's highlighted in your blog accompanying this podcast is the unscripted podcast that you did with the medical students that you work with.

And it was so. You know, again, it's like, even though we know stuff, when we hear it again, it, it can joggle our, our emotions and our, our, our thoughts differently. But when I was listening to that podcast in particular, when you were mentioning having, you know, your services as the core primary care physician, and then being able to have other, you know, services or people in your, like, like you mentioned, coaches, et cetera, being able to support that care.

Um, it was, it was really, you know, thinking as a micro micro practitioner myself, it was really freeing to not have to carry all of that weight to be able to do everything like do all of the, all of the coaching, all of the, the things that I, you know, that make sense. I, I, I was listening to the interview thinking like, oh my goodness, like, that is how she is an extension of herself, similar to how we have extensions of ourselves as doctors through virtual assistance or office staff, et cetera.

So I just, I love that. And if you have the time, I definitely would encourage you to jump on that podcast. The medical students do an incredible job, um, there, but Dr. Ley, you, your, your words there really hit home for me, especially in that podcast. And when, when you talk about, you know, empowering physicians to be able to not feel overwhelmed, but also to be able to take actionable steps, to incorporate more lifestyle medicine into their practice.

You mentioned the conference for a C L M coming up. So I wanna ask, what are your go to resources when you encourage people to look into additional resources, to learn about lifestyle medicine, and to take that next step?

Yeah, because it is, people get excited and then, then they get overwhelmed.

They're like, oh, I can't do one more thing. And, but they're drawn to lifestyle. Cause they're like, this is what I wanna be doing. This is this medicine that brings so much joy to, you know, we talk about the, the DPC doctors are the happiest doctors around. It's kind of freaky. Um, it's like, because we're, we are, we're just doing what we know we can do, but this lifestyle medicine it's like it, it brings you so much joy cuz you really see that connection with patients.

You see patients intrinsically getting better, um, on something that wasn't. Didn't have to go through a prior authorization from a, from an insurance company. You know, when, when somebody learns to meditate, when somebody learns to food prep and they're like, oh my God, I mean, asparagus, I never thought I'd like asparagus it's Hyster.

Like, yeah, you never, you, you don't have to go back to the insurance company. And the say, mother, may I, these are, these are foundational. And then that they, they pass on and on. So when people get excited about lifestyle medicine, one is the lifestyle medicine website. So it's, it's literally the word lifestyle,

And that's the American American college of lifestyle medicine. So that's the foundational educational, um, society that, um, I've been involved with for a long time. The people there are outstanding. And if you wanna go, like, we'd go to DPC conferences. If you wanna go somewhere and, and leave, like you're floating on a cloud.

And you're like, oh my gosh, these are my people. And these people are doing amazing things and I can do it too, cuz it's not just, you look at people and go, wow. You know, you're a star, it's the same thing. It's the same thing in DPC. It's like tag, you're it tag. You're it. We're all part of this community.

We're all adding to it. So that conference that's, that's the, um, a C M the American college of lifestyle medicine conference. That's the one in, Orlando. And this is, what's really cool for you people in, healthcare economics, it's November 13th through the 16th in Orlando, but it's at the Rosen hotel.

So anybody who knows anything about free market medical care or Dave chase, or, you know, understanding some of the understanding knows the Rosen hotels are, are one of those companies that have taken healthcare benefits to the nth degree. And, and I just read this statistic the other day, it was, 24 years, they've saved over 240 million and they put it back into like education for their employees and all kind of stuff.

So they're a fantastic example of what you can do with a well designed healthcare plan that is extremely employee focused. So that's why I was like, I'm like, oh, we're at the Rosen hotel. This is so cool. So that's November, but I also wanna mention the American academy of family practice. So AFP is this, is there inaugural.

Lifestyle medicine conference. And we were so excited to hear about this and I'm actually co-chairing it with two other co-chairs and these are women that are, I just have so much fun and respect with. So those three of us that are co-chairing it. And it's, um, in October, And its always down in Florida, it's a place to go, but it's October 27th through the 29th.

And so you would just look under AFP lifestyle live. That's probably the best way to Google it. Um, cuz it's the, they consider the AFP live lifestyle medicine conference. That's the way I've been able to get to. But that one, so the a cm is, is like the conference.

That's a big conference. You have people there, all the gurus are there and you're going really deep into a lot of, um, specifics. The one that is being put on by AFP is gonna be it's we're really gonna have, we are having a lot of fun with it. We're taking all of these concepts of life, summit us and teaching people how to within two and a half, three days to infuse them into your practice now.

So helping people learn and understand what the concepts are and then right away, we've got these personas. We, we were actually have patient patient cases and. Infusing this into, this is how you would bring all of this lifestyle medicine into these real life patient cases. And we build on that for two days with the six pillars.

And then at the end we have participants actually, not, hopefully I'm not any surprises, but then we have them present the patients. This is how they would then do it. So you feel confident being able to take a lot of the stuff back in now I'm a huge fan of getting certified. So I'm actually board certified in lifestyle medicine.

And that has a lot of meaning for me. And I think it's, um, going through the, the education and the testing. It's not really all that hard, but it does take some focus, um, to get into, to become board certified. But that's kind of the, these conferences set you up for that. So if people are all interested in understanding more, these would be two conferences.

I'm like, just go, it's worth it. It's, it's just, you're around a lot of really good people. and then hopefully you'll come out. Like I did from DPC, just charged like, oh my gosh. And it sets you on that path to help you. If you decide you wanna become, , certified, which is again, it's really nice to, I, I feel very comfortable and to you and I being a physician is, is it's a profession. And it really means something. And when people come and say, they trust me, that means a lot to us. So for us, we're constant learners and we really feel like this is important. So I really wanted to know, I understand the science behind all lifestyle medicine.

I understand why it's evidence based. I can, I can really talk very. deeply to anyone who's interested in that, but I also can translate it on a very simple level to help people engage very easily into helping themselves change their lives. so yeah, obviously I'm excited about the, the prospects of people becoming certified, but even if you went through like the AFP course or the other course, you would be able to walk away with stuff that you could then go back Monday morning and practice.

I love it. And especially being in the depths of DPC, especially if you're early on and you're working on everyday workflows for, you know, what happens when a person calls into your clinic or what happens when the billing doesn't go through and to have actionable steps that make, you know, the, that make the, that lower, the barriers to integrating right.

Family, lifestyle medicine, I think is, is really awesome. So I, in closing, I wanna ask. For the people who are listening at no matter what stage of DPC they are. What are some words of wisdom that you would like to share with the audience? As a take home message, , to think about going forward into the future.

Wow. I, I think the biggest thing when people come to me and I get a lot of people are like, you know, Hey, I'm thinking about this. I'm like, do it. If you're thinking about it, you're suffering. There's a reason. Take the steps. And again, the timing might be different you, because I got a lot of people are like, I'm ready to do it in two years.

I'm like, fantastic. This is what I did before I opened. This is where I started. So wherever you are in this thought process find, , good information again,

so looking at this podcast, looking at some of the resources that you have been able to put out there because of the people that you've interviewed, you know, engage, lean in under, learn from all of those, have done it before. Um, everybody's a little bit different. So you'll pick up different things from those, from, from different people, um, be realistic, you know, be very realistic and, and understand why you're doing it and what you can do and hire somebody, the things that you can't.

So a lot of the physicians that, that I talk to, they're excited about there, but like, I, they, they don't want to run the business. They don't want to. Learn QuickBooks. They don't want to get a, a payroll. And so I'm like, okay, then you're putting your business plan, how you're gonna support a business partner and that business partner's gonna run the business, but you still need to understand what's going on.

Um, and that's okay. That's perfectly fine. Or like we talked about, you know, are you gonna do it solo? Are you gonna do it with a partner? Um, we've been able to grow and I work with a lot of employers. So we've created a network called tri DPC. And all we are is an overlying, um, administrative layer so that we can contract with the employees and then take all those employees and spread 'em out to all the docs.

So helping them, them stabilize and grow with a great diversity in their practice. So they're not just relying on like one O one company or one, area in the neighborhood. You've got all this infusion of all these different patients that can help stabilize practices. So find people in the area and maybe you wanna join a DPC that's already there.

But do your due diligence. So you can ask the right questions when you're thinking about joining another DPC, whether it's as a part owner or of somebody who you just, you know, you wanna be employed and you, but you understand the health of financial health of that DPC.

So yeah, I guess it's just, you know, the big thing is just, just take those steps. You know, living life consistent with what your values are and consistent with your joys. Like I said, it's, it's not. easy, but it's simple. And you can make it easier by connecting with those around you who are doing it.

yeah, obviously we , we just want everybody to be happier and not suffering so much. The, the collective knowledge of physicians is so important and we're losing these physicians. We're losing people because they're getting so frustrated and so crispy, and they're finding other ways of making a living with their medical degree.

And I get it, but, oh my goodness, we need your medical knowledge. We need your passion. We need everyone to lean in. I feel strongly. The answers for healthcare are not in Washington, DC. The answers for healthcare are not with one elected person, whoever that person might be or board of people, or, uh, we have to work with the legislation, but the answers for healthcare are local.

And they're with the people who really understand it, like all of us, and we can lean in together.

I love it and definitely leaning in keeping it simple. I love how you summarize that earlier, when you said tag your're it. And that's how we continue to grow this movement. So, Dr. Mackley thank you so much for joining us today,


Thank you so much. Always a pleasure and go get 'em team DPC. Woo.

*Transcript generated by AI, so please forgive errors.

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