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Episode 97: Dr. Geetinder Goyal (He/Him) of First Primary Care - Houston, TX

Direct Primary Care Doctor

Dr. Goyal Portrait
Dr. Geetinder Goyal

Dr. Geetinder Goyal is the founder of First Primary Care in Houston, TX. He is board-certified in Internal Medicine, Pulmonary Medicine, and Critical Care Medicine. He has practiced in India, New Zealand, The United Kingdom, Uganda, and the U.S., where he has remained for the last 16 years. He attended medical school at the Government Medical College in Chandigarh, India. Following that, Dr. Goyal completed his residency in Internal Medicine at the University of Texas Medical Branch – Galveston. Dr. Goyal then went on to Yale School of Medicine in New Haven, CT where his fellowship was in Pulmonary Medicine and Critical Care Medicine. Towards the end of his training, he realized that our healthcare system only takes care of the sick, and no one is looking out for a patient's overall health and well-being. So, Dr. Goyal decided to abandon the traditional route and start First Primary Care to finally provide patients with genuine healthcare––not just "sick care." Today, First Primary Care is a leading DPC in Texas and was placed #908 on the 2021 Inc. 5000 list of fastest-growing private companies in the U.S. He is married to Dr. Le Vo, a practicing Internist at Houston Methodist Hospital in the Texas Medical Center. Geetinder and Le have two adorable daughters, Avni, ten, and Saya, six. When he isn't caring for patients, Dr. Goyal enjoys working out, watching sports, traveling, and having great conversations with friends.


Resources recommended by Dr. Goyal

- Misis Institute HERE

- Traction (which mentions the EOS Dr. Goyal mentioned in his interview) by Gina Wickman HERE

- Gary Vaynerchuk speaks about toxic employees, below

- Gary Vaynerchuk speaks about hiring... and firing.


CONTACT: phone: 713.280.7991

8582 Katy Fwy; Ste 110 Houston, TX 77024



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Welcome to the podcast,

Dr. Goyle Maria. I'm so excited to be here.

This is amazing because I love when episodes get to compound on top of each other.

And when I say that, we heard about first primary from Dr. Kate progress in season one, but now we get to hear from the founder first primary, having you on a podcast. And it was wonderful to, share the stage with you at the DPC summit in Kansas city. But this is a space where you get to share even more of your story, especially for those people who, were so interested in hearing your story.

And then for those people who have not heard your story yet. So again, it's wonderful to have you on. Now. I wanna get started with the fact that as you said in your introduction that you are a pulmonary critical to care doctor. And so going back to. Your experience in medical school and your training to become an internist

can you share what led you to becoming a pulmonary critical care doctor? And how did you have a mind shift to then become a primary care physician?

You know, the. Kind of one common theme that I had seen in most of the internal medicine residents was that nobody really wanted to do primary care.

Everybody wanted to be a specialist. And in fact, most people entered internal medicine with the idea that yes, we are going to specialize one day. Right. And on top of that, if you look at the primary care experience we have during our residency programs, which is usually, you know, residency run clinics.

First of all, they're obviously the fee for service old system where you're again, you know, pushing people through there's no, Continuity again for in care, in so many ways. So overall the primary care experience is not something that inspires you, right? You, you don't really feel like you did what you could the best way possible.

On the other hand, that happened in the ICU. Why did it happen in the ICU during residency? Because we had all the time we needed for, with those patients, right. Where you could really learn the physiology, the disease process make changes and then see results happen. And it was all there. Right. So just procedures also in general, during internal medicine was what I love doing. And, and, and that kind of what led to, Me choosing to do pulmonary critical care as a fellowship. I really, really appreciate my time in, in, in the fellowship. I think I learned so much, I was able to go to Yale, which has a tremendous fellowship program.

But one thing that was Very shocking to me was that, you know, 50% of my time in the ICUs I was spending basically doing end of life care that if I hadn't taken care of, you know, 10 patients a day, five patients, I felt like, we need somehow.

To figure out how to let these patients die peacefully and not continue to do what we are doing. So even in the ICU medicine, I was, you know, internally at conflict of why are we doing this? And to have those conversations with the family members, in the ICUs, it, it just became daily thing for us.

And, and it took a toll on you. At some point, it takes a toll on you. But what was striking is that, you know, why is that we are having these end of life discussions in the ICUs when they should really be happening, you know, several years ago in a primary care doctor's office that who is this person's doctor who knew this was coming.

And yet nobody talked to the person about end of life. And, you know, you, and I know that America spends more money on healthcare in the last six months of people's lives than, than ever before. . And how sad is that? Right? And, and the answer is what, you gotta fix primary care. If, if you're not gonna fix primary care, this is not going to be fixed.

So here I was, Yale trained Palm critical care. But I felt, you know, like, look, there's no way I can enjoy doing Palm critical care for the rest of my life. If end of life is what I'm going be doing. If that's what I'm going be doing, I'd rather do it at the primary care level and meet people 20, 30 years before they end up in ICU, not in ICU.

Right. And, and then DPC came along then, you know, free market medical association came along and David Goldhill came along, you know, Josh hums of the world came along and, and, and then you like, look, there is a solution. We can fix this. And, and that was it, you know, you know, blessed to.

Friends family who encouraged me to go do it in spite of, you know, training and then saying, look, I've made a mistake. I'm gonna go back to primary care. And yeah, that was seven years ago now. Incredible.

Can you share in the last seven years, what has your journey in DPC looked like in terms of how many clinics do you have at first primary and how, who who's on your team at first primary?

Yeah, so first of all, I had a blast doing this, right. Both practicing medicine, as well as growing the clinic. It's not been easy that there's, you know, I, I think that's something that needs to be clarified that DPC is not an easy way out. Right. It is very hard. It's very challenging.

It's just doing medicine on your terms, So it's been challeng. But it's been a blast. We have four offices. We have about 3,200 members. And we have total six physicians and three nurse practitioners right now. , I wanna say about 60% of our volume is its employer base and 40% is kinda retail based.

The journey. In, so there are two things to it, right? Obviously you have to figure out how to sell this because You know how to fix healthcare, but do people believe you? So that is a big, I feel like jump that all of us sometimes need to make, which we are still learning how to make.

But we figured out how to sell DPC. I think, you know, Going by the growth we've had. And then the second part has been actually changing primary care. You know, now that you can do primary care on your own terms, how do you redefine primary care? So that's been a good fun, right? And, and, and it becomes more fun when you have team members to play with.

Right. And you're not on your own. So adding, you know, awesome people that I have somehow convinced to come work with me has been a blast. I'm so thankful for them. And, and now our focus is to create a world class organization where, people want to come to work and, , and they feel like they can live their best life, as I say it.

thank you so much for just giving us that. Really detailed picture as to what first primary has become now. So now I wanna take a step back and talk about those challenges and talk about the team building and talk about how you are redefining primary care at first primary. So I wanna start with, when you talk about, you know, how to educate your community, how to inform people as to what direct primary care, the model of free market medicine is.

I wanna go back to when you were dreaming and thinking about DPC, learning about DPC by, mentioning David gold hill, by mentioning, the free market medical association, what did you dream about? And how did you then take that dream and put it into actionable steps in the beginning?

excellent question. Because it is all about the dream. You gotta dream a dream, right. And then go figure out how to go get it. Right. So the dream was always to, to make a big organization, we we've trained in multiple places. We, worked trained in world class organizations in general, but I still feel like when it comes to organizations who truly are physician.

And the decisions are made by keeping patients and physicians first are far and few in between. Right. And so that was the dream to, to create a physician led organization, which does true healthcare and, created as big as possible. You obviously start small. So I started in a thousand square foot space.

One thing I did do, which people, you know, typically I feel like don't do. And, and I love the concept of micropractice and, and, and, you know, physician entrepreneurs, single mom, and pop shop, you know, I, I think that's awesome. And, if that's the dream, that's the dream. Right. But for me, it was like, look, I, I'm not that if I'm going to give up.

All these fellowship training and stuff. I want to create something big and this is an opportunity to go do it. So, one thing I did differently at the start was I, I did ask a good friend who was, who was just finishing his family, nurse practitioner training to come work with me and make a team because I felt like.

We need to be out there selling as well. We can't just be sitting in the clinic and we may have time when we have, you know, only 50 1600 patients. But if it grows, how are we going to do both? We had a lot of time in the beginning cuz each patient, we both knew together so well.

And we would go see the patient together. We would manage the patient together. So it was really like one team. It wasn't like, , your panel, my panel. And from there. The the second mindset. I've, I've always that I've had, I feel like a little different from people is when people come knocking on my door and say, Hey, will you take these patients?

Some employer groups have come. I, I typically don't say no. Right. Even though their price points are not where our price points are. Because my customer acquisition cost is. If, if they are bringing me a whole group of patients, why would I say no? I, I want to say yes, I want to get to know these people.

I want to show them how well I can take care of them. And then I'll go back to them. I said, look, you need to pay me more. . And, . A lot of the times, it wasn't the case because in a group setting, when you look at the utilization overall in a group, you have to be really a data scientist to, to prove the value that, Hey, you need to pay me more.

Right. And generally all those things have worked out really well for us at separate price points. So when employer groups came to us and said, look, can you take our patients? We were more open to it than, than I have found. Generally DPC doctors to be. And, and then it was all about learning, you know, all about learning, how to work with self-funded plans, how to talk to TPAs, how to talk to brokers, how to talk to CEO, CFOs, how to get to meet new CEO CFOs, who can, you know, look at your ideas and say, okay, I, I like it.

I want to do healthcare differently for my employees. And, and then the initial challenge was, okay, you are going to companies. If they have 50 employees, they'll say, look, but you only have one office. Houston is so big. I can't sign up with, all my employees with you and I can't just give five employees what you have.

I have to give it to 50 employees. Right. So, and I'm like, well, if you sign up 50 people with me, I'll be able to open more offices. Right. So again, it was that chicken and egg situation. And, and that's where. Needed help. I needed financial help to build capacity and then fill those places up.

So there was an element of risk in saying, look, no, we we're going to expand. We are going to make this work. Let's expand our team. Let's expand our facilities. Even though we will incur losses, but we'll catch up because the vision was, you know, always to grow big and, and, and I. See how else I could get out of that.

So long answer to, to your question, but

no, it's great. It's great. And I really love, you know, because you are such a seasoned DPC physician To be able to, break it down into what you just did. Now I wanna ask though, financially, how did you guys set up a buffer to protect yourself from, , bankruptcy in terms of being able to put the finances where the finances needed to go so that you could grow and could expand and bring other team members on, but not go bankrupt.

Yeah, listen, I, I mean, that's different strategies not one strategy. We have some friends and families who are available. So we have raised some money to just have kind of, you know, angel investors come into our company and, and invest in it. you know, nothing crazy, but something that Small money with small goals that way and focus more on just doing the right thing. And so that's been our, backup you know, I, I do have a pretty big nonclinical team in my staff. So, Sometimes some people are discretionary that if, look, I have to pay only five people out of 10.

I know which five to let go. Sure, sure. Unfortunately, but So far that hasn't been the case we've been fortunate and, and we generally, , know how much we run on a month by month basis. So, you know, that look, I, my losses cannot exceed this much amount month over month, over month.

Right. DPC is that way a really good model because of consistency in what we get revenue wise. Right. And that's one of the, the big attractions. Brings us to DPC, which allows us to do medicine freely.

Yeah. And it's so interesting because physicians who are still learning about DPC in medical school, in residency, and even physicians who I've spoken with in fee for service just the idea that you could be paid like a gym membership, Netflix.

Like when, when I say that to them, they, when they ask, you know, how, how are ABC doctors compensated? And I say, typically this membership model, and they're like, oh my gosh, it's that simple? Like I know I've mentioned that on the podcast because a physician literally had that reaction, but that is, that is a huge draw.

I completely agree with you that when you have the ability to, like you've said, to have the time to give to your patients and you have a lessened financial stress because of the membership model. It definitely is a huge draw as to why people choose DPC.

Yep. No doubt about it

Going back to you had this dream, you started actu you started taking actionable steps to build the dream you planned financially for the dream to happen. And to be big when you started with your partner, you guys are initially our way health and now your first primary and successful with multiple clinics and multiple physicians.

So what brought on the name change and how has first primary been a better fit for you and your community?

So, you know, when I first started, I thought long and hard about what the name should be and This is really hard to, , pick a name out. so. Our way health was actually suggested by my wife and, we both liked it.

And I was like, man, our way health really is what we are trying to do. Right. It, it really needs to be a healthcare that is driven by the. Physicians run for the patients. That's, that's our way health let's go with it. And I had some challenges getting it because there was a couple of similar you know, domain names.

But when I got it, what I didn't realize was people would always butcher their name because they'd be like, wait, what is your clinic called your way, health, our way health, my way health. Right? So, Always be questions like that. And, and secondly, I would have to explain to people.

our way health really mean. So what is our way health? nothing about that really told people. Okay. I'm a primary care clinic, So name change actually happened. Almost two years after we were open when one of my current partners, Jay, and he's not a physician Him. And I met, he, his skillset was business process automation.

And he also had actually worked with a CRM customer relationship management company called Entreport. He actually helped build report when they were a startup and he had. Military background and he absolutely hated healthcare. Right. He had not gone to see a doctor, since he left military, which was probably 20 something years now.

But you know, we started working more, I started learning his skill set and he started seeing what medicine could be he bought in fully And he worked before me, you know, without any pay for a long time, actually. he was the one to suggest that, look, we should change the name.

If you want me to market this, I need something I can easily, uh, market And I think our name should have primary care in it because that helps us with the SEO, with, you know, all sorts of things. So he came up with this name, fresh primary care. And at that point I was so desperate for ideas to grow this clinic.

I was. Do whatever you wanna do with the name. I don't mind first primary care. It's hard for me to give up our help, but let's, let's roll with it. So yeah, that's the story, but, you know, I, I think it has done well, we haven't grown since then. who knows whether it was the name or other things.

But at least I don't have to explain to people what this name means, right. At, at least that for sure has.

Definitely. And you can, you can use that time to, to do things taking care of the patient members. So, yeah, totally, totally hear you now, in terms of on the back end, were there any legal changes that had to happen for you to switch to first primary care?

So you know, when Jay joined me and we were thinking of the name change We only had one entity our way held PLLC. And so we kept that entity because that's where our mal practices, that's where our physicians are hired and paid.

That entity is the one that has a contract with the patient basically. But first primary care was opened as a separate. Are we help DBAs as first primary care, but first primary care is not a professional LLC or an entity. So I was able to also bring in non-physician partners, although they don't own any of the rway health PLLC, I fully own that, or my physicians will own that.

But first primary care is, is a separate entity. So yes, we had to do those legal things. And, I've had a legal team since then, because as we continue to grow, unfortunately, you will need lawyers, you know, just to, tie up all the legal work that you need to do, because

we are even giving, what we call Equity stock options to our employees now within our entity. So all those things had had to be figured out legally as well. Gotcha.

and, you know, especially for those people who are listening and dreaming big, like you were in initially, this is really important for them to hear.

And in terms of when you were, you had The PLLC set up. You had your, you had your doors open, you're wanting to grow. I wanna ask, how did you find the people that have come to work at first primary care, including the clinical team members, as well as the non-clinical team members?

You know, I think finding the right people is. Probably harder than selling DPC. You know, we've been lucky to be honest. I have to believe luck plays a role in this. So Dr. VO, who is a chief medical officer she found me, I didn't find her. She came to me and said, look, I'm gonna do DPC.

Do you wanna hire me? And I was like, sure, I'd like to meet you first. So, you know, we met and she was the first, other physician that I hired or joined. And she's a partner now within, in our clinic. And, and, you know, again, I, I had to learn a lot of this on the fly, to be honest.

So a lot of those decisions you make based on gut feeling I've listened to a lot of business gurus. And Gary V is one of my favorite. And he always says, you can never get hiding. Right. But you can get fighting. Right. so that's kind of what, I think everybody should understand.

It's true. You, you never know whether you're doing the right thing or wrong thing. When you hire, you, try your best, that it was the right thing. But if you still feel like, continue to feel, it was the wrong thing, you gotta fire fast We fortunately haven't had to, fire many people but you know, I think in healthcare, people.

Are desperate for environment where they can enjoy doing medicine. So I think for us, it's that way, easier to recruit sure. People from the traditional system because it's true, right? When we say that, look, this is better, For the doctors and the patients. It's true. And they see it, No matter how much you tell them, you don't really get it until you come and do it.

And so I think that way it's easier. I feel like to incorporate people into the culture you're trying to build because they have a really positive impact on their life. Once they leave that old system and come into our ecosystem.

It's almost like, you know, you're comparing apples to oranges. It's not almost like it is like you're comparing apples, oranges.

Earlier this year at the hint summit in the elevator was randomly this nurse who was asking the people I was with, like, what are these hint, you know, Lanyards that you're wearing. What, what is, what kind of, you know, gathering is this? And we were talking to this person about DPC and she's like, where, why have a die herd of this?

I I've been working on the floors, the, fill in the blank complaints about charting, not taking care of patients, having too many patients on the floor, being overworked, underpaid, all of those things under being undervalued, especially was one of the concerns that she had. And so I asked her, I was like, where are you from?

She's like San Diego. I was like, reach out to these DPC doctors cuz they might be looking for help. And yeah, I mean it's, it's literally like you never know, you never know who you're gonna meet. I totally agree with you in that you, for the most part, we go into hiring with an open heart, but when it comes to people who really get it.

That is I'm sure how your team has also continued to quote unquote, sell DPC to your community without you having to sacrifice that time that you need to give to your patients. So I completely agree with you and that the world is so different. When you have the DPC model guiding your practice so amazing.

And in terms of the physicians that you have hired the nurse practitioners that you have hired, how does contracting work? Cause you, you mentioned they're under our health P L C, but in terms of, do they come on with a salary? How does their compensation work and are there benefits.

Yeah. So all our folks are employees.

We haven't gone down the route of contractors mostly because we really want to be with the people when they first start. And it's more to. Show how things are done, right? Mm-hmm in the sense of, how much time we spend with people, what we can do. We, we don't tell people how to do medicine.

Right. but just what the culture is. So a lot of handholding happens in the beginning and I think that that works better. A person is an employee and not a contractor. So all our people are employees. And we are working on the benefits slowly. We are making them better. We would obviously buy everybody's small practice insurance.

We are, one policy mm-hmm , that we have for the entire clinic. Now we have so we offer. And this is optional because people can be uncomfortable about this, but, but we offer our own DPC services to our employees as well. Right. Especially when it comes to doing procedures, small things, Hey, IV fluids, a lot of that stuff they can get at our clinics, right.

If they want to choose one. Other person as their physician, they are, have, you know, free to do that without any cost to them. Right. so secondly, we also offer Sedera membership. Now I'm a Sedera member for several years. I've used them, love them and we sell Sedera. And we have probably close to five, 600, members who do DPC So that's a part. We pay a hundred percent of the employee only. And then we recently started offering disability insurance. I have. On the clinical side, 90% of my team is actually female. So we are now building a, a strong maternity policy. That was the reason to have disability insurance as well.

So people can, have income if we can't afford to pay them for entire time. They're out. we don't have a 401k yet. That's in the process. So hopefully, you know, those kind of things we can add. As well, but I think, I think the biggest park cause I think I have to say it out there that, that the biggest park is I, I give you flexibility back with your life Because in DPC, we, we don't have, a specific time when you work. We, we don't really have that with that, Hey, you gotta clock in at eight and you gotta clock out at five, So you take care of your patients. You do 'em however you want to be a team player inspire us. Teach us. And, , you will be fine here, but we don't expect you to come here at eight.

So I think the biggest part is still the flexibility that people get back in their lives.

Gotcha. And in terms of when a physician comes on as an employee, do they start at you know, do you, do you give them 50% of like a certain amount until you reach this many patients? Do you have, pre-enrollment done by your marketing team?

So they are started to be profitable on day one. How do you compensate a physician and how do you onboard them?

Everybody's been slightly different to be honest because most of the folks, again, that we have hired, they have come to us and say, look, can we work with you guys? And if we like the person, then we figure out a way how to, bring them on board Like in that person, in the sense, look, if you have the right mindset and, you buy into the culture that we are trying to. Come on let's let's try to do it together, right? That's the idea then the question is, okay, what do you need to, not stress out about money. Let's have a Frank open conversation about it.

Let's get you there and then get to work. And then slowly as the panel grows, we want to get you up to 200,000. By the time, you hit 500 patients. But generally our goal is to membership wise cap at 600. So that's kind of the idea. The other thing I can tell you is we do. Family, nurse practitioners, three of them.

And you know, even when I did my fellowship, I was working with nurse practitioners. So all my life, I'm very familiar with them. And I'm also very familiar with the debate happening at the larger level between doctors and, nurse practitioners. Right. And so are all my other physicians that come work with me.

Right. And, and so I think that is something that does need to be addressed. And I want us to be that place where, the role sees us look, Hey, do it like these guys are doing it. So we are a very, again, team based. Very open to collaboration. We hand hold our, our nurse practitioners almost like they're interns the first year before we start giving them more and more autonomy.

And I think they bring a tremendous value to our system and, we couldn't be more grateful and happier for the three that work with

us. Awesome. And in terms of when you mentioned Having everybody involved in that culture.

What do you guys build into your community? Whether that be like monthly meetings or, you know, daily check-ins or whatever, so that you guys are meeting each other at that level of excitement to bring DPC to as many people in the Houston area as possible.

Excellent question. And I think that that's been the part that I've enjoyed most doing.

it's hard, and you never can be like, I'm there already. Like, it's always a process that you keep learning and keep sort of, modifying. So. One book I can recommend especially if people are looking to build a larger organization, but even if it is two people, right? Three people.

I believe in this book called EOS entrepreneurs operating system It really simplifies business strategy for you, right? Like, again, you don't need to go to an MBA or anything like that. You just need to be able to communicate. Simplify and repeat a lot of the times. So when, when messaging is clear in your own head, you are able to communicate it better, more, you simplify more easier to, , it becomes to communicate.

And, and then I think a lot depends on The, the ability of the people to feel like they are being listened. See we have four offices, so it's not like we are all in the same place. Right. So they are each kind of their own microcultures . So you really have to have, your physicians who are the team leads that are acutely aware of the culture.

We are trying to. And, and they, are doing that in their clinics while they are themselves there. Or when we are meeting together, whether it's through zoom or in person So that, that is one of our biggest challenges. I feel like going forward as more and more people join us. But we do meet Tuesdays every Tuesday, once a week, 12 noon to one, we will have a get together.

We'll talk about different things. One, one a month is just a clinical meet where we'll just talk about, Healthcare whether it's interesting cases mm-hmm or how to do it and all that stuff. But we have marketing and sales meeting, business process meeting, and then one meeting is just focused on culture.

What is the culture we are trying to be? So once a month we will definitely do something that purely is about, okay, what is the culture we're trying to build? How do we evaluate people when we hire them? And it is based on those core values. We want everybody to have when they, when they've come to


Awesome. And when it comes to building the culture and harnessing the power of your guys' marketing team and. Seriously. for the listeners, if you've not checked out first primary care's website, just go, just pause this podcast and go , the brand really comes across strong, clean, and very personable. The content that you guys put forth is full of testimonials full of the power of DPC. And when you talk about the data, it might not always be in a graph, but it is definitely through the words of your patients and your physicians and your clinicians. And so I wanna ask, when you guys are reaching out to employers, how do you use your marketing tools to.

break that ice to start working with an employer who is interested in providing DPC for their employees.

Yeah. You know, employer market is, is a tough market. so any DPC is out there trying to know that it is a tough one to crack It takes a while. You need to know these people sometimes two, three years before they will actually make the change happen, even though they've been interested.

Right. Because a lot of, chefs are in that kitchen when you are trying to change a company's health plan. So it needs persistence. So most of our employer needs come. I would say three different ways, right? Number one is our own efforts of our team to go out there and meet and network.

I have about team of four people, including me, who are dedicated to basically networking. So we each are part of a couple of networking groups a month. So not more than two a month between the four of us, we have a bond. So we continue to meet new people, talk to, you know, learn from them and tell them what we do as, to make a living.

So that helps. And that's how we get new leads. Secondly we have seen a little bit more calmly now. Healthcare consultants and brokers coming to us and say, look, I would like to do DPC for this employer group. . That wasn't the case earlier. Now I see a little bit more momentum there, especially since the work of Dave chase health, Rosetta, and all that has gone on to educate the brokers.

More and more are at least curious, even if they are not doing much on the ground, the. Third way is talk to your patients. when I sit down, I want to know what they are doing, who they work for, you know, everything. Basically. I want to tell them my story, why I am doing this and it's critical to connect people at that level.

Right. And I think once you start connecting with people at that level, your patients will help you, help introduce you to so many business owners that they know and they, they themselves might be business owners.

Absolutely. And when you talk about how. Physicians clinicians are coming on and becoming employees and you work with them to figure out what works for them.

what works for their needs? How do you bring employers on, are you flexible with them as well? Because 60% of your panel you mentioned are from employers. So how do you craft. a bridge for employers to leave a BCA type plan and then go, come onto using first primary. You, you mentioned Sedera.

What are the other ways that you bring the employers on?

So. Three different ways. and this is all on our website. Also, if, people go to, know, what we do for our employers so again, every employer is different, so you really have to go talk and understand what would work best for them.

Right. And what are they currently doing now, if you are somebody who is currently not able to afford anything as a benefit. I would just start by say, Hey, you know, just my DPC membership at $85 a month will be awesome for these people. So yeah, if you are an employer that is currently unable to offer anything. Then just starting with a DPC membership can be, , excellent. What other health membership can give them so many benefits, than DPC? I, I don't think there is any So that becomes, I feel like a relatively easier conversation.

Those are probably our faster sales cycle wise. Then you will meet employers who already have something in place, right? And if you have a fully insured plan and fully insured means you're paying blue cross Cigna United Aetna plan, those are challenging. Often they're paying a ton.

And even though they may hate it, they are scared to take it away from employees. And in that case it, it really is a challenge. Do you try to convince them to, move the deductibles and carve out some money to open something like a health reimbursement account and offer DPC? But it's hard to get people off of full, Fully insured plans.

Sure. We have done that successfully with, with few clients, but it has taken on average two to three years to do that. And a lot of the times you approach it in a, kind of bite size things that say, Hey, why don't we try DPC? Let's see how it goes. You guys are, frustrated and spending a lot of money anyway.

And then that leads to kind of further integration into the health plan. Or then they may look into moving to a more self-funded plan. Self-funded plans is where you can really do. I wanna say magic basically because if you can control. the team that's doing the plan design with you.

not control, but collaborate is the better word. Then I think healthcare plans run beautifully if they're DPC centric and the. Plan administrator works with the DPC doctor to take care of the patients we can do so much care at no cost to the employees. Now, you know, now we design plans where you have DPC your labs through DPCs your imaging through DPC, your specialists, surgeries, all that have done through DPC will be no cost to you.

And in doing this for seven years, we have built, you know, an ecosystem where we know a lot of cash pricing in the city of Houston. So we make these self-funded plans run so efficiently now. So that's our Sweet spot. But still a challenge to get them to listen.

Totally hear you.

But I love that, there are people who are coming to you through the health brokers and through people who are looking for DPC or looking to incorporate DPC now. with you having seven years of experience you know, working to break that ice and to build those relationships with employers, what advice do you have for other people as they're opening and looking to either grow big, like you with multiple clinics or multiple physicians, or just growing with more patients, what kinds of things do you recommend people track over time?

To be able to be ready for, if somebody approaches them like an employer, to be able to say, this is good data that I have about my patient panel and my community that I can show you as an employer.

That's that's the excellent question. What can you be ready? So I think, you know, data wise. You have to rely on the platforms that you use. Like we use spruce. So, Again, I, have someone who does it for us, but we are now taking all the screws data per employer and, and looking at, each employer wise, how many texts come?

How many calls come, how much time we spend with, as a group or that can be drilled down to each person also. And I think people. When they are in the DPC ecosystem, they sometimes forget how easy it is to, talk to your doctor. So they'll send text, right. And, and a low utilizer.

If you really go look at the spruce conversation is like, look, this person is not a low utilizer. Right. He's been texting and doing this small thing so many times a year. So I think sometimes we are still. Unable to accurately capture the value that DPC brings. I feel like is hard to capture the value of a relationship, but even otherwise it's hard to capture the value.

So if you can figure it out that like, show the value I think that's going to be life changing or game changing. But second thing is I usually go by, , look, let's do a. Don't need to do a whole group. I want you to give your executive team, the people you love the most three months, pilot, what is it gonna cost?

150 bucks. You probably spend that on a meal, right? Let's see what they say. So not all pilots have gone successfully, , but there are a few pilots that have, you know, now led to whole company signing with

us. Awesome. And when you talk about a pilot program can you give us an example as to what you built in for that pilot program that ended up being successful for the employer?

Yeah. So, This is a trucking company. For example, they have about 25 employees. I met the owner of the company at a there's a group called Vista Vista is a CEO coaching group. So I was part of that group. I met him. We learned about each other's businesses and he was like, man, I would love for you to take a look at our health plan.

I was a yes. And I would love for you to try our, membership model out as just you. and he was like, sure. Right, let let's do it. So him and his wife signed up, I stayed in touch with him. And then I was like, look, tell me when you're planned and what happens, let's take a look.

and now all the employees have DPC basically, you know, and it took us about year, 18 months to get it done. But they've been, our just this company over the last three years, they've been our member. The total revenue is about 50 to $60,000.

I. Looked at how much I spent Vista because it was a thousand dollars a month membership to that CEO coaching. And I was like, it's okay. We made our money back. So, but you know, these sometimes end up becoming lifelong relationships. just those kind of things. So that's one example, but we have, you know, few others, they're all kind of different that.

Love it. And , it just, it goes back to how you're personalizing these relationships. Yeah. Were, you know, your, employees, your. Retail members, your employer based members are not numbers. They are people. And you're building those relationships like you dreamed you would be able to.

So I love that. So now in closing, I wanna ask for those people who are internal medicine physicians and are. Listening to you and thinking about, could DPC work for me and my specialty. What would you say to those people to think about as they're thinking from the lens of an internal medicine physician, either in residency or in fellowship or in current fee for service practice?

No, I there's no doubt in my mind, anybody can do it. Right. Internal medicine, family medicine, they, they can both do it. It doesn't have to be that you need to cater, to kids to be able to do this. I think it's easier to do it as a family medicine than it is in internal medicine.

At at least it sounds easier because I feel like it's easier to sell. But I think anybody can do it. think if you are good at what you do you are bold about it and you go out there and tell people you will be successful regardless. I think the me, message is that.

There is no other alternate. this is the only way. So if we are not gonna do it, then find, some people who are doing it and join them basically, because the old way is not going to work. So yeah, we have to be bold. We have to step out and, fix it on our own.

Amazing, thank you so much, Dr.

Goyle for joining


Absolutely. Maryelle

*Transcript generated by AI, so please forgive errors.

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