Direct Primary Care Doctor
Dr. Scherer grew up in Streamwood, Illinois, and attended the University of St. Francis in Joliet, Illinois. After completing her bachelor's of science in Biology, she earned her Doctor of Medicine at Loyola University Stritch School of Medicine. She completed her training at the Waukesha Family Medicine Residency in Waukesha, Wisconsin, specializing in Family Practice. Dr. Scherer most recently practiced at the Richland Medical Center in Richland Center, Wisconsin, providing general family practice, obstetrical care, inpatient hospital care, and urgent care.
Her areas of interest are preventative medicine, lifestyle medicine, and lactation/breastfeeding medicine. Her continuing education focuses on lifestyle medicine. She is an International Board Certified Lactation Consultant, IBCLC.
Dr. Scherer and her husband, Mark, moved to Olney, Illinois in 2018 to be closer to his family as they raise their two children. She is thrilled to be practicing in the community and helping to improve the lives of her patients.
Dr. Scherer walks the talk when she walks with her patients during Walk With A Doc sessions!
How Dr. Scherer harnessed YouTube to help keep her connected with her community. 07.03.2020
Dr. Scherer's velomobile!
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YouTube: HERE
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Tel : 618-746-2676
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TRANSCRIPT*
Welcome to the podcast, Dr.
Cher. Thank you so much for having me.
It's so great to talk with you again. And for those of you who don't know, Dr. Cher joined me on stage at the DPC summit that happened last July in Kansas city. And it was just so amazing to hear your story, but I love that you have come onto the podcast to be able to share your story with a greater audience.
I was feeling kinda left out that it took so long to make it on this podcast, but I'm happy to be here.
So happy to have you. So I wanted to start with something very interesting is you were doing a series of videos during the early days of the pandemic.
Harnessing the power of YouTube, making sure that you were keeping in contact with your community through a media where you could show your whole face without having to mask in person. And one of the things that came across in that video was this quote, when, you were talking with your patients about masking and being preventative when, with our behaviors during the pandemic, and one of your patients asked about why can't we just let it be what it will be?
And. You guys were talking about the pandemic at that time. In that video, it made me think about how healthcare is in our country and how patients frequently act or behave that way. And why can't we just let it be what it is when they just say, oh, I have good insurance.
I'll just use my insurance card. And if it, if my insurance doesn't cover it I'm not gonna get it. So I wanna ask about, how we as a culture play into the system and how you as a physician looking back on yourself as a, an employed physician, how did you play a role in that healthcare system?
And just letting things be as they were, as you continued to work in fee for.
Wow. That is quite the question. I can very vividly remember doing the YouTube video and wondering, like, why can't we just let the pandemic happen? Just take the masks off, let the massive amount of casualties happen.
And I think that what happens is we, as citizens on this planet, have this idea, especially in this country, that healthcare is going to save us that don't worry if you're in a major car wreck, you're in the best country in the world. Absolutely true. Just. There has to be room at the hospital.
So when it was the pandemic and they wanted to just pull the masks off and everyone just go mingle and make this thing over as fast as possible, it was, you don't know what you're asking for as the colleagues are out there saying, we're inundated, there's no room at the end. I know locally in our hospital systems, we had no place to transfer people.
The tertiary care centers were transferring into the rural areas. And so it was trying to let people know that yes, we have an amazing healthcare system. When it comes to major injuries and illnesses, you can get amazing care. The problem is you can't get it if you can't get to those hospitals. And so put, like trying to explain to people that we were just stretching out how long it took for people to get infected with COVID so that we didn't overwhelm.
Our healthcare system. So then when you think about extrapolating that to just our general healthcare system and maybe specifically of what primary care has become, I think there's a lot of help that I think DPC offers where I can take the time with the patients to go through a dietary log, to go through an exercise log, to explain to them that they have choices in their health.
And I often use the expression that I'm just your GPS. I will help make the best recommendations that I can for your health, but you're ultimately driving the car. Now, what I do offer with that GPS though, is I have seen the patterns. So if you don't wanna take your blood pressure pills, and if you don't wanna exercise every day, and if you don't wanna eat healthy every day, I know what's coming down the pike.
And unfortunately, most of the time they don't, they may have seen, oh, grandma, Betty, when she was 80, she ended up in the hospital with a stroke. But I think as our society's getting sicker, there's a lot more of younger people having strokes, having heart attacks. And it's yeah, you don't know what you're asking for.
Oh, I'm just gonna, live life to the fullest. And I'll just, be sick when I'm 80, but I'll be fine today. And I think a lot of it is helping patients understand that they control their health destiny for the vast majority of things. And so I think DPC affords me that time.
And when we look at the healthcare system, having been in fee for service up until 2018, it was, I'm gonna do the best I can in seven to 10 minutes. But is it the best for patients and probably not. And so we can keep letting things go the way they're going in corporate medicine and fee for service life, but is it really good care?
Is it, are people gonna be blindsided unfortunately at a much younger age because we in primary care, do we have time to do the true preventative care, not mammograms, not pap smears, but lifestyle. The what you do with your forks and your feet really do play into how well you age and how healthy you are when you get to the older ages.
So I do think that what doctors who have time can do, who have a passion for it is really change the trajectory of kind of forecasting. If we intervene today, While we have the resources instead of waiting until you have a stroke or a heart attack, and then it's too late because permanent damage has been done.
I think DPC just offers that time.
I love, especially when you mentioned the fork and the feet, and when you talk about that you came to this realization that the seven to 10 minute visit was not enough for you to be able to be the physician who you trained to be. So
When did you start thinking about doing medicine a different way?
I think part of it was. Back probably in 2014 or maybe even in 2013, my husband had convinced me for animal ethics reasons to become a vegetarian. And in 2014, I came across the forks over knives, D V D. And I showed it to him and he said no, show me the evidence.
I don't want a propaganda video. So we went down this whole road of actually researching kind of a whole food plant based living. We were already vegetarian. Was it much of a jump to go to a vegan? And so in doing that, I started getting more interested in reading and research and went to a American college of lifestyle medicine conference back in 2015.
And I was like, oh my God, like the evidence is there that we have a lot of control over health destiny based on the choices that we make in our lifestyle. My husband and I trained to become. Leaders for the chip program, the complete health improvement program out of the lifestyle medicine Institute.
And we started hosting a class now in the town I used to live in before I opened and we moved and opened up my DPC. There were more cows than people. It was a dairy cow, a dairy industry, huge in our town. I think cows outnumbered people five to one. And I got on the radio and I started talking about lifestyle and in our small town of 5,000, I got 32 people to sign up for my first chip program up there we had a baby, we ran another program after having the baby and we had another 31 people or so sign.
Some of those people still meet with me during the winter months on a nightly or once a week. Zoom call my people from my old town, still join on to hear about lifestyle medicine. So as I was literally posting these in the basement of the hospital, I would be up on the third floor during the day, putting people on all the blood pressure diabetic meds.
And then at night I would be telling them, this is how you can get off of your meds. And I started to feel this discord of, you have to make sure your diabetics on a statin and an ACE inhibitor and Metformin, and is there A1C at goal? And if I got all those metrics met in that 10 minute visit, great, the insurance would pay me, but I needed that time.
So essentially the chip program was this giant group visit and it was very well structured. And I started really to feel this discord. And so that was, the wheels were in motion. I had just had my second baby and I wanted to back off on hours and the finances of the clinic, weren't gonna let me back off on hours.
And so the bricks were just stacking up. And then what happened? The straw that broke the camels back one morning, I had a nine o'clock woman exam, a nine, 15, woman exam. And then the rest of the patients, like 15 minute slots for, acute issues. Each of those women should have had a half hour at minimum for their physical mm-hmm So I walk into the first lady she's probably in her forties or so. And I walk in and I'm like, Hey, how's it going? Haven't seen you in new year. She breaks out sobbing that her loved one is gonna be deployed. And I was like, oh, this is gonna take more than 15 minutes. So yeah, I did the doctoring thing that I was always going to do, which is comfort her and, address things.
And I don't even know if we did her physical. I don't know if I made her come back, but it's now 9 45 and I'm supposed to be going to my nine, 15 patient. I walk into my nine, 15 patient and she I'm like, Hey, how's it going? She's I lost my husband this past year. Tears streaming down her face. It's 9 45.
She was on the schedule for nine 15, my nine thirty's waiting. So it's now like 10 30 by the time. I am done with my first two patients. I'm an hour behind. I literally went to the waiting room and I said, look, I'm running at least an hour behind. If y'all wanna go get lunch and come back I'll see you tonight.
And I went to administration and I said, I can't have this anymore. And they said, you'll see the people we put on your schedule. And I said, I own this practice. I was a partner in this practice and they said, you need to see who we put on your schedule. And I went home and I was completely distraught because that's not the healthcare.
There was no way that I could have said, Nope, no time for crying, get undressed. We gotta do your pap smear. Like you can't do that. When the patient clearly needs something else. And so I get home and I used to walk to, and from work, it was probably like a, just over a mile, even in the winter. Oh my God.
I looked like the abominable snowman. And so this was Wisconsin and I had on big puffy snow pants, cuz there were only like $15 at farm and fleet versus like the 60 or $80 compressed snowboarding, snow pants. So as I walked, it went as the legs of these giant snow pants rubbed together. I had on ski goggles and a face mask and big puffy snowmobiling gloves and in the winter when it was icy, I even put like the tracks on the bottom of my boots.
And so I was like hardcore. I had a rain bag that my backpack would go in so that I could carry my laptop, back in front, forth to work without getting wet. And I would walk most days. And I remember as I would walk, I'd be like, okay, I'm if I can get hit by a car and like some pelvic fractures, like I kind of wanna go to rehab, don't ruin my head.
Like I like my brain. I don't want the traumatic brain injury. And I like my hands, but, I could probably endure some, limp or something like that. So let's just have a pelvic injury and I could go to inpatient rehab and it won't be my fault to take time off of work. And my husband looks at me.
He goes, that's not normal now. He's not in medicine. He's an engineer. He's you know that you shouldn't be thinking like that. I'm like, I know, but I just need a break. I just need a reason to get away. He's like, how about you just take the break or, get away. I'm like, you're a stay at home.
Dad. We have two littles now. Who's gonna pay for this. And he goes, we'll figure it out. And I was like, I can't, he's you can, I'm like, maybe I should just go on an antidepressant. He's your job should not make you go on an antidepressant. And I'm like, okay, you're making some sense. And I stumbled upon um, well I tried to do physician coaching and I would say that was helpful.
And what's funny is that I did physician coaching up until I went on maternity leave and I still had four sessions left of my coaching package. And then I went on hiatus from coaching and then next time I contacted her was nine months later when I had opened up my DPC. Like my coach had no idea.
I just fell off the radar from maternity leave. Didn't contact her, went back to work, I think for, I don't know, September through January. Opened up my DPC in, in may and then contacted her and like, Hey, you know, you know how you're not supposed to make major life changes all in one year. Well, I've had a baby move states and quit a job and opened up a business.
And by the way, I'm successful in the first 30 days, she's like good job. So we went back and we looked at what my dream practice was. And even though I had not opened that document for a year and a half, my DPC fit nine out of the 10 characteristics of that vision that I did with my coach the first day.
And so my husband and I really sat down and said, how long can we live on savings? And yeah. And then one Sunday afternoon I was on, Atlas MD and was gonna get their. Boot camp or base camp steps to do to open up a DPC. And all of a sudden they call me like, I'm on their website and I've typed in I want information and they call me two seconds later.
And that was it. I was like, babe, we're doing this. And we did. We packed up our brand new house that we had built move states to my husband's hometown knew nobody. I knew nobody down here really, except my in-laws and opened up a month later.
I think it's so important to highlight for you, for my, myself, for all of the physicians who have responded to the calling of going into medicine to take care of other people, for you to envision yourself being hit by a car, just to get out of the thing that you were called to do, it's, that's just so wrong.
It is it's just, it's devastating to, to be in the physician, Facebook groups, the, family, physician, moms group, and . Now being on the other side, your heart's just aching as the stories are being shared, that sound very similar. Maybe they're not, wishing for an inpatient, rehab stay, but we didn't get out of medical school, if you went straight through, I think I was like 27 by the time I was done with school or something like that.
And then add residency onto it and. Just all that effort and to think, I just wanna walk away. I just want something to happen so that I don't have to continue doing this, but not because I dislike the patients. Not because I dislike the care yeah, I was energized when I was with the patients. I wanted to spend 45 minutes with the lady who, lost her husband.
I wanted to be there as a support, but the system made it so hard to do it in a way that felt good to my soul and made it sustainable. And so I don't, leaving had to happen because it would have probably killed me. And I was in like, during this timeframe, I was in therapy for a year and a half during my physician co like I did everything to try to stay in the practice I was in.
And just couldn't it could, I couldn't reconcile it. I couldn't, spend the time with patients to develop that relationship, spend the time with patients to help them with the best choices that they can make. And there are some people who look at me when I talk about exercise. And when I talk about eating vegetables and they look at me like I have three heads and I'm like, that's fine.
I'll do standard of care. You'll get you all of your meds. Like it's okay. You still have control over this. And to have that time to practice medicine, the way that I envisioned it, the way that I think most people who are going into primary care really want to see people live their best. Because through our training, we have seen the worst.
We have seen patterns repeat themselves and to try to intervene with the patients. And it's seven to 10 minute visit. Isn't going to do that. The blockage that there is of a patient calls, a call center, and then you find out three days later about why that person called where in DPC, they're gonna leave a voicemail, they're gonna press number two and it rings to me directly.
Or they're gonna send me a text message. I know what's on that. Patient's mind. And what they're worried about the day that they're worried about it, not in the big system where it's going to the call center gets routed to the triage nurse. And then two days later it makes it to my desk. And then the patient's just absolutely distraught that no one cares
about them.
Yeah, absolutely. And you know, you highlight how very frequently, if not a hundred percent of the time, it's not the patients that make us choose DPC. So on that I wanna ask, how did you actually learn about direct primary care?
I had done one of Pam WELS seminars and one of the people that she brought in, I think mentioned DPC. And then I think that's where I got into Atlas and I found one of my med school classmates and one of the faculty members from my. Family medicine rotation during med school, both of them had opened up DPCs in the Chicagoland area.
And I reached out to both of them like, Hey, do you remember me from like seven and a half years ago? and it is, both of them were like, absolutely. And I shared with them kind of my frustration and both of 'em were physician moms. And they're like, do it, just jump. And they helped me.
I think they probably steered me into Atlas MD which really started putting the, those steps in front of me of what to do next. But I think it was through Pam Wek where I learned about DPC and then a former classmate and a former faculty member who were already doing it. Who said, jump do it.
Just do it. You won't regret it. .
I wanna go back to the list that you had. You said, your DPC hit nine out of 10 of your original list as you were working with that physician coach.
Was your coaching more related to how you how you cope with the system? And then the second question I wanna ask is what were those things on that list that your DPC hit home on?
All right. So I wound up there, this wasn't even the straw that broke the camels back, which is really sad.
I was a C-section trained. Doc. So in the small town, I was on C-section call every third night. Most of the time, my general call for inpatient medicine was on Fridays. And so a lot of times I'd be on C-section call the whole weekend. Whenever I was on call that Friday. And there was a weekend where I was up over 60 some hours consecutively had done, I think, 10 admissions and like three deliveries.
And I wound up hallucinating. My, I was like, why is our son wearing red pants? And my husband's like, our son is in bed sleeping. I'm like, no, he's like right there. He's like, you need to go to bed. I'm like, I know. And the pager stopped, but I couldn't fall asleep. And I had a little meltdown of like, I wanna sleep so bad.
I've been up so long. Like I am unsafe for patient care at this point. So my husband. Three o'clock in the morning calls our office administrator is like, look, you need to find her coverage. She needs to go to bed. And I was so wound up that I couldn't fall asleep and it probably took me another four days of trying to get a good night's sleep before I did.
I think I slept four hours when I was actually able to fall asleep. And I was just, I had now gotten myself so anxious about sleeping that the night before I would be on call, I'd be like, oh, I gotta sleep well tonight because tomorrow I'm I could be up all night doing a C-section. And I wouldn't sleep well the night going into call.
And then when I was on call, I was like I need to sleep tonight because I might get called at two o'clock. So I should go to bed at nine. And there was so much anxiety around sleep that I wa just beside myself, my anxiety had gotten through the roof and this was not the straw that broke the camel's back.
Like I worked through this with the counselor and got my anxiety under control. But in that whole process, I probably looked up the AFP's, you know, resource thing and did the intake call with the happy MD and my clinic because of my breakdown. My clinic actually paid through my CME money and through some professional funds For the happy MD coaching program, they paid the vast majority of it.
And I worked with the happy MD coach to really stay at the practice. Like we were trying to limit, let's put five, four or five urgent care spots, through two or two or three in the morning, two or three in the afternoon, let's block. Those let's only have two new patients a day. All these things to try to make the day manageable.
Let's do a lot of anxiety, deep breathing, mindfulness stuff when I'm on call so that I don't get wound up. And I did it all with the intention of staying. I think that coming back from maternity leave and the. Practice saying, no, you can't drop down a half day or a whole day. That really made it where I was like I'm gonna do something else.
So I don't even think that my, my desire with the happy MD coaching was to move on. It was fully to stay where I was. We had just built a house. I loved my partners. I loved the patients I, had trained to do C-sections. I was I was enjoying the OB aspect, but once it really felt like I wasn't providing the care that I could.
Once I knew that, finances of the clinic were gonna take precedent over good quality patient care that I decided to leave. Let me see if I can find, let me see if I can pull up the ideal. So three days a week no call making. A hundred to 125,000 practicing for wound toum outpatient, preventative care, lifestyle, nutrition, exercise, no inpatient.
Question about continuing OB independent hospitalist care for patients. Husband could be chief employee, Southern Illinois, or Indiana . And I currently so this I would've done like a year and a half to two years before opening up my DPC. I made this little thing, the coach drew on it and emailed it to me.
And I live in Southern Illinois. I did give up OB I don't do inpatient. I have so much time for preventative care lifestyle medicine, nutrition. I do walk with the doc with my patients. I ride my bike to work. I take care of babies to old people. I now make more money than I was anticipating here. And on average, I see 18 to 20 people a week.
And I try to work three days a week and just do urgent care on Tuesdays and Thursdays, which is why I am talking to Muriel from our trailer on the lake. where we were swimming on a Thursday afternoon. And my husband is my husband was my chief employee. He's been my bookkeeper, my maintenance man my tree trimmer.
He has been my chief employee. I now have a nurse working for me. And I don't have to see anywhere near your 14 to 16 patients a day. I see way less than that.
Amazing. And it's, so I just cannot speak enough about how important it is for someone to put their intentions out there in the world.
And the fact that this happened more than a year before you opened your DPC and then you were successful. So quickly in a community where you had never practiced. My suspicion is that you were living and breathing and just putting that energy out in the world, around you, even though it was a new environment.
So I wanna ask about your practice and opening now. How did you plan your DPC so that you ended up hitting all of those points that you did on your list?
It must have been subconsciously because like I said, I didn't even, I couldn't even find the list and until I went back after. Like I had opened up my DPC called my coach and said, Hey, by the way, I forgot to let you know that I had done this. I said, could you send me my ideal paper that you had, that she had drawn.
And when she did, it was just funny like, oh, okay. Um, So I gave notice in
January, I had to give a 60 days notice. So I was done in January and then, and my, so my baby, would've been like six months old at that point. And we were still finishing the build on our house up there. And so I would work on the business aspect, making a website we would take some trips down there.
It was like seven hours away where we moved. So we'd take some trips down there to talk with the landlord about the build out and all that. And I just got all my ducks in a row. While the baby was sleeping and my husband was fixing the house or finishing the house, I should say. And then we took possession of the office on April 10th.
We moved down on April 1st. We took possession of the office on April 10th and I opened on May 1st, 2018. So we were in town about a month in our new house down here. That was a handyman special with now a nine month old. A the building, the build out had gone perfectly when they handed it over to me on April 10th, it was gorgeous.
The landlord did it. It was amazing. Cause I, it was slight unseen. I trusted the landlord's wife to pick the flooring and the wall color and it's their, the landlord's old kitchen cabinets are the cabinets that are in my office. I was like, I don't want you to spend a mint. Like I want the cheapest rent you could possibly give me.
And so they, they graciously like, and I'm all for repurposing and reusing. And they built me a beautiful office and what had happened. So I'm now I was in a town of about 5,000 up in Wisconsin. I'm now in a town of about 11,009 to 11,000, depending on which forms you read. And our, I think our county has about 16,000 and we My father-in-law wa is well established in this city.
And the, my last name is very well known in this town. My father-in-law handed out business cards before I ever got down here. And I put a little description of what DPC was on every one of the business cards. And I probably had 200 made and he needed more every person. And he is a realtor too. So every person he came into contact with, he's oh my daughter-in-law's coming.
She's doing this whole new healthcare thing. She's really great. And he handed out over 200 business cards before I even stepped foot in this county to live here. Then he called the paper and he said, I think you should put my daughter-in-law on the front page. So this reporter calls me, asks me about my story.
And I'm like, I wanna, make, I want healthcare to go back to where the doctor had time to care about the patient, where it was a relationship between the doctor and the patient that there wasn't a threesome, cuz that usually doesn't go well without a whole lot of rules. And so they put me on the front page of the paper the week before I open my practice.
She's oh, we have so much to do. I'm gonna put you on the front page next week too. Cuz this paper only comes out once a week. So it may I graced the front page the week before I open, I graced the front page the week I open and then I joined the chamber. And so the following week I had my ribbon cutting ceremony on the front page of this small town's paper by the end of my first month because of that publicity.
I had 42 signups in a brand new town. The month I opened, I was swimming with my head underwater. I had no idea what the heck I was doing. I had no idea how to send a fax or send a prescription off. I was inundated. I had no staff, so I'm onboarding 42 people in that first month. And I still the joy was just immense that I loved it.
And then what happened is that over Memorial day, we were at a family reunion and my husband's come, cousin comes up to me and he goes, Hey, I hear you can save me some money. And I was like, I don't even know who you are, but I'd be glad to talk to you. He's no. Don't come talk to me. Come talk to my business.
So I came to talk, there were three partners in the business and I was like, look, I can get you 90 days of a ol for under $4. And he's I don't know, is that cheap? I'm like, that's ridiculously cheap. And he's okay, maybe you should talk to our insurance broker. He had a third party administrator of his partially self-funded plan.
So I met up with this guy. Who's Hey, I think what you're doing is amazing. This company would be foolish for not signing up their 22 employees with you. Why don't you, why don't we host a luncheon in the town? So I went door to door with these flyers because this guy wants to get more businesses as a third party TPA.
We had no financial agreement. We had no contract agreement. We were just two people who were, could work together. And we hosted a lunch. 12 of the businesses in town came, six of those businesses signed up with me by the end of. So I was open Mar or may through December of 2018. I had 204 signups in eight months over a hundred of them from these six businesses to this day, four years later, I have all six of those businesses still.
That so in, at the end of 2018, I stopped advertising. I stopped trying to get new patients and I I'm up to about 3 29, 3 30 at this point. So it just it's been. Amazing. And then the other thing that I've done is I went, I was in the rotary club and I said to the principal of the middle school, I said, Hey, look, if you ever want me to come talk to the kids about anything, I'm happy to do a lecture.
I'm happy to, talk at your in-service days, whatever. And she's Hey, will you come talk about vaping? And I was like, sure, I had no idea about vaping other than it's bad. Like you shouldn't vape, but the AAP had a whole PowerPoint series that you could use to talk about vaping. So I met with their middle school faculty members on their last day of school or whatever and discussed what vaping was and what to look for.
And this is when all the little pods were becoming popular and people could, vape in class without anyone knowing. And the middle school apparently. Told them or told the high school people that I was coming and the high school people were like now you gotta come talk to us. So I went and talked to them and then the county south of us said, Hey, will you come talk to our middle schoolers and high schoolers in a big conference?
So I went and talked to the students and the teachers down at the next one. And then I got a call from the other place. Will you come do four lectures for all the gym class periods? And then I went to the Catholic school and had to run two or three sessions at the Catholic school. So I went this vaping lecture circuit, and I never once talked about my DPC, but I have so many teachers now who signed.
Because they saw me because they met me. I got a, I opened up a walk with the doc chapter not as advertisement, but because I really think people should get moving to the best of their ability. And we had to take some hiatus from, in person walks during COVID, but I've been doing that.
And just being part of the community and being available, I think has been some of the best publicity. I've never once paid to advertise. It's all been. Kinda word of mouth. It was the getting in partner with the TPA guy. And I don't have any real connection with him at all. He likes some statistics of what some of the charges and things are from the companies.
And so it's been very interesting because most people would say you would be absolutely crazy to go to a town of 11,000, where I think like the median income is $32,000 a year, but who I got in with were the farmers, the truck drivers, the, these people who make too much to afford Obamacare, but too little, they make too little to afford Obamacare and too much to get state aid.
And so these people, once there was one truck driver guy who signed up his five people in his family with me. Who I think told every truck driver at the truck stop about me because all of a sudden I had a slew of them and it's been fabulous. I will accommodate the truck drivers. I have over the road truck drivers who leave on Monday morning and don't come home to Friday night.
I draw their fasting labs on Sunday morning before I go to church. It is meeting people where they're at and what's hysterical. I did a women's health fellowship. I probably have over 50% men in my practice. This is the most men I have ever taken care of because I have a lot of the middle class workers who don't have benefits through their job.
So amazing. So amazing. And I, as you have gone from where you were to what you've been able to do now in your DPC, I wanna I wanna highlight the business aspect because that's what we really highlighted when we were talking at the summit, but you don't have an MBA. You went to medical school, you're clearly capable of learning something and being able to take that information and run with it.
But how did you approach becoming a business owner when you went from this, ideal practice, ideal day that you had written down and the dream of doing something different, the dream of continuing to give your patients the time that they needed to becoming confident enough to open your own business.
I think it was out of necessity that I made the jump. I realized that this was the only way to save my medical career of continuing to practice clinical medicine. So the desire was there the necessity was there to learn. Um, I. The cool thing is my dad owned a construction company growing up.
So I've actually had some chats with him about being a, small business owner being self-employed. I, my brother and sister-in-law now own his company. And so I had a chat with my sister-in-law about what phone system are you using? And, do you use this QuickBooks and trying to learn some of those things?
The DPC docs group, I think by far is where I've learned the most business sense which may or may not be the best place to learn it, but there are a ton of super smart people in that group who can answer most questions. I think that I honestly did pay for things, so I probably spent more money than I should have on a corporate lawyer to set up my corporate entity, but I had no idea how to do it.
and to do it with the state and to do it with the county and to get city approval and to put an ad in the newspaper for so many days. And I was like, I have no, I, so I just paid him and I probably overpaid him. I probably could have used an online thing to set up, an S Corp or an LLC. But I was like, I don't understand this.
And I'm just gonna pay for someone to help me do it, to basically do it for me. And then, financially when it came to QuickBooks my, my husband took on as the bookkeeper and when we started paying payroll he started working with it, but it was asking people, Hey, who do you use and kind of tapping into to that?
I think I used the DPC manual to, to make my manuals when I got an employee. So I, I employed someone. I think about 11 months in, so I was already 200 and some patients onboarded, and then I hired staff. And so I was like, Hey, can you make this HIPAA, policy, can you make it like, look fancy on paper?
Can you, and so she did can, I'm like, can you hang up all the posters that I'm supposed to hang up now that I have employees? And can you research what posters it is that I'm supposed to have hanging up? And so I think that I have farmed out a lot of, Hey, can you find me the website of all of the OSHA requirement, things that I'm supposed to have?
Can you list all the chemicals we have and, do an electronic MSDS catalog. And and so it was slowly but surely using. Paid people to help me figure it out using my husband to help me figure it out, using the DPC docs group to figure it out. And there are some amazing people who, who have calculators to help you figure out, what are you expected to make at this patient volume?
And how would you onboard a new physician? And so there are some amazing people in the DPC docs group. And I think I didn't need an MBA to do this. And I may not be the best business owner, but my employee seems to be happy and we're making money and we're still working today.
Awesome. How did you fund your DPC?
I, my husband and I live remarkably frugally and we had enough money in savings and so I gave myself a $30,000 loan to start the practice. And I was like, okay let's make it or break it. Let's just do this. And I would say it took me.
Somewhere around 14 to $16,000 to start the practice, to buy stuff, to get the corporation set up. Like I said, I probably overpaid for that, but I was happy to do so I didn't have to do the leg work. And I paid that loan back within six months of opening. So we were restored a whole on that loan within six months.
And I started taking a salary at that point. We may have even started a salary in less than six months. So it was I may, I took out my own loan, like I said, we rent, so I didn't buy a building. We didn't even buy a house. We live in one of my in-law's houses on an it's my husband's grandmother's house.
And she passed away over a decade before we moved in. And we. We were trying to live kind of bare bones. And we had two years of savings to where we were going to not worry about an income for the next two years. And we, I was able to pull a nice income within about six months of opening and pay my loan back.
yeah.
When you mentioned that eventually you were able to take a salary for yourself, how did you how did you start taking that salary
I think what had happened was that the business kept. The bank account kept growing. And so every month as the deposits would come in, as the auto payments were happening I was like, oh, like the checking account has I put 30,000 in and it's surpassed 30,000 at this point. So I'm gonna take out, I'll leave a buffer, but I'll start drawing back out that loan money.
And then we had talked with our accountant and they're like, okay, I think you should not only take some owner draws beyond that 30,000, but you should also now start paying yourself as a w two employee. So we started then drawing a small amount of w two wages as we could draw as much out of the owner draws that the corporate lawyer and the accountant recommended.
And then. As we got into that, would've been the ending of 2018, where we started doing W2 payments. When we got into 2019, we ratcheted up my salary to be the equivalent of a ha quarter, time to a halftime physician. And then my husband gets paid a bookkeeper salary, and then anything above that racks up in the bank account, we take his owner draws.
And so it comes out to about 40% owner draws, 60% salary for the amount of money that I take out of the business. And so I think it was just as the bank account started to grow and there was more and more money. We started paying ourselves more and more money. And then adding on a nurse hasn't really affected my income.
It affects how fast the bank account grows, but it hasn't. Necessarily affected my income to hire an RN. Over the last she's been with me a year now. So I had a part-time staff before her who worked with me for probably a year and a half, and then she resigned and then my nurse started a couple months later.
And, you know, I think those are really important words to hear, especially for the people who are thinking about the financial space about DPC, how can we make this work for, myself, my family financially. So that, thank you so much for those details. Now I wanna zoom out you've mentioned a little bit about the statistics of your practice, the income in your area.
But who in your practice has insurance and what's the churn been like in your practice?
I have, I would say what feels like very minimal churn. I have never really looked at I would say.
One month I might lose one or two in the next month I gain three or four and then I might lose like a couple months later. I don't feel like I have a huge turnover. I feel like a lot of the people have been with me since that very first year, four years ago. So I don't feel the turn, I would say at the end of the year, when people get their Obamacare or they qualify now and they switch and they'll be like, oh, I got insurance or something like that.
That there hasn't been as much of that, because what really stinks is in our area, we have two Obamacare products that have $16,000 deductibles. So even if people. Get a subsidy to get Obamacare and they're paying two to $50 a month for their healthcare. Most of them are working middle class or, the working poor who can't afford a $16,000 deductible.
So even if they have insurance, they can't use it. As for how many people are insured. I would say that there is probably 70% of my patient panel that has insurance anywhere from those people, with the $16,000 deductible, there's one of the companies has a $9,000 deductible. So they rather love to be able to use me to try to never go into high cost healthcare, to have to worry about those deductibles.
I would say 30% of my patients are either uninsured or on Christian sharing ministries and those people I get like the most excited about, because I am just like, oh, we can save you so much money. Like we can get you hooked up with this person, that person. It always makes me a little sad when someone has insurance and I'm like debating how to get them, their MRI of their knee.
Because if I don't think it's gonna need surgery, pay cash $600 at the local imaging place. But if you're gonna need surgery of your knee, I suppose we should rack up the $4,000 MRI because you're gonna burn through your deductible with your $20,000 surgery. And so I like it better when they don't have insurance, because then I'm like, let's just get the $600 MRI.
We'll get you over to the surgery center in Indiana now, or the surgery center. I sent some guy up for carpal tunnel surgery in Michigan. He gladly went without insurance to get his purple tunnel done. We can get you sent over to Oklahoma, things like that. And there was actually a local surgeon about three hours away who was doing colonoscopies in hernia repairs for cash through their surgery center.
So we had some options and I actually found it easier when people didn't have insurance. But for the most part, it, a lot of the insured people that I have just have super high deductibles that they realize that if they do anything at the hospital and get a bill that they're making payments on it for years.
So they would much rather come to me. For the fixed costs.
And especially for the DPC physicians listening it makes sense to us. And it's wonderful to hear when the community follows and understands that as well. So awesome. How did you develop your onboarding process, especially in the beginning when you had to onboard over 40 people
quickly. Yes, and then it just snowballed.
So as these companies signed up and they signed up 12 or 22 people in a day I, some of the times I literally went out to the businesses and saw the people at their shop. Instead of dragging all six people to me at different times of the day, I just went up and literally pulled them off the line for their 30 minute intake.
And the nice thing was a lot of them are these young, younger, healthier guys. But there are some of the companies that have some aging men in them. A lot of the machinists, there are not a lot of women working in these facilities. And they were all pretty much oh yeah, like you can see me in the boss's office.
That's no problem in the boss was fine with it because they much rather have me take 'em off the line for 20 minutes or 30 minutes than for them to drive to my office, not know how long it's gonna take and then have to take a half a day off of work for each of them to get onboarded. I use Atlas, so there's an online registration.
If I could get them to do their online registration first, I did If not, I had packets for them to fill out that were handwritten. And I would set if they came to my office, I would set two hours for each new patient. It took me a very long time to get through those 42 patients in that first month.
And I would say there were definitely weeks when I onboarded a business where I was like, oh my God, I'm back to a whole full-time job. But once I got 'em onboarded, it wasn't bad. And so I had I had, I tried to get as many of 'em as I could to log on and do their intake form on, through the Atlas link.
If they didn't, I entered it all manually. And then. I had 'em sign the contract. I had an electronic thing. I would send them or I just basically would open up my laptop that had a tablet component to it. And they would sign on the screen to sign the contracts and the paperwork. The cool things about the businesses is I went out and I met with all their employees and I went through the contract line by line so that all they had to do was sign it.
They didn't have to, I didn't have to, it was like a group visit. So when I onboarded the group of 22, I met all 22 of 'em over lunch, the boss, bottom lunch. I went through the contract, I answered all their questions, gave them the packet to fill out or the link to fill out. And that was hugely beneficial.
And I say probably four, five out of the six businesses. They, we went through the contract line by line as groups. So that was super helpful.
think that's so cool though, because you came from a very, you will see who we put on your plate, on your panel to, I'm gonna do whatever works for the community mentality.
So super awesome. And and it worked because you got everybody onboarded. So I wanna ask now, You've been in practice for multiple years. Now, you have come to a place where, you're balancing everything. You do have one employee in the clinic in addition to your husband, but you mentioned the book work clean.
And so for those people who ha are not familiar with the book work clean Jill, you mentioned it in a social media post where you were talking. I think it was in response to the question of how does one practice as a solo doctor. And so can you share a little bit about what is work, clean the book and how do you incorporate it into your.
Yes. So work clean is a book that talks about the restaurant industry, the chefs in the restaurant industry. I think it's called Mela where you basically get all the ingredients ready. Nicely prepared. And then you make the dish and it really talks about having kind of an order of operations.
And so I took some of the tips from the book and I had a checklist. And then, especially when I was solo when I had no staff. So the first thing I would do is respond to any emails and texts from the night I would go to my electronic fax. I would put them all in the patient's chart. I would then sort any documents that went up from the cloud into the chart.
And then I would see my first patient. So I would arrive at least an hour before it was my time to turn the lights on. And then I would restrain myself from responding to texts except every two hours to not get sidetracked, to focus on what I was doing. And then if I was, charting, three or four notes at the end of the day, I wasn't.
Answering emails. And I wasn't checking texts during those times to really focus did not distract myself. And I would only cash checks on the 15th or on every Friday. Now I cash checks on, I still do this. I cash checks on Fridays only I'll collect 'em all through the week. And I'll only go to the bank on Friday kind of saving time of not haphazardly.
Like, oh, I gotta check. I should go put this in the bank, get the checkbook out on the first of the month and the 15th of the month, or, pay the bills on the first and the 15th and having those routines to really just not forget something, but also to not get distracted, cuz it's very easy.
Especially as patients can constantly text or email of oh, I should respond to that because it takes a lot of time to switch gears from writing notes or ordering drugs to now responding to a patient. So the work clean came up with this idea of. Get all your prep work done in a right order, very succinctly and then move on.
And so I also combine this with bullet journaling. I have con I have two ways that I journal, so one's bullet journaling and the other is using the reminders on my phone, because if I do get a text or a call, when I'm not, next to that, I can, I always have my phone. I, most of us can't exist without our phone.
So I'm always putting like, don't forget, to take care of Joe Smith. Don't forget that Joe Smith needs a refill. And if not, if I'm by my bullet journal, then I just, write these things down. And that way I don't forget what I'm doing, but instead of maybe stopping and doing 'em right at that moment, I'll put 'em down on the list.
And then when it's time to order drugs, when it's time to fill medicines, doing it as a whole group for the day instead of getting distracted and being all over the place. One of the other cool things that I forget to mention the fact that I take care of a lot of the businesses in the industrial park, I do drug drops.
And that's what I've affectionately termed them as. So instead of weeding for six people to come, and they're all like, we'll be there at four 30 when we get off of work. But my last patients at noon, I drive all their meds refills out to the industrial park and I drop 'em off in gray bags with their names on 'em and I'm like, Hey, do you want me to drop your drug off at your place of business?
And most, I get the permission and they're like, oh yeah, not a problem. We love it. Cuz then they don't have to forget about it on their way home and realize they have to turn back around. I don't have to wait for 'em until five o'clock at night. So it's not uncommon. And a lot of 'em are now on like the same refill schedule.
I think Wednesday, I had to go to three of the businesses and drop off like six meds. And so I will go out there and just saves me time of not having to wait for them to come and pick it up. And then I don't have to stick around if my day's done at noon or two, I'm not sticking around until they're done at work at four 30 or five for them to come pick up their meds.
So there's just a lot of the work clean aspect is just trying to have some sort of order of operation. So that every day you do the same thing without getting bogged down in all of the tasks, because there are a lot of them. I make to-do list that take up a whole sheet of paper throughout the day of all the things to get done, but then batching 'em and getting 'em all done together is probably the easiest way to save time.
Amazing.
And for those in the audience who are interested in the book I will put a link to work clean in Dr. She's blog. So please check that out now, in terms of your ability to batch things together and your ability to really create your boundaries. One of the things that you have in your practice is a phone tree.
And so there's a lot of, people in the pro phone tree camp, a lot of people in the don't need a phone tree camp. How did you develop your phone tree and how has it impacted your practice?
My phone tree came out of some frustration of people calling me at 6:00 AM to tell me that they needed a medicine refill.
And I had it coming directly to my cell phone and. They were like, oh I didn't mean to get you. I thought I would just go to voicemail. And I'm like, yeah. But if I have you directly to my phone, it's gonna ring every time I can't just make it. So I finally got a phone tree and it's been tremendous because I would say 95 or more percent of the people who call think they can just leave a voicemail.
They all know. And the phone tree says, if you need me right now, press number two. And they press number two, really when they need me. But for the most part, I'm still answering voicemails fairly quickly. Like I'm still checking emails where I get the voicemails. So it's not that they're waiting a super long time, but they also know that.
If it's not super urgent, I'm gonna respond to it the next business day. And it has just made life a little bit better, but I emphasize almost with every single one. Just remember if you need me press two. It'll ring directly to my cell phone, just like every other time. And they do when they need me, they press two, but every time else, like a lot of times they like to leave Kathleen a message, my assistant, which has been great because there's a lot of stuff that she can take care of without it having to come to me.
So I think as I. As I hired my nurse to manage things more, giving her an option that when they call me, if they just need to talk to her to tell her something, the phone tree gives me that option. It also helps the patient decide. Is this something that really, I need to be bothered with? at that moment or can it wait until I have time to respond?
The text messages still come through after hours, I put a text message that says I'm gonna respond to these after 8, 9, 10 am the next day, whatever time I pick. And if you need me though, call and press two if you need me right now, call and press two. And so it's become this thing that just, I keep saying to every patient to assure them that I'm still there to answer their calls, but to put in a little bit of a boundary, because there are people who are like, I need a refill.
I took my med at six o'clock in the morning before work. That's great. I can take care of that at 10:00 AM. I don't need to hear about it at 6:00 AM. So they still have access to me. It's still pretty well that most patients understand that I'm on their side and that it's not. It's not a barrier between us to where I don't want to talk to them.
It just gives me an option to allow them to put non and things in a voicemail.
And in terms of myths that you have picked up over the years as a DPC physician, and, as a person who was , in the fee for service world, what are some myths that you have heard about or still see that are proven wrong by DPC thriving in this country in more and more communities, every.
I think the myth that it's really hard in a rural area where people have so much Medicaid that they, that there's no way that you can survive in a rural community. I think that is untrue because a lot of the small businesses. Would like to be able to offer those benefits, but can't, and so C DPC as an affordable primary care option when they can afford nothing, at least they can afford primary care.
I don't have a lot of patients on Medicaid. Mainly because I can't order drugs or imaging. And so I really, if anyone has Medicaid, I basically try to steer them in a different direction. I think the other part is that people think DPC is cherry picking the healthy people. I think that is completely wrong.
I have some of the most complicated patients that I've ever had. I love the fact that I have the time to really be the coordinator. If they have several specialists versus just always kind of at a glance like, oh yeah, I know you're going to them or to them, but to really sit down and think and help them understand what all the consultants are saying to get a person into rheumatology in our area, their next available is June of 2023.
So I am by default. A rheumatologist. And doing a lot of phone calls to be like, Hey, this isn't working. What's your curbside recommendation. Because the next time that they're gonna see the patient is a year, like for their next new patient is a year out. So tell me how to manage their RA.
Tell me how to manage their lupus. What am I doing? So the people who say DPCs cherry picking the healthy people completely wrong that DPC is only picking off the wealthy people who have, income. I've had to float people 11 cents for their drug, for their infection until payday. So I don't have a, I don't even have a dollar to my name, doc.
like just I'll on payday. I'll come back with the 11 cents. I'm like just take the 11 cents. I think during COVID I reached out to some of the workers who I knew their jobs in the service industry were gonna be affected and asked them, is there something I can do? If money's tight, we can drop down your membership.
Let's go down to five bucks a month, things like that. So the fact that people think DPC is for the rich is definitely not true that we're cherry picking easy patients, not true that this can't be done in a rural area, I think is not true. And there may be someone who says you don't know if you could handle 500 to 600 patients in the area.
You're right. I've only wanted about 300 because I wanna see my kids grow up. Because I want to be at the lake on a Thursday afternoon. I don't wanna work eight to five every day. I could probably come up with 500 or 600 patients to work full time, but I choose not to. I usually stroll into the office after 11 and I leave at four.
And that's on Monday, Wednesday and Friday, and then Tuesday and Thursday, a lot of the weeks I see one or two on those days. And I ride my bicycle to work. I live seven and a half miles away, and I have a Velo mobile, which is an enclosed recumbent bicycle that looks like a Bob sled. And it takes me 25 minutes to ride my bike in 25 minutes to ride my bike home.
I we've homeschooled our kids with the pandemic for the last two years. I've tried to assist with some of that teaching at the schools, doing the part-time pastoring program. Like I've had time to have a life. My, my thought at this point is how can I live in retirement today instead of waiting until I'm 65 to be in retirement.
And so if that means playing with my family, if that means, going to the library with my kids, going to the lake, riding my bicycle to work, taking ukulele lessons, becoming a part-time pastor. I get to do those things. So I don't know if this community could support 500 or 600 patients. I don't wanna find out.
I enjoy my little micropractice of 300 and some patients who I take really good care of. But I do think someone could, I haven't advertised at all since 2018 so I'm sure there are other places, or if people situated themselves just in the next town over could probably get another 300 patients, but there are people who say there's probably no way you could have a full time practice.
I don't know. I'm not willing to find out cuz I like my lifestyle. And I like my income where it's at and I'm pretty happy,
such a different place than. Walking through the snow, thinking about getting hit by a car again, I just, I cannot highlight that enough, how stark the difference is. So in closing, If you are blank, you should be looking into DPC. How would you fill in the blank for someone who is looking into DPC?
So if you are struggling and your mental health is being negatively affected by your job and the regular healthcare system. You should be looking into DPC.
If you would rather be spending time with your family than charting at night, you should look into DPC . If you would rather be taking care of patients in the way that you envisioned, when you wrote your med school and residency applications about caring for people, truly caring for them, you should look into DPC.
Beautiful. Thank you so much, Dr. Share for being on the podcast today.
Thank you so much for having me. I'm glad. I'm glad I finally get to get on here with you.
*Transcript generated by AI, so please forgive errors.