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Finding Balance and Success in DPC: The Evergreen Primary Care Story

Insights from Dr. Shary Vang, Dr. Anita MacDonald, and Dr. Leslie Surbeck - Direct Primary Care Doctors


The Co-Founders at Evergreen Primary Care
(L to R) Dr. Vang, Dr. Surbeck & Dr. MacDonald

Direct Primary Care (DPC) is a model of healthcare gaining traction for its patient-centered focus and emphasis on building lasting doctor-patient relationships. In a recent episode of "My DPC Story Podcast," Dr. Maryal Concepcion and DPC physicians, Dr. Shary Vang, Dr. Anita MacDonald, and Dr. Leslie Surbeck shared valuable insights into their journey of establishing a successful DPC practice, Evergreen Primary Care.


The Autonomy of Partnership Model

Evergreen Primary Care operates under a partnership model, where each partner's compensation is based on the revenue generated from their own patient base. This setup fosters a sense of autonomy and flexibility in their work, allowing each physician to have greater control over their practice and patient care. Dr. Surbeck emphasized the need for meticulous research and the involvement of a lawyer well-versed in DPC when considering a partnership. This underscores the importance of due diligence and legal counsel when embarking on a joint venture in the DPC space.


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Selecting Compatible Partners for Long-Term Success

Dr. Vang stressed the significance of selecting partners with compatible personalities and aligned values to avoid conflicts and ensure a harmonious working relationship. This insight sheds light on the critical role of interpersonal dynamics in the success of a DPC practice. By creating a supportive and cohesive team, physicians can effectively navigate the challenges of running a DPC practice while delivering exceptional patient care.

Operational Strategies for Sustainability

Dr. MacDonald highlighted the necessity of regular business meetings, transparent communication regarding expenses and responsibilities, and a support system for vacations to ensure fairness and sustainability within the partnership. This emphasis on clear communication and operational transparency underscores the vital role of efficient teamwork in the sustained success of a DPC practice.




Community Building and Collaborative Care

The Evergreen Primary Care team has actively contributed to the growth of the DPC movement in Minnesota by creating a community of DPC doctors through meetings, a Facebook group, and an email list. This proactive approach to community building exemplifies the spirit of collaboration and knowledge sharing within the DPC community. Additionally, Dr. Surbeck's discussion of their partnership with a pediatrician demonstrates the value of collaborative care models where different specialties come together to provide comprehensive medical services to their community.


Marketing and Public Engagement

Dr. MacDonald emphasized the importance of marketing their practice by selling preventive care in everyday practice and reaching out to employers, patients, and the public. The focus on offering comprehensive, high-quality primary care without flashy advertising highlights the emphasis on patient care and service quality. Moreover, their initiative to offer free vaccines to the community, garnering media attention and coverage, showcases the power of community engagement and positive publicity for a DPC practice.


Adopting Technology for Enhanced Efficiency

The physicians at Evergreen Primary Care leverage technology such as Electronic Health Records (EHRs), phone trees, and communication platforms like Spruce and Hint to efficiently manage their practice. Dr. MacDonald's insights about considering hiring a Virtual Assistant (VA) for administrative tasks like paperwork and referrals underscore the importance of leveraging technology and support personnel to streamline practice operations and enhance patient care delivery.


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A Commitment to Inclusive Patient Care

The doctors discussed their commitment to providing inclusive care to a diverse mix of patients, including those with high deductible insurance, Medicare and supplement plans, health shares, and uninsured individuals. This dedication to serving a wide range of patients reflects the core ethos of DPC – delivering accessible and comprehensive care to individuals from diverse backgrounds and socioeconomic statuses.


Conclusion

The insights shared by Dr. Vang, Dr. MacDonald, and Dr. Surbeck provide a rich tapestry of experiences, strategies, and values that have contributed to the success of Evergreen Primary Care. Their dedication to patient-centered care, collaborative approaches, and strategic operational planning exemplify the power of the DPC model in transforming healthcare delivery. As the DPC movement continues to expand, the lessons from Evergreen Primary Care serve as a guiding light for physicians and aspiring DPC practices, fostering a culture of innovation and excellence in the realm of primary care.


The episode expressed gratitude to the listeners and encouraged them to share the podcast's efforts in promoting DPC, reinforcing the podcast's commitment to championing the DPC movement and sharing valuable insights from the frontlines of primary care.


 

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OUR GUESTS:

Dr. Leslie Surbeck graduated from Undergraduate at Bryn Mawr College in 1997 and then went to Medical School at University of Minnesota, Minneapolis, MN, where she graduated in 2004.She completed her Residency at Hennepin County Medical Center, Minneapolis, MN in 2007 then served as Chief Resident from 2007-2008. After resiedncy, she served as a Staff Hospitalist at Hennepin County Medical Center and Hudson Hospital from 2008-2011and then became a Primary Care Physician at HealthPartners from 2011-2020.

She loves learning about each unique person and working together with her patients to find solutions that fit. She tries to approach every clinical situation with humility and an open mind and believes the practice of medicine should be evidence-based but never one-size-fits-all.

Her Interests outside of medicine: spending time with her partner and our two daughters, gardening, and long walks.


Dr. Shary Vang graduated from University of Minnesota in 2003 then attended Medical School at University of Minnesota, Minneapolis where she graduated in 2007. She completed residency at Abbott Northwestern Hospital in Minneapolis, MN beween 2007-2010 and served as Chief Resident from 2010-2011. She then went on to serve as Physician & Director for HealthPartners Center for International Health 2011-2021.

She is the proud daughter of Hmong refugees and her philosophy as a physician is simple: provide a space for patients to be heard, treat everyone like family, and provide the best care she knows how. Her medical interests include: Diabetes, Hypertension, Stroke, Thoracic Outlet Syndrome, Piriformis Syndrome, ADHD, complex medical care, Refugee/Immigrant Health

Outside of medicine she enjoys spending time with her husband, 3 children and their large extended family. She loves listening to podcasts including favorite are Terrible, Thanks for Asking, Unlocking Us with Brene Brown, Criminal, Heavyweight, and Where Should We Begin with Esther Perel. She is an avid pickleball player and supporter of her husband’s pickleball company, PikNinja Sports.


Dr. Anita MacDonald attended undergrad at Amherst College and graduated from Medical School at Case Western Reserve University in OH in 1997.

She completed her Residency at Forbes Family Practice in PA in 2000.

Prior to DPC, she was a Primary Care Physician at HealthPartners Health Center for Women from 2004-2020 and then served as their Clinic Medical Director between 2010-2020.

She loves the ability to have relationships with her patients in DPC and feels listening, partnering with, creating a plan together, coaching, empowering and advocating on her patient’s behalf are all essential to her practice. Outside of medicine, she enjoys time with her family, appreciating the beauty of the natural world, true crime podcasts, meditation, educating herself about and doing what she can to promote racial, economic and climate justice.


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In the MINN POST!


PODCAST EPISODES:


FIRESIDE CHAT:

- Dr. Lauren Hedde speaks about DPC Lite and how she handles all her patients without additional staff. Find chat HERE


RESOURCES (click here to learn about FREE DPC resources)

 

CONTACT:

Website: HERE


SOCIALS:

FB: HERE

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Listen to the Episode Here:



 

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Transcript*

Dr. Maryal Concepcion [00:00:04]:

Direct primary care is an innovative alternative path to insurance driven health care. Typically, a patient pays their doctor a low monthly membership and in return, that's a lasting relationship with their doctor and has their doctor available at their fingertips. Welcome to the MyDPC story podcast where each week you will hear the ever so relatable stories shared by physicians who have chosen to practice medicine in their individual communities through the direct primary care model. I'm your host, Mariel Concepcion, family physician, DPC owner, and former FIFA service doctor. I hope you enjoy today's episode and come away feeling inspired about the future of patient care, Direct Primary Care.

Dr. Leslie Surbeck [00:00:53]:

I'm doctor Leslie Serbeck, and DPC means to me getting to be a true professional and not just a employee.

Dr. Shary Vang [00:01:02]:

I'm doctor Sherry Vang, and after practicing 1 year of direct primary care, I strongly believe that this is the best avenue for primary care to provide for the people in their community.

Dr. Anita MacDonald [00:01:12]:

I am doctor Anita McDonald, and Direct Primary Care has changed my life. I love not being rushed every day when I see my patients and giving them the kind of care that I think everybody deserves.

Dr. Leslie Surbeck [00:01:27]:

We are the cofounders of Evergreen Primary Care.

Dr. Shary Vang [00:01:30]:

Located in Saint Paul, Minnesota.

Dr. Anita MacDonald [00:01:32]:

This is our DPC story.

Dr. Maryal Concepcion [00:01:40]:

Doctor Leslie Serbeck Graduated from undergraduate at Bryn Mawr College in 1997 and then went to medical school at University of Minnesota in Minneapolis where she graduated in 2004. She completed her residency at Hennepin County Medical Center Minneapolis in 2007 then served as chief resident from 2007 to 2008. After residency, she served as a staff hospitalist at Hennepin County Medical Center and Hudson Hospital from 2000 8 to 2011 and then became a primary care physician at HealthPartners from 2011 to 2020. She loves learning about each unique person and working together with her patients to find solutions that fit. She tries to approach every clinical situation with humility and an open mind and believes the practice of medicine should be evidence based, but never one size fits all. Her interest outside of medicine include spending time with her partner and their 2 daughters, gardening, and long walks. Doctor Sherry Vang graduated from University of Minnesota in 2003, then attended medical school at University of Minnesota Minneapolis where she graduated in 2007. She completed residency at Abbott Northwestern Hospital in Minneapolis between 2007 to 2010 and served as chief resident from 2010 to 2011.

Dr. Maryal Concepcion [00:03:00]:

Then for a period of time, she served as physician and director for Health Partners Center For International Health. She is the proud daughter of Hmong refugees, and her philosophy as a physician is simple. Provide a space for patients to be heard. Treat everyone like family and provide the best care she knows how. Her medical interests include diabetes, hypertension, stroke, thoracic outlet syndrome, piriformis syndrome, ADHD, complex medical care, and refugee and immigrant health. Outside of medicine, she enjoys spending time with her husband, 3 children, and their large extended family. She loves listening to podcasts including Terrible. Thanks for asking.

Dr. Maryal Concepcion [00:03:40]:

Criminal. And where should we begin? With Esther Perel. She's an avid pickleball player and supporter of her husband's pickleball company, Pick Ninja sports. Doctor Anita McDonald completed undergraduate at Amherst College and graduated from medical school at Case Western Reserve University in Ohio in 1997. She completed her residency at Forbes Family Practice in Pennsylvania in 2000. Prior to DPC, she was a primary care physician at HealthPartners Health Center For Women from 2004 to 2020 and then served as their clinic medical director between 2010 to 2020. She loves the ability to have relationships with her patients in DPC and and feels that listening, partnering with, creating a plan together, coaching, empowering, and advocating on her patient's behalf are all essential to her practice. Outside of medicine, she enjoys time with her family, appreciating the beauty of the natural world, true crime podcasts, meditation, educating herself about, and doing what she can to promote racial, economic, and climate justice.

Dr. Maryal Concepcion [00:04:51]:

Welcome to the podcast, guys.

Dr. Leslie Surbeck [00:04:53]:

Thank you.

Dr. Anita MacDonald [00:04:54]:

Thank you.

Dr. Shary Vang [00:04:55]:

Thanks for having us.

Dr. Maryal Concepcion [00:04:57]:

You guys are the 1st physicians from Minnesota to be sharing your story on the podcast, so I'm Really looking forward to the audience hearing more about your story and more about how DPC is going in Saint Paul and in Minnesota. So I wanted to start, though, with with the idea that you 3 are 3 physicians who founded your direct primary care together, and that's not a typical thing that we see. We see a lot of micro practices. We see people who are having people join them later on. But How did you guys happen to come together to open Evergreen Primary Care?

Dr. Leslie Surbeck [00:05:31]:

Well, a little bit of serendipity. We all did practice at HealthPartners. And Anita and I actually worked at the same clinic for several years. Anita was medical director there, and she actually hired me when I started there. And so Anita and I knew each other, and through COVID, we had quite a lot of disruption to our practice. Our practice our group was moved several times, and then the organization decided to kind of dissolve our group, our clinic. We're we were at the health center for women, but we were a group of 7 women physicians all doing primary care. And so When that happened, I think, for me, at least, it was almost like the last straw.

Dr. Leslie Surbeck [00:06:18]:

There were a lot of things about working in a a big organization that We're frustrating, and I I had always thought about leaving and starting something different, but I it's a little bit scary to do that. And so When this happened, it was kind of like, well, if I'm ever gonna do this, if I'm ever gonna go independent, like, now is the time. And so that was sort of the impetus for me. And then it turned out that Anita, also, the clinic had closed, and And she had decided to take and I'll let you speak, Anita, too, but she decided to take a little time to, like, think about what she wanted to do. And so at at some point, decided, like, okay. We're in this together. We're gonna do it. And then we actually hooked up with Sherry through the DPC Facebook group.

Dr. Leslie Surbeck [00:07:09]:

And I put on there, like, hey. Is anybody out here in Minnesota? And then, Sherry, you said, hey. Yeah. I'm I'm out here, and I'm interested in DPC. But you weren't you hadn't started anything yet. And so then we kind of all started meeting. And because we had all worked for health partners, we had a lot in common, a lot of grievances in common. And we started meeting, and it was kind of just like, hey.

Dr. Leslie Surbeck [00:07:33]:

Yes. This is what we wanna try, and now is the time.

Dr. Anita MacDonald [00:07:37]:

Yeah. I would say From the story I always say is, like, it was very traumatic how my clinic was closed. I had dedicated 16 plus years to the organization. You know, like, I was moved to another clinic. Was not With any of my nurses, not with any of the staff, not with my my work home, all the reasons why I was staying with the organization. And so I Left, I took, gave myself a sabbatical, left on good terms, and just took some time off. And then I I worked in the Hospital. The hospitalist for a few months during the 1st surge.

Dr. Anita MacDonald [00:08:13]:

And then and then I was looking around and trying to get another job and looking at Organizations and it was just the same issues everywhere. It wasn't just our organization. Really, it was just constantly but you have to see so many patients because primary care doesn't make enough money and you have to build code more and we all Everyone knows this is a problem, and we're gonna try to fix it. But having the experience of 16 years in an organization where they're We think we're gonna fix things because we know primary care is not sustainable and it not happening. So so that's when I had been learning. I actually did the DPC sum of the AFP one using up my CME money before I left the organization. And so I was really interested in it. I'd heard about it before, but the idea of starting out on my own was daunting.

Dr. Anita MacDonald [00:09:04]:

And then when Lovely approached me and said she actually had I called her saying that I'm gonna do this, and I'd love for you to join me, but I'm gonna do it. And so, like, alright. Well and then we had our 1st meeting. I think our 1st meeting was the 3 of us at Lovely Place. I just have this memory of us Meeting Sherry, I've known Sherry a little bit, but I just knew from that 1st meeting that this was gonna work, that we shared the same Value same kind of approach to patient care. I could tell we would be able to work together and it was just so exciting. And I'm You know, some way I mean, a lot of ways, it helped me because I don't know if I would have done this on my own. It helped so much to do this as a team.

Dr. Anita MacDonald [00:09:49]:

It didn't go into different Reasons why, but that that's what brought me here to ever be.

Dr. Maryal Concepcion [00:09:56]:

So beautiful. And and, Leslie, you called it. It's so serendipitous that this happened. And, Anita, I just really love that that you highlight that you might not have done it had it not been for the 3 of you going in this together, and it's really important for people to hear that. Sherry, can you share your take on how did things go from meeting on Facebook and then taking that the good side of Facebook to actually opening a a clinic.

Dr. Shary Vang [00:10:21]:

Yeah. You know, I was when I left when I finished up residency in my chief year, I I kind of found my dream job right out of the gate. I was working in this primary care setting where we were supported by a large health care system serving a population of patients that, like, really was my goal when I wanted to be a doctor. It was to really able to take care of immigrants and refugees. And so I thought I was gonna stay in my job forever. But, you know, as as more years come by, you you realize, Okay. There are certain things you don't like about it, but I had sort of made my peace with it. I think more so because I also had 3 small children, and so I was like, well, you know, there are some things I didn't like about it, but We'll make it work.

Dr. Shary Vang [00:11:00]:

And then about 2 years before I left, I think I started to really feel like there was a lot that I was having to give up personally and professionally to that I really didn't feel like I was enjoying about primary care anymore. And so once the pandemic hit, and I think I had all my my 3 kids at home, and I was it was between my husband and I with no other child care. It really Made me open my eyes about what I was doing in my life, and I I had so many people in my life prior to that were like, oh, when you can open your clinic, and I was like, I would never in a 1000000 years do that. I at my current job, I was working Tuesday, Wednesday, Thursday. I had 4 days off outside of that every week. And I was like, this is honestly the perfect setup to be raising my 3 children. So I really didn't think I was gonna do it. And then Once the pandemic hit, and I really had to stop and look at what I was doing and how life was for me and where I was professionally, I joke about it, like, going through my midlife crisis.

Dr. Shary Vang [00:12:00]:

I realized that I couldn't and it it was funny because at that time during the pandemic, our employer came up with this new hour shift where they needed us to do more evening and weekend hours. And I said, well, for people like me who are caregivers, that's not so easy for us to do. So what Can you guys do to help us? And there really wasn't an answer on their end. It was just, no. What can you do to continue to stay in your job? And so for me, I think that was the push for me to decide, do I wanna stay here, or is it time for me to leave? And so I think it was July or August before I left. I actually started to explore the idea. Like, could I go on my own? Because I'd heard about This whole DPC model and I knew I wasn't interested in opening a a traditional model clinic, and so I started to explore. I even went to look at space.

Dr. Shary Vang [00:12:49]:

And I thought, okay. I do the numbers. This is what I need to do to make ends meet. And I really thought about it, and I thought, okay. We could do this. But then when I really sat down and thought about All the other aspects of my life that I needed to manage, my children, my marriage, I was like, there's no way, even in the DPC model, could I go on it alone? So kind of like what Anita said at that point, I said, you know what? I just have to hunker back down and do my job and try to make it work with my employer, but In the end, it didn't work out still. And so when I left in March of 2021, I said to myself, I am gonna enjoy my unemployment. I'm going to set it out for a month, and then I'm gonna decide, like, do I really wanna stay in medicine? Because at that point, that whole previous year, the pandemic with What was going on with my employer negotiations, it just made me really reconsider my life as a primary care physician.

Dr. Shary Vang [00:13:46]:

I mean, I I feel like at prior to that, like, I was very grateful in my life that I got into medical school when I did, and I got into Residency where I wanted, and then I got the dream the job of my dreams. And so, like, I never had to really stop and really think, is this really, really what I want to do with my life? Is this what I wanna spend my life day in and day out doing? And so this was the very first time in my life where I really had to stop And really decide. Like, life really is too short. I mean, my dad died when he was 63. You know? And so for me, I was like, Do I really see myself being a physician if this is what physicians if this is what our life is like? But for so for that 1 month, I did decide I was not ready yet to leave medicine, then, but I knew that I couldn't go back into a large health care system. So much Anita, there were other organizations who were like, oh, just come work for us. And I would have worked with a Similar population, but I think the way in which I departed, it just really left me like, I had a distrust in the large health care Again, that they would value me as a unique physician with a unique skill set and would be able to support me Like, I support them and everything else that they had asked me to do up until that point, and so I really couldn't go back into the large large health care system. So when I saw Leslie's post on Facebook, I was like I think I think, Leslie, what the the post was, something about asking for a lawyer that, you know, was about DPC.

Dr. Shary Vang [00:15:12]:

And I reached out, and I said, I don't know anything about that, but there is the space that I did look at. And then I think 2 weeks later, you're like, are you interested in opening DPC? See, and I was like, actually, my 1 month is up. So, yes, let's talk. So I think that's kind of how we all started it. But yeah.

Dr. Leslie Surbeck [00:15:30]:

And I'm loving it. I'm just grateful. I I was going to do it regardless, but I joke that if they hadn't Come with me. If I hadn't met them, if they I'd probably still wouldn't be open yet. Like, it is just so I'm so fortunate to have you guys helping and carrying the weight part of the weight because it is a lot of work. And and also just to have, like, People to practice with who, yeah, share share my values and all of that. It just makes it So much more enjoyable and less scary. So

Dr. Anita MacDonald [00:16:10]:

Mhmm. Yeah. We were able to we Had that meeting in March or April? Was that our 1st meeting?

Dr. Shary Vang [00:16:15]:

April. Mhmm.

Dr. Anita MacDonald [00:16:16]:

And then we opened in October. I mean, so because The 3 of us were working together and and, Leslie, you were still working somewhat and then Sherry and I were most We're pretty much not working. So we have the time and we could just just focus. And it was amazing how quickly we were able to make all The the decision making would, I think, would have been I it was one of the main reasons I would never have been able to do for myself because I just have a hard time Making decisions, like, just, you know, coming up with the name. Yeah. I wouldn't I I would I wouldn't have come up with a name by this point in time. By having we each have our own skill sets, and it's great just to be able to run things by each other. And And and now we have, like, we had our 1st retreat meeting where it kinda spent the whole day looking at where we are, and you're able to, like, Kinda divide up our tasks a little bit into categories.

Dr. Anita MacDonald [00:17:10]:

So I'm more the finance, bookkeeping, insurance person because those are my my attention to detail and just focus on things that need to get done, get them done. Whereas Sherry is our Marketing, media, social media person. She's so great at networking and just con lots of ideas and just So much energy and follow through and so good with people in that way. And and Leslie is your HR. Right? But she also build our page our our, website. She's got great like, just the design. I I'm not very Creative that way. So I'm like, I wanna be able to build a website.

Dr. Anita MacDonald [00:17:53]:

I mean, it's just it it really I think we kinda balanced each other out So wow. And I'm I'm yeah. I'm just so grateful.

Dr. Maryal Concepcion [00:18:02]:

I love this. And so when you mentioned and I I love I really Appreciate how you just laid it out there. Like, I'm the financial person. Leslie is the the HR person. I'm sure she's She's gonna love that for the rest of her life, and Sherry is is the the social person. Can you though start us back at When you had that meeting in April and you were like, we're totally gonna do this together, what were those initial goals that you had set out, and where are you guys on your trajectory?

Dr. Leslie Surbeck [00:18:31]:

Gosh. You guys jump in too. But, I I mean, I think that when we first met in April, I just wanted to figure out if it was possible if it was possible to practice without support from an organization. Like, could could I, just me, with my training, take care of patients and provide Comprehensive primary care. And it turns out that we can, and we can do it for really pretty darn cheap. And that so so in that sense, like, I think we've accomplished what we set out to initially, and now I I feel like the the Focus for me is more on, okay, how do I make this sustainable, and how do I get to the point where I'm making a comparable salary to what I was because, I mean, I think it's I think DPC is a really important option for patients to have, but it's also, In some ways, even more important just for physicians to have it as an option because in the health care field, I feel like there's been So much consolidation, and it's not very diverse. Right? There's there's really 1 model or a couple models, and And I don't think that lends itself to a very healthy industry. And I think that the the physicians have really lost a lot of power, especially in primary care.

Dr. Leslie Surbeck [00:19:56]:

And so I want this to be able to pay me, not only just for me, but so that other people can do it and survive And have a have a good quality of life and a good income. And so I would say I also would say one of my other goals was not to lose a lot of money because I was that was what I was really scared of was, like, investing a bunch of money and not and then losing it. And we have far exceeded that. Like, we We're making money. So now it's just about growing my practice to a size that that is sustainable financially.

Dr. Maryal Concepcion [00:20:31]:

So awesome to hear. And how about you, Anita and Sherry, in terms of how you guys look back on that April meeting and than look to today where you've reevaluated where you guys are on the trajectory. What are your what what do you recall from that meeting in April, and what do you feel about your future today.

Dr. Shary Vang [00:20:49]:

We were reflecting on this last week, and I I think I was the only one of the 3 who was like, I wasn't. I I didn't have any doubt that, financially, we would do well. I think I just know, like, for for I mean, between the 3 of us, we've had over 40 years of experience. So For me, professionally, I knew that that was not gonna be a problem, and I feel like I said, even when I was looking at my own financial picture of being a primary runner, I had no Fear going into this because and when we talked a little bit about your exit strategy. Right? Like and I think for me, I Because I already knew I was unhappy in my current situation, I was already starting to, like, do bits and pieces of, like, doing more procedures, Figuring out what else I could do besides just straight up primary care to in a in a in event that I did ever not have a job in my with my current system that I would be able to be self sufficient and be able to make my own and to create my own cash flow on the side. And so that's what I had going into this. And so for me, I I didn't worry about it. But, like like, Leslie said, I think for me, it's after this 1st year, it's been trying to balance What it's like to be a business owner because my husband is also a business owner, and we've got 3 young children.

Dr. Shary Vang [00:22:01]:

So for me, it was more of just how is this gonna work in my life besides work. How do I balance life and home? And because I really can't shut off my brain from the business, there are patients that might text me, Or I have this to pick up on, or I have this part of the business I need to work on because my partners are relying on me to follow through. So for me, it's just been a figuring out What my schedule looks like, what how to build the and create those boundaries with my patients, and then how to be a more efficient business owner. So I'm looking forward to how to grow the business now that we kind of have a foundation set.

Dr. Maryal Concepcion [00:22:36]:

I I love the the The chances that I get to speak with physicians like yourselves who have who have decided on DPC, you guys are are very much in that sophomore phase, and you have so much wisdom now and so much confidence differently than you did when it was like, Forget this. We can't go back to that. What are we gonna do? And so, Anita, when it comes to your your take on things, can you also Highlight the financials because you are the financial person of the of the clinic. How did you guys come together to like Sherry was saying, she's a primary breadwinner, and and Leslie wanted to have the clinic continually be profitable. How did you guys look at things in terms of strategizing how you would take patients on and how you would benchmark your financial growth.

Dr. Anita MacDonald [00:23:22]:

Well, I don't know if it was so systematic. I mean, one of the the, Like, I had I mean, your podcast has been incredible. I mean, it's one of the like, I think I was still, like, I don't know if This is it sounds to be good to be true. Can this really be done? You go to the DBT summit and you see, well, there are people doing it, but they're just in rural areas. And it's not gonna work Here in where there's insurance these big health systems just dominate this area. So I was really worried about how how that would work. But so, like, I remember, you did I think it's Lauren Hetty, the burden free with the burden free doc. I mean, I just I listened to that podcast, and then I looked at her blog, and she did a fireside chat at one point.

Dr. Anita MacDonald [00:24:10]:

And just to see, like, you can really my take that, we can really doesn't cost that much. You can really I mean, The prices of the EHRs are very doable. Like, before, I knew we're used to Epic. I'm like, how in the world? Like, small small practices can't afford Epic. How can we are we just gonna do on paper? Like but no. They're actually very affordable. Do we don't have to have staff, at least, but not at the beginning. And Obviously, you don't need to have coders and billers.

Dr. Anita MacDonald [00:24:40]:

So the biggest cost is really the the rent. That's really been our biggest cost. Malpractice isn't Too bad here. And then we were just it and it was part of the the fun of building the practice. Like, most of our Our equipment and furniture, we're on Facebook Marketplace, eBay, driving all over the place to pay stuff. Got a $250 autoclave and that that we got donations. I mean, it was really fun putting it all together. So but my Focus is always been just keep that bottom line really low because I don't wanna go into debt.

Dr. Anita MacDonald [00:25:17]:

And then the lower we keep our Regular operating budget, and we can easily meet our expenses with smaller smaller number of patient members. I think my biggest challenge has been at the beginning, and it's still an ongoing challenge for me, is Price point. How do we come up with the price point? And it's always been like, well, there's a question. I have insurance. Why would I pay $80 every month in addition to my insurance when I don't have to. And I think all the 3 of us are similar and that we really Didn't want to just be doctors for the wealthy, for people with a lot of expendable income. And so how do you how do you make that work? And I love the Podcast, the the episode with Garrison Blissings, and it just opened my eyes about how flexible you can be with the with the pricing. Like, we have our Set pricing, but, you know, I have patients where I don't charge that much for them.

Dr. Anita MacDonald [00:26:15]:

And and we have a patient assistance fund. And We really want to be able to I think I really wanna make it affordable, but what's affordable is different for Different people. And that's the part that I always struggle with. So in terms of, like, how do we it's either you have to have a larger panel To be able to make the in in charge of the price that we're doing, or do we need to raise our prices so that we can we can have a smaller panel? That's the I think that's a challenge and Honestly, right now, we're I'm feeling pretty good about where I am, but I'm not I have about 125 patients on my panel, and it's pretty comfortable pace. But I'm busy every day, and and I'm not Frankly, making what I was making in my other job. So, like, how do we how do we Figure out how to either yeah. Do we need to increase prices? Do we need to just grow more? Do we need to at this point now where we need to get some Additional staff. We've talked about getting a virtual assistant because to offload some of the work that we're doing now, I mean, that's a that's.

Dr. Anita MacDonald [00:27:25]:

These are all the issues we're dealing with, we're we're trying to figure out. But that's also the thing about this whole journey. It's been like, okay, well, let's Try something. Let's change it here. Why don't it's it's that's what makes it so fun. And and I guess I would say the other thing that You know, in terms of what I've learned and kind of reflecting back on not so much the financials, but In terms of just practicing and and being able to practice medicine the way I feel people deserve to be able to get the kind of health care where I can have this relationship with my patients, and I can not be rushed, and I can spend the time with them, and I can look things up, and I can follow-up with them. And then also just hearing from my patients, like, I was worried about, will people pay extra for this? And I have so many patients who say We're so feeling so lost and adrift in this current system. They can't get in to see their doctor.

Dr. Anita MacDonald [00:28:24]:

They're already weeks out or They have chronic conditions, but they've got different specialists managing different things, and they don't know who to call when something comes up. We just feel, especially in a number of my more complex patients with chronic disease or older, they just they really feel Abandoned in a lot of way by the system and scared. And so they tell me how how helpful it is to just Know that they know who to call, have me there. I'm on their side. I'm looking out for them and they can get in when they need to. It's I mean, In that way, it helps answer that question for me about why would you pay extra. And and it's just what Was surprising to me that in terms of when we started to now, that's been one of the most surprising things about how Happy how much my patients are actually valuing and willing to pay for for my care outside of insurance.

Dr. Maryal Concepcion [00:29:24]:

It's it's truly incredible. And as your practice has grown, you you can always look back on the successes that you have already experience, and you're not even within your 1st 5 years. It's it's incredible. And, especially, Anita, as you shared, 16 years working for a system that promised to change and to change and to change and never did. And, Sherry, how you how you spoke about how the organization was you were working so hard for them, but then It was up to you to maintain your job. I mean, it's it's just so different when you are sharing now your story at Evergreen because you you are are Saying it like it is, you you don't know and then you try something, and then if

Dr. Anita MacDonald [00:30:02]:

it works, it works. If it

Dr. Maryal Concepcion [00:30:03]:

doesn't, you try something else. But you have that autonomy, and you guys are determining that autonomy together. Now I wanna ask here in terms of the people who have found your services to incredibly valuable and necessary. Who are the people who have joined your practice? Because, Sherry, I know you mentioned, like, your dream your dream job after residency was where you could serve people who weren't super, super wealthy immigrants and people who truly need care and culturally sensitive care also. So Who has joined your guys' panels? I have a pretty

Dr. Shary Vang [00:30:36]:

I think a very unique mix of patients. I have several Hmong patients as well. These are patients who have typical patients that would be served best in the DPC model. They have jobs. They're employed, but they have high deductible insurance. So I have a handful of I I also as a side I don't know if we consider a side gig, but as a side offering to DPC, I also do these immigration exams. And so I've gotten a couple of patients from that because I do have some, again, individuals who are here legally but Don't have any insurance coverage, and so this is a really affordable way for them to get ongoing care. And then I would say the far majority are Still working individuals with high deductible, but I do have several well insured individuals who just have significant enough health needs that they require that ongoing relationship with a physician.

Dr. Shary Vang [00:31:28]:

But I it is I have a pretty diverse panel of patients, so I'm pretty happy with that.

Dr. Leslie Surbeck [00:31:33]:

I think that's been pretty interesting to me too how diverse our patients have been so we I have some of my patients that have followed me from various places that have good insurance and are willing to pay. We all have some Medicare patients who have Medicare and supplement, but, again, just because they value having a home where they can communicate easily and directly with the physician. They're willing to pay that. But then, yeah, we have people on health shares. We have people with high deductible where they're doing it to save money. And then we have or I have some people who are self employed or Don't have insurance, which I don't recommend, but this is what they can afford, and so it's better than having nothing. Right? And so it's really fascinating to me because it's like this huge swath of people people coming from Really fancy neighborhoods and then people coming from not so fancy neighborhoods. So it's I I really like that.

Dr. Leslie Surbeck [00:32:38]:

And it speaks to how DPC is really filling a a need out there.

Dr. Maryal Concepcion [00:32:44]:

So Absolutely. Anita, how about you and your panel?

Dr. Anita MacDonald [00:32:47]:

Like, it's pretty similar. I do have, since I've been in practice in the Twin Cities for a very long period of time, I do have a significant proportion of my patients are found me, which is, again, it's like because I left And I was gone, you know, I left. I didn't I didn't know what I was doing, and and I felt like I was abandoning my patients, but I felt I didn't have any other Choice at the time and how how just emotionally hard that was. And then now, I just will, like, see someone pop on on my Scheduled for a meet and greet is somewhat one of my current patients that familiar name, and it's just it's the best feeling. I mean, we connect. And so so I do have quite a few of those patients. And then, it's similarly. Like, I have a few uninsured patients and then a few patients, Probably more who have these high deductible health plans where it's just this is a this is a financially good decision too.

Dr. Anita MacDonald [00:33:47]:

They don't need to have Lot of expendable income. They're actually saving money with the DPC. And then we also have an employer, which Oh, yeah. Is fast. We're trying to that's our goal is to try to Get connected with more employers who can pay. I mean, I think that's the sweet spot, really, for for this to become more affordable for people It is to have employers pay for the membership for their for their patients. And so we have we do have Some of those patients as well.

Dr. Maryal Concepcion [00:34:15]:

And when you talk about the employer group who has joined your practice, what is the demographics of this particular employer who's joined your group?

Dr. Anita MacDonald [00:34:23]:

Well, this is it's pretty interesting because they found us. They I think they went on the DPC mapper even. So they are based in Wisconsin and have been working with reform medicine in Wisconsin, a large DPC group For a time, so they are very familiar with it. And they opened up a satellite office. They're an engineering company. And they opened up a satellite office here in the Twin Cities. And so they just were looking for DPC, and they found us.

Dr. Leslie Surbeck [00:34:54]:

I think they contacted us before we were even open.

Dr. Anita MacDonald [00:34:57]:

I Incredible. And we didn't have to sell them. We had to sell their employees because it's a choice for the employees. But they're what are they? Medium size? I mean, I think we have about Fifteen, 20 patients that are practicing on them?

Dr. Maryal Concepcion [00:35:12]:

Yeah. Awesome. And when you talk about selling the the practice to not the employer, but the the patients themselves. I wanna hit on, Leslie, how you're designing the website, Sherry, how you're doing the marketing. How did you guys come together to collectively come up with the the key highlights about your practice that you wanted to share and and make sure people knew about going into working with employers, reaching out to just members of the community.

Dr. Leslie Surbeck [00:35:40]:

In my mind, first, you you Decide what you wanna offer and what you have to offer, and then you let the marketing develop from that. Right? And I always I would always get kind of grouchy, like, before when I worked at at this the big employer driving down the seen like a big billboard that had some, like, marketing phrase about our employer. Right? Like, I don't know. Whatever phrase they had paid A gazillion dollars to some firm to, like, come up with. Right? And and it was always kind of like, what? That doesn't that That has nothing to do with what we're doing in the clinic and or talking about their latest campaign and blah blah blah, and and it always felt so disconnected from What was actually happening in the clinic? And so I don't know. I guess, for me, it just always seemed like, okay. Well, You know, we just describe what we want to bring to people, and and and the people who feel Like, that is something they're looking for will will will find us, but that's probably very simplistic. But, I mean, I don't know that we we sat down and said, okay.

Dr. Leslie Surbeck [00:36:50]:

Like, here are the people we're gonna go after or anything like that. We just said, okay. Well, who are we, and let's, like, Tell our story, and then and that's why I mean, I think the the name Evergreen too resonated with us because it's Organic and growing up from the roots and natural, and it's not it's not something that we're trying to it's not fancy. It's not flashy, but it's strong and and secure and organic. So that's just kinda what I think of of how we present ourselves is, like, we're doing basic, Comprehensive, high quality primary care, and we're in the trenches doing the work. So, like, we don't need a lot of snazzy stuff to to sell it.

Dr. Shary Vang [00:37:42]:

I was just gonna say, and I think that translates to, I think, what Brought a lot of media attention eventually to us is because for us, I mean, COVID, the pandemic, and vaccine, and the The whole equity piece of vaccines was a really big part here in the Twin Cities as well as throughout the nation. And so for us, when we had Opened up our clinic. There we realized that, like, for me, in the Hmong community, that there was still a a whole bunch of Elderly long folks who still hadn't gotten their booster yet or some who hadn't even gotten their primary series. And so I that was one of my goals, and, like, I can now build a clinic that I want, then, yeah, if I can get free vaccines and I can vaccinate the community at large that I, like, I have my Business housing? Why not? And so the 3 of us agreed to give out vaccines free to our community, to our neighborhood, And so we went into the Facebook groups of the community that we live in, for me into the Hmong community, on my personal Facebook, and we Really held a lot of community drives because we were also building our practice at at that time, so we didn't have many patients. And so for us, it was like, why We can do so many things at once. This is like a easy way for us to market ourselves, to bring people in our doors, but to also offer a service that is so much needed in so many communities, even in the community which we have our clinic in in the Midway area in Saint Paul, which is one of probably one of the Horace communities, in the Saint Paul area, we went to poorer neighborhoods. And so for us, it was really important that we also take care of the to people around us. And so I that's how we got some people who work at the men post to come to our event.

Dr. Shary Vang [00:39:24]:

And, obviously, we we always use it as an opportunity to Tell people about this model because for us, it's not even coming here, but just to know that there's an we're not the only ones in town. And so that piqued their interest, and they went back to their newsroom, and they started talking about it. And then they reached out to us, and we got a story. And I think that's how Minnesota Public Radio heard about us too, and so that's where we got some natural media coverage, which really, I think, brought us out into the larger community as well. So we were very fortunate about that.

Dr. Maryal Concepcion [00:39:56]:

And I wanna give you guys props in terms of, when you visit the website for Evergreen Primary Care, There's actually a media page, and so you guys have highlighted where you've been featured in the media. And I think that, especially for the movement, if If people are listening and they have not thought about that or they have not yet interviewed or done or been featured in an article, It's something something to think about putting where you've spoken about your clinic, your practice, your way of practicing medicine, your DPC on your website. You you never know who is going to find your website, and you never know what time of day they're gonna be on there. But if it's on your website, It is for people to to find it. So just like how you guys were thinking that the employer found you guys on the map are, If somebody approaches you from Saint Paul, they're like, oh, of course, this is exactly what I want to continue to feature in in another media. So I think that that is amazing that you guys have that on your website. Just wanna highlight that. Now when we go back to Sherry, you mentioning that you guys have a clinic that's not necessarily in the richest part of Saint Paul.

Dr. Maryal Concepcion [00:41:03]:

Can you share about How DPC is in Minnesota when you talk about there's other people in the neighborhood, so to speak. And when you were looking for a space and you had potentially found A space which is now your clinic. What was appealing to it that was that what that made it a potential space for you guys?

Dr. Shary Vang [00:41:22]:

We all knew we wanted to stay in Saint Paul. Leslie and Anita, their clinic, was also in Saint Paul. My clinic was in Saint Paul, and then, in fact, I think we're all about, what, less than a 3 mile radius from our previous location sites. I mean, thankfully, we're we do not have a noncompete, and so we were able to we Kind of had our choice where we wanted to stay, but for us, we knew we wanted to stay in Saint Paul because that's where diversity is a really big part of Our desire to care for people, people of diverse socioeconomic status, people of color, of different sexual orientation. So for us, it was Really, the only natural choice for us to be in Saint Paul when our location is perfect because I I think for me, one of the big draws is The covered parking. My my one of our older buildings, and so I was stuck in a cubicle in a basement. And so I I always looked for a better space, and so I have a good sized room with windows. And so for me, personally, as a professional, this really checked off all the boxes of what I needed.

Dr. Shary Vang [00:42:26]:

And I think for us, the 3 of us, it was the perfect amount of safe space to start out. It's a 4 room exam room office with a Tiny little lab space and a a little waiting room, so I think it's perfect for our needs at the moment. And we really like it because we have our own office and our own so that It is only not only our office, but also our exam room in 1 room. And so we kind of have our own little space, and so it's it's perfect for us. Awesome.

Dr. Anita MacDonald [00:42:52]:

That's a good fact. And that we're in Minnesota, so that cover Cover parking. And there's a skyway that goes between the parking garage to the 2nd floor where we're located, so you get to stay inside the whole time.

Dr. Leslie Surbeck [00:43:05]:

But we and we really looked I mean, I mean, I think too, price is a big was a big thing to start out because that is the biggest expense, and we actually looked at a lot of alternative spaces too. We We looked at churches, which I think could have been a really cool thing, but all of them needed a lot of buildout. And so and, actually, there was there was even 1 little house we looked at. It was like

Dr. Anita MacDonald [00:43:33]:

but it

Dr. Leslie Surbeck [00:43:33]:

was just too it would have just been too much, And this was, like, ready to go, really didn't need a lot, was at a good price point, and had covered parking. So

Dr. Anita MacDonald [00:43:46]:

I'm located. Yeah.

Dr. Maryal Concepcion [00:43:48]:

Yeah. Awesome. Having grown up in Sacramento and then going to Omaha, Like, I saw Brian Yang. He's a psychiatrist now. He had his remote start for his car from the window, and I was like, Oh my gosh. The things that they make these days for keeping warm, so I absolutely understand where you guys are coming from. So now when you guys then found your space and you you found that had clinic space enough for each of you to have your own clinic, How do you guys operate the day to day? Do you guys all work every day? Do you set your own hours depending on your patient needs, or do you have set hours per week?

Dr. Anita MacDonald [00:44:24]:

We can set our own. I mean, we have the clinic is technically 9 to 5, Mondays through Friday, but we use Alation and we can just set Our own hours when we're gonna be in the office. So it's it's very I'm here, like, I'm here pretty much. 9 to 5, I think. Sometimes they come in a little bit later, but I always have work to do and I can get it done here better than I can home, and I just love the space too. So I just really like it here. And, but, yeah, I think we all I mean, it's nice. I think we've got a good balance of the Flexibility of the practice group practice in a way.

Dr. Anita MacDonald [00:45:01]:

So there's some things like our pricing is standardized or some decisions we have to all agree on, but we do have the Flexibility to set how many holds I wanna put in my schedule or which days I wanna work or which days I'm gonna work from home or there's I think there is a A a good amount of flexibility, which is important. And with with the technology these days, with these e EHRs, and And we use Elation, Spruce, and Hint. It's it's really great. I mean, with the phone trees we do through Spruce, that also helps So we can easily cover for each other also.

Dr. Maryal Concepcion [00:45:38]:

And, Anita, earlier, you had mentioned that you guys are at the point where you're considering having a VA join your practice. In terms of the things that you guys have evaluated to say, like, yeah. We could totally hire a VA to do x, y, z. What are those tasks that you guys have identified that a VA could help you out with?

Dr. Anita MacDonald [00:45:57]:

Well, I should say I'm the one who's most resistant to it because I'm always like, Online, we can't can't pay someone else because then we will be able to get that amount. And and I'm also not very good at delegating. And I just like To do everything myself because I know it gets done right. And if someone so and it's working for me so far, but I do think Sherry and Leslie are more reasonable about this. And there are things, scanning forms and, I mean, doing referrals. You you all know, Actually, probably better because I just hang on to all these things so much. And I actually do like like, I like all the variety of Paths. That's sort of why I went into family medicine too.

Dr. Anita MacDonald [00:46:38]:

I just love variety. So I don't mind. Like, I do laundry. I sweep the floors. I I just love it. I do I learned how to do the spreadsheet site. I like doing the blood draws and the all of that. But, yeah, I guess they don't necessary like scanning the forms this much for people to look at our scanner, but but I think probably Leslie and Jared can speak more about the different tasks.

Dr. Leslie Surbeck [00:47:02]:

Yeah. I I think it's yeah. A lot of the paperwork, the forms, the communicating with patients about nonmedical things, billing. I mean, we don't bill a lot, but for, like, labs and other procedures or or whatnot, it would be nice to have someone Do all that organizing and do that. I get I get behind on that some, but I agree with Anita. It's, it it's fun to do different tasks. Like, I love the blood drawing and doing the centrifuge and all of that and, like, figuring out the Ethernet in the in the office. So I I do I get that, and I I like it, but I I would probably I would like some help with the forms.

Dr. Leslie Surbeck [00:47:47]:

Definitely. How about you, Sherry?

Dr. Maryal Concepcion [00:47:48]:

Yeah. How about you?

Dr. Shary Vang [00:47:50]:

I think that's true for me too. Like, I mean, for example, like, in our practice, we have a fax inbox. We we use elation for our EMR, and so we have a fax in box. And my day is to deal with the faxes on Monday. Anita has Wednesday, and Leslie has Friday to make sure that someone's touching and sending out the faxes to the appropriate patient charts. And so it's things like that. Right? I mean, yeah, Realistically, it probably only takes less than 10 minutes of my day, but it's just the interruptions throughout the day that make me inefficient as a physician, and so my goal is to try to use my brain where, like, where I can grow the business. And for me, Now that I know how to put faxes in each patient's in like, in the inbox for my colleagues, I want to be able to offload that to someone else to do so that I can Use my brain and my energy where we can grow the practice and not just to sustain the practice.

Dr. Shary Vang [00:48:44]:

And so that's where we're hoping to move this next year is to offload a lot of those tasks that aren't helping us grow the business anymore and finding someone to help us with that.

Dr. Maryal Concepcion [00:48:53]:

I love it. All all season DPC talk there right there, guys. That was amazing. Now when when we talk about EMRs and tech that you guys have chosen, How did you guys decide on your tech? You mentioned that you use Alation, Hint, and Spruce. What how did you guys go from, okay, we've we've been used to the the big box, EMRs to this is the one that we want collectively.

Dr. Leslie Surbeck [00:49:19]:

Well, it is hard to make a decision. I mean, there There's so many, which is awesome. But I remember I think it might have been on your podcast someone making the comment that sometimes it's not The most important thing is not making the best decision, but just making a decision.

Dr. Shary Vang [00:49:36]:

And so I just we

Dr. Leslie Surbeck [00:49:38]:

I had that in my mind because it's like you just You can't re you could research EHRs for months. And so, Anita, you were the one who kind of Spearheaded that, and and that was really helpful because she would kind of looked at a a number of them and, like, looked at the costs and because there are a lot of hidden costs too. To. So one may look like it's cheaper initially, but when you put in the credit card fees and this and that and that and so she sort of did that comparison, but then at some point, we just had to make a a decision.

Dr. Anita MacDonald [00:50:13]:

I think that when we had the demos, it seems like Alation Kind of was looked like reasonable to work with and then they had a great introductory offer. I mean, I think, ultimately, Especially since we were starting out with no patients, I think that was a big part of it. And we also we started out using their The their billing membership management because they had they had started that. And it worked pretty well. It was just when we did get an employer, Hint was So much better and and hence, as a financial person, much easier to extract the information I need to do or bookkeeping every month. So I like I like him for that reason. But, yeah, I think it was. And and frankly, all these resources, it's your podcast, it's the DPC docs Facebook page, DPC women Facebook page, the Atlas' site, the Bagel Check All these the the DPC Frontier, all of these.

Dr. Anita MacDonald [00:51:14]:

And I think the Facebook group probably the most because it's so nice. You can just search on Whatever EHR you're looking at and at the time, there were even somebody who had put made up a spreadsheet Servalization, Atlas, I think acute, and and but, yeah, I think it We had good introductory offerings from from all 3 of those. With Alation, we did learn just for tips for other people. If you Do a contract for a year, you can keep the 2.75 per month pricing for it, but you have to agree to your contract. We pay ours quarterly. Although we're actually looking at possibly switching now to we're looking at, AeroGPC. So

Dr. Maryal Concepcion [00:51:59]:

But you guys are out. Make, Yeah. You're making the decisions as it comes, so that's that's important. And in terms of something else that, Anita, you had brought up was the idea that you guys have a patient assistance fund. And so when in your in your journey did you guys decide that you were going to create that fund, And how how have you funded it?

Dr. Shary Vang [00:52:24]:

I honestly can't remember how we came up with the idea. I know that we had a little bit of money. Yeah. I think For me, again, I think it goes back to kind of, like, what I what really makes my my purpose in being a physician, right, it is to really try to encourage my patients to be healthy and have a healthy lifestyle. And so and I and I really believe in this model, model, and I really believe in its ability to care for people. And so I never for for those patients who want to be a part of my practice, I Our goal was to encourage them to to never have cost b barrier if they wanted to continue with their practice for some reason, and we really wanted to work with their patients, But also to encourage them to seek preventative to to have ongoing preventative health care. So our goal for the patient assistance was to give some, like, scholarship to our patients who needed a little bit of assistance with payment of their monthly membership Just so that we can support each other's physicians too because, I mean, we love giving free care, but we also, at the end of the day, have bills to pay, and so This is a way to help each other. We haven't really used our patient assistance fund for our memberships.

Dr. Shary Vang [00:53:33]:

Most of our patient assistance fund has been used to help pay for PAP smears. We have some skin biopsies for some patients who are uninsured that tend to be a little bit more expensive in the 100, $200 range. So we've Use it for things like that. But as far as sources of funding, I I had a patient who just absolutely loved the care I was giving him, so he whipped out a $100 Bill for a tip, and he's like, put this in your fund. And so we're like, okay. Great. Thanks for that. It's it's come from various sources.

Dr. Shary Vang [00:54:00]:

I mean, I also I also donated to it. I had this little TV, stint that I did, and I got some money from that. So Instead of using it for myself, I said, oh, well, put this money into the fund when we had our open house. We also had a little raffle drawing for some items. My husband has a pickleball business, and so we were we were donating some of that stuff, and people donated money. So it's just little bits here and there. And then I also for grants. We haven't actually received this money yet, but it'll be coming up in December.

Dr. Shary Vang [00:54:34]:

There's a community in mini a coop in Minneapolis that is they select businesses to donate tips for, and so we were selected to be the December recipient. So roughly, we'll They said on average, people get about $1,000, so that'll be going towards our patient assistance fund too. So we're just different ways people can support us for our work and so that we can continue to take care of patients and continue to keep people healthy. And then, oh, and then Anita's mother-in-law also. Yanita can talk a little bit more about that.

Dr. Anita MacDonald [00:55:04]:

My mother-in-law, not only did she she contributed she's an artist, so she contributed to a lot of the art in the clinic, but she also, in her retirement, makes handmade soaps and lotions, lip balm. She makes a lot of different products, but she She we get them at cost from her. And so then we when we sell them, the profit goes to the patient This is fun also. We haven't had a a lot. Christmas time is bigger, and I think we need to promote it more at that time because people really love the products when they try But but we're all kind of uncomfortable selling also. I think that's the other the other issue. Just we're not, I mean, that's part of the thing too. Like, going back to the whole thing about PPC, you have to we didn't go in.

Dr. Anita MacDonald [00:55:49]:

Like, I went to meth because I didn't wanna have to sell anything. Right? Right. And but we do I mean and we do end up selling a a lot just in a everyday practice. You're selling Preventive care, essentially, why I'm trying to encourage people why you should get your your colonoscopy, and that's a form of selling. But But, really, when it's our business, we have to sell this business to a patient, to public, to employers. And so it It's easier to sell it when it's, like, really like, it's our our care. It's a lot of it went to soap or lotion. Yeah.

Dr. Maryal Concepcion [00:56:24]:

And I I'm totally planting a seed, but when I was looking at your guys' website, even a a passive way to to have people have the ability to purchase, especially during Christmas time. If there's a an Etsy store that your mother-in-law has or something like that, it would it would take the the sales many part of it out and allow people to still buy the things and support the assistance one. And On that note, I wanna ask in terms of when a person is benefiting from the assistance fund, Sherry, you mentioned, like, pap smears, skin biopsies. How do you identify those people who could benefit from the assistance?

Dr. Shary Vang [00:57:00]:

That's the beauty of DPC is you Generally know the financial picture for your patients, and so I will offer it when I know I have a patient who's uninsured and who is struggling financially already, and I just take that off the table. And I say, I want you to do a pass mirror. We'll cover that for you. And most of the time, they'll say, oh, thank you so much. And they're usually very grateful. I have a patient who 1 patient who isn't technically included in a patient since that she received a free scholarship for care because she is a patient of mine who is uninsured, and she was in danger of I mean, her electricity had been shut off. So I knew she had a very difficult picture, but she was a new diabetic, and She really needed the care for me, and so I offered to care for her, but I had another patient who, again, really supported our practice and had already told me that he would love to pay more and give more, and so I said, hold on to that, and I'll tap you when I need to, and sure enough, he was willing to pay for a year for this patient. So it's things like that that make you realize and, I think, just remind Me that this is why I went into medicine, and this is why I am now in this sort of model because this is truly a community Service that we give to our patients, but it really is the right way to practice medicine.

Dr. Shary Vang [00:58:21]:

And when I see Patients helping each other out. I mean, this is what we're all about, and so it really invigorates me about our our clinic when when that things like this happen.

Dr. Maryal Concepcion [00:58:33]:

And you don't need a billboard to to make that make people aware of that in your community. So Right. Amazing. Yeah. And then when we talk about the the the fact that you guys opened up in a community that you live in that you wanted to continue practicing in, One of the recent partnerships that you guys have created is a partnership with doctor Michelle Peterson, who's a pediatrician. So can you please share how, Even going beyond the 3 of you, you guys have paired now with a a 4th physician to help your community get the care that they need.

Dr. Leslie Surbeck [00:59:05]:

Yeah. So I think sort of a small world, it we off often joke that Saint Paul is Saint Small because it's everybody knows everybody, and is connected. So I think how she heard about us was through a friend of hers who worked at health partners who did coding. Is that right?

Dr. Shary Vang [00:59:25]:

She

Dr. Anita MacDonald [00:59:25]:

was our coder.

Dr. Shary Vang [00:59:26]:

Yeah. She was our coder.

Dr. Anita MacDonald [00:59:27]:

Home. One of the children.

Dr. Leslie Surbeck [00:59:30]:

And so she heard about us, and she had actually already opened her own direct care practice, But it was mostly doing at home or home visits. So she was traveling, and she focused more on kids with complex needs. And I think I think she opened right before COVID happened and so hadn't grown a ton during COVID. And So she was sort of trying to decide what to do and had decided to, like, expand into just general pediatrics And then also heard about us, and so she kind of approached us. Like, I think or, anyway, just to let us know she was in the in the the neighborhood and all of that. And it so happens that we Anita takes care of 12 and and older. And then Sherry and I are internal medicine, so we do 16, 18, and older. So we Had families who have little kids and wanted direct care, but there aren't that many options.

Dr. Leslie Surbeck [01:00:31]:

And so when she kind of approached us, we're like, oh, this makes Perfect sense to sort of join forces, and we happen to have an extra exam room. And so it just kind of This came together that we would she's not a full, like, partner in the LLC, but She rents from us 2 days a week, and we talk to her or talk to our patients about who have young kids about her and vice versa. Her her Families that that she takes care of, she also lets them know about us for adult care, and so it's just been a really symbiotic relationship, and it's been fun.

Dr. Maryal Concepcion [01:01:08]:

Awesome. And when you mentioned the LLC and just her involvement, I I and I didn't ask this earlier, but when you guys created the clinic together and then now bringing on another physician to help support what you're doing and your patients' families. How does that all work legally in terms of are you guys all co owners of the LLC and then she is a 10.99? How are you guys working together legally?

Dr. Anita MacDonald [01:01:33]:

I think that we are all partners and it's a professional LLC. That's what needs to be here in Minnesota. And, so she's actually just renting. She has her own separate practice, and so she's just renting our room. So and and she has a we have her on our website as a resource, but But it is something that we've thought about if we were to add physician to our group. How would that work? That was one of the more complicated things we had to do when we had to use a lawyer To create the our LLC. And there was a question, LLC, partnership, those legal issues that was all new to us. But that was the most com because that's much more if you're single, a single doctor with your own solo practice, it's much easier.

Dr. Anita MacDonald [01:02:18]:

You can just do that through a website even to create your own LLC. But for 3 people, there are a lot of different contingencies. How do you it's like, We all we all put in a certain amount of money each month. And then we're paid by our own patient payments, Essentially. And then we split our costs otherwise 3 ways, the rest of the operating expenses. And we have to kinda outline All those details and then what to do if someone would wanted to leave the practice, all those things have to be kind of planned out An operating agreement.

Dr. Leslie Surbeck [01:02:52]:

I think if we were to add someone that were was an actual employee, we'd have to work out those details, and we probably That would be something different than having someone join our partnership. But for now, she's really an independent Practitioner who really kind of just is has a relationship with us. And it's nice. It it's It's really nice, but it doesn't like, she takes in her own money, uses her own supplies, pays us for the space she uses, and so we didn't have to get into a lot of thorny details or whatnot. But the 1 I mean, one interesting point In a group practice like ours where we're all coowners, one of the things I think that made it feel more comfortable when we started was that We worked out a way. We each make what we bring in from our own patients. Right? So in that way, it makes it Easy to some degree because it's not as though we have we all have to be paid the same or work the same or if If you wanna work more, you can, and you so that's really been nice because we're a partnership, but we also have a lot of autonomy to work the way we want.

Dr. Maryal Concepcion [01:04:06]:

And as you are highlighting something unique about your setup and how Evergreen is operated, I wanna ask for others who are considering a partnership. What other tips would you have for those people if they're considering a partnership in the near future for DPC?

Dr. Leslie Surbeck [01:04:23]:

I guess if I could go back and do it all over again, I would maybe use I would do more research in what lawyer I would use. You can spend a lot of money on a lawyer. And if they don't really understand DPC, it Can take a lot more time than you would imagine just to sort of explain and and and all of that. And for lawyers, Time is money, so I think that would be one thing. But it's hard in Minnesota that I don't know that there were a lot of there aren't a lot of lawyers that know a lot about DPC. And Keene Atlet or Keene Josh Umber's father was really helpful for us, but he's also not A lawyer in Minnesota doesn't know Minnesota law, so we felt like we needed some help there. So that would be one thing to think about.

Dr. Shary Vang [01:05:15]:

I think for me, it was just more of just making sure that we are all we we share a lot of the similar that we're all Similar, but also unique enough where we weren't going to have big personality clashes. Because, like, as much as we have our own time and space, We also all share a business, and we are also the face of our business. So for us, I think that, for me, that was important, but I think We understood we saw early on that I think we would work well together. And so for me, that was a big piece because Besides my family, they were gonna be a big part of my life.

Dr. Maryal Concepcion [01:05:52]:

You're work sisters. So yeah. Yeah. Absolutely. And, Anita?

Dr. Anita MacDonald [01:05:56]:

Yeah. I think I mean, finding the right people is huge. I would say just, Like, in terms of specifics, we made the decision to to not to just divide up expenses 3 ways and not, like, Where we supply you use or to to not worry too much figuring it all gonna work out in the end because There's always but we keep raising it issues as we grow. Like, okay, are things still fair? Because, like, someone has maybe more patients, They might use more supplies. Is that still fair? Someone's malpractice is less expensive than in others. So we have to keep addressing those issues, but just being open with it. I guess the other big thing we do is we have a meeting every week, business meeting, hour and a half over lunch, Where I think that does help too. It helps us keep just we're dealing with issues as we go that have to get done, but also it's good time to just check-in With each other and making sure it's still going well where we want it to go.

Dr. Anita MacDonald [01:06:59]:

Does anything need to shift? Do we need to do something different? And just being sensitive to to It's gonna be different for all of us. We well, we have different goals too. We also have different financial responsibilities. And so just trying to be really Mind that that we are different in those ways and we wanna be respectful, and we want to switch for all 3 of us. So

Dr. Shary Vang [01:07:21]:

One of the things that the 3 of us figured out eventually because I think with the 3 of us, we're like, okay. When I go on vacation, I'll still manage my own Patients, I'll still address my own calls, and then I think Anita and I went on separate vacations are like, okay. I I I had to tell my husband, Like, you go in with the kids. I'm gonna sit out here. I have a 5 minute phone call with the patient, put in some orders. I'll come in and join you guys. And I was like, they did that day here and there, and I was like, okay. This isn't this isn't the vacation I was envisioning.

Dr. Shary Vang [01:07:52]:

So then just in the last few months, we kinda developed this support system when we're on vacation about, like, we're each gonna give each other a week of support that we will offload all your day to day, your fax inbox, Your any patient calls that I will I I will cover you completely so you can sort of be you can Hang up the the clinic hat for that week and then really enjoy your vacation. So I think that's been really nice, and we wouldn't be able to do that if we didn't have this group practice. So for me as a mom, like, that was great to experience that because I just went on vacation with my family to the Vegas, California time for a week, and I didn't have to worry about my patients because I had my 2 partners who were stepping in to take care of that. So that was that was a game changer for me.

Dr. Anita MacDonald [01:08:40]:

And we that's another one where we're trying to figure it out. So at first, we were like, oh, well, like, do you will we pay each other when we go on vacation? Like, for each person you see, we'll have a certain amount that we would pay each other. And then I think eventually we came to well, And and we'll say everyone gets 2 weeks. Everyone has to take at least 2 weeks completely off, and then we'll cover each other For that, you won't have to do any additional compensation. I think we might need to expand it to more than 2 weeks, but but as long as we're all doing it, and I think that's a Simpler, stress free way to to do it. And, yeah, it makes a big difference.

Dr. Maryal Concepcion [01:09:21]:

And the for the listeners, you might not be able to see it, but the smiles on all their faces is just amazing. And when it comes to potentially adding another physician to your practice or helping the movement grow in Minnesota. How are you guys contributing to direct primary care in your state?

Dr. Leslie Surbeck [01:09:38]:

Well, we are trying to create a kind of association of Minnesota DPC doctors, and so far, we've met Three times, I think, we're trying to meet every quarter, and it's it's been great because it's a chance to see how other people are doing things, share resources, just have some camaraderie. And, also, recently, doctors who are sort of Curious about DPC or thinking about starting a DPC practice have started coming, and so that's a a nice way for them to to sort of meet us and and see what's happening and get some support.

Dr. Anita MacDonald [01:10:16]:

We have a resident coming too. Yeah. Yes. Part of the group.

Dr. Maryal Concepcion [01:10:21]:

Yep. And how do people find out about these meetings? Do they contact you through the website? Do you guys have a website set up for this particular organization or network. We do have a Facebook group.

Dr. Anita MacDonald [01:10:32]:

And Email list.

Dr. Maryal Concepcion [01:10:35]:

Awesome. And, Sherry, for the audience, can you say what the Facebook group is?

Dr. Shary Vang [01:10:40]:

Yeah. If they just look up, MN DPC docs, they should be able to find us.

Dr. Maryal Concepcion [01:10:44]:

Perfect. And I'll include that along with the other resources that you guys have mentioned in your accompanying blog. It's been such a pleasure to speak with you guys and to hear where you have come from and where you are at today and where you're going in the future.

Dr. Shary Vang [01:10:56]:

Thank you. Thank you. It was a pleasure.

Dr. Maryal Concepcion [01:11:04]:

Next week, look forward to hearing from another amazing DVC physician. Now I looked through the stats for the podcast since it started, and the data is beyond incredible. MyDBC story is ranked In the top 0.15% of all podcasts on the globe. Yes. The globe. Every single month over the Last 2 seasons, we are ranking in the top 250 of the Apple Podcast Medicine chart every month as well. If you would like to join us in helping spread the word DPC, consider sponsoring the work we're doing. Go to the sponsorship tab at mydpcstory.com or check out the link in the show notes.


Dr. Maryal Concepcion [01:11:39]:

Now to our listeners, thank Thank you so much for helping more and more people find the pod by sharing the word about DPC. To our guests, thank you so much for sharing your stories. If you are looking to be a guest next season, apply on the contact page at my dpcstory.com. There, you'll also find DPC swag, Past episodes, resources, and more. And as always, if you're looking to read more about DPC on the daily, check out dpcnews.com. Until next week, this is Mariel Concepcion.

*Transcript generated by AI so please forgive errors.

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