Leaving Corporate Medicine for DPC: How Dr. Jeremiah Fillo Rebuilt a Sustainable Family Medicine Career

Dr. Jeremiah Fillo of Big Trees MD

What happens to a family physician when the system he trained inside of decides he no longer has value?

That is the question at the center of one of the most personal episodes of the My DPC Story podcast. Host Dr. Maryal Concepcion stepped away from her usual introduction and turned the microphone over to a very special guest before sitting down with her husband, Dr. Jeremiah Fillo of Big Trees MD in Arnold, California. What followed was an honest conversation about sustainability, not only as a doctor, but as a whole person with a family, a community, and a sense of self worth that no corporation gets to define.

If you have ever felt like a charge sheet instead of a clinician, this one is for you.

What Sustainability Really Means for a Family Physician

Most conversations about physician sustainability stop at the paycheck. Dr. Fillo pushes the definition further. For him, a sustainable career has to support the whole person: time with his two young sons, a daily routine that works, autonomy over his schedule, and a voice in how he practices medicine.

His advice to any physician trying to last in this profession is simple and worth writing down. Keep track of the core priorities that have to be met for you to be sustainable and happy, and do not settle for something that does not fit. You may not find the right situation right away. That does not mean you stop looking.

The Slow Boil of Corporate Medicine

Dr. Fillo describes his corporate experience the way you might describe a frog placed in a pot of water with the heat turned up slowly. At first the autonomy is real. The relationships with patients are personable. There is salary instead of relative value units, and there is room to actually practice medicine.

Then the water heats up. The salary turns into RVUs. The visit times shrink. The pressure to add codes after clinic grows. None of it, as Dr. Fillo points out, has anything to do with patient care. The focus had moved to reimbursement.

The breaking point came in the form of an evergreen contract with non-negotiable rates, an exclusivity clause, and an ultimatum to sign or be terminated. His wife was pregnant at the time. That was the moment he started looking for the exit.

Replaced by a Non-Physician Model

Eventually the corporation made the decision for him. They chose to keep the clinic open without him, moving to a non-physician model and keeping the nurse practitioner instead.

Dr. Fillo is candid about how that landed. His first response was that his value was gone. He had come out of a routine that let him be present for his boys and his wife while earning a living wage, and all of it disappeared at once.

For physicians in California, his story connects directly to the AB 890 reality and the larger trend of communities losing access to fully trained family physicians. It is a pattern that is becoming familiar across rural medicine, and it is exactly the kind of devaluation that drives so many physicians to look at independent practice.

Rebuilding Self Worth After Being Pushed Out

The most useful part of this episode may be what Dr. Fillo did with the months of uncertainty that followed.

He did not let the system define him. When the ruminations got heavy, he stepped away from the work focus and put his attention on what he still had: his home, his family, and his kids. He coached soccer. He went into the national forest to collect and split firewood for the coming winter, with the proper permits, so his family would have heat. Doing things with his hands, completely unrelated to medicine, reminded him that there were many parts of his life worth his time.

His message to any physician who has been devalued and tossed aside is direct. The system does not decide your worth. If you are worthless to them, they are not worth your time. Keep your eyes open, because there are always other options.

Finding Direct Primary Care and Quieting the Referralologist

When Dr. Fillo eventually joined the Direct Primary Care practice at Big Trees MD, he had to unlearn some of his corporate training. He calls it tamping down his "referralologist" reflex. In fee-for-service, the knee-jerk reaction was to refer. In DPC, with real time and a fuller tech stack, he could pause and ask whether this was something he could handle himself first.

That does not mean he never refers. Plenty stays outside his scope, and the referral gets billed to the patient's insurance the same way it would in fee-for-service. The difference is that he can do more workup before he gets there. Direct Primary Care gave him room to let his training breathe again.

Why DPC Works for Physician Parents

For a physician raising two boys under ten, the flexibility of Direct Primary Care is not a perk. It is a requirement.

Dr. Fillo describes a typical day where he confirms an in-office visit with a patient, then gets a call that one of his sons has a split head at school. He reschedules the patient by an hour, the patient agrees, the family gets cared for, and the day keeps moving. The corporate world had no room for that kind of life. DPC, paired with asynchronous telemedicine as a side income, lets him get the work done and get paid without choosing between his career and his family.

What This Means for Rural Communities

Dr. Fillo is blunt about what happens to a community when physicians are treated as disposable. It is not sustainable. When you push out physicians for a non-physician model, cut hours to three days a week, and make patients wait weeks for an appointment, you are offering a resource that is drying up.

Patients are paying into insurance and getting no local care in return. They end up driving thirty, forty, or fifty minutes to an emergency room for problems a fully trained family physician could have handled. The episode also calls out the access barriers rural practices face, including a national laboratory company that declined to extend courier service to the community for being "too rural."

Listen to the Full Episode

This conversation covers job share as the foundation of a two-physician marriage, the gaps in residency training around independent practice, the reality of building self worth after a layoff, and the day-to-day of running a sustainable DPC practice. It is honest, it is occasionally very funny, and it is a reminder that there is real life after fee-for-service.

Subscribe to the My DPC Story podcast wherever you listen, and share this episode with a physician who needs to hear that the system does not get to decide their worth.

Have a question or a story of your own? Call the My DPC Story voicemail and you may hear your answer on a future episode.

Frequently Asked Questions

What is Direct Primary Care? Direct Primary Care is a model where a patient pays a low monthly membership directly to their physician and, in return, builds a lasting relationship and has their physician available when they need them. It removes insurance from the primary care relationship while patients keep insurance for everything outside of primary care.

Does DPC reduce the physician workforce? This is a common concern. As Dr. Fillo notes in the episode, when physicians are happy and able to serve their communities, more family physicians are practicing, not fewer. A sustainable model keeps doctors in medicine.

Can a physician join an established DPC practice instead of building one? Yes. Dr. Fillo joined a practice he did not build from scratch. In the episode he talks about working with an existing tech stack and keeping an open line of communication with his practice partner about what to adjust over time.