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Navigating the Uncharted Territories of Pediatric Direct Primary Care: A Conversation with Dr. Nitin Gupta

Direct Primary Care Doctor


Dr. Nitin Gupta of Rivertown Pediatrics
Dr. Nitin Gupta

In the ever-evolving landscape of healthcare, the relationship between physicians and their patients is at the core of medicine. In a recent episode of "My DPC Story Podcast," Dr. Maryal Concepcion sits down with Dr. Nitin Gupta, a board-certified general pediatrician and the founder of Rivertowns Pediatrics, to delve into the intricacies, challenges, and triumphs of pediatric direct primary care (DPC). Their conversation unravels Dr. Gupta's remarkable journey, from his early experience in medicine to his establishment of a patient-focused DPC practice. Let's explore the insights, revelations, and pivotal moments that have shaped Dr. Gupta's path in pediatric care.


Cultural Disillusionment and the Pursuit of Compassionate Care:

Dr. Gupta's journey into the field of medicine has been a testament to the transformative power of compassion. His early rotations in internal medicine were marked by a sense of disillusionment with the prevailing culture. However, it was through the lens of pediatrics that Dr. Gupta found his calling, steering his career trajectory towards a path defined by empathy, dedication, and patient-centered care. His experiences in Grenada during medical school, where he witnessed firsthand the compassionate care provided by doctors, became a pivotal inspiration that fueled his unwavering commitment to prioritize the well-being of his young patients.




Cultural Influences and Career Choices:

Dr. Gupta's journey also reflects the importance of cultural influences in shaping career choices. He candidly discusses the societal expectations and pressures inherent in his cultural background, shedding light on the nuanced interplay between personal aspirations and familial influences. This illuminates the wider discourse on the multifaceted elements that underpin a practitioner's journey in the medical profession.


Transplanting Compassion: From Grenada to New York:

The juxtaposition of Dr. Gupta's experiences in Grenada and the United States illuminates a profound narrative of transitioning from an environment steeped in patient-centric care to one characterized by the complexities of urban healthcare. His relocation to New York, driven by aspirations for professional growth alongside his wife, heralded an era of adaptation and bridging cultural disparities in medical practices. The challenges he faced in Brooklyn underscore the critical role of empathy and tailored care in addressing the diverse needs of patients within differing healthcare contexts.


Navigating the Residency Landscape: A Quest for Compassionate Education:

As Dr. Gupta unravels the intricacies of the residency application process and his eventual match at UMDNJ in Newark, his narrative unveils the profound impact of compassionate education. His journey stands as a testament to the transformative power of medical training that espouses holistic care, empathy, and patient advocacy – values that serve as the bedrock of his subsequent endeavors in pediatric DPC.


Dr. Nitin Gupta's profound journey serves as a compelling testament to the enduring power of compassion, dedication, and commitment within the realm of pediatric care. As the landscape of healthcare continues to evolve, his story resonates as a poignant reminder of the undaunted resolve required to navigate the uncharted territories of direct primary care. Through his unwavering pursuit of patient-focused care, Dr. Gupta's odyssey encapsulates the ethos that propels pediatric medicine towards a future defined by compassion, excellence, and resilience.

The comprehensive exploration of Dr. Gupta's journey brings to light the multifaceted factors that shape a physician's path, underscoring the pivotal role of cultural influences, transformative experiences, and compassionate education within the realm of pediatric direct primary care.


 

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BIOGRAPHY:

Nitin Gupta, M.D., F.A.A.P, is a board-certified general pediatrician who has a passion for delivering the best possible care for your child. After earning a bachelor’s degree in Nutritional Sciences: Physiology and Metabolism from the University of California at Berkeley, he graduated from St. George’s University School of Medicine and completed his residency in pediatrics at the University of Medicine and Dentistry of New Jersey-New Jersey Medical School. He also trained at Weill Cornell Medical College in Pediatric Gastroenterology and Nutrition.


Dr. Gupta’s adventurous career spans from working in the inner cities of New York and New Jersey to the far reaches of rural Maine. He has spent years working in the Emergency Department at The Brooklyn Hospital Center and in Urgent Care at PM Pediatrics. He enjoys teaching and even filmed a pilot episode for a medical talk show!


Originally from California, Dr. Gupta and his wife moved to Dobbs Ferry with their two young children, where they enjoy taking advantage of the great outdoors. In his free time, Dr. Gupta can be found hiking the trails of Westchester County, walking his dog through town, or paddle-boarding on the Hudson River. Dr. Gupta is also an active member of Rivertowns Rotary whose motto is “Service Above Self.”


MEET Dr. Gupta at the

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HEAR what the Pediatric DPC Mastermind is all about in this conversation with Dr. Deanna Barry!




LINKS/RECOMMENDED RESOURCES:

For the LATEST in DPC News: DPCNEWS.com

Rivertowns Pediatrics Website: HERE


CONTACT:

Address: 18 Ashford Ave, Suite 3W Dobbs Ferry, NY 10522

Phone: 914-330-8445

Fax: 914-330-8446

Email: info@rivertownspeds.com


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Transcript*


Direct Primary care is an innovative alternative path to insurance driven healthcare. Typically, a patient pays their doctor a low monthly membership and in return builds a lasting relationship with their doctor and has their doctor available at their fingertips. Welcome to the My DPC Story podcast, where each week you will hear the ever so relatable stories shared by physicians who have chosen.


Into practice medicine in their individual communities through the direct primary care model. I'm your host, Marielle conception family physician, D P C, owner, and former fee for service. Doctor, I hope you enjoy today's episode and come away feeling inspired about the future of patient care direct primary care.


Direct primary care is the way medicine is supposed to be practiced. I am Dr. Ni Gupta of River Towns Pediatrics, and this is my D P C story.


Dr. Nitin Gupta, MD F A P is a board certified general pediatrician who has a passion for delivering the best possible care for all children. He cares for. Okay. After earning a bachelor's degree in nutritional sciences, physiology and Metabolism from the University of California at Berkeley, he graduated from St. George's University School of Medicine and completed his residency in pediatrics at the University of Medicine and Dentistry of New Jersey, New Jersey Medical School. He also trained at will Cornell Medical College in pediatric gastroenterology and nutrition. Dr. Gupta's adventurous career spans from working in the inner cities of New York and New Jersey to the far reaches of rural Maine.


He has spent years working in the emergency department at the Brooklyn Hospital Center and Urgent Care at PM Pediatrics. He enjoys teaching and even filmed a pilot episode for a medical talk show originally from California. Dr. Gupta and his wife moved to Dobbs Ferry with their two young children where they enjoy taking advantage of the great outdoors.


In his free time, Dr. Gupta can be found hiking the trails of Westchester County, walking his dog through town, or paddle boarding on the Hudson River. Dr. Gupta is also an active member of River Towns Rotary, whose motto is service above self.


Welcome to the podcast, Dr. Gupta.


Thank you for having me.


This is such a treat. Oh my goodness. So, uh, just for the audience to know, we've been texting this morning, you know, a few hours before, but it's like mm-hmm. I was up at 6:00 AM reading car's book with Mike Car's Spring. Yeah.


I was wondering why you were, cause I'm on the East Coast and, and I got a text from you at 8:00 AM actually.


Yeah. And I was just like, what is, what is she doing at five? That, that was, that was when my two year old woke up and then an hour later was when he wanted to read about Radiator Springs. So I am ready, I'm so ready for an adult conversation. This is so good. So I got the pleasure of meeting you recently at the pediatric D P C Mastermind, the very first one.


And I'm so looking forward to another one. But, you know, I think that it is so interesting. One of the, one of the things I, I found most interesting was that at that pediatric D P C Mastermind, there was still. Oh, you can do peds in D P C. Like, that's amazing. And so you've been open years and years and years already.


And you know, you're up there telling your story and looking around the audience as is common at conferences about D P C, we still see people's chins on the table, like completely gaping mouths. Like, this is real. This is not a magic unicorn piece of like style, style of medicine. So with that thread that like, you are not a unicorn, you are a real person.


Yes. Can you, can you bring us back to what was your life like as you were choosing to become a pediatrician before River Town's Pediatrics opened? I love it. Okay, so the, the backstory, this, uh, the origin story is many of us pediatricians, you know, we're all fans of, like comic books, or at least, at least the people I surround myself with.


Okay. So the, the backstory, you know what I, I, I come from a, you know, an immigrant family from India. My parents, my dad was a, a generational engineer, so basically his dad was an engineer. All of his brothers were engineers and dad before that were engineers. So naturally he came over to the US to, you know, as an engineer.


Uh, in the early, in 1970, as you know, we talked, uh, I was actually born and raised in the San Francisco Bay area. My dad was an earthquake and structural engineer. So of course California is, you know, where, where we settled When I was six years old, my dad had a heart attack. And so that kind of, I, I think right there was kind of my moment where I questioned my dad's mortality.


Not even, not question my dad's mortality. I realized my dad was mortal. And that's something six year olds don't necessarily understand, you know? So that was, that was a tough experience for me. But that was probably that moment where I realized I'm going down the path of becoming a doctor much to my father's dismay.


So you just ruined that generational line there, man. I did. I did. You know, I was supposed to be an engineer. My, my, and my dad had a really good point. He was like, why would you wanna be a doctor? Uh, you're gonna spend all these years going to school, all these years, going to medical school, then training, and then you're not gonna start your life a, according to him, uh, uh, that generation of Indians.


You don't start your life until you get married, you know, or, and have kids. So he was like, you're not gonna be, you know, you're not gonna be able to start your life or have kids until you're in your thirties. Well, I guess he was right. Yeah. I guess like my first real paycheck really didn't come until like, I was like 32, I think, as an attending.


Uh, so yeah, there, there were many times where I thought, damn, why didn't I listen to him? But, uh, you know, it was, it. I knew I was gonna be a doctor. I really got into nutrition, uh, because that, uh, uh, that was a, a major thing. My dad was a diabetic and he had a heart attack. Uh, he was only 35 when he had his heart attack.


So nutrition was a major. Major factor in his disease control, but also in our lifestyle at home. So that's, uh, knowing that, uh, that we actually, at that time, and I don't know if things have changed, but nutrition education in medical school was only a thing two weeks long. That was the case for me and my medical school.


So knowing that I studied nutrition, physiology, and metabolism at uc, Berkeley, that was my undergrad. And then from there, and I was a pre-med right from the, uh, from the start knowing, knowing I was gonna, uh, go down that path, people were thinking, people always questioned me at that time saying like, how's nutrition gonna help you as a doctor?


Amazing. It's just amazing. Now, now with what we know now, you know, that's crazy. Now people are realizing. Yeah, I, I guess that may be as I, I guess that kind of tells you how old I am, I guess. But I mean, that was only like, what, 20 years ago? Wait, 30 years ago when I declared I was gonna, Going to nutrition and, uh, use, uh, apply that.


But, uh, now, now, you know, people understand. Um, that's good. Uh, it wasn't until medical school that I realized I was gonna go into pediatrics, and I've always been a kid at heart. And, you know, there, my first rotation in med, uh, uh, as a third year was internal medicine. And, oh, I just, I really, I, I didn't, didn't like it.


Not that I didn't like the medicine part, I didn't like the culture of internal medicine there, there didn't seem to be the kind of care that I thought physicians should have. Now, I don't know if it was because physicians were burnt out already at that time, but, you know, amongst the nurses, the physicians, there was always already a dur, a a level of care that I just didn't think was right.


When I say care, not, I'm not talking about like putting in orders and, you know, getting vitals and all that. I'm just talking about like human care, like for the, and that's, that's the thing. It was just like, I, I just didn't see that. And then my next rotation was surgery and, uh ooh. Now, now that, listen, there are very fine intern internists out there and surgeons out there, but in that environment I was at, I mean, this was just a different beast of people.


And I, maybe that was the medical culture at that time. I don't know. But my third rotation was pediatrics and that's where I knew I was home. You know, all of the attendings, the residents, the nurses, all the staff, they all did 110% of what they needed to do for those kids. And I think that definitely reflects in medicine in general.


You know, if you look at kind of the morbidities and mortality of diseases, our kids sure. It's, it's easy to say like, kids don't get as sick. And sure that that can be, sure, I'll give you that, but let's also not forget that pediatricians also bust their butt off to make sure that that kid is not going to die.

Be harmed. You know, we, we, we are the masters of preventative medicine. That's, that's our domain here. Uh, so that's how I got into pediatrics. And I think, uh, my, uh, uh, uh, you know, even, uh, until my graduation day of medical school, my dad was like, you know, there's still time.


It just makes me think of, uh, when I was talking with Dr. Katie Lou, how, you know, she comes from an Asian background and I'm Filipino, and with you being Indian, it's just like, you know, I, I, I feel this is very cultural. Like I can absolutely empathize with the, the, the subtle, you know, passive aggressiveness of our parents sometimes. Oh my goodness.


Well, what's funny is like, there's like almost like, I guess with my dad's generation, a tribalism on of like, we're the engineers, and you know what, the people who became doctors were the ones who couldn't do math.


So it was like a slap in the face. I brought shame to the whole family, but, but if you look on like every doctor in media, like. Tv. Like there's at least three different Dr. Gupta at tv. So it's like, I was like, I, you know, look, there must be other members of our family who went into medicine that, that's beside way.


Um, so, so I, I, I, I, you know, so after I graduated, uh, from uc, Berkeley, I was applying, uh, applying to medical schools. So at that time, I think it was like, maybe, I don't know, it was super competitive. I think it may still be, I don't know if it's still the same, but it was super competitive. So of course I didn't get it.


Uh, so I tried to, you know, I was gonna apply again the next year. Uh, I dabbled around in other things, other industries too. Uh, at one point I worked for a bank doing home loans. Uh, that was, that was before the runup of, uh, 2008.


And proof that you have math skills. Great job there. There we go. Exactly. Uh, but, uh, you know, I, I, I, you know, getting depressed and like, I'm like kind of, you know, could I make a career, uh, working outta uh, that community bank?


Actually, I probably could have, but I wasn't feeling it. Uh, you know, so of course I'm getting depressed and wondering what are my options? What if I don't get into a medical school the next year? You know, cuz the application process takes like, I think like a year or two, it's horrendous. Uh, then I've met some folks who went to St. George's University of Medical School in Grenada and they were doing very well and you know, they got residencies and they're great doctors. So I went. So that was it, an amazing experience. And I think having that experience really did, uh, plant that seed for this practice. Rivertown, SPEDs, because in that country, uh, doctors made house calls.


Doctors were available. There was no such thing as like health insurance. Uh, you know, so if a patient couldn't afford the, the doctor's fees, the doctor just said, don't worry, just save your money for the medicine and uh, I'll just go charge the rich dude. I'm gonna go see next. That's literally what one of my attendings told us.


So told me that's how he, that's how he made a living, you know? And it was, if you think about it, that's a very socialized medicine type thing, but it was on the terms of the patients and the doctor. It wasn't dictated by somebody else. Uh, so just seeing that level of care and compassion that the doctors had in Grenada for those patients really planted that seed.


And so let me ask you though, though, when you talk about these home visits, how long were these home visits? Like were the doctors pushed to see a certain number per day?


No, no, nobody was, no, the doctor was his own boss. So it was basically who, uh, you know, it was the patient if they called the office and, you know, he just went and made his rounds and, uh, it wasn't, you know, uh, but for them it was a, it was technically, it was basically a fee for service.

And so, you know, if a patient called, then he went and saw them. Uh, if it was an elderly person, he went and saw them. If they could come to his office, you know, he asked them to come to his office. Um, and that's how it worked. It just, it just worked for his village in his community, uh, and seeing that firsthand really re and it wasn't just in Grenada.


That, you know, that kind of care is providing India too in many countries across the Absolutely.


My, my, my dad sat in the neurologist line, like outside of the neurologist's office. Yeah. And it was like, you will be seen after the person in front of you is finished seeing the doctor. There was no appointment time, so absolutely.


Yeah. But, uh, you know, the, the care was given. He wasn't rushed. Uh, and I saw that a couple times. Uh, we also did a few rotations in the island of St. Vincent's, same thing. And then we did our third and fourth year, uh, rotations in, in the us. Uh, so you go from something, you, you go from witnessing doctors who are active leaders and compassion in their community.


To like Brooklyn, you know, like, not saying that there's no compassion in Brooklyn, but you know, it's a, um, yeah, I, the reason why, you know, I got married in, in the middle of medical school to my wife. She was in finance. Uh, we didn't wanna be in California cuz uh, uh, like we just, you know, she's also an Indian American.


Her family's from Southern California. My family's Northern California. Just watching, and I'm sure this is, this expands all cultures, uh, all, all imi immigrant cultures. You know, the drama that happens after a, any p any person gets married. So we are just like, you know what, we're just gonna move across the country.


So that was it. That's how we ended up in New York. My wife. Uh, basically, uh, moved her job over to New York City and I was able to do the bulk of my rotations, actually all of my rotations in New York, in Brooklyn, New Jersey. And that's, that's how we ended up. And of course, I played for residencies, tried to get, uh, tried to get back home to California.


That didn't work. Uh, matched at U M D and J in Newark. An insanely incredible experience. I mean, like, it was just a, you know, we saw, I, I, I think I was trained by some of the best diagnosticians in, in pediatrics and, you know, the experiences. I, I don't know if anybody else can reproduce those experiences that I saw.


Uh, it was definitely hard. It was a very hard residency, but I guess it toughened me up. Uh, then I did a fellowship at, at Cornell in gi cuz I really, really wanted to apply my nutrition. Uh, cause I thought like, well, you know, proper nutrition will help prevent constipation, blah blah blah. Uh, so I did two years.


I did two outta three years of pediatric GI fellowship. I absolutely hated it. Zza you cannot practice pediatric nutrition. Like that does not, there's no job opportunities for that. There was no hope in sight. It was either gonna be, you know, you know, as a general pediatrician, pediatric gastroenterologist, you know, it's like 95% of what you're gonna see is reflux and constipation and that's it.


Yep. That was not for me. You really have to have a certain passion to manage constipation day in, day out. That I, I did not have that passion. Uh, also the thing was, I moonlighted in the ER cuz I just needed, I needed a asthmatic, I needed an ear infection. Oh my gosh. I needed diversity in, in what I saw. Uh, so I guess, uh, I just knew I was just a generalist.


I actually, by the time my third, my third year of residency was up, I, I was actually kind of sad I was going in into the fellowship, but you know, I basically applied for that fellowship my first year of residency.


I can believe that easily. I mean, just peds fellowships in general, they are very, very hard to get into.


I mean, well, I think about my roommate in college. She is one of the best surgeons and one of the best people I've ever known roommate in medical school, and she is. Still applying for ped surg fellowship because the demands that are on the fellows and then the research that is needed to be able to be accepted into the fellowship that she's going for.


Mm-hmm. It, it's, it's quite challenging. And so, um, that's interesting. She's going for ped surge fellow. The, the, the, she is, you know, the sad thing is the fact that she's gonna go, she's gonna go do a pediatric pediatric fellowship. She's gonna take a massive pay cut in her, in her compensation potential. Oh, for sure.


And I mean, we think about the people who didn't go to med school who after undergraduate went to Genentech, in my case, like a ton of people went to Genentech and it was like, they have mortgages, my gosh. And homes and 401ks, and we're like, um, yeah, we're paying a medical school to go get education, to take care of other people.


And it's a lot of money when you, uh, think about it at the end of four years of training and then you make, you know, you work 80 hours a week and you make 47, 50 $2,000 a year. So it, it is a definitely dedication for, you know, and it's not for everyone. Yeah. Let me ask you though. Yeah. When you said that you completed two out of your three years of Yeah.


Fellowship and then left, it makes me think of, you know, Dr. Janet Nabas, who's. Near you. Yeah. She moved off of Broadway, but she was a surgeon before she left to go to family medicine. What was your experience like, you know, internally when you were like, I literally am a two out of three year fellow. Like, how can I leave?


Because I think about people. Yeah. Dang. So, um, because of, you know, shame or guilt or whatever. So what was going on in your head?


So what was going on in my head was during the whole time in fellowship and even towards the end of my residency, my dad was dying. So, uh, you know, these are the repercussions from having a heart attack at 35, you know, and diabetes for, for three decades.


And so he was having multiple TIAs and uh, got to the point where he wasn't able to walk. He had massive demen, like terrible dementia. And so I basically left home at 18, right? Then whatever it took to get to medical school, then residency, there's basically a void in everything. I missed that much my dad's life.


And then I find out my dad is dying and has only a few years to live, or a few months by the time. So I, I was trying to go every weekend, flying back to California to go see him, help out my mom, uh, who was getting hospitalized left and right. I was miserable in my GI fellowship because like, look, I shouldn't have been there.


I really should have been. I, you know, I was very satisfied with, I loved general pediatrics. From day one, I realized crap, I am not into constipation as much as I'm trying to will myself into. And so in my second year that my dad's like, why are you there? Like, you're not happy. And this was during his lucid moments.


And he is, he is like, you know, that's just extra credit. You already did your fellow, your residency, like, why aren't you practicing? And it kind of got to me and I kept remembering that. And then finally, after running out of p t o days, p t o hours, whatever, no more vacation days, no more sick days, because I kept flying back and, uh, forth.


I said, you know, forget, I'm just quitting. Like, there's just no point. Like, I, I, I probably wasn't even gonna be like, would I have even practiced if I finished? Like, there was just, why not? Let me just quit. I spent basically, what would've been my, you know, six months, the next six months. By my dad's side, and he passed away and I have zero regrets.


Then it took the next couple months, uh, to help take care of my mom, get the family's finances in order, and from there, you know, because I did hate kind of every day working in my fellowship. The, I did see a lot of the ugliness of medicine in New York City. I didn't even know if I was gonna, even, did I even want to go back to medicine?


You know, there, you know, there, at that time there was a lot of hedge fund opportunities to go work for, you know, there's a lot of questions in my mind if I even wanted to continue, just because seeing how also the way my dad died, how my dad was dying. It was just, you see the ugliness of kind of end of life care, the limitations of kind of, you know, chronic illnesses, how, uh, medic medical system kind of helps those people or doesn't help.


Absolutely. And so I was, I was disgusted by medicine in general. But uh, the funny thing is, while I was at home, um, kind of with my dad in his last days and with my mom, there was this like locums company that had talked to me. And there was this hospital up in Northern Maine, in Caribou, Maine, where the C E o I, they were clearly desperate.


They needed help. And, uh, you know, like I, I, this locums my locums agent, I was like, yeah, fine, fine. He get, he just called me outta the blue. I was like, okay, cool. You know, I'll entertain. He's like, yeah, we can get you, you know, a position. You could work temporary all over the country. I was like, sure. I was like, that sounds good.


I sent him all my stuff and then he's like, Hey, Dr. Gupta, I got a great, a great opportunity up in Caribou, Maine. I was like, Maine, uh, that sounds cool. That's where Stephen King's from. But I wasn't serious about it. I was like, lemme just explore the op the idea. And I had a telephone interview with the c e o and this was like in August of 2011, and I just kind of kept in touch with them.


I said, you know, I'm not, I'm not ready yet. Uh, my dad is sick. I'm not ready. Anyways, after my dad died, my dad died in October, uh, October 3rd at 2011. The c e o called me October 4th. He's like, I just wanted to check in. I wanna see how your dad's doing. And I was like, well, he, he died. I'm like, oh, I'm so sorry.


And he just, he was just very compassionate. Sent flowers. And I was like, right there. I was like, you know what? I'm going to Northern Maine. That's how it happened. Oh man. Yeah. January 3rd to March 3rd, I was up in Caribou, Maine. That was like the, the dead of winter up there. I had never been so cold ever in my life.



It's just crazy cuz I think about you growing up in California. Yeah. And then going down to like Grenada and St. Vincent. Yeah. Yeah. And then going to Caribou Main, like you've pushed the limits with regards to Yeah. You know, temperature, what you can Yeah. Temperature and, and practicing in all those situations.

Cuz the patients are totally different in those situations too. Like, you know, I, so the patients, yeah.

I remember, I, I'm a student of culture, you know, I do like to explore, I like to see the different cultures. I think one thing I, the reason why I struggled training in New York and the New York metropolitan area was there was a lack of compassion.


Now people are gonna deny it and be like, no, we're very passionate. No, no, we aren't. We're New Yorkers. Uh, and in training, I mean, training programs are malignant. That's what residency and civil fellowships are. They're malignant and you know, they, they really should be HR nightmares. And I'm surprised there aren't more lawsuits amongst these things.


But I, you know, being, doing all my training in New York, in the New York metropolitan area, you know, I didn't see the compassion I saw in the Caribbean, and I thought, this is how medicine is like, oh, you know, New York is a. Supposed to be the mecca of everything, and it's like, oh, well this is how medicine is.


So anyways, I went up there to Caribou, Maine, and it was so, it reminded me the compassion was there. That was the thing. The neighbors, I, I had this at that time, she was a 70 year old nurse named Sandy, and she just knew the history of everybody she knew. You know, she, a busy day was 12 patients a day over there.


And Sandy would gimme like a 30 minute briefing on every patient that was coming a ahead of time and to tell me the whole history. And, you know, everybody knew each other. There, there, there were stories of like one neighbor going into labor and there's a massive blizzard. So somebody from the hospital went and a snow sled picked her up, brought her in.


Same thing, they, another slow snow sled went and got the ob, g n brought them in. You know, these were just things that the, and, and this wasn't like, they weren't paid to do the this, they were just. They're, yep. These are their, this is their community, their neighbors, their family. Uh, uh, you know, the, the briefing that Sandy would give me every time I saw before every patient, you know, there were subtle things like, um, Hey, you know, this family, they have dirt floors.


I was like, really? I. Dirt floors in this winter. She's like, yeah, they're basically, you know, she's like, yeah, they're poor. And I say, oh, how did they get here? Because they came from another, like a village, like 30 minutes away. Oh, they borrowed a friend's car and the friend brought the, the neighbor brought them over.


But what that told me was like, well, that, that visit that I was gonna see, that was the visit. They, they pulled so many strings and did so much tr to get to that appointment. So that meant it wasn't gonna be, I wasn't gonna talk about one single ICD 10 code or ICD nine at that time code. I think that coding is, is one of those kind of, kind of led to our, uh, kind of our, our decrease in compassion where we have to, every kid, every patient has to be classified as a single ICD 10 code.


But I had to address everything. That's what that told me. And I didn't care if there, and basically it didn't matter if we were getting paid for multiple ICD 10 codes. It was, we had to address everything. And go into the sample closet, fill up that SA supplies, give it to that kid. But that's, that renewed my passion for medicine, for pediatrics.


That's awesome. And when you were in Maine just for a locums, and you said you left in March, what was with this renewal of your passion in general peds, what drove you to find other jobs after that? Before river Towns?


It was terrible. My wife, my wife, you know, her, her, she wasn't gonna move, right? So like, uh, she, her career is taken off.


So I basically just kind of bounced from job to job. And again, it's a difference in culture and of, of the medical culture, of the patient culture. Let's also save patient culture too. So I worked, I I, right after Maine, I, I took a, uh, GenEds job, outpatient GenEds job in Astoria. And that area, that neighborhood was.


You know, there was a lot of anti-vaxxers, there was a lot of like vaccine space. The, the VA air quotes, I'm saying vaccine spacers. They're, they're, they're the geno, anti-vaxxers, I guess. They're the ones who were like, no, we believe in vaccines, just not right now. I was like, so when? Well never, but we believe in them.


I was like, okay. I couldn't deal with that. And there was a, there was a, so the, the doctor I worked for, he was amazing, very passionate. He started the practice like 40 years prior, but cultures changed, ideology changed, and so he was kind of getting pushed around by the patients. I lasted three months in that job.


I say, you know what? Screw that. Nobody cares about preventative medicine. Then you know what, I'm gonna go back to the er. And so I worked, I started working in ER again. Because I felt like there was no credit for like being the general pediatrician, being preventative, let's go to the er, those guys get the credit.


So I worked for five years at one of the hospitals that I did my rotations in an amazing experience there. But you know, towards the last two years, that experience, you really saw administrations kind of move in, take a heavier hand in how things were run. They stripped up as they stripped our er of our nurse.


They limited our access to the medications. And it was kind of like, well, you know, like, what the hell? Like, how are we supposed to, you know, attend an emergency if we, if you're taking our tools away, our, our support away. But, you know, pixels not working.


That's, that was my favorite in the er. The pics not working.


Yeah. I can't, yeah. Just oh, just overhead page. The, uh, pharmacist. I was like, really the one pharmacist for the whole hospital. He wants us to overhead page and he is gonna drop everything and come running down. But you know, this was the cost cutting. Do, uh, you know, it's, it's lean man, lean operations, right?


This is, uh, you know, I'm all for capitalism. Cool. But like not in a hospital setting. Uh, it's okay to have some redundancy. It's okay to have some glut in certain areas because you have to be prepared. For those emergencies that are gonna come. So it, it, you know, it was getting harder and harder. And uh, you know, I think what kind of set that off was there was a hospital, uh, kind of, uh, a few miles away that basically got sold to private equity and it got turned into luxury condos.


So the land that hospital was sitting on was worth more than the hospital itself. And guess what? The hospital I was working at, guess what, you know, that's, that, you know, there was, it was pretty obvious the writing was on the wall. Now that hospital is still standing, but only parts of it are, are still there.


But I think what happened was, I think Covid changed the game a little bit. There was gonna be less, kind of like that hospital was on the chopping block, but Covid kind of kept it going. Barely. But anyways, I, I lasted there for five years. I found my forever home up in Westchester. Anyways, after that, which is about anywhere from a hour and a half to two hour drive to work and with traffic, I'm assuming.


Oh, with traffic three hours. Oh my gosh, that's insane. I, I am, I'm very New York naive because I've only been to Binghamton to see the Carousel and then nowhere else in New York, uh, to this day. So I, I, I appreciate LA traffic. So I can, I can sort of picture the, uh, the parking lot.


You came to my great state of New York and you went to Binghamton of all places.


Like that's the only place you went to Binghamton. But it, so I was 12 at the time. I, oh yeah. Okay. I'm 40 now, but I will tell you that, uh, my, my uncle refurbished a 1938 Stda Baker and was in the great race, the North American, or I think it's the North American great race. So the great race. So Uhhuh, uh, it was, it was a timed race between Ottawa down to Mexico City, and so Binghamton was one of the stops.


That's the only reason I have been to New York. So, wait, he raced in a refurbished Stda baker. Yeah.


So he, um, okay. Well that's. That's a completely different podcast. And that is, that is an interview that is a story that needs to be told. It's, uh, it's great sharing the backseat of a van with your cousin who takes the, the seat laying down and I was sitting down the entire trip to, down to Texas.

So, yeah, it's good times, but I, I think about this, you know, you're, you're coming from what I, what I keep hearing is the word compassion and yeah. That is awesome. And I, you know, I, I think about going back to the, the peds DP C Mastermind, how, you know, a big discussion was about equity and, you know, in the, a aap world, equity and, and pediatrics, you know, are, are supposed to go together.


But I thought about when, when you were sharing your story, how the, the time with patients that that matters and the com Yeah. The compassion that you have with patients. Yeah. That matters. Not just equity because equity's great, but then what happens if you, everyone has care, but the care is. Two minutes, eight minutes, 15 minutes.


Like what? What is that? So that is, so that, yeah, I'm glad we're talking about that because this is a big equity. Sounds fantastic. It really does. But again, it's not realistic and actually it probably harms, and let's talk about that because equity sounds great on paper. However, you got a kid with multiple medical complications, Mo a very sick kid.


I, we currently have a few kids who are very complex. They have complex care. They a lot of complex care coordination that needs to be done. You know, they're paralyzed from the, you know, this kid's paralyzed from waist down. Like lots of you, you know what? Honestly, that kid does not need equal care to my son who's seven, who barely gets sick.


I don't want that. I want less care for my kid. And I want more. I wanna dedicate more care to this kid. So we have to talk about that. That kid needs more compassion. That kid. I mean, my son needs compassion. That's fine. I'm whatever. I'm good. But that other kid, that kid needs more care and we, and we shouldn't be afraid to say that.


Totally. I, I absolutely second that. My cousin, who I, in my mind, I, he's always four, but he's now, I think 24. He has down syndrome and so he had occupational therapy, music therapy, physical therapy. What else am I leaving out there? Um, speech therapy. And yeah, it was because of all of that intervention at such a young age that he's a flipping dj, like nice, he's a, a kid with Down syndrome who does dj well, excuse me, an adult now.


But, you know, I, I absolutely agree. Like personalized care is what's needed. And that personalized care is not going to be like, you know, you, you can't have the, the black and white one, one paper fill this out. That's your visit. Um, that, that's not gonna allow a child to get the, the care that they need for sure.


Yeah. Yeah. So that's, so it's the compassion community also, you know, needing, you know, for instance, our kid who has our, our most complex kid right now, the community has actually come together. There's a community organization that is actually paying for his membership with us, and that is key in this kid's care.


We confuse healthcare with health insurance. We confuse health insurance with equity. We confuse, we're basically putting more importance on payment than we are on care and compassion, uh, and community. Yep. Uh, and this is what is failing our kids. So, uh, when I, when I first started off on this D p C journey, uh, there was only a handful of us.


This was about five years ago when I went, uh, uh, joined, uh, went on this journey. And I think from those who, uh, Were doing this. They were adult docs. They're family medicine docs. Uh, all I heard was like, I don't think you'll succeed. And I was like, why? And they're like, well, kids all have insurance. I was like, but the kids don't have care.


They may have somebody footing the bill, but that doesn't mean they have care. And so what I mentioned in my talk at the Mastermind was what I discovered was what kids, what patients lack in this country, wh which actually most patients lack, is the ACC access, the quality and the convenience, the A Q C.


It's so true. And you know, I, I had been talking with, uh, Dr. Shannon Schul, who's a adult gastroenterologist, and. We were talking about, you know, being a disruptor, and then I was reading, I think it was the Harvard Business Review magazine, and they were literally defining disruptor as bringing more innovative solutions, specifically cheaper, simpler, and more accessible.


Yeah. And it was like, There you go. There you go. That's how innovation has, you know, um, I, I wanted to ask you this because like, when we think about innovation and, you know, just pulling from the fact that your wife is in a different profession and is on Wall Street. Yeah. I, I wonder when you were in those early days, cause there weren't a lot of mentors, and that's really like super irritating to me to hear like, you know, the, the poo-pooing of like, I know you have a dream, that's cool.


Oh, you're so, you know, like, oh, bless your heart, but that ain't gonna work. Yeah, yeah. Its like, you know, and now, yeah, yeah. And now, you know, you've, you've blown that, that fallacy out of the water. But when it came to, you know, I've done the five years in, you know, stint now in er, I've done all the things.


I've, the, the one, the, what I want to do is general peds. And when you were dreaming about river towns, Coming from your wife's perspective of, you know, appreciating innovative changes in the markets and Yeah. You know, investing in things that are disruptive, you know, in that definition that I mentioned earlier, that can really change culture and change finances and change everything.


I mean, now we're seeing D P C as a model that can be really taken forward to the next level by incorporating it in, you know, with employers, with state employee plans, with school districts, all of these things. But what was the discussion like when you were dreaming about river towns with your wife because of her different perspective?


So, yeah, my wife. So yeah, the, she took a financial, a finance angle to it, which she's an analyst, so she basically, she dissects like the companies that, um, she covers and she can tell you where they're losing money, where you know, what's making more money and what they should be focusing on with me. You know, it's always been gradual conversation.


It it, well, it's always been constant conversations for over a decade with her about like my thoughts of how medicines run. I always, always chat with her and so she always kind of kept that in mind. She realized when I was gonna be like, I'm not gonna take insurance because you know what? It's insurance that's fucking this up.


But you know what, by the time I started this, when I left my job five years ago, this was, you were, it was hard to find an independent practice anymore. In New York, all the independent practices are being bought out. Air quotes, I'm bought out. They're not getting bought out, they're being incorporated.


They're being absorbed. Basically, the big hospital groups are saying, we'll pay your overhead. There's rarely a big tra cash transaction. The reason why you wanna join us is because we have the big insurance contracts that we've made. Sure. That they squeezed you on. And as we're talking, you know, the, there's the, uh, the one company out there and people can go find this, the one company who, you know, oh, you're struggling with your clinic.


We'll, we'll, you, you will, uh, we'll do all of the work for you. We're gonna take a, I think it's like 0.5% of all of the payments that you do get, because we're gonna do all of the Yeah. The paperwork and all the insurance, uh, you know, forms for you. Oh, you're still struggling. Well then how about you take out a loan, but you can only get the loan if you use our, you know, paperwork processing service and then, oh, if you're still failing, we'll just buy your clinic.


And it happens to be, this is an insurance company. Like, patients do not have an idea. And at the same time, you know, I was reading about this. I had a patient literally drive up to like, I mean, I, I love your main story. Like I love that the neighbor drove that family to your clinic. Yeah. But like legit people will, cuz my clinic's across from the post office.


It's like, whoa, they will you turn into my parking lot, honk the horn and be like, no care for anybody else in the neighborhood. But hey, you know what? I got my 90-day refill for $1 42 cents. Cause I used that magic insurance company. And so, you know, it, it is, it is definitely like education of our culture is a huge thing.


Yeah. And so I love that you're sharing the story Yeah. And, and telling it like it is from your, your history because people don't get it that, like you've said, insurance is not healthcare. Yeah.

Insurance is not healthcare. So, you know, I, I broke it down. I was telling my wife, like, look, if I, uh, you know, I've reached out to a couple of independent pediatricians, they told me like their reimbursement for like any ear infections like 9, 9 2 1 3, they're getting $32 for that.


$32. Think about that. Now you're in New York. And I'll, I'll tell you, my estimate at that time was, uh, you know, if you're taking, if you're an insurance based practice at that time, your operating costs were about $300 an hour per doctor. So that included, you know, your overhead, your an overhead included, your MAs, your billers, your everything, all that glut.


So imagine if you're getting reimbursed $32 for like, you know, an ear infection, how many patients you gotta see, right? So, uh, but on the flip side, you know, we got so addicted to insurance. That was the only thing we knew, but. You know, if you think about it like, oh, insurance, in theory, the insurance is supposed to make it a a healthcare affordable.


How is that affordable when we're charging like $200, $100 for a flu a test, $100 for a flu B test, that's $200 right there. You know, if somebody else is paying the bill, supposed to be paying the bill, what do you do? You upcharge everything. And so that's only driving up the cost. We keep driving up the cost.


You know that, that $40 rapid strep test. That, uh, a clinic will charge, well, that strep test is $2 $20 for that ua. The UA is 80 cents. Yeah. Uh, so what if you just, you know, instead of the thing, what everybody's paying is thousands of dollars a year in insurance. You know, they got, they're paying thousands of dollars a year and their deductibles, they're paying theirs copays.


Well, what if you just paid the doctor directly? Get better care, get more convenience, get quality, get the access, and you pay the doctor directly. It doesn't have to be expensive. Just cut out the administrators, cut out the overhead, cut out the insurance, cut out the hospital facility fees, cut out all that out, and actually just put care back between the patient and the doctor.


That's it. It's really easy. What, what blows my mind to this day, and will probably for the rest of my life, is that like, you know, we, we will talk to people who are old enough to remember that that's how medicine used to be, period. Like I think it was Jimmy Carter was the first president born in a hospital like legit.


Yeah. I mean there's, there's people who, it was only 30, 40 years ago. Yeah. It was. That managed care. It was like, what, 30 year, 35 years ago. That managed care became the status quo. Mm-hmm.


Yeah. And that was it. It is so sad when you talk with doctors who were at that cusp of, of, you know, HMOs and managed care.


It was like, it was like, what the internet promise, like, you know, this, this utopia that has not happened. Yeah. But it's like when, when we think about managed care and the promise that people really believed in, like it was, it was coming from, wow, this can make healthcare more affordable for people. Like that idea that people bought into, it's so sad because it was such an earnest desire and then, you know, look what it's turned into.


But it, it, it is, it is so interesting how we've gone in such a short time relatively, you know, like how long was the Roman Empire, you know, in power? And then how long has the United States been, you know, in existence? And then look at our healthcare system just within a short time we've really. Gone to this place of like, I'll only do what my insurance covers.


Not thinking about what does that service actually cost or like, yeah, what does it mean to me? Oh yeah, I forgot the fact that not only am I paying, you know, $40 for that strep test, but then I'm also paying the bill for the urgent care. Cause I couldn't get in to my doctor to get the strep test. Yeah, yeah, yeah, yeah.


I, there's another thing, so I, I had this long conversation like, well, not a conversa, well, a debate with like a medical student. He, he was like, well, how are you helping people? I believe in healthcare for all. And I was like, I do too. He's like, but then he, why aren't you taking insurance? I was like, oh, no, no.


I don't believe in health insurance for all. He's like, they're the same thing. I said, no, they're fucking not. I said, it's, I, like, I, I wanted to go, I wanted to go to the dean of the medical school and say, you need to educate these people for sure. It's just like, it's just like nutri. Tell them that health insurance is healthcare.


You're screwing that?


Well, it's just like nutrition, like how you were saying, you know, like your, your education nutrition. And I, I will second that. Like, I had zero, zero horses in nutrition that I recall at Creighton. And when it comes to the things that we need to be educated with, I was very jealous of my dental friends who Yeah.


Would be like, oh yeah. Like I know about, you know, ideal patient. I know about p and l. Yeah. And, and I was like, where did you learn this stuff? Like we just learned about the heart today. Like that's, that's like, yeah, you guys are going way beyond and Well, so now what's important though is I have no sympathy for physicians to say like, I didn't learn anything about business in medical schools.


Like since when that, how did you stop learning? You're the smartest kid in your class, like in high school, like why did you stop? Like so go learn it. But also the thing is the business of what my practice does, it's really simple. Like it's it. There's nothing complicated about it. I know what my overhead costs are.


They're a hell of a lot lower than they were, than they are. If I were to take insurance, and this is how many patients I need at my rates. And this is how it can turn a profit. It's like it's really, there's no, I'm not, I'm not worrying, I'm not pinching pennies waiting for a reimbursement from an insurance company.


You know, like I'm, I'm not gonna hold my breath for six months waiting for a reimbursement, only be told like, oh, we decided that was too much. We're gonna pay you this much. Uh, no. I know exactly what my monthly income is every month, and I know how to hire accordingly. I know how to make my expenses accordingly.


And that's it. It's really simple.


When going back to your wife and the discussions. Yes. I love that you had the discussions over 10 years. It's amazing. Like, yeah. Yeah. I love the, I love the long term. So, uh, yeah. So ba basically, if you try to go get a, a small business loan and say, I'm not gonna take insurance, you're not getting a small business loan.


So my wife was my, uh, my loan. So basically all I had to do was it, I didn't even write anything on paper. I didn't even have to present anything. I was like, Priya, here's my idea. My rent is gonna cost me $3,300 a month and I'm not gonna take insurance, but I am going to you, you know, like, and, and my malpractice at that time was like $9,000.


Uh, it, it was like if I were to have 400 patients at a hundred dollars a month, I'd be rich. And she was like, huh, $480,000 a year. Your expenses are this much. She's like, yeah, that would work. That was our discussion. She's like, well, what about the testing? I was like, look, a UA is 80 cents. A strep test is $2.


Uh, a flu test is $10. I was like, I just absorb it into the cost. That's just part of my monthly cost. She's like, what about the vaccines? I was like, that's gonna be a little scary. So in the beginning, so I said, here's what we're gonna do. I'm gonna just mark it to like, Toddlers and up cuz they don't need as many vaccines.


And then I'll figure out the vaccines later. And that was my business plan with her and it worked. Of course. Now my, I don't have 400 patients and, and no, they're not paying a hundred dollars a month. It, it, you know, things have changed. Times have changed. I just, you know, you can't, again, let's go back to equity.


Uh, you know what, those newborns are not the same price as a. 14 year old. So the newborns pay more. The, the 14 year olds pay less. But, uh, on average, at this point where I am, because there is inflation, rent does go up, malpractice does go up. Uh, there was a couple of, like a pande, there was a pandemic and some, you know, like shipping, like, so think costs of goods have gone up.


So on average, our patients, uh, uh, on average pay 1 25 a month.


I'm gonna be the devil's advocate here, but I thought that you could only charge $10 a month for a kid. So, so tell me about that. I, this is an ongoing discussion and debate. I'm totally being devil's advocate in here, but to those people who say, like, you, no, it's, it's $10 a month, it's $25 a month, whatever.


How does your mind process that, that argument of the flat rate for kids, period.


Honestly, would you trust a doctor that only charged it at $10 a month? How good is that doctor? What kind of care is that doctor gonna give? Let's just leave it right there on that. Think about it. I, I mean, like, that's ridiculous.


It's just ridiculous. You know, those same people were charging too little are also the same people who are, who are complaining that they're being overutilized. Well, it's like, well, cuz you're being overutilized, cuz you're charging like $10 a month. You know, your patient population, the, the community, they need to also know that you can, uh, like pay, rent and eat.


So like, if you're charging $10 a month, guess what? You're not getting pediatric patients. You're not. If you, there is, there is a thing when people, when you know you have kid, how many kids you got? Two boys. Do you ever go on Facebook? To get like the Facebook parent groups and ask like, Hey, can somebody recommend like just a, so, so, you know, it is just something that's so, so just, I just only want paid $10.


Like, no people on, uh, they go onto the Facebook parent groups. They always ask for the best, like, best place to get a haircut. Best place to like send my kid for daycare. Best place. They don't ask for like $10 a month. And now I'm not that, that sounds, I'm, I'm just being realistic on that. You, you're just not running a practice.


With those, you have to be realistic.


I'm glad you're talking so transparently because it's important for other pediatricians to hear that, especially if they're considering direct primary care. Yeah. But I don't

understand. Are those pediatricians who are getting their advice from non pediatricians on how to start up their practice?


Like why would you do that? That that is where it's so important that we see AP peds, DPC Mastermind. We see, yeah. You know, pediatric groups because absolutely, like DPC is a business model. Okay. We can learn from each other, general things, but when it comes to pediatricians as specialists, you mentioned in a previous interview that like, What is the drive to go into pediatrics in your case, but primary care in general, you know, internal medicine, general internal medicine, general family medicine, pediatrics.


When look at, you know, what we do in fee for service, the typical thing that a medical student will see or a resident who's rotating will see is I what I heard another resident call a primary care doctor a ologist. And so it was mind blowing, you know, to hear that from a first year resident who's in family medicine in California.


But then hearing you talk about like what is the drive for people to choose pediatrics in, in general, like if we're devalued by the, the fee for service system because $42 value by the American education system, the medical education system we're, we are devalued by the medical system. And that's, and, but that's an intentional devaluation.


Look, I mean, c v s and Aetna are now a company, uh, what is it? Uh, Optum, which is u h c. They're gobbling up hospital groups. Cigna is gobbling up hospital groups. You know, you're an idiot if you don't see that the insurance companies are taking over, right? And to them, if you're an insurance, this is how in, here's how simple.


It's insurance companies make money by not giving, by not paying the money you give them. That's how they make money. That's what insurance is. You're paying a company to hold onto your money. What they're gonna do with that money is they're gonna try to grow that with investments or whatever. You know, some would call it a Ponzi scheme.


It kind of is if you think about it. And, but they, they hold because that money on hand for them is valuable. They can invest that, they can grow that money. That is their goal. Now, in order to continue to grow that money, they can't dispense that money. So they're gonna do everything possible to not pay.


So if they're buying out hospital groups, they're buying out practices, then, you know, like you are going to be irrelevant. P a generalist primary care. Now in medical school, the amazing thing about going to medical school in a different country is the smartest people go into primary care outside of America because they're the ones who have to know everything.


And so if you go into a specialty, you only, you dumb yourself down into knowing everything about that one thing. My, my research project impedes g I guess what I was going to be the world's like foremost expert in pediatric gallbladder disease. Guess what? I would go bankrupt. Like I was, I knew everything about the gallbladder, like the pediatric gallbladder.


There is no job prospects for that, but I would know a whole lot about very little. Uh, and I'm a geek. I love knowledge. I love it. So that's why I love being a journalist. I love being a jack of all trades. I, you know, I just, the other day, like, you know, I went and stitched up a kid, cuz I still keep those skills.


I, I'm able to, I love being that person. I'm not a urologist.


I, I, it was, it was like, we don't even, that's not, you know, not a real word. I'm sure Urban Dictionary might add that someday, but it's like, yeah, we all know what that means. Right? So continue.


We all know that. Continue, we, we, we, my patients pay me directly to be the best damn doctor. For their kid. I work for my patients.


So if I were to work for an insurance company, yeah, of course I'd be referring like crazy. When I used to work for a hospital system, the, the mantra was, if it takes longer than seven minutes, refer, but only refer to one of our specialists because that counts part of your R V U. So, you know, how does that not violate stark laws?


I do not know. But again, I don't give a shit about that. I just care about me running my business and doing it well, and I'm doing it well. It's awesome. I, I have a tiny little practice and we're one of the largest, we, no, we are the largest pediatric covid covid vaccine provider in the county. My little teeny tiny practice.


It's, it's incredible. And, you know, I arguably, I wouldn't even say that it's teeny tiny because look what river towns has, you know, developed into, I mean, just in your clinic you have, we just

hired a new pediatrician. Yep. Dr. Mindy Gallagher.


Yep. You have Dr. Gallagher, you have Dr. Solomon who's family practice.


Yes. I mean, you clearly that again, that poo-pooing of like that No, you, that's, that's such a sweet idea. But that, that doesn't gonna work. It's has, has gone on. But we also have Staten Island. We have Rivertown, Staten Island, Dr. Vladimir Bar. Yep. Uh, so he was my grasshopper. He was my, he was my padawan for a while.


And then he, uh, and then he opened up over there. It's something, it's not, it's not a concept. That was gonna be like a good luck to you. I wish you the best. It's what's absolutely necessary, because this healthcare system is failing.


When we talk about your growth, I wanna take a step back into the, the first days of river towns, because before you added on physicians at Dobbs Ferry, before Staten Island opened up, when you were going from talking with your wife, getting, you know, she was your, she was your small bank loan or you know, small, small business loan and then opening, how did you then use those finances to fund your D P C and bring patients in?


Okay, so I think in the D P C world, we'd like to talk about how you can open up your practice on a shoestring budget full. Yes, that can happen and that's good. If, if, if it, you know, that's fine, but. I'm gonna be realistic. Look at the market you're in. I'm in New York. I'm in New York City. I I am, you know, there is nothing shoestring budget.


Here I am surrounded by hospital groups that have Super Bowl commercials. I don't have a Super Bowl commercial. And what, what boggles me is that they have Super Bowl commercials that call that they tell them that they say they're the best. I don't know how you have five hospitals saying they're gonna only be one, but whatever.


I digress. You know, for me did some market research polling people around. Uh, I needed an office. I needed an office. That's my showroom. I needed a home base by having an office, by, uh, by having a five year lease that it says I'm here. I am serious. I am going to be your pediatrician. Yes, I do house calls because you know why?


Cuz nobody else does house calls. I marketed the hell out of that. The budgeting before opening up. I, I paid off my student loans the year before. Doing locums was a big help living. You know, we, my wife and I, we try not to splurge too much early on. Now we do splurges, but we did everything we could just pay off our student loans at those times when I was doing like home loans, like for that local bank, I learned a lot about loans.


So that really got me in my mindset. Let me. Dedicate to paying off my student loans. So pay off your student loans. If you're gonna go down this path, pay off your student loans. You don't need that on your mind. Save up a nest egg. Save up a nest egg that can support you for about the next two or three years because it might take that long for your practice to take off.


Take off. And what Dr. Vladimir very upset at the DP C Mastermind is in five years, half the people, or would you say more majority or was it half majority of people were gonna fail? I think it was majority. Yep. Majority of people were gonna fail at five years. So you gotta have that nest day, you gotta be prepared.


And so when I first started the practice, so I started with the hundred thousand dollars budget. I'm in a big market with big names, with lots of flash. So $50,000 of my budget went to marketing in my area. Social media is the biggest form of marketing it, or is the most efficient form of marketing.

Everybody. Parent group, there are Facebook parent groups. That's a big market for me. Now look, I'm tar If I, I'm not targeting senior citizens who look at print ads. No. I, my demographic, average parent demographic average age is 35, uh, for parents. So they're on social media, they're on Instagram, Facebook also Google.


So we have a big Google presence, Facebook, Instagram, uh, I no longer pay for Google ads cause I don't need to. Yay. But, uh, you know, marketing materials, the business cards, business cards do make a difference. I know it sounds old school, but you know, you just drop a business card, drop a stack of 'em, drop brochures.


That's what I did. I just went around everywhere. Pre pandemic. Of course, during the pandemic, we doubled down on the social media marketing even harder. And you also gotta remember if there is something that's working in terms of marketing, push that farther. You don't be like, Hey, this post really worked, or The message of this post really worked.


And then change the message. No, no, no. Keep messaging. That's your ticket right there. And then adjust as the times change. Right Now, if you look, if we were following my social media, we've been targeting a lot of newborn house calls cuz we have a little baby boom going on right now. So guess what? I want all those newborns.


So we've been doing a lot of newborn house call posts. Uh, you gotta know your market in the beginning. It well throughout, not just in the beginning. You gotta know what your market needs. My market needed covid testing. My market needed covid vaccines. The big hospital systems couldn't get their act together.


They couldn't do the testing, they couldn't do the vaccines, but I did. And so we did it. That's, you know, you, if you're gonna charge people out of pocket more than $10 a month, you gotta give 'em something. You gotta, you can't just be like, and you gotta make sure. You know, you're doing it for the right reasons.


Are you doing it because you need to be the doctor that you were meant to be then yes, go for it. If you're doing, if you try to go down this path because you just want a better lifestyle and make it all about you, well, you're going to fail. People read through that, you know, so you gotta, you gotta make sure you're better than everybody else.


When you talk about marketing and Yes. You know, strategizing specifically for your market, given that you're a, amongst these hospitals that have Super Bowl commercials, like I just, I love that so much. How did you go about developing a marketing plan to be so effective?


So I, um, I teamed up, I interviewed a lot of different, uh, local marketing companies and I fell like kind of, yeah, I, I, I've, no, I didn't settle on.


I one day interviewed Lauren Don and told her and her team what I was going to do and what I, what I was hoping, this is my plan. I'm not gonna take insurance. And she said, huh, you're gonna start a new industry. And I was like, you know what? Let me cancel all my further interviews. You are the one. And that was it.


She got me. Cuz this is what we're doing. We're not start, actually, we're not starting an industry, we're resurrecting a former industry, but we're bringing it back into focus. And so that's what we did, except what we did early on, we realized we, I, I tried to do the, so I was true two hands on the beginning.


Lauren would always tell me like, no, no, no, we shouldn't do it that way. So again, she's the specialist at what she does. So for the first three months, she's like, we should do it like this. And I was like, no, but the d p C handbook says I should do it like this. So I talked about like how you don't need insurance and these are the benefits of me versus an insurance-based practice.


And I talked about all the different types of finance and money and how you're gonna save money. And Lauren's like, okay, I'll give you three months. And guess what? We went nowhere. Uh, and then after three months I'm like, oh my God, Lauren. She's like, okay, so can I, can I work now? And I was like, yeah. So she, we took down our rates on our website because she has these little widgets on the website that show you how much time people spend on what part of the page.


People clicked out right there on the pricing page. She took that down and then she made it all about me and what I offer. My expertise and, and then made it about the patient. What you need, made it about your kids. Like about the kids. That's what it was. And it was basically the marketing went back to the patient and the doctor.


That's what it is. That's what parents want. And the difference between the marketing, between the Super Bowl commercial hospitals is they always say only at New York Presbyterian. Only at Montefiore. Only at Northwell, but they never specified as the doctors. And there's a reason for that. Why? Cuz doctors leave.


You know, because they're just a number. For us, it's the marketing is about the, it is, you know, when we market it, we specifically say, Dr. Gupta, Dr. Gallagher, and we keep it about you as well. So messaging, it's important. You have to introduce people to who you are and the relationship. So let me ask you there, because you know, locally it is extremely hard to see somebody who, to see anybody of physician or non-physician provider who sees kids in our area.

And so really common in our areas, oh, I'm gonna go and get blueberry pediatrics. That that's the local, you know, the local draw. So when you talk about that's the, uh,

that's the telehealth.


Telehealth, yeah. And it, it's so interesting because, you know, the, the, the commercials that I see, Facebook, Instagram, like, it, it's, it's definitely heavy social media.


But as you talk about you guys marketing. Yourselves versus how these hospitals are marketing like the system. I see. Like blueberry pediatrics is the example here. Mm-hmm. Where it's, it's b blueberry, pediatrics, the, the name of the company versus the doctors. Mm-hmm. Are you finding, because you guys are growing, adding physicians, there's a need that keeps being met by your clinic.


Why do you think people are preferring you guys as you're marketing yourselves versus something where it's marketing a company, but it's still accessible? You know, affordable virtual care.

Parents want a doctor, that's it. They want a doctor to see their kid. They don't want a device, they don't want a hospital system.


They don't want a clinic, they want a doctor that they can trust. Uh, blueberry pediatrics, they're fitting a role, right? So a lot of what we do is a lot of what they do. I. I feel like, I wanna say we've been doing it first, but I never really, I never really investigated how long, because, you know, we send a lot of our families, the o the Bluetooth otoscopes, and we do a lot of, uh, video health, uh, televideo.


We do a lot of pictures, we do a lot of video, but, you know, uh, uh, I, those, those are fine. Like we got a, we got a fungal diaper rash. Yeah, we can just get a picture on that or, you know, but like, you know, I can't take a strep test through a video. I, you know, if you got a Bluetooth otoscope, you know, like some of our families are very savvy with it and they could do it, uh, but the majority can't.


So, uh, also, you know, the, there's also, I think that we don't, we are not gonna go down that we, we're just not, we're not gonna do, there are some devices that can do, that can record the heart. Heart sounds, lung sounds, we're not gonna go down that because if a kid is struggling to breathe, like we want our hands on them, you know, you know, if we get a a, a listen, you know, from a recording, we don't know if that's the right up or long.


We don't know where that is. So, uh, but what I think is important for us is I intended to be the hometown doc, the small town doc. That's what we are. So y there's a relationship there, there's a very interpersonal relationship. So I will swing by and just see your kid on my way home. I will, you know, it, it is important that we put our hands on you.


So blueberry pediatrics is definitely fitting a role. Uh, where, and, and they're, I think, I believe they're thriving. I hope they're thriving because they're, they're providing something that, you know, what the status quo is not providing. So, yeah, good job. Blueberry pediatrics, I, I like to view them as a collaborator cuz they're normalizing a market for us.


But again, I, it's not like a specific doctor there. And so I think for us, uh, the gadgets, the do hickeys, uh, things, that's not a worry for us. Something that I, I, I see coming up is something about like, ai, oh, AI's gonna replace the doctor. No, they're not gonna replace me. It's not chat. G p t is not gonna replace me because there is something that robots just can't do.


And that's be human. Absolutely. The human touch is, no's not there. I'm not worried about ai actually. If ai, if AI is there, like I would, you know, knowing me, I'd figure out a way to utilize it. Well, you could, you could bring Baymax, like an actual life size baymax into your clinic and I'm sure you'd get more patients just cuz they'd walk in the door to pick.


That would be awesome. Baymax. Yes, I would be there. Like I would totally fly to do that. Yeah. Yeah. But there is something. About an actual human, and those human experiences, there's a reason why we slaved ourselves through residency. It's those experiences we're bringing.


And like when you talk about humanism, I mean, look at what we're doing.


Like we're listening to your story and that's what's making an impact in people who are listening. Yeah. It's not like, oh, there's a picture of Dr. Gupte. He's so handsome, but like, no, no. He has a story behind, like all the handsomeness. So, you know, I, I think that, thank you. I think that that is something that people need to hear because it is a big thing that people are talking about right now.


Like, or are we gonna re be replaced by the, the speed and the exactness that, uh, an AI might have compared to the human brain. And while a traditional fee for service. Physician is being replaced as we speak, not from ai, but by the systems they work for already. Yep. Absolutely. That one hits to my heart because my husband just got replaced by a non-physician model at the clinic that he was working at.


So, amen to that statement. This is where, you know, it is, it is so heartbreaking for people to go to medical school, to go to residency and to not be prepared with the fact that like no physician job is guaranteed. I mean, yes, like we are business owners and we take a risk in D P C, but when you expect that your, you know, golden handcuffs, uh, employed role is guaranteed to last forever,

um, that's gone.


Yep. Even if you're a partner somewhere, you think you got a cash cow, you got an income. No, your, your insurance reimbursements may drop and you may get bought out. Your, the other partners in your group might be like, Hey, let's sell ourselves to Cigna, and that might happen. And actually it does happen, and you will be replaced.


That's where we're going. Uh, so I'm not even worried about robots or chat, G p T or ai. It's happening right now. You're being replaced, uh, or you're being made redundant. Uh, do more with less. Right? It's, it's all comes down to the lean operations. Uh, that is not a new concept. That is a concept that kind of makes capitalism work.


Now, whether you morally agree with it, in medicine, nobody gives a shit. So now for something like Rivertown Peds, where I'm directly paid by the patients, we're thriving, we're growing. It's a slow growth, but it's fine. It's happened. It, it's growing now. Right now, the economy is. It, it, it, it, you know, it looks like it's taken a downturn.


I have some families who aren't able to pay me anymore, or that not able to pay the regular rates, uh, their, their current rates. You know, when, when I, when I started this, there was a couple purposes. I wanted to make more money. I wanted to be able to, uh, provide the me kind of care that I wanted to be able to pr provide the care that, like, I'm smart.


Like I wanna make sure I provided the best kind of care I possibly can. Ne uh, you know, I wanted to change my lifestyle. Well, uh, you know, one thing about being an entrepreneur is your lifestyle sucks. So, but also I wanted to. Send a message that this is gonna be possible, and this is gonna be a con, you know, like this is gonna be resistant to the whims of the economy.


So we are gonna start, we are starting to see a slight flattening of growth right now, but a but a slight flattening of growth is better than going backwards. So I'm not letting those patients go because they can't afford to pay me. I'm saying, look, I've been your pediatrician for years. Like, we got a relationship.


I'm not going anywhere. Uh, and you're not going anywhere either. You know, the atti the amount of time, the relationship we have, look, I'll stop their payments, I'll stop the charges, and I know that when they're back on their feet, they'll pay me again. It's fine. Uh, I, I, I'm fortunate I'm in that situation now.


25% of our patients are on Medicaid or uninsured. Uh, I'm gonna say we are gonna be recession proof because, hey, when people lose their jobs, We're cheaper than Cobra when they, if they lose their Cobra. And they're completely uninsured. We're cheaper than going anywhere else. So, you know, your kids are gonna be vaccinated.


Your kids, you're gonna, kids are gonna get the care when you need it.


It's crazy. You know, I, I think about coming up next month, uh, there are, I think the number that I was told was like 116 kids who can't matriculate into, uh, seventh grade because they don't have their TDAP vaccine and the public health department is needing someone to vaccinate and they don't have anyone.


So I'm like, I'll do it. Uh, my husband will do it also because he is currently, you know, joining my D P C, but we have the time to do these things. And so it was like, great, we, we have now people to vaccinate, but then, oh, but you know, the, the uninsured or the people who have V F C can get the vaccines from public health, but then we can't get the vaccines for the other kids because they're insured.


And so, you know, they can't get in to see their provider, you know, physician or non-physician provider. Before school starts. So, oh, then how about we run their vaccines through their insurance at the local pharmacy and pick it up in a vaccine fridge and vaccinate these kids. There's 116 kids who can go to school.


It's like, you know, the, the idea that, again, it's like this health insurance is not healthcare. I mean, look at if you're 25% of your, your kids have Medicaid, I can just imagine the number of clinics that are excited to take that reimbursement for each visit that they have. And you know, their accessibility as I'm assuming like the Medi-Cal patients are, goes down because they have Medicaid or Medi-Cal.


And so when it comes to that part of, you know, being a disruptor and accessible care, that in some, you know, families' minds is the number one thing. Like you're talking about, parents want a doctor that they can actually talk to when they need to. And that's what you're bringing.

So as you guys, those, those Medicaid patients, they can't afford to go to a Medicaid doctor.

Because they're working jobs, they need to be able to take their kid to a doctor that can see them or have, have their babysitter, uh, take their kid to the doctor. We don't realize that insurance does not mean healthcare.


It's like, if there's one lesson that you've learned from this episode, like that is, that is, that is a huge one right there.


When you guys, I mean, I like, I don't think you, you're giving yourself all the credit that you guys deserve because when you talk about recession proof and when you talk about growing solely, like, I, I wanna really highlight that you guys are not going into the red and you're growing with multiple doctors and now, you know, multiple locations.


So a couple of things, like I noticed on your logo there's a trademark, which I think is flipping awesome because somebody asked me like, why is my DP C story trademarked? And I'm like, cuz I worked my butt off to create this thing. Like, I'm proud of it. You know, I, I won. All of our

logos are trademarked.


Yeah, yeah, yeah.


Um, you just can't take it. Yeah. Um. So, you know, can you speak to that? But then also can you speak to how your Rivertown Dubbs Ferry, and then we have now Rivertown Staten Island. So

the branding, the, the logo worked hard on it. I wanted a bat symbol. I wanted that logo to be visible, recognizable, but the, so therefore those were trademarked.


But there, but there's two parts to that. You know, it is bouncing out the logo and the doctor for me, they're not the same. And actually, if you look at your goo, like when I, every month I get these Google kind of reports. So it's like 50 50 people are Googling river town's pediatrics, which I will say was, is a logo.


And then they're googling the individual doctors. We're not one in the same, but we're under the kind of same, the, the same symbol, the same logo. Uh, and I don't know. Like, I just didn't want somebody taking my logo.


I totally get that. And like, yeah, like when I relate to that, you know, my history, what I, what I was exposed to was my dad created a logo for esma, that's a martial art of the Philippines.


And Uhhuh. Everybody has used this triangle and the, there's a, a knife and a stick, and it's like he never trademarked it. And so now, you know, everybody's using that idea and my dad created it, but it's like he had no, no, no protection. No. So, you know, I, I think that it's like how you were exposed to compassion in when you were in medical school and, and rotating.


That was how I was, you know, exposed to like, what happens when you don't protect what you have created. So I think it's super important for people to hear, especially as, you know, the, the movement grows. Like consider getting your stuff trademarked because, you know, it, it's literally a way of future, uh, of helping your future self.


I, I feel it's on stickers. You know, and I sometimes see that out, like on social media. Somebody took a picture of their kid and they, you, you know, my logo's right there. Uh, it's kind of cool. And, and Staten Island has its own logo. Uh, every, every borough we've, we've been, uh, uh, kind of, um, brainstorming like what logo for every borough of Manhattan, if we ever create another office in, in a different borough for us in Westchester, the, it's, uh, you know, our logo highlights the Tapan Z Bridge.


Uh, and so that is something like the bridge is, I mean, the river towns, the bridge is right here in our river towns. It's, it's something very, uh, kind of, uh, it, it, it's recognizable for us. So for Staten Island, if anybody's ever taken the Staten Island ferry, you know, you passed by the Statue of Liberty.


So the logo contains the Statue of Liberty. Uh, for Staten Island, uh, we're trying to figure out, you know, we got ideas for Brooklyn, we got ideas for Manhattan trying to figure out Bronx. Maybe we just won't open up an office in Bronx. Cause it was like, well, could we do pin stripes? I was like, no, the Yankees might get upset.


We're still figuring out the Bronx. But you know what, maybe we'll, I, I'm satisfied not even opening up an office down there. It, I don't know. But we are growing. We're growing slowly. We're growing. Well, you know, there were times in the beginning where, uh, especially in the first year, you know, I asked my accountant, I was like, oh man, did I make a mistake?


I'm not, you know, I'm not, I'm not growing that much. I'm not making that any money. And, and he is like, give it time. I was like, should I take insurance? He's like, no. Cuz my accountant has a lot of fee for service doctors in, in his practice. And he is like, and he's provided me so much reassurance over there.


He is like, look, they're failing. You have the right business model, you know, just be patient. It will come. So I think a, a question I get asked a lot is like, how long did it take me, uh, for me to become, to start paying myself? So first of all, my expenses have been paid starting after, after year one took about a year, took, uh, for me to break even.


Year one, I started paying myself after year two. Now I'm not paying myself aga, uh, now, uh, maybe I'm paying, I'm taking more expenses out. I'm spending a lot more, but, uh, I just hired a new pediatrician. I have other business ventures that I'm, I'm doing so I'm putting up, pouring a lot more money back in.


Uh, I'm not, I, I am on payroll, uh, so I am getting something, but I am starting to look forward to the next pediatrician I'm gonna hire, so I'm saving that up. So, so if I do pay my, you know, whatever I'm paying myself, it's really with the mindset of like, I'm probably gonna have to use this again to pay another pediatrician soon.


Probably in 2024. 2020 five's when I'm looking for the next one.


They might be listening to this podcast, so That's awesome. When you, yeah, when, when you talk about, hi hiring Dr. Gallagher recently, and then Dr. Brek, and then also Dr. Solomon.

I wanna ask, so Barry, Evan, and Solomon are mm-hmm. They're independent.


So Gallagher is true, a true employee. Dr. Barry is, uh, he licensed the brand. And so, uh, with brand licensing is basically he's, he pays me an annual fee. You know, I've, I set up his back office structure and, uh, and then, you know, whatever he is making, he is making Dr. Saman, uh, she's a co-brand. Uh, so she started up her, she was the first family practice D p C in Westchester.


And then she was struggling financially. It just wasn't taken off. I was taken off and I, I was like, uh, I think six months in, I, I kind of was, we had a kind of like regular kind of meetings just to see how it, it was just us. Like we, I didn't, I, I approached her initially to be like, Hey, I'm starting up my own practice.


I don't wanna be viewed as a competitor, just as a collaborator. So we had regular kind of check-ins and, you know, uh, after six months of me being. Uh, after I started, I, I said, Hey, how are you doing? She's like, not good. I think I'm gonna close. I was like, don't close, maybe close this office, but come to my office.


I have an extra room. I have a lot of, I have a lot of the parents want, uh, what their kids are getting from, from me. So she's a co-brand, so I don't, I didn't hire her. Uh, she basically, and then once she joined, She basically, we both elevated it, it elevated both of the practices.


So I, I don't know if it was at the P'S DP C Mastermind or if it was somewhere else, but somebody was talking about how, like, when you go get gas, uh, you know, you go off the freeway and it's like there's a shell and a Chevron.


Oh, was that me? You? Yeah, that was me. That was, that was absolutely genius. Like for people to really understand. It's not competition, but collaboration and it increases awareness in the market. Like, that was, I, I like, I mean, it literally stuck out in my mind because it's like, you know, when, when A D P C opens, it means that there's a ton of people who are looking for that care that another D p C needs to open.


Yeah. Not that like, oh, they're all gonna jump ship and then go, because remember, yeah, they're buying into you as a, the doctor and not, you know, oh, d they're not, yeah, they're not buying into DP C they're buying into that doctor. Then that's key. So if, uh, we're not competition or collaboration, uh, you can, another pediatrician can open up across the street from me.


I'm not gonna care. I'm kind of at my own capacity anyways. Like, cool. I mean, I don't know why you didn't just join me, but, okay, fine. If you wanna do things the hard way you can. I, you know, but yeah, it's, it really, there's, I think it's also important, a, a question I'm always asked is like, but with your model, how do we take care of everyone?


I'm gonna be blunt, I'm not taking care of everyone. I'm not, and do I care? Yeah, I care about the patients who are my patients. But you know, like us trying to take care of everyone. Well, how's that going? Because we're not doing it. Like we, we we're focused too much on the payment side, and we're not taking care of everyone.


The kids are left behind. They really are just in your, in your town alone. 119 kids need to Tdap and half of them are insured. Well, how's that working out?


Well, yeah. And I mean, when we talk about, uh, Equity. Like, you know, I think about how there's a family medicine doctor in the Santa Cruz area who has over 4,000 patients, and it's like, great, you have a doctor, but what kind of care is that and how are you, you know, how easy is it to get in to see that doctor?


It's so interesting to, to hear people talk about their healthcare and they don't see the value proposition sometimes of D P C because they're so exasperated with the system as patients, you know? So no matter what insurance they have, they can have double, you know, Medicare.

And so I, I rarely ever talk about the finances.


I rarely do, just because like the general American. The American public can't do math. We know that we're famous for being poor at math, so I don't even talk about it, cuz also I don't talk about it because that's just not my brand. I'm, my brand is not there to save you money on your insurance. You will, you will.


Like, uh, we're priced well below the average family deductible of New York. You are going to save money with us. I just don't tell you that because I don't wanna talk about it cuz you're not gonna get it. Most people don't get finances, so why even talk about it? The, uh, what we, what we should talk about is the care and the care that, like, you know what?


Your kid fell and, uh, needs stitches on a Sunday afternoon. Cool. I can meet you in the office in 15 minutes. Done. And, uh, you know, that's, that's it. Oh, and by the way, you, I just saved, I, I don't say, by the way, I just saved you $1,200 on an ER visit. I'd say that. Because I don't need to, well, that's not what's gonna be shared on Facebook.


Like, oh no, Dr. Gupta just saw my kid in 15 minutes. Like, yeah, don't, don't you have that? Oh, I do. All of our kids

do, right? Oh, yeah. Yeah. Oh, this Sunday. This Sunday I rented out the movie theater for, uh, super Mario Brothers. So I'm gonna take a selfie with a hundred kids in my practice. Uh, it's gonna be great.


Uh, that's another thing. It's like, Hey, yeah, it's fun. We're all gonna hang out. I love

that. So that's good. Yeah. Let me ask you this because as you know, there, there might be again, your future D p C pediatrician partner who's gonna open the Brooklyn office and then figure out, help figure out the logo.


When people hear about, you know, this, this awesomeness of like not only the patients getting access when they need it, but also that you're. Like you, you talked about like you're able to keep up your skills, you're able to do the things that you wanna do as a physician and bring all of your nerdiness and all of your, um, education and technical skills to being able to treat every single patient of yours.


That is so attractive to medical students and residents. Like, hands down, when they hear what we're actually doing as doctors, they flip out. Like, they're like, yeah. You know, they, they, and this has happened for years and I love that the trend is growing, but like they migrate, like everybody wants to hear the one doctor talking about D P C.


And as we're in this space of more and more people are getting educated about it, they're being mm-hmm. They're aware of it. And this movement continues to grow. What would you say to people who are thinking about D P C who are also thinking about. Could I to pay off my loans, do an employed position?


Because when it comes to New York and non-competes, that's a thing. Versus in California. Yeah. Where it's not. So how would you advise people who are thinking about D P C to think about their contracts and choose them carefully and wisely as they're planning D p C in the future? So

universally, doesn't matter if you're in New York or California, do not sign a non-compete.


Like just don't. I mean, just physicians across the board nationwide have to stop signing non-competes. They're obsolete. You are obsolete, they've replaced you, they are easy to replace you. So why are you giving them the power to not let you work in your state? Again, don't sign an non-compete. It's just ridiculous.


And, uh, can you do an employed position and start up a practice at the same time? Is that your question? So for me, I needed, because I'm starting a, this is a brand new market, right? I went a hundred percent all in. I didn't sit by on my butt like waiting for the phone to ring. No, I was out there just pounding the pavement.


As I'm pounding the pavement, I have Lauren, Don Creative group, you know, she's doing the social media marketing, you know, I'm pounding the pavement, shaking hands, kissing babies. This is basically, I was like, I was running for like the mayor and, and, and that was it, just getting the visibility out there.


If I were trying to do this on the side, as, you know, if I was doing my moon li at my d p c as my moonlighting job, I don't think I would be where I am right now. I had to a hundred percent commit to this. Now, is it doable? I, I, I think so, but I think really you have to be honest. Like, is your market ready for your practice?


If, if your market is ready, if there's a couple of other practices in, in the area that are already doing it, then your market's ready, then you could probably moonlight and like, uh, build. But if, if you are creating a brand new industry, You kind of have to go all in on it, that that's why like, I, I don't know, like you really do need to have that budget.


You need to have a nest egg really set up if you're gonna go this route. Uh, I think, I think marketing, d p c pediatrics is gonna be much more of a challenge because, you know, one of the first questions you might get is like, oh, but I already have insurance. You know? And, and that's one of the things, it's like, well, you're not competing with their insurance.


You're never competing with free. Right? That's something you never compete with. You never compete with free. You have, you compete on the product. You tell them what the product is all about, that's gonna take time. And as a pediatrician, you have to tell these families what it is that you offer. And what you're gonna dedicate to those, their, their kids.


So I think it may be a bit more challenging to do it if, if you have a full-time job to start your own practice. So, I don't know. I mean, is it done? I'm sure it's being done. I couldn't have done that.

What about your thoughts on how to incorporate d PCPs into employer health plans?

Yeah, I don't know.


I, I, I, I tried, I tried and failed cuz like, it just made zero sense, right? Child labor is not a thing in this country, so it just was not gonna happen. Now if I do have a few employers who have paid for the memberships, Only a few, but the thing is, look, a a kid is going to be at least an 18 year commitment.


People change jobs all the time, especially if you're in the tech industry, right? I, I think if you're trying to bank on employer paid, uh, memberships, you're gonna have to deal with a lot of swings in your own financial stability. Uh, because jobs change a lot. People keep moving on. So I tried. I don't think it's a market for peds.


I don't think it's there. And I think it, uh, it's too complex in a state like New York where everybody else has insurance. I just don't know where it's fitting, you know, uh, there's a, you know, I don't know where that role is, so I wouldn't get too hung up on that. And that's my advice. Don't even bother with that.


That part get hung up on how you're gonna provide the best care possible for your

kid. I love that. So let me ask you in closing. Yeah. Do you have any other advice for people who are considering doing D P C in the pediatric space? I think, um, if you're gonna go into the pediatric space, have patience, have a thick skin, and fully know yourself and why you're doing this, know your why, what is your why and know it, commit to it and you really gotta believe in yourself because God, your family is not gonna believe in you.


My wife did thankfully, but the rest of my family kind of questioned it. My neighbors definitely doubted it. My community definitely in the beginning, doubted it. I mean, some people even called me evil for not taking insurance. But I think, you know, it was the passion of pediatrics, of being a member of this community that really showed, and that's why we're thriving now.


But it took a lot. Of effort. A lot of effort, and it's been well worth it. Look at the impact that you're making. So thank you so much Dr. Gupta, for joining us today.


Thank you. Thank you for having me. I've, I'm honored to be here and I'm glad I finally get to sit and chat with you.


Next week look forward to hearing from Dr. Lola Ashia of InTouch Primary Care in Sugarland, Texas. If you've enjoyed the podcast and you haven't yet done so, subscribe today and share the episode with a physician you may know who needs to hear about D P C. Leave a five star review on Apple Podcast and on Spotify now as.


Well as it helps others to find all these DPC stories. Lastly, be sure to follow us on social media. If you're wanting to continue learning more about DPC in the meantime, check out DPC news.com. Until next week, this is Marielle conception.



*Transcript generated by AI so please forgive errors.

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