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Writer's pictureMaryal Concepcion

Overcoming the Non-Compete: Dr. Rachael Dirksen’s Journey to DPC

Updated: 5 days ago

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Dr. Rachael Dirksen. Photo credit: Maggie Rechkemmer

In this latest episode of the "My DPC Story Podcast," hosted by Dr. Maryal Concepcion, we had the pleasure of hearing from Dr. Rachael Dirksen, founder of Remedy Internal Medicine. Dr. Dirksen's story, from her rural upbringing and diverse academic background to her challenges and triumphs in the healthcare system and a noncompete in particular, paints a vivid picture of why DPC is not just a model but a movement.


Early Influences and Educational Journey

Growing up in rural Charlotte, Iowa, Dr. Dirksen understood firsthand the challenges of accessing healthcare. The closest primary care providers were a considerable drive away, and specialty care was even harder to come by. This environment cultivated a deep appreciation for relationships and community—a value she aimed to bring into her medical career.

Initially set on becoming a dentist, she pivoted to medicine, influenced by her passion for science and patient interaction. Her academic pursuits were uniquely blended, majoring in biochemistry and English literature. Her transition to medicine was cemented by the guidance of an English professor who saw her potential beyond even PA school and encouraged her to aim for medical school.


Volunteer Experience and Early Career Challenges

A pivotal experience in Dr. Dirksen’s journey was her volunteer work with AmeriCorps VISTA in Madison, Wisconsin. Living on a low income with limited insurance coverage, she faced a medical bill she couldn't afford, a stark reminder of the gaps in the healthcare system. This gave her a profound understanding of the complexities and frustrations that patients face, which she would carry into her medical practice.


Dr. Dirksen's residency at the University of Colorado further illuminated these challenges. While she appreciated the program's primary care focus, the systemic inefficiencies were glaring. Patients often left without essential follow-up care due to insurance or residency restrictions, and she witnessed firsthand the discrimination in emergency rooms and the consequent emotional toll on healthcare providers.



The Leap to Direct Primary Care

Despite these hurdles, Dr. Dirksen found enduring value in her continuity of care rotation, where she built considerable relationships with patients. It was these experiences that propelled her towards Direct Primary Care, favoring long-term patient relationships over episodic, transactional interactions.


Frustration with fee-for-service medicine’s demands and its impact on work-life balance played a significant part in her shift. The unsustainable workload fueled her decision to seek a model aligning more closely with her values—a model where patient care isn't a victim of insurance constraints but thrives on trust and accessibility. Encouraged by the positive experiences of colleagues practicing DPC, she made the conscious decision to transition.


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Navigating Legal Hurdles and Finding Fulfillment in DPC

Opening her Direct Primary Care practice was not without challenges. Upon leaving her university position, a non-compete clause threatened to halt her plans. Originally faced with a demand for $140,000, she negotiated tirelessly, eventually paying $50,000. This period underscored the often punitive nature of non-competes, particularly in the healthcare sector, which can stifle physician availability, especially during critical shortages.


Support from an employment lawyer who advocated for negotiation was crucial. Dr. Concepcion echoed the sentiment, highlighting the profound impact of such restrictions on both personal well-being and career trajectories.


Once free of these constraints, Dr. Dirksen found immediate benefits in DPC. She now enjoys building meaningful relationships with her patients, a process she cherishes deeply. The financial viability of DPC became evident, countering misconceptions that it lacks stability compared to fee-for-service models. In fact, she attests to the financial and emotional satisfaction DPC offers, emphasizing price transparency and patient empowerment.



Cultural Shift Towards DPC

The podcast also illuminates the growing cultural acceptance of Direct Primary Care. Dr. Dirksen's practice, Remedy Internal Medicine, serves a demographic ranging from youthful patients with chronic conditions to an older Medicare population. The value of accessible, personalized care is becoming increasingly recognized, resonating with those nostalgic for the relational aspect of healthcare.



Navigating Legal Hurdles and Finding Fulfillment in DPC

Opening her Direct Primary Care practice was not without challenges. Upon leaving her university position, a non-compete clause threatened to halt her plans. Originally faced with a demand for $140,000, she negotiated tirelessly, eventually paying $50,000. This period underscored the often punitive nature of non-competes, particularly in the healthcare sector, which can stifle physician availability, especially during critical shortages.


Support from an employment lawyer who advocated for negotiation was crucial. Dr. Concepcion echoed the sentiment, highlighting the profound impact of such restrictions on both personal well-being and career trajectories.


Once free of these constraints, Dr. Dirksen found immediate benefits in DPC. She now enjoys building meaningful relationships with her patients, a process she cherishes deeply. The financial viability of DPC became evident, countering misconceptions that it lacks stability compared to fee-for-service models. In fact, she attests to the financial and emotional satisfaction DPC offers, emphasizing price transparency and patient empowerment.


Cultural Shift Towards DPC

The podcast also illuminates the growing cultural acceptance of Direct Primary Care. Dr. Dirksen's practice, Remedy Internal Medicine, serves a demographic ranging from youthful patients with chronic conditions to an older Medicare population. The value of accessible, personalized care is becoming increasingly recognized, resonating with those nostalgic for the relational aspect of healthcare.


Resources like "Never Pay the First Bill" by Marshall Allen and Dollar4.org, which help patients manage medical bills, were noted as valuable tools in this evolution. The mutual support within the DPC community, alongside dedicated resources, underscores this cultural shift toward a more patient-centered approach.


Dr. Rachael Dirksen’s journey from rural Iowa to the forefront of Direct Primary Care highlights the profound impact of personalized, insurance-free medical practice. Her story underscores the enduring relationships and patient empowerment that DPC fosters, offering a viable and fulfilling alternative to traditional fee-for-service models. Join us in our next episode, and consider supporting our podcast through Patreon for more inspiring stories from the world of Direct Primary Care.


For further insights and resources on DPC, subscribe to the "My DPC Story Podcast" and stay connected with our community. Let's continue to champion a healthcare model that values patients over paperwork.


 

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