Redefining Sustainability: Dr. Pouneh Alizadeh’s Path from Employed OB/GYN to Direct Specialty Care and Locums

Maryal Concepcion
14 minutes ago
7 min read

Direct Specialty Care Doctor: Lessons in Boundaries, Family, and Flexibility from a Physician Who Crafted Her Own Version of Success

Dr. Pouneh Alizadeh in a blue and white striped shirt. — Dr. Pouneh Alizadeh

Direct Primary Care (DPC) is more than a practice model—it’s a mindset shift, an act of reclaiming autonomy, and, for many physicians, a crucial step toward regenerating the genuine joy of medicine. Each DPC journey is unique, colored by personal circumstances, specialty, and the desire to balance professional fulfillment with a rich home life. In this blog post, we dive deep into Dr. Pouneh Alizadeh’s “My DPC Story” episode, drawing out rich insights for those contemplating their own DPC evolution—particularly physicians at the crossroads, worried about boundaries, sustainability, and family.

If you’re familiar with the nuts and bolts of DPC and are seeking to customize your path, Dr. Alizadeh’s experience is a journey in self-reflection, intentionality, and creative career-building. Let’s unpack her story and what it can mean for yours.

From Traditional OB/GYN to a Customized Practice: Recognizing the Need for Change

Dr. Alizadeh’s launching point is resonant for any specialist or primary care doctor feeling the grind of shift work, call schedules, and institutional pressure. After training and then working as an employed OB/GYN, she “opened a practice as a resident,” transitioned into leadership, and found herself grappling with the realities of 24/7 call.

As she puts it, “As an OB GYN in residency, it's a lot different when you take... shift work. And so from an hours perspective, switching to being on Q3, Q4 call was a huge—was a huge change for me. And so there were definitely times where I'm like, how is this sustainable?...I am human, and sleep is kind of important.”

Key Takeaway for DPC-Minded Physicians:Even before full-on burnout strikes, it’s valid to look ahead and ask, “Is this sustainable? What will this look like at fifty? Sixty?” As Dr. Alizadeh emphasizes, you don’t have to be “burnt out to a crisp” to warrant a change. Proabactive self-awareness—without guilt—is foundational for any journey into DPC or a custom-built clinical life.

The Family Factor: Realigning Practice to Life

One of the most powerful portions of the episode centers on the intersection of Dr. Alizadeh’s professional aspirations and her identity as a mother. After having two children during residency and her early attending years, she hit a crossroads:

“I really realized that there was going to be kind of a fork in the road of, like, how I wanted to show up as a parent and how I wanted to balance that with my career.”

Dr. Alizadeh encountered the questions many parents face:

“Do I delegate school pickups to a nanny, or reserve my energy for games and special events?”
“Does being present mean doing all the mundane bits, or just the ‘big’ ones?”

Ultimately, her answer was to lean all the way in: “For me, I really just wanted to be there for everything. I wanted to drive my kids to practice... I kind of like that.”

Advice for Reflective DPC Physicians:Define presence for your own life. There’s no one-size-fits-all. Whether you outsource logistics or crave everyday involvement, give yourself permission to configure your career around what fills your familial cup—not simply what others expect.

The Courage to Draw Boundaries—And Leap

Dr. Alizadeh’s transition didn’t start with a perfectly drafted business plan. Instead, it began with a moment of radical honesty. After advocating for herself in her leadership role and being denied the time flexibility she needed, she was “told, well, yeah, you're great, you're probably better than most, but it wouldn't be equitable to give you more time than somebody else.”

The shock? Within days she resigned, without her next step mapped out.

Her biggest surprise, and a lesson for all physicians afraid of “disappointing” loved ones, was the uniform support from her family after she shared her decision. “I think I told my husband first and I said, I think I'm going to quit my job. And he goes, oh yeah, about time. I was like, wait, what? I thought I was holding it together really good...”

Reflective Question:What assumptions are you carrying about how those close to you will react if you change course? Are you limiting your own options based on imagined objections?

Embracing Locums: Autonomy, Exploration, and Reinvention

Rather than immediately diving into private practice, Dr. Alizadeh leveraged her skillset and entered into locums work—taking temporary call shifts in smaller communities, sometimes for weeks at a time, sometimes blended with telemedicine and eventually, her own direct specialty care (DSC) offering.

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This approach provided key advantages:

Financial Buffer: Locums gigs can be lucrative—though unpredictable—and can support you while building a practice intentionally (not under duress).
Creative Space: “The first time in a very long time where I slept every night. Like eight, eight to nine hours a night for three weeks straight...I felt like a whole new human.”
Professional Growth: Working across various hospitals, Dr. Alizadeh acknowledged the need to be “malleable and flexible,” learning to integrate herself into different teams and settings—a sharpening of skills and business confidence.

Pro Tip for DPCs Considering Locums:“View yourself as the business, as the service, and you conduct yourself in that way, it works really well. And you just have to be able to say, if it's not the terms that you agree to, that you walk away...There are going to be plenty more opportunities.”

Scarcity mindset is deeply ingrained in medical training—break that chain intentionally.

Building Flourish Gynecology: A Custom Direct Specialty Care Practice

After settling into locums, Dr. Alizadeh recognized an additional gap: the desire for continuity, connection, and providing care outside the constraints of institutional policies. “I started to miss like longitudinal care and continuity… I missed having a little bit of a home base.”

Her answer? Flourish Gynecology—a direct gynecologic care practice initially telemedicine-based, focused on perimenopause, menopause, and general gynecology for women seeking “just a physician in my own way without an ivory tower.”

Her DSC practice wasn’t conceived to immediately rival her locums income. Rather, it was a passion project: “Locums is still my primary income and I’ve intentionally grown my DPC slowly. I don’t have any employees, it’s just me.”

Real-World Takeaway:Direct care doesn’t have to be your sole financial vehicle from day one. There is courage and wisdom in growing gradually, in letting a side passion become a main focus when and if it feels right for your whole life.

Financial and Administrative Strategy: Keeping It Lean, Keeping It Legal

Dr. Alizadeh emphasized two foundations for any DSC or DPC practice blended with locums:

Lean Overhead: By starting with a telemedicine platform, her initial costs were “not terrible”—EMR, medical malpractice, Google Voice, and a few digital tools.
Legal Architecture: She set up a PLLC (Professional Limited Liability Company), used DBAs for her direct care venture, and subcontracted consulting or medical director work—all under the umbrella. Each state has nuanced requirements, as host Dr. Maryal Concepcion reminds us (California, for instance, mandates S-corp status for DPC).

Pro Tip:Talk to your colleagues, accountant, and a healthcare attorney—don’t just copy-paste someone else’s structure.

Boundaries, Flexibility, and Time: The Constant Dance

One of the most important themes is the intentional balancing act Dr. Alizadeh practices, not just once but in recurring self-checks. She books blocks of time for locums, schedules GYN visits when she’s home and not on call, and accepts that “I noticed that I will fill my time regardless of what it is...every couple of months, quarterly, I check in with my husband, check in with myself...Did I overdo it?”

She isn’t afraid to downsize her workload for a season and is comfortable evolving the practice—perhaps later choosing a hybrid model or employing staff as her needs and energy shift.

DPC Lesson:Sustainability isn’t static. Organizations rotate faculty, parents gain or lose caregiving burdens, interests wax and wane. Building a structure that allows for regular inventory—and permission to change course—is part of what makes DPC powerful.

Community and Networking: The Secret Ingredient

Leaving the familiar world of employed medicine can feel frighteningly lonely. Dr. Alizadeh is emphatic: “Surround yourself with people that do this because you will find a lot of naysayers...But really, you can take care of yourself, you can be a business owner, you can give your own benefits. There is a lot to learn. You don't have to learn it all at once.”

She specifically recommends:

FlexMed Staff: A physician-founded organization supporting locums careers.
The Rise Up Summit: An annual virtual conference blending DPC and locums topics, fostering crucial peer connections and practical strategies.
Local and National DPC Groups: For mentorship, legal resources, and sharing lived experience.

Crafting Your Own Version of Success: Questions for the Journey

As you consider your DPC evolution, draw on Dr. Alizadeh’s example to reflect on these questions:

Am I waiting for “total burnout” before honoring my real needs and boundaries?
How do I want to define presence and fulfillment—both at home and at work—in the coming years?
Could I leverage locums as a bridge to more autonomy, or as a blended model?
Am I letting fear of the unknown—or fear of what others will think—hold me back?
Is it time to take a self-inventory: is my workload serving me, my patients, and my family?
What would a phased, slow, or “passion project” DPC launch look like, rather than a leap-or-nothing approach?

Final Thoughts

Dr. Pouneh Alizadeh’s story isn’t a template—it’s an invitation to reimagine what’s possible and to claim a version of medicine that nourishes the doctor and the human behind the white coat. Whether you’re contemplating DPC, blending specialty care, or seeking a more humane balance, let her journey be proof: sustainability, joy, and professional impact flow from honest self-reflection, incremental shifts, and the courage to say, “No more,” even—especially—without a perfect plan in hand.

For more ongoing inspiration, never hesitate to listen to the stories of those just a step or two ahead of you. Your journey to sustainable, tailored direct care is yours alone—but you don’t have to walk it alone.