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Why DPC? A Pediatrician's Powerful Switch Explained

Dr. Andrea Wadley - Direct Primary Care Doctor, Pediatrician



DPC Pediatrics and Lactation through home visits and telemedicine
Dr. Andrea Wadley of 127 Pediatrics

In a candid discussion with Dr. Maryal Concepcion on the My DPC Story Podcast, Dr. Andrea Wadley unveils the intricacies of her transformative journey into Direct Primary Care (DPC). She opens up about the motivations, struggles, and unique triumphs experienced while establishing and running her DPC practice, 127 Pediatrics, dedicated to exceptional pediatric and lactation care.


The Venture into DPC: A Leap of Faith

Dr. Wadley shares the critical moment she took the plunge from a traditional insurance-based hospital position into the world of DPC. Guided by mentors, she embraced entrepreneurship, patient-centered care, and the balance between professional obligations and personal life. Her mentors' support and wisdom proved invaluable as she navigated the early stages of her endeavor—a testament to the importance of guidance in healthcare innovation.


Fostering a Community of DPC Pioneers

Understanding the value of mentorship, Dr. Wadley became a beacon for aspiring DPC practitioners herself. Through mentorship programs, social media groups, and webinars, she supports those drawn to the DPC model—underlining the significance of patience, financial acumen, and the artistry of cultivating a sustainable practice.


Innovating with Compassionate Care

Dr. Wadley's pediatric practice distinguishes itself by profoundly focusing on personal attention, such as home breastfeeding services. This unique approach facilitated growth through referrals and solidified her reputation as a pediatrician who puts family needs at the forefront. Dr. Wadley opens up on her challenges and adjustments, such as adapting to more home-based care and wellness visits amid the pandemic, illustrating the vital need for flexibility and innovation in healthcare.


Striking a Balance in Medical Practice

As her practice became busier, Dr. Wadley had to evolve her practice's focus to maintain professional enthusiasm and personal well-being. She emphasizes smart business decisions such as using effective EMR systems, automation, and shared call responsibilities to keep her practice running smoothly. Patient turnover, generally due to relocation or differing philosophies, posed challenges to which Dr. Wadley responded with grace and adaptation, ensuring her practice continued to serve her community effectively.


The Power of Personal Connection

The episode touches on a vital aspect of DPC - the close relationship between physicians and patients. Dr. Wadley's recent board certification in breastfeeding and lactation medicine underlines her dedication to serving specific patient needs. Dr. Concepcion and Dr. Wadley discuss at length how this specialization not only caters to their patient's immediate health concerns but also fosters a trusting and intimate doctor-patient relationship that stands in stark contrast to the impersonal nature of larger, fee-for-service models.


Financial Prudence and Practice Stability

Launching 127 Pediatrics required financial savvy and a considerable upfront investment. Dr. Wadley speaks candidly about her initial funding, the cost structure of a DPC model, and the financial strategies that allowed her to build a sustainable practice without compromising patient care quality. Her story is a blueprint for financial responsibility and strategic planning in a DPC business model.


Resilience in the Face of Adversity

Dr. Wadley's personal narrative takes a profound turn as she reveals her diagnosis with multiple sclerosis. Musing on the impact this had on her practice and personal life, she shares how this led to raising fees and, surprisingly, a healthier and more secure future for her clinic. In facing her health issues, Dr. Wadley embodies the resilience that characterizes so many in the medical profession, underscoring the importance of self-care for caregivers.


Advocating for the Future of DPC

Lastly, Dr. Concepcion wraps up with an important reminder to cherish the core values that make DPC so special—personalized care, professional autonomy, and patient advocacy. Through this engaging conversation, listeners are encouraged to subscribe, follow social media channels, and join the MyDPC Story Patreon community for deeper insights. The episode concludes with an appeal to stay informed and continue advocating for the burgeoning movement of Direct Primary Care.


BIO

Dr. Andrea Wadley is a board-certified pediatrician and newly board certified in breastfeeding medicine. She completed her medical school and pediatric training in San Antonio, Texas at the University of Texas Health Science Center at San Antonio. She returned to the Dallas/Fort Worth area of Texas after residency to live with her husband and be close to her family. When she first began her career, she was a pediatric hospitalist who cared for newborns during their initial birth hospital stay. She helped to cover multiple birthing hospitals in the Fort Worth area. After her time as a hospitalist, she desired to return to general pediatrics. As she looked over the landscape of practices in her area, she knew that she wanted to provide a different solution for families. Therefore, she opened her direct primary care pediatric and lactation practice,127 Pediatrics, in 2018. She does house calls only and cares for a small number of pediatric patients as well as offers lactation consults to patients outside of the practice. 


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Transcript*


  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 MyDPCStory podcast, where each week, You will hear the ever so relatable stories shared by physicians who have chosen to practice medicine in their individual communities through the direct primary care model.

I'm your host, Mariel Concepcion, family physician, DPC owner, and former 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 saved my life and my career, and not only am I a DPC doctor, but I'm also a DPC patient. I'm Dr. Wadley, and this is my DPC story.

  📍 📍 📍 📍 Dr. Andrea Wadley is the owner of 127 Pediatrics. She is board certified in both pediatrics and breastfeeding medicine. She opened 127 Pediatrics, inspired by Psalm 127, in July of 2018 in order to give families in the Coleyville Fort Worth, Texas Areas a better option for personalized general pediatric and lactation care.

Her interest and approach toward breastfeeding parents stems from her time as a newborn hospital pediatrician. When Dr. Wadley is not seeing patients, she's caring for her young daughter, supporting her husband in his business, and providing for the needs of their two dogs. As a family, they love adventure.

They also enjoy their involvement in a local church. Dr. Wadley obtained her undergraduate degree from Texas Christian University in Fort Worth, Texas. She completed both medical school and pediatric residency at the UT Health Science Center in San Antonio, Texas. She has appeared as a top doc in Fort Worth and 360 West magazines on multiple occasions.

She offers a wide range of pediatric and lactation services, both in person and online. And virtually.

 Welcome to the podcast, Dr.

Wadley.

Thanks for having me. I'm so excited. You said in your opening statement, you are not only a DPC physician, a DPC pediatrician, you are also a DPC patient. So we'll definitely get into that more, but I think that really brings to the table, a different understanding than someone who might be a DPC doctor, but not have a DPC doctor themselves. So with that, recently you had shared on a different podcast about your experience being eight years in a insurance based practice, hospital based practice before you opened your TPC.

Looking back as the doctor that you are now, five years into your DPC, what would you have wanted to ask differently about every year that you continued on in that hospital based practice before you left?

Yeah, so I was a newborn hospitalist. I got that job straight out of residency. I had moved to the area to live with my husband. Finally, we got married and lived apart and all the good stuff. But it was a fantastic job and it started off with just me and one other pediatrician. And we were covering hospitals.

We were seeing babies. It was a happy time. And then, the corporate structure took over lots of. pediatricians, lots of hospitals, lots of administrators, and then we always had a boss that was never a doctor. So it just got to be more than I really bargained for. So looking back, I really wish I could have Had the foresight to renegotiate my contract each year as things were changing and developing and, we were taking on more and more hospitals to cover, but we weren't taking on more and more staff, pediatricians, and so I was doing we all the few pediatricians that were there, there were doing the job of two or three people, and so I think just having a voice and speaking up and renegotiating and what my, RVUs and salary and stuff would have looked like at that point.

So definitely. And when you say that, there's listeners out there like I was not that far away from this place myself. They're thinking, but I don't even know what I'm worth. I don't even know what my RVU value is. So do you have any tips on how people can learn how to value themselves as physicians?

Yeah, so I think in residency, we don't. Do enough of, or even in med school, we don't do enough at the business side of medicine. And I, I jumped into this job because I needed a job. That's what I did. You know, I did all this training and I just, I needed a job. And so I got a job well, and it was easy to just let the administrators do their administration, without actually knowing, but I would, I would advise people who are starting off, just making sure you, you some of those. Numbers and figures and ways that they're talking about things because you're the one doing the work and you're the one producing that income So you have to have a handle on what that looks like and you know How much our view it takes to earn your salary how much beyond that are you going?

What really you should be paid for the work that you're doing? And just for those people who aren't aware, this is where to talk to other DPC physicians in your area. Ask what is the MGMA data? What is your region showing? What have other people been paid?

Especially if you're looking for a bridge to DPC, if you're going to do a fee for service type gig where you're paid on RVUs and also definitely ask the people who are there. Like, how many years have you been here? Have you been able to renegotiate your contract? Any tips from their perspective as well?

Because, it's definitely going to be administration dependent, hospital system, corporate dependent. So those types of things I think it's sage advice to say, you know, renegotiate your contract because, we think about cMS rates reimbursement for, the codes that we get, they always change.

So how do our, our reimbursements stay stagnant. So great point. Now, one of the things that you had also mentioned in a previous podcast is that when you were thinking about I, I'm really interested in DPC. There were very few concierge pediatricians in your area and just DPC and pediatrics was not that common as much as it is now.

It's still growing. It's, I think you said there's over 500 people in the DPC pediatricians group, but on Facebook. But When you were deciding this is it, this is the way I'm going to go forward, what was it specifically that helped you as takeaways from talking with those concierge pediatricians and anybody else in the DPC space who saw kids when you decided to open?

Yeah, so everyone in town knows this one concierge pediatrician that does home visits. And so thankfully I found her and thankfully she was very kind and talked to me about, our practice model and what she did and how long it took her to get back to the income that she had left, in her fee for service practice.

And so she was very inspiring, but it really ended there. There was really no one else to talk to, like no one else. was doing this. And so I'm not sure honestly how, but I stumbled upon the family doctor. It was, it's mostly family doctors, the main DPC Facebook page. And I remember finding that page.

I was at a CME conference. I was there, in the hotel room by myself. And I remember Reading that all those posts like that whole page for one whole evening and like, Oh, wow, I can do this. Why can't this work for kids? And so what she was saying combined with the more of a, she was more concierge, but also didn't take insurance.

So she was, you know, a higher fee and she was in a different kind of. setting as far as income goes in the neighborhood that she was in and people knew her. So it was a little bit different than me just starting from zero. And so the idea of DPC appealed to me because I've always wanted to take care of, the middle to lower class families.

left out of the health care game. And so just DPC just resonated more with me. something that Dr. Nitin Gupta had talked about another pediatrician in DPC and also, Dr. Lisa Davidson She's a family medicine doctor

in Denver, they both spoke about how you know, dr. Gupta spoke about how You know, we think about gasoline stations, there's four in a corner, and it's not oh, if somebody opens across the street, we're going to all close down. It's, there's, that's the gas station corner. And Dr. Lisa Davidson had talked about, she's closed to new patients, but she still tells other people but there's this other DBC doctor in Denver open.

So I just want to go back to that concierge pediatrician, because was there ever like you what I'm getting from your statement is that she was like, Hey open arms welcome, welcome to this world of amazingness, rather than I can't talk to you because your competition. Yeah, so she really was very generous with her time and telling me stuff.

Beyond that, I know other people had sought out her guidance and, she got to the place where she just couldn't tell everyone anymore. And so they started coming to me instead. And so I understand that piece of it, but yeah, so it was very generous of her to tell me all of that information and kind of just give me a framework.

It was like a 20 minute conversation, but really I learned the majority of the rest of it. from the Facebook page, which is amazing that you can start a practice by reading a Facebook page. And then, thankfully my husband is an entrepreneur and went ahead of me. And so he was able to do some, help me with some of the entrepreneurial, like here's how you set up your business entity and that kind of stuff.

So I was very fortunate. That's very cool. I'm laughing because it's like the things you didn't learn in med school that you could Learn how to open a practice on Facebook. And, Dr. Janice Olikoski, she bought her practice off of Facebook. There, there are some useful things on Facebook.

Oh, my goodness. So let me ask you, when you decided to open up as a home visit model, which you continue to this day, what made you decide on a home visit model versus having a home visit model plus a brick and mortar? So honestly, part of it was fear. So I was the only one in this town or really anywhere that I knew of that was silly enough to do pediatrics as this is this model, in DPC and try and figure out vaccines and try and figure out all the things. And I was like what have it in real estate in this area where I live? It's a suburb Dallas, Fort Worth, and it's so expensive. And we had just bought, a business suite condo for my husband's business. And I was like nobody's going to loan us money again.

And so I thought so part of it was fear. What if this fails? I don't want to be into building. And then part of it was I, wanted really Very much to take care of newborns and I with all of my newborn experience in the hospital And I got really into helping mom's breastfeed and try and teach them all of those things that they should have learned You know months in advance in the 24 hours that I had them in the hospital I just knew that my practice would be focused on young families with newborns and really just home visits Works better for that trying to leave the house with babies.

Not so fun. No, not fun at all, especially if you have more than one and you're like, okay as I wrangle who goes in the car first and who's running around crazy while I'm trying to, latch in the car seat, I totally get that. Now, when you talk about fear one of the things I want to ask is about finances, because when you were leaving your job even though you were, spoke about how, you weren't necessarily being compensated, but I'm guessing compensation was pretty good for being in a hospitalist position.

Going into DPC, did you, how did you financially plan to open? Yeah. So I really was fortunate. My hospitalist job really was pretty lucrative and the, the bad part of being five pediatricians when there should have been 10 was. That it was busy and it was exhausting and it burnt me out, but the good part was we made the, that money so I, whatever I easily made my RV use in the first few days of the month and then the rest of it thankfully was bonus money.

And the, you know, that bonus money got lower and lower as time went on and things changed and the structure of the way they were doing things, but thankfully I had paid off. My med school loans and we had paid off some parts of the house and the car and, so I had some wiggle room and so I really did start with just the savings that I had, thankfully, and could you give us an estimate as to your opening budget? What did you set aside to be able to open the practice you wanted? So really, I spent more money on lawyers and accountants and stuff than I really needed to. So I ultimately ended up spending about 20 grand, but I think I could have done it for a lot less if I had done some of the legwork first and then presented it to the lawyer.

I found a great business lawyer who is fantastic, but he did a lot of the, Oh, what is DPC and how does this work with the law sort of research that I paid for. And I probably could have come to him farther along than I did. But yeah, so I invested that and I paid myself that money back pretty quickly within about 18 months.

Awesome. And in terms of your legal status, what are you what is your business? Is it an LLC? What is it in Texas? I have a Physician's Association. That's what so in Texas you can have a PLLC or a Physician's Association, and he advised me to do Physician's Association. And then I Incorporated.

So incorporation. Gotcha. Now, your name of the practice, it came from, it was inspired by Psalm 127. So can you for those listeners who might not be familiar with Psalm 127, what is Psalm 127 and how did it inspire you to, to use that as the inspiration for your practice name? Yeah, so I knew nothing about SEO at the time, so I didn't think about naming it something local.

But I just was trying to stand out and be different and my faith is very important to me. And I actually, I go to a church that is called 121 Community Church and it's from Philippians 1 21. And so I thought if they can do it, I can name it for something that is important to me and really Psalm 127 speaks to me because the first part of it talks about how the Lord builds the house and if he doesn't build the house, then you're all of your labor is in vain.

And so I felt like this. DPC practice was a a gifting from him to be able to, take care of kids in a different way. And then the second part of Psalm 127 really has to do with how kids are a heritage and a gift. And, All the reasons I became a pediatrician to begin with is because I believe all those things.

So it just, felt like a good fit. And then I have a amazing friend who is a graphic designer who made this amazing logo with the house and the hands. And it just, it felt like the right thing. Amazing. And one of the things that you pride yourself on is the wait times for your practice and your patients is very different than in the fee for service world.

With that, I want to ask if you have some stories that you could share about what patients have told you their wait time experience was before joining your practice that I'm sure a lot of listeners have patients that can relate to. Yeah, so really my wait time stories are myself and my daughter and sitting in the pediatrician's office for hours and hours to see our fantastic pediatrician.

He's a fantastic pediatrician, but my goodness, we would wait. For two hours with a screaming baby to see him for five minutes, you know, and it's like, I went to med school too. I could just figure this out instead of sitting here. And and then really last week I took her to the eye doctor.

It was the same thing. We sat there for two hours to see the doctor for five minutes. And, my patients are less focused on the wait times. With me and more of the personal touch. So they were just tired of seeing someone new every time being sent to urgent care when their kid was sick, never being able to get in with their pediatrician, not always sure that they were seeing, you know, a doctor in the practice.

that's what I hear most often. And then the things that we talked about before, so packing up the baby and I do. a lot for families that are bigger. So three and four kid families, right? While you're trying to wrangle the newborn and you have two other kids under the age of three, like nobody wants to do that.

And then also, families who are wanting to breastfeed is a big pull for my practice. And then I take care of a lot of physician Family, kids. And it's interesting because they know the system and they understand the system and they still feel like paying me is a good thing to do for their kids, right?

That's so interesting. And I love that your example was your own with your own child. And, when you say that about physicians being that your practice is heavily populated by physician families and their kids, it really doesn't surprise me because it's we know the value of having a doctor who knows you, who's available when you need them like nobody else.

Yes, we can be the worst patient sometimes. I will give all of us that. But at the same time, when it comes to if you have, I think of my older patients, not necessarily. Kids in this sense, but think about how coordination of care and helping somebody navigate through the system.

And you don't have to be an older patient. You can definitely be a kid with, the need to see a specialist or whatever even just that, that added personal touch of, hey, as an expert in this, field of medicine, I can also help you navigate the system outside of my practice. It's really invaluable.

So I totally love that, that is how your population has come to be. Now when it comes to the lactation part, I think that this is just so amazing because it's just compounding on you being. a pediatrician to the really young kiddos. You just were part of the first class of board certified, like actual, there's a board certification for this, the North American board of breastfeeding and lactation medicine.

So congratulations on being one of the first people ever certified. When you have this. Now as something to bring value to your practice. Does it change your practice, or does it change the way that people look at your practice because you have the certification? So I've had it for two whole weeks now.

So I went for it because I had done, I've done all this education for breastfeeding medicine. And at first I was skeptical. It's like, ah, we don't need another. board to keep up with and all the things. And they were like no, it's not gonna be like that. Um, So I'm one of the first 100 people who has passed this exam.

And I think it just really validates the field of breastfeeding medicine, makes it more of a specialty and it. There's been this resurgence maybe of women's health, children's health topics that, a lot of our physician colleagues are talking more about menopause now. I learned more about menopause than I've ever known in anything I learned in med school.

And it just, it's just validating that these mom, baby, women. Health topics are important to people. And really there's just, like anything else in medicine, there's so much misinformation out there that it's just reteaching and relearning the science behind the breastfeeding instead of passing down those myths of, while this Lactation consultant's been doing this for 30 years and she says that it's the right thing to do.

Well, she's just passing down information that she learned without actually knowing the root of it, right? And so I just, I think it's just, it's a great thing for patients and it validates this field and this importance of how important breastfeeding is. And one question there, because very commonly when we talk about people who are physicians who also are IBCLCs and now board certified in breastfeeding and lactation medicine what What portion of your clinic do you see with people who are, having struggles with breastfeeding versus people who are like, everything's going pretty good, but I just want to make sure that it keeps going good.

So again, I attract mostly physician moms because of my training and because of, They can pay for a board certified pediatrician and lactation consultant to come and see them for a consult. But really it just, it makes such a huge difference for them in their life. And so about half of them are probably worried well and probably would do just fine without me.

But the rest, I make a huge difference with just tweaking one little thing here or there or teaching them something or diagnosing them with. Insufficient, milk supply or glandular tissue or something that probably they deep down knew inside, but just no one had ever spent the time with them to, know what was causing their low milk supply with their last kid or whatever.

So it, it makes a huge difference for people. And you hit on one of the huge value propositions that we bring as DPC physicians is the time that you're able to spend with your patient. I remember the lactation consultants who taught me in the hospital, like, when I was, Postpartum in my you know, three day stay or whatever both times in the hospital I'm like, I literally can't remember my name.

So whatever you just told me cool I have no idea what you just said. And so like hopefully it'll all work out like that. That's really I mean I was very thankful I didn't have any concerns with my own milk production , but man, like if you're.

if you are not, educated in that there are people out there who are board certified and IBCLCs, it's crazy to think about how the typical experience in a hospital setting postpartum is not at all what it would should be standard of care for breastfeeding education. Now you spoke earlier about how, you were financially able to, start paying yourself, if I heard correctly, at the 18 month mark.

And before 18 months what was going on in your mind? Were you like, this is great the whole time? Or what was your experience? Oh, man, you can ask my husband this question. He would have a better answer. So he started his business a few years ahead of me. And so he still wasn't quite financially stable in what he was doing.

And I just, Up and quit my really good paying job, right? And and then I started this practice in an area of town where nobody knew who I was. Nobody knew I was a pediatrician. I'd been in the hospital. I'd never, had anyone in the practice and plus. I was relearning all of general pediatrics.

So the first 18 months were pretty rough. So really I just talked to everyone that would listen. So at the time networking was a big thing and so we did, networking groups. I visited breathing centers. I got reacquainted with the hospital staff. from a different perspective. They already knew me, but OBGYN office, like I just was telling and telling and telling.

And so finally I was like, I don't know that anyone's ever going to sign up. But then suddenly around 18 months I had this handful of patients that kind of grew like a snowball on itself. And I had this Cohort almost of babies that were all born in the fall that year, and so they've all aged together Throughout the practice time and so like I know when my busy months are going to be when all those babies are Needing all those visits, but and then after that it just really grew On itself from mostly referrals.

And I, I did enough social media and it was back in the day where Facebook was a thing and you could use your business page and you could teach people on Facebook and they would find you. And so people were finding me. The patients were referring their friends, my pediatrician colleagues finally didn't see me as a threat because, my tiny little practice versus their 5, 000 patients.

But I was able to market my breastfeeding services to them. And so they were able to send me breastfeeding clients and, eventually some of those stay on or they tell their friends. It was a long process. I don't know that I have the guts. to do it again, but I did it then. And, just pulling from that time in your practice do you have any words of encouragement for people who might be experiencing growth that there, that isn't their desirable number per week or per month?

Yeah. So I actually mentored DPC pediatricians. I started a Facebook group for pediatricians because people were. starting to become interested in this. And so I pep talk people fairly often. They'll reach out to me. And I just, I tell them to keep going and keep doing things and keep doing the things.

And, I did a year in the Entre MD business school and Dr. Una talks about snowball and how you do these things, you do these things, you do these things. And then suddenly you get to the top of the mountain and the ball starts rolling down the other side and it's just collecting snow. And so you just have to keep believing and keep moving forward and doing the things that you're doing. Love it. Now, after the two to three year mark when your practice was, you had that, that cohort of kids who are all born in the fall and your practice was definitely different than the first 18 months.

How did your practice change because, the number of visits per day or, the way, the number of people who were in that snowball contacting your practice at the same time, how did you adjust your practice because it was more busy? Yeah, the babies kept me busier and then, then they start going to daycare and so they're sick more often and so you're seeing them a lot for well visits and you're seeing them for six visits and then the pandemic happened and so then everybody stayed home, except us doctors, right?

It was the perfect model for the time we were in, which, you know, I was able to keep all of my kids up to date on their vaccines because it was just me going to their house wearing an N95 mask, right? And so during the pandemic, I actually gained some patients that I otherwise probably wouldn't have taken on because they're outside of the driving radius that I usually Do, but they had stories, they couldn't sit in a waiting room.

They couldn't be exposed to this crazy virus or anything else for, specific reasons. And so I took those families on, during the pandemic, they moved on afterwards, which is okay because they were far away, but it just. It was just a, for such a time as this, I was in the right spot to be able to do that.

And then in my personal life, because I have this small little micro practice, I was able to keep my daughter home from an environment that I didn't feel comfortable sending her to while we didn't know what was happening with this virus and what was it doing to kids. We didn't know. So I kept her home and homeschooled her.

So both my practice and my home life was. more stable than it could have been during that time. Yeah it's really awesome not to, wish any other similar situations on us, but man, I will completely agree with you when, when you can determine your hours and how you want to work and, your boundaries.

The autonomy is great when it comes to, it doesn't have to be a pandemic, it can be a family member is sick or whatever it is, but when you can determine that time, you just can't find that as easily in fee for service when somebody else determines your hours and how many RVUs you're supposed to pump out a month.

So I think that's really great. And now when you talk about after, the pandemic had Ended and people, we're not necessarily geographically close and they decided to, leave the practice and move on. Tell us about churn in your practice in general. Are there any other reasons why people decide that they're going to move on to a different type of practice or back to fee for service? Yeah, so most of my churn comes from people moving. So I have to maintain a tight radius, or else I can't do the things I'm promising. So often it's people move outside of that radius. Some people leave because they just don't want to pay the money, and they would rather just, use their insurance, and that's fine.

And then some people, if they just It's just a personality conflict, I think. And so when I first was starting, I was marketing to birthing centers and the birthing community. And there's plenty of really great people in that community, but there's also plenty of people that are just really hard to deal with, honestly.

And so I attracted some of those families. And, vaccines is one thing, but it's when you say no to antibiotics, you say no to this, you say no to that. And it's I didn't start a practice so I could argue with you all the time. And so I had to make some tough decisions and decide to only take vaccinating families.

And just really for my own sanity, like I started this practice so that I could love medicine and arguing with these families and fighting over what was going to happen with their kids is just not. Helping me meet that goal. So yeah I hear you. And I think that is something that I hear a lot when it comes to people who see DPC physicians who see kids in their practices is, do you take unvaccinated kids?

Why? Why not? And that's definitely a personal decision in terms of, who is your ideal patient and who is not your ideal patient and why for both of those. And I think that, as you've pointed out that can change over time. And that's okay, because your business is breathing and living just like everything else.

And so, it's not something to be, just putting this out there, because I've heard other people say like, you know, I'm so I feel so guilty, because, I my practice, like the ideal patient has changed. And it's cool, that's normal. So I think that, that's really helpful for people to hear that, your practice has become more fine tuned over time so that, you can take care of yourself also, like mentally and professionally having a practice that you were not Like, Oh, I have to fill in the blank because of, particular family or whatever.

I think that's wonderful. Now, in terms of being a solo doc in a micro practice, do you have assistance from like a virtual assistant or somebody who helps out virtually or locally? So I just recently hired a virtual assistant and she is really just helping me with the online course. Creation and I'm working on online breastfeeding classes and putting more evidence based information out into the world.

And so she's been helping me with that. But as far as the practice goes, I really just do it by myself. I. Maybe I'm just a control freak, but I need to stay in a certain radius. So I know who I'm going to bring into the practice and I to be able to schedule people within that radius so that I'm not driving from one side of town to the other, if I don't have to, you know, so I just, I kind of do it all myself.

But I have a really great EMR that, has all the bells and whistles and does the things. And then I'm pretty organized, I'm pretty organized. And I have. Automations. I don't answer my phone during the day. If you, if it's important enough to leave a message, I'll call you back. I'm not looking to add hundreds and hundreds of patients to the practice.

So I don't know, I've just been able to do it by myself. And thankfully, I have a DPC friend who is a pediatrician in Dallas on the other side of the Metroplex. And she and I share call. So like if I'm sick, like I had COVID over Thanksgiving, or she's sick or she's going out of town, vice versa, we, our patients know each of us.

And so we, we can cover call for each other. And taking phone calls. So that's nice. So I'm not completely alone, which is great. That's fantastic. And when you guys take call, is it just virtual or do you do you extend your range to see people in Dallas? So at first, when we weren't like super busy, we would drive to the other person's patient's house if needed.

But now we don't. We just tell them, hey, if I'm out of town, she's on call. If she can't solve it over the phone or over video, then you might have to go to urgent care. And most families are totally fine with that because it's very rare that I have to send anyone to urgent care.

I totally love that. And yeah, I agree. And that, that is, like that is possible in DPC, even if you don't have somebody as a backup we have virtual care only days because of things like travel. When your patients, One, you know them two, they can get a hold of you, and three, 80 to 90 percent of everyday issues can be solved by talking to someone who is medically trained to go through the differentials, ask the right questions, evaluate you, and do all the things from the patient's home.

It really is a thing that works in DBC. So for those people who are wondering about oh, but I, I'm so afraid because of 24 seven call and I don't know if this is your experience too, but when your patients know that they can get ahold of you, for the most part, my patients are like, I'm so sorry.

I dialed the wrong number. Like they don't actually call because they know that. They'll get a hold of me, easily the next day. Yeah, I there's like this breaking in period where, people are like anxious, they're like, did she really answer the phone? Are you sure? And she'll, they'll call and call and ask questions.

And then you just like, Don't hear from them cause, cause you're doing the things, right? You're answering their questions and you're there when they need you. And yeah, so I agree. And it's not as bad as it sounds like my hospital call, even though we took a call from home was way worse. The nurses were calling me all night, every few hours from different places.

And yeah, it's not like that. Thankfully with my little practice now. I'm so glad I just I'm laughing because we did this like Saturday Night Live follies for our residency graduation and like one of the things was like, you get a, the resident gets a call at 2am like I, excuse me, can I get an order for colase?

And you're like is the patient pooping? Oh no, they're asleep. I just don't see it on the orders. And I'm like it's things that like that, like I know there's audience members like yourself, like you and I are just like, oh my gosh, that is real when you are trying to get sleep on call.

So I love that. Now one of the things that we talked about, earlier is that you are also a DPC patient. And I wanted to ask about. The thoughts that you had given that you had a DPC doctor in your pocket or, so to speak, that you could contact and who knew you versus having the diagnosis that you have with, in the world of, and now I'm an only fee for service access.

Yeah, so I don't wish a chronical medical condition on anyone as a physician, I have access to things that patients don't, and even then, it was really difficult to navigate this system and get the care that I needed. So thankfully, my DPC physician, so my initial presentation was that my eyes, We're going a little crazy.

I was seeing double. And so I went to the ophthalmologist first and he was able to look at me and say, I think you need a neurologist. And because I had a DPC doctor who called him back right away and was able to discuss with him what he thought I had. I mean, I was in the MRI machine within a day or two of that visit to the ophthalmologist, which is unheard of, right?

I'd still be waiting for an appointment a year and a half later if I was in another place. But so he ordered the MRI right away. He was able to, interpret it and get me to the right place. Unfortunately, it wasn't. The place I needed to be, but I was able to use my physician network and get to the right place.

I needed to be he has since retired, but the person who took over for him is just like I couldn't live without her. So it's impossible to get a hold of my specialist office. And when I can't. My DPC doctor is very comfortable refilling some of the meds and, even the specialty meds.

She doesn't have a problem refilling now that it's generic and, you know, she takes care of my comorbidities and my health otherwise. And when I had COVID over Thanksgiving, all he did was text her a picture of the positive COVID test and she called it back sloven and I had it with in my body within an hour.

So just so amazing, just, I, and my husband, he has minor sort of chronic conditions he's had forever. And even before I was diagnosed with something, he told me like, we can't ever go back to the system the way we can go back to the system. So we're always going to budget. to have a DPC doctor. So it's so powerful, that when it comes to prioritizing that's your husband's comment, hearing, how he like started before you, but how he like reflected on your DPC journey and your business journey.

And then for him to say that, that's so powerful. Now, in terms of with you being a solo doctor and having been diagnosed with a chronic diagnosis. I want to ask about how it impacted the way that you thought about your clinic and the legacy of your clinic and also how you thought about how to, financially think about the future.

In case anything were to happen where you couldn't work at your DPC. Yeah. So that of course went through my mind. So I was diagnosed multiple sclerosis. I can't ever say the word. And that initial flare, which was probably one of the hundredth layers that I've had, but that initial one was pretty bad.

Like I, my vision was very bad and. It's very heat sensitive and I live in the center of horrible summer Texas. And so it was just, it was rough. It was rough getting to appointments. It was rough keeping track of everything. I leaned pretty heavily on Dr. McDonald in Dallas and she was very helpful in doing some stuff for me.

And I pushed patients back, you know, some, you know, I just, I don't feel good today. Can I push your kids? visit back in and people are pretty understanding. Yeah, it scared me. And so it was about a year ago that I actually contemplated selling the practice and doing only online education.

And I actually approached a couple of DPC docs to consider it. And it's just, it wasn't the right timing for them. And I actually went. I went back and raised my prices and did some things, you know, got on a better path. I was on a better medicine. I was able to exercise and eat right and do the extra things.

And so I'm in a good spot now to where I feel comfortable that I can take care of my little hundred patient practice. The future is unknown at this point but yeah, for now. And, I appreciate you being, open as you were. I think about, physicians who, don't know necessarily how many years they have left under their belt to practice. And they're still wanting to do DPC. It's, I think about how the calling to do DPC is so great. It really goes back to Psalm 127 and what, the inspiration that you got out of it, because When we only have, one life, whatever a person's belief is just focusing on that idea of one life on this earth that we can impact, the world, what are you going to do with it?

I think this is something that a fellow Texan Dr Aleem Kanji had said, and he was talking about, if he were out of endocrinology fellowship and on his deathbed, he wanted to be able to say I could pick my daughter up at school. Like I didn't have to stress about knowing my family.

And I think that just this idea that DPC really gives us the abilities to be Not only the physicians that we were called to be, but also to be human and to deal with whatever was on our plate because of the time it allows us. And so it's it's the thing that I wish more people heard about in terms of the autonomy that you get through DPC really means.

Things like this, like you can adjust where you need to. So, you know, I appreciate you sharing. Now one of the things =that you had mentioned online is that one of your friends and mentors, Dr.

Rick McGee, who has since passed. He, when you were opening. I love this that you wrote that he showed up to your office with a bunch of medical supplies, and he even brought his black doctor's bag and He didn't even understand necessarily all the way what your practice was going to be, but he still wanted to support you.

So I want to ask there, when we think about mentors and I envision the people who I still talk, like literally one of my mentors called me the other day because he usually would ski up in our area, but, and he just called to say hi. But like, when you think of your mentors who've really touched your life and made an impact on your.

Your career and on your person, what qualities specifically about Dr. McGee made him such a great mentor and friend? He just, he was just such a kind man. So he and my husband knew each other many years before I even knew either of them. And he served as a father figure for my husband whose own father passed away, and when he was In his early fifties, and so our family had known him for a long time and just anyway, he moved away.

He moved back to town and then he became a newborn hospital doctor in a practice that I was in. And I had the honor of teaching him how to. Do that practice. And I felt like I was like I, you've been practicing pediatrics longer than I have been around and here I am teaching you, but just his kind spirit.

And he was always so just centering, you get worked up about silly things and you'd be like, it's okay. We're going to be okay. I just, I need people like that in my life. But for sure, when he, when I left that job, he was still there and he Definitely showed up at my office and was like, Hey, I have all these things that you can take to do your thing.

And he didn't know what it was, but he was very sweet. And then actually, one of my mentors is now a DPC pediatrician that It looks to me for mentorship, and it's very humbling, but Dr. Noemi Adame was one of my attendings in residency. She made a big impact on me as far as hospital medicine and evidence based medicine.

She was always reading the literature and always teaching us how to make sure we're doing the right thing for the kids, and so that's been kind of full circle as well. I love it. And when you mentioned that you are the go to person rather than the concierge doctor who you spoke with, that you're the person who lots of people reach out to given that those are the, the experiences and the presence of these other people who have been in your life, especially in the pediatric space.

How do you talk to DPC doctors? Or how do you talk to other people? Not necessarily, those who are just like, Oh, I don't know what to do. I'm struggling in the first, 18, 24 months, whatever. What are some major things that you like to tell people who are reaching out to you as DPC pediatricians?

I get a lot of phone calls from people that are DPC curious, they are tired of their fee for service job, and they've heard about this movement, and so I just am honest with them, I, It's not right for everyone. If you want security, you want that paycheck. It's not your thing. If you don't want to be an entrepreneur, then it's not your thing.

You can't go into it and expect it to happen overnight. You have to be patient. That's a lot of what I tell people, and then when they get to the place where they're like no, I really want to do it I have a, a paid mentoring program. I don't advertise, but I'll, take people through the beginning stages to get them launched.

And I helped several pediatricians last year be able to do that. And then our Facebook group. So I started that Facebook group almost five years ago. I think when I opened my just after I opened my practice because people were so many people were coming to me and I was like, I can't answer all of you.

And so now it's grown to the place where people are answering each other's questions. One of the doctors is doing a full peds DPC webinar series where she's. You know teaching the other docs business stuff and Practice stuff and all kinds of things and now we have a mastermind Every year or diana thinks not every year, but I think we're gonna do every year and then and then you know in the early days Dr.

Gupta ninton and I started about the same time and we would have just Like zoom chats where, you know, Hey, we're going to be on zoom tonight. And we would all get on and encourage each other and keep it going, cause there's one of us in each state and so trying to keep the movement going and encouraging people.

So that's a lot of what we do together. Love it. And, in that spirit of helping the next generation of DPC doctors, when it comes to medical students and residents, as they're, in medical school, not necessarily learning the business things that, we wish they would know at the end of graduation, what Love it.

Would you say to them in terms of, hey, in, in your medical training, whether you're a medical student or in residency, these are the things that I would start learning about early or start doing in terms of networking in your place in medicine right now? Yeah, I would say if you're looking to do DPC or if you're just looking to do something besides the Expected path, right?

Then you should try and learn a little bit about entrepreneurship, a little bit about, business and money and how to make money and how to charge for what you do. And there's. a million and a half podcasts now, which is wonderful. It's great. And, there's so many ways you can learn these things.

So just being on top of it, I think before you get too far down the road. And then, sometimes It's better to have, a busier job for a couple of years to just get some experience and then launch into your DBC. A lot of physicians will work urgent care or something like that for a while to just make sure they have good experience before doing that.

So just thinking about all those things and then thinking about how you're going to, deal with your debt. If you are coming out of med school residency and have some debt, how are you going to manage that while you're. Not making much money in the beginning, so. Thank you so much, Dr. Wadley, for joining us today and sharing your story. Thanks for having me. This was great.

Thank you for joining us for another episode of My DPC Story, highlighting the physician experience in the world of direct primary care. I hope you found today's conversation insightful and inspiring. If you want to dive deeper into the direct primary care movement, consider joining our My DPC Story Patreon community.

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Until next time, stay informed, stay healthy, and keep advocating for DPC. Read more about DPC news on the daily at dpcnews. com. Until next week, this is Mariel Concepcion.



*Transcript generated by AI so please forgive errors.

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