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The Day Everything Caught Fire and How It Sparked a DPC Practice · DPC Life: Direct Primary Care Podcast

0:00
I mean, I just would really advise anybody that's opening
0:02
and doesn't know anything about business to look at their small
0:05
business development center. I've read some business books
0:07
and they just don't make sense to me.
0:09
Like they're, they're all talking about these businesses
0:11
that are aimed at growing and they want to, it's for the
0:13
world. And that's not at all what I,
0:15
you know, what I want to do. That's interesting.
0:17
So it's hard not to, you know, once you're an entrepreneur,
0:20
it's hard not to then think about what's coming next.
0:23
When I was working for the hospital system, I wasn't
0:26
growing. I wasn't, you know, I was not
0:28
growing at all. Welcome to DPC Life, the podcast
0:32
where independent doctors share real stories, bold ideas, and
0:36
the freedom of doing medicine on your own terms.
0:40
I'm your host, Doctor Anne Gonzalez, and together we'll
0:44
explore the winds, the struggles, and everything in
0:47
between. Let's dive in Right today I have
0:52
with me Doctor Melissa Boylan. She is the owner and founder of
0:58
Neretta Family Medicine in Columbia, SC.
1:01
And that's actually that's where that is where I went to
1:05
residency. So I know how hot it is there.
1:12
Yes. So I'll let you take it away.
1:15
Tell us about. How you got into DPC?
1:19
So I worked for a hospital system right out of residency
1:22
here for about 10 years. And there actually was a day in
1:26
which I started to consider other options.
1:29
So I, I don't know that I've, I've really talked about this
1:32
day before, but it was the day that, that our office was going
1:35
live on a new EMR. And the, the night before, the
1:39
University of South Carolina's men's basketball team had made
1:43
it to the Final four for the first time, I think ever.
1:46
And that so we went to bed that night, you know, all happy and
1:51
everything. And we woke up in the middle of
1:53
the night and there was smoke in our house.
1:55
And it was my husband woke up. He was the one that woke up and
2:00
he jumped out of bed and went outside.
2:03
And it turns out that our pine straw in the backyard was on
2:06
fire. So that was the morning that we
2:11
went live on the EMR and I walked into my office, you know,
2:16
tired. But then, you know, the, the go
2:19
live was, it was just a disaster.
2:21
It was, it was just not great. So it was that day that I made
2:24
the decision. I was like, what am I doing?
2:27
I need to look for something different.
2:29
So I, yeah. And then I spent the next three
2:31
years trying to figure out what I wanted to do.
2:32
And I came across DPC and thought about it for a while,
2:36
but I, I had some concerns about it.
2:39
So I had to kind of sleep on it for a while and then I just
2:42
decided that it was that it that I went to a conference and I
2:45
decided that my fears were kind of calmed down by by talking to
2:49
people at that conference. And so I decided to do it.
2:51
So yeah, I opened Noretta in July of 2020, so.
2:56
Right in the middle of the beginning.
2:58
Good timing, so. Yes.
3:01
Although actually a lot of people did great during the
3:04
pandemic, yeah. Absolutely.
3:07
It was actually not a bad time to open a practice.
3:10
I mean, you know, people were getting used to working at home
3:13
and so emails were answered very quickly.
3:16
It wasn't a terrible time and I was able to start seeing
3:18
patients in person. We didn't have to do, you know,
3:20
I didn't close the office to patients in person visits.
3:23
So it actually worked out OK. You had three years to kind of,
3:27
well, maybe not a whole three years to kind of plan your DPC,
3:30
but you were thinking, yeah. Yeah, I was thinking about it.
3:34
It took me about, I think I made the decision in August of 2019
3:39
to do this. And ironically, here again,
3:41
we're we're with Mother Nature. It was on the day of a hurricane
3:44
that came through Columbia. So it was so, yeah.
3:49
So lots of lots of ties to Mother Nature, big decisions
3:51
being made on on days of disaster.
3:54
But anyway, so yeah, it was in in August and then I opened in
3:57
July. It's in 2020 and since then, so
4:00
we're in 25 now. So it's been 4 years, a little
4:03
more than four years for you. And what do you think?
4:08
I'm sure there's lots of ups and downs throughout, but what would
4:11
you say probably like the best thing that you did that has
4:14
worked for you? So that's interesting.
4:16
The best thing that I did, well probably probably not spend a
4:21
lot of money when I started up, I think that was, yes, far and
4:24
away the best decision that I made.
4:26
I think I'm always, I've always been somebody that likes to save
4:28
money. And I think not having a lot of
4:31
debts right out of the gate was a really good decision that I
4:35
made, especially because I wasn't sure how it was going to
4:37
work with the pandemic and if people were going to sign up or
4:40
if they weren't. So that was a a really good
4:42
decision. And then I think my second good
4:44
decision was to hire somebody to help me.
4:47
So there came a time about 2 1/2 years in where I was really just
4:50
spending a lot of time and working.
4:52
So I hired somebody and I made some false moves with that.
4:57
But I ended up hiring a gap year student who now does full body B
5:01
in my clinic and then also does, you know, front desk stuff and
5:04
things like that. That was a really good decision
5:06
at that time because it's mutually beneficial for me and
5:08
for him. So when you said you kind of
5:11
kept your overhead low, was there something in particular
5:14
that you thought, wow, that was really good, that really helped
5:16
me keep it low? Like were you renting or?
5:19
Yeah, definitely renting. I'm still renting.
5:21
I'm in a place I started out subleasing a space and then I
5:25
got kicked out four months into my sublease.
5:28
You know, that's the danger of a sublease.
5:29
I guess the landlord can just kick you out.
5:31
I I didn't do anything to deserve it, but I think it was
5:34
just a tax thing that happened. But I was lucky to find a space
5:36
that that was affordable after that.
5:39
That's been very, very helpful to have a low, you know, a low
5:42
amount of money that I'm spending on lease it.
5:44
It's great. And yeah, I caught when I was
5:47
opening my practice, of course, I had nothing else to do during
5:49
the pandemic. But I mean, I priced out
5:52
everything. I priced out my two by two gauze
5:54
pads. You know, it was absolutely
5:57
everything. So, so you, so I, I took the
5:59
time to do it and it and it really, I think it really paid
6:01
off. Aspect from the beginning, did
6:03
you have a business plan? Yeah.
6:05
So that's that's. Another interesting story.
6:07
So I, you know, made the decision to do this in August of
6:10
2019. And it just so happened that
6:12
there was a small business competition that my alma mater
6:16
was putting on for people who were who had innovative ideas.
6:20
And so I thought, well, what the heck, let me go ahead and enter
6:23
that. And with that, I had to put a
6:25
business plan together. So I had to do a like a Shark
6:27
Tank pitch, a video pitch, and then a business plan.
6:30
And, and this is, I mean, I just would really advise anybody
6:34
that's opening and doesn't know anything about business to look
6:36
at their small business development center in their town
6:39
or in their city because they helped me so much.
6:42
I was very fortunate to get a consultant who was very
6:46
interested in DPC. So he spent hours and hours and
6:49
hours with me. I mean, it was amazing.
6:52
It was, it was. Yeah.
6:53
I'm so lucky to have had him. And so he helped me do my
6:57
business plan, get my financial, my budgets set and everything.
7:01
So it was very, it was very helpful to enter that
7:03
competition because I risk averse.
7:06
And so I doing the the small business competition was the
7:09
only thing that kept me on track.
7:10
Otherwise I would have been floating in the ocean, you know,
7:13
But it gave me a timeline, gave me deadlines.
7:16
And so I just progressed through it and it was, yeah, one of the
7:18
best choices I made. That is fantastic.
7:20
Yeah, having, I mean, it just made you accountable to do
7:24
everything that you had to do. Right, exactly.
7:28
All those things that I just had no idea what they were like.
7:31
I had no idea how to write a business plan.
7:33
But thankfully, because I had a deadline, I took the steps to,
7:36
you know, get some help with it. And yeah, so it worked out.
7:39
I didn't progress in the small business competition, but that
7:41
wasn't really my goal anyway. It was just to just to have some
7:44
accountability. Yeah, like you said.
7:46
So for the, you know, the competition, did you have to
7:49
come up with an elevator pitch? Do you remember it?
7:53
I did. Oh gosh, you know, we, I was
7:56
just talking to my husband. So Neretta my practices 5th
7:59
anniversary. It was actually in July and we
8:02
were just talking about that. We Oh my gosh, she was so fo
8:04
made. I remember my so I borrowed a
8:08
friend to come over. And so my husband and her
8:10
friend, they had they wore T-shirts that said friend number
8:13
one and friend number two. It was so cute.
8:16
And it was a conversation between them about how, you
8:18
know, friend number one couldn't get into their doctor and friend
8:21
number 2 was ADPC patient. So he was talking about about
8:24
how he could. And so that was how the that's
8:26
how the elevator pitch went. And it was.
8:28
It was a lot of fun. Fun and cute.
8:30
So that's really cute. Maybe someone else out there is
8:33
going to take that idea and use that for their marketing.
8:36
Fine, that's fine. I'm fine with.
8:37
That I have friend number one and friend #2 T-shirts.
8:40
Yeah, you. Can lend.
8:41
So yeah, you can find those on Etsy.
8:43
I think I had, you know, like the thing one thing too.
8:47
So I've I have 3 kids in one year for Christmas.
8:49
They were thing 123. That's so cute.
8:51
I still have the streets. That's great.
8:53
They don't fit anybody, but you know, right, right.
8:57
But it's a nice memory. Yeah, So and I just wanted to
9:00
say the small business centers that you were talking about,
9:03
they're usually in community colleges a lot of times.
9:07
And also another thing that's really helpful and I don't know.
9:10
Did you use or go through Score SCORE?
9:15
No, I can't remember if they're actually hooked up with the
9:17
small business center near us, but it's a, it's an organization
9:22
that helps kind of new business owners and like met and gets you
9:27
hooked up with mentors who have been in business for years and
9:30
years. And it's either free or very low
9:33
cost. They do a lot of webinars online
9:36
and you know, like programs. So for anyone starting out, you
9:40
know, that's a great resource. So both of those two.
9:43
Yeah, that's great. I mean, gosh, I might take.
9:45
It you can, you actually can, because I still get emails from
9:48
them and they do in person talks.
9:52
And so I don't know if they just do them in bigger cities.
9:56
So probably they do some in Colombia.
9:58
The one that was close to me was in Asheville, since it's an hour
10:00
away. But and then they do yeah,
10:02
webinars and yeah, they're free. OK, Yeah.
10:06
Oh, gosh. Well, that's, that's really good
10:08
to know. That's a, that's a great
10:09
resource. Yeah, yeah, Because that is
10:10
something that I, I still can work on is sort of my business
10:14
sense. Like that's something that I'm
10:16
so used to being focused on patient care and not paying
10:19
attention to the business side. I mean, now obviously I have to,
10:21
but I'm still learning. I mean, my gosh, there's so much
10:23
to learn when it comes to comes to running a business, although
10:26
you don't have to know it all upfront, so.
10:28
It's, it's very learnable. I mean, you can learn.
10:32
I mean everyone else had to learn at some point too that
10:34
does business. So you can learn it too.
10:36
Yeah. Exactly the business part.
10:40
Like it, enjoy it, hate it. What do you think?
10:45
Oh gosh, I would say that it's not my favorite thing because my
10:49
brain doesn't work that way. I'm more focused on having a
10:53
mission based and service based practice.
10:56
So my goal is not to make a lot of money.
10:58
And I know that everybody's different, so some people do
11:01
want that, you know, and that's fine.
11:03
And my goal is just to kind of make a living from this and
11:06
prove that this is a sustainable way of practicing.
11:10
And the other problem I was talking with somebody about this
11:12
recently is I've read some business books and they just
11:15
don't make sense to me. Like they're, they're all
11:17
talking about these businesses that are aimed at growing and
11:19
they want it for the world. And that's not at all what I,
11:22
you know, what I want to do. So I just want the nuts and
11:24
bolts of how to run a business, make sure that I'm planning for
11:27
the future and ups and downs and things like that.
11:29
So I wouldn't say that business is my favorite thing to do.
11:32
I mean, I like to be organized. So like bookkeeping is fine.
11:35
I do that myself. But you know, I it's not my
11:38
favorite thing. Understandable.
11:40
Yeah, the bookkeeping is hard. I think it's a.
11:43
Yeah, it can take time and you know.
11:45
Definitely. So you're five years in.
11:48
So in that five years you said the overhead, low overhead was
11:52
really good. Good call.
11:54
What would you say if you had to go back and start all over
11:58
again? Is there something that you
11:59
would have done differently or just not done at all That's.
12:01
An interesting question. Well, the yes.
12:05
So I'm coming up against this now.
12:06
So five years in. First of all, I had some stops
12:08
and starts with lawyers. Right out of the gate.
12:10
There was one that told me that I shouldn't open and so and then
12:14
they dismissed me as a client, which was kind of interesting.
12:17
You didn't. Fire and then the second one
12:19
charged me too much money yeah I got fired before I even opened
12:23
my business yeah that was that was strange I think surrounding.
12:27
If I would have known more, I would have surrounded myself
12:30
with professionals right from the get go that I knew I got
12:34
along with and that you sort of had my same philosophy and that
12:38
I knew would be there for me long term.
12:40
Because now I'm having to kind of go back and say, OK, well,
12:44
you know, I, I, you know, I'm looking for XY or Z and, and I
12:48
don't really know that I want to go back to that professional
12:51
that I used before. So I'm having to kind of kind of
12:53
start over again. So I think developing, you know,
12:56
just making sure that whoever you hire, I know everybody's
12:58
like in a rush, you know, whenever they're trying to open
13:01
the DPC, but really making sure that your professionals that
13:03
you're working with, your consultants are, are somebody.
13:06
That you drive with that. 'D be something that I would
13:08
probably do do differently. That is, yes, that's a great
13:11
point. A lot of people when they start,
13:13
try to keep it so bare bones and keep the overhead so low that
13:19
they're doing everything themselves.
13:22
And you've probably heard the saying, it's either you pay in
13:25
time or you pay in money, right? Yeah.
13:28
Yeah, exactly. If you're trying.
13:31
I'm finding that there's definitely a balance.
13:33
You can find the balance. I mean you don't have to go with
13:35
the cheapest, cheapest person. You can go with somebody and pay
13:38
a little bit more and then put the value you get more than than
13:41
you otherwise. Would we were trying to do, you
13:43
know, save the money when we started.
13:46
So we did a lot of stuff ourselves.
13:48
And in retrospect, that's probably one of the things I
13:51
would do differently 100% because things like building
13:57
your website. I mean, I enjoy computers.
14:00
Like I like computer stuff. I like the creative stuff.
14:04
That's one thing is I, I, I, I think that's why I do enjoy the
14:08
business part, because it's more of a creative thing.
14:11
But now in retrospect, Oh my God, how much time did I spend
14:14
doing that? You know, like.
14:16
The website was somebody that I hired.
14:19
I, I hired somebody to do that. And I'm so thankful that I did
14:21
it because I mean, it's still expensive.
14:23
There's an upkeep cost that I pay every month.
14:25
But it was just so worth it to have somebody do that because I,
14:28
I don't know anything about SEO and all these things.
14:31
And I do feel like my website has brought traffic to my
14:34
practice. So that was something I was
14:36
thankful for. But I did try and do a lot of
14:38
things myself too for sure. So let's talk about something I
14:41
know that you've been working really hard on for the past
14:45
couple of years. Doctor Boylan is in Columbia,
14:48
SC, and there are quite a few DPCS around you.
14:51
I don't know how many in South Carolina, but there just seem to
14:54
be a whole bunch of them. Yeah, there are a couple in
14:58
Columbia. There aren't that many in
15:00
Columbia, but spread out all over the state, there are.
15:02
I think we counted there something like 25.
15:05
That's great. 30 maybe? She's been working on something
15:08
special, very different, kind of new in DPC world.
15:12
So tell us more. We the the group of us, South
15:17
Carolina is a relatively small state.
15:18
We kind of, we feel like we know everybody that has ADPC.
15:21
We might not know absolutely everybody, but we know a
15:23
majority of the people. The thought was we had been
15:26
talking about it for a while, just trying to get AMSO
15:29
unmanaged services organization together for the DPC docs in
15:33
South Carolina. Before you go into it, would you
15:35
explain an MSO? Because I had no idea about this
15:39
four years ago. I don't know that I can still
15:42
really explain it in detail, but but the goal we sat down and we
15:47
just said if we, if we did an organization, regardless of what
15:49
type of organization it was, you know, we wanted something that
15:51
would kind of bring us together and be able to negotiate, you
15:55
know, with, with vendors. We wanted to have a presence,
15:58
all of the DPC practices together.
16:01
We wanted. So we had some goals that we
16:02
wanted to achieve. And so we started looking at an
16:06
MSO, which is sort of a, an MSO something that helps to manage
16:10
your back office stuff. So it's kind of like having an
16:13
administrator that will go and do all of the things that we,
16:17
you know, that we are learning how to do as small business
16:20
owners, but all of the administrative stuff.
16:22
So we started thinking about putting that together, but now
16:25
we're kind of wondering if that would be a piece of it.
16:27
But maybe we actually are just looking at putting an
16:31
association, you know, together of DPC docs in South Carolina.
16:34
So we're currently trying to decide and and we have a meeting
16:37
tomorrow actually with a lawyer to try and decide what type of
16:40
organization looking at starting.
16:42
Yeah. So trying to decide what really
16:44
is best structure for it. Yeah, I wrote down some things
16:48
about reasons that we were looking to looking to start this
16:51
and you know, we realized that a lot of the DPCS in South
16:54
Carolina have similar problems. One of those main problems is
16:58
probably not exclusive to South Carolina, but it's vaccine
17:00
access. See, that's a big, that's a big
17:02
problem across DPCS. So we wanted an organization to
17:05
see if we could go and and work on that.
17:07
We also wanted to have something where we could be represented
17:10
legislatively. So if at the time we were
17:13
thinking we needed to pass a South Carolina DPC law, we don't
17:17
have one on the books. But now we're thinking that with
17:19
the new legislation that went through earlier this year, we
17:21
may not need a lot, which is kind of nice.
17:24
But yeah. And then we just wanted
17:25
something to help market our practices, increase public
17:28
awareness of DPC in South Carolina.
17:30
And then I think the big one was that with employers.
17:33
So there are employers that we know across the state.
17:36
We have some DPC owners that are very much focused on employers.
17:40
And the problem is, is that they may have a few practices here.
17:44
There may be a few practices there, but the employer may have
17:46
employees everywhere, you know, across the state or in multiple
17:49
different locations. So how do we associate ourselves
17:52
together so that we can share these employers, the employees
17:55
of the employers and you know, you know, and do it in a way
17:59
that's that just makes our lives easier.
18:01
And so that's not really something that's that's offered,
18:04
but we feel like we could grow DPC more if we're able to do
18:07
that. So that was one of our, one of
18:09
our big sort of, you know, reasons why we've looked into.
18:12
Doing yeah. So not only to support the
18:14
current DPCS, but to really help advance the movement overall.
18:20
Exactly, exactly, right, exactly.
18:22
So we'll see what happens with it.
18:24
So we've been working on it for a while, about a year and a
18:26
half. We've been having meetings and
18:28
we thought we were headed down the MSO road and actually at the
18:31
DPC summit this year, I think the light bulb came on and we
18:34
decided that we may not need to go down that road or we may want
18:38
to try something different or have two different types of
18:40
organizations, you know, so, so it was a good, it was a good
18:43
light bulb to to have turn on because we were about to sign on
18:46
the dotted line since then. So yeah.
18:49
Yeah, yeah, it. Was it was pretty?
18:50
Yeah. So, so I think the only like I
18:54
guess fully formed MSODPCMSO is the one in, is it Pittsburgh?
18:59
Doctor Gentilly and Doctor Lynn, Yeah.
19:02
Yeah, so they have AI guess a lot of people know about it
19:06
because they're that and kudos to them, my gosh, for spreading
19:10
the word about their about their MSO.
19:12
They've done some talks at the DPC Summit.
19:13
So a lot of people know about them.
19:15
I think there's another one in Georgia and there might be one
19:18
in. Texas as.
19:19
Well, those are larger organizations and I don't know a
19:23
lot about them, about how they're run, who they're owned
19:25
by and that kind of thing. But yeah, I think there are a
19:28
few other ones out there. But the one in Pittsburgh is
19:30
we've talked to Doctor Gentilly and her partners about how they
19:34
started and and how they're structured and it's been very
19:37
helpful and very grateful to them for for talking with.
19:39
Us. Well, I'm really interested to
19:41
see what happens because the first time I heard about the MSO
19:45
in Pittsburgh, that's a fantastic idea.
19:48
And actually when we first opened the part, the group that
19:52
my partner and I left was part of an MSO.
19:58
It's OK. Oh gosh, that's been so long.
20:01
United Women's Health. So the group we were in was an
20:04
OBGYN slash primary care office and it was probably one of the
20:09
only independent OB guy in offices left, you know, because
20:14
everyone has been just bought up by the hospitals and they, you
20:19
know, just got to the point. I mean, it was hard because they
20:24
and being independent, you cannot.
20:26
You can't, you don't have any leverage for the insurance
20:29
companies, right, For reimbursement and contracts.
20:32
You just can't. And you go to them and they just
20:35
laugh at you because, you know, what are you going to do?
20:39
There's nothing you can do. So I mean, it was really, really
20:44
hard sometimes, you know, just like, and you know, now I know
20:48
now I just had no idea. Of course, you know, like those
20:51
margins sometimes are so thin, like you're barely making
20:55
payroll, right? And so, yeah, I do.
20:59
I have no idea, but now I understand.
21:02
But so that it got to a point where it was either like, sell
21:06
to the hospital or do something different.
21:08
And so somehow they ended up in this managed service, managed
21:14
MSO, I'll just say MSO, this organization.
21:17
Yeah, yeah, yeah, yeah. I know.
21:18
It's a mouthful and. Yeah.
21:20
So, but you know, we thought, OK, that's really good because
21:23
you know, when you start a DPC, even if you're trying to keep it
21:27
lean and you're trying to keep it small, you do have to
21:30
purchase some things and some things when you buy it, you have
21:32
to buy 100, you have to buy 100 speculums.
21:37
You have to buy, you know, 50 vials of lidocaine.
21:42
How many are you going to use in a year?
21:44
You know, I mean, unless you're doing heavy, heavy procedures,
21:47
you know, you got to buy 1000 syringes, you got to buy.
21:50
And so exactly thought, OK, well, it would be really nice to
21:54
have some sort of way to purchase, have this purchasing
21:59
power so that you can buy in bulk, but then not have to have
22:03
100, you know, like extra things laying around that you know
22:06
you're never going to use. It's going to expire at some
22:09
point, right? Right.
22:11
Exactly. So yeah, yeah, so we did.
22:13
We we kind of thought that'd be really an interesting thing to
22:18
look at because you know, when you start DVC, you're most like,
22:21
wow, I'm going to have so much more time, right?
22:24
Yeah, yeah. You know, you have so much more
22:26
time. And I do, I mean, I'm not saying
22:28
I don't, but you know, you start thinking about all these
22:31
different things that you want to do and with that time.
22:34
Right, exactly. You know, exactly right, right.
22:36
Right. That's yeah, that's very true.
22:38
I mean, and this is sort of taking us a little bit on a
22:41
tangent, but you know, I did AI published a research paper
22:44
recently. That was yeah, that was one of
22:46
my one of my goals, lingering goals from residency to was to
22:49
publish a research paper. And and so, yeah.
22:51
So I finally, finally did it. It was a small study with some,
22:54
you know, it was not as randomized as we would have
22:57
liked and all this kind of stuff.
22:58
But but it did show, you know, that DPC doctors actually work
23:03
as many hours as non DPC doctors.
23:06
But Despite that, we feel less burned out and more fulfilled.
23:09
And so, you know, I, you know, I obviously I didn't participate
23:12
in the, you know, I didn't take the survey for our project.
23:15
But, but I mean, I, I totally understand how that's the case.
23:17
I mean, you know, it is being a business center is a lot of
23:20
work, but at the same time it's yours, you know, and, but yeah,
23:24
there are some things that would be nice to, you know, if you
23:26
could collaborate with other practices to do certain things
23:29
that would make your life easier.
23:30
So, and you don't have a big organization anymore behind you,
23:34
you know, because I work for a hospital system for a while.
23:36
So that's gone. So you've got to figure out,
23:38
figure it out on your own. So why not collaborate, You
23:40
know, and it's interesting talking about independent
23:43
practices. I went to a independent
23:46
physician meeting a couple of months ago and I just, I learned
23:49
this and I have no idea. In South Carolina, only 17% of
23:53
physicians are independent, 17%, and that's below the national
23:57
average. I was just shocked that it was
23:59
that it was so low. So, so yeah, you know, it's
24:02
important I feel like for us to, for us to collaborate and
24:05
hopefully start something that can, that can bring our, you
24:08
know, that can help us all. Yeah, yes, I am very excited to
24:11
see how that works, because you know if your model works and can
24:15
be replicated and that. Yeah.
24:17
Yeah, exactly. That would be wonderful.
24:20
Yeah, yeah, I know it's, it's, it'll be interesting to kind of
24:23
see. We wanted to keep it, try to
24:25
keep it South Carolina just to start for legal purposes, who
24:29
knows? I mean, I think that's what
24:30
we're going to do. But but yeah, I mean, it'll be
24:31
interesting to see if it can grow or if we want it to grow or
24:34
how it changes and evolves. And you know, it will be very
24:38
interesting over time, so. Yeah, I know you said something
24:41
about legal because I'm in North Carolina.
24:45
Yeah, yeah, yeah, yeah, yeah. I keep trying to glide onto this
24:48
group. Yeah, yeah, yeah, yeah, yeah.
24:51
No, no, absolutely. I mean, I, you know, again, I
24:54
think that's a question for our lawyer tomorrow, you know, is to
24:57
is to ask like how important is that?
24:58
Is it that we keep to state lines or, or can we, you know,
25:01
can we expand it right over here?
25:03
I don't know. So, OK, thank you.
25:05
That'd be nice. Yeah.
25:09
Absolutely. So Speaking of more time, right,
25:13
even though, yeah, you're working still a lot of hours,
25:16
but you probably feel like you have more time.
25:19
Yeah, yeah. What do you do with your extra
25:21
time? That's interesting.
25:24
So it's hard not to, you know, once you're an entrepreneur,
25:27
it's hard not to then think about what's coming next.
25:31
You know, I mean, I am, I've been thinking, so my first
25:34
couple of years in practice, it was just about figuring out how
25:36
to be in practice. How is this going to work?
25:38
How's the figuring out the business side to some degree and
25:41
that kind of thing. But now I'm to the point where
25:43
it's like, okay, well, what is next?
25:45
You know, I want to evolve, I want to grow.
25:47
So what's, what's the next thing?
25:48
So I'm debating between a couple of different things.
25:51
I think I might have, might have decided on something I, you
25:54
know, I was deciding maybe to do lifestyle medicine or you know,
25:58
or something, something else. But I think I might be looking
26:01
into natural cycle tracking for women.
26:05
So we'll see. There's a, there's a really nice
26:07
program put out. It's called Facts for Fertility,
26:11
I think is what it's called. So I think I might do that as my
26:13
next training. But but it's, you know, with my
26:15
extra time, I mean, that's what I'm doing.
26:17
I feel like I'm just thinking about kind of what's coming next
26:19
and that kind of thing. But.
26:21
But yeah, my husband has been very busy during the past couple
26:24
of years, too with his job. So.
26:25
So we love to go out and love to do things around South Carolina,
26:28
love to check out festivals and go out to eat in new
26:31
restaurants. We'll travel to another city to
26:33
eat at a restaurant. That's good.
26:35
But yeah, we like to do those things too.
26:37
So. And I have had time to craft for
26:40
the first time in forever. So yeah, I hadn't done any
26:43
crafting in years and years. And so I finally had time to to
26:47
do some crafting for to make Christmas gifts for nieces and
26:50
nephews and. Things, Yeah.
26:51
What kind of crafting do you do? So the one I did most recently
26:56
was punch needling, which is basically, I don't know if you
26:59
know what it is, but it's like rug making essentially, but you
27:02
do it by hand and yeah, so that's it's really quick and the
27:06
and the final product looks pretty good so.
27:08
Yeah, yeah, I think that a lot of people that I know or have
27:12
heard of, you know, again with the extra time, they're doing
27:16
things that they used to do, you know, before school, before
27:22
medical school or before kids or something, you know, and, and
27:26
they're they have time to do that again, like people penny to
27:29
ride horses and so yeah, yeah, yeah.
27:33
Extra. Yeah, that's, that's very
27:34
interesting. That's actually a tip that I
27:36
give to people that are feeling lonely or depressed.
27:39
You know, in my practice, I'm like, well, what did you at
27:40
least to enjoy doing as a, you know, as a kid?
27:43
Can you do that again? Can you start?
27:44
Can you pick that up again? So, yeah, that's funny.
27:46
So I'm, yeah, I'm moving out of my depression phase of my
27:49
career. Hopefully not really depressed.
27:53
Yeah. No, no, no, no, but, but sort of
27:56
that. Unhappy.
27:57
You know, these last three years were very.
27:59
Yeah, they were. Yeah, they were.
28:01
I was not. Happy.
28:01
That was a long time to kind of be like, I'm out of here.
28:05
Right. And it was right.
28:06
It was too long. Yeah, I wish.
28:09
I wish I would have made the move a little bit earlier.
28:11
But at the same time everything. Right, that's true.
28:14
I think just about everyone who does DPC says yeah, I wish I'd
28:17
done this earlier so. Yeah, exactly.
28:22
But it it gave me time to really.
28:23
Appreciate this. You know, this type of practice,
28:26
so, you know, I, I feel like I had to, had to hit my bottom
28:29
before I, before I started to climb out a bit before I was
28:32
willing to take the risk to do it.
28:33
I think that was the big thing for me.
28:35
I, I really need to be sort of pushed off the Cliff in order
28:37
to, in order to make the make the decision.
28:39
So, so I think I needed to, I needed that, that significant
28:43
unhappiness before I was able to, you know, make the decision.
28:46
Are there any other DPCS around you like in Columbia?
28:51
Yeah, there are. So Doctor Victoria Leventeshu
28:54
has a practice called Victory Family Medicine, and then Dr.
28:57
Phoenicia Franklin has Living Well Family Medicine.
29:01
So those are the two others. Now Palmetto Proactive, who has
29:04
some practices in the Upstate part of South Carolina, They
29:07
also have a branch office here in Columbia too.
29:10
Those are the DP CS in the Columbia area that are pretty
29:13
active. So Doctor Franklin, she's in a
29:15
little bit of a different position having taken over, you
29:17
know, a DPC practice, whereas Dr. Leventa Shu and I both
29:21
started ours from scratch. So it's interesting comparing
29:23
notes. We, we go out to dinner every
29:24
couple of months and kind of kind of share notes and things.
29:27
So it's, it's been a good, good, you know, collaboration.
29:30
Oh, that's great. Yeah, that you do have others
29:33
to, you know, just to talk with. And did you go, I mean, well,
29:37
Doctor Franklin wasn't there yet when you started.
29:41
Did you go to anyone's offices to to check it out?
29:44
Yeah. I did, yeah.
29:46
I'm trying to think. So there was a practice in
29:48
Columbia at the time that has since closed.
29:50
So I checked out that practice. I also shadowed it at Palmetto
29:53
Proactive. So Jerome, Doctor Jerome I is
29:56
practice in, I think I went to his practice in Spartanburg.
29:59
Of course he has a couple of them, but yeah.
30:01
And then I, I'm trying to think, I feel like I went to one more,
30:04
one more office, but that was, it was very helpful.
30:06
I, I would recommend that to anybody that's looking at doing
30:09
this because it really gives you a feel of, you know, of how that
30:12
how that works. And so I have been opened my
30:15
practice to anybody that wants to come and see it.
30:17
But I find that what I'm focusing on is educating the
30:21
students. So undergrad students, Med
30:23
students, residents, residents come and do rotations with me.
30:27
So, so I really enjoy introducing the idea to people.
30:30
And, you know, it's, it's, I don't want to say it's new
30:32
enough, but it's not well known enough to still be useful and
30:36
valuable. I feel like to do that.
30:37
So yeah, that's, that's been really fun.
30:39
I really. Enjoyed it grimming the next
30:41
generation DPC directors. Yes, yes, that's right.
30:46
I know get them in, get them in, you know, introduce them now so
30:48
that they know they know this is an option because I certainly
30:50
didn't know it was an option and I never had the desire to open
30:53
my own practice. So it just sort of grew out of
30:56
necessity. So no I.
30:58
If you'd ask me, you know, even five years ago, a few things.
31:04
Absolutely. Absolutely.
31:05
I mean, I would have laughed at you if you had said that in
31:09
2025. I'd be five years into owning my
31:11
own practice. I would have thought you were
31:13
crazy because I just, I mean, you don't have any mentors that
31:17
own their own practice. You know #1 and #2 I just didn't
31:20
have a desire to do it. So.
31:21
So yeah. So that's that's.
31:22
Interesting that you can identify.
31:24
Definitely, Yeah. So what?
31:26
How do you get the students to come to your practice?
31:29
Did you just go to USC and say, hey, I'm welcoming students?
31:34
Yeah. So actually, I don't know how
31:37
this happened to begin with. I'd have to think about it.
31:38
But I was actually invited by the pre Health Honor Society at
31:42
USC to come give a talk to them. So they have, they're very, very
31:46
well organized at USC. Yeah.
31:49
And so they have these chapter meetings, you know, once a month
31:52
or, you know, I guess it's once a month and then they invite a
31:54
guest physician to come in and talk.
31:56
So somehow I got looped into that and I gave a talk a couple
31:59
years ago and then after that that sort of, you know, it's
32:02
just been a continual cycle of students asking to shadow me.
32:05
So I don't have them in that often.
32:07
You know, once a week or twice a week is usually what I do.
32:09
But so that led to the pre Med Honor Society asking me to come
32:14
and give them a talk. So it's just kind of been like a
32:17
like a loop of, of people. And then I got hooked up with
32:20
the family medicine interest group at the University of South
32:22
Carolina's School of Medicine. So this this week, or was it
32:25
last week, I went and gave them a talk about DPC and residents.
32:29
Of course, I'm still in the city where I did my residency.
32:31
So, you know, residents that are interested will come out and do
32:34
a two week rotation with me, which is really fun.
32:36
I really enjoy having the residents with me.
32:38
So I teach them how to draw blood, which, you know, we all,
32:42
we all know the secret about that.
32:45
You know, we're not really taught.
32:46
How to do that? But yeah, and I have them do all
32:48
kinds of things that they wouldn't otherwise get a chance
32:51
to do. So it's I, I really enjoy
32:53
having. Yeah.
32:54
So, yeah, that's fantastic. So is that just kind of one of
32:57
their elective rotations? Yeah, exactly.
33:00
Yep, 2 week electives. And I guess they have more
33:02
freedom because when I was in residency, and I think probably
33:05
when you were there, it was very regimented, like you didn't have
33:07
a lot of freedom to, I don't know, do things that you were
33:10
really interested in or possibly interested in.
33:13
But I think their, I think their schedule has changed and allowed
33:16
some possibility. So, so yeah, I'm trying to think
33:18
how many I'll have this year. I think I'll, so between July
33:23
and December, I think I'll have three different residents that
33:25
are coming out to do a rotation with me.
33:27
Yeah. And then they all come out
33:28
during their practice management rotation and spend an hour with
33:31
me and I just kind of. Tell them about DPC and show
33:33
them my office SO. Yeah, but I'd, I'd recommend it,
33:37
I mean, to anybody it it's just so fabulous.
33:39
I really, really enjoy it. So anybody that has a residency
33:42
in their in their town, you know, reach out.
33:44
There's actually another family that is at residency here now,
33:47
here now. And yeah, I'm probably going to
33:49
reach out to them too, just to say, hey, I'm here, you know, if
33:51
anybody's interested. So there's.
33:53
Two wow, that's great. The other hospital.
33:56
Systems. So, OK, that's new, yeah.
33:59
They started one a couple years ago, so cool.
34:02
Well, that's good. Yeah.
34:03
The more the more residents, right?
34:05
The more the better. That's fantastic.
34:08
Yeah, exactly. And I tell everybody I was like,
34:10
you don't have to do this right out of residency.
34:12
I mean, I don't know. You know, like I said, I wasn't
34:14
interested. But I also feel like there's
34:16
probably some value in getting out into the world and figuring
34:19
out what kind of doctor you want to be, which, you know, you may
34:22
not know, coming out of residency and getting some
34:24
experience under your belt first.
34:26
So I tell all of them, you don't have to do this right out of
34:28
residency, but I just want you to know it exists and it's here.
34:31
And I'm here to help you if you have any questions.
34:33
So, So. Yeah, so.
34:35
When you go and do these talks for Med students versus
34:39
residents, do you give them the same spiel or you use different
34:42
talks? That's very interesting.
34:44
Right. So I had to.
34:45
So my talk for residents, I thought that I was just going to
34:48
give the same talk to the Med students.
34:50
But as I was going through it, I was like, I think there could be
34:54
other valuable things that I want to add.
34:57
I did a more basic talk for the Med students compared to the
34:59
residents. I talked a little bit about
35:01
myself in my resident talk because I wanted people to know
35:04
kind of what my characteristics were so that they could decide
35:08
if that was, you know, fit them, which may not make sense, but I
35:11
think you know what I mean. And yeah, so I did alter it a
35:14
little bit and I think I'm going to give a version of this talk
35:16
to the college students that I'm giving a talk to on Sunday.
35:20
So I'm going to further modify it and just really try to keep
35:22
that sort of basic for them. But again, you know, if it
35:24
piques somebody's interest and they if they don't do primary
35:27
care, if they do specialty care, I mean, you know, direct
35:30
specialty care. Assistance too.
35:31
So that's that's so wonderful. So thank you for educating the
35:36
new students, the up and coming students and residents about DPC
35:40
from. USC And you know, when I was in
35:43
the, when I was working for the hospital system, I wasn't
35:46
growing. I wasn't, you know, I was not
35:48
growing at all. I felt like I was just doing the
35:51
same thing over and over again and I wasn't meeting new people.
35:56
I, I felt so isolated in my big hospital system.
36:01
And I feel like now that I, that I have a DPCI mean not only do
36:04
you have a small business community, but you also have,
36:07
you know, you also have other DPC doctors that are looking to
36:10
share and learn and grow as well.
36:12
And that's totally different than in the hospital system,
36:14
right? Everybody just wants to, you
36:16
know, wants to. Yeah, exactly.
36:18
And just make their money and move on.
36:20
And so I, yeah, I was really shocked at how much how how much
36:25
more connected I feel being a part of the DPC community now as
36:29
opposed to when I was in the hospital system.
36:31
I mean, I actually know people now.
36:33
I've met other people, you know, I kind of know some other
36:36
practices that are in the area. I mean it is just it was just
36:40
mind blowing to me about how how just doing opening this DDC
36:45
practice actually grew my network.
36:46
Yes. Yeah, absolutely.
36:49
Yeah. It really it just like life.
36:51
It's expanded my life. I guess in a way it's life
36:54
expanded, yes. Because again, you know, I was
36:57
like very stuck, just very much same thing, you know, head down
37:01
taking care of the work starting at night, you know all the
37:05
things, you know, taking care of the kids, all the animals and
37:10
run in the, you know, all the things.
37:11
Yeah, all the things. It was just a monotonous kind of
37:14
rat race, right? And yeah, there was no incentive
37:16
really to grow or. Learn how to change, right?
37:19
Yeah, well, there you're right, there is no incentive because at
37:22
one point I thought I wanted to try and do POCUS, I wanted to
37:25
learn how to do point of care ultrasounds.
37:27
And so I took a couple courses and I was like, OK, this is
37:30
really cool. But number one, you have to get
37:32
like you got to get signed off on stuff and where are you going
37:36
to do that unless you learn it like, oh, USC is amazing.
37:40
They give people that pocket ultrasound first day.
37:43
Yes, yeah, I know the students, the Med students come out of
37:48
there and they know what they're doing with a, with a, with a
37:51
poker. Yeah.
37:52
Yeah. And that is, it's so incredible.
37:54
And so, I mean, I was like, well, OK, when am I going to
37:57
take time off for my current schedule to go shadow an ER
38:02
Doctor Who's probably not going to want me there or go to a
38:05
radiology Like it just and no one really cared when I told
38:09
when I told, you know, the higher ups, they were just like,
38:14
what? We have radiologists for that.
38:16
Like you don't need to be doing that.
38:17
Yeah, that's. Great.
38:18
And I'm like, I'm not, you know, for example, like for DVT rule
38:21
out, I'm not going to make the final call, right?
38:25
But it just gives you guidance, right.
38:28
So. Exactly.
38:30
But yeah, like that was one thing, you know, no one it would
38:33
have been really cool to do because we were in an OB gun
38:37
practice. I mean they do ultrasound all
38:39
the time. Right, exactly.
38:42
So, yeah, but yeah, here's there's just no room for growth
38:46
or incentive like you said. Yeah, yeah.
38:49
There's there's not that's, that's interesting.
38:51
I've done more learning and growing because the other thing
38:54
is, is that I feel like I in terms of CME, you know, that was
38:57
the other thing. I mean, I felt like I just kind
39:00
of got CME naturally and when I was in the hospital system for
39:03
whatever reason, I don't know. But now I actually have to seek
39:06
it out and, and that's actually, it's good.
39:08
That's actually been helpful. I've learned some things.
39:10
Yeah. So yeah, yeah, it's good.
39:13
But yeah, definitely life expanding.
39:16
It's great getting you and so many other DVC docs and the
39:19
support. So you're just talking about the
39:21
monthly call like you have the other Columbia DPC docs.
39:26
So we have a N Well, now it's going to be North and South
39:29
Carolina call with you once a month.
39:32
Doctor Catherine Locke and Asheville, she started this just
39:35
monthly support Zoom call. And so we started probably four
39:40
or five months ago and it was just like 3 or 4 of us and the
39:43
last one was 10. So it's a nice, it's a very nice
39:46
supportive community just to talk about DPC topics.
39:50
So, yeah. So I look forward to seeing you
39:54
on the call. Yeah, yeah.
39:55
Yeah. Well, thank you.
39:56
I appreciate it. Well, is there anything else
40:00
that you would like to tell our listeners, maybe new DPC dogs or
40:03
people who are call them DPC Dreamers, anything that you
40:07
would want to tell them? You know, I, I don't know, I
40:10
would just say that that if you're scared of doing DPC,
40:14
you're, that's normal. So just keep plugging away.
40:18
I mean, if you really feel like your heart is in it, and I did,
40:20
I felt like it was what I was meant to be doing.
40:23
You know, I, I sort of just got through it and, and with some
40:26
help. And you don't have to do it
40:27
yourself, right? There are lots of lots and lots
40:29
and lots of small business resources out there.
40:31
So, so, yeah. And I, I would recommend
40:34
probably to go to the DPC Summit.
40:36
Not that I'm plugging, you know, the specific, the specific
40:38
conference, but I mean, gosh, people are just so nice and
40:41
willing to share. And it is just such a fabulous.
40:44
I, I'm not a networker, you know, I, I, when I go to other
40:47
conferences, like non medical conferences, I'm like sitting at
40:50
a table by myself because I just don't, you know, I'm not a
40:52
natural networker, but you can't help but network at the DPC
40:55
Summit. I mean, it really is.
40:57
Really is interesting how that works.
40:59
So very true. Yeah, I know I'm, you know, like
41:03
don't necessarily want to promote one thing over the
41:05
other, but yes, the summit is amazing and then it's summer
41:08
camp for DPC docs. Yeah, yeah, I know.
41:11
We need like a, you know, like a bracelet making class like.
41:16
Yeah, yeah. Exactly.
41:17
Right, Right, right. So right.
41:18
Exactly. But yes, so that, yeah, the
41:21
summit and then I, you know, I just always really talk about
41:24
the DPC masterminds that the DPC Alliance does because that's, I
41:28
mean, that's why I know so many South Carolina doctors because I
41:31
went to the one in Greenville and OK, OK, that was one of the
41:36
best things I did, you know, before.
41:39
Opening up, I I can believe it, yeah.
41:41
I didn't have a chance to go to one.
41:42
I've never been to 1. You know, I guess now I'd be
41:45
more of a veteran than a mentor than a Yeah, yeah, exactly.
41:49
But yeah, I can imagine that, I mean, having, you know,
41:51
one-on-one or whatever it is, you know, being able to ask your
41:54
questions would be very. Very helpful.
41:56
It was a wonderful experience. It was the weekend before we
41:58
opened, so just the timing, I mean, just happened that way.
42:03
But it was wonderful because, yeah, you know, if you go to one
42:06
that's fairly close to you, then you'll meet doctors that are
42:09
near you and then you get that, you know, it's kind of like a
42:13
mini residency group, I guess I would say, you know, because a
42:17
lot of us still keep in touch and it's a wonderful support
42:21
group. Well, that's yeah.
42:23
And that's one of the things that we're, you know, with our
42:26
MSO like organization, you know, that we're going for is we, we
42:29
wanna, Yeah. So I I understand.
42:32
That All right, Well, I have taken up enough of your time, so
42:35
please let us know. How do people find you?
42:38
So people can go to Noretta's website,
42:42
soitsnorettafamilymed.com. It's NORETA familymed.com.
42:47
I'm on LinkedIn and you know, Noretta has a Facebook page and
42:51
an Instagram page. So yeah, any of those places
42:54
would be good to to find me and feel free to.
42:56
Reach out and if any students happen to listen to this, yes.
43:00
And you're in Columbia, USC, you know, reach out to Doctor Boylan
43:03
and she'll, she'll show you what DBC is all about.
43:06
I'd be happy to thank you so much for being my guest.
43:10
I really appreciate it. It's so nice to see you and chat
43:13
with you. And yeah, hopefully I'll see you
43:14
next year at the summit. Absolutely.
43:16
Yeah. Well, thanks.
43:17
Thanks so much for having me. It's an honor to.
43:19
Be on your job. Thank you.
43:22
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43:25
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