Latest / DPC Life: Direct Primary Care Podcast / Starting DPC After Years as a Hospitalist: How Dr. Nadia Sirdar got 50 patients in Bethesda

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Starting DPC After Years as a Hospitalist: How Dr. Nadia Sirdar got 50 patients in Bethesda · DPC Life: Direct Primary Care Podcast

• 0:00
  I didn't realize this is almost more adrenaline.
• 0:02
  I am the rapid response. Like I'm everybody.
• 0:04
  They actually told me like, you can't do this.
• 0:07
  And I was like, why? And I said, you can't do it.
• 0:09
  You're not going to be able to do it.
• 0:11
  And I said, really, you are here to help.
• 0:14
  You are here to serve. And yet if your community
• 0:18
  doesn't even know you exist, how can you serve them?
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  Everyone stood up. All the legislators stood up and
• 0:26
  they clapped for me. And I was like, this is crazy.
• 0:29
  Like this is not because I'm like, who am I?
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  Welcome to DPC Life, the podcast where independent doctors share
• 0:37
  real stories, bold ideas, and the freedom of doing medicine on
• 0:42
  your own terms. I'm your host, Doctor Ann
• 0:45
  Gonzalez, and together we'll explore the winds, the
• 0:48
  struggles, and everything in between.
• 0:52
  Let's dive in. Hospitalists aren't supposed to
• 0:55
  build a 50 patient DPC panel in six months, but that's exactly
• 1:01
  what Doctor Nadia Serdar did by running an intense networking
• 1:06
  schedule. In this episode, she breaks down
• 1:09
  the reality of saying yes to nearly every event, meet up, and
• 1:14
  community appearance, what that Sprint did for her growth, and
• 1:18
  what she'd do differently. So you can grow fast without
• 1:22
  burning yourself out. Welcome back to the DPC Life
• 1:26
  podcast, where we discuss everything DPC both in the
• 1:30
  office and beyond. Let's get into the first half of
• 1:35
  our return interview with Doctor Nadia Sirdar.
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  I am so excited today to have Doctor Nadia Sirdar returning
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  for a second interview. Thank you so much for being on
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  the show again. Thank you for having me.
• 1:50
  Absolutely. And this is Doctor Nadia Serdar
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  of Bethesda Modern Primary Care in Bethesda, MD and you have
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  been open now for six months. Six months of with my soft
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  launch, which is in October and then my official ribbon cutting
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  was January 8th. So fantastic.
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  So like kind of like first quarter of like the real place
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  and then six months since my soft launch.
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  OK, good, good. And I'm just going to recap.
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  You are internal medicine. You were a hospitalist
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  previously and then decided to leave that behind and go to
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  direct primary care? So 3 slash 6 months in, how are
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  things? Going, I think they're going
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  really well. We just sort of hit our first
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  quarter officially like from the ribbon cutting and we're at 50
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  patients. So that's a big deal.
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  We're really happy about it. It's been wonderful.
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  It's slow and steady. I think I kind of like was going
• 2:49
  a little bit of at a breakneck speed kind of coming out the
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  gate just because I think I had so much anxiety about like if I
• 2:55
  would be known in the community or if I would make the right
• 2:59
  connections with regards to specialists.
• 3:01
  But I think all of that is sort of settling a little bit in the
• 3:04
  sense that I feel confident to say yes and no to different
• 3:06
  things instead of yes to everything.
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  It's funny because you know, that term like ROYI always used
• 3:14
  to hear it and think like, it doesn't mean much, like I don't
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  really get it. But now I understand there's
• 3:19
  like these funnels where my patients are coming from, some
• 3:23
  are more sort of like high yield than others.
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  And so it's just helpful to be a sort of a little bit more like
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  proactive about figuring out what those funnels are.
• 3:34
  And I think that CEO mentality is kind of been a big shift
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  where you say like instead of just doing everything, you have
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  to sort of kind of like reserve 20% to do the business part and
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  the strategic part. And so that part has been like a
• 3:49
  learning curve, but I think it's going well.
• 3:52
  Yeah. It's all good.
• 3:54
  It sounds like you're enjoying it.
• 3:56
  And I'm enjoying it. It's funny, 'cause like, I feel
• 3:58
  like I'm way busier somehow. I don't know how I'm busier than
• 4:01
  when you do hospital medicine 'cause you do 12 hour shifts.
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  But I would say I'm probably like mentally we're occupied
• 4:08
  with or thinking about the practice 24/7, but I don't mind
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  because it's mine. I'm building something from the
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  ground up. So it's almost like when you've
• 4:17
  got like your Legos and you can see the shape coming in.
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  And so you're just very careful, like 1 like a lot of time.
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  But it's like so rewarding because every when is like the
• 4:28
  practice is when and it's really it's it's really cool.
• 4:32
  Right. And you did it.
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  I did it, yeah. Something that you did.
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  It's crazy, Like I, you have like this weird.
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  I don't know if you've had this, but like I had a little bit of
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  like or a lot of it of like that imposter syndrome where you're
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  like, oh, it's because they like me or like, oh, cuz I'm a nice
• 4:51
  person. No, it's I'm a competent
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  physician and I'm giving a good like I'm able to offer really
• 4:56
  good care and that's the reason. But it's weird.
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  Like I have to keep telling myself that because I think you
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  get so beat down and when you're like an employed physician that
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  you forget your value and you forget like your skill set is so
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  an important and you've honed your skills over decades and
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  that's worth a lot. Right.
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  Yes. And that's really common, the
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  imposter syndrome, especially when you are starting out,
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  especially with the way that some people react to when you
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  talk to them about, oh, I'm doing direct primary care and
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  you get all kinds of reactions and that's, I think that's a
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  normal kind of response. Yes, yes, we all have to
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  remember that we are physicians. We went to medical school in
• 5:45
  residency and have done this for.
• 5:46
  Years and. We know what we're doing.
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  We know what we're doing and honestly, like, it's fantastic
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  to me to be able to say from the very beginning of the patient's
• 5:57
  intake to like when we're managing their symptoms and
• 5:59
  managing their issues that you're part of the whole
• 6:03
  trajectory. Because I think one of the
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  difficult parts about or one of the parts about hospital
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  medicine that's different is you are at the very end of that
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  trajectory. Like that's when people get to
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  inpatient, right when they have had completely uncontrolled
• 6:17
  hypertension or they're coming in with an MI.
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  It's the end stage of the medicine trajectory.
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  And so it's what's really cool is to meet people at the very
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  beginning or before and you're part of that sort of process to
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  either prevent or help the progression of like you're much
• 6:36
  earlier in that trajectory. And it feels so much more
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  rewarding because you have so many more wins when you hit
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  them, when you help people in the beginning versus all the
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  way. At the end, yeah.
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  Has that been a difficult shift to go from hospital medicine and
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  being at the end to coming? To.
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  Direct primary care. So you know what's funny?
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  I thought it would be a lot harder because it's just all I
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  knew. I would say probably the hardest
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  part for me is missing my colleagues just because we were
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  all so close and we are so close.
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  But the reality is everyone's busy, right?
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  And so I'm going to see them maybe once in three months,
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  maybe once in six months, depending.
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  And they've been incredibly supportive and incredibly, you
• 7:20
  could do this like you got this, you're doing so well.
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  So that's been really meaningful.
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  It's funny, I don't. I don't really miss it.
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  I guess it's hard to say, but I don't really miss it.
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  I think that I'm getting so spoiled by how happy my patients
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  are with me that I don't think I could handle it going back and
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  having people be so mad. It's like I know everyone's not
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  happy. So I mean, it's just, you know
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  what? It's not like every day like
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  that, but there are a lot of days that felt like you were
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  going into battle and it doesn't feel like that right now.
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  You know, it's feels much more. Sometimes I'll get excited about
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  someone's blood pressure, but I can just go up on their meds a
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  little bit and it's going to be fine.
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  It's not like I need to think about the ICUI, need to think
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  about the specialist that I'm calling.
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  It's just different. And so the acuity is different.
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  But also like the system, 'cause you, you're in charge of
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  creating a system that works for you and for your patients.
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  And it's just a lot more. It's just a lot more like
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  manageable. Yeah, I was going to ask if you
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  missed the acuity and kind of the rush of adrenaline of it all
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  because it is different. Yeah, so I, OK, so here's what's
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  the crazy part I thought, I thought going into primary care
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  would be nice and boring, like really, really like relaxed like
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  oh, you have hypertension and I could do this medicine it'll be
• 8:45
  fine. I've sent 2 patients to the ER
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  and it's been pretty like adrenaline heavy where I'm like,
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  Oh my goodness, we are going to the ER like now, now.
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  And thankfully they had really good outcomes.
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  But I was like, wow, I didn't realize this is almost more
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  adrenaline because there's no nurses in the back.
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  There's no like code system. I can't call a rapid response.
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  I am the rapid response. Like I'm everybody like I just
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  remember my 12 year old being in the other room like reading her
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  little comics or anime and she was like, mommy, is everything
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  OK? And I'm like, everything's fine,
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  I'll be right back. That's all good.
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  This versus. Systolic is above 200.
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  Like this is insane. I mean, really it it's been a
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  few of those adrenaline type situations, but because I care
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  so much and also like knowing that what could potentially
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  happen? So not true, true like code
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  situations, but just like places where I'm like, oh, you're
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  walking in with a systolic about 200 that happens here.
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  Oh, crap. Like, I'm really glad you came
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  to me. Yes, yes.
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  And Yep, it'll happen. It'll happen a lot.
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  Yeah, I mean, I think I think that there's a little bit of
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  that. My husband's a stroke physician
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  and my kids have gotten in this habit of saying, like, Daddy,
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  did you save someone's life today?
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  And I'm like, did I save someone's life?
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  I hope. I think so.
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  But I think it's much more delayed gratification.
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  And that's OK because the reality is like, sure, if you
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  get someone through a code, yeah, you got a pulse, but like,
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  what's their life going to be like after that?
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  It's different, right? It's not the same win as, OK,
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  we're going to talk about all these, like, modifiable risk
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  factors. We're going to get you on a good
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  plan. And now you're going to live
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  into your 80s thriving and not suffering in and out of the
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  hospital, right? It's a totally different
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  trajectory. And sometimes you'll see it.
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  Hopefully if they stay with you long term right you'll be able
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  to follow them. That's the hope.
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  I think so. I think so.
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  Well, there are a lot more hospitalists going into direct
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  primary Care now, which is amazing.
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  So that's really cool. So I didn't even think about it
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  because nobody I knew had done it when I was when I was
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  thinking about. So I talked to you in the fall
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  and I had started my process in January of 2025, like just
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  thinking and building and sort of starting.
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  But I was in hospital medicine all the way until October and
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  everyone I talked to was like, Oh my God, you're so brave.
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  And never heard of anyone doing this.
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  And in fact, I did reach out to a few of the older primary care
• 11:15
  doctors that were like seasoned thinking like they would be
• 11:18
  fantastic as like mentors. And I got really discouraged.
• 11:21
  They actually told me like, you can't do this.
• 11:24
  And I was like, why? And I said, you can't do it.
• 11:27
  You're not going to be able to do it.
• 11:28
  And I said, really why? Why is that?
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  Because these are people I respect.
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  I had taken care of their patients following an inpatient.
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  And it was sort of devastating because I was like, oh, they
• 11:39
  must be right. They know what they're talking
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  about. They've been doing this 30
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  years. One person told me you should go
• 11:43
  to urgent care and do shifts there to figure out, like, how
• 11:46
  to do outpatient medicine, which I respectfully disagree.
• 11:53
  Yeah. And then the second person told
• 11:55
  me there's no way you can do outpatient medicine after
• 11:58
  inpatient medicine. Like, I would be able to do
• 12:00
  hospital medicine. So my answer to that is internal
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  medicine is a continuum. In inpatient medicine, we take
• 12:07
  care of the end result of the same disease process that we're
• 12:11
  addressing in primary care. So really I've taken care of
• 12:15
  folks at the very end of that continuum.
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  And in that setting, outcomes are very, very different and our
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  expectations are different. And yeah, the acuity is very
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  different. But if you back up several steps
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  right now, what I'm doing is to get to prevent getting to the
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  end point there, you know what I mean?
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  So it's the same medications. Like when you're inpatient, we
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  start you on blood pressure medicine, We titrate those meds.
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  Same thing in outpatient, but smaller doses, a little bit more
• 12:42
  time, a little bit more nuance, right?
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  So it's literally the same medicine.
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  Like the human body doesn't change.
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  Now, do I have like questions sometimes about how much I
• 12:52
  should be stressed out about something?
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  Sure. Like I'm like, Oh my God, it's a
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  red number. I'm like laughing at myself
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  because like in image of Edison, you see red numbers all the time
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  and you're like, it's like it's like borderline high.
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  But now I'm like, Oh my God, I can't miss anything.
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  So I'll like talk to my nephrology friends, talk to my
• 13:08
  cardiology and they're like, no, that's fine.
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  You're going to be OK. Like you're going to see him
• 13:12
  again in a few weeks. I'm like, yeah, you're right.
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  OK, OK. So like over time I've been able
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  to calm down. But just like that initial
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  discouragement is something that I found to be very off putting
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  because what that means is you're telling the other
• 13:25
  physician that like your skill set is very limited, that the
• 13:29
  life you've chosen, that's it. You, there's no flexibility,
• 13:32
  there's no other outs. And frankly, what you kind of
• 13:35
  start thinking about is, oh, I guess I might not be able to
• 13:37
  practice medicine that I guess like that's where you're sort of
• 13:41
  thinking, right? Because if you don't want to
• 13:42
  continue to do hospital medicine for 10/15/20 years, which is
• 13:46
  really hard to do that the average person does it for like
• 13:48
  5 to 7 and you're telling them that they don't have options.
• 13:51
  And I don't think that's actually accurate.
• 13:54
  So. Right.
• 13:56
  I'm curious, these physicians that you spoke with, are they
• 14:00
  direct primary care doctors or are they regular fee for service
• 14:02
  doctors? I think initially fee for
• 14:04
  service, insurance based and then they went to concierge
• 14:08
  where they would and there's so much nuance between like the
• 14:11
  concierge and the DPC, but I think they were still taking
• 14:13
  insurance doing an add on fee. Some of them were like fee for
• 14:17
  service straight, but I think there was like a sense of, it's
• 14:22
  sad to say this, but like they were older women who maybe did
• 14:26
  not feel super excited to see someone do something different.
• 14:30
  And I don't, I don't know, because I wasn't threatening
• 14:33
  their position in any way. And in fact, I was coming to
• 14:36
  them as like potential mentors to ask them their advice and
• 14:39
  their guidance. But something I think, I hope
• 14:42
  I'm never like this, like in my next stages of my career, but I
• 14:45
  really want to pay it forward in terms of encouraging people to
• 14:47
  like, think about all the options.
• 14:49
  And like, I was actually thinking about reaching out to
• 14:52
  the residency directors for the local programs and being like,
• 14:54
  do you want me to come talk about DPC?
• 14:56
  Because I think internal medicine residents should know
• 14:59
  this option. Like I think they need to be
• 15:01
  aware and maybe start thinking about the business aspect and
• 15:04
  start listening to the podcast. And how amazing would it have
• 15:07
  been if I knew about this 15 years ago?
• 15:09
  I mean, who knows where I would have been?
• 15:10
  So I'm so happy with the trajectory that I've had because
• 15:14
  everything kind of happens for a reason.
• 15:16
  Every step kind of led me to the next step.
• 15:18
  But I just think there's so much opportunity and there's so much
• 15:23
  talent. Like there's so many amazing
• 15:26
  physicians who just want to bring something more to the
• 15:27
  table. And you just give them the
• 15:29
  option and the ability, the structure to do that.
• 15:31
  And that's a win for the system. That's a win for the patients,
• 15:35
  right? Right, Yeah, I think that a lot
• 15:39
  of people in traditional medicine fee for service
• 15:42
  medicine, they have blinders on. They just.
• 15:46
  This is the one path and it's kind of been sold to us like
• 15:49
  that since we came out of residency, right.
• 15:51
  That's exactly right. That's all you do.
• 15:53
  But like you said, hospital is five to seven years.
• 15:56
  It's the same for ER docs a certain amount of time.
• 15:59
  And so I kind of think of it as like an NFL player, how many
• 16:03
  years do they have? 5 to 7 also correct.
• 16:06
  What do you do? Because like you.
• 16:09
  Said you can't be put out to pastor.
• 16:11
  It's like, yeah, like going to war and what are you going to
• 16:13
  take somebody with 1520 years of expertise and just.
• 16:16
  But I'm out there in the middle of nowhere.
• 16:17
  I mean, people will say to me, I had one patient, it's so funny.
• 16:21
  I had one patient. A lot of my patients signing up
• 16:23
  are physicians, which I take is a huge compliment, but it's also
• 16:27
  a huge responsibility, right? And so I'm very, very
• 16:30
  transparent with them about my background and about like where
• 16:33
  I'm coming from. And 99% are like, OK, that's
• 16:37
  amazing. I love that.
• 16:38
  I love that you do acute medicine and now you're 'cause
• 16:40
  you're comfortable with more, you could work more at this like
• 16:43
  maximum scope of practice. I'm not going to get scared if
• 16:46
  someone has an arrhythmia. Like I get it, right.
• 16:48
  But one, one doctor was like, oh, I almost did what you did.
• 16:51
  I almost direct primary care. I was about to sign a lease.
• 16:54
  I almost did it. I almost did it.
• 16:55
  And I was like, oh, OK, that's awesome.
• 16:57
  Like why didn't you? And she's like, I got scared and
• 17:00
  I was like, OK, well, just that happens.
• 17:02
  It's OK. And she's like, I have the best
• 17:04
  job now. She has a, she's like, I had an
• 17:07
  opportunity to start a work at the World Bank and that doesn't
• 17:09
  happen all the time. And I'm like, well, that's
• 17:11
  amazing. I your job sounds amazing, but
• 17:13
  she's not seeing patients, right?
• 17:15
  Like clinically. And so it's interesting because
• 17:19
  she was very like, she was very excited and happy to hear about
• 17:23
  the practice. But at the end she was like, I
• 17:25
  did primary care and I just want to know, did you do extra
• 17:28
  training to be able to do like outpatient medicine?
• 17:31
  Like how are you going to do it? Did same training you did right?
• 17:37
  That's like my. Husband was like, let's take in
• 17:39
  the background. He's like rolling his eyes.
• 17:41
  I'm like, Oh my God. So I was like, well, like, I'm
• 17:45
  really happy to, I'm American born of internal medicine
• 17:47
  training and I'm really happy to like look things up and ask my
• 17:51
  fellow trainees. But it's interesting that she
• 17:52
  asked that and then she signed up.
• 17:54
  She like signed up to be with, I think it's important for us to
• 17:58
  tell people who are in training how many options are out there.
• 18:02
  And then I think it's actually the onus is on us to educate our
• 18:05
  peers in like a very sort of like not antagonistic way, but
• 18:11
  just to say like, by the way, I also thought like you and I just
• 18:14
  figured this out and I want you, I wanted to share with you like
• 18:17
  all the things that can happen out here where you still get to
• 18:20
  see patients. Cause a lot of the doctors that
• 18:22
  I know that are like burning out, they're like, OK, I guess I
• 18:25
  have to go work for insurance company or I guess I have to go
• 18:28
  do like, I don't know, utilization review something
• 18:32
  that I don't have to see patient, you know?
• 18:34
  Medicine or just quit medicine all together?
• 18:37
  Yeah. I know.
• 18:38
  And that's kind of like and no judgement, people do what they
• 18:41
  need to do, but I think that's just a waste of all your
• 18:44
  training, right? And look at our shortages.
• 18:49
  It's funny you say that because I bet that the fee for service
• 18:52
  doctors are thinking, oh, what a waste of what you're doing.
• 18:56
  I know, I know. It's so crazy.
• 19:00
  I guess everyone's got their own perspective.
• 19:01
  Everyone's got their perspective, but the positive
• 19:04
  side has been and that like most people, I'm going to, it's so
• 19:08
  cool. So like I have like a cardiology
• 19:12
  bestie who was like always on consults at the hospital and
• 19:16
  she's an outpatient Doctor Who does both, right?
• 19:18
  And she's in a private practice. And I always had like a girl
• 19:21
  crush on her because I'm like, you're so awesome.
• 19:23
  Like you come in and you do like MIS and you go out there and you
• 19:25
  do like other, like you just come in and out and you make it
• 19:28
  look easy. Well, it turns out she had a
• 19:29
  girl crush on me because she's like, I can't believe you're
• 19:31
  leaving hospital medicine. You're going to make your own
• 19:33
  practice. It's so cool.
• 19:34
  So we end up going for drinks because we're like, let's talk
• 19:36
  about this. And so I ended up giving her my
• 19:38
  whole list of podcasts, all my like, entrepreneur books, like
• 19:41
  all my business stuff. And then she was like, I want
• 19:44
  you to come and meet all my specialist friends.
• 19:46
  There's this like special society called like the Osler
• 19:49
  Medical Society. And it's like a huge William
• 19:52
  Osler, like from medical history.
• 19:55
  Yep. And I would never in a million
• 19:56
  years have thought I would get to be involved in that, but they
• 19:59
  invited me twice to come. And everyone there wanted to
• 20:02
  talk about DPC. And then after like 9 months,
• 20:05
  you attend two of their meetings.
• 20:07
  They do like a big like a vote or something in the spring.
• 20:11
  And then they invite like 5 or 6 physicians to be part of a
• 20:14
  cohort for 10 years. And that cohort is supposed to
• 20:17
  be physicians who can work together in different
• 20:19
  specialties to teach each other, learn together and also be kind
• 20:23
  of like a class of like network where you can help each other
• 20:27
  and help grow both academic, I mean, sort of professionally and
• 20:31
  just in terms of knowledge. And so they invited me recently
• 20:35
  and I'm so excited cuz it's. Congratulations.
• 20:39
  I'm so excited. I sent it to my mom and she was
• 20:42
  like, is this the same as William Mosler?
• 20:45
  So yeah, the same one, Yeah, it sounds like AB and I for
• 20:49
  doctors. Totally, 100% I think so like
• 20:54
  it's just, it's lovely because like we all share, I think you
• 20:58
  each give 2 presentation each year, the first year and then
• 21:01
  the second year you host and give a presentation and the
• 21:05
  third year you have the option to do either or just kind of
• 21:08
  like watch stuff. But the nice thing is the other
• 21:12
  people that are joining in your like same class, like I've
• 21:14
  already started working with them.
• 21:16
  Like one of them has a space and he had two doctors.
• 21:19
  He's a orthopedist. He had like APMNR doc and then
• 21:22
  he had an ortho spine doc. And they're literally about to
• 21:25
  send the leaves. And then the ortho spine doc
• 21:26
  kind of pulled out for whatever reason.
• 21:28
  And he was like, I can't believe this.
• 21:30
  I'm so discouraged. I don't think I can do it.
• 21:32
  And I was like, wait a second, yes, you can.
• 21:35
  I'm here for you. Let me go on my little Facebook
• 21:37
  groups. And I just, I said.
• 21:38
  I saw that. You know, and so I send me your
• 21:41
  spiel and let me send it to every single group I'm part of
• 21:44
  and let's see what happens. Well, you saw that direct
• 21:46
  primary care is primary care, but then there's a direct
• 21:49
  specialty care. And then you know, Laura from,
• 21:52
  is it Laura or Laura? I think she's really, really
• 21:55
  active in that Facebook. And so she had said, oh, I'm
• 21:59
  happy to repost in my specialty care cuz I think she's
• 22:02
  hematology. And I just thought this is
• 22:05
  amazing. And he's one of the people
• 22:06
  that's in the ulcer medical society with me.
• 22:08
  So I was like, amazing, right? That is, that sounds
• 22:13
  fascinating. Is that a local thing or is that
• 22:16
  a national group? I think it's local.
• 22:20
  I think it's local. I I'm sure they have chapters.
• 22:22
  I asked the physician who had been the one to like sponsor me
• 22:26
  and invite me and she said we're really low key.
• 22:29
  It's there's no big deal. We just like meet like once a
• 22:33
  month, but I don't know, I was like, William Mossler was like
• 22:36
  the father of modern medicine. I think that the name itself is
• 22:39
  amazing. So I imagine they do have
• 22:42
  chapters, but I'm still learning about it.
• 22:44
  But just to say that like being part of a group of like 30-40
• 22:48
  docs and then a even smaller cohort of like 5 or 6 and we're
• 22:52
  all starting at the same stage in life, like professionally.
• 22:56
  It's so helpful. Yes.
• 22:58
  So thank you. I love that.
• 23:03
  Appreciate that. We'll pause it here for today.
• 23:06
  In the next episode, Doctor Serdah gets tactical how she's
• 23:10
  carving out a niche in perimenopause and menopause
• 23:13
  care, the speaking gigs that are filling her panel, and the exact
• 23:17
  strategies that have worked best for bringing new DPC patients
• 23:21
  through the door. Make sure you're subscribed so
• 23:24
  you don't miss Part 2. Thank you for listening to DPC
• 23:29
  Life. If today's conversation inspired
• 23:32
  you, hit follow. Leave a review and share it with
• 23:35
  a friend who's ready for change. Remember, wherever you are in
• 23:40
  the journey, your DPC family has your back.
• 23:45
  Until next time, keep building a practice and a life that truly
• 23:49
  fits you.