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Starting DPC: Lessons from a Live Physician Q&A · DPC Life: Direct Primary Care Podcast

0:00
And if they give you a hard time about you taking time off and
0:03
not covering them 24/7, then perhaps that's not the right
0:07
patient for you. That's part of being a business
0:11
person is be prepared to hear no most of the time.
0:16
Usually what I will say is I love you, you're my family or
0:20
you're my friend, but you're not my patient and I can't treat you
0:25
because you're not my patient. And this is to keep you safe
0:29
because I cannot be objective because you are my family or
0:33
you're my friend. You will not be able to sustain
0:37
your practice. You won't be able to continue if
0:40
you don't set boundaries because that's just If you don't have
0:44
any boundaries, then you're just going to burn out again.
0:47
Welcome to DPC Life, the podcast where independent doctors share
0:51
real stories, bold ideas, and the freedom of doing medicine on
0:55
your own terms. I'm your host, Doctor Anne
0:59
Gonzalez, and together we'll explore the wins, the struggles
1:03
and. Everything in between, let's
1:06
dive in. Hi, and welcome back to DPC
1:09
Life. I'm your host doctor Anne
1:11
Gonzalez, family medicine physician in Hickory, NC, DPC
1:16
since 2021 and also founder of Harmony OPS for DPC.
1:22
This episode is a question and answer session that I did with a
1:26
group of doctors who are either looking at DPC or have recently
1:32
opened their DPC. The questions they asked are
1:36
ones that I hear very frequently.
1:39
Are you ever actually off? Can you have a niche?
1:42
What does growth even look like in the first few months?
1:46
What is? Normal.
1:46
Growth and then how do you handle family and friends who
1:50
want free medical advice? I'm releasing this one now
1:54
because if you're in that pre launch window, these are
1:59
probably your questions too. One thing I will mention before
2:03
we get into it, at the end you'll hear me talk about a
2:07
program called Independent Practice Path which is not
2:10
available currently, but what I am building right now for pre
2:15
launch doctors and early stage doctors is different.
2:19
If that is, you stay until the end of the episode and I will
2:22
tell you more about it and where to go.
2:25
OK. So if anyone has questions, you
2:28
can go ahead and put them in the chat.
2:29
We'll go ahead and get started since there's a few of us here
2:32
now. Yeah.
2:33
All right. Well, thanks everyone for coming
2:35
in. I'm Anne Gonzalez, family
2:37
medicine doctor in Hickory, NC. Been DPC since 2021 and I have
2:43
enjoyed every bit of it, but definitely at the beginning it
2:46
was very scary. We just kind of were like what
2:48
are we doing? But here we are, it's 4 1/2
2:51
years later and we are still open.
2:53
So that is a good thing. But definitely with DPC.
2:58
I learned about DPC in 2013 and we didn't open until 2021 when I
3:03
heard about DPCI, had three young children and there were
3:07
definitely no resources like there are now.
3:10
We have so many books, we have so many podcasts and guides and
3:14
things that are available, but that wasn't available then.
3:17
So if I had known about it, if I'd had those kind of resources,
3:22
then I might have considered actually doing it sooner.
3:24
And one thing that a lot of doctors say, almost everyone
3:27
that goes into DPC, they say I wish I had done it sooner.
3:31
And so that is why I am doing this to try and help people get
3:34
out of fee for service sooner because it's a zoo out there,
3:39
right? It's a jungle.
3:40
So great. Alejandra has dropped a
3:43
question. So yes, drop your questions in
3:45
the chat that I got a couple online and I'll try to answer
3:48
those too. So we'll do this till about,
3:51
we'll do questions till about 12:40 and then if it's OK with
3:56
everyone, I'm just going to share what I'm doing to try and
3:58
help doctors get out of fee for service and into their own DPCS.
4:02
Well, since Alejandra did have a question here.
4:05
Oh, this is a really common one. OK, so Alejandra asked a
4:08
question I have. Given that running your own
4:10
practice is a business, do you ever truly feel like you're off?
4:15
I worry about the added stress of running a business and
4:19
feeling guilty for taking time away or not having anyone to
4:22
cover for me when I'm away. So this is a super, super common
4:27
question and it does hold people back because they think that if
4:31
they're by themselves in a micro practice and it's just them,
4:34
that it is 24/7, you know, they're on call 24/7, which that
4:38
is not. I don't recommend that for
4:39
anybody. That is not good.
4:41
So yes, in a way, you don't ever truly feel like you're off in
4:47
the sense that when you have a business, it's like a baby.
4:51
You just think about it constantly.
4:53
That's just how it is. But you also have to create your
4:57
own boundaries. And so when people start out, I
5:00
always tell them that they need to figure out how they want
5:03
their practice to be. So start the way you want to
5:07
finish. Do you want to work three days a
5:10
week in clinic? Do you want to just do
5:12
telehealth home visits? Do you want to do a combination?
5:16
Do you want to be in the office every day?
5:17
Do you want to work 9:00 to 3:00?
5:19
And then, you know, think about your situation because some
5:22
people have young children right now, but if you continue with
5:25
your DPC when they are older, how are you going to structure
5:29
your days? And so that's definitely one of
5:33
the things I tell people when they start out, try to start the
5:36
way you want to finish. And when you create your
5:39
schedule, it's always easier to to pull back time as opposed to
5:47
adding time. So if you open your schedule and
5:51
it's very open, then it's easier to pull that back as opposed to
5:54
later on trying to add time. I, I hope that makes sense.
5:58
But so when you schedule, when you're, you're, when you're in
6:01
practice, you don't want to be doing all the time seeing
6:05
patients from 8:00 to 5:00. You need time to work on your
6:08
business. And so, yeah, do you ever feel
6:10
like you're off? Not really.
6:12
But The thing is, when you have patients and you have a small
6:16
practice, they know that you are a solo doctor.
6:19
They know that you can't do this 24/7.
6:22
And so if you're lucky enough to be in an area where there are
6:25
multiple DPC's, it's great to know the other DPC doctors in
6:30
your area so that when you need coverage, you all can provide
6:34
coverage. You know, you can cover some for
6:35
somebody when they're away and then vice versa.
6:38
And so that's really nice to have a lot of Emrs will give you
6:43
kind of like extra logins for temporary use, for example, if
6:47
you need to be, if you're going away and you need someone to
6:50
cover for you. So that's, that's a really nice
6:52
perk for a lot of them. But so if you have other DPC
6:56
doctors around you, great, try to get to know them so you can
6:59
cover for each other. Another thing you can do is if
7:02
you're going to be away, like when we go to the beach in the
7:05
summer, we go away for a week every summer.
7:08
And I always tell people about a month ahead I'm going to be
7:11
going to the beach. If you need anything, tell me
7:14
now. Please ask for your refills now.
7:16
If you have anything that can't wait until I get back, let me
7:19
know. I will be gone this week X dates
7:23
if you need something urgent. I do have partners.
7:26
I have a partner and we have a nurse practitioner so they can
7:28
cover. But even still, you can say if
7:32
it's an emergency, if you're by yourself, if it's an emergency,
7:35
go to the urgent care, go to the emergency room.
7:38
Don't think a lot of patients will fault you for that.
7:41
And if they give you a hard time about you taking time off and
7:44
not covering them 24/7, then perhaps that's not the right
7:49
patient for you. You know, you want to set this,
7:52
you want to set this out at the beginning.
7:54
You want to tell people this is how it works.
7:56
So that's it's very important to set the expectation.
8:01
So I hope that answered that question.
8:06
Let's see and I got a question from a pediatrician and she was
8:13
asking about niches in DPC so she has a focus on I know she
8:21
said pandas, M cast, a couple other things I can't remember
8:25
off hand but she wasn't sure which way should she go
8:28
concierge or should she go DPC? Is it possible to have something
8:33
like this like a more niche practice in DPC?
8:36
And yes, absolutely you can doctor Noemi Adame.
8:40
She is the owner of Culver Pediatrics in Culver, IN.
8:44
She is ADPC pediatrician and a lot of her patients right now
8:49
are PANDAS patients and they come from all over the country.
8:54
So they she is a pure DPC. She does not bill insurance.
8:58
If you decide to do a practice with a niche like this, but then
9:02
do concierge, now some concierge practices, they do bill
9:08
insurance as well, some don't, majority of them do.
9:13
And so if you do a concierge practice focusing on these
9:17
SPECIAL needs, then you will have to still deal with
9:21
entrances. And that's one of the perks of
9:23
being ADPC Dr. is that you don't have to deal with insurance.
9:28
You know, you kind of have to pick your battles.
9:30
Which one would you prefer? But you can absolutely have a
9:33
niche at our practice right now, we do regular primary care, but
9:38
we also have different service lines.
9:42
So we serve menopausal women. We do a lot of hormone consults
9:47
because there aren't a lot of doctors in our area that are
9:50
doing hormone replacement therapy.
9:52
So we have that. And then we also have weight
9:55
management and we also do cardio metabolic evaluations.
10:02
So we had little niches, but DPC, if it's your business, you
10:07
can do what you want to with it. So if that's how you want to run
10:10
it and you want to focus on those patients, you absolutely
10:14
can. Now what you need to do though
10:16
is make sure that your messaging is very direct to those kinds of
10:21
patients. So if you are a pediatrician and
10:25
you want to focus on PANDAS, for example, then your messaging
10:29
can't just say I'm a pediatrician and and you don't
10:32
want to imply that you're seeing everyone because if you want to
10:36
see those patients, they won't feel called out.
10:38
So you want to definitely put that in your messaging.
10:42
I treat patients with PANDAS or I treat neurodivergent children
10:48
or whatever it is. But you want to put that out
10:51
there and make sure you're calling those people out because
10:54
otherwise they will not feel like you are talking to them.
10:58
So it's really important to do that.
11:00
Awesome, Alejandro, thank you for asking questions.
11:03
Are procedures typically included in membership or an
11:07
added charge? Again, it's your practice, so
11:11
you can decide how you want to do it.
11:13
Some places will include it. We don't actually charge, for
11:18
example, a knee joint steroid injection.
11:21
We don't charge for the procedure itself, but we do
11:25
charge 25 bucks for the catalog and cover the cost of this
11:28
syringes and all. And then that's just, we just, I
11:31
call it put on their tab for their monthly membership fee.
11:34
So that's that's what we do for that.
11:36
Shave biopsies, I don't charge for the procedure punch
11:41
biopsies, we don't charge for it.
11:43
If they have insurance, then you know the pathology will go under
11:47
their entrance. So we don't have anything really
11:49
to do with that. But if they don't have
11:51
insurance, then we'll do a cash pay price.
11:54
And so that way it'll be kind of a client build situation.
11:58
All right. Another question that I got was
12:00
from Doctor Elmo Oni. She does a lot of social media
12:06
and I don't know if you've seen her social media, but she's
12:09
great. But she asked how do you grow
12:12
outside of social media? So there's a lot of different
12:16
things that you can do outside of social media.
12:19
I think right now, social media is a great way to grow your
12:23
practice because it's free. You can, you can be on camera
12:27
like this. You can put still photos up and
12:32
talk over it. I mean, there's so many
12:34
different ways that you can do social media, but there are a
12:37
lot of ways to reach people without it #1 is just networking
12:41
in person. And I know a lot of doctors
12:46
aren't very comfortable with it because you've never had to
12:49
actually go out and promote your practice before.
12:53
So it's a learned skill for sure.
12:56
And it's hard to get used to it because 1, you have to make sure
12:59
that your messaging is correct. Like I was talking about, you
13:01
want to make sure that you are talking to that person and
13:06
you'll have to learn how to read the room.
13:09
You have to figure out, are these people more focused on the
13:14
cost? Are they focused on the price
13:16
and the cost savings? And why would I spend more if I
13:20
am paying for insurance already, for example?
13:23
So that's one kind of audience. Then there are people who are
13:27
frustrated with the system. They're tired of being seen by
13:31
somebody different. Every time they go to their, you
13:33
know, family practice or internal medicine, there's a new
13:36
PA, it's somebody else. They never get to see their
13:38
doctor, Yeah. Or they're rushed 5-10 minutes
13:42
with the doctor or they wait forever in the waiting room.
13:44
You know, So those, that's another kind of group that you
13:47
have to tailor your elevator pitch to.
13:50
So definitely networking in person.
13:52
And that can be going to health fairs, it can be going to the
13:56
Chamber of Commerce and getting involved there.
13:59
It can be getting involved with AB and I.
14:02
So B and I is another kind of networking group where you have,
14:06
they have different industries. So like you may have one doctor
14:10
and one plumber and 1 roofer and one insurance person.
14:14
So they, the idea is to refer back and forth to each other to
14:18
build your businesses. B and I is a little bit more
14:20
involved, like you have to go every week, but can be worth it.
14:25
And then things like health fairs, you can go to health
14:27
fairs and that's a really nice way to get new patients and at
14:32
least to get attention. Because when you go to a health
14:36
fair, you know, if you go, you can have like some sort of
14:39
raffle. Doesn't matter what you're
14:41
raffling off. If it's like an Amazon gift card
14:43
or I don't know, Starbucks, gift something, put the fishbowl out,
14:47
tell people to fill out the name and stuff.
14:49
Then that way you have their information.
14:52
So when you think about social media, if you think about TikTok
14:55
and what happened to TikTok, what 6 or 8 months ago where
14:57
that was like gone for a day or two and then Oh no, it's back.
15:00
Well, that can happen to any social media platform.
15:03
So Facebook, Instagram, TikTok, Blue Sky Threads, any of those,
15:07
they could be gone at any point. So all of those followers that
15:11
maybe you, you gained could be gone.
15:14
So it's really good to have your own e-mail list.
15:17
So when you go out networking, if you go to a health fair, for
15:20
example, and you get someone to sign up for a raffle, you get
15:23
their e-mail address. So you want to build your e-mail
15:26
list because that one is yours. You, no one can take that away
15:29
from you. And that way you have people
15:32
that you can reach out to regularly to say, hey, this is
15:36
what we're doing at the practice.
15:37
You know, you can send the monthly newsletter if you want.
15:40
You can send them an e-mail when there's something new that
15:42
you're offering at your practice or if you have somebody new
15:45
joining your practice or you just want to reach out and tell
15:48
them about updates like for pneumonia vaccines, for example.
15:54
And you that's yours. So you can contact them.
15:57
And with people who sometimes people feel uncomfortable about
16:01
emailing a lot, and I pretty much tell people just e-mail
16:05
until they tell you to stop. It feels like you're bombarding
16:10
them. And honestly, a lot of times
16:13
they don't see it. Think about your e-mail inbox,
16:16
like my in inbox. It makes my husband crazy
16:19
because he'll see all these unread messages and I just
16:23
either I don't, I don't read them or I like just delete the
16:26
ones I haven't read and just toss them.
16:28
So odds are you may not, they may not have seen your e-mail.
16:33
So if you just continue to send emails, that's a good thing.
16:36
It's really not bad. The other thing is if you have a
16:39
new e-mail address and say that it's new, maybe you've sent a
16:44
couple of emails out, but then you got a list from your
16:48
previous practice. If they were nice enough to give
16:50
you a whole list of emails of your patients and then you plug
16:54
in those thousand patients or whatever, and then you send 1000
16:58
emails out, odds are most of those are going to go into spam
17:02
because you didn't warm up your e-mail.
17:05
And Google and Outlook, you know, all of these things they
17:10
have like bots that they test and they see, you know, how many
17:13
people are you emailing? Have you ever emailed before?
17:16
If you've never emailed before, they're like, you might be a
17:19
spammer. And so then that's why those
17:21
emails go into the spam folder. So what you want to do is start
17:26
slowly. So do like 20-30, fifty maybe in
17:29
the first week and then the next week do like 100, maybe 200 and
17:34
then gradually ramp up. And when you send those emails
17:38
for that first week, what you want to do is send it to people
17:43
that, that you know, like family, friends, and then ask
17:47
them, please look for my e-mail, open it, you read it.
17:52
And then if you can reply because that sends signals to
17:56
those bots that, OK, this e-mail has some information in it
18:00
that's valuable and people want to read it.
18:02
And then you're more likely to land in somebody's inbox that
18:06
way. So when you start an e-mail
18:08
address, I would do that. So the original question, how to
18:13
grow outside of social medias? Yes.
18:15
So your e-mail list and then networking.
18:18
And the other thing about networking is when you do meet
18:20
people, for example, don't expect that after meeting them
18:23
one time, you tell them about DPC that they're going to come
18:26
back and join your practice because people are busy,
18:29
everyone's busy, they forget. So what you need to do is if you
18:33
have their e-mail or you have their phone number, you know,
18:35
you need to reach out. You need to be reminding them
18:38
all the time that you're there because they'll forget.
18:42
And if you don't remind them, then that's it, they're gone.
18:46
So you want to continue to reach out to them.
18:48
Thank you, Catherine, for your question.
18:51
Do you do a charity care sliding scale or free clinic work in
18:57
your DPC or outside of your DPC to see more of a variety or
19:02
social economic statuses? That's a great question.
19:06
Thank you. Yeah, You know, a lot of people
19:09
when they start DPC, they are very concerned about their
19:14
patients who are economically challenged, which is fair
19:19
because we are asking people to pay out of pocket when they
19:23
could go to a doctor and use their insurance.
19:26
Or if they don't have insurance, we are still asking them to pay
19:31
because again, you're the boss. You can decide to do this
19:34
however you want to. So you can either if you have a
19:38
free clinic, for example, in your town, you can just always
19:41
decide to go volunteer there. I mean, there's nothing stopping
19:45
you from doing that. That's up to you if you want to
19:48
do that. But then there are people who
19:50
have developed, they've kind of, they've opened a 5O1C3 branch of
19:56
their practice to offer really free, you know, charity care and
20:01
they have application processes. It's a nonprofit.
20:05
And so then of course, if it's a nonprofit, then you have a board
20:08
of directors, you know, it gets a little complicated, but it is
20:11
a, it's a great way to do that. The other option is a sliding
20:15
scale, so. If you have someone that you
20:20
want them to still be part of your practice, but you know that
20:23
they can't afford it, you can always offer them a reduced
20:27
rate. I mean, that's up to you.
20:29
It's your practice. No one has to know.
20:31
I just tell them, please don't share this with anyone that I'm
20:34
doing this. You can decide what you want to
20:37
do. You can decide the amount that
20:38
you want them to pay. So get our practice.
20:41
I have patience anywhere from we've got patients from like $10
20:46
a month up to our regular lowest amount to your membership is 65
20:52
S anywhere from 10 to 65. I've got someone 50 and some are
20:56
40 and I don't really remember how we came up with that.
21:00
But yeah, so you have, you have the option of doing that.
21:03
That is your prerogative totally to to give discounted
21:07
memberships and you don't want to give so many though that
21:14
you're not able to make the money that you need to stay
21:16
open. So I would try to be very select
21:20
about it. Another option is I've heard, I
21:23
can't remember who it is they have like I think they have a
21:26
just at the jar where they say, hey, if you have extra money and
21:29
you want to donate to somebody's membership, just toss it in the
21:32
jar. It's not, it's not tax
21:34
deductible or anything because it's not organized nonprofit,
21:37
but people can do that. And I've also heard of other
21:41
people who, you know, for people who are well off and want to
21:46
provide more, you know, care for someone else, then they'll just
21:49
pay for like 2 memberships. Again, it's, it's not, it's not
21:52
tax deductible because it's not 5O1C3, but that's another
21:55
option. If you decide that you want to
21:57
try and do that, you can absolutely do that.
22:00
The thing about having applications is it gets a little
22:04
bit hard to figure out. You really have to be very
22:07
careful about how you decide who you're going to offer these
22:11
scholarships to because you want to be fair about it.
22:14
So that's why we just don't even deal with that.
22:17
We just kind of say this is what it is.
22:19
Please don't tell anyone else all right, let's see if you have
22:22
any other questions, just drop them in the chat.
22:26
Let's. See, I just ask them, yeah.
22:27
Yeah, go ahead. No.
22:28
No. No, you go right ahead, please.
22:31
I had a question about like growth rate and what it's
22:36
supposed to look like or what it should look like.
22:37
I left my, it's like position at the end of February and I'm
22:42
doing like the month of March, just doing enrollments.
22:44
And then I'm opening in April and I've already have like 8
22:48
patients signed up, which I don't know what I was expecting.
22:51
So I think that's pretty good. It was, there was a lot right in
22:54
the first week. And then it's just been kind of
22:56
like sort of slow and then it was sort of crickets and that's
22:59
kind of trickling in a little. So I don't know, I guess just
23:02
what would you say as far as growth rate?
23:04
I don't know what to expect. Yeah, that's really hard.
23:07
It's hard to say because everyone's area is different.
23:10
It's really hard to say. I think 8 is really good though.
23:12
For one month, that's not bad. You've got 2 a week.
23:16
And again, it depends on how much you have marketed, how much
23:21
you've advertised, you know how you've done it, how much social
23:24
media, how much networking in person.
23:27
I know you've done some, so I think that's why you've gotten
23:30
those 8. Yeah, most of them have been
23:32
patients that have followed me from, well, actually no,
23:36
probably only half. So yeah, maybe where.
23:38
Yeah, previous patients that followed me from my practice and
23:41
then yeah, there are a few new ones.
23:43
So how did those new ones find you?
23:46
Honestly, I think mostly through our church community.
23:48
OK, well, that's a great resource then.
23:51
Absolutely. Yep.
23:53
So have you. I mean, is it possible that you
23:57
can talk to a group of people at church about your practice?
24:01
Yeah, so. Did you already do that?
24:04
So yeah, so he actually just keeps sharing everything that I
24:06
put up, you know, so he's he's been a really good, he's been
24:10
really helpful, like telling people.
24:11
So I had a couple people sign up and go.
24:13
I know I've never met you, but Kevin and you're great and.
24:16
Oh, that's awesome. Yeah, it's.
24:18
Nice. So he's been really helpful in
24:19
that way, but we've known him for a long time.
24:21
I have run into that where they'll.
24:23
Oh yeah. But then I stopped to pay and I
24:27
already have insurance and sometimes I don't know, I try
24:30
not to be able to have insurance.
24:32
Terrible. It's hard.
24:34
Relatable as a yes, you know, but you know, you'd have a
24:38
direct for direct access. I kind of just tell them I try
24:40
to touch on those pin points and sometimes they're still really
24:43
hyper focused on that, yes, I have to pay extra.
24:46
And then I kind of go, OK, I don't think this is right gonna
24:49
be yeah, this might not be for that, but.
24:53
Yeah. And it's it isn't.
24:54
And that's that's definitely one thing you have to learn.
24:57
And I think we talked about it, you know, initially, you know,
25:00
you're going to get get your feelings hurt a lot hearing no,
25:05
but that's part of being a business person is be prepared
25:10
to hear no most of the time. And after a while you get used
25:14
to it and you just start to really make peace with the fact
25:18
that this is not for everybody. It really isn't, and you want to
25:22
be able to treat everyone, but they don't all want it.
25:25
You know there's certain people that do though, and so those are
25:28
your people. Do one more thing yeah about
25:31
Andres question for being always on.
25:33
I have the same a similar concern or fear.
25:36
And I think, and when you and I spoke a few months ago, I was
25:40
telling, look, can I just take a day off a week that I'm just out
25:42
of touch. So I actually built that into my
25:44
patient agreement and into my contract.
25:46
And I tell everybody upfront, Sunday's my phone's going to be
25:49
off. I'm not going to look at this
25:50
line. So if you have something urgent,
25:53
go to the urgent care. Otherwise we can talk on Monday.
25:55
And so far everyone seems like, yeah, absolutely.
25:59
You have a family and you work by yourself.
26:01
Like, yeah, I'm, you know, initially I was not apologetic
26:04
about it, but kind of, you know, I'll take it.
26:05
Here, this is what I'm doing and you know.
26:08
The reaction has always just been, yes, that's perfect,
26:11
that's fine, Yeah. So.
26:13
It is if you don't think it's fair.
26:16
I mean, that's just not a reasonable human being.
26:20
Actually. Yeah.
26:22
So if they, if anyone's, oh, well, I'm paying you for this.
26:26
And then you can just, you know what?
26:27
I don't know if this is the right fit for you.
26:30
Rather cut them loose now than later.
26:32
When after a while, after they've been bugging you for.
26:36
Yeah. So that is definitely something
26:38
when you start. And actually that's what I was
26:41
going to share with people that came today is you want to set
26:45
your expectations from the beginning.
26:48
And so one thing that one of the established docs shared with us
26:51
when we opened is a whole handout for people to use in
26:56
their practice to say this is how we communicate.
26:59
So during office hours, you can call, you can text, you can
27:03
portal message. If it's after hours and it's
27:07
emergency, you know, please do this.
27:09
Or if it's something that can wait till the next morning,
27:11
please message on the portal. Because if it's not an
27:14
emergency, I'm not going, we're not going to respond to that.
27:18
But then also realize that some people think things are
27:20
emergencies and you may not think they're an emergency.
27:23
So there's that too, but in just a minute I have to pull it up,
27:27
but I'll put that in the chat. I have a link to out what we
27:30
use. And so you are welcome to take
27:32
it and just copy paste, you know, take out whatever our
27:36
stuff and change it for whatever you do.
27:39
But that's one thing you want to have as part of your welcome
27:43
packet is to give it either handed out to them and is hand
27:46
out or in an e-mail or somehow get it to them just so that they
27:50
have that for reference, that this is how it works.
27:53
And that way when people, if people get upset about, you
27:56
know, you're not responding to me immediately, then you could
28:00
say, well, remember when we talked about the expectations
28:02
for the practice? This is how it works.
28:05
You know, I, I check my messages at the end of the day, or I
28:08
check them in the middle of the day and the end of the day and I
28:10
try to get back to everyone within X number of hours.
28:13
So expectations are really key and expectations and boundaries,
28:21
which again, boundaries are another thing that we went into
28:25
medicine because we want to serve people and we are people
28:28
pleasers. But the boundaries are huge.
28:32
You will not be able to sustain your practice, You won't be able
28:36
to continue if you don't set boundaries.
28:39
And then you keep the boundaries.
28:41
It's not just setting them, but you want to stand by them
28:45
because that's just, if you don't have any boundaries, then
28:48
you're just going to burn out again and that's just what's
28:50
going to happen. So yeah.
28:54
Hi Casey, thanks for your question.
28:57
Now for aesthetics, weight loss and adding hormone therapy, all
29:01
cash pay. Interested in adding telehealth
29:05
and urgent visits. Is there an EMR you recommend?
29:10
Also with the respect to entrance, you can also offer
29:14
super bills. So hey, for you doing aesthetics
29:19
and weight loss and all that. We do aesthetics as well.
29:23
I find it to be brutal. I don't know about you.
29:27
It's a tough business. It's enjoyable, but it's tough
29:30
EMR for well can you what do you use now for your EMR?
29:36
Currently I do paper. Charts OK, so and.
29:40
I like paper charts. I know, right?
29:43
There is something about them for sure.
29:46
It really depends. I mean personally we use Servo,
29:50
which is it was developed as a functional medicine EMR.
29:56
So I would say as far as off all these different things that
30:01
you're offering it, it might be a good fit for you.
30:05
Atlas is another EMR that I probably would not recommend for
30:08
what you're doing just because it's a pretty simple EMR.
30:11
I'm not. I mean it, it works great for
30:14
DPC. There's nothing wrong with it.
30:16
It's just Emrs probably have more of what you will need
30:20
because you'll need ways to kind of, you know, segment your
30:24
patients. Yeah, I think my DPC story,
30:28
doctor Marielle Conception, she did like a survey of doctors
30:32
last year of all the Emrs and what they liked about it and
30:35
what they didn't like about it. So if you go to mydpcstory.com,
30:39
you should be able to find that comparison there and you can
30:42
look at all the different ones, but all of them pretty much you
30:46
can do a demo. So I think there's 5 or 6
30:49
different Emrs now that are really kind of directed at the
30:53
direct primary care space. So you can do the demos.
30:57
I would just demo all of them and see which one really fits
30:59
with the way that you think. That's kind of what a lot of
31:02
people say, like does it fit your brain?
31:04
So I I would just demo all of them and then you said do.
31:09
You use this. Sorry.
31:10
Go ahead. Do you use a?
31:11
Separate DMR for your aesthetics.
31:14
A separate type of VMR. Right now we are actually
31:18
transitioning because our photos were everywhere.
31:23
Are you doing pictures where? Yeah, the storage of the photos
31:27
was really hard 'cause we had them in different places and you
31:31
know, like it was on one phone and it's really not good.
31:35
It was not great. So we just started with RX Photo
31:39
and RX Photo is more, it's more of just a photo storage kind of
31:45
situation so that you can do like side by side pictures
31:49
before and after. So you can show people, but you
31:52
also can do notes in there and they don't have to be
31:55
complicated. You can kind of, if you have an
31:57
iPad, you can kind of scribble on the iPad kind of thing, which
32:00
I think that's what we're going to start doing is take all of
32:02
our aesthetic notes and just do them there along with the
32:06
pictures and we'll see how that goes.
32:09
I, I don't love that we have a separate one.
32:11
It's just, it's still, even though I think Servo does OK
32:15
with aesthetics, it's still not great.
32:16
And I don't know that there's anyone that's perfect for it,
32:20
you know, But yeah, that's what we started doing.
32:23
And let's see, you mentioned also about insurance and super
32:28
bills. Was that?
32:29
Super bills, yeah. The practice I used to be at was
32:32
being me a cash based practice as well and we would give super
32:36
bills for those people that had insurance, as long as it was
32:40
detailed enough they could turn that into new insurance.
32:44
And so having an EMR that actually will produce a
32:46
superbill. Is really key.
32:48
Yeah, I think not really. I haven't tried to do a
32:52
superbill in Servo, but I'm pretty sure you could because it
32:56
does a lot of the coding, like it has a lot of the codes in
32:59
there. So I'm pretty sure you could do
33:00
it. As far as DPCI think a lot of
33:04
people really recommend not doing that for DPC.
33:07
It's probably now that the the big beautiful bill passed and
33:12
you can use your HSA up to $150.00 a month for GPC
33:16
membership, then that's already a great benefit.
33:20
You can probably do a super bill in Servo and I think probably
33:25
some of the other ones. I don't know about Atlas, but
33:28
maybe a hint. I think you probably can and
33:31
maybe acute or Sigma and maybe Elation.
33:34
But best way to find out is to just demo them.
33:37
All right. Hello, Teja.
33:39
How are you? Thanks for your question.
33:43
OK, so let's see. We got a couple couple pieces
33:47
here, so I'll do one at a time. How to handle extended family
33:51
members and friends who may not be interested in joining DPC.
33:56
Thinking you are family or friend and ask medical questions
34:00
frequently. Yeah, that's hard.
34:03
That happens to everyone, doesn't it?
34:05
Yeah. This is one of those boundaries.
34:07
Got to stay strong. Usually what I will say is I
34:11
love you, you're my family or you're my friend, but you're not
34:14
my patient and I can't treat you because you're not my patient.
34:19
And this is to keep you safe because I cannot be objective
34:24
because you are my family or you're my friend.
34:27
And they might get their feelings hurt and not want to
34:29
talk to you. But that's just, I mean, that is
34:33
that's how I approach it. I think it's just best that way
34:37
to kind of keep that that boundary.
34:40
I'll read it out then. Do you suggest taking the
34:42
membership for them reduced price?
34:45
How do you manage boundaries when requests stay simple,
34:50
refills quick opinions versus when you're essentially becoming
34:54
their PCP? Where do you draw the line
34:57
between being helpful and taking on full physician responsibility
35:03
without a formal patient relationship?
35:05
Yeah, that's hard if you want to have your family and friends as
35:11
DPC members. I mean, we we have that.
35:14
We live in a pretty small town, so we do have friends who are
35:18
patients, and luckily they do respect the boundaries.
35:21
We haven't had to deal with anyone overstepping those and
35:25
trying to abuse that relationship.
35:28
Luckily, I feel like maybe family members might be worse,
35:32
but how do you manage the boundaries when requests stay
35:35
simple? I think probably if this is an
35:39
expectations thing. So the first time that they
35:41
start asking you, can you do this for me?
35:45
I if, if it's really a pinch and you want to be nice and do it, I
35:49
mean, that's up to you obviously.
35:50
But you can say, well, you know, because this is a blankety blank
35:54
situation, I'll do it for this time because you can't access
35:58
your doctor or whatever. Or you can just go ahead and set
36:01
that expectation saying, I don't feel comfortable doing this
36:05
because you are not my patient. And I don't think that I can be
36:10
objective treating you if you're already enmeshed in that.
36:14
I'm sorry. But yeah, I think probably,
36:18
yeah. Draw on the line at the
36:19
beginning before things kind of develop.
36:22
OK Well, thank you so much, everyone, for your questions.
36:26
It's 12:45. And so I just wanted to speak
36:29
real quickly about how I'm helping doctors with getting
36:33
kind of getting out of that thinking about DPC situation and
36:39
through the transition into actually opening their practice.
36:43
So I'm not going to take too long for this, but I'm just
36:47
going to show you this one thing, OK?
36:50
So I've thought a lot about this and I've thought about how do
36:52
practices grow? And the thing about DPC, people
36:55
wonder, are you going, am I going to have patients follow me
36:59
#1 and they worry about having patients when they open, which
37:06
there's a lot of reasons why people don't have patients when
37:08
they open. And there's a lot of ways to get
37:10
patients before you open. So number one, of course is
37:13
talking about it. If you don't talk about it, no
37:15
one's going to know. And you just have to get used to
37:19
talking about it. There's different ways to talk
37:21
about it, but you just have to get used to saying the same
37:24
thing over and over again so that it becomes second nature.
37:28
It's just like breathing so that when someone asks you a
37:30
question, you don't get all tripped up and like, oh, and we,
37:34
yeah, we can see you anytime and you can call on the phone and
37:37
oh, we do labs and we do medicines.
37:38
You know, it just comes out with a jumble.
37:41
So that's one of the things that we go through in this program
37:45
that I'm doing. The independent practice path is
37:49
really trying to nail down your messaging.
37:51
So if you have a niche or if you're seeing everyone you know,
37:55
but still trying to figure out who is your ideal patient, who
37:59
do you want to see? So this is this is a diagram
38:03
that I came up with, but how people about how practices get
38:07
patience and I call it the four Rs.
38:10
So each section so reach, resonate, respond and retain,
38:14
it's a circle. It's like a whole ecosystem and
38:17
people can enter sphere from different areas, but they all go
38:24
together, they all feed into each other.
38:26
So that's the four hours of how practices get patients.
38:30
But within the practice, what the physician does and what they
38:35
need to do in order to make that work is what's on the inside of
38:38
this diagram here. So the actions that is going out
38:44
to the Chamber of Commerce, going out to health fairs B and
38:48
I doing things, social media, that's that's how you reach
38:53
people. So that's the first thing.
38:55
Second, clarity, that's about your message.
38:58
So making your message very, very clear about who you help
39:03
and how you help them. And also being clear with
39:07
different audiences. So some people, like I said,
39:10
they are more focused on the money.
39:11
I'm already paying for entrance. Why do I pay you more?
39:15
And some are focused on, I can't get in with my doctor.
39:17
I never see the same person. So you want to be very, very
39:21
clear and dialed in about your message and then respond.
39:25
That's your systems and systems and automations, especially if
39:30
you are a micro practice. That's what's going to save your
39:34
sanity because there's no way for you to keep everything in
39:37
your head and to answer everyone manually because there's just
39:41
too much. When you are in DPC, you know,
39:45
you're by yourself. All of the boundaries that
39:47
surrounded you when you were in private practice, when you were
39:50
in employed practice, all those boundaries are gone.
39:54
So now it's nothing between you and your patient, which is what
39:57
you wanted. But it's also makes things more
40:00
difficult because now you're not only the physician, you're the
40:03
secretary, you're the janitor, you are the lab person, you're
40:06
the pharmacist, you're everything.
40:08
And there's just too much. So whatever there is, that is
40:11
busy work that you can automate, try to do that.
40:15
So that is your systems and that's how you respond to
40:17
questions and how you respond to inquiries and how you respond to
40:21
do you take my entrance like that question you're going to
40:23
get asked 10 times a day. And then after that
40:26
accountability, this is also with systems.
40:30
But then how do you retain your patients?
40:33
And that is partly that boundary setting, you know, making sure
40:37
that your expectations are clear and what they can expect from
40:41
you and what you expect from your patients.
40:44
And that's how you retain your patients.
40:46
That's how you keep them. And then when you retain your
40:48
patients, then they refer other people to you.
40:51
So that is my practice engine practice momentum flywheel.
40:58
So the program goes through all of that.
41:01
It is. We're starting on Tuesday, next
41:04
Tuesday. So that's the 24th.
41:06
It's an 8 week program. We meet once a week on Tuesday
41:10
evenings. I tried to stay away from
41:12
evenings, but because a lot of the people that are going to be
41:15
in the program are still employed, it's hard to do like
41:19
daytime meetings just because they're working and have no
41:21
control over their schedule. So we'll do this for 8 weeks
41:25
throughout the whole system, you're going to learn how to
41:29
tailor your message to different audiences, how to say it.
41:33
You know, you're going to practice it.
41:35
You're going to start building your systems because we're going
41:38
to use Harmony OPS my CRM to get your systems going so that you
41:42
can start collecting emails, you can start sending out messages,
41:46
you can start posting social media on multiple platforms that
41:50
way. And then by the end of it,
41:53
you're going to have people interested in your practice.
41:57
The thing is, the key is getting the word out.
41:59
If you get the word out enough, people will be interested
42:02
because people are desperate for something different from the
42:05
current health system. So we will be starting Tuesday,
42:10
8 weeks, the cost is 2500. And at the end you're going to
42:15
have people on a waiting list ready to join your practice.
42:18
So I think it's a way to compress time, I guess is what
42:23
you can say. So you can do this on your own,
42:25
absolutely. You're a physician.
42:27
You've learned a lot of things. You got here by yourself
42:30
already. But if you're ready to move
42:33
ahead and you're ready to do this, this is the way to get
42:37
from point A to point B with guidance and going in the right
42:41
direction and doing it faster than you would alone.
42:44
So that is what I've got going. Well, thank you so much for
42:51
joining me. Let me put this app.
42:54
Where'd it go? Let me put the link in the chat
42:57
for our new patient guide. And then I'm also putting the
43:03
link in there for the independent practice path so
43:06
that if anyone wants to learn more, you can see it there.
43:12
So let's see. OK, So here in the chat, that
43:19
first one is our that's our new patient kind of guide.
43:23
So just take that and you know, just edit it for your own use.
43:29
And then underneath it is the independent practice path.
43:33
So all right, if no one else has any questions, I'll let you go.
43:37
I really appreciate you coming on.
43:39
Thank. You.
43:42
For all this. Oh, you're so welcome.
43:44
It's good to see you. I hope everything's going well.
43:47
I think that you're doing well. Thank you.
43:51
Thanks there. Things are moving.
43:53
Along. Yeah, yeah, it's tough.
43:55
But the good thing is because you don't have as many patients
43:58
yet, this is your time to get out there, show your face.
44:04
People don't know about you, Just you just need to get out.
44:07
There I do have extra. One quick question, how do you
44:10
get? Reviews from patients.
44:12
What is your method? Do you maybe there were how many
44:15
apps you probably have something already through there or how do
44:18
you guys typically? Do so before when we were
44:21
starting, we had Atlas at first. So after every patient
44:27
encounter, what I would do, thank you Alejandra, is I would
44:32
send an e-mail like a summary e-mail just like the assessment
44:35
and plan say this is what we talked about this is what we're
44:37
going to do. And then at the bottom of that,
44:40
I said something like, well, if you were pleased with your
44:43
interaction, are you pleased with your visit?
44:45
The best way you can show is by referring other people.
44:47
And the best way people can see us is by doing a review.
44:51
And then I had, if you go on Google, do you know how to get
44:53
your review link on your Google profile, business profile you.
44:57
Think so. Unless I don't know what you're,
45:00
unless I'm talking about something different, I think so.
45:03
So you should be able to see Google Business profile and then
45:07
you should be able to see there's a bunch of like icons
45:09
like edit your profile and yeah, do you see it?
45:13
Do you see review? I have read reviews I might not
45:17
be verified yet, maybe that's why.
45:20
Yeah. So are they sending the postcard
45:22
to you? Is that or was this under your
45:24
previous practice? Yeah, I had to kind of change it
45:27
from my previous practice. So it's a little like they want
45:30
to send stuff to like my old e-mail that I don't have anyway,
45:33
so I got to do the whole weird video thing where I watch.
45:35
Yeah, yeah, yeah, yeah, yeah. That's one thing definitely.
45:38
I didn't say earlier, but if you're leaving an employed
45:42
practice, you know, employed position this as soon as you
45:45
decide that you're leaving and you give your notice, then talk
45:48
to whoever's in charge of that stuff and say I need to get, I
45:52
need to have my profile 'cause it is yours.
45:56
So I did and they were like, oh, yeah, it's open.
45:58
You can just claim it like you're not.
45:59
We don't actually even do anything.
46:01
But I think the like the way that they want to verify it is
46:05
sending something to like my old office, yeah.
46:09
Did they give you the postcard option?
46:11
Or maybe they don't do that anymore?
46:13
Well. They did not give me a postcard,
46:16
or maybe that's what it was, that they were going to send it
46:18
to my old office 'cause like I already had.
46:23
Yeah, so. I bet that's it, yeah.
46:25
OK, so when you do get that there should be under reviews,
46:31
like there should be something that says ask for review.
46:34
Do you see anything like that? I don't now, but yeah.
46:38
But there is a way to get a link directly from Google.
46:42
So you can copy that link, paste it into your e-mail and then or
46:47
you can make a QR code out of it.
46:49
Go to Canva, make a QR code so that when people leave your
46:52
office and be like, hey, can you just do a review for us?
46:55
And this have them scan on their phone and so when they do, it
46:59
takes them directly to Google. I'm pretty sure it doesn't make
47:03
them login. I'm not 100% sure though, but
47:06
it'll take them directly to that and then they can go ahead and
47:10
write their review. So.
47:14
So I actually have a different one for the clinic itself that I
47:18
made from scratch to that one I do have.
47:20
Yeah, I see that. OK, ask reviews.
47:23
OK, that's the link. Reviews.
47:25
OK. Yeah, so you can use that.
47:27
QR code too. Oh, it does.
47:29
OK, good. Yeah, you can do that.
47:31
I would say because you are where you used to work, you
47:36
didn't go very far, correct? Well, no, I didn't move.
47:39
Yeah, no, no. I mean, yeah, yeah, just on the
47:42
other side. I would probably try to get more
47:46
of your reviews under your name because of that personal
47:49
recognition of Doctor King. People know that as opposed to
47:54
Planted, which I think is such a thing.
47:56
I love that name, but but yeah, no one really knows that that's
48:00
what it's called. So, yes, right.
48:02
Yeah. OK.
48:03
All right. Sounds good.
48:05
All right, Well, thanks again, everyone for coming.
48:07
I appreciate it. Yep.
48:09
Yeah. Did you ever get to talk to
48:11
what's? Her name I did.
48:13
So yeah, I did talk they'll they she was interested in having a
48:18
second provider. She was open to the partnership
48:21
track, but the issue is like doesn't have like any structure.
48:26
She didn't come up with any structure or anything so.
48:29
I think, yeah. Conversations fast there, but I
48:33
wasn't sure like what will be a good time to like follow up to
48:37
Yeah, a Week, 2 weeks. I would go ahead and reach out
48:40
mainly because kind of like I said with the emails, like
48:44
people just are so busy, I'd just go ahead and reach out,
48:48
touch base with her. A quick question in that point
48:51
to join as a partner partnership track, is there a structure for
48:56
TPC or like different structure or how to like even understand
49:00
the finances if this is the right way to go?
49:03
So as far as a like set structure, every office is going
49:08
to be different just because do you know, you see one DPC,
49:12
You've seen one DPC is what they say.
49:15
So yeah, it'll be different for everyone.
49:18
And yeah, it's hard to say 'cause each contract will be
49:20
different. Yes, mentioned that she already
49:24
has a practice manager. Nice, so lot of her.
49:29
Initial cost. Go ahead.
49:32
Yeah, leave that right. Even if I join more than 60,
49:37
more than 50 or 60% will go for the office and overheads and
49:43
like the partner will only carry less than 40% is what I
49:47
understood. So I have no idea, like who do
49:52
like, yeah, that's completely new information for me, how to
49:55
understand the finances, right? I'd say 50% is fair.
50:01
If you start hitting 70%, that's that's like employed practice
50:06
overhead, so. Yeah, I would.
50:11
I think I did not understand when you said 70% to yes, the
50:16
office as an overhead and I'm like the I'm carrying only 30%
50:20
home or. Well, if they're, if they tell
50:24
you that their overhead is 70%, I would be very cautious about
50:30
that. That's pretty high.
50:31
That's like an employed practice kind of overhead, not a DPC
50:36
practice. I mean DPC practices, their
50:38
overhead can be as low as 25%. So 70 is really high.
50:43
And I think it's fair if you feel like you're going to be
50:46
going in the partnership track to to really ask to look at the
50:50
finances and say, well, what is going towards this overhead?
50:53
So, you know, obviously there's going to be the salaries for the
50:57
office manager and the MA and then malpractice rent insurance
51:02
on the building or whatever you're, you know, wherever you
51:05
are supplies, there's always something, you know, there's so
51:09
many different things. Yeah, I mean, 50% might be fair,
51:13
but you know, if you start looking at what the expenses are
51:16
and you see things that don't make sense, I would ask about
51:20
it. I would say what?
51:22
What exactly is this? Yeah, so.
51:25
Well, I got to run. I'm sorry to cut this off.
51:29
It's nice to see. You.
51:30
So that was the Q&A session from last month and I wanted to add a
51:34
few things before you go. At the end of that recording I
51:39
was talking about a program called the Independent Practice
51:43
Path which is not available currently and might be coming
51:47
back again this fall. I have replaced it with
51:49
something that is action oriented with more immediate
51:53
results and a lot lower commitment and it's probably
51:58
better suited for where most pre launch doctors and early stage
52:02
DPC doctors actually are right now.
52:06
I would point you towards the Harmony OPS social media Sprint.
52:11
It runs for two weeks and this is what you get out of it.
52:16
Your brand voice is documented so AI can help you write
52:20
captions that actually sound like you.
52:24
A two week content calendar ready to schedule and your DPC
52:30
connector page called is DPC Right for me, that's a branded
52:36
page to your practice. It educates patients about DPC
52:41
and helps them run their numbers and then drives them to contact
52:45
your practice directly. If you are pre launch then that
52:51
page is how you start building a wait list before you even.
52:54
Open your doors, you keep. Everything at the end, you keep
52:58
the voice guide, the planner, all the posts, whether or not
53:03
you continue with Harmony OPS. The cart is open now and closes
53:08
on April 18th. The Sprint will start on April
53:11
20th. After the Sprint, there is a
53:13
next step which is called the DPC Connector.
53:17
That includes ongoing lead capture, e-mail nurture
53:21
sequences, and the CRM to organize the leads that come
53:25
into you from the Is DPC Right for Me patient page.
53:30
There's also an employer page included with the DPC Connector
53:34
and that is coming soon, but the Sprint is the starting point
53:38
right now. The link to sign up for the
53:40
social media Sprint is in the episode notes.
53:44
It's $99.00 and you get to keep the brand voice guide, the
53:50
content planner, and the posts. Whether or not you continue with
53:55
Harmony, OPS hope to see you on the inside for the social media
53:59
Sprint. Thank you for listening to DPC
54:03
Life. If today's conversation inspired
54:06
you, hit follow. Leave a review and share it with
54:09
a friend who's ready for change. Remember, wherever you are in
54:14
the journey, your DPC family has your back.
54:19
Until next time, keep building a practice and a life that truly
54:23
fits you.