Latest / DPC Life: Direct Primary Care Podcast / “Do You Take My Insurance?” How Dr. Donna Mayeda Explains DPC Without Feeling Salesy (Replay Episode)

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“Do You Take My Insurance?” How Dr. Donna Mayeda Explains DPC Without Feeling Salesy (Replay Episode) · DPC Life: Direct Primary Care Podcast

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And it became very clear to me that the bottom line was all
0:03
about how do we generate revenue.
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Some of the fun things about DPC is just having autonomy to
0:10
practice the way that makes sense for me, it makes sense for
0:14
my patients. And it was just so easy to just
0:19
make that decision. And I didn't have to ask for
0:21
permission from anyone. I didn't have to like do any
0:23
kind of red tape. But I do believe like I am going
0:27
to give them a healthcare experience like they've never
0:31
experienced before. Like it's going to just like be
0:33
blow them out of the. Water.
0:35
Welcome to DPC Life, the podcast where independent doctors share
0:39
real stories, bold ideas, and the freedom of doing medicine on
0:44
your own terms. I'm your host, Doctor Anne
0:47
Gonzalez, and together we'll explore the winds, the
0:50
struggles, and everything in between.
0:54
Let's dive in. Hello and welcome back to DPC
0:57
Life Podcast, where we talk about all things DPC both within
1:02
the office and beyond. And today's episode is a
1:06
coaching call. We play with Doctor Donna Maeda,
1:09
and the question that she was wrestling with is one that I
1:12
hear very frequently from new DPC doctors.
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How do you explain DPC to somebody who just wants to know
1:21
if you take their insurance without feeling like you're
1:24
selling something that is a skill.
1:27
And today you're going to hear exactly how Doctor Mayeda works
1:31
through that. Let's get into the episode
1:33
today. My guest is Donna Mayeda from
1:38
Keola Noah, DPC in Honolulu, HI, and she has graciously decided
1:45
to come on and be a guest for coaching.
1:48
But before we get into that, I just want to welcome you to the
1:52
podcast. Thank you so much.
1:54
Anne Oh, you're so welcome. And so first let's talk about
1:58
your background and how you got into DPC and then we'll get into
2:02
some of the things that you wanted to work on for the
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podcast or during the podcast. Sure, sure.
2:08
Yeah. So I'm a brand new DPC baby.
2:12
My practice is it's five months now, five months old.
2:16
And it's been such a wonderful journey.
2:19
I wish I had made the switch sooner, but I am trained in
2:25
internal medicine and never in a million years after finishing
2:30
residency could see myself even doing a private practice on my
2:34
own. So I always thought it was
2:37
always going to be some type of employed physician doing primary
2:40
care. So I loved the company that I
2:44
worked for. I was there for six years in
2:46
California before I moved out here to Hawaii and it I love my
2:53
patience. We got bought out by a kind of
2:57
big corporation four years in and there were a lot of changes
3:03
that happened. And I got it was a good
3:06
experience for me because I got to see what it was like to work
3:10
for a huge organization, a huge big corporate organization in
3:14
the United States. And it became very clear to me
3:18
that the bottom line was all about how do we generate
3:21
revenue. And it really kind of opened my
3:24
eyes to the kind of the business of healthcare.
3:30
And I understand for all of their reasons why that is
3:33
important and their bottom line. But it I had this kind of
3:40
awakening moment where I realized that's not my bottom
3:43
line. That's not the reason I went
3:45
into medicine. And I was sitting in all of
3:48
these trainings as a doctor, primary care doctor on how to
3:53
code your visit so that you can maximize reimbursement from or
3:58
from insurance payers. And it was taking away from my
4:01
ability to focus on taking care of patients.
4:04
And I was just like, this doesn't, this is just not what I
4:07
signed up for. I one of my really good friends
4:11
who's in the organization, he was the one that kind of cued me
4:16
in into what DPC was. And he thought I actually hired
4:20
him to join our company. But he was right out of
4:23
residency. And he said he was thinking
4:27
about it strongly, but he just, it was too scary.
4:30
It was too scary for him to write out of residency to start
4:33
a DPC practice. He was worried at the time about
4:38
getting called all the time and just being on 24/7.
4:42
And as I started to talk to more and more doctors who did, who
4:46
are doing DPC, I'm realizing like there's a way to do it and
4:50
still have and make it be sustainable and have a life.
4:54
In fact, there's probably ways to do it where you would have
4:58
more work life balance than you would in a traditional insurance
5:01
based private practice or an as an employed physician.
5:04
And I'm finding that to be true. So I, yeah, I'm just so, so
5:10
excited to be where I am right now.
5:12
Well. Good.
5:13
Well, I'm glad that you broke away.
5:15
You're part of the Rebel Alliance, as you said, so that's
5:20
wonderful. So how has it been going?
5:24
It has been a really fun journey.
5:27
I guess this is what I'm learning is called a micro
5:29
practice. So it's just me and my partner
5:33
in life, Michael, but he's also now my business partner.
5:38
So he is not trained in medicine, but he is his official
5:43
title for our practice is the Operations Unicorn.
5:47
And he's got, he has his opinions about that title, but
5:51
it really captures what he does. So he does all of the other
5:54
stuff that that I just really don't have that much interest in
5:58
doing. So I can really focus on taking
6:01
care of patients. And so I'm so, so fortunate to
6:05
have that him in my corner and really supporting all those
6:08
things. I've been listening to episodes
6:10
of your podcast where you guys are talking about something
6:14
about taxes or like doing taxes. Yeah, like what?
6:18
Where do we start with that? And I was just like, Yep,
6:21
totally resonates with me. I don't care at all.
6:24
I just want to make sure I'm doing it correctly and not
6:26
losing a ton of money. So your.
6:28
Unicorn takes care of that. He does, he does.
6:32
So it that's been fun. And I'm some of the fun things
6:36
about DPC is just having autonomy to practice the way
6:41
that makes sense for me, it makes sense for my patients.
6:44
One of my very first patients, she was 101 years old.
6:48
And she, yeah. So her family reached out to me
6:51
because she was hospitalized for her fall and was going to get
6:55
discharged from the nursing, the rehab.
6:59
And they were worried about how they were going to get her into
7:02
the car, into an appointment to the office.
7:06
And so I was thinking about it, thinking about it.
7:08
And I asked, what's your address?
7:11
I put it in Google Maps. They live 3 minutes away from
7:14
where I live. So I was like, I'm just gonna
7:16
come to your house. It doesn't make sense for you
7:19
guys to do the whole thing to get her into the car.
7:21
So I did my first home visit and it was just so easy to I would
7:27
just make that decision and I didn't have to ask for
7:30
permission from anyone. I didn't have to like do any
7:32
kind of red tape. And it was such a fun visit.
7:34
I mean, they were like the daughter was cooking in the
7:36
kitchen while I was taking care of we were, it just felt like it
7:41
was just felt like kind of what I had always thought of when I
7:46
started my journey to become a doctor.
7:48
So. Well, it's wonderful, Wonderful.
7:52
So. So you're a transplant though to
7:55
Hawaii. So how has it been getting new
7:58
patients? Yeah.
8:00
So that I think has been the biggest challenge.
8:04
Not so much like once I can meet the patient and once they come
8:09
in for a visit, that's been smooth sailing because that's
8:14
just what I've been doing. I think specifically in the
8:17
state of Hawaii too, DPC is still a very new concept and
8:25
people are just very confused about what it is.
8:28
They've never heard of it. Majority of people have never
8:30
heard of it. And when I start to describe the
8:33
idea to people, they're like, oh, you're concierge medicine.
8:38
That's concierge medicine. And it's like, I know I just
8:43
like kind of like, I just like like this visceral reaction.
8:47
Like how do I and I haven't quite figured out how to, I
8:55
don't know, debunk that perception.
8:58
So when we first, before we even moved here, we were talking to a
9:01
bunch of local doctors here and we told them what we were trying
9:04
to do. And a lot of interesting
9:07
reactions. A few people are like, oh,
9:09
that's never going to take off here.
9:10
Like, no, you're never going to be able to convince people to
9:13
pay a monthly membership to see you.
9:17
And then a couple of other people like, yeah, I've thought
9:20
about doing that. I just couldn't do that to my
9:22
patients. And this feeling of like, I'm
9:26
being this greedy person who's trying to capitalize on other
9:30
people. And I just.
9:32
It made me not. It made me, of course it, it
9:35
made me feel awful. It there was a lot of doubt that
9:38
I could really do this. I think I'm like one of five DPC
9:42
practice in the whole state, one of three on the island of Oahu
9:48
and I was the only one that was taking new patients.
9:51
So it is less what? Seems to be working.
9:55
Yeah, so it is, it was really scary.
9:58
And, and so I think my biggest challenge is just talking to
10:02
people about what DPC is, how it's different from concierge
10:05
medicine and how to convince people that I'm not trying to
10:12
just take advantage of people by asking to pay a membership fee.
10:17
And how it's different from like why I'm choosing to walk away
10:20
from having to deal with insurance and chasing them for
10:24
reimbursement. And how.
10:26
And it's so funny because we had a friend who put together, she
10:31
loved the idea. She wanted to support us.
10:34
She put together a focus group for us.
10:36
Wow, that's great. Generous.
10:38
She got all these local MA working moms to all join and
10:44
just to help us figure out like what is it?
10:46
What is our messaging? What are we trying to, what are
10:49
we trying to do? So we started it off.
10:50
It started off so well, so good. We asked him like what are your
10:53
biggest pain points with interacting with the healthcare
10:56
system and all the typical things that you would expect.
11:01
I can't find a primary care doctor.
11:03
I do have one, but my I can never get an appointment.
11:06
I have to wait six months to get one.
11:08
When I do get one, they spend 5 minutes with me.
11:10
I end up spending the whole day in the waiting room.
11:13
They never respond to my messages, all those things.
11:15
And I was like, yes, this is going to be great.
11:17
Like I'm going to tell them what I like, what I can do now with
11:20
this DPC model and the service that I can provide.
11:24
So I shared that with them and they're all like, but I still
11:28
have to pay you $200 a month, which is what my membership
11:33
price is. And I was like, yeah.
11:36
And they're like, I don't see the value.
11:37
I don't see the value in that. I was like, so to me it was like
11:43
this, like where, what, where was the disconnect there?
11:46
Like I couldn't quite. I was like, oh, I thought it was
11:49
going to be like, I can solve all those problems.
11:51
I can see you same next day. I can do longer appointments.
11:54
I'll have you can text me. But again, it was like they
11:58
didn't quite see what was how it would be helpful.
12:02
And it's just, I think what I'm struggling with is that people
12:08
are so used to medicine being a transactional thing.
12:12
It's like, why would I pay a monthly membership when I only
12:17
really see the doctor 2 * a year?
12:19
And it's like, are you seeing the doctor 2 * a year?
12:21
Because that's the only, that's the maximum number of times
12:25
you're able to get in with your doctor.
12:27
And is that actually what's benefiting?
12:30
Like is that actually what's leading to better health
12:33
outcomes for you? What would it look like if you
12:37
had a relationship with your doctor where they knew you and
12:40
they knew your values and they knew what things would work in
12:44
your day-to-day and what things wouldn't?
12:46
I think that's just so novel and new that it's hard to really to
12:50
really explain that in words because they have nothing else
12:54
to compare it to. Yeah.
12:57
Well, yeah, you're right. I mean, because it is new,
13:00
you're going to have a harder time like explaining because you
13:03
have a lot of educating to do. And one thing that I'm curious
13:08
about is how did you come up with your pricing?
13:13
I mean, I know everything is more expensive there just
13:15
because it's an island, but what compared to other DPCS?
13:21
How is your pricing? Yeah, we so it was a huge topic
13:25
of of just, I don't know, it was a huge, it was just, it was a
13:32
big topic between me and my husband slash business partner.
13:37
I knew what the pricing was for DPC and on the mainland, right,
13:41
it was usually somewhere around low hundreds.
13:44
And I think the highest that I saw was like 150 a month.
13:48
And he was like, oh, we've got to charge like 300 a month.
13:52
And I was like, I don't know. But he was really somebody who
13:58
was like, the services that you're providing is invaluable.
14:02
And, and the argument that we have is that it's like, well, I
14:05
can see that, but if no one's willing to pay for it, then how
14:08
valuable it is. So we went back and forth and
14:13
ultimately we talked to some local Hawaii doctors who were
14:18
doing PC and that's how we landed on it.
14:20
So there was, we're kind of right in the middle of the other
14:23
DPC doctors. And I think honestly, I think
14:26
that it's a good spot. We, what we've kind of
14:32
discovered is that it's not so much the pricing, it's just the
14:37
concept of it. We were like, oh, maybe we'll
14:40
make it $50 cheaper or $50 more. But for someone who's going to
14:45
balk at paying a membership fee, I don't think that changing the
14:49
pricing is going to really persuade them one way or another
14:53
that, you know, they can get it. Yeah.
14:56
Yeah. So, yeah, I mean, I would love
14:59
to hear your thoughts in how you guys landed on pricing and what
15:02
are other factors that we should be considering for that?
15:06
Well, one thing that I mean, yeah, I live in a smallish about
15:14
where we work. It's a smallish city.
15:16
I mean it's a city, but it's pretty small.
15:18
We're at, I would say our highest tier is 95 and there's
15:24
another practice in town. And they are probably like, I
15:28
don't know how much they're pricing now, but it's
15:30
definitely, it's at least probably $30 less.
15:34
I mean, it's significantly less, but we started kind of on the
15:37
higher end because we knew we wanted to stay higher so that in
15:42
the future we wouldn't have to change.
15:44
OK. So, so we kind of honestly, I
15:49
don't even remember how we came up to with our price.
15:52
Ultimately, we looked at kind of the people around us and sort of
15:55
said, OK, we're not the highest. I mean, let like in the region,
16:00
not necessarily because there's only us and another practice in
16:03
our city, but what I think #1 you've got really, like I said,
16:09
a lot of education to do. And there's another physician,
16:13
Dr. Mintz, he's in DC, like Maryland area, and he actually
16:20
calls his practice concierge. He's DPC.
16:23
And the reason why is because people are familiar with the
16:26
term concierge. And I think what you were saying
16:30
earlier when people would be like, oh, you're concierge and
16:33
it kind of gets your heckles up and you're like, no, it's not.
16:36
Well, there may be a point to leaning into that a little bit
16:41
because really when you say concierge, people don't know
16:45
that. A lot of concierge practices,
16:47
what they do is they charge you a retainer, right, for the whole
16:51
year and then you still pay every time, you still bill your
16:54
entrance. Know what I mean?
16:55
I didn't know that when we started.
16:57
I didn't realize that. And so when you say concierge,
17:01
they, I mean, you could tell them how DPC works and that they
17:04
wouldn't really know the difference because what they
17:07
know is the concept of paying more.
17:11
And so it might just be easier to kind of lean into that.
17:14
I think Doctor Jacqueline Harris, she calls it like
17:17
concierge for the common person or something like that.
17:20
I can't remember exactly what. It's on our website.
17:22
And it's really quite nice. It's just slips my mind at the
17:24
moment but it might just be like why fight it?
17:28
Because. It may just help.
17:30
It may. Help.
17:31
Yeah, yeah, instead, and we've had people tell us like, you
17:36
really should just embrace it because you're.
17:39
So we have thought about that and we've kind of played around
17:43
with the wording where it's like, yes.
17:45
And what we, what I've landed on is that everyone has such a
17:49
different perception of what concierge is like There's,
17:54
there's the definition that we all know, right?
17:56
But to the lay person, they could just mean like, oh, it's
17:59
just a Doctor Who knows me who will respond to my messages.
18:04
Yeah. Right.
18:06
And so I usually start off when people say, oh, so you're
18:10
concierge now I kind of try to pivot and say something like
18:14
it's on the spectrum. Usually it's more affordable
18:18
than what concierge. I think that also reminds me,
18:22
going back to how we landed on the pricing was there's a lot of
18:25
MD VIP doctors. OK, yeah, here.
18:28
And we just wanted to go right underneath what they were doing.
18:32
Yeah. And we actually did talk to MD
18:34
VIP because we were thinking about it.
18:36
And again, it's like, it's nice to have some of that security
18:40
when you're starting to practice.
18:42
But we're just like, we're just gonna totally go completely
18:47
rebellious here and just go out on her.
18:49
And I'm so grateful. I'm so grateful.
18:51
It's hard work, it's challenging work, but I, I feel like it's
18:55
the right type of work. And, and we've played around
19:00
with offering discounts for, we offer discounts for public
19:04
school teachers, first responders, military down the
19:09
line. I have this grand vision of
19:13
being able to start our own nonprofit where Kaola Nola can
19:17
then kind of support that. And maybe with some government
19:19
funding and stuff, we can then offer free health or subsidized
19:23
health to people who otherwise couldn't afford a DPC
19:26
membership. So I really wanted to put down
19:29
roots here and be a doctor of the community.
19:34
Yeah, yeah. Well, I think that you are the
19:38
boss, so you need to do it the way you want to.
19:42
And I was going to say earlier with your operations Unicorn,
19:46
you are quite fortunate to have an operations Unicorn because
19:52
actually Doctor Doug Ferrago, he did a talk at the summit a
19:55
couple years ago about why do DPC practices fail because that
19:59
was something there's really not.
20:03
I mean, number one, I think a lot of people when they do
20:05
close. Sometimes they don't want people
20:08
to know because there's already a sense of failure or shame or
20:12
something. And and so he actually went
20:14
around and would contact people and he was just really digging.
20:18
And one thing in particular that he found for practices that
20:22
succeed are that they have a spouse working with them.
20:27
So. But yeah, so that's a good thing
20:32
for you. So, yeah.
20:34
So I think that leaning into the concierge, at least the concept
20:38
will, it'll be easier. You're not going to spend the
20:41
energy on trying to explain, well, no, DPC is different
20:44
because there's still a lot of similarities.
20:47
Honestly. I mean, if you think about it,
20:50
it's they both have smaller patient panels.
20:52
They both have longer, longer visit times and spend more time
20:56
with their patients and are very responsive when their patients
20:59
need them. So the only real difference is
21:02
the payment really. I mean if.
21:04
I mean, that's the big difference.
21:06
Yeah, I think it helps when I say it's usually more affordable
21:09
than most concierge practices and we don't, you don't have
21:12
co-pays. And again, I think when you say
21:17
that people are just like, wait, you still have to pay a co-pay
21:20
when you have concierge, when you're at a concierge.
21:23
Practice. They don't know.
21:24
That they don't know that. No, not all.
21:26
There are some that are different and they don't.
21:28
But like I said, I didn't realize that they did before.
21:33
I didn't either. Yeah, exactly.
21:36
So I would say if you think they don't know what DPC is for sure,
21:39
there's probably people who just don't understand concierge
21:42
either. So when you explain it your way
21:44
well, they might end up thinking that all concierge is like that.
21:48
No, exactly. Yeah, which is not necessarily
21:51
bad. Yeah.
21:52
So, yeah. And I also.
21:53
Tell patients like we don't have a contract.
21:56
I know some DPCS also do that where you have to sign up for a
21:59
minimum of at least a year. I just tell patients it's month
22:04
to month payment. You don't have to.
22:06
You're not obligated to stay with me cuz the most important
22:09
thing is to find a care team that you trust and you know is
22:14
going to support you in accomplishing your health goals.
22:16
And if it's not me, then that's totally fine.
22:19
That hopefully that means that you found somebody else who can
22:22
support you. And that's the most important
22:24
thing because I think that's how we're going to improve health
22:28
outcomes in our country. Yes, agreed.
22:31
Yeah. And it's about finding a
22:34
physician, right, that you can trust and build that
22:36
relationship with. And hopefully, I mean, obviously
22:40
I think that there is a people want DPC over there because like
22:46
you said, there's, you're the only one taking patients, right?
22:50
And you're at least where you are.
22:52
So it seems to be working. Yeah, it was funny.
22:57
When we first moved out here, my husband was on the phone and he
23:01
was calling all these people. I was like, what are you doing?
23:03
And he's like, I'm trying to find a PCP for us.
23:06
And I was like, oh, good luck. I don't think you're gonna find
23:09
one. Yeah.
23:11
And we still have it to this day.
23:13
Fortunately, we found a pediatrician for our kids.
23:16
And that, I think that's the most important.
23:18
So we're just kind of in the wind though.
23:21
Right, did, I'm just curious like #1 did you find someone and
23:26
like get on a schedule and how long is the wait time at least?
23:29
For the pediatric for you guys like nothing, you have yet to
23:32
find one. No one's taking.
23:34
I don't know that we can find even.
23:37
Insurance based. Oh yeah, even insurance because
23:39
we don't have any other DPCS. So insurance based.
23:42
Yeah, we couldn't find anybody. And the one of the exciting
23:46
things about this journey too, is because we've been, I had to
23:50
learn how to use social media when we started this.
23:54
We've had through those avenues, we've had, I've had a handful of
23:58
doctors reach out who are in primary care.
24:00
They're employed physicians and they're like one actually asked
24:03
me if I was hiring. I was like, I have like 10
24:06
patients I would hire you. And it's like I just.
24:09
Started man. Oh.
24:11
That's funny, but I was like, I'm not hiring, but I can help
24:14
you start your own DPC. So so we've been supporting
24:21
other doctors and having those conversations with people who
24:24
want to do and again, it's all the same thing.
24:27
It's been so fun to see. Like in the beginning, it's
24:30
like, I'm scared. I don't know.
24:32
Well, one of the doctors that I'm talking to, she knows she
24:36
wants to do private practice. She's not sure if she wants to
24:39
do insurance based versus DPC. And I'm like, come on over.
24:42
It's so much nicer over here. Dark side.
24:45
I'm hoping I'll be able to convince her, but it's been, I
24:49
think that there's and so we're hoping that once their DPC
24:54
practice is open, then we can kind of do like a bargaining
24:57
system or something or we can support.
25:00
Each of it. Yeah, but that's also like one
25:03
of the fun, the ideas that we've had is to just create like a
25:06
local Hawaii, like for the state of Hawaii, like get all the DPC
25:10
doctors together, get all the, my husband calls them DPC
25:14
curious doctors. Yes, yes, right.
25:17
And get them into the fold too, so they can and start to build
25:21
that support network so that you have a direction on where to go.
25:26
Like do you need to hire an attorney?
25:28
Do you have a CPA? How do you do what do you do
25:31
website so that we can start having those local support
25:34
resources for others who so that it's not as daunting when you go
25:39
out on and I also acknowledge that a lot of them don't have
25:41
operations unicorns. So people are just doing this
25:44
solo while they're still doing their employee job.
25:47
So wow, you know, I and they're so I I think that it's much
25:51
needed. I think we're starting a
25:53
movement. I feel like where it's the
25:56
revolution, it's the that we were talking.
25:58
About right away. Yeah, yeah, yeah, yeah.
26:01
So it's all really exciting work.
26:04
It is. And so we use, I don't know if
26:06
I'm allowed to say this on your podcast, we use Hint for EMR.
26:09
And one of the things I love about Hint is they have a Hint
26:12
community where they kind of provide resources and support
26:16
for other doctors who are doing DPC.
26:19
And they're they offer to sponsor a happy hour for us that
26:24
we would like coordinate for other doctors on the island that
26:27
are DPC or interested in DPC. So we're doing that in February.
26:32
Oh, how cool is that? Wow.
26:35
Wow, that's neat. Yeah.
26:37
So you. Yeah, definitely will spread the
26:39
word. That's amazing.
26:41
Yeah. We in North Carolina, we have a
26:44
monthly kind of women's DPC group that we, we just have a
26:47
Zoom call once a month and that's been really nice.
26:50
It's just. OK.
26:51
And especially for people who don't have other DPCS around
26:55
them, like or don't have or are solo in their practice, like,
27:00
yeah, I have a partner, so I'm very lucky in that way.
27:02
But it's been a lot of fun. And it's nice because we get to
27:05
talk about certain topics, like each month we kind of have a
27:08
topic about like supplies or yeah, it's huge.
27:14
Yes. It is, right, Yeah.
27:16
So this month was more of a kind of a planning, planning for the
27:20
year or like your word for the year, things like that.
27:24
So I think that's great to have, especially since there's so few
27:28
of you to have a group. Yeah.
27:31
Yeah, yeah. We'll keep you posted.
27:33
I'm excited. Yes.
27:35
So what else would you like to talk?
27:38
About I don't know what else did I write on my.
27:40
OK, you talked about feeling awkward when talking to
27:43
patients. About.
27:44
Explaining DPC. Yes, more so feeling salesy.
27:49
Like feeling like I've got to sell myself.
27:55
It's just not something that I felt like I've ever really
27:58
needed to do. And so I don't know, like a
28:01
really good example is my, my mother-in-law invited me to play
28:06
pickleball with her and all of her friends it one day and it
28:09
was a group of people. And The thing is that when
28:12
people find out that you're a doctor, they all light up.
28:15
And especially if they find out you're a primary care doctor,
28:17
cuz they're like, I need, right? And they're asking all these
28:21
questions. They're so curious.
28:22
I was answering all their questions, but I just felt like
28:26
if I tell them about my practice or if I give them my business
28:30
card or have them tell them to sign up for a discovery call,
28:34
what free discovery call is made that it feels, I don't know,
28:37
just genuine. I just, I know it doesn't and I
28:40
know that I need to get better about doing it, but I just felt
28:43
like it would be like I was trying to sell them something.
28:47
I'm also doing like a free webinar was my first one, yes,
28:51
at the end of the month for cancer screening.
28:52
And I was like after the fact, after I came home, I was like, I
28:55
should have told them about that and tell them to come and it's
28:59
free. It's like it's online.
29:00
So if there's really like not anything that they have to lose
29:04
there. But it was just one of those
29:06
things where like, I still am trying to navigate how to talk
29:10
to people and they do seem interested.
29:13
And I think part of the whole like, because maybe there's some
29:16
like PTSD from talking about DPC and letting them know.
29:20
There's maybe like a shame component of like they get so
29:24
excited that I'm a doctor. And then of course, the next
29:26
question they ask is what insurances do you accept?
29:30
And then to be like, oh, well, we're doing this model and then
29:33
kind of making them feel disappointed.
29:35
I think that's shy away from it. Yeah, yeah, definitely.
29:39
I think you're right that there's because you've had that
29:41
experience already and it was so such a let down.
29:47
But yes, it is. I mean, sure, they're
29:50
disappointed, but you can't control that.
29:51
Obviously you know that is on them.
29:54
But when you are, when you're talking about DPC, like do you?
30:00
And when they were asking questions, how would you respond
30:04
or how do you respond to people when it's just kind of an off
30:07
the cuff conversation? You meet somebody, what do you
30:10
do? What's your pitch, your elevator
30:12
pitch, or do you have one? I don't think I have one.
30:16
I mean, I answer their questions and I kind of let them drive.
30:19
But I think anything that where it's like, I mean, I'm even
30:24
trying to think like what would I say if I did?
30:27
And it's like, if you're looking for a doctor, let me know.
30:30
Or I don't know. Or even like reaching for my
30:33
business card and giving it to people.
30:35
Like maybe it's like, oh, here's my information.
30:38
Let me know if you ever need anything or I can ever help with
30:42
something. Yeah, yeah.
30:44
So, so you don't really have kind of, and it's OK to have a
30:48
pitch because that way when you get caught off guard, it's like
30:55
it's prepared. There's nothing wrong with that
30:57
because you actually do want to have that because you want it to
31:00
feel comfortable. You want it to feel easy.
31:03
You don't want it to feel forced and you don't want to sound
31:06
confused either about what you're trying to say.
31:12
So, so being clear about it is actually good and it is
31:17
completely normal to feel like you're selling because this is
31:20
something we do not learn. We don't learn how to do this.
31:24
We've never had to do this. I mean, very few of us have
31:27
because most of us have been employed and we never did the
31:32
advertising. We never had to promote
31:34
ourselves. So it is completely new and it's
31:37
OK to not be good because you've not done it before.
31:41
Everyone starts from zero. So, but you know an easy way and
31:48
this if you've listened to the podcast, you've heard me say
31:50
this before, but this is the easiest way to kind of create
31:54
your elevator pitch and you can base it on the pain points of
31:58
the person if you if they've already said I can't get in.
32:01
So when you call your doctor, it's when blank and then what
32:09
you do. So when you call your doctor and
32:11
you can't get in for two weeks, but you're sick and you need to
32:13
be seen now. Well, at my practice, you can be
32:15
seen the same day or next day, and it's a really good hook.
32:20
That's The thing is it's a very good hook.
32:22
And then people will be like, wow, that's amazing.
32:24
I can never get in with my doctor.
32:26
But it's short and it's intriguing and it just kind of
32:31
gets the ball rolling. Yeah.
32:35
And you can have longer, but if it's just a quick kind of
32:39
conversation or you just want to get things going, you want to
32:42
get some interaction going, then having it like that, it is
32:46
totally a hook, really. And then they can ask and then
32:51
you go from there. But yeah, and the feeling of
32:55
selling, again, very unusual. We're just uncomfortable with it
32:59
because we don't, we have never had to do it, but it took a
33:03
while for me and for my partner to kind of get comfortable with
33:07
that. And we used to exactly how you
33:10
felt. We people would be like, oh, you
33:12
don't take my insurance. And again, yeah, you would feel
33:15
bad. You feel like you said, a little
33:16
bit ashamed. Like, wow, why am I trying to do
33:20
this when everyone uses their insurance?
33:23
And so you, it's a lot of just thinking, mind work, mindset
33:27
work of OK, what are you trying to do?
33:30
Right? You're trying to provide a
33:32
service that will give people the most amazing primary care
33:38
that they've ever had. Yeah.
33:40
And I mean that is not a lie. Right, Yeah, yeah.
33:43
I mean, I feel, I think because of like my cultural background,
33:46
it's like humility is such an important trait for a lot of
33:50
people. But I do believe like I am going
33:53
to give them a healthcare experience like they've never
33:56
experienced before. Like it's going to just like
33:59
blow them out of the water. I know that just, and not just
34:02
me, but it's just like the DPC model in general, right?
34:07
I don't know how to, I wish there was like a way for me to
34:11
be able to convince that to someone in like a 5 minute
34:13
conversation, which is a lot of times the only times I have with
34:17
people. I'm also like a more like
34:20
relationship based person over like repeated interactions, but
34:24
I may not always get that with some people when I cross their
34:27
paths. And I loved the episode that you
34:30
had with Doctor Uno when she was on and you guys were talking
34:33
about introverts versus extroverts.
34:35
Like definitely an introvert here.
34:37
And so it is very draining for me when I'm having these
34:41
conversations with people that and then I'm trying to do all of
34:45
these things at once and try to convince them.
34:48
But I do think they're, I know, I think I just have to practice
34:53
it and be OK in the beginning if I don't get the hook quite right
34:58
and I lose a few patients because if I don't try, I'm
35:02
losing them anyway. Sure.
35:03
So I think that they're, yeah, that's definitely something that
35:06
I can try. And you don't have to practice
35:08
it on people. I mean, you can literally
35:10
practice it in the mirror and you can record yourself.
35:13
I mean, I think that is it's really important to record
35:17
yourself because it will show you what you do.
35:21
Like if you're fiddle with your hair a lot or if because, I
35:25
mean, you never really think about it before.
35:28
And a lot of people will have little, just little tells like
35:33
when you can tell they're nervous when they're talking.
35:36
So if they say certain things or they start saying things like
35:40
that. And you may not even hear it
35:43
yourself when you're saying those, but other people, of
35:48
course, when they're listening to you, they can tell so.
35:51
And the other thing about being an introvert, one reason to
35:54
practice it is because then it is just second nature and you're
35:58
not working so hard at it. And it's not causing to, it's
36:03
not draining your energy because you're trying to remember and
36:07
try the other and trying to convince.
36:09
I mean, sometimes if someone's going to get it, they will get
36:14
it immediately. They'll understand immediately
36:16
and you won't have to convince them.
36:20
And there's some people that, I mean, yes, if you talk to them a
36:24
little longer, they will understand, they'll get it.
36:27
But I think if you're saying concierge, I mean that's kind of
36:30
half the battle that people understand.
36:33
Yes, you're paying additional for it outside of insurance, But
36:40
yeah, so selling, thinking of the selling as service and
36:45
you're going to provide this amazing service that they may
36:49
not get otherwise. Yeah.
36:52
And there's, I mean, you want how many patients 3400 and how
36:58
many people live in Honolulu? Yeah, that's true.
37:03
Yeah, that's true. You don't.
37:04
You're not going to win every single purple.
37:06
Yes. Oh, absolutely not.
37:07
Yeah, you will not. And it takes a little while not
37:10
to feel bad when people are like, Oh no, I'm never playing
37:13
because for a while you're just like really butt hurt.
37:16
Like that is not. I feel really bad because that
37:19
person was just like, why would I ever do?
37:23
But yeah, it starts after a while it just rolls off your
37:25
back. You're like, you know what, It's
37:27
just not for you and that's OK. I hope you find what you're
37:29
looking for. Yeah, One thing that I would
37:33
love to hear, what's your response when people ask if you
37:37
accept their insurance? Cuz I've gotten mixed feedback.
37:42
I've had some TPC dogs that say you just say don't say we don't
37:46
accept your insurance, Just say we work with people with all
37:49
types of insurance. And then I've had other people
37:52
are like, that's just too you're kind of running them around.
37:56
You should just be open and say like, we don't accept your
37:58
insurance. We don't work with insurance at
38:00
all. So I'm curious, I'd love to hear
38:02
what you how you approach that. Yeah, So what we say is very
38:06
similar to more the second, I guess it's somewhere in between
38:08
the two. I say we, we don't bill
38:11
insurance, we don't bill any insurance, but we can see
38:13
anybody whether or not you have insurance because we bill a
38:16
monthly membership. Most of the time people will be
38:19
like, oh OK, no insurance. But a lot of times if they they
38:24
are calling us, hopefully they have heard about us and heard
38:27
about how the model works and how our office works and they've
38:31
looked at the website. But you'll still get a lot of.
38:33
People. So many.
38:34
Yeah, right. I mean, it's just, yeah.
38:38
And we still even on our website, we have kind of a form
38:42
like if you want to join the practice and you're kind of
38:45
indicating like raising your hand and there's a check box
38:48
that says, I understand federal health does not bill insurance.
38:52
And still people will be like, oh, wait, you don't.
38:56
But we had one recently that came in and he was surprised
39:01
that we didn't bill insurance, but he still was like, no, I'm
39:04
still going to join because he was fed up with the system.
39:07
So, yeah, I mean, I think you just have to find the way that
39:10
you find is most comfortable for you because of ultimately, yeah,
39:15
you're going to have to tell them at some point that you
39:16
don't take insurance and that it's monthly membership.
39:19
So another way to describe it is it's kind of, it's like a gym.
39:24
It's kind of like a gym. You if you go to the gym,
39:29
wonderful, it's great. Take advantage of it.
39:31
And if you don't go to the gym, you're still paying the monthly
39:33
membership, but it's there for you.
39:36
And so we're here for you. Yep, Yep.
39:40
We've tried the gym analogy and I think some people have like a
39:44
visceral reaction to that too, That's they're like, they're
39:47
like another thing that I'm going to pay for that I never
39:50
use. And I actually knew I had a
39:52
patient when she was signing up. She's like, how do you, how do I
39:55
know this isn't going to become a gym membership?
39:56
I was like, I'll work with you. You can always cancel again.
40:00
And she's become one of my biggest, my biggest, like
40:04
advocates. Good.
40:05
Yeah. People to sign up and she's
40:07
like, oh, I get it now. So, yeah, I think it helps to
40:12
remember that we're not trying to win everybody over and and
40:16
we're still early on here and I'm building a practice from
40:21
scratch. I think it's yes, I think it
40:24
would be different if I was doing this where I had my
40:28
original practice and my patients already me.
40:31
So. So yeah, but it is hard like
40:34
sometimes. So Michael, my husband will
40:36
answer the phone sometimes and I can hear him talking and he's
40:41
like, Oh yeah, we're we don't take your insurance.
40:43
And we hello. Like they, they just like hung
40:46
up on it. And it, that can be just, I
40:49
don't know, but I think it helps to remember not to take those
40:52
personally. Yeah.
40:54
And yeah. Yeah, it definitely does.
40:58
And like I said, it's hard at the beginning and you do feel
41:01
you feel it deep down, but it gets better.
41:05
Yeah. It does get better, but yeah I
41:07
think your your front office can work on their.
41:11
Yeah, we've got and we've gotten better.
41:14
We've practiced with each other and now that I remember, like in
41:16
the early days, we've remembered it.
41:18
So now we kind of, we kind of say we do use, we'll use your
41:22
insurance if you need to pay for things like labs and diagnostic
41:25
testing, medications and things. But then the monthly membership
41:28
will cover all the services through our office.
41:32
Yeah. So are you doing labs in your
41:35
office or dispensing medicine? No.
41:38
So then you can say we your monthly membership covers
41:41
everything within this office and your entrance can pay for
41:45
everything else outside which it encompasses specialist imaging,
41:50
all of that. So it's makes it very clear.
41:54
But it is, it's new. It's all new, but you know, you
41:58
have some patients and this is. Right, this is.
42:02
A good start and it'll get there.
42:04
It'll get there. So I think the webinar is a
42:07
great idea and I would say either like a monthly newsletter
42:13
or I think monthly is a nice cadence just because if you were
42:18
doing it every week or every two weeks, it's still, it just flies
42:21
by, right. So a month is nice and I think I
42:25
we've been really good. I've been trying to be very good
42:27
about doing a monthly 1 and I will admit, like the past six
42:30
months I have not been as good. And I feel like that has made a
42:34
difference. It's kind of hard to tell
42:36
because we're at the. It was towards the end of the
42:39
year and at the end of the year you always lose some people.
42:42
I mean, generally every year that's what it seems to be.
42:44
There's a few people because they know that either they're
42:46
going to get interns at the beginning of the year or for
42:48
whatever reason, there's a few that will drop off.
42:52
But I kind of feel like, yeah, the fact that I haven't been as
42:56
diligent about that. And so when you were talking
42:58
about what's the value for me? And then having that touch
43:02
point, I think makes makes a difference.
43:05
Because if you have, if they haven't heard from you in like 3
43:08
or 4 months and then they're like looking at their credit
43:10
card bill and why am I, they, I, they don't even remember I'm
43:15
here. And then that's when you lose
43:17
them. So that's, I think having
43:19
something like that is, is a good thing.
43:22
But I love the webinar. I, we did one of those when we
43:24
started and we recorded it and put it on the website and it was
43:29
not, I mean, you're doing a topic, but we did it on just
43:32
direct primary care in general, just like, what is it?
43:35
And this was very close to COVID.
43:36
I mean, so there was a lot of town halls and stuff.
43:39
So, but it's really nice because then you can put on your website
43:43
and then you can cut it up in pieces and put that on your
43:46
socials. So reuse it, repurpose it
43:49
because that's that way you're not having to, I repeat
43:52
everything all the time. Yeah, it helps.
43:55
It helps. That's kind of the goal.
43:57
Yeah. And I think it's something that
44:01
this is something that my partner and I have talked about
44:03
extensively. It's like as long as we are
44:06
doing things that we enjoy doing because we didn't always have
44:11
that freedom when we were employed by our companies, it'll
44:15
be worth it even if it doesn't convert to any patients.
44:18
And so I, that's really been our guiding principle whenever we
44:23
are deciding whether what we should do for the practice.
44:26
And so for this webinar, community health education is
44:30
something that I feel really strongly about.
44:31
So I asked myself like, would I be doing this even if I was
44:34
already full at Max capacity? Yes, it's OK, let's just do it.
44:38
And then it has the added benefit that I get more exposure
44:41
in the community. And so something similar to that
44:44
as we do, we do every month, we do what's called a walk with the
44:48
dock. So we get out into the community
44:50
because we're in Hawaii like it's beautiful here.
44:53
And we'll just go for like a one mile easy walk And we put it on
44:56
our website. We encourage people to come and
44:59
our my mother-in-law is always kind of cracking up.
45:01
She's like, any takers today? And I'm like, no, but you know,
45:04
I still enjoy it. But we've had a couple people
45:07
join in, the most recent one we did and it was great.
45:11
They didn't end up signing up as members or even really.
45:13
And I, and that was one of the things where it's like I didn't
45:16
push it. I didn't, I didn't say like
45:18
schedule a discovery call at the end.
45:20
And maybe I should have. Maybe that's where I can kind of
45:22
practice some of my discussions. But it was still enjoyable to
45:25
just walk with people and talk to them about DPC and why I'm
45:28
doing what I'm doing and learning their story too.
45:31
Yeah, Yeah, I think it is. You can approach that many
45:36
different ways. You can either before or after
45:40
the walk, talk about a topic. And that way, not even talking
45:45
about the DPC itself, but just blood pressure.
45:49
Like what's a good way to take a blood pressure?
45:51
How do you get a good blood? How do you check it at home?
45:53
Just something real small so that they can see OK, this, they
45:56
know their stuff and I like the way she explains it and I like
46:01
that way. And if it's not right for them,
46:03
I mean, they may know somebody who lost their entrance and
46:06
needs a doctor or something like that, but it's always just
46:11
putting, yeah, putting that word out.
46:13
And you never know. Some people will follow you on
46:17
social media for a couple of years and then they come in.
46:21
Yeah. Very true.
46:23
Yep. Well, I think you all are doing
46:25
great again, Having 10 patients being in just a couple months is
46:30
wonderful. So yeah, keep on going, keep on
46:33
hoofing it. Just keep plugging away.
46:36
It's going to get there. You just, yeah, just got to
46:38
keep. The only way you're going to
46:39
fail is if you stop. Right, that's true.
46:42
So just going to keep. Going yeah, is that talk I
46:47
forget you mentioned his name about why DPCS fail recorded or
46:53
somewhere or live somewhere I would love to watch.
46:55
It good question. It was, so it was at the DPC
46:58
Summit a couple years ago and it was recorded, but I think you
47:01
have to purchase like the whole summit recording.
47:05
And honestly, it was two years, OK, two or three years ago, I
47:11
can't remember now. But I'll tell you what I do
47:14
remember the main things, the ones that did not, the ones that
47:19
closed. And so some of these were
47:20
closing for terrible reasons, like health reasons, deaths in
47:24
the family, things like that. So of course those were.
47:27
He said there were a lot of sob stories, like he cried and they
47:30
cried and like there's some really sad stories.
47:33
But I think one of the big reasons is just, it was kind of
47:37
just like what I said, they kind of stopped.
47:39
They didn't continue to try to promote.
47:42
I think either they weren't very good at promoting themselves or
47:45
they didn't want to or, and that was part of it.
47:48
I think some just ran out of money and I think it's all
47:51
related of course. And some, that's the other thing
47:56
I was thinking about and some maybe the pricing wasn't quite
48:00
right and that's kind of speculative, but still.
48:04
But yeah, I think most of the time it seemed like the
48:06
personality wasn't the right fit for the type of practice or they
48:12
just weren't really promoting themselves.
48:14
Like you've learned, really have to like put yourself out there.
48:19
And I think that maybe that was one of the reasons why some
48:23
people just couldn't make it. But like I said, the ones that
48:28
did succeed seems like they have help, reliable help.
48:34
Yeah, that's. True.
48:38
So yeah, that's a great combination.
48:40
Yeah. But yeah, I'll see if we can
48:43
find out about that. But I remember someone was
48:46
talking asking about it on the groups one recently and I think
48:50
he did say something like it's you have to buy the whole thing.
48:54
That's that's kind of what I remember from.
48:57
It that's helpful though. Yeah, I don't think you guys are
48:59
doing the right things. And I mean, you've got, is this
49:04
your office that you're in right now?
49:06
Yes, looks like it. Yeah, keeping the overhead low.
49:10
Is it the thing? Yes, Yep, Yep.
49:12
We got really lucky. And then that's one of the
49:14
benefits of being in Hawaii. It's just, it's so community
49:18
based that it was like somebody knew somebody who was renting
49:21
out space. So I'm renting out two exam
49:24
rooms from another primary care doctor and she gave us a really
49:28
great deal. Yeah, two exams.
49:31
So I use this one room to see patients and then our other room
49:34
we use as kind of like an office.
49:36
Yeah. Oh, that's amazing.
49:38
That's. Perfect.
49:39
It's perfect. It's all that I need, yeah.
49:43
Yeah, I mean really, if you continue as a micro practice,
49:45
you really don't need more. No, no.
49:49
And that's, and I think there's that's the beauty of that
49:51
because everyone's surprised when it's just me, but I'm the
49:56
one that comes out to get them. And then they're like, oh,
49:58
you're the doctor. I'm like, yeah, come on, let's
50:02
go, I'll take your blood pressure.
50:06
And they love it. They love it because you don't
50:08
spend you don't spend forever waiting for someone you didn't
50:12
schedule an appointment to come and see to take your blood
50:15
pressure, ask you some questions that don't have to do anything
50:18
with anything, but it's on their checklist of things to do.
50:21
Yes. And then you have to wait for
50:23
the doctor to actually come in and ask all the.
50:26
Questions. Yeah, it is.
50:28
It's a great way to practice and I'm so glad you guys are having
50:31
a good experience and growing. So yeah, keep going.
50:35
So tell us. Tell the listeners how to find
50:38
you on the interwebs. Yeah, so I think if you
50:43
honestly, if you just Google primary care doctor in Hawaii, I
50:46
might, I'll probably be one of the first ones.
50:49
But we're at kayolanoah.com also can follow us on Instagram or
50:53
Facebook and we try to publish content, but we're also doing
50:58
free discovery calls just to make sure that this is this is a
51:01
good fit and you can ask any questions about your health or
51:05
the practice itself. Yeah, love to meet all of you
51:08
guys. Well, very good.
51:11
Thank you so much for coming on and it's really nice to meet
51:15
you. And I don't like you said,
51:16
you're one of the very few out in Hawaii, so that's amazing.
51:20
Congratulations. Conversations like the ones that
51:23
Doctor Mayetta had with patients that she described in this
51:26
episode, those are conversations that happened hundreds of times
51:32
between DPC doctors and potential patients.
51:35
They're having these conversations where people who
51:38
find them on social media, every curious neighbor and every
51:45
patient who calls your office asking if you take their
51:49
insurance before even knowing what DPC is.
51:52
You can't personally walk every one of them through it.
51:56
If you are a new DPC doc and you're already feeling like this
52:01
is a problem to DM me. I want to hear what's happening
52:05
in your practice. Thank you for listening and I'll
52:09
see you on the next episode. Thank you for listening to DPC
52:13
Life. If today's conversation inspired
52:16
you, hit follow, Leave a review and share it with a friend who's
52:21
ready for change. Remember, wherever you are in
52:24
the journey, your DPC family has your back.
52:29
Until next time, keep building a practice and a life that truly
52:33
fits you.