Latest / DPC Life: Direct Primary Care Podcast / Hiring a Second DPC Doctor: Mistakes, Red Flags, and Lessons Learned

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Hiring a Second DPC Doctor: Mistakes, Red Flags, and Lessons Learned · DPC Life: Direct Primary Care Podcast

0:00
Yes. So hiring out of desperation.
0:02
Is not. A good thing.
0:04
Exactly. Does it work out?
0:05
Exactly. Somebody said this.
0:07
You hear all these sayings and stuff in DPC and I think one of
0:09
them is that the worst day in DPC is still better than the
0:12
best day in employed medicine. I think that's the one thing
0:15
people don't realize either about DPC is you are the brand.
0:19
And so she saw how we treated the grandmother and the time
0:22
that we took and the money that we saved her and stuff.
0:24
And she's like, I have insurance, but could I be a
0:27
patient? And we're like, Yep.
0:29
Welcome to DPC Life, the podcast where independent doctors share
0:34
real stories, bold ideas, and the freedom of doing medicine on
0:38
your own terms. I'm your host, Doctor Anne
0:41
Gonzalez, and together we'll explore the wins, the struggles,
0:46
and everything in between. Let's dive in.
0:50
Welcome back to DPC Life, the podcast where we talk about all
0:53
things DPC and just about everything outside the office.
0:58
My guest today is Doctor Wendy Molaska, a family medicine
1:02
physician and the founder of Dedicated Family Care in
1:05
Madison, WI. Doctor Molaska and I met at the
1:10
Greenville Mastermind in 2021, right around the time that she
1:14
had opened her practice and we were about to open our DPC
1:18
practice. So I feel like we are DPC babies
1:21
that grew up together. She is a wonderful physician and
1:24
a wonderful human being. I'm so excited that she has come
1:27
on the podcast with me. She is extremely involved with
1:32
the Wisconsin Medical Society, having been on the board of
1:36
directors and also as past president.
1:39
She's also very involved in pediatric literacy, the Council
1:43
on Immunization practices in Wisconsin, and also has a strong
1:48
passion for social justice. So we talk about how she is able
1:52
to do all of these things while still working in and running her
1:57
own DPC. So let's get into the episode
2:00
today with Doctor Molaska. So today I have with me Doctor
2:04
Wendy Molaska, who is a wonderful family physician and
2:07
we're going to learn so many interesting things about what
2:10
she's doing with DPC today. So we met at the Greenville
2:14
Mastermind in 2020. Yes, one.
2:17
Yeah, 2021 and I think. Barely.
2:20
Yep, a couple of months. OK.
2:22
So I'm going to let you kind of tell us about your practice.
2:24
So Doctor Wendy Molaska. Yeah, no, thanks for inviting
2:28
me. And I'm really looking forward
2:30
to this because yeah, it's basically like we just get to
2:32
spend some time chatting. But yeah, super lucky that I got
2:35
to meet you because I'm from Wisconsin and my DPC practices
2:39
in the Madison, WI are technically Fitchburg, kind of a
2:42
little suburb of Madison and my best friend in all the world
2:45
that lives in Greenville, SC. So when there was a mastermind
2:49
there, I was like, oh, I get to do 2 things at once.
2:52
I get to learn about DPC and visit my best friend.
2:55
So because a lot of people who do the masterminds always seem
2:58
to go to like their kind of local place.
3:00
So if you're in the Midwest, you'd go to one in the Midwest.
3:03
And so, but I ended up in South Carolina and then we were able
3:06
to meet there, which was awesome.
3:07
So, but yeah, a practice is dedicated family care and we are
3:13
family medicine. So womb to tomb.
3:16
I just signed up another patient for Hospice the other day and
3:19
have pregnant women and everything in between, which is
3:22
awesome. And yeah, I opened in May of
3:25
2021. So yeah, finally, I first heard
3:29
about DPC in like 2019, but at that time then I had two young
3:32
kids and actually I was also just diagnosed with breast
3:36
cancer at that point. So I was like, I can't do that.
3:40
I can't start a business and deal with all this other stuff.
3:43
But by December of 2020, pandemic administration working
3:48
from home and telling you, oh, we don't have PPE for you, but
3:51
you still need to take care of dying COVID patients.
3:53
It finally realized that, hey, this is taking a toll on me and
3:57
my family and everything else. And so why am I continuing to do
4:00
this? So December of 2020, I quit my
4:03
employed position and then in May of 2021 saw my first DPC
4:07
patient. And it's been a roller coaster
4:10
since then. But yeah, we have expanded.
4:12
I started as a micro. I started as a micro.
4:15
Good and bad. Good and bad.
4:16
Exactly. And I think that's one of the
4:18
things is like somebody said this, you hear all these sayings
4:20
and stuff in DPC and I think one of them is that the worst day in
4:23
DPC is still better than the best day in unemployed medicine.
4:27
So I think that's one of the things I take business aspects
4:30
of it, but being able to practice medicine the way I was
4:34
trained and feel like I'm actually helping people is huge.
4:39
So I think that's kind of the biggest thing from that.
4:42
But yeah, I opened as a one room micro practice.
4:45
I had a one room suite. It was just me, exam table in
4:49
one corner and desk in the other corner, and I was the
4:54
receptionist and the medical assistant and the phlebotomist
4:57
and the janitor and the doctor and everything in between.
5:00
And once I started growing, I started attracting a Latino
5:04
population and my Spanish was kind of rusty.
5:07
So one of the nurses that I'd previously worked with, she was
5:10
originally from Bolivia. She was an RN and she was a
5:13
certified medical interpreter. So I started per diem just kind
5:16
of calling her in every once in a while to help with the
5:19
interpretation and then and eventually hired her part time.
5:23
We expanded into the clinic that we're currently in.
5:26
So we now have three exam rooms, one procedure room, a small
5:31
reception area, an office for the docs and stuff.
5:34
And she came on full time. Eventually hired a medical
5:39
assistant, one that I'd also previously worked with.
5:41
I keep stealing people from other organizations.
5:44
It's wonderful cuz you already know how they work.
5:47
And she was initially part time right because she was going to
5:50
nursing school. But she is now in RN.
5:52
She is originally from Ecuador and she is trilingual because
5:56
she speaks English, Spanish in her indigenous language of
5:59
Quichua. So she's also taking the medical
6:02
interpreting course so that she can be certified as medical
6:05
interpreter but she interprets as well.
6:07
After her we added office assistant.
6:10
Super lucky to have him. He is actually this nurse's
6:15
cousin, which is how we found him.
6:17
But he was working at a credit union, really good customer
6:20
service skills, just a real go getter.
6:23
And again, he's from Ecuador, so speaks English, Spanish in
6:26
Quichua and agreed to come on board as kind of our office
6:29
assistant. So he does a lot of our front
6:32
office work, behind the scenes work.
6:34
And yeah, he's just been amazing.
6:36
And then as of two weeks ago, we added our new physician, Doctor
6:41
Amy Watteo and I I'm so excited. She is awesome.
6:46
She is also bilingual English and Spanish.
6:49
It's it's been a whirlwind that we are continuing to grow and it
6:53
has just been fantastic. And yeah, everybody's like,
6:57
would you do anything differently?
6:58
And I think the one big thing is always people are like, well
7:00
maybe I would have gone into DPC earlier and I don't how good
7:04
this could be. Yes, that's definitely something
7:06
most people say is I wish I had you would have done it sooner,
7:10
you know, but. You don't know what you don't
7:12
know exactly. So I'm curious, how did you find
7:17
your new physician? That seems to be a really hard
7:20
thing for DPC doctors right now to find other.
7:24
Doctors. Yes.
7:25
So I actually had found a physician.
7:28
It was not a good fit. I'd hired someone.
7:31
She started, ended up quitting within three months.
7:34
So huge learning experience, good and bad, but you know, you
7:37
take your lessons from it and stuff.
7:39
But this one, so interestingly enough, I've been doing a lot of
7:43
talks and I have Med students, nursing students, pharmacy
7:48
students, all kind of residents rotating at the clinic.
7:50
And so I did a talk at the local residency program.
7:54
So in Madison we have family medicine and residency program.
7:57
We have the medical school here, we have a lot of training
8:00
programs and stuff. So I was doing a talk about DPC
8:03
at the residency and Doctor Watio was at that talk and was
8:08
like, oh, this sounds really cool.
8:12
And yeah, so she came and rotated at the clinic and got
8:16
some experience seeing what this was actually like.
8:18
When she graduated in June of this year, we had signed a
8:23
contract back in like January or something so that she would be
8:26
starting here. She took a few months off, which
8:28
we can blame her after residency and yeah, now just started the
8:31
other day. So mine was actually kind of
8:33
fortuitous that I'd had this experience of going into a
8:36
residency doing a talk, having her rotate out here as well and
8:40
stuff. But yeah, I think you're right.
8:42
I think it's been hard for people to find docs for these
8:46
positions. So she was a third year.
8:49
When she she was actually a second year.
8:52
Yeah, when she heard my talk. Yep.
8:54
And then rotated as a third year.
8:58
I think that obviously the earlier that people know about
9:02
DPC, they can start planning, but that's perfect.
9:04
If she's second year, then she can plan her third year with
9:07
rotations. That would be really helpful
9:09
coming out and going directly into DPC since that's their
9:13
first job. That's I think that would be
9:15
great. It might, I would think.
9:17
For me it would have been hard. Yeah, and that's one of the
9:20
things, when I look back over my career, really happy with the
9:25
way my career has played out over the last 20 years.
9:27
So like out of residency, I was at a rural FQHC and we were in
9:32
the middle of nowhere. And so it was you or no one.
9:35
And so you're still on that kind of steep learning curve out of
9:38
residency and all of a sudden, oh, a 26 weeker comes in and
9:41
delivers and you got to wait an hour for a helicopter to get
9:44
there. You're like, OK, I guess I'm
9:46
trying to put in lines and do all this stuff that because it's
9:49
me or no one. And so I think that experience
9:52
was really helpful to be able to really expand my knowledge base,
9:57
my confidence, my procedures, all of that kind of stuff, which
10:00
now I'm able to again, use in DPC and do all of these
10:03
different skills and stuff that I've learned over the years.
10:06
So I do colposcopy and endometrial biopsies and all of
10:09
these other things, which I think is hugely important.
10:12
I think in this situation, again, because I'm already
10:15
experienced in in this situation.
10:17
I think for Doctor Watio, it's going to be good because yeah,
10:21
she is like, OK, yeah, I want to learn how to do, you know, this.
10:25
And I'm like, OK, great. I can teach you how to do that.
10:27
So some of that's going to be great.
10:29
But yeah, I wouldn't go back and change anything that I did in my
10:32
career to end up here, right? Yes.
10:34
And actually on the flip side, since she's very fresh out of
10:38
training, so there's a lot of that stuff like the more
10:41
specialized things like the Culpo and endometrial biopsy,
10:45
she's very fresh with just having learned it within the
10:48
past few years. So that's also good.
10:50
I mean, that's another bonus for coming out.
10:52
Of yeah, I think the big thing too, is one of my fears was
10:55
always, as we age, as family practice docs, you get set in
10:59
your ways. And I remember working with this
11:01
one doc when I was in medical school and like, the stuff I was
11:04
learning in medical school was way ahead of where he was.
11:07
I was like, what are you doing? Why are you doing this?
11:09
This doesn't make any sense. We were taught this in medical
11:11
school and the evidence shows this or whatever.
11:13
So my fear has always been to be one of these old docs that has
11:16
never kept up with all of the changes in the times.
11:19
And so having this young person right out of residency.
11:21
And then this is also part of the reason that I try and have,
11:23
Yeah, I've met students, residents, all these people
11:25
rotating at the clinic as well to kind of keep me fresh and
11:29
make sure that I'm staying on top of everything as well.
11:31
So yeah, she brings a whole wealth of knowledge and stuff
11:34
that is really up to date and so forth.
11:36
So. Yeah.
11:38
Well, I'm going to back up a tiny bit and if you don't mind,
11:42
will you share, if you don't mind, what you learned from
11:47
hiring that first doctor? What do you think you know?
11:50
Were there red flags or was there something that you wish
11:52
you had picked up on soon? Yes.
11:55
So I think at that point I was so desperate for another doc
12:02
that I kind of settled and I didn't pay attention to some of
12:08
the things that I should have. So this was an internist, but
12:12
she had gone on to do pulmonology and palliative care
12:15
in Hospice. So really she was a specialist.
12:18
But when she came and interviewed and stuff, she was
12:20
like, I really want to get back to nuts and bolts.
12:22
I really want to go back to doing primary care and so forth.
12:26
And what we quickly realized when she started, because again,
12:31
it's different than having a resident come out and rotate to
12:33
kind of see how things go. She did come out and like
12:36
shadowed for a day and stuff like that, but it's different
12:39
than actually seeing somebody at work and so forth.
12:44
And So what we quickly realized is, yeah, she's specialist.
12:47
And that just doesn't work in primary care.
12:50
And so there are a lot of just basic stuff that we had to go
12:53
back and be like, oh, she's like, I haven't done a pap in 10
12:56
years. How do I do a pap?
12:57
And we're dealing with acute, chronic and preventative care
13:02
and trying to sometimes do all three at once.
13:05
One situation to remember was one of her patients called into
13:08
the clinic early in the morning, at 9:10 in the morning.
13:11
And they're like, hey, I cut my finger.
13:13
I think I need stitches and I heard the staff talking to her
13:16
and she's like, well, I don't have any openings and blah,
13:19
blah, blah. And I'm like, wait, that's not
13:20
how TPC is. If somebody calls in and tells
13:23
me they need stitches, I just say come in.
13:25
That's not how I this clinic is supposed to run.
13:27
It's like, yeah, if you have that acute need, you just come
13:29
in and we work it out, especially because most of our
13:32
visits are so long. It's like if you have a 60
13:34
minute visit with a patient, sometimes you don't need that
13:36
whole 60 minutes. So the 15 minutes that takes to
13:39
put in sutures is not going to be a big deal.
13:42
And then I started hearing some patient complaints as well,
13:45
which was really tough. And I think I technically,
13:47
because up until that point, I'd not had like any patient
13:50
complaints. So we kept getting great Google
13:53
reviews and patients always saying how comfortable they felt
13:55
here at the clinic. And now we had people saying
13:57
that they don't feel comfortable when they're talking to her and
14:00
they don't feel heard. And I kind of, and I think
14:04
that's the one thing people don't realize either about DPC
14:06
is you are the brand. And so I worked really hard to
14:09
build my brand and the brand is me.
14:12
And now I have somebody else here who is also gonna be part
14:15
of my brand. And to hear that patients are
14:17
just like, I don't feel like she was listening.
14:20
I don't feel heard. All of those things were really
14:23
bad. So yeah, we decided to part ways
14:25
after about 3 months, which I think was good for all of us.
14:29
So it was mutual. It was kind of a little bit of
14:33
both. Yeah, maybe not.
14:36
It was kind of a little bit of both.
14:37
I think she was surprised when I she was very surprised, I would
14:41
say, when I sat down and tried talking to her about some of the
14:45
concerns that I had. And I think then she was very
14:49
uncomfortable because I think nobody wants to hear that you're
14:54
getting patient complaints and that you're not meeting patient
14:57
needs and stuff. As doctors, we're all so many of
14:59
us are type A and perfectionist and stuff like that.
15:01
And I think that's probably really hard to hear.
15:03
And so I think that was probably a blow.
15:05
And so that she quickly made the decision that she just didn't
15:09
want to continue. So yeah.
15:12
Yeah, well, definitely a learning.
15:15
For sure a learning experience. And I think like you said, the
15:18
big thing was that, and everybody always says this hire
15:22
slow and fire fast. And so the fire fast happened,
15:28
the hire slow was did not. And I think that was the biggest
15:31
problem. There was like, I was like, oh,
15:33
there's a doc, she's interested, she's available now.
15:37
She doesn't have commitment where she has to give today's
15:39
notice or any of this other stuff.
15:41
She could start tomorrow, blah, blah, blah.
15:42
And so there was all this stuff where I was like, and I have a
15:44
wait list of all these patients and I feel bad turning patients
15:47
away and stuff. So let's get her in and let's
15:50
get her started and stuff. And that's where I think I made
15:53
my biggest mistake was like, hey, we should do more betting.
15:57
We should actually look at this a little bit more and.
16:00
Yeah, yeah, yeah. So hiring out of desperation.
16:03
Is. Not a good thing exactly.
16:05
Does it work? Out exactly.
16:11
Yes. Well, I do want to talk a little
16:14
bit about other things that you do outside of the clinic because
16:18
you are incredibly involved in advocacy.
16:21
So tell us more about what you do and how you kind of fit that
16:25
in, because you're very busy at your.
16:26
Practice as well. Yeah.
16:27
So I do a bunch of different things for advocacy.
16:30
I think I probably got involved with this just because I started
16:34
really early with it in medical school.
16:36
So during medical school they have a student representative to
16:40
the board of directors of the Wisconsin Medical Society.
16:43
And so from my medical school, I was elected to that position,
16:46
able to serve on the board of directors for the medical
16:47
society. So I was able to see very early
16:50
on in my career the importance that doctors and our positions
16:54
and so forth play an advocacy for ourselves, for our patients,
16:58
for our communities, how we help shape policies and laws and try
17:04
to make sure that some bills get passed and some bills don't get
17:08
passed and all of those types of things.
17:11
So I was fortunate to have that experience all the way back in
17:13
medical school. And so then Fast forward, I went
17:16
to residency in a different state.
17:18
I practiced in another state, and then eventually I came back
17:20
to Wisconsin. And so when I came back to
17:22
Wisconsin, I again became involved with the medical
17:25
society here and eventually was again elected to the board of
17:29
directors for or my district in the state.
17:32
And so I served on the board of directors for many years again
17:35
and then ran for president and was elected president of the
17:39
medical society in 2021. No, 2022, because I had just
17:44
started the practice. Yeah.
17:45
And Dobbs was 2022. So then it became very apparent
17:51
very quickly. So Wisconsin had an 1849 law on
17:54
the books when the Dobbs decision came down from the
17:56
Supreme Court saying that, hey, abortion.
17:59
And so the 1849 law in Wisconsin basically says that, yeah, any
18:04
provider is providing abortions are subject to felonies and jail
18:09
and all this kind of stuff. And so it became very apparent
18:12
very quickly that so I was started my tenure in April of 22
18:17
and then Dobbs was in June, July of 22.
18:19
And so all of a sudden I had to get really comfortable with
18:24
press releases and interviews and talking points and stuff.
18:28
And the one thing that occurred to me is that you have to get
18:32
really good at being able to talk to so many different people
18:36
with so many different viewpoints.
18:38
And so at one meeting, there was a doctor that stood up and just
18:44
tried to excoriate the medical society for the fact that we
18:47
have policy that say that abortion is healthcare.
18:50
And so his position, even though he was a physician, was that all
18:54
abortion is wrong, people should be punished for getting
18:56
abortions, all this kind of stuff.
18:58
And at that meeting, which I was the president, so I was running
19:02
and I was like, oh, crap, what am I going to do?
19:05
And somehow this brilliant idea occurred to me and I was like,
19:11
OK, so if it's OK to then say that abortions are wrong, that
19:15
our legislators can say that abortions are wrong, that's
19:19
stepping into the healthcare realm, right?
19:20
So legislators who don't have any medical experience are now
19:23
making medical decisions. And I knew from experience this
19:27
provider worked with drug and alcohol abuse.
19:30
And so I was like, so in the future when the legislators come
19:34
in and say, hey, patients who have drug and alcohol abuse
19:38
problems are it's really their own failing.
19:40
So we don't want to provide any of the medications that can help
19:44
and no counseling and no inpatient treatment and stuff
19:46
like that. So we should just do away with
19:47
all that because that's really a personal failing by the
19:49
patients. That's OK then, too, right?
19:52
And so that was like the AHA moment.
19:55
It's like we don't have to agree on all of the policies, but we
20:00
can't agree on is that we don't want legislators telling us how
20:04
to practice medicine. And so you might not agree with
20:08
abortion and that's OK, but you can't have the legislators
20:14
telling us this. You as a your own provider, your
20:18
own physician, you can say that, hey, you don't agree with this
20:21
and you're not going to provide abortion services.
20:23
None of this is saying that we're going to force you to say
20:25
that this is OK or that you have to provide abortion services.
20:29
But we just don't want that legislation in our exam rooms.
20:33
And I think that was the biggest thing was like learning how to
20:36
talk about different, different policies, different bills,
20:39
etcetera, so that you can get that buy in from all the
20:42
different people. And what's been really
20:44
interesting is I've been doing a lot of testifying at to the
20:49
state level here in Wisconsin because we don't have ADPC law
20:52
yet. So I've testified, I think every
20:54
year since 2021, we've been trying to get this bill passed
20:58
that says DPC is not insurance. And what I've learned is that
21:03
when I talk to the Republicans, I'm all about South Wisconsin,
21:08
never expanded Medicaid. So we have a huge population
21:10
that doesn't qualify for Medicaid.
21:12
So I'm like, hey, Republicans, you all don't wanna expand
21:14
Medicaid. So, hey, DPC can help fill that
21:17
gap because we are accessible, we're affordable, etcetera,
21:21
etcetera. For the Democrats, I use the
21:23
opposite tactic in terms of the fact that, hey, yeah, the
21:26
Republicans are never going to expand Medicaid.
21:28
So we need to make sure that we're covering all these
21:30
patients. And hey, look at my clinic,
21:32
because a lot of people think that DPC is only for the healthy
21:35
and the wealthy. And actually, 40% of patients at
21:37
my clinic don't have insurance and 40% are Latino and 20% are
21:44
BIPOC. And 15% are LGBTQ plus.
21:48
So I'm reaching all of these patients that sometimes are
21:51
underserved and have health disparities and stuff.
21:54
So you take the arguments to the different groups in different
21:57
ways to try and advocate for what you need, which is always
22:00
entertaining. Yes, and that is really that is.
22:05
Yeah, exactly. Right.
22:07
And as ADPC Dr. you learn that or you have to learn it.
22:12
If you haven't, you really need to because that's how get people
22:16
to buy in, yeah. Yeah.
22:18
And that's, I mean part of it is, yeah, just the marketing for
22:21
DPC, part of it is advocacy learning.
22:24
Who are you talking to and then how are you going to address
22:26
that so that yeah, you get their buy in.
22:29
And so that works both for advocacy and for marketing.
22:32
Yep. So that I mean, obviously you're
22:33
testifying, you're going to all these meetings.
22:36
How do you work that into your clinic?
22:37
Are you or three days a week or just I don't know, how do you?
22:40
Do that. That's a lie.
22:42
So I've set aside, I've changed a lot over the last few years
22:47
how I did things. So trying to figure out, yeah,
22:50
when my meetings are. So I sit on a couple of other
22:53
committees and stuff as well. So I'm work with the Department
22:56
of Health Services here in Wisconsin and sit on the
22:58
Advisory Council for Immunization Practices.
23:01
And then since residency, I've been involved with Reach Out and
23:04
Read Early Pediatric Literacy program that's based in clinics
23:07
where you give out books, age appropriate language books to
23:10
newborns through five years and talk to parents about the
23:12
importance of reading at home. So in Wisconsin, I'm Co chair
23:15
for that Advisory Council for our Wisconsin affiliate and then
23:18
run the reach out and read program at my clinic, which it's
23:21
small clinic, so it's not that hard to run.
23:23
But and then I also said on our Governor Evers healthcare
23:26
workforce task force to try and figure out how we can better
23:30
improve our healthcare workforce here in Wisconsin.
23:33
So I've done a bunch of different things.
23:35
What I have, what I'm able to do now, especially with DPC, is
23:39
it's actually easier than when I was in the system trying to do
23:42
some of these things, is because I have so much more autonomy
23:45
over my schedule. So I'm able to go in and block
23:48
ahead of time. Hey, I need to be out for the
23:50
council on legislation from 1:00 to 4:00 next Friday and I have
23:55
more notice usually. So I'm able to block these out
23:57
once in advance so I don't have to reschedule patients.
24:00
But that's also the beauty of DPC is that I know my patients
24:02
and they know that I'm involved with a lot of stuff outside the
24:05
clinic. And so they tend to be really
24:07
good about, hey, if I call them, I will work try and work around
24:10
their schedule to fit them in again, if I have to reschedule
24:12
them because of other activities that I'm doing outside of the
24:15
clinic. But for the most part, I get
24:16
enough notice and then I definitely changed my schedule.
24:19
So when I was onboarding patients and filling up my
24:22
panel, initially when you're starting, and that's the kind of
24:25
hard part too, is like you're like, I need patience.
24:28
I need to get them in whenever they can because I need to fill
24:30
up my panel and I need to get more patience.
24:32
I need to make this successful. And then once it was clear that
24:35
this was successful and so forth.
24:37
And then I have a wait list and then I need another doc and all
24:39
this kind of stuff. I was like, OK, there's only so
24:43
many patients that can on board myself and there's only so big I
24:46
want my panel. So once I always feel like it's
24:49
that initial on boarding the patient that takes the most time
24:51
and energy to figure out who they are, what they need, follow
24:55
up, all of that kind of stuff. And then usually once you have
24:58
them tucked in over the first three months or so, it feels
25:01
like it's much easier once you kind of know them.
25:04
So now at this point, cuz I'm four years in, 4 1/2 years in
25:07
and I know my panel, it's much easier to take care of them.
25:11
So I'd now tend to do Monday, Wednesday, Fridays for seeing
25:17
patients in clinic. Tuesdays and Thursdays are a lot
25:20
of meetings and other things from outside the clinic and
25:24
usually that works out pretty well.
25:26
But yeah, sometimes things have to be changed around and stuff
25:29
as well, so. Yeah.
25:32
So Speaking of how to get patients, how did you get your
25:37
patient panel because you have such a wide variety?
25:40
I know it's really weird because I have like, it's wonderful and
25:45
it's like, it's what's interesting to me is like it's
25:47
the most diverse patient panel I have ever had.
25:50
And I've worked in an FQHC, an academic center, rural area, all
25:54
these other areas. And this is like the most
25:56
diverse patient panel I've ever had because I have literally
25:59
CEOs of companies who are thinking of me as their
26:01
concierge doc. I have some very wealthy
26:05
patients who have donated money to the clinic for some of our
26:07
underserved populations to make sure that they get care and
26:10
stuff. But then, yeah, I have a huge
26:12
underserved patient population, BIPOC, LGBTQ, plus patients
26:17
without insurance, undocumented, all kinds of different things.
26:23
And what I think started it, some of it I think was because
26:30
of the networking that I had already had in place a little
26:35
bit because of all of these other things that I do outside
26:37
the clinic. So as I talked to my colleagues
26:40
at the medical society, hey, I'm starting this thing and hey, I'm
26:43
doing this or whatever. I have actually, interestingly a
26:47
large doctor population of patients at my clinic.
26:50
And some of that was because they don't want their records in
26:53
Epic at the local systems because then anybody that they
26:57
work with can see them and so forth.
26:59
So what's interesting is you have these people who are like,
27:01
what EMR system do you use? Is it linked to Epic?
27:04
And I'm like, no. And they're like, great.
27:06
So some of it came from the networking and stuff I had ahead
27:10
of time. And then a lot of it actually
27:12
once I had a few patients, especially from the Latino
27:16
community and they understood that so they could speak Spanish
27:20
here and we would take care of them and they didn't need
27:23
insurance and all of this other stuff.
27:25
Word of mouth was huge. And there's one.
27:29
So one of my first patients in particular was actually a
27:32
grandma from Bolivia. She was visiting here for six
27:36
months and she got here and she's has diabetes and she has
27:39
insulin and her family made the mistake of putting her insulin
27:41
in the freezer. So what do you do if you're from
27:46
Bolivia and you don't have insurance here and you're
27:49
diabetic and you need insulin? Well, normally you're stuck
27:52
going to the urgent care as the best option.
27:56
And then you got to go. And so you have all of the
27:58
expense of the urgent care and then all the expense of a
28:01
pharmacy and the prescription for the insulin and stuff.
28:04
And this girl's, the grandma's granddaughter actually knew my,
28:10
at that time, part time interpreter.
28:12
And so she asked, hey, would my grandma be able to come and
28:16
stuff? And so the granddaughter is
28:18
actually ACPA, she's Latina and has her own business and all
28:22
that kind of stuff. And so she saw how we treated
28:24
the grandmother and the time that we took and the money that
28:27
we saved her and stuff. And she's like, I have
28:29
insurance, but could I be a patient?
28:31
And we're like, Yep. And so then she signed up, and
28:34
then all of her kids signed up, and then her sister signed up,
28:37
and then her family signed up. And then as ACPA, she talks to
28:40
all of these and Latino businesses and she's like, you
28:43
guys don't have health insurance or you need some healthcare or
28:47
whatever. So she's always giving out our
28:49
name. And that has been huge for
28:52
girls. So sometimes it's that 11 little
28:56
patient that leads to, yeah, explosive growth.
29:01
Yeah, yes. So word of mouth and then
29:03
finding a good referral source. So ACPA is really a good
29:07
referral source. I hadn't really thought about
29:09
that, but yeah. Other thing I really did was a
29:11
bunch of Chamber of Commerce. And when I say a bunch, I mean
29:14
we have our local 1, Fitchburg and Madison, but hitting the
29:18
smaller ones. So the Latino Chamber of
29:20
Commerce, the Black Chamber of Commerce, the LGBTQ plus Chamber
29:24
of Commerce, out Chamber of Commerce.
29:25
So those were the ones that I think really were because then
29:29
once you're able to talk to other small businesses, and
29:34
especially these small businesses that don't otherwise
29:37
sometimes offer insurance and they're like, wait, I can sign
29:39
up my employee for this much a month and I can actually either
29:44
pay for all that myself or have my employee pay half and I pay
29:47
half or whatever. So now I have a bunch of Latino
29:50
restaurants and daycares and construction roofing groups and
29:55
stuff like that who've signed up their employees.
29:57
So a lot of times, yeah, being able to go to those number of
30:00
commerce and especially the specialty ones where you're able
30:02
to say, yeah, all of my staff speak Spanish and so forth, that
30:05
could be super helpful. Yeah.
30:07
Did you have a special kind of elevator pitch for those
30:11
businesses in particular besides the?
30:14
Yes, Spanish, yeah. I think the biggest thing for
30:16
especially small businesses is that they can set it up the way
30:19
that they want. So we have some of the small
30:22
businesses where, so all of the small businesses will pay us
30:25
directly for the monthly membership fee, but some of them
30:28
will deduct like half of that monthly membership fee from
30:31
their employees paycheck and some of them will not deduct
30:35
anything and they pay the full amount.
30:36
We have one business that actually pays for everything
30:40
done at the clinic for their employees.
30:42
So the labs, the meds, the membership fee, which is really
30:45
quite nice. But the biggest thing was we're
30:47
happy to work with you in terms of how do you wanna set this up?
30:50
Do you wanna pay for your employees monthly membership
30:53
fee? Do you wanna pay for part of it?
30:54
Do you wanna pay for any of the labs and meds, etcetera.
30:58
And then making sure that, you know, we can send them an
31:01
invoice every month so they can look at it and see who's on
31:04
there. And then they have to let us
31:06
know as people come and go, and we make that pretty easy for
31:08
them. Yeah, Yeah, that's great.
31:11
We don't have a lot. I mean honestly we really now we
31:14
don't have any employers and we just really hadn't pursued that
31:16
too much. So that's very helpful of how
31:19
to. And I'm, I'm really surprised
31:22
like the ones that you don't think of, but definitely like I
31:25
said in Wisconsin fall into those cracks.
31:27
A lot of these service industries, daycares because
31:30
they don't get paid a lot. And yeah, a lot of times they're
31:33
just small daycare, so they're not offering health benefits or
31:36
anything. So the other thing that
31:38
employers like is that this is like a recruitment and retention
31:42
tool is that they're able to say, hey, we're covering your
31:44
primary care needs, so you do have some kind of health
31:47
coverage. So that can be a recruitment and
31:49
retention option for them to use for their employees.
31:53
Absolutely, yeah. So again, I'm backing up to
31:57
something you said earlier about when you were starting your
32:00
practice and you were telling your colleagues at the medical
32:03
society that you were starting ADPC.
32:05
What was the reception like? I'm just curious.
32:07
What? That I was insane.
32:14
You're doing what? Really.
32:16
Everyone. Or was anyone?
32:17
No, I mean, there was, there was both, there was both, right.
32:20
They're like, you're doing what? And to this day, I, when I'm at
32:24
other meetings and stuff like that, I still get the that they
32:28
don't truly understand what I'm doing sometimes.
32:30
So like I've brought people out here because I'm also on a
32:34
primary care investment committee for Wisconsin.
32:37
And so the head of that is the chair for the Department of
32:43
Family Medicine at the residency program.
32:46
And he's just like, this doesn't make sense.
32:49
And so I had to actually like bring him out to the clinic and
32:51
sit him down and show him how this works and stuff because
32:54
he's like, it just doesn't make sense.
32:56
You can't just charge a monthly fee.
32:58
And that covers everybody that's capitated care.
33:00
And I'm like, what kind of, But it's different.
33:05
And so, yeah, so I think there's still a lot of people out there
33:09
who are like, this doesn't make any sense.
33:11
But yeah, the more that I've been able to and the more that
33:14
people see me succeeding at this and being able to serve very
33:18
different populations and grow my staff.
33:20
And now I need a new building cuz we're outgrowing this one
33:23
and all that kind of stuff. Yeah.
33:26
It's amazing. It's just, you're so inspiring,
33:30
for real. Just just very inspiring.
33:32
And I really feel like you probably have some Harry Potter.
33:34
Magic. So it's like that little like
33:38
thing that Hermione wears that were chicken back time or
33:41
something. Yes, I would love that.
33:44
That would be amazing. That one, yes, well you, yes,
33:52
truly inspiring. And so if somebody who is either
33:55
in DPC already or if they're thinking about getting out of
33:58
deep or out of fee for service into DPC and wants to do
34:01
advocacy, what advice? Would you?
34:04
Yeah, do it. I would say it's simple.
34:07
Just get involved, especially locally is sometimes the easiest
34:12
kind of inroads to look for, like your County Medical society
34:16
or your state medical society, or if you want to go big and so
34:20
forth. Look at the AFP, the AMA, any of
34:23
these places. The biggest thing I also tell
34:26
people is that a lot of times you hear disparaging remarks
34:29
about the medical society, the AMA, the AFP, oh, I don't like
34:33
this policy, blah blah. And I'm like, yeah, I don't like
34:36
all of the policies that the AAFP supports or the AMA
34:38
supports and stuff either, especially the DPC doc.
34:41
I could care less about non competes or whatever it is at
34:44
this point in time. However, having that platform to
34:49
be able to then help to form policy and to have that input is
34:53
huge. So being a part of these
34:55
organizations can have a lot of benefits and can get you that
34:59
platform. So again, like I said, in my
35:02
state, we still haven't gotten it passed, unfortunately.
35:05
But I now know so many of the players and I've had many of the
35:08
legislators come out to my clinic so I can show them, hey,
35:11
this is what DPC is. And now I have the legislators
35:15
calling me up for other things and stuff too because they know
35:18
me now as well. And they're like, hey, there's
35:20
this bill that has to do with this related to health.
35:23
Can you tell me what your thoughts on it?
35:25
And so again, being able to then have the ear of these
35:28
legislators and talk about things that aren't necessarily
35:31
just DPC or whatever, but can't be related to health.
35:34
The one yesterday that I got called for an interview was
35:38
related to SNAP benefits, so food stamps and stuff, because
35:41
of the government shutdown at the federal level.
35:44
What as a physician, how does, what do I feel about this?
35:48
Because we had, again, our medical society signed on to a
35:50
letter to help our legislators understand that they need to
35:53
expand funding here in Wisconsin so that people can continue to
35:57
access food stamps and SNAP benefits while the federal
35:59
government is shut down. And so as that physician leader
36:03
liaison, though, I can go in and say, you know what?
36:05
Yeah, food is important. People.
36:07
If you don't have healthy food and access to food, you're going
36:10
to end up with more problems with your chronic diseases,
36:13
acute diseases. You're going to end up with more
36:14
ER hospitalizations, more mental health issues, all of these
36:18
types of things. And so food is important so that
36:20
the healthcare system doesn't become overburdened and
36:23
healthcare costs don't rise and all of that kind of stuff.
36:25
So. Yeah, that's amazing.
36:29
Yes, great advice and I wanna be mindful of your time.
36:33
So please tell us if anyone wants to get in touch with you
36:36
or find out more about your. Practices absolutely.
36:38
So website family DPC as in directprimarycare.com, My
36:44
personal e-mail, prettyeasydoctormolaskawhichisdrmolska@familydpc.com.
36:52
And then I'm on LinkedIn. We have a Facebook page.
36:57
One of my staff finally made me get on Insta.
36:59
So there's a couple of different options there, but yeah, feel
37:03
free to reach out. Feel free to, yeah, shoot me an
37:06
e-mail. There's a form on the website as
37:08
well if you go there that will get in touch with us.
37:10
Wonderful. Well, thank you so much for your
37:13
time. I'm so glad to chat with you and
37:15
hear more about what you're doing outside of your practice,
37:17
which is fascinating, and I hope other people will get involved
37:21
after they hear what you're talking about.
37:23
So thank you so much and we have to do this again and hopefully
37:27
I'll see you in. That would be amazing next year.
37:30
Thanks again to Doctor Molaska for coming on the podcast with
37:33
me. I hope that after listening to
37:35
the episode, you can see how life expanding DPC is when you
37:40
have the opportunity to not only practice medicine the way that
37:44
you want to practice, but then having the time to be involved
37:48
in the community, which is what family medicine doctors do.
37:52
They support their communities. So I hope that you're able to
37:56
see that it is possible to practice medicine and also be
38:01
involved with what's going on around you, especially during
38:05
these times. So if you are a woman physician
38:08
who's interested in opening ADPC practice or you've just recently
38:12
opened, in February, I'm hosting an event called DPC Women
38:17
Connect where we will have other women founders talking about
38:21
their experiences and offering their mentorship to a small
38:26
group of women physicians. This is happening in February at
38:31
my office in Hickory, NC. If you want more details, please
38:35
DM me Connect on Instagram and I'll send the details over.
38:40
Thanks again for listening and I'll see you again on the next
38:42
episode. Thank you for listening to DPC
38:46
Life. If today's conversation inspired
38:49
you, hit follow, Leave a review and share it with a friend who's
38:54
ready for change. Remember, wherever you are in
38:57
the journey, your DPC family has your back.
39:02
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39:06
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