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

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

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