Latest / DPC Life: Direct Primary Care Podcast / DPC Series Episode 1: Hospitalist to DPC with Dr. Brian Bost

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DPC Series Episode 1: Hospitalist to DPC with Dr. Brian Bost · DPC Life: Direct Primary Care Podcast

0:00
Welcome back to DPC Live, the show where we talk about all
0:03
things DPC both within the office and beyond.
0:06
And today we are starting a new series.
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This is called the Hospitalist to DPC series, and I will be
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having a conversations with Med PEDs hospitalist Doctor Brian
0:20
Bost, who is starting his DPC practice.
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So we're starting out talking about how he found DPC and how
0:28
he's going to grow his DPC slowly and intentionally.
0:33
We'll be touching base every six weeks or so to catch up, see how
0:37
he's doing with his goals and what kind of progress he's
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making. And we're doing this is because
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there are a lot of hospital doctors who are interested in
0:48
DPC, especially because they are are getting burned out within
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the hospital system and looking for a way to stay in medicine.
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They don't want to quit completely.
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They still want to see patients and still be a doctor.
1:02
So they're looking at DPC as an alternative to hospital
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medicine. Let's get into our first episode
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with Doctor Brian Bost. There's a lot of prominent
1:14
people who say you must be all in.
1:15
If you're not all in, you're not going to succeed.
1:18
I love hospital medicine, but at some point, how do I start to
1:21
address these gaps when one of my members or my patients need
1:25
something great? Text me.
1:27
I can solve an issue in minutes, and you're not lost in the
1:30
system. The money that is being paid
1:33
keeps me to my own standard, and my goal is to have a patient
1:36
panel who has medical complexity.
1:38
There's a lot of discussion of you're either all in or you're
1:41
all out. Welcome to to DPC life, the
1:44
podcast where independent doctors share real stories, bold
1:47
ideas, and the freedom of doing medicine on your own terms.
1:52
I'm your host, Doctor Ann Gonzalez, and together we'll
1:56
explore the wins, the struggles and everything in between.
2:01
Let's dive in. So today my guest is Doctor
2:04
Brian Bost. He is also a we have multiple
2:08
episodes now hospitalist turn DPC doctor and his practice is
2:14
B2 direct care. He's in Denver, Co and he
2:18
started in February of 2026 with telemedicine.
2:23
So congratulations and welcome. Thank you.
2:26
Thank you. Yeah, It's great to be on the
2:27
show. I've listened to many of your
2:28
podcasts and that's probably why we're having a conversation
2:31
today. That's very nice of you.
2:32
Yes, thank you. I appreciate it.
2:36
That's great. I hope it's helpful.
2:38
All right, Yeah. So starting out as a
2:41
hospitalist, going back to outpatient care, how's it going?
2:46
Yeah, I think it's been a bit of a leap of faith.
2:49
I think the term that comes to mind often is imposter syndrome.
2:53
And I think that after 16 years of all office based medicine, I
2:57
sometimes joke if you have a headache, it's either a brain
3:00
tumor or a stroke and not a migraine.
3:03
So it's been kind of getting comfortable with that skill set.
3:05
I've also been very cautious to have a slow rollout and we'll
3:09
talk more to really just rebuild some confidence in that space.
3:13
But it was kind of a big leap. I actually, when I was
3:17
evaluating this space, I spoke to a former hospitalist
3:19
colleague who'd made the transition outpatient medicine,
3:22
Ben Mendoza, and he gave me words of advice, which was we
3:26
still know more than we think we know.
3:28
Yeah. Well, let me back up a little
3:30
bit. So you just started though your
3:32
DPC, it's only been a couple of months.
3:34
So what? What made you decide to open
3:38
ADPC so different? Yeah, so that's a great story.
3:41
So I think after 15 years of being a hospitalist, I think the
3:45
job is becoming more challenging.
3:47
And the satisfaction from that in the way we see medicine, you
3:50
know, portrayed was changing a lot.
3:51
And I started to just see a lot of cumulative experiences among
3:55
friend and family of just things that were no longer being
3:59
managed appropriately in the outpatient realm.
4:02
Because as we know, fee for service and insurance based care
4:05
doesn't allow adequate provision.
4:07
And I sometimes would find myself with three or four
4:10
friends or family members or friends or friends to call every
4:12
day and help them navigate their, their Karen.
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That really came to a head last year when I was family member
4:18
who had been misdiagnosed and was helping direct family
4:21
members through this. And I just, I, I really started
4:25
to struggle with I love hospital medicine, but at some point how
4:29
do I start to address these gaps?
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And that's actually kind of how I straight into the DPC world.
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And I've, of course, not being an outpatient doc, had no
4:40
understanding of the evolution that had occurred over the last
4:43
decade or so in the DPC realm. And at the time, I was also
4:47
working in a critical access hospital where I had plenty of
4:50
time to speak with patients, which was unheard of in previous
4:53
hospitalist experience. And I thought that was one of
4:55
the best things I could have an hour with an entire family in a
4:59
critical access hospital. And I thought, that's what I
5:01
love about medicine is that length of time and just really
5:05
knowing. And I thought, wow, this seems
5:07
really unusual to be considering this change.
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And that's how I like jumped into the pool.
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How did you hear about DP? CI think it's so funny I think I
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was kind of stumbling through you know we're looking really
5:20
concerned about the hospital home transition and kind of
5:23
second medical opinions and I think I was honestly either
5:27
between LinkedIn or or looking at some of the Facebook forums.
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I just kind of started seeing this DPC and honestly, I think
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that it was just a sense that I, I didn't see myself ever
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entering a primary care space that I think I hit my radar a
5:42
couple times. I'm like, that's not what I'm
5:43
looking for. And then it was literally I
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think what I started to notice is especially amongst the
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community, I've never seen so many physicians just flat out
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say, hey, welcome. This is who I know.
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This is what I do. I think one of my favorite
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stories that I talked about it that in Summit earlier was Ben
6:01
Mendoza, my former colleague. We were chatting about Ehrs and
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he said, hey, here's Brad Brown's number.
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Call him. I chatted with Brad.
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Brad was like, yeah, you this sounds great.
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And hey, check out this EHR as well.
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And I'm saying I was like, whoa, wait a minute, this is this is
6:17
the era. I was like, this is not normal.
6:18
You don't. And I think every iteration,
6:21
hey, who do I look to for legal support?
6:24
So there never is enough motivation to hit my radar of
6:27
like, wow, this is a group of physicians who seemed excited
6:30
about healthcare. And I was realizing that the
6:33
excitement for healthcare wasn't really becoming, wasn't really a
6:36
part of my day-to-day job anymore.
6:38
And so that led me on the path. Yeah.
6:40
So how long did it take you to decide to make the leap?
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I think it was the pretty slow evolution.
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I'm still dabbling in hospitalists, but that's been a
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changing target. So I think there's been a lot of
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messages that have been difficult for me to kind of work
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through. And the story 1 is there's a lot
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of discussion of you're either all in or you're all out.
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And I think that is often times difficult for me as a
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hospitalist to understand because as a primary care doc,
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if you're leaving an insurance based practice and starting your
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own, yeah, there are these rough transitions.
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And I thought, well, I'm not a position where I can just give
7:15
up my hospital salary and like go all in and all out.
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And so I actually started very slowly and intentionally.
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I, while still being a hospitalist, I'm went through
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the LLC process. I set up my business model, I
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build my original Squarespace web page myself and I did the
7:33
soft launch. And I think that was one of the
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interesting things, I think from deciding to move forward, I
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decided I would do a soft launch in the spring and then look
7:43
towards the end of the year to do a full transition.
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And that's kind of where I am right now.
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And so I spent six months because there was no like urgent
7:51
issue and I enjoyed learning about what a BAA is and what a
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what all the privacy practices that you need and how
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telemedicine works and home visits.
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So, so that's kind of where I am now about six months in from the
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whole start and a couple months past version one soft launch,
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so. How do you feel?
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It's great. I get little pings of being
8:13
terrified of I sent somebody to go get labs, but I hit the wrong
8:17
button and then they called me in a panic of labs.
8:21
We're going to cost very exorbitant amount.
8:23
And you assemble through these learning curves and but it's,
8:26
it's been really fun. I think for me, the biggest
8:28
enjoyment has really been knowing that when one of my
8:35
members or my patients need something great, text me, I can
8:38
solve an issue in minutes and you're not lost in the system.
8:42
So there's more drawing pains coming up, especially with, as I
8:45
move to a brick and mortar hopefully in the next couple
8:48
months, the telemedicine. And I've had a very controlled
8:53
panel in that it's only word of mouth, it's only referrals,
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largely so that I could stumble through all these challenges 1
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by 1 and not with 10 new members at once.
9:04
Well, that makes a lot of sense. After you decided that you were
9:09
going to make the leap, what did your colleagues say?
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Or did you tell them? You know, I think I did partly
9:15
because I trust my colleagues opinions.
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I have a lot of Hospice friends from residency and I think he
9:24
told me to reinforce why I was interested in this and again to
9:29
work through my own imposter syndrome.
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And and I think what I've actually seen is that there's a
9:34
large Hospice comfort for now. I'm interested as well.
9:40
And I think part of that is that hospital medicine continues to
9:43
become very challenging is a long career.
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And at some point, what can you continue to do that's enjoyable
9:51
in medicine if you can't leave medicine?
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So I think I initially when I told people, I kind of expected
9:57
a lot of you're crazy and why would you do that and really was
10:02
a lot of intrigue. That's a very telling signal,
10:05
isn't it? Yeah.
10:06
So yeah, for sure, absolutely. And I think it's kind of funny.
10:09
I think I went through every podcast of yours and Mirial
10:14
Conception, like listening to like, where's the hospital list?
10:17
Tell me that there's somebody else that has done this.
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I went through Facebook groups, I found all the hospital list.
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We sent a message like any regrets?
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And again, I think knowing those who have gone through the
10:27
process, I thought, all right, this still feels right.
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So as you start your telemedicine, how are you going
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to balance that? How are you going to balance
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your patients with hospitalist work?
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Yeah. So this is the newest evolution.
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And this I think was a whole lot of concepts that became
10:44
solidified actually a couple weeks ago.
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I'd really kind of struggled with how is that balance and how
10:50
do you maintain that access? And my biggest fear would be if
10:53
I was on a rounding stretch and all of a sudden there was
10:56
someone who really needed my attention, my practice, and
10:59
especially not having a practice partner, the possible that I
11:01
would have a relationship with another DPC or for some that
11:06
coverage. And honestly, what I've decided
11:07
to do is just go back to kind of adverse shifts, which are night
11:10
shifts because it allows me to have that availability and to
11:14
not have to do 3 or 7 shifts in a row and let me keep those
11:18
skills. And I think the biggest thing I
11:21
think I really kind of struggle with, and I just made a blog
11:23
post about this was I want to see those translatable skills
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and possibles or where you see that your needs identified.
11:31
And I think really for me, I've really been fascinated by this
11:35
micro practice culture. And well, I think I was like,
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I'm operating in a nano culture, a nano practice.
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I was like, wow, this is it, right?
11:44
Like what is the niche? I was fascinated by reading
11:47
about the Hospice practices that are up there.
11:50
And I love seeing all of the especially kind of menopausal
11:55
women's care that has become very micro practice.
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And I thought, well, why can't a hospitalist have a micro
12:00
practice if you're not ready to leave hospital medicine and you
12:03
can reduce your FTE and take on this exciting practice.
12:07
We're a natural way to help patients in the system.
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And so that was kind of the cool thing.
12:13
I was planning to try to leave hospital medicine by the end of
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the year and have the DPCB kind of full time.
12:19
But I love both. And at the end of the day, I
12:21
want patients to get good care. And so I think this micro
12:26
practice model balanced with hospital medicine adverse shifts
12:30
is kind of where I'm headed. Yeah.
12:32
You still get to have have your cake eat it too.
12:37
Yeah, yeah. And again, I think I really
12:40
struggled with that message of there's a lot of prominent
12:42
people who say you must be all in.
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If you're not all in, you're not going to succeed.
12:46
And I thought, well, all in, what does that mean?
12:50
Like I have to do this 40 hours a week.
12:53
I have to have an office 5 days. And then I thought, well, gosh,
12:57
all these great micro practices are showing that you're doing
13:00
this because you're loving medicine, taking great care of
13:04
patients, but not also neglecting your own happiness.
13:07
And I thought, that's kind of where I want to settle up.
13:10
So the best part lies is I started with this and I have a
13:14
telemedicine going and it's phenomenal with some home visits
13:17
and now all of a sudden I'll start looking for brick and
13:20
mortar in the next couple months.
13:22
It is you start driving around town and you just like keep
13:25
looking at in windows and looking at empty buildings and
13:29
it's like, oh. Right, right.
13:32
Trying to find a. Good place to be.
13:34
So doing, you know, both hospitalist and outpatient, it's
13:38
kind of it's the reverse of a lot of DPC doctors right where
13:42
they pulled out of hospital and so you're kind of going the
13:46
other way. Right, right.
13:49
Yeah. There is a he's AI wouldn't say
13:52
he's a well, I guess he was a runner.
13:54
Jeff Galloway, he Are you familiar?
13:58
No, I know. Seems like it should be been a.
14:00
Runner and he has this kind of, I guess they call it the
14:05
Galloway method. And it's really basically like
14:07
run, walk. So if you want to do a half
14:09
marathon or a marathon, then you run, you start out running like
14:14
one minute and walk one minute and then run 2 minutes and walk
14:17
one minute. So it's kind of just kind of in
14:20
my head, I thought, oh, you know, kind of do in the
14:22
hospital, like you're running for two days and then you kind
14:26
of rest a little bit on your outpatient.
14:30
Right. Absolutely.
14:31
And so I think that natural progression may be that in
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whatever duration of time the hospital medicine then becomes
14:40
enough that I don't maintain that skill set and I'm ready to
14:43
really just go from a micro practice to having that beat the
14:46
full time. And I, and again, I think
14:49
sometimes the best things for longevity of medicine are having
14:52
different hats and different skills.
14:53
And that's the space that I'm going to operate in that I see
14:55
myself for a while. Yeah.
14:57
So yeah, run walks right now it's 5 minutes, 5 minutes of 55.
15:01
You know, it's an even an even balance.
15:03
It's good. Yeah, that's good.
15:05
Now your telemedicine practice. How did you, how did you settle
15:11
on a price? It's so funny.
15:13
I don't really know how I so it's 75 a month.
15:17
I think I settled on that. It's just a middle ground
15:20
between I'm not lowballing my value.
15:24
Also knowing then I would start as an entry point and just see
15:28
kind of how that price worked. What I've decided is, is that
15:33
the numbers I'm working with right now when I move to brick
15:36
and mortar will be 140 per person, 220 for a couple and 300
15:40
for family, which is about market appropriate for where I
15:43
am in Denver, as well as I want to let people use the HSA
15:47
benefit. And then what I decided is 75
15:50
will kind of remain for a rural telemedicine.
15:53
And I think it's like all the conversations of price, right?
15:56
It's a little bit of throwing the cars in the air.
15:59
It's kind of like looking at what everyone else is doing.
16:01
And I want to be accessible. And I think what I really
16:06
learned so much is to not undermine my own value, which is
16:12
discussed. And if this is the first podcast
16:14
you've listened, please listen to many because that has been a
16:18
really challenging concept is to not undermine my own value.
16:20
And it's so funny. Even this morning when I was out
16:23
walking my dog and listening to Nani, I thought, gosh, should I
16:26
drop it by $10 when I launch brick and mortar?
16:29
I thought, like, no, this is what.
16:32
Yeah, right. But it's that's it.
16:34
It's like, why, why? You know why?
16:36
Would you drop it? Why so right?
16:39
It's so funny. But that's, and I think there's
16:41
a room full of all of you who've been well established.
16:45
It's like the internal pain or process that you must go through
16:49
when you start. And, and I mean, there's
16:51
literally one day where I think I spent all day going back and
16:55
forth about $5, like what looks better if you pulled the
16:58
website? And I just thought, no, the work
17:01
I do and the value I bring has a price.
17:04
And again, I think I want to make sure that I'm held to my
17:10
own standard and the money that is being paid keeps me to my own
17:15
standard. And I don't want to.
17:17
My goal is not to have 500 patient panel.
17:20
My goal is to have a patient panel who has medical complexity
17:24
that I'm there to help. And that's worth 140.
17:27
The telemedicine 75 will be an interesting game card.
17:31
But I think that's part of what I feel is an obligation to,
17:35
especially in our rural communities where there's.
17:37
No health. So for hospitalists who are
17:40
considering DPC right now, you're talking about still
17:45
working in the hospital and then having your telemedicine
17:48
practice. So this means that you are not
17:50
opting out of Medicare, is that correct?
17:53
Correct, correct. Yeah, I feel like not opting out
17:57
of Medicare comma now. I do think as they get further
18:01
along in this process, there will come that point where I
18:05
want that patient population. I think, I don't think it's that
18:08
far away again. I'm starting my almost starting
18:10
my 16th year as a hospitalist. So I do think that we're also
18:17
really challenged in Colorado. Unfortunately, the bill to allow
18:20
Medicaid members to have ADPC did not get through the
18:24
legislative session this year and that's a big struggle.
18:27
So I think part of it is learning to think as ACEO or as
18:31
a business person. The decision I need to make
18:34
right now for where I see my balance of skills and enjoyment
18:39
is not opting out of Medicare. But I easily see that changing
18:44
in the next kind of three to five years, yeah.
18:46
And if you decide eventually that you don't want to do
18:50
hospital anymore, then that probably makes it easier that
18:53
decision. Yeah, totally, totally.
18:57
So yeah, I've lovely neighborhood in Denver and two
19:01
of my neighbors have been hounding me and when we've had
19:04
these Medicare discussions, they're very strong in their
19:09
opinions of me not opting out of Medicare.
19:11
So yeah, it's a, it's a struggle, but I don't think I'm
19:14
not far off from being ready to opt out of Medicare in the
19:17
future. Yeah, definitely.
19:18
I mean, if you're continuing to work in the hospital, it just
19:20
doesn't make sense to do that. However, there are people who do
19:25
and they still see patients, their own patients in the
19:28
hospital. Right, right about them, how
19:30
they do it. I have, I've heard of a couple
19:35
things. I think the logistics and
19:37
especially as a hospitalist and in the bigger cities, I would
19:40
feel it would be challenging for me to separate that role.
19:43
So I think when the time is right, I'll opt out of Medicare
19:46
and happily then be ready to hang up on the hospitalist come.
19:50
Yeah. So people who are still seeing
19:52
patients both outpatient and then they follow their patients
19:55
in the hospital, what they've been doing, the ones that do,
19:58
they just charge their patients like a flat fee per day.
20:02
Wow. So OK, interesting.
20:04
Yeah. I can't remember who it was, but
20:07
it was like 10 or 20 bucks a day.
20:09
You know? It's not.
20:11
Yeah, yeah, it's a. Pretty amazing deal for the
20:13
patient. Yeah, it is for sure, for sure.
20:17
When I think it's funny, I was working in a really wealthy
20:21
exclusive community in Colorado as a hospitalist where a lot of
20:25
our patients not only just had a private pilot, but they had kind
20:29
of a true close year style doctor.
20:31
And I went this all also started to come together wise.
20:35
I would be the hospitalist, I would be talking to their Doctor
20:40
Who knew everything about their care, like including had already
20:44
reviewed an epic, the labs that I had ordered.
20:46
And I just thought like, wow, this is incredible that I'm
20:50
speaking to this person's physician in Florida or you
20:56
know, LA and I've got this a very secure person to transfer
21:00
the care back to. I grew up in the Kaiser system
21:03
in Denver. And what I loved is when I
21:05
discharged the patient, everything was safe.
21:07
So inherently, like I love the idea of continuing to socially
21:12
round on a patient in the hospital to support them and be
21:15
A and help out the hospitalist understand in a disastrous EHR
21:20
in the hospital that yes, and that skin lipoma and the 30
21:24
iterations of it on the EHR are obscuring the fact that this
21:28
patient actually had a Melanoma, which is the bigger issue.
21:30
And so I very much see part of my role is to be the continuity
21:36
of care in and out. And that's actually one of the
21:38
service lines that I'm most interested in is basically
21:41
having a hospital to home program where you get that high
21:47
level care to navigate that transition.
21:50
Like I have a family member and who is hospitalized at last.
21:54
And I just remember looking at the 8 pages of discharge
21:58
instructions were like fill out this survey and but nothing was
22:03
like, how do you take these medicines and what do you do?
22:07
And so anyway, so I would love the long winded explanation, the
22:12
idea of inpatient, outpatient, kind of traditional, but
22:15
probably just more as a social rule to make sure that care is
22:19
appropriate. Yeah.
22:21
Had you thought more about that niche of the hospital to
22:25
outpatient, what were you thinking?
22:27
What would you do? Yeah.
22:29
So it's so funny. I actually just had a discussion
22:32
today with one of the healthcare attorneys that operates in the
22:34
space because I really envision a hospital to home program.
22:38
And so if you're already establishing the DPC, like
22:42
that's part of your regular care, but if you're not, and so
22:47
I've kind of socialized this concept amongst friends,
22:51
regardless of what happens if something changes drastically in
22:54
your health, you're getting ready to leave the hospital.
22:57
Those transitions of care are such high risk.
22:59
And so especially for boy, you've never been to the doctor,
23:03
but you just left the hospital with a STEMI and now you're on
23:07
all these medications and you're so confused.
23:10
And So what I'm actually looking at developing is a true hospital
23:13
home program where you don't have to be ADPC member, but to
23:17
bridge the gap from hospital discharge to like a 30 day
23:21
program, a 60 day program with really good understanding for
23:24
both the hospital team and the primary care that listen, this
23:28
isn't this is to help the patient, to help make sure gaps
23:32
don't occur. I know there's a lot of
23:33
resistance on the hospitalist whenever somebody external
23:36
becomes involved. But as a hospitalist, I love the
23:39
fact that if there's somebody else to help make sure the
23:42
patient actually gets their meds filled, if the patient leaves
23:45
the hospital or has a stent and they don't get the Plavix,
23:49
everyone fails, right? So I'm actually in the process
23:51
of developing the hospital to home program and finalizing,
23:55
yeah, some of the details and working through some of the
23:57
logistics of what that looks like with my malpractice
24:00
coverage and insurance. But that's, and then the goal is
24:03
never to drive somebody out of their primary care ecosystem.
24:07
And so my, the anticipation is that, hey, there's here's kind
24:11
of the outreach introduction to the primary care provider and
24:14
also the hospitals team about how I'm here to facilitate and
24:19
then warm hand off at the end or ultimately this could be an
24:22
access point into the DPC. But that's that's one of the
24:25
things I'm most excited to kind of experiment with because I
24:29
think that's a really important skill set that we have as
24:32
hospitalists. As a geriatrician, that sounds
24:34
fascinating to me. Right, right.
24:39
Yeah, and it could be really, really beneficial for people who
24:42
don't have insurance, for example.
24:46
Exactly. And I think you do this long
24:48
enough, you see enough iterations where systems have
24:51
tried to do the home visit. You can Bill for the complex
24:55
discharge, follow up all the stuff.
24:57
But at the end of the day, like, boy, when you've got really bad
25:00
nausea and you don't know whether you should be using the
25:02
Ndansotron or the medicopramide or like, and how to do these
25:06
when you get home, it's really, really terrifying for people who
25:10
are not medical. And again, what I've loved is
25:12
when I did this kind of voice of fellow members.
25:14
Yeah, I went to the house, took all the toes out, wrote down the
25:18
colors and what they're used for and on the structure and, and
25:22
great. You're, you're going to feel
25:23
comfortable calling me as your first call.
25:26
I know exactly when you need to talk to a specialist.
25:29
So let's just make these really challenging transitions
25:32
accessible. Another friend of mine reached
25:35
out and she knew I was starting to operate in this space and she
25:38
was like, holy cow. A friend of hers was 45 had just
25:41
had a stroke and was yeah discharge to basically navigate
25:48
their own urology and PCP follow up and I was like what is going
25:53
on? And so I just can't imagine that
25:58
terrified patient or family member of what do we do in going
26:03
back to the ER is the worst thing for any little concerned
26:06
call somebody who knows your care.
26:07
So that's that's actually the big passion project.
26:10
I think that I got a little bit derailed on and so I was trying
26:13
to understand kind of the DPC space.
26:15
And again, that was to be like the big micro practice.
26:18
Aha moment of boy, I'm really passionate about your failing in
26:22
the system or you're leaving the hospital and you're terrified.
26:28
And so great, let's navigate this space and see what I can
26:31
do. Once you start thinking about
26:34
DPC or just think thinking more as the CEO or business person,
26:40
you start seeing things that like, oh, I could do this or I
26:45
could do this. It's it's really.
26:47
You know. DPC makes your life bigger.
26:50
It's life expanding because it's mind expanding, truly.
26:55
Right. Yes, right.
26:56
Well, that's so funny. And my other passion is cooking.
26:58
And so I've been experimenting with trying to do some DPC
27:02
outreach to some of my friends from the culinary industry here
27:05
of like, hey, I worked in an Italian restaurant in high
27:08
school. Like, well, you're in split
27:10
shift and you're, you've got a couple hours to get care.
27:13
And so it's so funny is that that's, it's all these ideas
27:17
spin off and at some point you're like, wow, need to
27:19
sequentially go through one or two before trying to tackle them
27:22
all. So yeah, but I was talking to,
27:24
yeah, my chef friend of mine, I said, we got to do this.
27:27
Like, you need better healthcare.
27:29
And he's like, how do we make this happen?
27:31
I'm like, boy, I've got like 3 things I really need to get
27:33
going right now. I'm not really sure where this
27:35
one prioritizes, you know, so, but yeah, that's, and I think
27:39
again, mix the DPC is it's the liberty to do what you're
27:43
passionate about without the restriction of getting
27:47
administrative approval, of trying to look like you're
27:51
thinking outside of the box so far that you're crazy.
27:53
And yeah, great. As long as you're meeting your
27:55
malpractice requirements and have the right patient
27:57
agreements, I love to just see what the space is doing for
28:02
meeting your own internal needs as a physician, but also the
28:05
needs that you're seeing amongst friends and community.
28:10
Yeah, yeah. And just recently, I think Amy
28:12
Walsh had written this article about women leaving medicine.
28:16
And you know how DPC can be the answer for a lot of them because
28:20
for a lot it's just either they do DPC or they quit.
28:25
And I know for Amy, that was kind of the situation for her
28:28
and several other doctors that I know, so.
28:32
Yeah. And I thought that was huge.
28:34
And I think I sent it to so many of my not just physician, but
28:37
especially female physician friends.
28:39
I was like, it's sometimes it's fresh in hospital, my son.
28:42
It's a silent struggle. I'm like, are we as happy as we
28:45
used to be? And that would give me good
28:48
ammunition for some other friends and colleagues I'm
28:50
trying to drag into this space. Yeah.
28:52
Yeah, it's true. And I think that I think Doug
28:55
Varego and his book, he's just talked about how people are just
28:58
so beat down and you just don't even realize like.
29:00
That it. Is until you start thinking
29:03
about it differently and we kind of briefly talked about
29:07
hospitalists having kind of a shelf life for hospitalist work
29:10
and ER doctors that. Totally.
29:14
It's great that you're really trying to encourage hospitalist
29:18
and naughty as well, but because it's true, I mean, you cannot do
29:22
hospitalist work well, well, right for years on end, right?
29:29
Yeah, Yeah, I think I was in the generation where hospitals was
29:34
just making that jump from, hey, you have a gap year of fellows
29:37
until fellowship too. Awesome.
29:39
We've all been there watching Society of Hospital Medicine and
29:43
just the legitimacy of our career has been fantastic.
29:46
But yes, I think there's a self life and part of that is the
29:50
changing way Healthcare is delivered in the hospital.
29:54
But also, boy, I haven't reached that age where 7 shifts are in
30:00
the hospital. I'm like, wow.
30:02
And it is having these ways to kind of offload as well.
30:04
And tangentially, as we chat a little bit about it and as
30:08
you're apart a couple months ago, just to throw out a space
30:11
for people, I threw out a hospital to DPC Facebook page,
30:17
no agenda. I I think, I think there's a
30:20
soft, there's a need to cultivate a safe space at 190
30:25
people on the page as of today. And it's not even a month old.
30:28
Yeah. So, yeah.
30:30
So I think, you know, what you're saying is this space
30:32
speaks to emergency physicians and speaks to hospitalists.
30:36
And what about the direct specialty care of the surgeons
30:39
who are entering the, you know, the ENT, the allergies, the
30:42
rheumatologist? I mean, it's just, again, it's
30:45
amazing when you see what is going on.
30:47
And I always give a disclaimer that I'm fully gracious to
30:52
everyone who's been doing this hard work for the last 10 to 15
30:56
years, cuz I'm coming on the coattails of people who have
30:58
laid a lot of strong foundational work for people
31:01
like me to, to step in now and help to spread that word.
31:04
So, but it's always kudos to everyone like yourself and you
31:08
know, just the whole, the whole crowd who've been working hard
31:12
to, to make this legitimate. I am. 2nd Gen.
31:17
So I'm with you. There were plenty ahead of me
31:19
who definitely made it work. Yeah.
31:22
Let me see if there's anything else on my list here that I
31:25
wanted to ask you today, because what we're planning to do is
31:28
kind of make this a series where we're going to come back every
31:31
six weeks or so and talk about kind of where you are, what kind
31:34
of. Thing you're going.
31:35
Through how the practice is growing so.
31:40
Love it. Right now it's you're at how
31:42
many patients? Rider kind of hopping around
31:46
it's kind of funny I felt like a small soft panel which were like
31:50
kind of a friends and family cohort.
31:51
I'm right around 15 that's great so very yeah so yeah and it's
31:56
been fun like and it's just been really interesting of who has
31:59
found me and and yeah and the goal is I think in a little bit
32:04
of an interesting spot of trying to work towards the brick and
32:07
mortar. I would love to make sure
32:09
everyone knows that the LLC, the insurance like as a hospitalist
32:13
paperwork like makes most of us nauseous just thinking about it
32:17
like and it's our biggest barrier.
32:19
Most of us were never so many of us were W twos, not 1090 nines.
32:23
But so yeah, the big goal is going are starting to look for
32:26
that brick and mortar and to really start to develop that
32:30
streamline of building a wait list and figuring out the
32:34
medical models. Yep.
32:35
So again, we'll talk again in about 6 weeks and so by then,
32:40
what kind of things do you think you'll be looking at doing?
32:44
Or goals, I guess. Yeah, that's great.
32:48
So the goal is within six weeks to pretty much know what brick
32:54
and mortar is starting to look like, I think.
32:56
And then also how am I going to navigate the, I don't want to
33:01
bring a whole lot of people into telemedicine as I get ready to
33:03
change a model. And so I think for me it is to
33:09
this is a great chance to make sure like the radiology system,
33:11
the specialty referral understanding if I'm going to do
33:14
labs in the office and kind of what some of those other system
33:17
components are. And I think honestly what I'll
33:20
be very open. I'm happy the big stumbles,
33:25
right? Like, that's been my best way to
33:27
learn is like, yes, I clicked the wrong button and the lab
33:30
wanted to tell you it's going to be $1500, even though I knew it
33:33
was supposed to be 35. Like, OK, thank you for not
33:35
doing that. And like, how am I going to pay?
33:39
And there's a thing. So yeah, I can't do that.
33:41
Yeah. Right.
33:41
So yeah. So I think goals for six weeks
33:44
are to really bring what the brick and mortar program looks
33:50
like together and to really have what that what has it been like
33:55
to actually find that space and how much progress is realistic
33:58
in six weeks. And I think honestly also start
34:01
to figure out where does social media presence lie of wanting to
34:07
have enough content there but not letting it seem like it's
34:11
the main focus right now. Like that's been really
34:13
interesting part as well in. Social media?
34:16
You mean as in for patients or for other doctors?
34:20
Great question. I mostly or yeah for other
34:22
patients, right. So I love to buy kind of big
34:26
Chief Crayola initial web page. I'm having it done now through
34:30
up work again, part of that is, is I want to be ready when I'm
34:36
ready and but not to lose interest of people who are ready
34:41
for my services. Yeah, that makes sense.
34:45
People on a wait list or. So I'm releasing the wait list
34:50
next week. OK, so that was kind of the
34:53
first. So yeah, and I think that's
34:55
probably the right time frame. Again, I'm just move things
35:00
forward by about three months and I'd anticipated kind of
35:06
brick and mortar October, November, but I'm going to bring
35:09
that up to like July ish. July, August.
35:13
Yeah, I'll, it's just, I'm ready like I'm, I'm want to, I just
35:18
want to get going, you know. And so I think it have
35:23
anticipated the telemedicine to really work to grow that.
35:27
And I think right when I was getting ready to hit the gas and
35:30
build that up and said, well, I actually want to bring brick and
35:34
mortar forward a lot quicker because I'm ready.
35:39
The need is there. That's what I want to do.
35:42
And so now I'm in this funny conundrum of like, yes, I have a
35:45
practice and please join me. But it's going to be different,
35:47
you know, it's going to be different, right?
35:51
So it's kind of funny, right? Like you're.
35:54
Yeah. So well, that's kind of, you
35:58
know, it's it's kind of the plan for now.
36:00
And there may just be this who get to enjoy a really fantastic
36:04
price for. And this again, I don't want to
36:07
say hand selected, but people who have found me so far have
36:11
been largely through word of mouth and or were colleagues in
36:15
rural places that really didn't have access to healthcare.
36:18
And so, yeah, they may just get a really fantastic price, which
36:22
would be great. I mean, part of what has been
36:25
awesome about this is just knowing that I'm giving my
36:29
service to people who are really deserving and really grateful.
36:32
So. Yeah.
36:34
Well, a couple months ago I talked with Doctor Eric Peterson
36:37
and he's in Florida, but he has, he's got patients in, I wanna
36:42
say Kentucky or Minnesota. Memory is failing, but it's like
36:45
states away from him, you know? Tomorrow.
36:49
Wow. So it's.
36:50
Possible you could do both. Yeah, for sure, for sure.
36:53
So very good. So I was thinking about when I
36:57
was saying in six weeks we'll touch base again.
36:59
There is, oh, I don't know who wrote this book, but it was kind
37:03
of like the idea is that you split the year into four
37:07
quarters and instead of making yearly goals, you make quarterly
37:11
goal like you kind, which kind of makes sense anyway, but.
37:15
Right. And I think it's been
37:16
interesting too because and I'm sure we'll delve into this more
37:20
like I don't know what the ideal number is.
37:23
And I think when I read a lot about the DPC and the
37:27
traditional DPCS, 3 to 600 and a micro practice and what's my,
37:34
what's my goal, I feel like that question comes up more right now
37:37
than my prize. And I'm like, I don't know, they
37:40
could be 50 in person, 50 telemedicine, they could be 7575
37:44
maybe. And I think again, that's some
37:46
of that flexibility of having Hospice work to offset some of
37:51
the financial pressure. Hey, this is this is a great
37:54
spot to be in that I get the figure this out as I go along.
37:59
And I have to say, boy, I don't need 50 members within three
38:02
months to keep all systems afloat.
38:04
I just want to make sure I'm enjoying what I'm doing and
38:07
giving really good care and have a bit of that backup bandwidth
38:11
from hospitalists. And depending on the acuity or
38:14
the complicate complexity of your patients, 150 might feel
38:19
really good to you. Totally.
38:22
Exactly. Exactly so because.
38:25
We also were thinking, yeah, 250 but I around 1:50 I was like,
38:30
oh, that's a lot. And I'm not part time, I'm part
38:35
time. So yeah, that's that was
38:38
probably when. Yeah, I was.
38:39
Like, OK, no, I don't think we're getting to 250.
38:43
Right, right. So all right, good.
38:45
So yeah, I'm not trying to have any of those numbers in my head.
38:48
I'm just like, what's going to happen is going to happen.
38:51
And and again, I think that's I was really, do you think it
38:54
caused me a lot of consternation for a long time when I was like
38:58
looking at DPC of trying to make all these numbers work.
39:02
And again, I thought, well, I can continue to do hospitalist.
39:06
Let's just figure out a path forward that doesn't seem so
39:10
obsessed on creating specific numbers.
39:13
But let's create what I want to do and what people need and see
39:16
if that drives forth, you know? Let me ask you one last question
39:21
and this one is going to be interesting because as things go
39:24
along, you can come back and, and and refer.
39:26
So, yeah, right now, where do you think, you know your
39:31
practice will be? What do you think you'll be
39:33
doing in five years? I think in five years I will be
39:38
full time DPCI see a natural transition over the next couple
39:43
of years of of winding down hospitalist.
39:46
And again, I think the goal is to learn and build and enjoy and
39:52
love what I do. And I think in five years I will
39:56
be on the home stretch to retirement and really just enjoy
39:59
DPC and being opted into Medicare and maybe more like
40:04
very traditional. I may kind of have the five day
40:09
office or stay micro and the right numbers.
40:13
So yeah, but I think it'll be full time DPC in five years.
40:15
Very. Good.
40:17
That's exciting. Yeah, Yeah.
40:19
All right. Well, sure.
40:20
I am going to let you go for now and then we will meet again in
40:24
about 6 weeks and see where you are and you have your goals.
40:28
That's. Great.
40:29
Yes, you make it great. If you don't, you know it's OK.
40:32
But it's nice to have something to shoot for, right?
40:34
Yeah, Yeah. No, I think so for sure as well.
40:37
I'd say it keeps me honest to sticking with this.
40:40
Yeah, so. All right, well, good.
40:42
So, and I'm sorry, I forgot to say earlier, you are Med PEDs
40:47
trained. So yes, you know, Med Pete's in
40:50
the hospital. Med Pete's works out very well
40:53
outpatient as well. So do you plan on seeing?
40:56
Yeah. And.
40:57
Adults outpatient. That's great.
41:00
I think that's my biggest $1,000,000 imposter question.
41:03
It's hospital medicine is very specific and I have so much
41:07
admiration for primary care pediatricians who and I don't
41:11
have kids, I rescue Dobermans. So to have a conversation about
41:14
anticipatory guidance of toilet training or behavioral issues,
41:19
I'm just like, Oh my gosh. Like it gives me a little bit
41:22
anxious. So my plan is to actually have a
41:25
conversation with families who want to enroll and understand
41:28
that I am a board certified pediatrician, but these are the
41:35
areas that I don't have the right skill set.
41:36
And it's funny because friends of mine who are primary care
41:39
pediatricians like, yeah, but we just refer for all that stuff
41:41
still. I'm like, what do you Yeah, so
41:45
that's that's funny. That's a great question.
41:47
So I think on a case by case discussion of maybe awkward when
41:52
I give you a book to read, because honestly, I don't know
41:53
how you totally train a kid anymore.
41:55
I say that in just a little bit just in case anyone's really
41:57
listening. Like, this is kind of a total
41:58
whack job, but you know well. You.
42:01
Can tell. You kids.
42:02
The beauty. Oh yeah.
42:05
So that's actually kind of what I'm starting at is, yeah, I'm
42:08
picking like 11:50. But I can easily see myself
42:12
caving as I get over some of these imposter syndrome issues
42:16
and be like, it's all still Pediatrics and with the right
42:21
patient selection, they will appreciate my humility and being
42:25
like, what? You still toilet train?
42:27
What don't they? They burn that way.
42:29
I don't know, you know, yeah. So I say these things in the
42:32
hospital too. I'm like, I don't know what age
42:34
they walk. Not anymore.
42:35
I don't know. I just like they don't get out
42:36
of the bed when they're sick. Kids still walk.
42:39
Like, I don't know. I said, yeah, the pediatric
42:42
residents never knew how to take that sense of humor.
42:44
I was like, no, actually, I do know.
42:47
You know the ironic. Exactly.
42:48
I don't know. He's just a pediatrician, kind
42:51
of. Humor, huh?
42:54
You are right, Yeah, we should be.
42:55
So yeah. So yeah, that'll be interesting.
42:58
You know too is what does the ultimate patient mix look like
43:01
in the DPC and how much if it feels to.
43:04
I started to use the term like little P so like direct care
43:07
versus direct primary care. And yeah, I'm leaving it open
43:10
and I think that'll be part of the fun of these check insurance
43:13
is what am I really doing very. Good.
43:16
Well, we'll talk again soon. Thanks again for joining me for
43:19
this conversation with Doctor Brian Bost.
43:21
Make sure that you subscribe so that you'll be notified when the
43:24
next Hospitalist to DPC episode comes out in about six weeks.
43:29
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43:35
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43:37
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43:44
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44:06
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44:11
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44:15
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44:19
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44:23
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44:25
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