Latest / DPC Life: Direct Primary Care Podcast / Stop Answering the Same Question 30 Times: Systems for the Modern DPC

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Stop Answering the Same Question 30 Times: Systems for the Modern DPC · DPC Life: Direct Primary Care Podcast

0:00
Showed that patients are more likely to send female doctors
0:03
more demeaning messages, negative messages through the
0:07
portal than than male doctors. But there's something, there is
0:11
something about being a female physician that is shortening our
0:16
lifespan, right? Patients that are treated by
0:19
female doctors have better outcomes.
0:22
We, the corporate medicine world, does not reward the way
0:25
female physicians practice. Welcome to DPC Life, the podcast
0:30
where independent doctors share real stories, bold ideas, and
0:34
the freedom of doing medicine on your own terms.
0:38
I'm your host, Doctor Anne Gonzalez, and together we'll
0:42
explore the wins, the struggles, and everything in between.
0:46
Let's dive in. If you've ever struggled to
0:50
explain DBC, listen to the end of this podcast.
0:53
I'll share a DPC savings calculator for patients that you
0:57
can use to compare DPC plus a health share versus traditional
1:02
insurance and then how it fits in a larger system so that you
1:06
can open your practice with patients already lined up.
1:10
Let's get into this week's episode.
1:12
I want to explain something that I am starting.
1:14
It's called the independent practice path or IPP, becoming
1:20
the boss. I mean, it's very difficult if
1:22
you've always been an employed physician.
1:24
So I've been hearing the uncertainty and the fear of how
1:28
do I become a practice owner in a reasonable and sustainable
1:32
way? How do I get patients?
1:35
How do I explain DPC to them? How do I make sure that I'm
1:40
going to be able to make the income that I need?
1:43
So that's what the independent practice path is.
1:45
And it's going through all of those things to help you
1:48
transition from employed physician to independent
1:51
practice owner so that when you open your doors, you are not
1:55
actually just opening. It's a continuation of what
1:59
you've started several months prior.
2:03
You're going to learn how to explain DPC to patients, to
2:08
employers, family members, other doctors, colleagues.
2:12
And you'll start those conversations early from the
2:16
very beginning. You're also going to start
2:19
building your systems so you don't start with a like a Google
2:25
worksheet and just your phone. And that's it.
2:29
I want you to have systems that you would find in a mature DPC
2:35
practice. The goal is to open a practice
2:38
with momentum so you're not just opening your doors and waiting
2:43
for people to come to you. I'm starting this as a small
2:46
initial cohort because this works best when people can talk
2:50
to each other and hear how other people are doing things and they
2:55
work through some of the situations together.
2:58
The independent practice path is what I set out to do over a year
3:02
ago. I wanted to help doctors who are
3:06
ready to get out of the fee for service system be able to
3:09
succeed in DPC. There are certain things that
3:12
you can do to try to make sure that you will succeed.
3:17
So if you are seriously thinking about getting out of employed
3:20
practice and you want to talk to me about this, just e-mail me
3:23
through the e-mail in the show notes.
3:25
Tell me about your situation, where you are in the process of
3:29
planning a DPC, and then we can figure out whether this would be
3:33
a good fit for you. Just remember, no matter where
3:36
you are on your DPC journey, your DPC family's got your back
3:41
today. I am very excited to welcome
3:43
back Doctor Noemi Adame. And we talked several months
3:47
ago, but she's had some new things that she's learned and
3:52
found out about her practice since then regarding her systems
3:55
and automations. I'm going to take a step
3:57
backward and last time we talked, we talked a little bit
4:00
about the pieces that you've written about how women doctors,
4:06
how their workload is different from male doctors.
4:09
Can you just kind of recap that for us?
4:12
So when it comes specifically to gender bias in medicine,
4:17
physicians have a very different job than male doctors.
4:21
And I've spoken out in different podcasts, I've written articles
4:25
about it that have been featured in Sophie Docs and Kevin MD.
4:29
Basically, it boils down to this.
4:31
Patients expect different things from us than they expect from
4:35
male doctors. Patients demand more from us.
4:38
They treat us differently. Some objective findings and
4:43
studies include, for example, that patients send and this
4:48
isn't the primary care setting. Using portal data, patients send
4:51
female doctors 25% more messages through the portal than they do
4:56
male physicians. And this is accounting for
4:58
different variables including complexity and panel size.
5:02
And another study, my little more recent study was pretty eye
5:06
opening, showed that patients are more likely to send female
5:10
doctors more demeaning messages, negative messages through the
5:15
portal then then male doctors. They same study that showed that
5:19
patients and female doctors 25% more messages also showed that
5:24
staff sent female doctors 24% essentially the same, more
5:29
messages. So not only are female doctors
5:32
getting more messages and demands, right, because every
5:35
message it comes with work, right?
5:38
You have to dig through the chart, you have to make
5:39
decisions, you have to review, right?
5:41
You know, you have to, you know, engage for clinical reasoning
5:45
and decision making skills and then send, send the message and
5:49
or any additional orders that go.
5:50
So it's not just about you're not you're not answering.
5:53
It's not like answering your kids text saying, Hey, what's
5:56
for dinner tonight, right? You know, answering a message
5:58
from a patient is a whole different thing.
6:01
So we have more demands or more expectations from patients.
6:04
We have more expectations from staff.
6:06
There's also some soft skills expectations, both patients and
6:10
staff. Some studies have shown expect
6:12
female physicians to more be more nurturing, be more giving,
6:18
be more available. And so all of that comes with
6:23
invisible labor that you're not compensated for, certainly not
6:27
in the corporate world. And it takes its toll.
6:31
It takes its toll and it explains why female doctors have
6:35
we have higher burnout rates, we have higher rates.
6:38
This is compared to our male physician colleagues.
6:40
We have higher rates of depression, higher suicidality.
6:46
I know this is this is serious, right?
6:47
You know more if you. Mentioned longevity data.
6:50
The longevity data was very interesting.
6:53
So in the general population, female physicians or sorry, in
6:58
the general population, women outlive men by quite a few
7:02
years, almost a decade. That longevity benefit is not
7:07
seen amongst physicians. We do not have that longevity
7:11
benefit with our male colleagues that women in the general
7:15
population do. And what's interesting is
7:19
because you might think, well, it's, you know, because it's a
7:20
stressful job. And so, but when you compare
7:23
other high earning, high achieving professions like
7:26
engineering and law, women in those professions do have a
7:30
longevity benefit over their male colleagues.
7:33
But there's something, there is something about being a female
7:36
physician that is shortening our lifespan, right?
7:41
You know, it is shortening our lifespan.
7:42
And I do think it's because there are expectations from all
7:48
angles, you know, from staff, from patients, from our
7:51
families, from our communities. I know certainly as a physician
7:55
in a rural community, I have been asked by my community to do
7:59
things that I can guarantee it, it's probably things that e-mail
8:03
doctor would be asked to do. So from a perspective of
8:07
physician well-being and how it intersects with tech is I think
8:12
that, you know, we always talk about boundaries, right?
8:14
Oh, you need to set boundaries. You need to set boundaries, but
8:16
having to constantly, constantly reinforce boundaries and say no
8:21
and say no, I can't do that. Or no, that's not an appropriate
8:24
request or no, you need to do this instead.
8:27
Or having to or even just read through the request or take that
8:30
request, process it and have to make a decision about it all
8:35
that also takes its soul. So I'm all about setting systems
8:37
up to prevent, right? I'm a primary care doc, right?
8:41
So I'm all about prevention. So I really feel and really
8:45
encourage DPC docs to set up systems to basically as a
8:50
buffer, right, So that you're not fielding and having to
8:53
constantly reinforce boundaries, having to constantly answer the
8:56
same questions over and over about whether you take
8:58
insurance. It is demoralizing to have to
9:00
answer 2030 phone calls about, hey, do you take insurance and
9:04
have to say no and explain the DPC model to have one or two
9:06
people sign up, you know, so if you have a system that either
9:11
prevents those inquiries because people are already can go to
9:14
your website and already know what the process is or to have
9:17
some other way to qualify leads. So by the time someone does
9:20
filter through and you do answer that phone call, they already
9:24
know some of those basic questions, right?
9:25
They already know some of those basic the answers to some of
9:27
those basic questions. And five years ago when I opened
9:31
that was there really weren't a lot of those options.
9:34
And now there are, right with AI, I know people have very
9:37
mixed feelings about AI, but now with more robust CRMS, you know,
9:42
like your Harmony OPS, now with, with AI, there are ways that you
9:46
as the DPC dog, even if you have a micro practice, even if you
9:49
have no staff, you do not have to be answering those questions.
9:53
And basically suck up your bandwidth and your emotional
9:58
labor in answering these questions that are just gonna
10:01
exhaust you because it is exhausting.
10:03
And instead, it's going to free up your bandwidth for the things
10:06
that matter, which is direct patient care, that personalized
10:09
touch to your patients who have already committed to you and who
10:12
are already enrolled. Yep.
10:14
OK, we're done. Thank you.
10:17
Kate just wrapped it up. No, you didn't actually.
10:21
All the points, Yeah, all the points that I wanted to kind of
10:25
raise today. And and usually the podcast, I
10:28
just kind of we just like very free form.
10:30
But there's a couple things that I definitely wanted to touch on
10:32
today and you've kind of pointed all of those out.
10:35
So I'm going to back up a little bit.
10:36
And yes, you're right. You know, DPC doctors, it'll be
10:39
really interesting, wouldn't it, to do some kind of study about
10:43
DPC doctors? Like, do they look like women?
10:45
Yeah. You know it's.
10:47
It's funny because I'm a data person, right?
10:50
You know, I'm crunchy, but then I'm also very data-driven.
10:53
So when and I've evaluated the, the literature on gender bias
10:59
and medicine and the different burdens between female doctors
11:04
and male doctors and there's a lot of data out there, but not
11:08
in specifically in DPC. You know, first of all, it's a
11:10
relatively young field. It's a relatively small field,
11:13
and most of us are not in academics, right?
11:15
You know, it's so funny because when I was in academics and
11:17
somebody said, oh, you should do a study on that, I was like, oh,
11:20
yeah, sure. Because I had access to an IRB.
11:23
I had access to a statistician. I had access to all these very
11:27
eager medical students and residents who are more than
11:30
happy to, you know, lend, lend their labor to have their name
11:34
on a paper, right? You know, when, you know, here I
11:37
am in rural Indiana, right, looking out at my cornfield, and
11:41
I don't have those resources, right?
11:43
So. And that's where a lot of us, we
11:44
don't have have the resources to say, yeah, let's let's do this.
11:48
And it would, it takes a lot more to be able to pull that
11:52
data. But yeah, I think it would be
11:54
very interesting. So yes, all the data that I have
11:57
on gender biases and medicine is not taken from the DPC world.
12:01
But I do feel like it applies because all this data is from
12:05
different fields. For example, the data that shows
12:08
that female physicians have better outcomes, right?
12:10
You know, that is in surgery, in primary care, in hospital, you
12:16
know, in hospital medicine and in multiple studies, multiple
12:21
fields, patients that are treated by female doctors have
12:25
better outcomes. And we're talking for example,
12:27
in hospital medicine world, decreased length of stay,
12:31
decreased readmission, decreased mortality.
12:35
In the surgical world, it's also decreased mortality, decreased
12:39
readmission rate. And it's not because we have
12:44
better training, right? We go to the same medical
12:46
schools. It's not because we're
12:48
necessarily better doctors. It's because we practice a
12:53
little differently with some of those soft skills.
12:55
We listen more. We are less likely to interrupt.
12:59
We're more likely to adhere to clinical practice guidelines,
13:03
right? This is what the literature
13:04
shows. This is no shade to my male
13:07
colleagues, right? Love and respect my male
13:09
colleagues, but all those things, nobody is handing out
13:14
bonuses for listening more to patients, right?
13:18
You know, no one is handing out bonuses for interrupting
13:21
patients less so certainly in the corporate world.
13:25
We, the corporate medicine world does not reward the way female
13:29
physicians practice. They don't.
13:31
It does so in our world, in the DPC world, where you know, we've
13:37
said this before, I am the system.
13:39
You can first of all, create your workflows to protect
13:42
yourself, to protect your energy, to protect your
13:43
bandwidth, to protect your time. But you can also price in a way,
13:48
for example, as a female doctor, where you can keep your practice
13:50
size smaller than perhaps a your male counterpart would do.
13:54
Because if patients are demanding more from you, if your
13:57
community's demanding more from you, if your family's demanding
14:00
more from you, if staff is demanding more from you, guess
14:03
what? You're going to need a smaller
14:04
panel size, then maybe a, a male doctor that's practicing in the
14:08
same field and then in the same, in the same market, you know, in
14:11
the, in the same demographic. And so that to be able to
14:15
compensate yourself. That does mean pricing
14:18
differently, but also setting up automations to protect yourself.
14:23
Right, yes, because there's only so much of you to go around.
14:26
And I love Doctor Amy Walsh. She's so funny.
14:28
She's always like you are not and all you can eat Doctor
14:31
Buffet, you know, and no one's going to protect that except for
14:36
you. Right.
14:37
Yeah, yeah. OK, so I have a few things that
14:41
and I'm what I want to do is kind of talk about these few
14:45
things that, you know, you and I have noticed in practices and
14:49
not only talk about how we're doing it now in our own
14:52
practices with automations, but how can people who are starting
14:55
out maybe and they don't have a CRM, they don't have, you know,
14:59
automations yet, Like what can they do that will at least help
15:04
them to protect themselves? So, OK, first one messages.
15:10
You've got lots of things that you do and I know I have things
15:13
that I do, so we'll hold those. So one thing I was thinking
15:17
about with messages. So people will, you know, a lot
15:20
of times, like you said, you get into questions about like, do
15:23
you take my insurance and you know those kinds of things.
15:26
And so if you are getting phone calls or text messages or you
15:31
know things like that, one thing is to have like they call them
15:34
text snippets or like you can use something called a text
15:38
expander. So it's if you.
15:40
Say a macro. Thing, yeah, a macro, yeah, the
15:42
same thing over and over and over again.
15:45
And then that way, that'll save you a little bit of time and
15:47
you're just not pouring that kind of, you know, energy into
15:51
that. So that's one thing.
15:53
And now you use auto replies. Yes, right.
15:58
So what I have noticed now that we have a, you know go high
16:02
level type of a CRM similar to your Harmony OPS.
16:07
When somebody either calls or texts us and this is pre
16:09
patient, right. This is not someone who is a
16:11
patient. If somebody calls or texts our
16:15
publicly listed clinic number, they get an auto text reply.
16:21
OK, so they call and we miss their call, which typically we
16:24
do. We don't typically answer.
16:25
Or if they text us, they get an auto reply that says hey, to
16:30
start your journey with us or to enroll in our practice, go to
16:34
our website and it has the link to our website and sign up for a
16:40
group Q&A, which is what we call the meet and greets.
16:42
We don't do one-on-one meet and greets.
16:44
We do group. So what I have noticed is that
16:48
people who do either call or text and they get the auto reply
16:54
within a few minutes, they sign up for a meet and greet.
16:59
So we don't have to reply, right?
17:02
You don't have whatever it is that their question was, it's
17:06
OK. It's going to be answered in the
17:09
meet and greet. And we might, and you know, we
17:11
might end up replying again just for that personal touch, but
17:15
we've already captured their data.
17:17
OK, We've already captured their data.
17:19
And then they've already, they already know, oh, I'm going to
17:23
have my questions answered at the meet and greet.
17:26
So that's the first one is having auto replies.
17:31
I noticed that it kind of stops the back and forth because they
17:35
get this auto reply that says, hey, go to our website and sign
17:37
up for a meet and greet and you have all your questions
17:39
answered. At the meet and greet, they kind
17:41
of stop. They just sign up and they don't
17:43
answer any more questions or that we might get a message
17:46
like, hey, thanks. I already signed up for the meet
17:48
and greet, which is like, OK, great, we'll answer that.
17:52
So that's one. I actually took it a step
17:56
further because sometimes you do have people that are like, well,
18:00
my meet and greet because we only do, we do meet and greets
18:02
only once a week and they're group.
18:03
Some people are like, well, I like, like to join before then.
18:07
So what we, what I did is, and this is especially for our
18:12
complex neuroimmune population, if they signed up for one of
18:15
like our pants PANDAS meet and greets, which we do separate,
18:18
they get tagged PANDAS. And that group that gets that
18:24
tag gets an automated e-mail that says, hey, you know, thank
18:29
you for signing up for our group info session.
18:31
You know, this is this, we're going to have about 3 to 8
18:34
people and sometimes people have a lot of questions.
18:37
So why don't you watch this video first where Doctor Adama
18:40
talks about her, you know, her path, that letter to opening up
18:44
her practice, her background, her path to how she ended up
18:48
taking care of or becoming the regional expert in PANS and
18:51
PANDAS, how to enroll in our practice and what to expect
18:55
after you enroll. So they basically watch, I
18:57
recorded like basically the first half of a meet and greet.
18:59
And so they watch the video. I also have links to several
19:02
blog posts where I talk about my approach to PANDAS, my
19:06
diagnostic, my holistic non pharmaceutical approach, my
19:09
western pharmaceutical approach, how we do follow up and ongoing
19:13
care. So they basically do all of this
19:15
before they sign up for the meet and greet, but before they
19:18
before they actually do the meet and greet.
19:21
And we give them the option if after learning all of this,
19:24
watching this video, reading this blog post, you're ready to
19:26
join. Here's the link to enroll.
19:29
If you still have questions, Doctor Adama will answer them at
19:32
your scheduled meet and greet. So we've had a couple people
19:35
that sign up from that. So and that reduces the well, I
19:40
signed up for a meet and greet, but I want to talk to someone,
19:42
you know, like you've already. And usually the questions that
19:46
they have are answered in that video and in the blog post.
19:48
So, and I know that some people will say, well, that seems so
19:53
impersonal and that it's, it's not, I don't feel it's about
19:57
being impersonal. I feel it is about making sure
20:02
that you are automating the things that are repetitive.
20:08
You know that and answering those questions that are
20:10
repetitive. So that frees you up that if I
20:13
have a patient who's established, who's already
20:16
paying me, that texts me, hey, my kid is sick.
20:19
I have the time for them, right? I have the time for them for my
20:22
patients that are already that are that are already part of my
20:25
practice instead of and my team, same thing is my team is an
20:30
extension of me. So that way my team is working
20:33
on referrals, working on prior auths, working on, you know, you
20:38
can't, we have a very complex population doing letters to
20:40
school, whatever it is that we need to do.
20:42
We are focused on our patients because we are doing pre
20:46
education marketing basically to the people who sign up up for a
20:49
meet and greet answering their questions.
20:51
The other thing is because we do meet and greets and they've
20:53
gotten pretty big, anywhere from 4 to 8 people will sign up and
20:57
everybody has some questions. By doing that pre, you know that
21:00
little video, I don't have to talk a lot.
21:04
I just go straight to questions. That was the other reason why we
21:06
added the videos. So that automation has really
21:10
helped with people who either want to sign up, they're ready,
21:12
right? They don't need the meet and
21:13
greet or who or too short to make the meet and greet more
21:17
productive. So that's one of our automations
21:19
that we've done, yeah. That makes yeah, that saves you
21:22
so much time. So much time, yeah.
21:24
And effort. Oh.
21:26
And it is a time investment upfront, but then?
21:31
It's so nice after right once it's done it.
21:34
Is so. Yeah.
21:35
And the video that you made, what you did essentially is you
21:39
took all the questions that people have already asked you in
21:42
the past. You just put them all in one
21:44
because you know what they're going to ask.
21:45
You right I recorded the meet and greet I recorded a meet and
21:48
greet that is OK yeah yeah. So it was pretty authentic,
21:52
right? Yeah.
21:52
So I literally, it recorded the meet and greet.
21:55
I told the people, right. You know, hey, I'm gonna record
21:57
it. I did not record their Q&A's.
22:00
So once I talked about my piece, I stopped recording.
22:04
So there. And they all turned their video
22:07
off so their faces didn't show in the recording.
22:11
But yeah, I did once I didn't record them speaking or them
22:15
asking questions, I stopped recording.
22:16
But basically, yes, that recording was the most common
22:21
questions, right, You know, which is, well, you know, how
22:24
soon after I enroll can I see you or, you know, do you do
22:28
virtual or do it, you know, like that?
22:31
What's your general approach? Can't you know, what is it that
22:33
you do right? Basically, what is it that you
22:35
do for these, for patients? It's different, you know, so,
22:37
but yeah, that those automations really, really help because
22:41
you're, you're basically giving their information upfront, which
22:46
is very reassuring. You know, that's very reassuring
22:49
to people because they're like, oh, she's done this before,
22:52
right? She knows what questions to
22:53
answer, but it just frees up your time a lot.
22:56
The other is it prevents inquiries where, you know, and I
23:02
hope I don't sound callous when I, when I say this, you know,
23:05
people have been traumatized by the system, right?
23:06
You know, doctors have been traumatized by the system and
23:09
patients have been traumatized by the system.
23:10
And so we've had one of the other reasons we needed to do
23:13
automations like this is because people would call and keep my
23:18
admin on the phone for like 30 minutes to an hour emotionally
23:23
unloading about how the system has harmed them, about how, you
23:27
know, doctors have dismissed them or mocked them.
23:30
And I believe it. You know, I, of course I do.
23:33
But when you're trying to run a business, it's hard to have my
23:38
staff that I am paying hourly to listen to an unqualified lead.
23:45
Hey, after you enroll. Absolutely.
23:47
Yeah. My first visits are in.
23:49
My first two visits are like an hour and a half.
23:52
And then a huge part of that is to allow that, to allow the
23:55
patient to emotionally unload. But that's after they've
23:57
enrolled, you know? So having these automations
24:01
helps reduce tying up my staff with someone that just calls to
24:09
to vent and to instead, you know, get freeze them up to help
24:13
patients that are already. Enrolled, right?
24:15
And that brings up another point.
24:16
It's, you know, you definitely want to be answering yeah, from
24:21
new people. But like you said, you have to
24:23
focus on the people that are already your patients, You know,
24:27
you really want to retain them. And so you have to kind of
24:30
balance right the time and the work.
24:34
Right for them. Yes, OK.
24:37
So that was great. That actually hit another.
24:40
One. Well, now it's talking too much,
24:42
no? No, no, no, it's good.
24:44
We're good. So yeah, that was the other
24:46
thing was the new patient inquiries, you know, like how do
24:48
you try to make that easier? So the next thing that will
24:51
happen is the onboarding. And so something that people can
24:55
use and everyone really for any systems that you have in your
25:00
practice, even if you're solo, is to have your SOP's, your
25:04
standard operating procedures, right?
25:07
So that you know you're not going to forget something and
25:10
remember it later because you want everyone to have the same
25:13
experience, right? You don't want someone to come
25:15
in and be like, well, I didn't know about that.
25:17
And then they're mad and they leave.
25:19
But that would be worst case. But so definitely having your
25:23
Sops for onboarding and then what we've done, and you can
25:28
still do this in independently out of, you know, any kind of
25:31
system. If you just use like Gmail or
25:33
something, you know, your workspace, whatever is having
25:36
e-mail sequences and having those emails already written
25:39
out, you know, you can just copy paste.
25:42
This is the information. This is what you need to do.
25:44
And a lot of times Emrs now are really sophisticated in this and
25:48
that they do you can do that. You can send out emails with,
25:53
you know, links to forms and, you know, signing up.
25:56
So that's something that also makes it easier is when they
25:58
have these forms ahead of time so that they can sign those, you
26:02
know, read over agreements and things like that before they
26:04
come in your office and they don't sit in your office for 40
26:07
minutes looking at these things. Right, Yeah.
26:10
Or worse, you filling it out for them.
26:12
Oh. Yeah, yeah, yeah.
26:14
That's a nice thing about being Pediatrics.
26:15
Our families are young and tech savvy, yeah.
26:21
And even my older patients, most of them actually, it's pretty
26:23
good. It's pretty good.
26:24
Not everyone, but. Right, a lot of yeah.
26:27
And then, yeah, but onboarding, having an SOP and then having
26:32
kind of like an SOP for patients, I guess having a
26:35
patient handout, this is how we do things here, right?
26:40
This is how you reach me during the day.
26:43
This is how you reach me in the evening.
26:45
This is what to expect. That was another thing you have
26:49
for your patients. Yeah, you have auto replies for
26:52
things like refill requests. And then?
26:55
Oh, like how to schedule appointments?
26:57
Yeah, you do self scheduling. Yeah, yeah, you know, and I know
27:01
I was a little worried because I was worried, Oh my gosh, with
27:04
self scheduling, people are going to like, you know,
27:06
schedule for things like pink eye.
27:08
And honestly, like we have our acute same day self scheduling
27:14
appointment, only 25 to 50% go utilized.
27:18
So most go unutilized. People don't want to come in to
27:21
the doctor for pink eye or ringworm.
27:23
They'll send us a message and then be like, hey, what do you
27:26
think of this? Can you send us some antibiotic
27:27
apps? Sure.
27:29
But anyway, but your SOP. So starting with onboarding.
27:32
So my tech stack is I have my CRM is a go high level white
27:36
label go high level system similar to your Harmony OPS.
27:39
And then I have Sigma MD as my onboarding, sorry as my EMR.
27:44
So for but they do their calendar is linked and I do have
27:48
some link, but I do not have a way to link that once somebody
27:52
enrolled in Sigma that automatically gets communicated
27:57
to my CRM. So we do manually have to tag
28:04
when somebody enrolls in Sigma, I do manually need to then tag
28:10
that person's contact information on my CRM as a
28:15
member. OK, So I do have to manually tag
28:18
them as a member. I would love a way to, I would
28:21
have to, I think really don't love to talk about that if
28:26
that's a way. But yeah, for now, right now I
28:28
do have to tag them as a member. But once they get tagged as
28:30
member, they get an e-mail that is a welcome e-mail and it's,
28:36
you know, very warm, very or you know, I think, I think it sounds
28:39
very warm like, you know, welcome.
28:41
We're so excited to partner with you.
28:44
This is to help you make the best out of your membership and
28:48
out of Sigma because at that point we want them to start
28:51
using Sigma to communicate with us.
28:53
So it just, so basically what it explains how to use the 2 main
28:58
things people want to do when they join a practice is they
29:02
want to know how to message you and how to schedule an
29:06
appointment, right? Those are the 2 main things.
29:08
So we basically we show them screenshots of what the Sigma
29:13
app looks like to do both of these things.
29:15
This is how you can send us messages.
29:16
This is how you can self schedule appointment as now that
29:20
you've enrolled self schedule your first appointment and we
29:23
have customized our self scheduling appointment that the
29:26
intake appointment is literally labeled first appointment
29:29
intake, you know, virtual intake.
29:31
So it's like, again, you can give people a handout they're
29:34
gonna forget, right? But if they go to their app, you
29:37
know, their Sigma app and they click schedule a visit with your
29:41
clinician and they see an appointment that says first
29:45
appointment, the intake, they're like, oh, OK, yes, I that's a no
29:49
brainer, right? They don't have to remember what
29:51
was in the e-mail or whatever. They automatic.
29:53
That's very clear. And we have it customized.
29:56
So that appointment can only be the first appointment.
29:59
So once they've scheduled that appointment, it disappears as
30:02
they're from their, from their appointment type list, you know,
30:05
so that way you don't have some, you know, down the road, they're
30:08
not trying to schedule, you know, an hour and a half
30:10
appointment for an intake. So Sigma's actually pretty
30:12
robust in, in itself scheduling and we so you don't have to be
30:16
chasing them to self schedule their first appointment, right?
30:19
You know, as soon as they enroll, they can self schedule
30:22
their first appointment. So the onboarding e-mail
30:24
includes how to self schedule your first appointment, how to
30:28
send us messages. And so the Sigma uses this chat,
30:31
you know, that that's really it's texting, but I really like
30:34
it, especially as a female doctor, because I feel like
30:38
Twilio or text based Emrs create this illusion of, oh, I'm
30:43
texting my friend, you know, whereas the Sigma app, because
30:47
it is app based, it feels more professional, I feel, and it
30:51
does create this buffer of you're not texting your friend.
30:55
I am your doctor, I am your child's doctor.
30:57
You're texting a team of professionals.
30:58
So the way we've customized our, our chat boxes on on Sigma is
31:04
there's a general one that I wish I could delete, but I
31:06
can't. That general one stays that goes
31:08
to my nurse. There's one that's it's labeled
31:12
Josh and that is our my practice admin and that is for prior
31:16
auths, billing onboarding letters.
31:20
OK, so it says that and it says 72 hour response.
31:23
Then there's one that's a nurse and that's labs, vaccines,
31:27
status updates and that goes to Becca, our nurse.
31:30
And then the third one is doctor and that is medical increase or
31:35
after hours or after hours questions.
31:37
And that goes to me. And we can all filter our
31:41
inboxes so that I can see either just my messages or I can see
31:44
everybody's messages or just me and Becca's messages.
31:47
Well, we also have a refill line, OK, the refill line that
31:50
goes to Becca so she can set up refills for me.
31:52
And so again, you can give people a handout or tell people
31:56
at the beginning that they're going to forget.
31:57
But if they go to the but if they ought and when we had Atlas
32:01
and you know, people would forget.
32:02
Wait, do I text for labs? Who do I text for prior OPS with
32:06
their new system is they go to their app and they see, oh,
32:10
wait, I need to, they know they need to, they have a question
32:12
about labs. They open up the chat box and
32:14
they're like, Oh yeah, labs. I, this is the chat that I use.
32:18
So, but it's a no brainer. They don't have to remember it's
32:20
already in, in front of them. So, so our onboarding includes
32:24
an explanation of all of that, how to send us messages, who to
32:26
send messages to, which again, it's pretty self-explanatory and
32:30
how to schedule an appointment. And then the third and then the
32:33
third thing is here's all your intake forms.
32:36
You know, so we have a social history form, We have a mind
32:39
body spirit form for our PANDAS patients.
32:42
We have an initial PANDAS intake or, you know, get all the
32:45
history related to PANDAS. And then we have a, we tell them
32:48
how to send us medical records. They can either link their
32:50
portal to our EMR, they can fax us and that we have our fax
32:54
number in there, or they can send it through the Sigma chat
32:58
to Josh. So basically it's how to
33:00
schedule, how to send us messages.
33:04
These are the forms that you have to fill out.
33:06
This is how you send us records. And then the third and then the
33:09
fourth, sorry, is if your kid is sick, blah, blah, blah.
33:12
If you have a question, but you know, like that, those kind of
33:15
housekeeping issues, which again, I think it's pretty
33:17
self-explanatory. When they open up the Sigma app,
33:19
like, Oh, I can schedule if they go to if they go to schedule a
33:22
clinic, a visit with your clinician, The first appointment
33:24
type that pops up is an acute same next day appointment.
33:28
And that those are on a 1 to 48 hour roller rolling schedule
33:30
Monday through Friday. So that way if someone is I'll
33:33
cut my kid is sick. What I do and they and they go
33:35
to their Sigma app and they click reschedule your clinician.
33:37
Oh, same day, next day appointment.
33:39
It's very clear. And so then they can self
33:40
schedule and they don't have to remember, you know, anything
33:43
because it's already. So that has reduced.
33:46
So just to give you some data on that, since we started
33:49
implementing this, our even though our panel has grown by
33:55
20%, our messages, our daily messages have stayed steady like
34:01
in the last two years because we've implemented systems that
34:05
decrease the back and forth, the back.
34:08
Bypasses it. It bypasses it, right?
34:11
So so you know, because that's one of the worries, right?
34:13
Oh my gosh, the more in my pal grows, the more text I will
34:15
make. That's why you need systems that
34:16
prevent unnecessary messages so that as you grow, you don't
34:21
necessarily that doesn't necessarily translate to more
34:23
messages With our CRM. This is our pre patient
34:26
increase. Our inquiries like texts and
34:29
phone calls have decreased like 80% in the last six months.
34:34
But but our enrollment has increased, but our meet and
34:38
greets have increased by like 150% and our actual enrollment
34:44
has increased by like 30%. So less inquiries, but more.
34:50
Now I would panic if it was less inquiries but less enrollment,
34:53
right? You know, but less inquiries and
34:56
more enrollment to me translates that to people don't have to be
35:01
texting us and calling us with our website, with our current
35:04
systems. They already have an idea of
35:06
what we're all about and they're signing up for meet and greet
35:09
and getting their info that way. Yep.
35:11
They're getting their questions answered so.
35:12
They don't have to call. Yeah, they can just go straight
35:15
into. The right, right, right.
35:16
Yeah, so right, that's. Amazing.
35:21
That's incredible that happened. It took five years, right?
35:24
You know, so that's why I think it's important for you and I to
35:27
talk about it. So for the newbie, so they're
35:30
like. So it doesn't take five years
35:32
for this. Exactly, exactly.
35:37
And that's what I, you know, I tell people a lot is, you know,
35:40
you want to start how you want to finish.
35:43
And so this is actually getting you to that point early, so.
35:47
Right, that is great. And that kind of well, you know,
35:50
when you started, how many patients did you start out with
35:54
like when you. Open your doors.
35:55
I have been here for five years. So I think the first couple of
35:59
months I had like 20 pretty quickly.
36:03
I think I went up to like 20-30 pretty quickly.
36:07
I know that at six months we were like at 50 or so.
36:12
We were like 50 and we are currently like at 1:20.
36:20
But we are Pediatrics and a lot of we've had a lot of churn in
36:27
the last year or two. But we're talking like kids who
36:30
are like in college. And I was like, dude, you're
36:34
like a man with a beard now. And a.
36:36
Job you like, it is time. To go.
36:45
So that we've had a lot of patients age.
36:48
Out. So, so that's why it seems like
36:52
we haven't grown. The other thing is we've
36:54
increased our prices quite a bit.
36:55
So even though, you know, we're right now like about 120
37:00
patients, our revenue has increased dramatically because
37:04
our price points is that's the other thing.
37:06
You know, that's a whole podcast, I say.
37:08
That's like a whole. Other price, right, Yeah.
37:11
So, yeah, our revenue has increased dramatically, even
37:14
though our patient, our growth hasn't been like, Oh my gosh,
37:16
it's not. Well, we're never going to be
37:18
the practice that has 400 patients.
37:19
I don't want 400 patients. Yeah.
37:21
That's not with the way that you're practicing.
37:23
No, not with the patients you have.
37:25
No. Yeah.
37:25
So, yeah. So what I was thinking, what I
37:27
was trying to get to is, you know, when you had 20 to 30 to
37:30
40 patients, you know, that's that's doable.
37:33
You can answer the phone. Yeah.
37:35
You can answer all the messages. You can take care of all of
37:37
those things especially. I mean, did you have staff when
37:40
you opened? No.
37:41
No, I did not have staff until like 2 years later.
37:43
Yeah, so it was just you. Yeah.
37:46
At what point did you feel like this is getting a lot?
37:49
It's getting to be a lot. Well, you know, it's funny that
37:52
you ask because I get very anxious talking on the phone.
37:58
So it wasn't early on. It wasn't even an issue of I
38:01
don't have time because I had time, right?
38:04
I had a lot of time. I didn't have the emotional
38:08
bandwidth, right. And that's important to address
38:11
also. And I don't think a lot of
38:12
people talk about it is I did not have the emotional bandwidth
38:19
to be answering the phone and answering these questions and
38:21
being on the phone with someone and then to have them say you
38:25
don't take insurance or my gosh, your prices or what?
38:28
I just did not have it. So even when I had like, like my
38:33
text stack was, you know, it was a Google Voice number and
38:37
MailChimp and then Calendly so an e-mail.
38:40
So honestly, what I would do if somebody called, I would text
38:44
them back and say, what's your e-mail?
38:46
And I will send you information through e-mail.
38:48
I really did not want to be on the phone.
38:51
So, but it was still time consuming, right?
38:53
Because it I had to still do this manually.
38:56
So somebody would call or text, I would ask them their e-mail,
39:00
then I would send them this e-mail, right?
39:02
That oh, you know, this is about our practice.
39:04
And yes, I used a macro for that.
39:06
But you know, these are our prices, This is our model, this
39:09
is blah, blah. And then they would, you know,
39:11
some back and forth would ensue. So that was what I did early on,
39:16
but it wasn't, it wasn't so much because I didn't have the time,
39:18
it was because I just, it was just so anxiety provoking for
39:23
me. To Was that anxiety provoking
39:26
because you'd never been a business owner before?
39:30
Well, did you have? Your independent practice or
39:33
you? No, no, I was always employed.
39:35
I was in academics and then I was employed.
39:37
I definitely think there was some shame about price, my
39:42
price. And that's because I wasn't even
39:44
the high bad high ticket. I'm way more high ticket now,
39:46
but which is where mindset coaching with Doctor Una really
39:49
like helped, right? You know, not to feel that shame
39:52
about. So this is what I'm charging.
39:56
So yeah, so it was, I think part of it was shame about answering
39:59
the questions about pricing and that kind of thing.
40:02
And the other is I just don't, I just feel anxious talking on the
40:06
phone. Like if I have to schedule an
40:07
appointment, you know, I will. And I have a, you know, service
40:12
that uses online scheduling and one where you have to call to
40:15
make the the appointment. I'm going to use the one where I
40:18
just schedule online. I don't know it just so, but it
40:21
was it was a little bit of both, but the main.
40:23
One was some of that shame, which again, we we don't talk
40:28
about it very much, but it's important to talk about.
40:30
And I don't think a lot of people recognize that that's
40:33
what it is. Yeah, it took me a long time to
40:35
recognize it. Yeah.
40:38
And I think that it's also, you know, because people give you a
40:41
hard time. Yeah, about it.
40:44
Yeah. Yeah, and it's a normal
40:45
reaction. Right.
40:47
It's like, do you go to the grocery store and do you go to a
40:49
restaurant and be like, hey, this is yeah, you just take this
40:54
like, yeah. Because I have insurance, no.
40:57
Right, right, right. Yeah.
41:00
So, yeah, So for us, when we started out, I think probably
41:05
around like 60 or 75, you know, somewhere in that range is when
41:10
it started to feel like very. Heavy like.
41:14
It was getting over. There's a tipping point, yeah.
41:18
Yeah, yeah. OK.
41:19
So. I would say 50, yeah, 50.
41:22
Yeah, yeah, yeah, yeah, somewhere in that range.
41:24
And I think that's also what other people feel is.
41:26
Kind of, yeah. But we've talked about all kinds
41:29
of. Things I know.
41:30
This, I know, this was really, this is really, really good.
41:33
I'm so excited that you came back on and wanted to talk about
41:36
this, but I want to also give you a chance to talk about two
41:41
things. One your retreat.
41:44
In. October and then also the DPC
41:47
Women's Cafe. Yeah, so they're, and they're
41:50
both related. That DPC doc is the most
41:54
rewarding thing I've ever done. I love it.
41:56
But Oh my God, it is isolating. And especially where I'm at as
42:00
a, you know, pediatric DPC doc, there's I think 4 pediatric DPC
42:04
docs in Indiana and three of them are all in the Indianapolis
42:08
area. And then there's me way over
42:11
here. So it's, it's isolating.
42:14
And so I created DPC or founded DPC Women's Cafe as a way for
42:19
female physicians, female DPC physicians to come together and
42:25
commiserate and share and celebrate and connect.
42:30
So we have weekly on Fridays at noon Eastern, we just meet
42:35
virtually and chat. We chat about, you know,
42:39
everything, anything and everything, personal,
42:41
professional questions, cases. Actually today we're going to
42:45
talk about automations if you want to join us.
42:48
Yeah. So, yeah.
42:49
But it, but that's what it is. And it's, I have a newsletter
42:52
that I sent out. Again, it's all, it's organic.
42:54
It's not a drip or anything. It's.
42:55
And mainly I'll have links to like whenever I'm on a podcast
42:58
and talk about, I'll say, hey, I was on a podcast, you know,
43:01
here's the link to it or information on the retreat.
43:03
But that's what DPC Women's Cafe is related to.
43:05
That is the retreat. The retreat is, this is our
43:09
second year. It's in my little town of
43:12
Culver, IN and it has CME, right?
43:15
We're aiming for 12 hours of CME.
43:18
It's from October 15th through the 18th.
43:19
It is part conference, part retreat, all about DPC curious
43:25
or DPC practicing female physicians coming together and
43:30
discussing things that really nobody else on the planet
43:34
understands except us. So if we have and we are still
43:38
looking for speakers, if anyone out there is interested, we were
43:42
looking for like 3 or more, three or four more speakers.
43:45
But all meals are included. All meals are Whole Foods, plant
43:48
based. We're going to have yoga every
43:49
morning. It includes a massage, you know,
43:52
so everybody will get a therapeutic massage.
43:54
And then the content is all about physician well-being and
44:00
burnout proofing practices. So my keynote, I'll deliver the
44:03
keynote on gender biases in medicine and how that impacts us
44:07
and ways to mitigate those gender biases in medicine.
44:11
We're going to have a talk on compassion fatigue and
44:14
preventing compassion fatigue. We're going to have a nurse.
44:17
Beck is going to give a talk about cat and veggie and how we
44:20
apply the principles of lifestyle medicine in a
44:22
community based setting. Josh is going to talk about how
44:25
to onboard remote staff because a lot of DPC dots, yes, talk
44:30
about that. And then we're going to have a
44:32
talk about pricing AQ and a on pricing because I really feel
44:36
when we talk about burnout proofing our practices, we have
44:41
to talk about pricing. Yeah.
44:44
And that's definitely as a new business owner, like you're just
44:48
going to have to get comfortable.
44:49
With it is, yeah. And it's hard.
44:51
It's hard, especially when you know, what's funny is though
44:55
someone else was doing the talking.
44:57
Like, people think, oh, you know, doctors in the system
45:00
sometimes get a little sanctimonious about like, oh,
45:03
DPC, you charge people and it's like, well, you are too.
45:09
You just don't feel it. You are too.
45:11
It's your staff is doing it for you.
45:12
Oh, when I was in the corporate world, there were times that the
45:15
front desk tab would turn away my patients because either they
45:19
couldn't pay the co-pay, they their insurance had lapsed and I
45:23
never knew about it. I didn't find out about it until
45:25
later. They were doing it for you,
45:27
right? They were turning patients away,
45:29
you know, but but when you're in the corporate world, you can
45:31
kind of turn a blind eye to what's happening in at, at the
45:34
front desk. But yeah, like that, there's
45:37
only one way to get a paycheck, and that's charging people for
45:40
your services, whether it's insurance or yeah.
45:43
Right. Well, that's the thing about
45:44
when you leave insurance based employed medicine is you know
45:49
you are surrounded by a buffer. So you don't you don't see all
45:52
these things. And then when you go into DPC,
45:55
you don't have that buffer anymore and you have to absorb
45:58
all of it personally. So that's where I do think like
46:02
that's where systems come in, right, You know, and and why I
46:05
like app based or portal based ways of communicating more than
46:09
text because the text even lower, even removes A buffer
46:13
even more because people do get comfortable.
46:16
And in that, oh, I'm texting my friend baby and yeah.
46:20
Yeah. And then the text, even if you
46:22
don't, you know, you may not look at your phone, you may not
46:26
look at the text, but it lights up, right?
46:28
It lights up or it Dings and it interrupts you.
46:32
Your vagus nerve goes yeah. Exactly.
46:35
So yeah, you can't help that. And you're you're, you know,
46:39
redirect it and then you have to come back, right.
46:41
So then you have to kind of, it takes a minute to get back into
46:44
it. So there's all kinds of benefits
46:46
to that. So anyway, well, thank you so
46:49
much for coming. Well, thank you.
46:50
It's always fun, always fun to talk to you.
46:53
Enjoy it and I hope I get to make it today.
46:56
The last time we talked on the Women's Cafe, we did talk about
46:59
pricing. Yeah, yeah, so important.
47:01
We we've had some interesting discussions about pricing and it
47:05
is hard to have those pricing discussions with our male
47:07
colleagues because a lot of them don't understand.
47:10
It's just, it's just different, different.
47:14
Love my male colleagues, love my male colleagues, you know, But
47:17
yeah, there there is. There is differences, yeah.
47:20
OK, so I'm going to put all of those links in the show notes so
47:23
that people can find you and, you know, look at the retreat
47:27
and get signed up for the Women's Cafe.
47:29
Yeah. All right.
47:30
Well, thank you again. And hope to talk with you again
47:33
soon. All right, sounds awesome.
47:35
Thank you so much. Thank you for listening to DPC
47:44
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Until next time, keep building a practice and a life that truly
48:05
fits you.