Latest / DPC Life: Direct Primary Care Podcast / Zero Patients, One Hurricane, New DPC: How Dr. Lok Built River Rock (Twice!) from Scratch

Transcript

Zero Patients, One Hurricane, New DPC: How Dr. Lok Built River Rock (Twice!) from Scratch · DPC Life: Direct Primary Care Podcast

• 0:00
  I literally went into the woods for eight weeks into the
• 0:02
  survival school and told myself if I don't emerge from the woods
• 0:07
  with something better than DPC, whatever that is, then I'll just
• 0:11
  do that. You learn how to be a doctor.
• 0:12
  You don't learn how to be a networker.
• 0:13
  You don't learn how to be the one to put your labs in the lab
• 0:17
  court box outside. And I just thought the people,
• 0:21
  the five people I emailed someone would want to be a
• 0:23
  patient. Nobody responded, nobody came to
• 0:27
  my clinic. I didn't have a patient until
• 0:29
  six weeks of me paying rent at the clinic.
• 0:33
  Welcome to DPC Life, the podcast where independent doctors share
• 0:37
  real stories, bold ideas, and the freedom of doing medicine on
• 0:41
  your own terms. I'm your host, Doctor Ann
• 0:45
  Gonzalez, and together we'll explore the wins, the struggles,
• 0:49
  and everything in between. Let's dive in.
• 0:54
  So my guest today is Doctor Catherine Locke, a direct
• 0:57
  primary care doctor in Asheville, NC River Rock Clinic
• 1:02
  DPC. And we met first.
• 1:06
  We met on the phone I think a couple years ago, right before
• 1:08
  you came down. Right when I was calling you I
• 1:12
  think. You had before you started,
• 1:13
  Yeah, you were just, you had just moved or you're about to
• 1:15
  move. We met like on the, I think DPC
• 1:17
  docs or DPC women one of the groups.
• 1:20
  So thank you for being here. I appreciate it.
• 1:24
  Yes. So let's start out with you
• 1:26
  telling us about how you got into DPC and your story, because
• 1:32
  you started kind of differently from a lot of us do.
• 1:35
  Yeah, So mine started in residency.
• 1:38
  It was my second year. My worst week was and I quote
• 1:42
  148 patient hours in a week. It was during COVID.
• 1:46
  It was really tough. And I had, right after an
• 1:50
  inpatient rotation, a month of integrative medicine, only 40
• 1:54
  hours a week. And for one of our didactics, we
• 1:58
  had someone from Maine, I forget his name now, he's a big player
• 2:01
  in DPC, but he gave a talk on DPC.
• 2:04
  And I thought to myself by the end of that didactic lecture,
• 2:08
  OK, that's maybe an option. And then through the months, I
• 2:13
  couldn't figure out any other option, even when everyone else
• 2:17
  was getting too brown for fancy fellowships.
• 2:21
  Not internships, but fellowships.
• 2:23
  I had nothing and decided to do a big soul search.
• 2:27
  I literally went into the woods for eight weeks into the
• 2:29
  survival school and told myself, if I don't emerge from the woods
• 2:34
  with something better than DPC, whatever that is, then I'll just
• 2:38
  do that. I emerged from the woods, still
• 2:42
  no idea, so I said OK, I guess I'll go into DPC.
• 2:46
  Love it. And so you finished.
• 2:48
  Let's see. You said it was your second year
• 2:49
  of presidency when you heard about it.
• 2:52
  So. But yeah.
• 2:55
  And then so how did you end up planning your DPC?
• 2:58
  Were you from when you came out of the woods till you got here?
• 3:02
  Did you take some time off or what's?
• 3:06
  What's the clinic? Well, I moved with my now
• 3:12
  partner to Asheville, NC and I was just on all the Facebook
• 3:17
  groups. So in DPC culture, there's
• 3:21
  Facebook groups, there's DPC docs, which I think probably has
• 3:24
  5000 people, men and women, DPC women, which probably has 4000
• 3:28
  people, DPC newbies. My favorite, which maybe is 2000
• 3:32
  docs thinking about DPC. And so it was on their DPC
• 3:36
  alliance, I think has the, what is it, the DPC University.
• 3:41
  It's all free on their website. I listen just to hear stories
• 3:44
  because it was so bizarre to me. You learn how to be a doctor.
• 3:48
  You don't learn how to be a networker.
• 3:49
  You don't learn how to be the one to put your labs in the lab
• 3:53
  court box outside. I kind of had to learn all that
• 3:56
  and I certainly did not go into it knowing 20% of kind of what
• 4:04
  would have been ideal, but you just learn along the way.
• 4:07
  I'd spent months trying to learn it, but you just have to do it.
• 4:12
  You just have to open and learn all the.
• 4:13
  Way, yeah, My partner and I were just talking about that this
• 4:16
  morning, that there's you have the books, you have the Facebook
• 4:18
  groups, there's, you know, the DPC university.
• 4:21
  But then until you get into it, there's something we just don't
• 4:24
  know. It just happens.
• 4:29
  Yeah, which you don't have in the insurance model because you
• 4:32
  have all this help and everyone else knows their roles, but in
• 4:35
  DPC, very empowered and you just figure it out and.
• 4:38
  It's, yeah, you're right, It really is.
• 4:40
  It's a very simple, a simple model.
• 4:43
  It's really. Financial model of patient pay
• 4:46
  through 100 or so dollars a month and you give them direct
• 4:49
  access to them and appointments. It's very simple.
• 4:51
  So you came to North Carolina, you got your clinic open, you
• 4:55
  were starting to come along, and then Hurricane Helene hit.
• 5:03
  Yeah, well, even worse than that.
• 5:05
  I first opened and I had a list of five people who said they
• 5:09
  might want to be interested. So I when I opened, it was just
• 5:12
  that I published my website, I had the clinic, I published the
• 5:16
  website. Nobody came.
• 5:18
  And I just thought the people, the five people I emailed
• 5:21
  someone would want to be a patient.
• 5:23
  Nobody responded. Nobody came to my clinic.
• 5:27
  I didn't have a patient until six weeks of me paying rent at
• 5:31
  the clinic. So terrifying.
• 5:34
  I mean, the whole process of doing quite terrifying.
• 5:36
  It took me a year of convincing myself and building trust in
• 5:40
  myself before I could even open the clinic.
• 5:42
  And then when you open it, though, shoot, I messed up in
• 5:45
  this, in this, in this way. We had a series of unfortunate
• 5:48
  events. One I opened without any
• 5:50
  patients and without any wait list, which I wish I would have
• 5:53
  done and encourage other people to do if they're opening.
• 5:57
  And then we had a hurricane that destroyed my clinic.
• 6:01
  Flooded at 3 feet, had a life threatening car accident at one
• 6:05
  point. All these like horrible things
• 6:07
  happened after opening my dream clinic.
• 6:09
  So then how did you recover from all those things?
• 6:15
  For me, it was the people, the people around me, my friends a
• 6:20
  little bit, my family, my partner, all the networking that
• 6:23
  I'd done to get patients. They're the ones that kind of
• 6:27
  came through for me when my business was flooded and I had
• 6:30
  to scrape mud off my table when I had a car accident for my
• 6:35
  grand opening and had a 5 inch scar with multiple stitches.
• 6:40
  Like they came out and they were helping me with the gift raffle
• 6:43
  and getting the food. It was really my business
• 6:46
  colleagues that I've networked with because in DPC, especially
• 6:49
  if you're a micro practice, which means you're just a doc or
• 6:52
  just a doc with an MA, it can be a little isolating.
• 6:54
  And so for me, my business community and my work community
• 6:58
  is really my colleagues with other clinics, acupuncture,
• 7:02
  other teams, really supportive, not to mention guests partner.
• 7:06
  She nursed me that to help. So then after you had to move,
• 7:09
  you got a new space, correct? That you're seeing now, yeah.
• 7:14
  I love it. Thank you.
• 7:17
  It's actually a jungle. When I take patients back, I say
• 7:19
  come on out of the. Jungle.
• 7:21
  So one thing that in particular I wanted you to talk about was
• 7:25
  the process coming from residency.
• 7:27
  How did you prepare? Did you specifically pick
• 7:31
  certain rotations, things like that?
• 7:34
  Because as a resident going straight into practice, I mean,
• 7:37
  you really know very little about regular practice.
• 7:43
  Yeah, I would say the answer is no.
• 7:45
  I didn't do any special rotations in Med school.
• 7:48
  I'd heard about DPC and then I thought to the person who
• 7:52
  suggested it, wow, do you think I'm really that posh?
• 7:56
  Because I didn't understand it. I thought it was for a certain
• 7:59
  level income. I thought it was more concierge.
• 8:01
  That's so much DPC as and then residency.
• 8:05
  I wasn't even sold on it really. And so I really didn't do any
• 8:09
  DPC rotations. I didn't shadow anyone the
• 8:12
  summer after residency. A lot of people take off and I
• 8:16
  interviewed maybe 3 DPCS in Portland, ME and none in
• 8:20
  Lewiston, ME where I did residency.
• 8:23
  Started reading the books, getting on the Facebook,
• 8:26
  listening to the podcasts and just learning.
• 8:29
  So what has been your favorite part of DPC so far?
• 8:34
  I would say if I were to be as honest as possible, it would be
• 8:38
  the creativity, like as a business owner, which I never
• 8:43
  thought I'd be prior to opening my clinic, feels like an
• 8:47
  extension of my creativity. I can make it whatever I want.
• 8:51
  For example, today for this podcast, I wanted to feel
• 8:54
  present, so I took a walk around a lake 5 minutes away and then
• 8:58
  I'm just going to do my bookkeeping later in the
• 9:00
  afternoon. Like I can just shift it and
• 9:02
  have what to me feels like a really meaningful life.
• 9:05
  Like at the park today, when I went there, I was able to watch
• 9:09
  the fountain have its water kind of spray to the right, and I
• 9:13
  could see that passage of time. And to me, that is very mean,
• 9:17
  yeah. Definitely.
• 9:19
  And what about you kind of talked about something that did
• 9:23
  not work opening no, no patients.
• 9:28
  What would you have done differently?
• 9:30
  OK, If you're going to open up ADPC or even thinking about it
• 9:33
  as you're making your website, start making a wait list.
• 9:38
  So have people sign up to be on your wait list so that when you
• 9:42
  do get close to the opening maybe a month prior.
• 9:45
  So hey, you can schedule your meet and greet starting on this
• 9:47
  day, the complimentary meet and greet which a lot of DPCS do.
• 9:51
  And so when you open up, you won't have zero patients.
• 9:55
  That's, I mean obviously you have patients now.
• 9:57
  So how did you get those patients?
• 9:59
  What seemed to work best? Networking.
• 10:02
  Yeah. I mean I'm in a medium sized
• 10:03
  town of 95 ish 1000 people, so really word of mouth.
• 10:07
  So I joined a networking group called B and II went to various
• 10:13
  networking groups in Asheville of creators, not so much
• 10:16
  actually, more like health professionals or mental health
• 10:21
  or the chamber I joined and I just try to meet as many people
• 10:25
  as possible. I learned my one minute elevator
• 10:28
  speech. But really it's not so much
• 10:30
  about that. It's just about a human knowing
• 10:33
  you enough to trust you to possibly refer.
• 10:36
  Who's been your best referral sources now?
• 10:39
  I see it's so scattered. I know a lot of, I do
• 10:42
  integrative medicine, so I would say a lot of it's like
• 10:45
  acupuncturist, massage therapist, mental health
• 10:48
  therapist. Recently I've been getting into
• 10:51
  SEO, search engine optimization, where you have to put certain
• 10:55
  words on your website, you have to post blogs every two weeks.
• 10:59
  And just 'cause I want to grow faster and I found that to be
• 11:03
  really high yield for me. Maybe it's just by chance, but I
• 11:07
  felt like it worked. Within a month or two.
• 11:09
  I scheduled blog post every two weeks.
• 11:13
  And I didn't just ChatGPT them like I try to make them
• 11:15
  Asheville specific. The best blog was primary care
• 11:19
  physicians taking patients in Asheville.
• 11:22
  And yeah, a myriad of other things.
• 11:25
  But for me it worked well. Well, that's great.
• 11:27
  Yeah, the Sao, it's not hard. It really isn't.
• 11:31
  It's just taking the time, like the blogs to do the blogs.
• 11:35
  And now, yeah, the AI is so easy to do them and you definitely
• 11:39
  want to edit them, put your own spin on it, make it specific to
• 11:44
  your area. Otherwise people can spot it
• 11:47
  very quickly. This is AI, but yes, the blogs
• 11:51
  help immensely. And then on the back end, like
• 11:54
  within the website, you can put your keywords, things like that.
• 11:58
  It's again, it's not hard. It's just something that if
• 12:00
  you've never done it before, you just don't know where or how
• 12:04
  what to do. And I didn't even start looking
• 12:08
  at SEO until now. It's been 2 years in private
• 12:11
  practice. But I I think it for me from my
• 12:15
  perspective, rather it falls in the category of things you just
• 12:19
  learn as ADPC Dr. that's not super essential, but you just
• 12:22
  learn along the way. Earlier you said coming out of
• 12:24
  residency you might not know a lot about practice.
• 12:27
  But I'll also add as a doctor in America under insurance, people,
• 12:32
  doctors don't know much about medicine in America.
• 12:35
  They don't know how to get affordable medication.
• 12:38
  They don't know how to fight for patients.
• 12:41
  Prior off a little bit maybe, but some of it's like you now
• 12:45
  have the time to advocate for patients and I think perhaps we
• 12:50
  are all learning that no matter how.
• 12:52
  Long, yeah, I mean absolutely. I think before we started
• 12:55
  learning about DPCI mean people would say my labs cost so much
• 13:00
  and I'd be shocked because I had no idea.
• 13:02
  I mean, I had no idea how much labs cost.
• 13:04
  And then once you Start learning about client build labs and
• 13:08
  seeing how inexpensive they are compared to actually what's
• 13:12
  billed, yeah, it's just again, it's hard to Unsee once once you
• 13:17
  know about it. Yeah, I think I needed the cost
• 13:19
  of 1 lab in residency and that was the CBC in the hospital.
• 13:23
  I think it cost $41 or $20 and now I know at LabCorp a private
• 13:30
  company costs I know at roof out insurance free one it costs
• 13:33
  $4.00. You just learn along the way.
• 13:36
  It's. I mean, it really is sad.
• 13:37
  It's very sad that we didn't know about that.
• 13:40
  And I mean, how are we going to help our patients if we can't
• 13:44
  even understand it ourselves? Right.
• 13:47
  Or advocate on a policy level like with AFP on the state or
• 13:52
  national level. We don't understand the
• 13:54
  legalities around higher offs and how cheap medicine and
• 13:59
  primary care can be. How can we advocate?
• 14:01
  So it definitely is. There's a lot of education still
• 14:05
  needed, yeah. And for myself, I'm still
• 14:09
  learning 2 years and it's. Always still learning new
• 14:11
  things. And I'll see, the second thing
• 14:15
  that I love about DPC is time. Well, for example, I had a
• 14:19
  patient with HIV, he's been on a prescription stable for a couple
• 14:24
  years. I don't know if it was residence
• 14:27
  thing or family doc thing, but I've never treated it kind of
• 14:30
  refer to ID for those medications.
• 14:33
  But now I had time to go on curbsiders podcast and look at
• 14:37
  some CME, maybe do an hour online of video since as
• 14:40
  patients, they're all members. So he'll probably be with me for
• 14:43
  a year. So it's it's worth the time and
• 14:45
  it's really exciting to be able to not throw everything to
• 14:49
  specialties just because you don't have time, nothing to do,
• 14:52
  but just because there's not enough time.
• 14:55
  That's very true. And you know, people talk about,
• 14:59
  well, if you all these doctors leave primary care right to or
• 15:03
  in the fee for service to go into DPC, what happens then?
• 15:07
  You're not going to have enough doctors in primary care.
• 15:10
  Well, it's. Obviously it's a process, but if
• 15:13
  you think about if you're have all these people who are doing
• 15:16
  direct primary care in such a higher level way of treating
• 15:19
  patients, these specialists are not going to be as busy.
• 15:23
  If you can build and create and develop more and more direct
• 15:27
  primary care doctors, then those people who would have gone into
• 15:31
  those specialties, If they see that primary care can be done in
• 15:36
  a way that is not soul crushing and you can have a good life and
• 15:41
  you can, you know, create your practice the way you want it,
• 15:44
  then it all will balance out. I mean it's you're to guess what
• 15:49
  percentage less specialty referrals do you have to make in
• 15:55
  DPC? Versus, I mean, Boyd, there's
• 15:57
  some that obviously you have to, right.
• 16:01
  I don't do a lot of referrals anymore.
• 16:04
  I really don't. Same very rare like maybe
• 16:08
  cardiology for a tilt test if they really want like a pops
• 16:11
  diagnosis. But really maybe dermatology if
• 16:15
  they have history of Melanoma. But.
• 16:17
  Rarely and usually in previous practice, I would think, all
• 16:21
  right, so three strikes. If I try something three times,
• 16:24
  I can't figure it out. You're out.
• 16:26
  That three strikes has been lengthened.
• 16:30
  Now it's more than three at this point because we the, yeah, a
• 16:34
  few. But yeah, definitely.
• 16:36
  I just don't refer as much to specialist because, yeah, the
• 16:39
  time you're like, well, I do know about this and I have time,
• 16:42
  so let's work on this. We're so well trained as
• 16:48
  physicians, our training is still a lot do it.
• 16:51
  In primary care, just such broad spectrum.
• 16:53
  So definitely, well, you mentioned Rupa Health and that's
• 16:57
  something I've heard about before and I know that it's a
• 17:00
  lab service. Tell us more about that.
• 17:03
  Yeah. So Rupa Health is a private lab
• 17:06
  company just like LabCorp, except they're all online.
• 17:10
  And so you can't go to a like you could a LabCorp in your
• 17:15
  town. But what's cool about them is
• 17:18
  they compare, I don't know how many, like 15 to 100 labs.
• 17:23
  So not just LabCorp for prices. So for example, Cbci think on
• 17:28
  there's 4 bucks that LabCorp for me, your client billing where
• 17:31
  you pay the bills. So they give you, I think, I
• 17:35
  don't know, LabCorp is maybe 20 bucks.
• 17:38
  And so it's really cheap. Yeah, it's really cheap.
• 17:41
  They have like hormone testing, which I know you're more into
• 17:43
  the menopause hormone stuff. They have hormone testing, more
• 17:46
  functional tests, which I'm just starting to get into.
• 17:50
  But no insurance is a caveat which half the time I just made
• 17:55
  that number up, but half the time it's cheaper to not use any
• 18:00
  insurance for that. Definitely.
• 18:03
  Lab paper First off and then you also pay less but you can send
• 18:11
  them to LabCorp if you choose their LabCorp option or you can
• 18:14
  draw them for RIP office as well.
• 18:16
  For Ripa Health, OK, so then LabCorp will draw it and then
• 18:20
  send it off to Ripa Health. Is that how it works?
• 18:23
  That's one way. The other way is your office
• 18:25
  draws it and then you send it in.
• 18:26
  The mail, SO and all the stickers.
• 18:32
  They give you everything, Yeah, if you don't send.
• 18:35
  Them to the LabCorp. What's the turn around then for
• 18:38
  your labs if you're sending to RIPA Health?
• 18:41
  I've only done it maybe two or three times, but they use
• 18:44
  Labcorps depending on the lab. You can choose which lab was in
• 18:48
  RUPA and you can actually choose LabCorp and it's about the same,
• 18:52
  maybe a couple days later than LabCorp.
• 18:56
  Yeah, I asked you the question and I, I forgot to listen.
• 18:59
  Did you say? No, actually I don't know.
• 19:02
  I'm not sure if they are on DPC Alliance.
• 19:03
  We use healthcare procurement solutions and I know if we do
• 19:09
  our you kind of like your annual lab panel, for example.
• 19:14
  And we don't mark up, I think we mark up our labs like 10%, which
• 19:17
  is $0.05. Yeah, it's very, very small,
• 19:20
  about $2025 for a lipid ACMPACBCTSH, maybe an A1C in
• 19:27
  there, I can't remember. But yeah, it's not, it's not a
• 19:30
  lot. It's definitely worth it for
• 19:33
  people with a high deductible, Yeah.
• 19:35
  We'll. Figure that out.
• 19:37
  Order. Yeah, so you mentioned earlier
• 19:40
  about being a micro practice and it's a lonely life for a DPC
• 19:45
  doctor if you are alone, even if you have an MA, you know, that's
• 19:48
  a different level of education. So it's not quite the same
• 19:51
  thing. And So what you've done is
• 19:54
  you've started our DPCNCSC women's FEM group Zoom once a
• 20:01
  month, which is awesome. I've really enjoyed it.
• 20:07
  Along with your help. So this was after the hurricane
• 20:10
  of being completely destroyed, volunteering for two or three
• 20:13
  weeks, like my patients didn't need anything because we were
• 20:16
  all literally just trying to get water and feed our neighbors.
• 20:20
  And afterwards, it was such suffering truly in Ashford,
• 20:25
  North Carolina. But afterwards, for the next
• 20:28
  year, it's now been a year since the hurricane.
• 20:30
  I've been on this journey of learning mutual aid, just
• 20:34
  finished this book here called Mutual Aid by Dean Spade and
• 20:39
  started just my own versions. Dipping my toe, I started this
• 20:43
  medical mutual aid table. We have Narcan, fentanyl test
• 20:46
  strips, COVID Diva cups. My members drop by pill bottles
• 20:51
  they're not going to use, diapers are not going to use.
• 20:53
  And then other members and their family members and kids can pick
• 20:56
  it up. I do veteran disability exams
• 20:59
  too, so my vets can also benefit from it.
• 21:02
  That's a small way of doing medical mutual aid, but it's
• 21:05
  this whole idea that you don't need to compete.
• 21:08
  With each other. Play DPCS in the state of North
• 21:11
  Carolina, where 30% of patients don't have a primary care
• 21:15
  doctor. We are not in competition with
• 21:17
  each other. And that is a constant learning
• 21:20
  for me too, because we get used to this idea of competition and
• 21:25
  being ahead of the crowd. And some of that's true.
• 21:28
  We are in capitalism. That's just a fact, an economic
• 21:31
  fact. But there's another piece of
• 21:34
  humanity, which is collaboration actually to get stronger and get
• 21:37
  ahead with each other. And so that inspired me to have
• 21:42
  monthly women's circles with North Carolina DPC doctors.
• 21:47
  And we went from, I think having four people the first time in
• 21:50
  March to our last two had 9 or 10 people.
• 21:56
  And it's a great group because there are some more seasoned DPC
• 22:00
  doctors there. And then there was one who was
• 22:03
  just thinking about, she's not quite there yet, but she's
• 22:06
  thinking about going into DPC. So it was a nice spectrum to be
• 22:11
  able to give a good, you know, kind of background 10,000 foot
• 22:16
  view of DPC to her in particular.
• 22:20
  Yeah, right. Like it feels so good to be able
• 22:23
  to help other people who are wanting to get possibly, oh, I
• 22:26
  don't know, but possibly out of their employed positions and
• 22:29
  make that huge leap for me, women's circles and becoming
• 22:35
  more and more a part of them. I believe that as women, we do
• 22:37
  things differently. We're more involved with our
• 22:39
  patients. Our patients feel more
• 22:41
  comfortable reaching out to us more frequently and more in
• 22:44
  depth, getting more into the root cause of their disease.
• 22:47
  I truly believe that US women doctors do things differently
• 22:51
  and so for me, hosting these women's group is a way for me to
• 22:57
  relearn that as women, we do have power in this world and it
• 23:01
  is very. And so that is, and it didn't
• 23:04
  take much to kind of launch that we just started it on Zoom and
• 23:11
  all you got to do is collect the emails and invite people.
• 23:13
  So if anyone's listening different states, if you want to
• 23:17
  start doing this, it's very simple.
• 23:20
  If you want to have one on your state, just because I think most
• 23:23
  states have at least a couple of DPCS.
• 23:26
  There's one, was it Montana was the last one I think to have a
• 23:29
  DPCI, can't remember maybe. Somewhere in the Dakotas, maybe?
• 23:32
  But most states have more than just one DPC.
• 23:36
  Yeah, if you're DPC and isolated start one.
• 23:39
  I literally just Excel sheet and zoom link and if you're in North
• 23:45
  Carolina, join us just. Shoot and Catherine does a great
• 23:48
  job. She will have a topic and then
• 23:51
  moderate. And so, yeah, you do, you really
• 23:56
  do a nice job with that. I'm learning.
• 24:01
  I'm actively learning the skills of facilitating.
• 24:03
  Oh, it seems like it. And then you were able to get a
• 24:06
  Doctor Phil SQ on, which was awesome.
• 24:11
  Yeah, he's famous of DPC world, right?
• 24:13
  He's kind of famous in the world, and he was telling us
• 24:16
  about national trends for this year.
• 24:19
  DPC has actually been really benefited by national policy.
• 24:23
  For example, you can now officially use your HSFSA for
• 24:29
  membership. And then next year, there's lots
• 24:33
  of things in the pipeline, but nothing's for sure good or bad.
• 24:38
  Things are always changing. But yeah, it was a nice update
• 24:41
  and I was glad he was there because I told the group that
• 24:43
  we're hiring a nurse practitioner now and we had a
• 24:46
  question about does she have to opt out of Medicare?
• 24:51
  And I had gotten some varying answers, like reading off the
• 24:55
  Facebook groups. And so that was perfect.
• 24:58
  I thought if anyone is going to know it's going to be Doctor SQ.
• 25:06
  OK, so you're hiring an Anthony for nurse who are coming out of
• 25:10
  residency or Med school right now, And if they're thinking
• 25:14
  about joining ADPC practice rather than starting their own,
• 25:18
  is that someone you'd consider? Hiring, sure.
• 25:21
  I think you're at a little bit more of an advantage being in
• 25:23
  Asheville because it's a great place.
• 25:26
  I think a lot of people really want to be there, so it's an
• 25:29
  easier draw where where we are is pretty awesome too.
• 25:32
  It's just not as big and you kind of have to find the right
• 25:36
  person to move, especially if you're young and you're coming
• 25:40
  out of residency. If you're single, I'm sorry,
• 25:45
  you're probably going to want some place that's bigger.
• 25:49
  I mean, that's just how it is. Maybe, maybe not, But yeah.
• 25:53
  And I will say we did a mediocre job of trying to recruit a
• 25:59
  doctor. We didn't put as much effort
• 26:02
  behind it as we could have, but we did some.
• 26:06
  What would you have done this? Yeah, probably more proactively
• 26:11
  going to the residencies around us, North Carolina, Virginia,
• 26:15
  South Carolina. The big institution which
• 26:18
  residencies are often a part of the big corporate medicine
• 26:21
  institutions and hospital systems have some loan repayment
• 26:25
  often are like profit if you're PSLF.
• 26:28
  Loan requirement. So I feel like take PC
• 26:31
  commanding not I'm not aware of any and I'm not aware of us
• 26:36
  actively having any movement in that area trying to solve.
• 26:41
  That. With getting new like I don't
• 26:46
  know of any nonprofit DPCS off the top of my head that you
• 26:49
  could go work for one still qualify for PSLF for example.
• 26:52
  That's a good question. There are few nonprofits, but as
• 26:55
  far as are they able to provide that?
• 26:59
  That's a good question. Yeah, I feel like that's
• 27:02
  probably inhibiting a lot of young dogs from joining DPC,
• 27:07
  starting their own urge. Yeah, But definitely joining.
• 27:10
  I think if I'd known there was ADPC that was already
• 27:13
  established in our area then I might have joined instead.
• 27:19
  Definitely. I mean even in Nashville we have
• 27:21
  a very high percentage, like per capita of DP CS.
• 27:24
  I know at least one who's definitely hiring and I think
• 27:26
  all of them are open to hiring, including myself so.
• 27:31
  Are you ready to hire another physician?
• 27:34
  Not yet. I'd love to hire another doc
• 27:36
  who's a different generation than me too.
• 27:39
  Maybe in a year or so or half a year or so.
• 27:42
  And different generation I would like.
• 27:43
  Older just to diversify my practice and it's just would be
• 27:48
  really incredible to run things past them, right?
• 27:50
  Like in DPC gives so much time to research stuff and she's so
• 27:54
  really sure. But would be really nice to have
• 27:56
  an older doc just need to say, hey, does this plan generally
• 28:02
  sound pretty good? Yeah.
• 28:04
  Yeah. And I appreciate having a
• 28:06
  partner that it's to talk to at the practice to say, hey, what
• 28:11
  about this and vice versa. Yeah, sounds good.
• 28:14
  But let's take a look around your office if we can.
• 28:17
  Yes. Hello tour, I'll give you the
• 28:20
  tour that I give all my patients on the 1st.
• 28:21
  And then like, let's describe it to for people who are on audio
• 28:25
  only. Yes, good podcast doctor.
• 28:33
  So they walk into this door. Here is.
• 28:35
  Double door. And they come into the show
• 28:37
  jungle with all these plans. There's a little waiting room.
• 28:40
  And then I got throughout the couple years come up with
• 28:43
  different materials. For example, I print my patient
• 28:46
  membership agreement all the offerings so that they know that
• 28:50
  get I have medical mutual aid table.
• 28:54
  A fountain is usually. On It's one of these people of.
• 28:56
  Great. Wall fountains That looks very
• 28:58
  relaxing. Yes, and it's I inherited it.
• 29:04
  I could never have afforded it, but it's still relaxing.
• 29:06
  And if I don't turn it on, then patient oh really sad and asked
• 29:09
  me to turn it on so you can hear us on.
• 29:13
  So you're having a patient like wine and I bring them over to
• 29:17
  this tea station and say while you're waiting, please feel free
• 29:20
  to get some tea. That's some lotion.
• 29:22
  Local tea is what I show them how to be because their weights
• 29:27
  are literally 10 minutes if not 2 minutes.
• 29:30
  Yeah, but and the weighting room is not big.
• 29:32
  There's four chairs in there. Yeah, Yeah.
• 29:35
  But it's a nice size, yes. And then I leave them to this
• 29:41
  room, which is a little bit bigger, which is my office.
• 29:44
  I say all appointments are 45 minutes on average.
• 29:48
  I show them then everything that's included in the
• 29:50
  membership. I say here's my medical exam
• 29:53
  table, which isn't even medical. It's like APT table, but it
• 29:56
  works. So I do osteopathy on there
• 29:59
  'cause I'm in DLI. Show them the microscope here.
• 30:02
  If they're uninsured, we can do things.
• 30:04
  Microscopes. Oh, Speaking of all this stuff I
• 30:07
  did not start out with by the way, and I'm showing you I
• 30:10
  collected a lot of it throughout the last week.
• 30:12
  Don't feel like right all this you do not need less.
• 30:14
  That I'm jealous she's got a. Brine Mill.
• 30:18
  Amazing. So it's a mini cryotherapy gun.
• 30:22
  This one took me a year and. 1/2 Oh, so you bought it straight
• 30:25
  out from the manufacturer? Oh my gosh.
• 30:27
  No I was able to get it used but you have to get the tank so it's
• 30:30
  still like 2. Or 30, right?
• 30:31
  And then you have to get the tank refilled because it
• 30:33
  evaporates. Exactly.
• 30:35
  And then I'm leading you to my back office and I just show
• 30:39
  patients the lab area. I show them the pap smear stuff,
• 30:43
  I show stitches stuff, I show them point of care labs, Abscess
• 30:48
  drainage stuff, STI testing, just so they know what's all
• 30:51
  included in the membership and that we can take.
• 30:53
  Care of and that was just a little storage area with some
• 30:55
  shelves and everything is stored back there.
• 30:59
  Draw them just right there in your exam room.
• 31:02
  I do it in my exam room. I hire a mobile phlebotomist to
• 31:07
  come every other Thursday. I get bigger.
• 31:10
  I would love to hire a nurse who has phlebotomy skills and have
• 31:13
  her every day. Yeah, that's interest.
• 31:15
  So I don't know of anyone who, I'm sure there's people who do
• 31:19
  it, but I hadn't heard of hiring a phlebotomy service.
• 31:22
  I imagine just it has to be probably a bigger city that you
• 31:25
  can do that. Yeah, I think she might be the
• 31:28
  only one in Asheville, NC, whose mobile you'd have to Google
• 31:32
  mobile phlebotomy services. And then and I paid $40 a draw,
• 31:39
  which is a lot. That's like half of the
• 31:41
  membership for a month. But it's a whole lot cheaper
• 31:43
  than paying a nurse. And I'm not ready for one thing.
• 31:46
  So how many lab draws do you do a week, you think?
• 31:50
  Anywhere from it's every other week, so on laugh call days,
• 31:54
  anywhere from 1:00 to 6:00. Yeah, and they just schedule
• 31:58
  through you. Schedule through me.
• 32:02
  Yeah. Well, that's I tried to learn
• 32:04
  how to draw blood. I was really good at it at the
• 32:06
  beginning, and then somehow I got really bad at it.
• 32:09
  I want the best for my patients. I don't want them to be
• 32:12
  traumatized. A lot of them come from medical
• 32:14
  trauma, so for me that's one of the things that's worth it for
• 32:18
  me to pay. Yes.
• 32:20
  And we don't draw labs currently.
• 32:23
  We're trying to get it. We're trying to hire a nurse
• 32:26
  eventually to do that for us too, but similar.
• 32:29
  Yeah, we've been talking with a nurse and oh, this is one thing.
• 32:33
  So the nurse practitioner that we're hiring, she used to work
• 32:36
  with us or we all used to work together at the same practice.
• 32:40
  So we know her very well. And this other nurse that we are
• 32:43
  hoping crossing fingers to hire to do lab draws and some other
• 32:46
  stuff, some intake and some other stuff around the office.
• 32:50
  She was my assistant like in 2011 at my previous office.
• 32:55
  Yes. So she was my assistant.
• 32:57
  She had started out in the lab and then was the CMA and then
• 33:00
  she went to nursing school. And this is great.
• 33:03
  She and her daughter graduated in the same nursing class.
• 33:08
  Oh wow, yeah, I feel like the DPC Dachshund, I know,
• 33:12
  especially ones that didn't do a ride out of residency, that's
• 33:15
  almost always the story, is that the help that they found was
• 33:18
  from their insured practice. And that's like the best way to
• 33:23
  do it because you know exactly. What you're paying for, there
• 33:26
  were a lot of stories and I think it's certainly there's
• 33:28
  some practices fee for service practices have non solicit
• 33:32
  clauses for the employees as well.
• 33:34
  So that's something you kind of have to probably wait it out,
• 33:38
  but that makes sense. If you leave and you're starting
• 33:43
  on your own, there's a good chance you may not be able to
• 33:46
  afford someone initially. So that if there isn't a time
• 33:49
  period like one year or something, then by then maybe
• 33:53
  you're at the point where you can hire someone from your
• 33:55
  previous office. Yeah, 90% of what I say today is
• 34:01
  off services that I didn't have when I first opened.
• 34:03
  Like at first I sent everyone to question LabCorp.
• 34:07
  I didn't have $40 a day to hire phlebotomist.
• 34:12
  Definitely. So is it $40 a draw or $40 a
• 34:16
  session? A person, Yeah.
• 34:20
  So yeah, it's an investment in time as well for you that you're
• 34:24
  not using that time to draw and process all of that.
• 34:28
  Exactly because you'll draw their blood.
• 34:30
  Have to set a timer for 30 minutes, spin it for 15 minutes
• 34:34
  and take it out. Make sure it's labeled to
• 34:35
  identifiers. Request it to the lab, put it in
• 34:39
  the box. It's a lot.
• 34:40
  When I was starting it was nothing and all the time.
• 34:43
  Now, yeah, you definitely have more going on.
• 34:45
  I was going to ask you about OMT because you're ADO.
• 34:49
  Are you still doing it? Yes, I do osteopathic manual
• 34:54
  therapy maybe once or twice a week, three times if the most.
• 34:59
  More so to just add diversity to my work and a hands on skill
• 35:04
  which I think is really important especially in the
• 35:06
  upcoming AI culture. For members it's really
• 35:10
  discounted. I think usually OMT is hundreds
• 35:12
  and hundreds for non members. It is $200 for my clinic but for
• 35:16
  members it's 125 which is the cheapest you'll find.
• 35:19
  It's more of a service for my members who.
• 35:21
  They love. It they love it.
• 35:22
  Do you get a lot of non members coming in for OMT?
• 35:27
  It's a minority, but they definitely do come in Asheville.
• 35:30
  There's hardly any D OS who are actually practicing OMT and so
• 35:35
  people are looking. For and then when they come in
• 35:38
  for OMT, do they come and join your practice?
• 35:42
  I think they almost all have except one.
• 35:45
  Yeah, that's funny. I hadn't realized that.
• 35:47
  Yeah, 'cause I mean, you walk in and it feels so much different
• 35:50
  than the usual clinic. So for anyone who's thinking
• 35:52
  about starting, that's one way, you know, to get people in the
• 35:56
  door. Oh.
• 35:57
  Good idea. Yeah, yes, absolutely.
• 36:01
  It's becoming more and more rare. 3% I think now is the
• 36:04
  number of deals actually do own team.
• 36:07
  So that would be huge to get people on.
• 36:09
  There, I didn't realize so low. I think it's something that's
• 36:12
  suffering because of fee for service.
• 36:13
  There's no time for it. Yeah, which is odd.
• 36:16
  I think you can double bill it as A9214 plus feature cone.
• 36:21
  Yeah, it does take time, yeah. All right.
• 36:24
  Well, I appreciate you coming on.
• 36:27
  I do so much and I would love to have you back on maybe in six
• 36:31
  months, a year and kind of just catch up, see where things are,
• 36:34
  what you're up to would. Love it, nurse.
• 36:37
  Somebody with you? I.
• 36:38
  Think, well, hopefully that'd be amazing, but also shove it to
• 36:41
  you. And because you inspired a lot
• 36:44
  of like this whole building the community in DPC like that was
• 36:47
  modeled by you and you doing this podcast and offering it
• 36:50
  free to everyone. When we started, initially
• 36:55
  thought about like MSO trying to help people in that way, but
• 36:58
  that just got very complicated sounding.
• 37:02
  This, this is definitely, I mean, I'm loving the podcast
• 37:05
  thing. It's a nice way to be able to
• 37:06
  reach people without huge amounts of effort.
• 37:09
  And so valuable to see the personal side of DPC.
• 37:13
  Is there anything that you want to tell the listeners?
• 37:17
  Yes, if you're coming out of residency, just do DPC, talk to
• 37:22
  DPC docs in your area and specifically talk to people who
• 37:26
  came out of residency like myself or did it just a couple
• 37:29
  years after. You can shoot me an e-mail, my
• 37:32
  email's public and if you're in Med school thinking about DPC,
• 37:36
  continue doing it. Maybe do ADPC rotation out of
• 37:38
  and. You have.
• 37:39
  Yeah, you have. Med students and.
• 37:40
  Residents come through, right? Yes, I love learners.
• 37:44
  Even in residency I loved it and they do a lot for me.
• 37:47
  They help me with some of the business stuff.
• 37:49
  So it's the Med. Students in residence, reach out
• 37:51
  to your local DPC docs because I cannot think of one who would
• 37:55
  refuse you. Definitely agreed.
• 37:59
  OK, so tell us how to find you. Doctor Locke at River Rock and
• 38:04
  my e-mail is on that website. If you're a patient looking for
• 38:08
  a meet and greet, Ioffer a complimentary meet and greet.
• 38:11
  If you just want to talk DPC, shoot me an e-mail.
• 38:13
  Good. Thank you so much.
• 38:15
  Thanks. Again, for joining me on DPC
• 38:17
  Life, I hope you enjoyed hearing.
• 38:19
  About Doctor Locke's. Experiences of starting her DPC
• 38:24
  straight from residency. So.
• 38:26
  I hope that this will help other.
• 38:28
  Other residents and maybe other physicians who are already in
• 38:32
  practice and. Maybe we'll tip you over.
• 38:35
  And get you started on your own DPC journey.
• 38:39
  And make sure to tune in next. Week where I have a special
• 38:42
  guest. She's an inspiration to many DPC
• 38:45
  doctors and also physician. Entrepreneurs all across the.
• 38:49
  Country and even the world. So please come back and listen
• 38:53
  to next week's episode and I'll see you then.
• 38:56
  Thank you for listening to DPC Life.
• 38:59
  If today's conversation inspired you, hit follow.
• 39:03
  Leave a review and share it with a friend who's ready for change.
• 39:08
  Remember, wherever you are in the journey, your DPC family has
• 39:12
  your back. Until next time, keep building a
• 39:16
  practice and a life that truly fits you.
• 39:21
  This show is brought to you by DPC Ads in Minutes and Harmony
• 39:25
  OPS Health, helping independent doctors like you grow and
• 39:29
  thrive.