August 2, 2026 • 35 mins
Waiting weeks for an appointment, rushing through a 10 minute slot, then struggling to reach your doctor afterwards is treated as “normal” in modern healthcare. We wanted to challenge that assumption, so we sat down with Dr Ryan Gannon, a family physician and co-founder of Blue Ocean Health, to unpack direct primary care (DPC) in plain terms and show what changes when insurance is no longer at the centre of the relationship.
Ryan explains how a membership-based primary care practice works day to day: predictable monthly pricing, longer consultations, and easy access through texts, emails, calls, video visits, and in-office care. We explore why time is not just nicer, it is clinically meaningful. Using examples like anxiety, we talk about how understanding sleep, stress, nutrition, coping skills, and context can change the plan from a quick algorithm to truly personalised care.
We also get into the practical realities of building a DPC clinic as a small business: patient panel size, overhead, retention, and the challenge of educating communities where big health systems dominate. Ryan shares how his passion for lifestyle medicine and strength training shapes the way he works with patients, including using nutrition and sleep logs, starting with realistic behaviour change, and helping people build long-term strength and health. We close by discussing physician burnout as a systemic volume problem, and the future of primary care tools, from wearables data to VO2 max and expanded sleep testing, while keeping the model sustainable.
If you care about better access to a GP, preventative medicine, and new models of primary care in the US healthcare system, this conversation is for you. Subscribe, share with a friend who is fed up with rushed care, and leave us a review with one change you would make to primary care.
Guest Biography
Dr Ryan Gannon is a family physician and co-founder of Blue Ocean Health, a Direct Primary Care (DPC) practice based in King of Prussia, Pennsylvania. Passionate about restoring the doctor–patient relationship, Ryan left the traditional insurance-driven model to build a practice that prioritises accessibility, longer consultations, prevention, and personalised care.
Alongside his work at Blue Ocean Health, Ryan serves as a Medical Director for a correctional facility and has a particular interest in lifestyle medicine, nutrition, sleep, and strength training. A former semi-professional football (soccer) player and competitive powerlifting enthusiast, he integrates evidence-based fitness and behavioural change principles into everyday primary care.
Ryan also writes about medicine, agency, and personal development through his Forge Substack, encouraging healthcare professionals and patients alike to think differently about health, responsibility, and human potential.
Connect with Dr Gannon
- Website: https://www.blueoceanhealthdpc.com
- LinkedIn: https://www.linkedin.com/in/ryan-gannon/
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Voices in Health and Wellness is published on Substack, as part of The Diagnostician. Every episode lands there with written notes and reflections you won't find in the podcast feed. Free to subscribe.
👉 https://thediagnostician.substack.com/s/voices-in-health-and-wellness
About the podcast
Voices in Health and Wellness features conversations at the intersection of medicine, lifestyle, and human potential, with clinicians, scientists, and thinkers shaping the future of care.
About Dr Andrew Greenland
UK-based medical doctor and founder of Greenland Medical, specialising in Integrative and Functional Medicine. Trained in both conventional and root-cause approaches, Andrew helps people optimise health, performance, and longevity, with a focus on cognitive resilience and healthy ageing.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr Andrew Greenland (00:00):
So, welcome to another episode of Voices in
Health and Wellness, where wehave honest conversations with
clinicians, founders, andinnovators who are challenging
conventional health care andbuilding new models of care.
Today I'm joined by Dr.
Ryan Gannon, a familyphysician, co-founder of Blue
Ocean Health, and a strongadvocate for direct primary
care.
Ryan has spent the last severalyears building a practice
(00:20):
outside the traditionalinsurance system, creating a
model that allows for deeperpatient relationships, greater
physician autonomy, and astronger focus on prevention and
lifestyle medicine.
Alongside his clinical work,Ryan is passionate about
nutrition, strength training,and helping people take greater
ownership of their health.
Ryan, welcome to the show.
Thank you so much for joiningus today.
Dr Ryan Gannon (00:39):
Thank you.
Appreciate you having me on.
Dr Andrew Greenland (00:42):
So if we could maybe start at the
beginning, um, a bit about yourjourney, really.
So what attracted you intomedicine in the first place and
why did you choose familymedicine?
Dr Ryan Gannon (00:52):
Yeah, geez, so I'm I'm definitely not someone
who knew that medicine was goingto be my path at a young age.
Um initially, I think itstarted because I had a very
heavy interest in nutrition andexercise from a young age.
Most of my background and uhwhen I was younger revolved
(01:13):
around soccer.
So anything that could give mean edge and you know make me a
little better, a little quicker,a little stronger was uh that
was my thing.
And then I ended up you knowplaying throughout college a
little after college, and incollege, I met a professor and
um became very fond andinterested in genetics.
So I ended up doing a goodamount of research there, and I
(01:36):
think that's where my interestin the the hard sciences really
took off.
Um after that, my path, the thequestion was really do I pursue
something you know towards agraduate degree, maybe a PhD
within biology or geneticsitself.
But I realized I really missedthe the people component.
(01:56):
Um, and I wanted something thatcombined that as well as the
sciences, and medicine lookedlike it could be a good fit.
So after that, I went as far asI could with soccer and then
ultimately decided to you knowpursue a path in medicine.
Um family medicine itself is inyou know, it initially I was
(02:20):
actually very much interested inpsychiatry, and I'm very
fascinated both with uhpsychology and you know holding
deep conversations and reallygetting to know people uh on a
much deeper level.
But I think um uh the well, theother aspect as well is in
terms of independence andautonomy, I I kind of I wanted
(02:42):
to hang my own uh shingle.
And in my mind, psychiatry waskind of the last or one of the
few remaining fields of medicinethat you could do that.
Um in medical school, I met mycurrent now business partner,
Dr.
Cavalak, and he ended upfinding a group of docs who
practice uh direct primary care,and we ended up getting
(03:04):
introduced to a whole bunch ofdocs doing this throughout
throughout the U.S., a bit more,uh we're currently in
Pennsylvania, but a bit more, abit more south and west.
And it was when I got to knowthem that it that really you
know further encouraged me tolook into to family medicine.
So it was sort of thiscombination of um the people
(03:24):
component, really, to you know,getting to know people on a uh
much deeper level, the model ofcare, um, and the ability to do
my own thing.
So I think it was kind of thesethree three things that really
push me towards this uh specificmodel and field in medicine.
Thank you.
Dr Andrew Greenland (03:42):
Um for those that are the uninitiated,
could you explain a little bitabout what direct primary care
actually is?
I mean, it's something which isa bit of an alien concept in
the UK, but it should be reallyhelpful if you can give us a
sense of what it actually is,what the model is.
Dr Ryan Gannon (03:54):
Yeah, yeah, absolutely.
Um, you know, at its most basiclevel, it's a uh membership
model in which patients umthere's variations in themes,
but for us specifically, ourpatients pay us a low affordable
monthly membership that gets usaccess to a primary care doc.
And what that looks like is youknow, we're frequently in
(04:15):
contact with our patientsthrough uh texts, emails, calls,
video visits, and themembership itself covers any
in-office visits as well.
The reason for it is it allowsus as the docs to have much more
time with patients.
Um, so in the US, currently theaverage physician appointment
is you know, roughly, dependingon what you look at, six to
(04:37):
fifteen minutes.
That's probably being generous.
Um, um, you know, for ourpatients, we spend our shortest
appointment um is typicallyaround half an hour.
You know, we'll take up to thatas needed.
When we get to initially uhmeet someone and do a medical
intake for that first visit,we'll spend up to an hour,
sometimes longer.
But it really brings in theconvenience aspect.
(05:01):
Um, it's sort of crazy in mymind that when you look at, you
know, in 2026, all businessesgenerally have moved towards
faster, better services.
Medicine itself is a service,and it's a little archaic in you
know traditional systems thatpatients are still stuck waiting
for appointments for hours onend.
(05:21):
If they ever have a questionabout a lab result, they can't
get a hold of their doctor.
Um, so the model is meant toreally address the access
component uh to a primary caredoc.
Dr Andrew Greenland (05:33):
Thank you for Claire.
I find that's really helpful.
So, at what point did yourealize that the traditional
insurance-based model wasn'treally the way that you wanted
to carry on?
Or was it just the fact thatyou bumped into somebody who you
know had better ideas?
I just want to get the kind ofsense of that decision point.
Dr Ryan Gannon (05:48):
In my training during during residency, I think
we all, you know, um as youknow, from a child, and as you
get older, you get theexperience of an outpatient
practice in general, and it kindof becomes the norm and the
expectation.
And then both, you know,personally having some family
friends who worked as docs and Ishadowed them, I got a little
(06:11):
bit better of a feel beforemedical school.
And then it wasn't untilresidency during my training
that I felt more of thebehind-the-scenes pressures that
doctors face and what they gothrough that you don't
necessarily see from the patientside.
I I knew just based on myselfand personality that if I, you
(06:33):
know, were likely to have topractice in a typical outpatient
setup, I would have lasted, youknow, probably a week, and then
I I just couldn't do it longterm.
Thank you.
Dr Andrew Greenland (06:43):
So tell us a little bit about Blue Ocean
Health today.
What does it actually look likeas a practice after three and a
half years?
Just give us a sense of youknow the operation, as it were.
Dr Ryan Gannon (06:53):
Yeah, so we were going on actually um this past
July was our fourth yearanniversary.
Um it's it's been a both funand interesting journey.
You learn a lot about businessin general.
I mean, by you know, if you'rea doc opening this type of
practice up, you you might aswell have gotten your degree in
(07:15):
a small business.
Um, but we're up to near nearly400 plus patients at this
point.
We still do, you know, as we'rewe're growing, we still do some
uh various jobs on the outsideto make the practice work.
Um and I would say I'm I youknow we previously talked about
(07:36):
direct primary care, what thatlooks like.
To expand a little bit aboutthat.
Um currently, when I lastchecked, I think there's at
least 2,500, maybe getting closeto 3,000 practices like us in
the country.
So we're starting to see theexpansion of primary care within
(07:57):
the U.S., I think diverge alittle more between traditional
outpatient medicine, directprimary care, and then towards
the the other extreme, more of aconcierge type of level.
I think we'll continue to seethings split like that.
And then the other aspect is umemployer, employer-based plans
as employers are looking to cutdown on insurance costs.
(08:19):
Um so with the direct, youknow, direct primary care, an
interesting aspect is they alltend to have like a unique
flavor to them or style, you cansay.
Um, it depends on the you know,the physician running it, their
particular interest.
Maybe they have some additionaltraining.
So some docs may focus more onspecific demographics or
(08:40):
populations or or conditions.
Um, we're starting to see morespecialists, whether it's
cardiologists or OBGYN docs,open up similar style practices.
I would say for usspecifically, we do all the
regular, you know, bread andbutter family medicine um
conditions.
I would say where we take areally heavy focus is on
(09:03):
lifestyle and preventativemedicine, both because, you
know, with my background, um, Ihave a really large interest in
patients' habits as a whole.
Um, that's something thatnumber one, you never rarely
discuss in medical school, butlargely makes up the life of
someone, their eating habits,their nutrition, their sleep,
their understanding of theirmedical condition, you know,
(09:26):
what things should or should notbe done with medicine.
There's so much that surroundsjust a medical visit that that
goes into it that you never getto focus about.
But that's largely my interest.
So for my patients who areinterested, which is probably a
majority, um, we really heavilyreview those things on the
initial visit, and thenperiodically throughout the the
(09:48):
course of the year we're incontact, you know, in addition
to doing, you know, checking allthe boxes from a primary care
perspective.
Dr Andrew Greenland (09:56):
Thank you.
And what does the patientmembership look like from a
patient perspective?
I mean, I think you've alludedto some of the things around
sort of consultation lengths andeverything, but if you look at
the whole package, what does itlook like on paper for a
patient?
Dr Ryan Gannon (10:09):
Like what does it consist of or a little bit of
all the above?
So when you um most directprimary care practices fall
within very similar price rangesfor us specifically, from zero
to 18.
Um, so from a newborn just bornup to 18 years old is $50 per
(10:30):
month.
And then we do from 19 to 63years old is 75 per month, and
64 years old and over is 100 permonth.
And the way you could thinkabout it is it covers all means
of access to us.
So, like I mentioned before,all aspects of communication,
whether that's phone calls,texts, emails, or video visits,
(10:50):
and then the in-office visits.
So we don't have an additionalper office visit fee or anything
like that.
So we largely structure itaround what a patient needs.
Typically, that consists of theinitial visit when we're really
um diving deep and getting toknow someone, so up to an hour
of consultation, depending onthe person.
(11:14):
Sometimes they have somethingacute going on that we need to
address a bit quickly.
I'm seeing them within the weekor at a minimum, we're touching
base by you know, text or acall.
Um I have some patients whochoose to utilize us purely
because of the responsiveness.
So maybe someone who is um ahigher level, you know, someone
(11:36):
within the corporate world or aCEO who is very busy and they
need someone who can respond bytext or email depending on if
they're traveling and how tocoordinate things like lab work,
etc.
Um, so it's it's highly it'sit's very much individualized to
the per the person, um, youknow, their conditions that
we're working on or you know,preferences, depending on what
(11:59):
that looks like.
Dr Andrew Greenland (12:00):
Thank you.
It's really helpful.
Trying to build anunderstanding of how this all
works.
So, how does the umphysician-patient relationship
change when you take insuranceout of the equation?
And so you've been doing thisfor a number of years now.
I just wonder if it kind ofchanges the frame with the
patients themselves.
Dr Ryan Gannon (12:15):
Oh my goodness, yeah, in so many ways.
I think um a good example iswhen we started, so you know,
four years ago in this pastJuly, we had a handful of
patients who followed us fromour our training.
So we started maybe with a youknow group of five to ten
(12:35):
patients.
And I had previously, you know,taken care of a handful of
these individuals who who choseto continue their care with us.
And I thought I knew themreally well on paper.
And then within the followingweeks of when we started our
direct primary care practice,um, I realized I didn't know
them really at all.
So the ability to actually sitdown with someone and just have
(12:58):
a conversation for an extended,uninterrupted period of time, um
it really changes the dynamicof your ability to get to know
someone and then also the levelat which you can deliver medical
care.
And I'll use like maybe a goodexample would be anxiety, right?
(13:20):
So we all know, you know, ifyou're you know PCP, we all have
um the various medicalconditions, we can kind of run
through this algorithm, we canplug in some numbers in a
calculator, we can administerforms and we can be
evidence-based.
But for me to sit down withsomeone, and if I have six to 15
minutes for someone who hasanxiety, I have no idea of
(13:42):
what's going on in theirbackground life, their
stressors, their sleep, theircoping skills in general, what
does their diet recently looklike?
Um, do they have other medicalconditions?
What's their understanding ofanxiety as a whole?
So you can have someone who ummedical therapy is absolutely
(14:03):
indicated for someone withanxiety versus someone else who
really just needs a therapeuticrelationship and to sit down and
have a conversation withsomeone for 30 minutes, and then
they're otherwise good.
They don't, you know, theydon't need um a medical therapy.
They that's someone who woulddo very well with therapy.
That that's just one you knowexample that comes to mind, but
(14:25):
it just it provides much moreoptions because of your ability
to longitudinally get to knowsomeone over time.
Got it.
Dr Andrew Greenland (14:38):
I'm building this picture in my head
of how it all works.
I'm guessing the business modelis absolutely key to get right.
I mean, from you you've beendoing this for a number of years
now.
So you must have a sense of thethe number of people that you
need to have in the practice,the kind of the number of staff,
how to make the membership workso that it actually covers
everything that you do.
How do you get that right?
It must be a very, verydifficult juggling act.
Dr Ryan Gannon (15:01):
Um it's I I think it's as complicated as you
want to make it.
I mean, on one level, you know,you pull out the calculator and
you calculate um what would areasonable comparable you know
income or how profitable do youwant to be, and then how many
patients realistically can yousafely or do you want to take
(15:23):
care of?
So I would say most people um II think I know myself very well
that when I look towards theend of what I want things to
look like, if you start withthat and then work backwards,
you can design what and at leastgear things towards building
(15:44):
that, right?
So a general a general PCP inthe US roughly carries,
depending on what you look at,anywhere from a minimum of one
to two thousand patients up tofour or five thousand patients.
Um, an average DPC doc,depending on how they set it up,
can carry.
(16:04):
I've seen parts part-time youknow DPC docs have a hundred to
a hundred and fifty patients.
I've seen established you knowDPC providers who carry eight to
nine hundred or a thousandpatients each.
Um, that may be someone who'sbeen operating a practice for 10
or 15 years and really knowsthose patients well.
So I think it uh it when youstart with that end structure in
(16:27):
mind, and then a business isbusiness, you always have to
make the math work.
Um, it's less complicated thanyou would think.
And we have a lot of docs oryou know, residents in training
who reach out and say, How doyou do this?
And my response is you made itto medical school and residency.
Um, you know, you could youcould figure it out, the
resources are out there.
And we're very fortunate inthat this has been in place for
(16:52):
minimum 15 years by now.
So a lot of the docs who havebeen doing this for a very long
time have created uh very usefulresources that it's a matter of
creating your list, checkingthe boxes off, you know, forming
your LLC, um, you know, makingsure what do you want your
location to look like?
Do you have the structure inplace?
(17:13):
You check that box, um, makingsure you got your patient
contracts, everything HIPAAcompliant.
So we're fortunate in that uswhen we started all that, you
know, all that was in place.
But I would say from a businessperspective, um, you know, your
rent is your largest overhead,making sure you have that
covered.
And um the beauty is is youdon't have to figure it all out
(17:36):
at once.
I think a lot of you know whatbusiness comes down to is not
having the fear, just starting,and then you figure those
aspects out along the way.
Dr Andrew Greenland (17:47):
And obviously you have been building
this for a number of years, butwhat has been the biggest
challenge in building thepractice, maybe clinically, but
also the the business aspects aswell?
What have you been the keythings that have um kept you up
at night along the way andthings that still keep you up at
night?
Dr Ryan Gannon (18:03):
The biggest thing by far in our area is just
awareness.
So um we're in uh you know, inPennsylvania, what uh which I
would say roughly thenortheastern US is densely the
most medically um from apopulation perspective.
Like the options that patientshave are numerous around here.
(18:25):
We have very large healthsystems in place that patients
automatically recognize um, youknow, the name, they have a
specific history that comes tomind.
Um, so our our challenge is iseducation from like a marketing
and advertising perspective andand explaining the the benefits
(18:46):
of the model.
You know, a lot of times we getasked, well, if I have
insurance, why would I go thisparticular route or you know,
variations along that theme.
If you know, if you go a bitmore west or south within the
US, it's been established enoughthat patients, you know,
generally already know whatthey're signing up for, so it's
easier from that perspective.
(19:07):
Um, I would say that's been ourbiggest hurdle that we've had
to overcome in the years, andthen you know, still continues
to be the biggest hurdle, is youcan never, as a small business,
have enough people know who youare.
Um, and then outside of that, Iwould say it's probably all the
things that generally come withbusiness.
Um, you know, there's neverthere's never a guarantee.
(19:30):
Um patients unfortunately cancome and go.
We're fortunate that we have avery high retention rate, but um
patients move or you know,things happen, financial
situations change.
Um, so you know, just alwaysmaking sure that the the numbers
work and make sense.
But my view is there's noguarantees either way.
(19:52):
There's a lot of docs who theygo to work for a hospital
system, and that hospital systemis taken over or goes under,
similar in the outpatientpractice.
So it's a matter of what you'recomfortable with, you know, the
the risk from eitherperspective.
Thank you.
Dr Andrew Greenland (20:07):
So I mean you said it's it's obviously
growing and there's uhpopularity here.
I think you said two or threethousand practices in the
country.
So there's obviously a need forthis, and there's a appetite
for this.
Where do you see it fittinginto the future of American
health care?
Dr Ryan Gannon (20:23):
I can't predict the future, but I'm I'm hopeful
that it'll be one of the main,if not main ways that primary
care is practiced.
Um I'm very much for options,so I want patients to have as
many options as are available.
So if someone chooses or wantsto purely go through an
(20:44):
insurance model, then they canhave that ability.
Um, I want options between DPCpractices.
I think you know, the sayingthat a rising tide raises all
ships, I think competition ishealthy and brings out the best
in within DPC practices, butalso within the medical system.
So I think if if a patient hasthe option to choose a primary
(21:08):
care doc, apart from justgeographically, but someone who
they believe that they couldconnect with on a much better
level or you know for adifferent reason, then I'm I'm
all for that.
Dr Andrew Greenland (21:20):
Thank you.
Um lifestyle medicine, wheredid your interest first come
from?
And um also how did yourathletic background shape your
perspective on health?
Because obviously there's alifestyle aspect to that as
well.
So I'm just curious.
Dr Ryan Gannon (21:33):
Yeah, like like I mentioned before, I think
that's my main that that's mymain interest.
So it all um started from youknow soccer at a at a young age,
and I I uh from very early on Iwould try all sorts of various
you know diets and nutritionstyles to see if that would help
me.
I um got into weight trainingat a at a very young age and to
(21:58):
see if I improved my strength oror strength.
Could I get an advantage overany any competition?
I would say my biggest shifthas been as I've grown older, I
don't play soccer anymore, butpowerlifting has become my
thing.
So for those who don't knowwhat that is, it's three, it's
basically a competition withthree main lifts the squat,
(22:20):
bench press, and deadlift.
So you basically train tobecome as strong as you can, you
know, within a given weightclass for those exercises.
And it's um both personallyreally fun for me because I love
seeing the income incrementalprogress that you can get over
time.
And the other reason that it'sreally fun too is because for
(22:42):
patients who are interested, Ican incorporate my knowledge
from a new training, um, from anutrition and a training
perspective in you know intotheir lifestyle.
I would I think there's a fewthings that make me as happy as
seeing um, you know, our elderlypopulation or older patients
(23:03):
that we care for, and especiallyum women, whether they're young
or older, being in the gymtrying to build their strength.
Um I think we've come a youknow a pretty long way in
society to overcome a lot of thestigma that kind of has
surrounded uh weightlifting ingeneral.
(23:24):
And as the science and theeducation is put more and more
out there, I'm very hopeful thatthat encompasses a large aspect
of primary care.
Um, but a lot of that dependson the doc.
A lot of docs you know purelywant to practice medicine, and
that's understandable.
But I would hope that they atleast have the knowledge of if
they have a patient who'sinterested, they would know who
(23:45):
to refer to in their communityfor you know a patient that that
would benefit.
Dr Andrew Greenland (23:50):
Thank you.
And and practically speaking,how are you incorporating these
principles into patient care,particularly what you were just
saying about the powerlifting?
What does it look like to apatient in that kind of
consultation?
Dr Ryan Gannon (24:00):
So it depends.
I mean, as you know, as part ofmy intake and I'm getting to
know someone, very often um, youknow, one of the first things
we'll do is I'll have a patientrecord a week of I I basically
call them our logs.
So a week of their nutrition,they they would not change
anything.
Um so I want to see exactly itis what they're doing at this
(24:23):
current point in their life.
So they're writing down to thebest of their ability what does
their new nutrition and fluidintake consist of.
If they are exercising, whatdoes that consistently look like
on a weekly basis?
Um, the other big one I do aswell is sleep.
So I created my own very uhin-depth, detailed sleep
questionnaire, both to screenfor sleep apnea, narcolepsy, and
(24:46):
other common conditions, butalso just to get an idea of if I
have this person, this patientin front of me from a habit
perspective, where do they sit?
How does this relate to umconditions that we know that
they have, what are they at riskfor, and how do we improve
their health as a whole?
Um and it's good in the sensethat sometimes I have patients
(25:09):
come to me and they'll say, youknow, doc, um, I don't care what
it is, give me the bestnutritious plan and workout
plan, and I'll do it.
So my response, number one,there is no such thing.
Um, and number two, if you'resomeone who's never stepped foot
in a gym, our first goal is toget you walking outside for five
minutes consistently dailyuntil we can progress you to a
(25:31):
point that number one, we got tomake sure you actually enjoy
and like what you're doing.
Um, and then number two, from ahabit perspective, what can we
build that's gonna beincorporated into your life and
have some benefit in the longterm?
Thank you.
Dr Andrew Greenland (25:44):
I was gonna ask you a little bit about
physician burnout, and I justwanted to get your sense of
whether you think it's um anindividual issue or a system
issue.
And has DPC improved your ownwell-being and satisfaction as a
physician?
I guess I might know the answerto that, but I prefer to hear
it from you.
Dr Ryan Gannon (25:58):
Yeah, that's I don't know, that's a loaded
question.
I suspect it's um it's largelysystemic, but obviously you have
um you know individuals whohave a tolerance or ability to
operate within that brokensystem.
Um from the system perspective,I think I think the issue is is
(26:25):
uh that you can't mosttraditional outpatient
practices, it's uh it's a volumegame.
So um in order to be deemedsuccessful, rather than being
purely about the care of yourpatients, is how much can you
see, how many patients can youtreat over the course of a given
(26:45):
day.
And you'll always lose in thatin that system or that game
because it's it's a defined end.
You can't um it fails very youknow very early on, and then not
only that, it becomes dangerousfor for patients as well.
Um DPC, so I I I you know Ihave some friends that I think
(27:05):
in a typical outpatient settinga very busy day would be 30 to
40 patients.
Um, obviously, if we're talkingabout like an urgent care or an
ER, that's different.
But on a DPC, I I refer to themas touch points.
So I may see um five to tenpatients in an office setting,
(27:28):
but it's very common to have atouch point with five to ten
percent of your patientpopulation.
So if that's a text or a callor sending an email about lab
results and then schedule a youknow, scheduling um, you know, a
future visit.
So it reduces I in my opinion,I it reduces burnout a lot um by
(27:52):
creating the space, not feelingrushed, uh, not dealing with a
lot of the headaches and thebackground noise that you would
otherwise have to deal with in atraditional setting.
Um but to answer your originalquestion, that that's tough.
Largely systemic, I think, butdoctors I think are notoriously
also very good at um grindingthemselves into the ground.
(28:14):
So some some games we shouldn'tbe playing.
Dr Andrew Greenland (28:19):
Fair, fair.
So, what does um a sustainablemedical career look like to you
when with your new perspectiveand this new way of working?
Dr Ryan Gannon (28:27):
What was the initial part?
Dr Andrew Greenland (28:29):
What does a sustainable medical career look
like to you now?
How do you view that?
Dr Ryan Gannon (28:36):
Sustainable.
Um I don't know if I wouldthink of things as sustainable.
I would say what does theoptimal, most enjoying like
career look like in the sense ofpersonal satisfaction and then
highest value that I can providefor patients.
And for me personally, it's amix on I don't so we we don't
(29:01):
we're not full as a practice.
Um, I don't know what thatnumber would look like, but it
would come before when I'm ifI'm feeling strained where I
can't spend the time withpatients, um, patients are
waiting for us, we're notfinishing on time.
So when things start toresemble uh like a traditional
outpatient setting, I know we'rewe're already past where I want
(29:23):
to be.
For me, it's the combination ofI'm treating patients to the
level that I both should and Iknow that I'm capable of.
Um and then the other couplebig components within medicine
itself is I still have theability and the time for
personal learning.
Um, you know, I'm someone whostill very much keeps up with my
(29:47):
own regular study schedule on aconsistent basis, or listening
to podcasts, or you know,reading things I'm interested in
or bringing more aspects ofthings like that to the clinic.
Um, and then the the other bigcomponent, like any other doc,
is you know, I have a lifeoutside of this as well, whether
it's at the gym or you know,being involved in my church or
(30:07):
or community.
Um, and I think that equationis a little different for
everyone.
You kind of have all those allthose buckets and you you get to
choose how much of each of themthat you want to fill, but it
it would resemble something likethat for me.
Thank you.
Dr Andrew Greenland (30:23):
Um what are your what excites you most
about the future of Blue OceanHealth?
If you're thinking ahead of saythe next year or so, where
would you like um Blue OceanHealth to be?
Any particular ambitions orthings you're looking out for?
Dr Ryan Gannon (30:36):
Yeah, right now um I would say our our season is
growth.
I would love for us to have ourum you know a second location
at some point.
Um, you know, do we bring onanother another doc or two?
Currently it's just Dr.
Kavalak and myself, so um wedon't we're fully capable of
(30:59):
still you know providing theservices and you know behind the
scenes, but at some point youbring on maybe a little bit of
ancillary staff to free up a bitmore clinic time.
Um but I would say our moremediate-term goal within the
next year would be you know anadditional location and
expanding our influence in intothe surrounding areas where we
(31:21):
practice.
Dr Andrew Greenland (31:23):
And if you had a magic wand and you could
fix one thing in the practiceovernight, what would that be?
Or if you can't think ofanything in your own practice
more perhaps more widely inhealthcare generally in our
practice, it would be um I wouldlove so the ability um to
(31:47):
implement what I would say islike higher level, it's not
testing, but um let's just let'sjust say higher level tools
within the practice moresystematically.
Dr Ryan Gannon (31:59):
So a few examples of that are we have a
you know small percentage ofpatients who wear things like uh
Whoop or the Aura Ring.
Um so the ability to at morelarge scale uh systematically um
both offer that to patients,but but be able to interpret and
(32:20):
go through the data.
Um, I would love an in officelike VO2, the ability to test
VO2 max.
Um I would love we partner witha few companies for um in-home
sleep testing, but the abilityto offer that more freely.
So I'm always thinking, whatare what are tools um that would
(32:45):
be like very high yield and avery high perceived benefit and
an actual benefit that we couldoffer our patients as a whole?
So I tend to think of thingslike it would look something
like tools along along thoselines.
Amazing.
Dr Andrew Greenland (33:01):
I suppose the the question is then where
does the where does the linecome where you're putting all
these wonderful things in?
And it kind of breaks the modelbecause they become expensive
and it's difficult to make themfit within the membership plan,
or is there a way around that?
Dr Ryan Gannon (33:17):
Yeah, that's that's something we always toy
with back and forth.
Initially, it's I think as youstart to add additional
ancillary services, it probablylooks like an add-on fee.
Um, you know, a VO2, theability to administer a you
know, a VO2 max is not somethingthat we obviously, number one,
would do for every patient.
(33:38):
Um, but number two, we wouldhave to you know cover the cost
for that.
Um certain certain thingswithin our practice we we
automatically include in themembership, whether you know, if
someone comes in, they need asteroid injection for their
knee.
It's gonna be in our minds,it's silly to charge the you
(33:58):
know the cost of for you knowthe single injection.
Um other things, both for us,but generally you'll see comp
pretty common across DPCpractices, is most tend to have
contracts with wholesalepharmaceutical distributors, so
they can serve as an in-housepharmacy.
And for the top 50 to 100 plusyou know medications, um if
(34:22):
patients choose to go throughus, some of them do you know
save a good amount of moneythere.
Sometimes it pays for aportion, if not all, the
membership.
Um, so there's there's a acouple things or commonalities
that you see most DPC practices,but for us in particular, I
think it comes from thatnutrition and um kind of the
(34:43):
training background.
I'm always teetering on theedge of a combination of like
performance and medicine.
Dr Andrew Greenland (34:50):
On that note, Matt Ryan, I'd like to
thank you so much for joiningus.
It's been such an interestingdiscussion.
I think many healthcareprofessionals listening will
really relate to your experienceof wanting to practice medicine
in a way that feels morealigned with why they went into
the profession in the firstplace.
It's been really interesting tohear about the DPC model.
I certainly have a betterunderstanding of it, and it's
very interesting to hear yourfocus on lifestyle medicine and
(35:12):
how you bring that into yourpractice.
So thank you very much forjoining us.
It's been great.
Dr Ryan Gannon (35:16):
Thanks for having me, I appreciate it.
So, welcome to another episode of Voices in
Health and Wellness, where wehave honest conversations with
clinicians, founders, andinnovators who are challenging
conventional health care andbuilding new models of care.
Today I'm joined by Dr.
Ryan Gannon, a familyphysician, co-founder of Blue
Ocean Health, and a strongadvocate for direct primary
care.
Ryan has spent the last severalyears building a practice
(00:20):
outside the traditionalinsurance system, creating a
model that allows for deeperpatient relationships, greater
physician autonomy, and astronger focus on prevention and
lifestyle medicine.
Alongside his clinical work,Ryan is passionate about
nutrition, strength training,and helping people take greater
ownership of their health.
Ryan, welcome to the show.
Thank you so much for joiningus today.
Dr Ryan Gannon (00:39):
Thank you.
Appreciate you having me on.
Dr Andrew Greenland (00:42):
So if we could maybe start at the
beginning, um, a bit about yourjourney, really.
So what attracted you intomedicine in the first place and
why did you choose familymedicine?
Dr Ryan Gannon (00:52):
Yeah, geez, so I'm I'm definitely not someone
who knew that medicine was goingto be my path at a young age.
Um initially, I think itstarted because I had a very
heavy interest in nutrition andexercise from a young age.
Most of my background and uhwhen I was younger revolved
(01:13):
around soccer.
So anything that could give mean edge and you know make me a
little better, a little quicker,a little stronger was uh that
was my thing.
And then I ended up you knowplaying throughout college a
little after college, and incollege, I met a professor and
um became very fond andinterested in genetics.
So I ended up doing a goodamount of research there, and I
(01:36):
think that's where my interestin the the hard sciences really
took off.
Um after that, my path, the thequestion was really do I pursue
something you know towards agraduate degree, maybe a PhD
within biology or geneticsitself.
But I realized I really missedthe the people component.
(01:56):
Um, and I wanted something thatcombined that as well as the
sciences, and medicine lookedlike it could be a good fit.
So after that, I went as far asI could with soccer and then
ultimately decided to you knowpursue a path in medicine.
Um family medicine itself is inyou know, it initially I was
(02:20):
actually very much interested inpsychiatry, and I'm very
fascinated both with uhpsychology and you know holding
deep conversations and reallygetting to know people uh on a
much deeper level.
But I think um uh the well, theother aspect as well is in
terms of independence andautonomy, I I kind of I wanted
(02:42):
to hang my own uh shingle.
And in my mind, psychiatry waskind of the last or one of the
few remaining fields of medicinethat you could do that.
Um in medical school, I met mycurrent now business partner,
Dr.
Cavalak, and he ended upfinding a group of docs who
practice uh direct primary care,and we ended up getting
(03:04):
introduced to a whole bunch ofdocs doing this throughout
throughout the U.S., a bit more,uh we're currently in
Pennsylvania, but a bit more, abit more south and west.
And it was when I got to knowthem that it that really you
know further encouraged me tolook into to family medicine.
So it was sort of thiscombination of um the people
(03:24):
component, really, to you know,getting to know people on a uh
much deeper level, the model ofcare, um, and the ability to do
my own thing.
So I think it was kind of thesethree three things that really
push me towards this uh specificmodel and field in medicine.
Thank you.
Dr Andrew Greenland (03:42):
Um for those that are the uninitiated,
could you explain a little bitabout what direct primary care
actually is?
I mean, it's something which isa bit of an alien concept in
the UK, but it should be reallyhelpful if you can give us a
sense of what it actually is,what the model is.
Dr Ryan Gannon (03:54):
Yeah, yeah, absolutely.
Um, you know, at its most basiclevel, it's a uh membership
model in which patients umthere's variations in themes,
but for us specifically, ourpatients pay us a low affordable
monthly membership that gets usaccess to a primary care doc.
And what that looks like is youknow, we're frequently in
(04:15):
contact with our patientsthrough uh texts, emails, calls,
video visits, and themembership itself covers any
in-office visits as well.
The reason for it is it allowsus as the docs to have much more
time with patients.
Um, so in the US, currently theaverage physician appointment
is you know, roughly, dependingon what you look at, six to
(04:37):
fifteen minutes.
That's probably being generous.
Um, um, you know, for ourpatients, we spend our shortest
appointment um is typicallyaround half an hour.
You know, we'll take up to thatas needed.
When we get to initially uhmeet someone and do a medical
intake for that first visit,we'll spend up to an hour,
sometimes longer.
But it really brings in theconvenience aspect.
(05:01):
Um, it's sort of crazy in mymind that when you look at, you
know, in 2026, all businessesgenerally have moved towards
faster, better services.
Medicine itself is a service,and it's a little archaic in you
know traditional systems thatpatients are still stuck waiting
for appointments for hours onend.
(05:21):
If they ever have a questionabout a lab result, they can't
get a hold of their doctor.
Um, so the model is meant toreally address the access
component uh to a primary caredoc.
Dr Andrew Greenland (05:33):
Thank you for Claire.
I find that's really helpful.
So, at what point did yourealize that the traditional
insurance-based model wasn'treally the way that you wanted
to carry on?
Or was it just the fact thatyou bumped into somebody who you
know had better ideas?
I just want to get the kind ofsense of that decision point.
Dr Ryan Gannon (05:48):
In my training during during residency, I think
we all, you know, um as youknow, from a child, and as you
get older, you get theexperience of an outpatient
practice in general, and it kindof becomes the norm and the
expectation.
And then both, you know,personally having some family
friends who worked as docs and Ishadowed them, I got a little
(06:11):
bit better of a feel beforemedical school.
And then it wasn't untilresidency during my training
that I felt more of thebehind-the-scenes pressures that
doctors face and what they gothrough that you don't
necessarily see from the patientside.
I I knew just based on myselfand personality that if I, you
(06:33):
know, were likely to have topractice in a typical outpatient
setup, I would have lasted, youknow, probably a week, and then
I I just couldn't do it longterm.
Thank you.
Dr Andrew Greenland (06:43):
So tell us a little bit about Blue Ocean
Health today.
What does it actually look likeas a practice after three and a
half years?
Just give us a sense of youknow the operation, as it were.
Dr Ryan Gannon (06:53):
Yeah, so we were going on actually um this past
July was our fourth yearanniversary.
Um it's it's been a both funand interesting journey.
You learn a lot about businessin general.
I mean, by you know, if you'rea doc opening this type of
practice up, you you might aswell have gotten your degree in
(07:15):
a small business.
Um, but we're up to near nearly400 plus patients at this
point.
We still do, you know, as we'rewe're growing, we still do some
uh various jobs on the outsideto make the practice work.
Um and I would say I'm I youknow we previously talked about
(07:36):
direct primary care, what thatlooks like.
To expand a little bit aboutthat.
Um currently, when I lastchecked, I think there's at
least 2,500, maybe getting closeto 3,000 practices like us in
the country.
So we're starting to see theexpansion of primary care within
(07:57):
the U.S., I think diverge alittle more between traditional
outpatient medicine, directprimary care, and then towards
the the other extreme, more of aconcierge type of level.
I think we'll continue to seethings split like that.
And then the other aspect is umemployer, employer-based plans
as employers are looking to cutdown on insurance costs.
(08:19):
Um so with the direct, youknow, direct primary care, an
interesting aspect is they alltend to have like a unique
flavor to them or style, you cansay.
Um, it depends on the you know,the physician running it, their
particular interest.
Maybe they have some additionaltraining.
So some docs may focus more onspecific demographics or
(08:40):
populations or or conditions.
Um, we're starting to see morespecialists, whether it's
cardiologists or OBGYN docs,open up similar style practices.
I would say for usspecifically, we do all the
regular, you know, bread andbutter family medicine um
conditions.
I would say where we take areally heavy focus is on
(09:03):
lifestyle and preventativemedicine, both because, you
know, with my background, um, Ihave a really large interest in
patients' habits as a whole.
Um, that's something thatnumber one, you never rarely
discuss in medical school, butlargely makes up the life of
someone, their eating habits,their nutrition, their sleep,
their understanding of theirmedical condition, you know,
(09:26):
what things should or should notbe done with medicine.
There's so much that surroundsjust a medical visit that that
goes into it that you never getto focus about.
But that's largely my interest.
So for my patients who areinterested, which is probably a
majority, um, we really heavilyreview those things on the
initial visit, and thenperiodically throughout the the
(09:48):
course of the year we're incontact, you know, in addition
to doing, you know, checking allthe boxes from a primary care
perspective.
Dr Andrew Greenland (09:56):
Thank you.
And what does the patientmembership look like from a
patient perspective?
I mean, I think you've alludedto some of the things around
sort of consultation lengths andeverything, but if you look at
the whole package, what does itlook like on paper for a
patient?
Dr Ryan Gannon (10:09):
Like what does it consist of or a little bit of
all the above?
So when you um most directprimary care practices fall
within very similar price rangesfor us specifically, from zero
to 18.
Um, so from a newborn just bornup to 18 years old is $50 per
(10:30):
month.
And then we do from 19 to 63years old is 75 per month, and
64 years old and over is 100 permonth.
And the way you could thinkabout it is it covers all means
of access to us.
So, like I mentioned before,all aspects of communication,
whether that's phone calls,texts, emails, or video visits,
(10:50):
and then the in-office visits.
So we don't have an additionalper office visit fee or anything
like that.
So we largely structure itaround what a patient needs.
Typically, that consists of theinitial visit when we're really
um diving deep and getting toknow someone, so up to an hour
of consultation, depending onthe person.
(11:14):
Sometimes they have somethingacute going on that we need to
address a bit quickly.
I'm seeing them within the weekor at a minimum, we're touching
base by you know, text or acall.
Um I have some patients whochoose to utilize us purely
because of the responsiveness.
So maybe someone who is um ahigher level, you know, someone
(11:36):
within the corporate world or aCEO who is very busy and they
need someone who can respond bytext or email depending on if
they're traveling and how tocoordinate things like lab work,
etc.
Um, so it's it's highly it'sit's very much individualized to
the per the person, um, youknow, their conditions that
we're working on or you know,preferences, depending on what
(11:59):
that looks like.
Dr Andrew Greenland (12:00):
Thank you.
It's really helpful.
Trying to build anunderstanding of how this all
works.
So, how does the umphysician-patient relationship
change when you take insuranceout of the equation?
And so you've been doing thisfor a number of years now.
I just wonder if it kind ofchanges the frame with the
patients themselves.
Dr Ryan Gannon (12:15):
Oh my goodness, yeah, in so many ways.
I think um a good example iswhen we started, so you know,
four years ago in this pastJuly, we had a handful of
patients who followed us fromour our training.
So we started maybe with a youknow group of five to ten
(12:35):
patients.
And I had previously, you know,taken care of a handful of
these individuals who who choseto continue their care with us.
And I thought I knew themreally well on paper.
And then within the followingweeks of when we started our
direct primary care practice,um, I realized I didn't know
them really at all.
So the ability to actually sitdown with someone and just have
(12:58):
a conversation for an extended,uninterrupted period of time, um
it really changes the dynamicof your ability to get to know
someone and then also the levelat which you can deliver medical
care.
And I'll use like maybe a goodexample would be anxiety, right?
(13:20):
So we all know, you know, ifyou're you know PCP, we all have
um the various medicalconditions, we can kind of run
through this algorithm, we canplug in some numbers in a
calculator, we can administerforms and we can be
evidence-based.
But for me to sit down withsomeone, and if I have six to 15
minutes for someone who hasanxiety, I have no idea of
(13:42):
what's going on in theirbackground life, their
stressors, their sleep, theircoping skills in general, what
does their diet recently looklike?
Um, do they have other medicalconditions?
What's their understanding ofanxiety as a whole?
So you can have someone who ummedical therapy is absolutely
(14:03):
indicated for someone withanxiety versus someone else who
really just needs a therapeuticrelationship and to sit down and
have a conversation withsomeone for 30 minutes, and then
they're otherwise good.
They don't, you know, theydon't need um a medical therapy.
They that's someone who woulddo very well with therapy.
That that's just one you knowexample that comes to mind, but
(14:25):
it just it provides much moreoptions because of your ability
to longitudinally get to knowsomeone over time.
Got it.
Dr Andrew Greenland (14:38):
I'm building this picture in my head
of how it all works.
I'm guessing the business modelis absolutely key to get right.
I mean, from you you've beendoing this for a number of years
now.
So you must have a sense of thethe number of people that you
need to have in the practice,the kind of the number of staff,
how to make the membership workso that it actually covers
everything that you do.
How do you get that right?
It must be a very, verydifficult juggling act.
Dr Ryan Gannon (15:01):
Um it's I I think it's as complicated as you
want to make it.
I mean, on one level, you know,you pull out the calculator and
you calculate um what would areasonable comparable you know
income or how profitable do youwant to be, and then how many
patients realistically can yousafely or do you want to take
(15:23):
care of?
So I would say most people um II think I know myself very well
that when I look towards theend of what I want things to
look like, if you start withthat and then work backwards,
you can design what and at leastgear things towards building
(15:44):
that, right?
So a general a general PCP inthe US roughly carries,
depending on what you look at,anywhere from a minimum of one
to two thousand patients up tofour or five thousand patients.
Um, an average DPC doc,depending on how they set it up,
can carry.
(16:04):
I've seen parts part-time youknow DPC docs have a hundred to
a hundred and fifty patients.
I've seen established you knowDPC providers who carry eight to
nine hundred or a thousandpatients each.
Um, that may be someone who'sbeen operating a practice for 10
or 15 years and really knowsthose patients well.
So I think it uh it when youstart with that end structure in
(16:27):
mind, and then a business isbusiness, you always have to
make the math work.
Um, it's less complicated thanyou would think.
And we have a lot of docs oryou know, residents in training
who reach out and say, How doyou do this?
And my response is you made itto medical school and residency.
Um, you know, you could youcould figure it out, the
resources are out there.
And we're very fortunate inthat this has been in place for
(16:52):
minimum 15 years by now.
So a lot of the docs who havebeen doing this for a very long
time have created uh very usefulresources that it's a matter of
creating your list, checkingthe boxes off, you know, forming
your LLC, um, you know, makingsure what do you want your
location to look like?
Do you have the structure inplace?
(17:13):
You check that box, um, makingsure you got your patient
contracts, everything HIPAAcompliant.
So we're fortunate in that uswhen we started all that, you
know, all that was in place.
But I would say from a businessperspective, um, you know, your
rent is your largest overhead,making sure you have that
covered.
And um the beauty is is youdon't have to figure it all out
(17:36):
at once.
I think a lot of you know whatbusiness comes down to is not
having the fear, just starting,and then you figure those
aspects out along the way.
Dr Andrew Greenland (17:47):
And obviously you have been building
this for a number of years, butwhat has been the biggest
challenge in building thepractice, maybe clinically, but
also the the business aspects aswell?
What have you been the keythings that have um kept you up
at night along the way andthings that still keep you up at
night?
Dr Ryan Gannon (18:03):
The biggest thing by far in our area is just
awareness.
So um we're in uh you know, inPennsylvania, what uh which I
would say roughly thenortheastern US is densely the
most medically um from apopulation perspective.
Like the options that patientshave are numerous around here.
(18:25):
We have very large healthsystems in place that patients
automatically recognize um, youknow, the name, they have a
specific history that comes tomind.
Um, so our our challenge is iseducation from like a marketing
and advertising perspective andand explaining the the benefits
(18:46):
of the model.
You know, a lot of times we getasked, well, if I have
insurance, why would I go thisparticular route or you know,
variations along that theme.
If you know, if you go a bitmore west or south within the
US, it's been established enoughthat patients, you know,
generally already know whatthey're signing up for, so it's
easier from that perspective.
(19:07):
Um, I would say that's been ourbiggest hurdle that we've had
to overcome in the years, andthen you know, still continues
to be the biggest hurdle, is youcan never, as a small business,
have enough people know who youare.
Um, and then outside of that, Iwould say it's probably all the
things that generally come withbusiness.
Um, you know, there's neverthere's never a guarantee.
(19:30):
Um patients unfortunately cancome and go.
We're fortunate that we have avery high retention rate, but um
patients move or you know,things happen, financial
situations change.
Um, so you know, just alwaysmaking sure that the the numbers
work and make sense.
But my view is there's noguarantees either way.
(19:52):
There's a lot of docs who theygo to work for a hospital
system, and that hospital systemis taken over or goes under,
similar in the outpatientpractice.
So it's a matter of what you'recomfortable with, you know, the
the risk from eitherperspective.
Thank you.
Dr Andrew Greenland (20:07):
So I mean you said it's it's obviously
growing and there's uhpopularity here.
I think you said two or threethousand practices in the
country.
So there's obviously a need forthis, and there's a appetite
for this.
Where do you see it fittinginto the future of American
health care?
Dr Ryan Gannon (20:23):
I can't predict the future, but I'm I'm hopeful
that it'll be one of the main,if not main ways that primary
care is practiced.
Um I'm very much for options,so I want patients to have as
many options as are available.
So if someone chooses or wantsto purely go through an
(20:44):
insurance model, then they canhave that ability.
Um, I want options between DPCpractices.
I think you know, the sayingthat a rising tide raises all
ships, I think competition ishealthy and brings out the best
in within DPC practices, butalso within the medical system.
So I think if if a patient hasthe option to choose a primary
(21:08):
care doc, apart from justgeographically, but someone who
they believe that they couldconnect with on a much better
level or you know for adifferent reason, then I'm I'm
all for that.
Dr Andrew Greenland (21:20):
Thank you.
Um lifestyle medicine, wheredid your interest first come
from?
And um also how did yourathletic background shape your
perspective on health?
Because obviously there's alifestyle aspect to that as
well.
So I'm just curious.
Dr Ryan Gannon (21:33):
Yeah, like like I mentioned before, I think
that's my main that that's mymain interest.
So it all um started from youknow soccer at a at a young age,
and I I uh from very early on Iwould try all sorts of various
you know diets and nutritionstyles to see if that would help
me.
I um got into weight trainingat a at a very young age and to
(21:58):
see if I improved my strength oror strength.
Could I get an advantage overany any competition?
I would say my biggest shifthas been as I've grown older, I
don't play soccer anymore, butpowerlifting has become my
thing.
So for those who don't knowwhat that is, it's three, it's
basically a competition withthree main lifts the squat,
(22:20):
bench press, and deadlift.
So you basically train tobecome as strong as you can, you
know, within a given weightclass for those exercises.
And it's um both personallyreally fun for me because I love
seeing the income incrementalprogress that you can get over
time.
And the other reason that it'sreally fun too is because for
(22:42):
patients who are interested, Ican incorporate my knowledge
from a new training, um, from anutrition and a training
perspective in you know intotheir lifestyle.
I would I think there's a fewthings that make me as happy as
seeing um, you know, our elderlypopulation or older patients
(23:03):
that we care for, and especiallyum women, whether they're young
or older, being in the gymtrying to build their strength.
Um I think we've come a youknow a pretty long way in
society to overcome a lot of thestigma that kind of has
surrounded uh weightlifting ingeneral.
(23:24):
And as the science and theeducation is put more and more
out there, I'm very hopeful thatthat encompasses a large aspect
of primary care.
Um, but a lot of that dependson the doc.
A lot of docs you know purelywant to practice medicine, and
that's understandable.
But I would hope that they atleast have the knowledge of if
they have a patient who'sinterested, they would know who
(23:45):
to refer to in their communityfor you know a patient that that
would benefit.
Dr Andrew Greenland (23:50):
Thank you.
And and practically speaking,how are you incorporating these
principles into patient care,particularly what you were just
saying about the powerlifting?
What does it look like to apatient in that kind of
consultation?
Dr Ryan Gannon (24:00):
So it depends.
I mean, as you know, as part ofmy intake and I'm getting to
know someone, very often um, youknow, one of the first things
we'll do is I'll have a patientrecord a week of I I basically
call them our logs.
So a week of their nutrition,they they would not change
anything.
Um so I want to see exactly itis what they're doing at this
(24:23):
current point in their life.
So they're writing down to thebest of their ability what does
their new nutrition and fluidintake consist of.
If they are exercising, whatdoes that consistently look like
on a weekly basis?
Um, the other big one I do aswell is sleep.
So I created my own very uhin-depth, detailed sleep
questionnaire, both to screenfor sleep apnea, narcolepsy, and
(24:46):
other common conditions, butalso just to get an idea of if I
have this person, this patientin front of me from a habit
perspective, where do they sit?
How does this relate to umconditions that we know that
they have, what are they at riskfor, and how do we improve
their health as a whole?
Um and it's good in the sensethat sometimes I have patients
(25:09):
come to me and they'll say, youknow, doc, um, I don't care what
it is, give me the bestnutritious plan and workout
plan, and I'll do it.
So my response, number one,there is no such thing.
Um, and number two, if you'resomeone who's never stepped foot
in a gym, our first goal is toget you walking outside for five
minutes consistently dailyuntil we can progress you to a
(25:31):
point that number one, we got tomake sure you actually enjoy
and like what you're doing.
Um, and then number two, from ahabit perspective, what can we
build that's gonna beincorporated into your life and
have some benefit in the longterm?
Thank you.
Dr Andrew Greenland (25:44):
I was gonna ask you a little bit about
physician burnout, and I justwanted to get your sense of
whether you think it's um anindividual issue or a system
issue.
And has DPC improved your ownwell-being and satisfaction as a
physician?
I guess I might know the answerto that, but I prefer to hear
it from you.
Dr Ryan Gannon (25:58):
Yeah, that's I don't know, that's a loaded
question.
I suspect it's um it's largelysystemic, but obviously you have
um you know individuals whohave a tolerance or ability to
operate within that brokensystem.
Um from the system perspective,I think I think the issue is is
(26:25):
uh that you can't mosttraditional outpatient
practices, it's uh it's a volumegame.
So um in order to be deemedsuccessful, rather than being
purely about the care of yourpatients, is how much can you
see, how many patients can youtreat over the course of a given
(26:45):
day.
And you'll always lose in thatin that system or that game
because it's it's a defined end.
You can't um it fails very youknow very early on, and then not
only that, it becomes dangerousfor for patients as well.
Um DPC, so I I I you know Ihave some friends that I think
(27:05):
in a typical outpatient settinga very busy day would be 30 to
40 patients.
Um, obviously, if we're talkingabout like an urgent care or an
ER, that's different.
But on a DPC, I I refer to themas touch points.
So I may see um five to tenpatients in an office setting,
(27:28):
but it's very common to have atouch point with five to ten
percent of your patientpopulation.
So if that's a text or a callor sending an email about lab
results and then schedule a youknow, scheduling um, you know, a
future visit.
So it reduces I in my opinion,I it reduces burnout a lot um by
(27:52):
creating the space, not feelingrushed, uh, not dealing with a
lot of the headaches and thebackground noise that you would
otherwise have to deal with in atraditional setting.
Um but to answer your originalquestion, that that's tough.
Largely systemic, I think, butdoctors I think are notoriously
also very good at um grindingthemselves into the ground.
(28:14):
So some some games we shouldn'tbe playing.
Dr Andrew Greenland (28:19):
Fair, fair.
So, what does um a sustainablemedical career look like to you
when with your new perspectiveand this new way of working?
Dr Ryan Gannon (28:27):
What was the initial part?
Dr Andrew Greenland (28:29):
What does a sustainable medical career look
like to you now?
How do you view that?
Dr Ryan Gannon (28:36):
Sustainable.
Um I don't know if I wouldthink of things as sustainable.
I would say what does theoptimal, most enjoying like
career look like in the sense ofpersonal satisfaction and then
highest value that I can providefor patients.
And for me personally, it's amix on I don't so we we don't
(29:01):
we're not full as a practice.
Um, I don't know what thatnumber would look like, but it
would come before when I'm ifI'm feeling strained where I
can't spend the time withpatients, um, patients are
waiting for us, we're notfinishing on time.
So when things start toresemble uh like a traditional
outpatient setting, I know we'rewe're already past where I want
(29:23):
to be.
For me, it's the combination ofI'm treating patients to the
level that I both should and Iknow that I'm capable of.
Um and then the other couplebig components within medicine
itself is I still have theability and the time for
personal learning.
Um, you know, I'm someone whostill very much keeps up with my
(29:47):
own regular study schedule on aconsistent basis, or listening
to podcasts, or you know,reading things I'm interested in
or bringing more aspects ofthings like that to the clinic.
Um, and then the the other bigcomponent, like any other doc,
is you know, I have a lifeoutside of this as well, whether
it's at the gym or you know,being involved in my church or
(30:07):
or community.
Um, and I think that equationis a little different for
everyone.
You kind of have all those allthose buckets and you you get to
choose how much of each of themthat you want to fill, but it
it would resemble something likethat for me.
Thank you.
Dr Andrew Greenland (30:23):
Um what are your what excites you most
about the future of Blue OceanHealth?
If you're thinking ahead of saythe next year or so, where
would you like um Blue OceanHealth to be?
Any particular ambitions orthings you're looking out for?
Dr Ryan Gannon (30:36):
Yeah, right now um I would say our our season is
growth.
I would love for us to have ourum you know a second location
at some point.
Um, you know, do we bring onanother another doc or two?
Currently it's just Dr.
Kavalak and myself, so um wedon't we're fully capable of
(30:59):
still you know providing theservices and you know behind the
scenes, but at some point youbring on maybe a little bit of
ancillary staff to free up a bitmore clinic time.
Um but I would say our moremediate-term goal within the
next year would be you know anadditional location and
expanding our influence in intothe surrounding areas where we
(31:21):
practice.
Dr Andrew Greenland (31:23):
And if you had a magic wand and you could
fix one thing in the practiceovernight, what would that be?
Or if you can't think ofanything in your own practice
more perhaps more widely inhealthcare generally in our
practice, it would be um I wouldlove so the ability um to
(31:47):
implement what I would say islike higher level, it's not
testing, but um let's just let'sjust say higher level tools
within the practice moresystematically.
Dr Ryan Gannon (31:59):
So a few examples of that are we have a
you know small percentage ofpatients who wear things like uh
Whoop or the Aura Ring.
Um so the ability to at morelarge scale uh systematically um
both offer that to patients,but but be able to interpret and
(32:20):
go through the data.
Um, I would love an in officelike VO2, the ability to test
VO2 max.
Um I would love we partner witha few companies for um in-home
sleep testing, but the abilityto offer that more freely.
So I'm always thinking, whatare what are tools um that would
(32:45):
be like very high yield and avery high perceived benefit and
an actual benefit that we couldoffer our patients as a whole?
So I tend to think of thingslike it would look something
like tools along along thoselines.
Amazing.
Dr Andrew Greenland (33:01):
I suppose the the question is then where
does the where does the linecome where you're putting all
these wonderful things in?
And it kind of breaks the modelbecause they become expensive
and it's difficult to make themfit within the membership plan,
or is there a way around that?
Dr Ryan Gannon (33:17):
Yeah, that's that's something we always toy
with back and forth.
Initially, it's I think as youstart to add additional
ancillary services, it probablylooks like an add-on fee.
Um, you know, a VO2, theability to administer a you
know, a VO2 max is not somethingthat we obviously, number one,
would do for every patient.
(33:38):
Um, but number two, we wouldhave to you know cover the cost
for that.
Um certain certain thingswithin our practice we we
automatically include in themembership, whether you know, if
someone comes in, they need asteroid injection for their
knee.
It's gonna be in our minds,it's silly to charge the you
(33:58):
know the cost of for you knowthe single injection.
Um other things, both for us,but generally you'll see comp
pretty common across DPCpractices, is most tend to have
contracts with wholesalepharmaceutical distributors, so
they can serve as an in-housepharmacy.
And for the top 50 to 100 plusyou know medications, um if
(34:22):
patients choose to go throughus, some of them do you know
save a good amount of moneythere.
Sometimes it pays for aportion, if not all, the
membership.
Um, so there's there's a acouple things or commonalities
that you see most DPC practices,but for us in particular, I
think it comes from thatnutrition and um kind of the
(34:43):
training background.
I'm always teetering on theedge of a combination of like
performance and medicine.
Dr Andrew Greenland (34:50):
On that note, Matt Ryan, I'd like to
thank you so much for joiningus.
It's been such an interestingdiscussion.
I think many healthcareprofessionals listening will
really relate to your experienceof wanting to practice medicine
in a way that feels morealigned with why they went into
the profession in the firstplace.
It's been really interesting tohear about the DPC model.
I certainly have a betterunderstanding of it, and it's
very interesting to hear yourfocus on lifestyle medicine and
(35:12):
how you bring that into yourpractice.
So thank you very much forjoining us.
It's been great.
Dr Ryan Gannon (35:16):
Thanks for having me, I appreciate it.
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