October 23, 2020 • 31 mins
Dr. Manvinder Kainth of Maple Primary Care discusses her path after residency that took her to opening her own direct primary care practice.
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Episode Transcript
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Announcer (00:00):
Ask Me MD, medical school for the real world with
(00:03):
the MD, Dr. D.J. Verret.
D.J. Verret, MD, FACS (00:06):
Greetings and welcome to another edition
of Ask Me MD, medical school forthe real world. I'm Dr. D.J.
(00:26):
Verret, and today we're talkingwith Dr. Manvinder Kainth about
her transition into directPrimary Care Medicine. We'll
(01:14):
talk to Manvinder right afterthis
Commercial (01:23):
Commercial inserted here
D.J. Verret, MD, FACS (01:45):
Welcome back to Ask Me MD, medical
school for the real world. I'mDr. D.J. Verret. And today I
have the great pleasure oftalking with Dr. Manvinder
Kainth, a direct primary carephysician here in the Plano area
about her experience inalternative primary care
delivery models. Doctor, thanksfor joining me.
Manvinder Kainth, MD (02:07):
Thank you so much for the opportunity DJ,
D.J. Verret, MD, FACS (02:10):
Can you tell us a little bit about
yourself and your background?
Commercial (02:14):
Sure. You know, going back to the beginning, I
grew up in Canada, that's wheremy childhood was. So I kind of
grew up with national healthcare. And then my family moved
to the Houston area when Istarted high school, and I was
there for high school, collegemedical school, ended up in
(02:37):
Seattle for residency and thenstarted my career. And, you
know, I was it was a, it's beenan interesting journey. So far,
I've been with three differentmajor health organizations. And
after the third, I decided tostart my own practice.
D.J. Verret, MD, FACS (02:59):
So and that kind of brings us to why
we're here in our discussion.
Can you talk a little bit aboutthe differences in direct
primary care, conciergemedicine, cash pay practices?
And why you settled on the modelthat you have?
Commercial (03:22):
Yes, it's a very good question. So I am, I did my
residency in family medicine. SoI knew fairly early on that I
wanted to do primary care. And Iwanted to get to know my
patients have a relationshipwith my patients and actually
make some meaningful changes.
You know, as you get to knowthem, what I found in the
(03:44):
typical traditional insurancemodel is that it was really
difficult to do that. And so Ireally didn't feel fulfilled. In
my career. As a physician, it'sreally hard to make an impact
when you only have about fiveminutes to actually talk to a
(04:05):
patient per visit. And, and thenthe other 10 minutes are spent
usually with documentation. Andso my thoughts after, you know,
the three different healthcareorganizations, I finally learned
with a third that they're allpretty much the same. They all
have kind of the same rules,regulations, goals, and none of
(04:29):
them really met. What I wantedto do. And what I wanted to do
was have the time to actuallytalk to my patients, and to talk
about lifestyle, behavioralchanges, in order to make some
meaningful change, which you andI both know, takes a lot of
time. It takes time to do it.
(04:52):
And then it takes time toactually put those things in
action. And so that's kind ofhow I came to To DPC or direct
primary care, as far as thedifferences in the models, so
direct primary care, or DPC isfairly simple. I always say it's
(05:13):
not the typical insurance model.
And it's not the conciergemodel, it's kind of somewhere in
between. It works very similarto a gym membership, where you
pay a low cost monthly fee, andthat covers all your office
visits, all your in officeprocedures, all telemedicine and
there's no question or thoughtabout co insurances or co pays,
(05:39):
or what is covered what is notcovered. And so obviously,
that's a huge difference fromthe typical insurance world. The
concierge model, the way that'sdifferent is that most concierge
doctors bill a high dollarmembership fee, often the
(06:00):
average is about 2000 to 2500per year. And they will also
bill insurance on top of it. Sothat is the big difference. So
people who have deductibles orco pays, they still have to pay
those bills, but they have topay the membership fee on top of
(06:20):
that.
D.J. Verret, MD, FACS (06:24):
How did you when you were you were with
a couple of large healthsystems? That sounds like I'm
assuming integrated deliverysystems as they're called
correct?
Manvinder Kainth, MD (06:35):
Oh, I guess so.
D.J. Verret, MD, FACS (06:41):
How did you settle on the DPC model?
Like what thoughts went throughyour head? And in? What fears
did you have in making that kindof a leap? And how did you
overcome those?
Manvinder Kainth, MD (06:56):
Sure. So it all kind of fell in my lap.
So when I was getting towardsthe end of my third year, with
my last healthcare organization,I knew that I wanted to make a
change. I was not happy, the waythings were running. So the
(07:18):
biggest challenges that I had,as I mentioned before, is time
with patients. The otherchallenges were that it was
difficult for my patients to getin. The other challenge was it
was difficult for my patients toactually reach me, they had to
go through the endless phonechain to actually get a human
(07:39):
being on the phone. So those areand then of course, the wait
time, you know, when you doublebook, you know, and have six
appointments in one hour inprimary care. To me, that's a
pretty busy schedule. And I'malways going to be running at
least 15 to 20 minutes behind.
And so patients having to waitin the waiting room was also
(08:00):
frustrating. So those are allthe patients frustrations. For
me as a physician, you know, Iwasn't being fulfilled with
basically throwing medicationsat patients, you know, when I
only have five minutes, and I ambeing measured on performance.
And somebody has a like, let'ssay it's a diabetic and they
(08:23):
have an LDL of 120. I'm justupping their SAT. And I'm not
talking to them about theirexercise, their nutrition, the
very nitty gritty stuff, becauseI don't have time to do it. And
so that was a big thing that Idid not like so I wanted to make
a change. The other thing is thecost model with different health
(08:45):
organizations, obviously,they're different depending on
where you go. But I'll tell youin the end, in my opinion, it's
it's always going to benefit theorganization, it's never going
to benefit the physician. Andalmost always the physician will
get slighted when it comes totheir pay. So I was getting to
(09:09):
that point, I happened to seethat the TMA was basically
sponsoring a DPC conference. Andit was just one day it was
almost free. The conference, Ineeded some CMA, I decided to go
(09:30):
and when I attended thatconference, it really opened my
eyes to the DPC model or directprimary care model. I honestly
had never even heard of it. Butit was after that conference
that I decided, you know whatI'm going to, I'm gonna take the
leap, and I'm gonna, I'm gonnago for it.
D.J. Verret, MD, FACS (09:54):
The thoughts you're putting out
there about why you were unhappyare ones that I see echoed quite
a bit on physicianmessageboards. With that in
mind, let's talk about how whatit took to actually start the
practice. Let Did you So as manyof our listeners know, I was was
(10:15):
in a little bit differentsituation finishing residency, I
actually took out a loan andopened my practice. So I didn't
have any of the real clinicalexperience behind me. But so
there was a whole lot of thingsto learn. In your case, after
having that bit of clinicalexperience. What did you have to
learn to actually get yourpractice off the ground?
Commercial (10:36):
Sure. So great question. I mean, really, in the
end, the biggest thing to learnis, how to own your own
business, and how to start yourown business and all of the
things that go with that,honestly, the clinical care,
that's the easy part. That's thepart that I enjoy. It's the
(10:57):
other parts that arechallenging. So I was fortunate
that the DPC, physicians aroundthe country, most of us are,
most of them are very open, andthey want to mentor other
physicians who want to do thismodel. And there is no fee to
(11:17):
that. There's none of that it'sliterally just physicians
helping physicians. So Iconnected with one of the
physicians who kind of startedthis model. And he really helped
me Walk, walk me through it andmake decisions. You know, the
very first step is, what do youwant your name to be? And filing
(11:42):
it with the state, getting yourID number. These kind of simple
things. I think, as physicians,we don't know, that process. So
getting that done. And then, youknow, my next step was, I need
to build a website. And before Ican build a website, I really
(12:05):
need to know a location and findthe right setting for my
practice. And then with all ofthat being said, when you're
starting your own practice, andespecially with the DPC model,
you have to keep your overheadlow. So finding a spot where I
could sublease one room is whatI was looking for, to keep my
(12:30):
overhead down. And I made thedecision not to hire any staff.
So it was me, my desk, my examtable in one room. Yep. And I
was the scheduler. I was my EKGtech. So I learned how to you
(12:51):
know, did I remember where toput the leads for medical
school? Nope, I had no clue. Butyou learn it. And it's those
kind of things that I had tolearn along the way is how to be
a scheduler, how to be anaccountant, how to be a medical
assistant, and then knowing mylimits and asking for help when
(13:17):
I needed it.
D.J. Verret, MD, FACS (13:19):
Enough, that's, that's interesting. I
run a similar smaller practice.
We do do insurance, I'm as aspecialist, but I don't have
medical assistance. I have areceptionist I do my own bandage
changes, my own suture removals,all that kind of stuff in order
to keep the overhead low and,and to stay nimble. And it
really helped during the time ofCOVID. I didn't have a large
(13:40):
overhead to worry about whenwhen things just turned South
all of a sudden.
Commercial (13:47):
Absolutely. That's definitely the case. You know,
and I, I was fortunate thatafter a year and a half of doing
the DPC model, I had enoughtraction that I was able to hire
a clinical assistant. So now weare a team of two. Me and a
clinical assistant. So it's beengreat.
D.J. Verret, MD, FACS (14:08):
Let's talk a little bit about some
specifics there. You mentionedchoosing a name of the practice
in your practice is Mapleprimary care not Dr. Kane's
practice. Yeah. What went intoyour thought process and
choosing that name?
Commercial (14:24):
It's a good question. You know, I wanted
something that was simple,something that people could
remember. And in the end, I kindof go back to my childhood in
that healthcare was easy inCanada. It was never a concern
for us. And I just feel like oursystem here in America is much
(14:49):
too complicated. And so I kindof went back to you, I want
something a little bit Canadian.
And that's how I came up withthe name and then and checking
with the state of course to makesure nobody else has that name.
And that was a that was one ofthe rate limiting steps. And
when, when the nice lady on thephone said, Oh, that's nobody
(15:10):
has that name. I was like,perfect. That's the one.
D.J. Verret, MD, FACS (15:16):
So you got a name you get a EIN number.
Manvinder Kainth, MD (15:20):
Yeah.
D.J. Verret, MD, FACS (15:20):
How did you come to your practice
location? What did you look for?
You said you were subleasing aspace, obviously somebody with a
sublease. But, but I mean, thearea obviously, we're in the DFW
area, a lot of square a lot ofsquare mileage around here, you
could have set up shop and whydid you choose where you get
Commercial (15:40):
So number of different reasons. Number one is
the thing we all hate abouthealthcare organizations is the
non compete clause. So I knewthat I didn't want to fight that
clause. So I was gonna go, youknow, outside of my mileage. So
that took out, you know, adecent amount of the Metroplex.
(16:04):
And I came to Plano and settledon Plano for a number of
reasons. I feel like Plano isnow is fairly Central, in the
DFW Metroplex. It was a locationthat was very close to North
(16:25):
Dallas right off of the highway.
And it was a place where therewas a clinic who was willing to
sublease a room to me, I wassurprised to find that it is
actually fairly challenging tofind a clinic that's willing to
sublease one or two rooms for avery reasonable price. You know,
(16:49):
obviously, I was looking forvery low rent. And so that's
that's really how I, I came to,to that area.
D.J. Verret, MD, FACS (17:01):
What was your biggest fear in switching
over to the DPC model,obviously, working for large
health system, you have a fairlyreasonably guaranteed paycheck
at the end of the month?
Obviously, we've seen that'sit's not completely guaranteed
with
Manvinder Kainth, MD (17:19):
I was gonna say sometimes, yeah,
exactly. sometimes that's thecase.
D.J. Verret, MD, FACS (17:24):
But But now you're going from getting a
paycheck on a regular basis tostarting from scratch all over
again. What was that like? Andhow did you kind of overcome
those, those concerns?
Commercial (17:36):
Sure. So towards the end of being employed, honestly,
the company was decreasing mybase salary significantly. And
this goes back to all theproblems with, in my opinion,
those organizations and how theydo accounting, and if they make
(17:58):
a mistake in accounting, they'renot held accountable. So in
essence, my resignation lettergot turned in when my
administrator handed me mysalary to be, which was $14 and
14 cents an hour. So that'sobviously
D.J. Verret, MD, FACS (18:20):
You could have gone to Hobby Lobby, I just
saw they increased base pay to$14. at Hobby Lobby.
Commercial (18:26):
Exactly. I mean, I'm sorry, but you know, as a
physician getting presented,that was just a slap in the
face. So you know, when I sawtaking the leap, I mean, my
biggest concerns were, am Igoing to be able to do this? Am
I going to go bankrupt doingthis? How am I going to get
(18:49):
health insurance or any type ofbenefits? And there's just so
many unknowns, but those werethe big things that came to my
mind initially.
D.J. Verret, MD, FACS (19:03):
And how did you? I mean, obviously,
those are real concerns,especially in the benefit
department. How did you overcomethose? I mean, initially,
obviously, logistically, how didyou do it? But But more
importantly, how did you getyour mind passed? This is this
is a huge mountain to go climb.
I how did you get past that tosay, Okay, one step at a time.
Let's go. What did it take? Howdid you do that?
Commercial (19:29):
So I tried to think logically about it. You know,
my, I asked myself, What are mychoices? My choices at the time,
I felt like was continue to workwith healthcare organizations
and maybe find another one, adifferent one. But in my heart,
(19:50):
and in my brain, I knew theywere all the same and they all
have the same challenges. Andthen I thought, What is my other
option, my other option is Toopen my own practice and do the
traditional insurance model. Andthen my other option was open my
(20:10):
own practice and do the DPCmodel. And then the last option,
which I put last was doing, youknow locums or urgent care. So,
for all the reasons I told youthat I liked DPC, that's how I
came to that conclusion of thisis what I want to do. Because I
(20:35):
don't enjoy urgent care or youknow locums type of, of jobs.
And then I chose DPC over thetraditional insurance model.
Because honestly, DPC felteasier to me not having to hire
multiple staff members to, youknow, process insurance and
(20:58):
verify insurance and deal withall the coding and the billing
and the that stuff. It actuallysounded much more doable for me
to just do most of the jobs thatwere needed. And so I had some
comfort in that. So that's how Icame to it.
D.J. Verret, MD, FACS (21:17):
Now that you've, you found your spot, you
opened your office, how did youget patients?
Commercial (21:23):
Great question. So initially, I let all of my
patients know where my practicewas going to be. And so I put in
the effort and the money to sendthem letters so that they knew
(21:45):
where I was. Because obviously,the health care organization is
not going to do that. For me.
They always send out the genericletter of it's with mixed
feelings that we announced thatDr. Manvinder Kainth will no
longer be working with health,blah, blah. So that's how I
(22:05):
initially got some of mypatients to follow me. Even
though I was in a differentlocation. A number of patients
wanted to follow me and itwasn't a large amount of
patience, but it was enough toget me started.
D.J. Verret, MD, FACS (22:30):
Did you did you see a hesitancy
especially in those patients,but even after that, for
patients to adopt the DPC modelover the classical insurance
model?
Manvinder Kainth, M (22:43):
Absolutely.
It takes a lot of time andeducation to explain the model
to patients and to other people.
And they do often. Mistake DPCfor concierge medicine. And I
tried to explain the differenceto my patients and all of that
(23:07):
just took time. But oncepatients were in the practice,
and they understood the model,and you know, they were used to
it, it just made a lot moresense to them. And it makes more
sense to everybody.
D.J. Verret, MD, FACS (23:25):
What is one thing you learned since
starting your practice in a row?
And if it's more than one we'llwe'll go down that road but but
maybe the biggest thing you'velearned that you wish someone
would have told you beforestarting your DPC practice
either in a good or bad wayeither way.
Manvinder Kainth, MD (23:45):
Oh, let's see here. It's not necessarily
something I learned butsomething I listened to. I
really listened to my mentorssaying keep your overhead low.
(24:06):
Remember that your your biggestasset is being a physician and
being a good physician. So neverlet that lapse. Don't think that
you have to have a fancy officewith like a cool water fountain
and a modern this and a modernthat and you know a serving bar
(24:30):
with coffee and teas and thingslike that. Concentrate on the
patient care and the patientwill come and they will stay
with you. So I would say thatwas the biggest thing that I
took from those mentors isreminding myself that patients
(24:51):
don't care if you have a fancyexam room or a fancy this or
that. They just want you knowquality care for an affordable
cost.
D.J. Verret, MD, FACS (25:02):
We're talking with Dr. Manvinder
Kainth about her experiencestarting a primary direct
primary care practice. We'lltake a quick break and we'll ask
Dr. Kainth what her top three isright after this.
Commercial (25:20):
Commerical inserted here
D.J. Verret, MD, FACS (25:46):
Welcome back to Ask Me MD, medical
school for the real world. I'mDr. D.J. Verret and today we're
talking with Dr. ManvinderKainth, about her experience
starting a direct primary carepractice. As we do with most of
our interviewees. We're going toask Dr. Kainth , what her top
three are. And Manvinder, whatI'm going to ask you is what are
(26:07):
the top three things you wouldtell a physician who was
thinking about starting a directprimary care practice.
Commercial (26:16):
So the top three things I would tell a physician
colleague who wanted to start aDPC practice is, number one,
have a mentor or if you mentors,and listen to their advice and
see what works best for you.
Number two, is keep youroverhead low. And don't be
(26:42):
ashamed to do all wear all thehats at the office. Don't go
fancy because you don't need it.
patients don't really care aboutthat stuff. They want good care,
and they want it at anaffordable cost. Number three
(27:02):
would be remember why you wentinto medicine. I really think
that the majority of physicianswent into medicine to help
people. And unfortunately, theway medicine has gone is nobody
(27:24):
in the system is happy as far asphysicians or patients or staff.
And remember why you chose to domedicine in the first place. And
remember that on days that youthink you're going to go
bankrupt, or that you think thiswas the biggest mistake of your
(27:45):
life. Just remember why you'redoing it and keep pushing
through.
D.J. Verret, MD, FACS (27:50):
And on that front. I think I know the
answer to this. But do youregret making the change?
Commercial (27:58):
Absolutely not, I am a much happier physician. And I
actually can say that I enjoygoing to work on most days. And
I couldn't say that before whenI was working for other people
when I was an employedphysician. So now I can say that
(28:18):
I I tell people all the time. Ireally love being a family
medicine physician.
D.J. Verret, MD, FACS (28:26):
One kind of we're approaching our half
hour here. But one other thingjust to give people a sense for
this isn't an overnight process.
How long do you think it kind oftook to set when you start after
you started your practice? Howlong did it take to get to a
comfortable spot for you?
Commercial (28:45):
That's a good question. I don't know if I am
even at that comfortable spotyet. I don't know how long it's
gonna take for me to feelcomfortable. And some of that is
my personality. But what I cansay is by keeping overhead
really low, I was profitablewithin three months of opening
(29:07):
my practice. And that alonereally helped me along the way.
And so I would say that comfortmaybe at year three, and really,
really comfortable, like fairlyclose to smooth sailing, I would
(29:28):
say would be your five but I'mI'm not at either of those
points yet.
D.J. Verret, MD, FACS (29:34):
I appreciate the numbers I've
heard generally it takes fiveyears to develop a medical
practice andpersonally. That's what it took
me to get to kind of a as smoothof a sailing as you can in any
practice. But to get to thatpoint took about five years.
Manvinder Kainth, M (29:52):
Absolutely.
I would completely agree withthat.
D.J. Verret, MD, FACS (29:55):
We've been talking with Dr. Manv
nder Kainth, about herxperience and directness.
rimary Care. Manvinder, thankso much for joining us some some
reat thoughts and hopefully, weere able to give some insight.
o for folks thinking aboutaking the switch, they'll at
east reach out to somebody inhe DPC space and learn some
(30:16):
ore about it.
Manvinder Kainth, M (30:17):
Absolutely.
Thank you so much for theopportunity DJ. I'm always happy
to talk to colleagues who areconsidering DPC or are just
curious about the model.
D.J. Verret, MD, FACS (30:30):
And I'll put a link to your practice in
the in the show's description.
So if folks have questions, theycan reach out to you through
there.
Manvinder Kainth, (30:40):
Sounds great.
D.J. Verret, MD, FACS (30:42):
You're listening to Ask Me MD, medical
school for the real world. I'mDr. D.J. Verret. Until next
time, make it an awesome week.
Announcer (30:50):
Thank you for joining us for another episode of Ask me
MD medical school for the realworld with Dr. D.J. Verret. If
you have a question or an ideafor a show, send us an email at
questions at Ask Me Md pdcast.com.
Ask Me MD, medical school for the real world with
(00:03):
the MD, Dr. D.J. Verret.
D.J. Verret, MD, FACS (00:06):
Greetings and welcome to another edition
of Ask Me MD, medical school forthe real world. I'm Dr. D.J.
(00:26):
Verret, and today we're talkingwith Dr. Manvinder Kainth about
her transition into directPrimary Care Medicine. We'll
(01:14):
talk to Manvinder right afterthis
Commercial (01:23):
Commercial inserted here
D.J. Verret, MD, FACS (01:45):
Welcome back to Ask Me MD, medical
school for the real world. I'mDr. D.J. Verret. And today I
have the great pleasure oftalking with Dr. Manvinder
Kainth, a direct primary carephysician here in the Plano area
about her experience inalternative primary care
delivery models. Doctor, thanksfor joining me.
Manvinder Kainth, MD (02:07):
Thank you so much for the opportunity DJ,
D.J. Verret, MD, FACS (02:10):
Can you tell us a little bit about
yourself and your background?
Commercial (02:14):
Sure. You know, going back to the beginning, I
grew up in Canada, that's wheremy childhood was. So I kind of
grew up with national healthcare. And then my family moved
to the Houston area when Istarted high school, and I was
there for high school, collegemedical school, ended up in
(02:37):
Seattle for residency and thenstarted my career. And, you
know, I was it was a, it's beenan interesting journey. So far,
I've been with three differentmajor health organizations. And
after the third, I decided tostart my own practice.
D.J. Verret, MD, FACS (02:59):
So and that kind of brings us to why
we're here in our discussion.
Can you talk a little bit aboutthe differences in direct
primary care, conciergemedicine, cash pay practices?
And why you settled on the modelthat you have?
Commercial (03:22):
Yes, it's a very good question. So I am, I did my
residency in family medicine. SoI knew fairly early on that I
wanted to do primary care. And Iwanted to get to know my
patients have a relationshipwith my patients and actually
make some meaningful changes.
You know, as you get to knowthem, what I found in the
(03:44):
typical traditional insurancemodel is that it was really
difficult to do that. And so Ireally didn't feel fulfilled. In
my career. As a physician, it'sreally hard to make an impact
when you only have about fiveminutes to actually talk to a
(04:05):
patient per visit. And, and thenthe other 10 minutes are spent
usually with documentation. Andso my thoughts after, you know,
the three different healthcareorganizations, I finally learned
with a third that they're allpretty much the same. They all
have kind of the same rules,regulations, goals, and none of
(04:29):
them really met. What I wantedto do. And what I wanted to do
was have the time to actuallytalk to my patients, and to talk
about lifestyle, behavioralchanges, in order to make some
meaningful change, which you andI both know, takes a lot of
time. It takes time to do it.
(04:52):
And then it takes time toactually put those things in
action. And so that's kind ofhow I came to To DPC or direct
primary care, as far as thedifferences in the models, so
direct primary care, or DPC isfairly simple. I always say it's
(05:13):
not the typical insurance model.
And it's not the conciergemodel, it's kind of somewhere in
between. It works very similarto a gym membership, where you
pay a low cost monthly fee, andthat covers all your office
visits, all your in officeprocedures, all telemedicine and
there's no question or thoughtabout co insurances or co pays,
(05:39):
or what is covered what is notcovered. And so obviously,
that's a huge difference fromthe typical insurance world. The
concierge model, the way that'sdifferent is that most concierge
doctors bill a high dollarmembership fee, often the
(06:00):
average is about 2000 to 2500per year. And they will also
bill insurance on top of it. Sothat is the big difference. So
people who have deductibles orco pays, they still have to pay
those bills, but they have topay the membership fee on top of
(06:20):
that.
D.J. Verret, MD, FACS (06:24):
How did you when you were you were with
a couple of large healthsystems? That sounds like I'm
assuming integrated deliverysystems as they're called
correct?
Manvinder Kainth, MD (06:35):
Oh, I guess so.
D.J. Verret, MD, FACS (06:41):
How did you settle on the DPC model?
Like what thoughts went throughyour head? And in? What fears
did you have in making that kindof a leap? And how did you
overcome those?
Manvinder Kainth, MD (06:56):
Sure. So it all kind of fell in my lap.
So when I was getting towardsthe end of my third year, with
my last healthcare organization,I knew that I wanted to make a
change. I was not happy, the waythings were running. So the
(07:18):
biggest challenges that I had,as I mentioned before, is time
with patients. The otherchallenges were that it was
difficult for my patients to getin. The other challenge was it
was difficult for my patients toactually reach me, they had to
go through the endless phonechain to actually get a human
(07:39):
being on the phone. So those areand then of course, the wait
time, you know, when you doublebook, you know, and have six
appointments in one hour inprimary care. To me, that's a
pretty busy schedule. And I'malways going to be running at
least 15 to 20 minutes behind.
And so patients having to waitin the waiting room was also
(08:00):
frustrating. So those are allthe patients frustrations. For
me as a physician, you know, Iwasn't being fulfilled with
basically throwing medicationsat patients, you know, when I
only have five minutes, and I ambeing measured on performance.
And somebody has a like, let'ssay it's a diabetic and they
(08:23):
have an LDL of 120. I'm justupping their SAT. And I'm not
talking to them about theirexercise, their nutrition, the
very nitty gritty stuff, becauseI don't have time to do it. And
so that was a big thing that Idid not like so I wanted to make
a change. The other thing is thecost model with different health
(08:45):
organizations, obviously,they're different depending on
where you go. But I'll tell youin the end, in my opinion, it's
it's always going to benefit theorganization, it's never going
to benefit the physician. Andalmost always the physician will
get slighted when it comes totheir pay. So I was getting to
(09:09):
that point, I happened to seethat the TMA was basically
sponsoring a DPC conference. Andit was just one day it was
almost free. The conference, Ineeded some CMA, I decided to go
(09:30):
and when I attended thatconference, it really opened my
eyes to the DPC model or directprimary care model. I honestly
had never even heard of it. Butit was after that conference
that I decided, you know whatI'm going to, I'm gonna take the
leap, and I'm gonna, I'm gonnago for it.
D.J. Verret, MD, FACS (09:54):
The thoughts you're putting out
there about why you were unhappyare ones that I see echoed quite
a bit on physicianmessageboards. With that in
mind, let's talk about how whatit took to actually start the
practice. Let Did you So as manyof our listeners know, I was was
(10:15):
in a little bit differentsituation finishing residency, I
actually took out a loan andopened my practice. So I didn't
have any of the real clinicalexperience behind me. But so
there was a whole lot of thingsto learn. In your case, after
having that bit of clinicalexperience. What did you have to
learn to actually get yourpractice off the ground?
Commercial (10:36):
Sure. So great question. I mean, really, in the
end, the biggest thing to learnis, how to own your own
business, and how to start yourown business and all of the
things that go with that,honestly, the clinical care,
that's the easy part. That's thepart that I enjoy. It's the
(10:57):
other parts that arechallenging. So I was fortunate
that the DPC, physicians aroundthe country, most of us are,
most of them are very open, andthey want to mentor other
physicians who want to do thismodel. And there is no fee to
(11:17):
that. There's none of that it'sliterally just physicians
helping physicians. So Iconnected with one of the
physicians who kind of startedthis model. And he really helped
me Walk, walk me through it andmake decisions. You know, the
very first step is, what do youwant your name to be? And filing
(11:42):
it with the state, getting yourID number. These kind of simple
things. I think, as physicians,we don't know, that process. So
getting that done. And then, youknow, my next step was, I need
to build a website. And before Ican build a website, I really
(12:05):
need to know a location and findthe right setting for my
practice. And then with all ofthat being said, when you're
starting your own practice, andespecially with the DPC model,
you have to keep your overheadlow. So finding a spot where I
could sublease one room is whatI was looking for, to keep my
(12:30):
overhead down. And I made thedecision not to hire any staff.
So it was me, my desk, my examtable in one room. Yep. And I
was the scheduler. I was my EKGtech. So I learned how to you
(12:51):
know, did I remember where toput the leads for medical
school? Nope, I had no clue. Butyou learn it. And it's those
kind of things that I had tolearn along the way is how to be
a scheduler, how to be anaccountant, how to be a medical
assistant, and then knowing mylimits and asking for help when
(13:17):
I needed it.
D.J. Verret, MD, FACS (13:19):
Enough, that's, that's interesting. I
run a similar smaller practice.
We do do insurance, I'm as aspecialist, but I don't have
medical assistance. I have areceptionist I do my own bandage
changes, my own suture removals,all that kind of stuff in order
to keep the overhead low and,and to stay nimble. And it
really helped during the time ofCOVID. I didn't have a large
(13:40):
overhead to worry about whenwhen things just turned South
all of a sudden.
Commercial (13:47):
Absolutely. That's definitely the case. You know,
and I, I was fortunate thatafter a year and a half of doing
the DPC model, I had enoughtraction that I was able to hire
a clinical assistant. So now weare a team of two. Me and a
clinical assistant. So it's beengreat.
D.J. Verret, MD, FACS (14:08):
Let's talk a little bit about some
specifics there. You mentionedchoosing a name of the practice
in your practice is Mapleprimary care not Dr. Kane's
practice. Yeah. What went intoyour thought process and
choosing that name?
Commercial (14:24):
It's a good question. You know, I wanted
something that was simple,something that people could
remember. And in the end, I kindof go back to my childhood in
that healthcare was easy inCanada. It was never a concern
for us. And I just feel like oursystem here in America is much
(14:49):
too complicated. And so I kindof went back to you, I want
something a little bit Canadian.
And that's how I came up withthe name and then and checking
with the state of course to makesure nobody else has that name.
And that was a that was one ofthe rate limiting steps. And
when, when the nice lady on thephone said, Oh, that's nobody
(15:10):
has that name. I was like,perfect. That's the one.
D.J. Verret, MD, FACS (15:16):
So you got a name you get a EIN number.
Manvinder Kainth, MD (15:20):
Yeah.
D.J. Verret, MD, FACS (15:20):
How did you come to your practice
location? What did you look for?
You said you were subleasing aspace, obviously somebody with a
sublease. But, but I mean, thearea obviously, we're in the DFW
area, a lot of square a lot ofsquare mileage around here, you
could have set up shop and whydid you choose where you get
Commercial (15:40):
So number of different reasons. Number one is
the thing we all hate abouthealthcare organizations is the
non compete clause. So I knewthat I didn't want to fight that
clause. So I was gonna go, youknow, outside of my mileage. So
that took out, you know, adecent amount of the Metroplex.
(16:04):
And I came to Plano and settledon Plano for a number of
reasons. I feel like Plano isnow is fairly Central, in the
DFW Metroplex. It was a locationthat was very close to North
(16:25):
Dallas right off of the highway.
And it was a place where therewas a clinic who was willing to
sublease a room to me, I wassurprised to find that it is
actually fairly challenging tofind a clinic that's willing to
sublease one or two rooms for avery reasonable price. You know,
(16:49):
obviously, I was looking forvery low rent. And so that's
that's really how I, I came to,to that area.
D.J. Verret, MD, FACS (17:01):
What was your biggest fear in switching
over to the DPC model,obviously, working for large
health system, you have a fairlyreasonably guaranteed paycheck
at the end of the month?
Obviously, we've seen that'sit's not completely guaranteed
with
Manvinder Kainth, MD (17:19):
I was gonna say sometimes, yeah,
exactly. sometimes that's thecase.
D.J. Verret, MD, FACS (17:24):
But But now you're going from getting a
paycheck on a regular basis tostarting from scratch all over
again. What was that like? Andhow did you kind of overcome
those, those concerns?
Commercial (17:36):
Sure. So towards the end of being employed, honestly,
the company was decreasing mybase salary significantly. And
this goes back to all theproblems with, in my opinion,
those organizations and how theydo accounting, and if they make
(17:58):
a mistake in accounting, they'renot held accountable. So in
essence, my resignation lettergot turned in when my
administrator handed me mysalary to be, which was $14 and
14 cents an hour. So that'sobviously
D.J. Verret, MD, FACS (18:20):
You could have gone to Hobby Lobby, I just
saw they increased base pay to$14. at Hobby Lobby.
Commercial (18:26):
Exactly. I mean, I'm sorry, but you know, as a
physician getting presented,that was just a slap in the
face. So you know, when I sawtaking the leap, I mean, my
biggest concerns were, am Igoing to be able to do this? Am
I going to go bankrupt doingthis? How am I going to get
(18:49):
health insurance or any type ofbenefits? And there's just so
many unknowns, but those werethe big things that came to my
mind initially.
D.J. Verret, MD, FACS (19:03):
And how did you? I mean, obviously,
those are real concerns,especially in the benefit
department. How did you overcomethose? I mean, initially,
obviously, logistically, how didyou do it? But But more
importantly, how did you getyour mind passed? This is this
is a huge mountain to go climb.
I how did you get past that tosay, Okay, one step at a time.
Let's go. What did it take? Howdid you do that?
Commercial (19:29):
So I tried to think logically about it. You know,
my, I asked myself, What are mychoices? My choices at the time,
I felt like was continue to workwith healthcare organizations
and maybe find another one, adifferent one. But in my heart,
(19:50):
and in my brain, I knew theywere all the same and they all
have the same challenges. Andthen I thought, What is my other
option, my other option is Toopen my own practice and do the
traditional insurance model. Andthen my other option was open my
(20:10):
own practice and do the DPCmodel. And then the last option,
which I put last was doing, youknow locums or urgent care. So,
for all the reasons I told youthat I liked DPC, that's how I
came to that conclusion of thisis what I want to do. Because I
(20:35):
don't enjoy urgent care or youknow locums type of, of jobs.
And then I chose DPC over thetraditional insurance model.
Because honestly, DPC felteasier to me not having to hire
multiple staff members to, youknow, process insurance and
(20:58):
verify insurance and deal withall the coding and the billing
and the that stuff. It actuallysounded much more doable for me
to just do most of the jobs thatwere needed. And so I had some
comfort in that. So that's how Icame to it.
D.J. Verret, MD, FACS (21:17):
Now that you've, you found your spot, you
opened your office, how did youget patients?
Commercial (21:23):
Great question. So initially, I let all of my
patients know where my practicewas going to be. And so I put in
the effort and the money to sendthem letters so that they knew
(21:45):
where I was. Because obviously,the health care organization is
not going to do that. For me.
They always send out the genericletter of it's with mixed
feelings that we announced thatDr. Manvinder Kainth will no
longer be working with health,blah, blah. So that's how I
(22:05):
initially got some of mypatients to follow me. Even
though I was in a differentlocation. A number of patients
wanted to follow me and itwasn't a large amount of
patience, but it was enough toget me started.
D.J. Verret, MD, FACS (22:30):
Did you did you see a hesitancy
especially in those patients,but even after that, for
patients to adopt the DPC modelover the classical insurance
model?
Manvinder Kainth, M (22:43):
Absolutely.
It takes a lot of time andeducation to explain the model
to patients and to other people.
And they do often. Mistake DPCfor concierge medicine. And I
tried to explain the differenceto my patients and all of that
(23:07):
just took time. But oncepatients were in the practice,
and they understood the model,and you know, they were used to
it, it just made a lot moresense to them. And it makes more
sense to everybody.
D.J. Verret, MD, FACS (23:25):
What is one thing you learned since
starting your practice in a row?
And if it's more than one we'llwe'll go down that road but but
maybe the biggest thing you'velearned that you wish someone
would have told you beforestarting your DPC practice
either in a good or bad wayeither way.
Manvinder Kainth, MD (23:45):
Oh, let's see here. It's not necessarily
something I learned butsomething I listened to. I
really listened to my mentorssaying keep your overhead low.
(24:06):
Remember that your your biggestasset is being a physician and
being a good physician. So neverlet that lapse. Don't think that
you have to have a fancy officewith like a cool water fountain
and a modern this and a modernthat and you know a serving bar
(24:30):
with coffee and teas and thingslike that. Concentrate on the
patient care and the patientwill come and they will stay
with you. So I would say thatwas the biggest thing that I
took from those mentors isreminding myself that patients
(24:51):
don't care if you have a fancyexam room or a fancy this or
that. They just want you knowquality care for an affordable
cost.
D.J. Verret, MD, FACS (25:02):
We're talking with Dr. Manvinder
Kainth about her experiencestarting a primary direct
primary care practice. We'lltake a quick break and we'll ask
Dr. Kainth what her top three isright after this.
Commercial (25:20):
Commerical inserted here
D.J. Verret, MD, FACS (25:46):
Welcome back to Ask Me MD, medical
school for the real world. I'mDr. D.J. Verret and today we're
talking with Dr. ManvinderKainth, about her experience
starting a direct primary carepractice. As we do with most of
our interviewees. We're going toask Dr. Kainth , what her top
three are. And Manvinder, whatI'm going to ask you is what are
(26:07):
the top three things you wouldtell a physician who was
thinking about starting a directprimary care practice.
Commercial (26:16):
So the top three things I would tell a physician
colleague who wanted to start aDPC practice is, number one,
have a mentor or if you mentors,and listen to their advice and
see what works best for you.
Number two, is keep youroverhead low. And don't be
(26:42):
ashamed to do all wear all thehats at the office. Don't go
fancy because you don't need it.
patients don't really care aboutthat stuff. They want good care,
and they want it at anaffordable cost. Number three
(27:02):
would be remember why you wentinto medicine. I really think
that the majority of physicianswent into medicine to help
people. And unfortunately, theway medicine has gone is nobody
(27:24):
in the system is happy as far asphysicians or patients or staff.
And remember why you chose to domedicine in the first place. And
remember that on days that youthink you're going to go
bankrupt, or that you think thiswas the biggest mistake of your
(27:45):
life. Just remember why you'redoing it and keep pushing
through.
D.J. Verret, MD, FACS (27:50):
And on that front. I think I know the
answer to this. But do youregret making the change?
Commercial (27:58):
Absolutely not, I am a much happier physician. And I
actually can say that I enjoygoing to work on most days. And
I couldn't say that before whenI was working for other people
when I was an employedphysician. So now I can say that
(28:18):
I I tell people all the time. Ireally love being a family
medicine physician.
D.J. Verret, MD, FACS (28:26):
One kind of we're approaching our half
hour here. But one other thingjust to give people a sense for
this isn't an overnight process.
How long do you think it kind oftook to set when you start after
you started your practice? Howlong did it take to get to a
comfortable spot for you?
Commercial (28:45):
That's a good question. I don't know if I am
even at that comfortable spotyet. I don't know how long it's
gonna take for me to feelcomfortable. And some of that is
my personality. But what I cansay is by keeping overhead
really low, I was profitablewithin three months of opening
(29:07):
my practice. And that alonereally helped me along the way.
And so I would say that comfortmaybe at year three, and really,
really comfortable, like fairlyclose to smooth sailing, I would
(29:28):
say would be your five but I'mI'm not at either of those
points yet.
D.J. Verret, MD, FACS (29:34):
I appreciate the numbers I've
heard generally it takes fiveyears to develop a medical
practice andpersonally. That's what it took
me to get to kind of a as smoothof a sailing as you can in any
practice. But to get to thatpoint took about five years.
Manvinder Kainth, M (29:52):
Absolutely.
I would completely agree withthat.
D.J. Verret, MD, FACS (29:55):
We've been talking with Dr. Manv
nder Kainth, about herxperience and directness.
rimary Care. Manvinder, thankso much for joining us some some
reat thoughts and hopefully, weere able to give some insight.
o for folks thinking aboutaking the switch, they'll at
east reach out to somebody inhe DPC space and learn some
(30:16):
ore about it.
Manvinder Kainth, M (30:17):
Absolutely.
Thank you so much for theopportunity DJ. I'm always happy
to talk to colleagues who areconsidering DPC or are just
curious about the model.
D.J. Verret, MD, FACS (30:30):
And I'll put a link to your practice in
the in the show's description.
So if folks have questions, theycan reach out to you through
there.
Manvinder Kainth, (30:40):
Sounds great.
D.J. Verret, MD, FACS (30:42):
You're listening to Ask Me MD, medical
school for the real world. I'mDr. D.J. Verret. Until next
time, make it an awesome week.
Announcer (30:50):
Thank you for joining us for another episode of Ask me
MD medical school for the realworld with Dr. D.J. Verret. If
you have a question or an ideafor a show, send us an email at
questions at Ask Me Md pdcast.com.
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