October 26, 2025 • 63 mins
In today's episode of the My DPC Story Podcast, host Dr. Maryal Concepcion interviews Dr. Isabel Amigues, the first Direct Specialty Care rheumatologist in Colorado and founder of Unabridged MD in Denver. Dr. Amigues shares her inspiring journey through training in both France and the US, and how surviving stage 4 metastatic breast cancer transformed her medical approach. Blending Western medicine with holistic healing techniques like meditation, visualization, and energy work, she delivers personalized rheumatology care outside the constraints of insurance models. The episode dives deep into her rapid practice growth, patient-centered philosophy, and the advantages of direct specialty care for chronic and autoimmune diseases. Listeners gain valuable insight on patient advocacy, overcoming healthcare burnout, medication access, and building a thriving DPC clinic. Connect with Dr. Amigues for expert rheumatologic care and learn how direct specialty care empowers both physicians and patients.
Keywords: direct primary care, direct specialty care, rheumatology, Unabridged MD, Dr. Isabel Amigues, Denver, autoimmune disease, holistic medicine, fee-for-service alternative, physician burnout, patient advocacy.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Maryal Concepcion, MD (01:18):
Direct Primary care is an innovative
alternative path toinsurance-driven healthcare.
Typically, a patient pays theirdoctor a low monthly membership
and in return builds a lastingrelationship with their doctor
and has their doctor availableat their fingertips.
Welcome to the my DPC storypodcast, where each week.
(01:39):
You will hear the ever sorelatable stories shared by
physicians who have chosen topractice medicine in their
individual communities throughthe direct primary care model.
I'm your host, Marielleconception family physician,
DPC, owner, and former fee forService.
Doctor, I hope you enjoy today'sepisode and come away feeling
inspired about the future ofpatient care direct Primary
(02:02):
care.
Isabel Amigues, MD (02:07):
I can be the physician.
I've always imagined that Iwould be, and I can see the
outcome of my patients exactlythe way I wanted them to be.
So it's improved myrelationships with my patients
and to improve the relationshipthat I have with my own family,
and my own community.
Because I am more in charge ofmy life.
(02:28):
I'm creating what I want it tobe.
I'm Dr.
Isabel Ami, and this is my DSCstory.
Maryal Concepcion, MD (02:40):
Dr.
Isabel Amigues is arheumatologist based in Denver,
Colorado.
She honed her expertise bystudying in Paris as well as
Columbia University in New YorkCity.
At age 40, she was diagnosedwith stage four metastatic
breast cancer.
A timely meeting with anon-traditionally trained
practitioner taught her adifferent approach to disease
where she experienced the powerof meditation, visualization,
(03:02):
energy, healing and love.
Her journey through cancerinspired her to learn more about
these alternative techniques,and she now blends Western
medicine and Eastern techniquesinto her practice at
UnabridgedMD.
Today we're going back toColorado and highlighting what
is absolutely becoming a muchneeded specialty in the direct
(03:26):
specialty care world.
And Dr.
Ami is going to be talking withus about how she has built this
insanely successful rheumatologyclinic in the direct specialty
care space.
But also I'm super excited to bechatting with her because I
think it's, it's veryinteresting when a person is
delivering care in the way thatwe do after they've had a
(03:47):
significant experience as apatient themselves.
So thank you so much Dr.
Amid, for joining us today.
Isabel Amigues, MD (03:53):
Well, thank you for having me.
I've heard so much about you.
I'm super excited to be heretoday.
Maryal Concepcion, MD (03:58):
Awesome.
So I wanted to, really highlightthat you are so passionate about
bringing to your patients a wayof not just the western medicine
that most of us were taught in,but also really focusing on
resilience and healing and notdealing with the the, the, the
victimhood of being a patient.
(04:18):
And so I would love if you couldstart us off with telling us
about your experience as apatient that helped bring you to
this space as a physician witheven more empathy because of
what you've gone through.
Isabel Amigues, MD (04:30):
Yeah, absolutely.
Thank you.
That's such a cool question,right?
So.
At a little bit over 40.
I was diagnosed with stage fourbreast cancer.
And being a physician andparticularly optimistic
physician, when it, I thought itwas just stage three, I was
like, yeah, whatever.
I was like, not afraid.
I don't know why.
I was like, yeah, whatever.
And then when it was stage fourand I had metastasis to deliver
(04:52):
and the bone, then I was like,okay, you've got my attention.
And what's interesting is thatit happened when I was going for
my midlife crisis.
So I had repeated my training.
I come from France, and Irepeated my my residency.
I repeated my fellowship and Ireally love I love learning.
So it wasn't, I didn't, I, and Ididn't have student loans
because in France, being adoctor costs like$500 per year.
(05:17):
And yeah,$500.
Wow.
I know, right?
And then you get paid as aresident.
Actually, I thought I, I get, Igot paid as a medical student,
but it was less than if I hadbeen a babysitter, so I was mad.
And then I come to the US andI'm like, okay, I should not
have been mad.
So anyway, and, and so basicallyI finished all of this and I
(05:37):
was, I was, I was I had kids andand I basically went through
this really.
Like stereotypical midlifecrisis where I was like, what am
I doing with my life?
This is not where I, what Iwant.
And when you want something sobad that that's all you're
doing.
So just like wanted to be adoctor, wanted to be a a, a
(05:58):
rheumatologist, wanted to be arheumatologist in the us, wanted
to have kids, wanted to doresearch, and here I am, all of
it, right?
I, I've got all of it, but thenkind of like, yeah, but for
what?
Like, sure, what's the good?
And I'm not, I'm not happy nowthat I have all of this.
I'm feeling actually veryunhappy.
And, and then this diagnosiscame and what's really it's kind
(06:20):
of, it's sort of a blessing, isthat.
It's not sore.
It is a blessing.
It's because I was in thismidlife crisis.
I was already starting to reachout to my friends in France and
to my community basically.
And, and in France, a lot of myfriends are not physician
actually in the US too.
But basically I started justlike listening and, and sharing
(06:44):
how unhappy and sad I was andhaving phone calls where I was
just like crying for a wholetime.
And one of my friend was, I, Igot my diagnosis of breast
cancer in France.
'cause I had decided on my 40thbirthday that I was going to go
to France alone for four days.
And then I was offering this tomyself.
And at the time it was like abig decision'cause I was leaving
(07:04):
my twins that were like threeyears old with the au pair and
and my their dad.
And I felt so guilty.
But then I was like, it's my40th birthday.
I get to do this.
And then I saw the tumorbasically on a Saturday.
They got, and I had my ticketsto go to France on a Wednesday.
That was like two weeks after mybirthday.
(07:25):
So I had taken those ticketslike right away.
And at the time I remember theywere kind of like, why would you
want to go to France now whenyou just got diagnosed?
And we know that it's at leaststage three.
'cause the lymph nodes lookedreally bad.
And and I remember I was like,well, it's not gonna change
anything and I need mycommunity.
So I go to France and in France,while, they confirm the type of
(07:45):
cancer it is and, and you knowhow bad it is.
My friend basically are like,well, do you wanna talk to this
naturopath?
And what's really interesting isthat as a physician who's done a
lot of research, I had alwaysbeen like, what the heck is
this?
Like, like, like why are peopletrusting their naturopath more
than they're trusting me as aphysician?
I've done two trainings.
(08:06):
Why are they listening to this?
But I had seen this naturopathswork through my friend as more
of a talking and discussing thanany sort of like weird,
supplemental herbs.
Mm-hmm.
And so I went and what's reallycool is that I actually reached
out to this naturopath and Isaid, Hey look, I'm in France
only for like four days.
(08:27):
And really it's only like oneday that I'm gonna be in Lyon.
'cause that natural path wasn'tnew.
Is there any chance you can seeme during this 24 hour?
I think it was like eight hourperiod that I was there and she
actually opened her practice ona Saturday morning just to see
me.
Right.
Like just that by itself orlike, hold on.
(08:47):
Like this is.
This is amazing because I feellike as a physician, I realized
how much I had startedprotecting myself mm-hmm.
Against patients, and I'm usingthe word against because this is
how it felt.
I was like, I'm against, like,they are not my, my friends, now
they are my enemy.
Right.
Like, but it's not true.
Right.
But I'm, I was protecting myselfbecause of the way, and we'll
(09:10):
talk about this, like the, theway the system is.
Mm-hmm.
And so I go and what wasincredible is that I start just
talking and sharing how unhappyI was even before the cancer
diagnosis and that I was dyingeven before the cancer
diagnosis.
And here she is using the wordthat I would always remember and
the word in French.
But she's like, do not see thecancer as an enemy, but see the
(09:33):
cancer as a friend who's here toteach you something.
And like any good friend, whenthat time has come, we leave.
And I carry those word the wholetime.
Stage four is very scary.
And yet if you start thinking ofanything that's happening to you
as a friend, as an opportunityto grow, we are.
(09:55):
So, I had to come to terms,right?
Like now it's easy to say, ohyeah, I did all of this, but
like I went deep, I went, I wasvery vulnerable and I.
I had a real talk with myself,which didn't happen.
Just like that.
It's not like, oh, you have tohave a talk with yourself.
It took a long time to really belike, okay, do I actually want
(10:15):
to live?
And it's really interesting'cause from the outside, no one
would, I've imagined that Ididn't wanna live, but the truth
is that there was a moment whereI was like, well, I'm being
given this option of living andnot feel guilty, right?
Because yeah, I could leavethis, this and leave my kids and
not, and, and because it washard for me to be a mom, it's
(10:39):
still hard to be a mom.
But at that time I feltextremely guilty.
I had a lot of trauma.
The kids, it was very hard tohave kids.
And then they were very preemie.
And so I think I had a lot oftrauma and no, I don't think,
I'm sure.
And yeah, just going deep andstarting to like talk to myself,
(10:59):
talk to my body as if my bodywas yes, part of me, but also
its own entity.
It's very interesting.
Mm-hmm.
And then just not being in afight with myself, not being in
a fight with my body and Istarted just letting my ego go.
Because when you are potentiallyfacing death, I think it's much
(11:21):
easier to let your ego go.
And and basically I went deepand, and, and like, try to
figure out what I wanted for mylife, what I wanted, as a mom,
what I wanted as a physician,what I wanted as, all of this.
And and I did a lot ofmeditation, a lot of
visualization.
I did a lot of exercise.
I did, I changed my diet to bemuch more, much healthier and I,
(11:45):
surrounded myself with lovedones.
And and what's interesting is,and, and I was able to say no to
anything that I didn't feel wasright for me, which, is
incredibly, I, I, I know thatI'm very lucky.
But it was not an all ornothing.
It was just like, I want to seepatient.
This is important to me, but Ionly want to see three or four
(12:08):
hours of patients per day.
That's it, right?
And only three times a week.
That's it.
And I was able to do that.
So my institution was like supersupportive.
They were amazing.
And and then, as I healed, Iwent into full remission.
I started like going into the,the science of,'cause I wanted
the power of placebo.
At that time I was like, I'm notgonna look at if this is proven
(12:32):
or not.
I'm just gonna do it.
Right.
I even did like energy healing.
And this is where you realize,you're like, hold on.
As a physician, my job is toshare the data, right?
And what those naturopaths aredoing is that they are also
sharing love and caring and allof those.
(12:53):
Which there's no reason not forus to share it.
We just have to be supertransparent.
So I have been very transparentwith some of my patients where I
would be like, look, I dovisualization.
At the time when I was sharingthis, I would be like, I don't
know the data, but it's helpedme.
Now I'm like, there is data.
It's not the best data, butthere is data.
And that's the thing.
Like I, all of those things thatI was doing, I realized that
(13:16):
there were data to support them.
But of course it's not super,like, it's something that anyone
can share.
And so I think that physiciansdon't necessarily know about all
of those data'cause we have somuch to learn already.
Right?
So it's gonna be hard to go andlook at those data.
And then it's not like there isa, there is, there is no drug
company advertising meditation,right?
(13:40):
And it's probably just as goodas a biologic, but there is no
money to be made on this.
Maybe there is, I.
And so, right, who do we see inour practice?
We see, all those drug companiesand we don't, hear about
meditation, but there is dataand it's interesting, like
recently rheumatoid arthritis,the FDA approved a vagus nerve
(14:02):
stimulation for rheumatoidarthritis on a very limited
amount of patients.
So it's, to me, it's more of aproof to con, like it's the
proof to concept concept findvery, very interesting.
And that's the thing, right?
Meditation stimulates theparasympathetic system the same
way that it stimulates the vagusnerve.
So if you meditate, if you do ifyou exercise, if you put some
(14:24):
splash of cold water on yourface, if you are in a loving
environment, you are more likelyto heal.
And that's what I had done forthe cancer.
We know cancer is veryinflammatory.
I did, of course, all of thechemo and the biologics for my,
for the, for the breast cancer.
Of course.
And all of those.
And and I, in rn now we justprove that, I bet work we're
(14:48):
gonna be able to prove this inoncology as well.
And so because all of thosedisease, they are basically
pro-inflammatory, like they'reinflammatory, right?
And so I think that that'swhat's really cool is that I
basically started like thinkingdifferently as a patient in
addition to being a physician,as a researcher, in addition to
just being a physician and belike, hold on, when it comes to
(15:11):
actual clinical care, it's notjust about the hard data, the
randomized control, placebo,double-blinded trial, but it is
about do you have hope?
Like am I offering hope to your,and, and things like that.
And so that is, that is what Ihave done.
Like that's, that's basicallywhat I did as a patient and what
(15:32):
I started to do as a physician.
And I think that that prettymuch, encapsuled, the, the, the
way it started.
Maryal Concepcion, MD (15:40):
one, I'm so glad that you are in
remission.
I mean, that is to anybody whohas been through a such a scary
diagnosis like that, I am sograteful that you are doing what
you're doing and that you arehealthy To be able to do that is
such a, an amazing place to be.
But I also think that this iswhere it is so awesome that you
brought yourself and all ofthese things that you had
(16:05):
realized and learned andpracticed to your patients.
Because this is really gettingat the heart of why people seek
out practices like yours andmine.
They want to have a relationshipwith their doctor who treats
them like a human being.
Just like we are treatingourselves like human beings by
leaving the system and goinginto direct care.
(16:25):
So I am, so, so much applause.
I'm like trying to notphysically clap, so it's not in
the mic right now, but I am verygrateful that you and your
community are celebrating whatyou're doing.
So let's take a step back nowinto the fact that you trained
both in France as well as in NewYork at Columbia, because I
(16:46):
think about how we workourselves to death in the United
States of America.
And I think that, when peoplethink of France, they think of
the south of France.
They think of like, takingbetter care of yourself walking
places instead of, having touber around everywhere.
But I'm just wondering if youcan talk to us about also the
what you, what you experiencedas a person in training between
(17:10):
the two cultures.
Because I, I always think abouthow growing up in a very, family
centered Filipino family inSacramento, it was like my way
of interacting with patients wasvery much more it was always
very much more family medicineesque, if that makes sense.
And so I'm wondering if you cantalk to us about, how your
(17:30):
mindset was as you went throughtraining in the states, because
you were, you were already aphysician in a different
healthcare system before youcame here.
Isabel Amigues, MD (17:39):
Yeah, yeah.
Well, another incredibly goodquestion.
So the training in France is alot more clinical, it's very
clinical and basically, secondyear of medicine.
So we have six years, right?
So we start at 17, 18, and thenit's six years.
The first year is really justbasic.
(18:00):
Science there's a little bit,there's a little bit of ethics
actually as well.
And we did our heart art in the,in the, in our first year.
And basically everyone can getin, but not everyone can
continue.
And so we were like more than800, and then it was like 60
people can get to the secondyear so that it's a loss of of
time for some, because if youdon't get in right, it's like,
(18:23):
okay.
And and then the second year youstart having some clinical
training where, so you startlike learning, medicine.
And then you go into a servicelike a department of medicine in
in the hospital once a week.
In the morning, like, so I thinkit was every Wednesday morning
and then the year after youstart every day, every morning
(18:44):
you are in the service.
And then from then on until theend of your.
Of your training.
You are at least every morninguntil one or 2:00 PM inside a
service.
And then you are, you are evendoing nights and so on.
You're doing nights, you'redoing weekends.
So they, they rely on havingmedical students.
(19:05):
Mm-hmm.
Which is why I was telling you Iwas upset because we were
getting money, but for the hoursthat we were working, we were
not getting so much money.
So I just to say, I just to saythat it was very clinical and
you are being asked to be a goodclinician and you're being asked
to listen to patients tounderstand and so on.
And you're working at the sametime to study, to learn all of
(19:28):
this.
And and you know that you haveanother exam at the end of the
sixth year where again, everyoneis gonna pass an exam and it's
the exam that's gonna decide.
Where you're ranked and everyonechooses depending on their rank.
So the first in, so in the pastwhen it was mostly men, they
would choose surgery.
As the medicine has shifted to amore woman, surgery became
(19:52):
behind.
It's actually funny.
Right?
And so it has, it's been morelike actually rheumatology is
very difficult.
The same way that dermatologyis, uh mm-hmm.
Is pretty difficult.
And you choose where you wannabe and uh, and and the type of
medicine that you wanna practicedepending on what's left.
And so, that, like that trainingwas really, really good.
(20:13):
Very clinical.
Then you go, do residencyfellowship and it's like six
month training and there is acontinuity of care, right?
'cause you're like taking careof your patient for like six
months and they're always yourpatient.
It's not like it's only one weekand then you have someone else.
And like, this drove me crazywhen I came to the US and so
then I moved to the US right?
(20:33):
And I think the first thing thatreally bothered me, so it was
New York, and I know that thisis very different from all
different places.
But the thing that's reallybothered me was the absence of
continuity of care.
Mm-hmm.
And realizing that it didn'tmatter.
(20:54):
Like, and that this to me wasjust so diss, demonizing because
if there is no continuity ofcare, how do you create a
report?
You are basically talking abouta case and I don't know, I just,
I remember like one of the firstday I actually almost quit and
again went back to France andthe first interaction I remember
(21:17):
I had a patient who had hadradiation therapy for cancer of
his mouth.
And first of all I was like,wow, I'm an internal medicine
and I'm like dealing withanything and everything in
medicine.
Whereas in France it was likethis patient would've gone to
the ENT group or it would'vegone to the ology oncology group
or so on.
And in the US it's like.
(21:37):
Well, you can have a diabetesand then an hypertension case,
and then like a psychiatric,case.
And then I also like hipfracture, DVT, whatever, like,
it's just, it's just kind oflike whatever.
And this patient that had thisENT what could have been an ENT,
I remember like, he would noteat and I open his mouth and no
(21:57):
one had cleaned it for weeks.
And, and I just felt helpless.
Awful.
Like, just like as if we hadremoved the dity of the patient
and the process, my own as aphysician and just like the
(22:20):
absence of caring.
And it took me a while, tounderstand that it's not one
person that doesn't care, it'sjust a system.
Right.
And I start, like at first I wasbut to, but, but to head, I
don't know what that expressionis, but against the nurses,
because in France the nurseswere really caring of their
(22:41):
residents and.
And they were nurses that werein the rheumatology ward for
years.
So really they were kind of nps,but just didn't have that,
thing.
And they were doing nurses and anurse would never ever have
asked a resident to put an iv.
If you were called to put an IVto one of your patients, you are
(23:03):
putting a central line.
Mm-hmm.
So the first time I was calledto put an iv, I was like, whoa,
like I'm gonna put a centralline.
Okay, fine, I'm ready for that.
And then they're like, no, no,no, no, you need to put an iv.
And I'm like, wait, like that'syour specialty.
Like, I'm not to put a centralline, I actually am not really
good at putting IVs like crazy.
And and it took, yeah, that wasthe first time I was like, wow,
(23:25):
like this is awful.
Like this is, this is not care.
And I remember telling.
My, my partner and the reason,became my husband and the, the
dad of my kids.
And I was like, if I'm sick, Iwant you to send me on a plane
to France.
I don't wanna be in the us.
What's interesting is that I'velearned letter.
I, I had my babies at CornellUniversity and it was like
(23:47):
unbelievable care, but it wasjust this, it was a community
hospital at the time, and, and Ithink it, it depends where you
are and mm-hmm.
Which you have and.
So, yeah, it was, it was it was,it was rough.
It was rough.
And so that's the first thingthat was, I thought was rough.
The second is I was in, takingcare of patients in Harlem
(24:08):
Washington Heights, so a lot ofAfrican American, and I couldn't
understand why they didn't trustme in what I was telling.
And that was like weird.
I was like, why would, like, I,I was like, it's scratching my
head.
I'm like, wait, like why, why doI feel like they don't trust me
until I learn about, what is itlike oh, somehow the Tuskegee,
like the ies, how they wereputting Cies and African
(24:30):
American people and, and thenyou're like, oh yeah, no, no, I
understand why you don't trustme.
Like, like, and so, historyreally helps us understand a
lot, right?
And, and so then I was like,wow, I'm so sorry.
And I would actually use thefact that I was French to
explain, look.
I'm French, I'm, I'm, I'velearned to care for my people
(24:51):
like you are my people.
I care, this is the data.
I recommend this, but at the endof the day, it's your choice,
right?
And yeah, the number of patientsthat would come, and I have like
some really cool stories ofpatients who had horrible lupus
coma and then, totally, totallynormal.
And that patient who come andAfrican American have said, my
(25:12):
friends told me to stop theCellCept.
And I was like, Nope.
I trust my doctor and I'm gonnacontinue it.
And the number, like you canactually see that this is just
the tip of the asberg and he'stelling me the story.
But for this person that saysno, because he's educated,
because it trusts me how manyother patients did not believe
what their doctors wereprescribing, right?
(25:33):
And with the political climate,now, I don't know how many
people are gonna trust us.
F but you see, this is like,this was the second thing.
And then the third thing was, Ihad finished everything,
fellowship and all this inFrance, and I'm coming back as
an intern and Oh wow.
I think that there's trauma tobe had there because and I'm a
(25:54):
pretty strong personality, but Iremember I was like, I'm
basically the, I'm sorry forthis word, like the bitch of of
the resident and for what, likethis is crazy.
And that was really painfulbecause there is no such thing
in France.
You are the intern the wholetime.
You're not the intern or theresident, however you call it,
but there's not one residentthat's more like powerful than
(26:16):
the other.
And what it is, is that ifyou're a resident that have
that, that already has threeyears under the belt as a
resident, you just are moreknowledgeable.
And so the younger resident isgonna come to you as Q So there
is this.
Symbiotic relationship where theolder resident are really happy
to share that knowledge to theyounger residents.
(26:37):
And that didn't feel like thatat all.
It felt like, well, I, Iremember, oh my gosh, I was like
in the ER and there's thisresident that comes to me.
(27:30):
I had not seen the patient.
I think he is like, please do arecal exam on patient, blah,
blah, blah.
And I looked at him, I said, Iwanna make sure that of what you
just said, you are asking me tonot do an intake, to not have a
report with this patient, butliterally you're asking me to do
a physical exam where the onlything you want me to do as a
recile exam on this patient.
(27:51):
Is that correct?
Yes, that is correct.
I said, I'll do it.
And you're like, how dissingagain, is it for the patient?
It's, I don't care about Recileexam.
Like I'll do whatever, but like,come on.
And that was something that Ithought was like, we need to
change that because.
It's, it's traumatic.
It's, and there are internsthat, commit suicide.
(28:12):
They have like no sleep.
And they are finally, doingsomething and suddenly this is
what you're sharing them withthem.
And, and to me it's like whenyou're seeing a patient, you're
from A to Z and then you wannafollow up and what's going on
after.
'cause you learn so much fromthat.
So yeah, those, I'm sharingabout all of the things that are
(28:33):
negative.
There is a lot of good stufftoo, not gonna lie, but that,
that was the free trauma that Igot, like free trauma.
Maryal Concepcion, MD (28:42):
I, I do think that it really highlights
also as, as I tied, therelationship that your patients
are looking for when they joinyour practice.
Now, I, I, I pull from what youjust shared, how important it is
for us to be in existence.
So people who are coming up inthe ranks of medicine and who
are going into attendingpositions, see that you can
(29:03):
actually do medicine the waythat you're doing at your
rheumatology clinic and I'mdoing at my family practice
clinic.
Absolutely.
So I think that this is, so,it's important for people to
hear as, as crappy as it is andas, as it as, like, I will call
out, everyone who's listening isthinking about like their quote
unquote favorite resident whodidn't bother to help a dang
time when they were on call asthe first year, second year.
(29:26):
And you're like, seriously, whyare you even a doctor?
Because you're such a.
Fill in your expletive there.
Yeah.
And so it's like we've all hadthose experiences and it's also
maddening, but I will say forme, it makes me even more it
makes me even more lean into thecommunity of DPC when it comes
to supporting each other indoing this medicine.
(29:47):
So a hundred percent.
So I, I think about how you havethis rich history of knowing how
care is as a physician in twocountries, how, it, it was to be
a patient, but then also how youopened your own rheumatology
practice despite all of thethings that you had been exposed
to.
And so I'm wondering if you cantell us about this moment in
(30:11):
your career when you decided toshift to direct care
rheumatology as the first directcare rheumatologist in the state
of Colorado.
Isabel Amigues, MD (30:18):
And it's funny, I didn't actually, I
don't think I fought for, Ididn't think of it for myself at
first because I had the bestdeal possible in my institution.
I was working two or three days.
I can't remember, like maybe atthe time I was working three
half days or maybe I had fourhalf day clinic.
They had not decreased.
I, I really like, thank you formy institution.
(30:38):
They were amazing.
In fact, to the point that whenI said I'm leaving, they didn't
trust, they didn't believe me.
They were like, con contact usin two weeks and like, because I
didn't go, it's funny, the sameway that my marriage left, which
was very kind.
I was like, it just doesn't workfor me anymore.
And that doesn't, doesn't meanthat I don't love you and
respect you.
It just, this is not for me.
(31:00):
And that was exactly the same.
It's like, I love thisinstitution.
Mm-hmm.
I really, truly love it, butthis is not in alignment with
myself anymore.
And so I want out and I'mwishing you the best.
And truly, actually, trulywishing them the best.
And and when I started, I didn'tknow that I was gonna do this.
And what happened is that it wasafter COVID.
(31:21):
So I had, I, I was dealing withthe cancer before COVID, then
COVID hit I had finishedeverything actually by the time
COVID hit, but COVID hit.
And it was interesting to seepeople go through sort of the
same internal, dialogue.
I don't wanna say monologue'cause I don't think it's a
monologue, it's dialogue whatyou're saying about what you
(31:42):
wanna do and what the boundariesare.
And I had already done it.
So it was kind of cool to watchthis being done.
But also I was like, Hey, Iwanna live my life now.
Like, what's going on?
And and after COVID, a lot of mycolleagues at the institution I
was in were burned out, likeburnt out.
(32:03):
And I remember like one of my pamy one of my colleague came and
it's funny, she just opened.
A direct care specialtypractice.
So she opened it after meseeing, like, I think she wanted
to make sure that it can happen,right?
And it be doing, but she wouldcome and she would be like
crying and, and I was like,okay, let's do an exercise.
(32:24):
We're gonna visualize what wouldit take to be the best care?
What would we want to be thebest care?
And we started sharing like theimportance of community.
Like it was a free Peter thing.
And again, I didn't do thatalone.
I did it with her Dr.
Sergio.
I'm in Sergio.
But basically we were like,there would be healing of the
(32:44):
brain, like the mind healing ofthe body and healing of the
spirit.
And the way we thought about itwas your mind.
It's all the mind, the mind bodylike meditation, visualization,
prayers for some.
And so on.
The body would be the medicineand how we help our bodies.
And then the spirit would be thecommunity.
(33:06):
And so then we started doingcoexist, which is a meeting.
At first it was kind of likewhenever we wanted and now it's
like every month we and it'sfunny'cause this was all done
with her and then I think shewas like, you're doing it now.
So I did it.
But it's okay.
Like I thought it was helping somuch.
And basically those coexistmeeting, we bring someone from
(33:26):
the community and I interviewthem and we have a community.
And, and what's really wonderfulabout this community, I never
know how many people are gonnabe there.
And sometime it's like, 10 andsome other time it's like 40.
And it's always like someone isgonna bring someone else.
Like it's a plus one thing.
And it is been really wonderful.
And and yeah, and, and startingfrom there, what's really
(33:49):
interesting is I started likejust creating how my community
would start, like community andI, I really use the word
community'cause I think thatthat's what I'm creating would
feel like in terms of withpatients and, and the caring,
how much I cared.
And I didn't continue to carefor patients because I had to,
(34:11):
but because I really, trulywanted to and cared and got as
much as those interaction as Iknew I was giving them.
Like it was really a given andtake meaningful and that, that's
how I started.
And just one day.
What was the story?
I started reading a lot on thedirect care, rheumatoid direct
(34:33):
of DPC.
Actually I started like, readinga ton of DPC books and how that
was possible.
I also started looking at locumsand at that point I was single
mom.
'cause I had divorced, I wassingle mom and with my mortgage
and kids and, and I was like,well, how can I do this?
And I asked my ex-husband and Iwas like, he's a physician too.
(34:54):
And I was like, here is what I'mthinking.
We had the kids every other dayand then every other weekend and
I was like, if I do this, I willhave to travel one week at a
time.
Maryal Concepcion, MD (35:03):
Mm-hmm.
Isabel Amigues, MD (35:04):
For Locums when I'm beating that, are you
okay with that?
And he is like, absolutely, gofor it.
I'm totally in support of that,which is super, I'm super
grateful because he is, he, hecould have said no.
But yeah, that's been, I'dstarted the practice while I was
doing the locums and, and thenthe practice took off and, now.
Super, super.
Now I'm hiring someone, ifsomeone wants to say, if there
(35:24):
is a rheumatologist that wantsto come in my practice, plug in,
come in, I'm hiring.
Maryal Concepcion, MD (35:31):
I love it.
And I absolutely would say, the,the next question I wanna ask is
because, there, there has to be,I'm like sending all the good
juju out into the world also inthat form of visualization that
you know, that there is somebodylistening if not today, than
tomorrow or next month.
Because I do think that hearingmore about your practice is,
it's, it's unbelievablesometimes when you hear where
(35:56):
specifically rheumatology hascome from in the direct care
space to hear your story.
So, your, your practice grewfairly quickly.
You have multiple staff memberson your website.
Yeah.
And, I just, I love that thatyour clinic is so successful
because rheumatologic disease,rheumatologic diagnoses, it is
something that we see a lot ofin family medicine and primary
(36:18):
care especially, and especiallywith these diagnoses, it's so
important to have thatpersonalized care because
rheumatologic disease,rheumatologic diagnoses can lead
to so many different symptomsthat, can be passed off too
often in the, in the quick,quick, quick care of fee for
service.
Like, oh, you're just a woman.
(36:38):
Like, oh, it's not that bad.
And it's, this is, I think whatalso people are so frustrated
with, which, shows why Oneexample I, I guess would, is one
example of why they would go toyou and other direct care
specialists.
So tell us about how yourpractice has grown quickly.
Because how your practice hasgrown quickly and what people
(37:00):
are coming to you for.
Isabel Amigues, MD (37:03):
Well, I'm gonna share one of the value
that we have in the practice,which is really important.
And I share this with the team.
Almost every week I say we arehere to show that a different
type of care is possible.
It is not just about thepractice, it's also about, and
this is, this is where, again,remember where it came from.
(37:24):
It came from me sitting downwith one of my colleague to this
to discuss like, okay, whatwould a better practice look
like?
Mm-hmm.
If our institution cannot be it,how does this practice look
like?
And then at one point realizingit's not gonna be with
insurance, it is not possible inthe insurance system.
And so, because of all of this,right?
(37:47):
And because of who I am and howmuch I love medicine, like I
love it so much.
This is, this is my callingthis, I, I've been a
rheumatologist in France, I'm arheumatologist in the us.
That's how much I like it,right?
And just, just always, alwayssharing like, this is not just
about patients.
This goes beyond the patients.
We are showing that we are like,this system works and that it's
(38:11):
successful.
And so, to me, one of the reallyimportant thing is to show other
doctors that this is possible.
(39:02):
And it's, it's interesting'causeI could be totally okay.
I could have been six monthsago, I could have said, okay,
that's it.
I'm done.
Like, I don't need to increasemy prices.
I don't need to hire someone.
I could have been in a verycushioned part and I'm like, no,
we want to show that this issuccessful.
And how do I, I remember liketalking to a cardiologist who
(39:23):
told me, I like you are, becauseI said, what do you think would
success look like?
And he said, if you can if youcan pay a physician 500 K, then
your practice is successful.
And I said, game on.
I will be able to pay a, aphysician.
I'm not saying that that's howI'm, this is not where I am
right now, but but why not?
(39:44):
Right?
Like then, then let's push that.
Let's push that envelope.
And why would insurance basedpractice be the only one when
they are being paid, like reallynot good?
Why would they be the only onethat can make those salaries for
their doctors?
Which by the way, there's not alot of people who make that
much, but you know what I mean?
Like, I'm like, yeah, let's,let's make it happen.
(40:04):
Like physician used to be verywell paid and now.
We are paid much less than anyCEOs.
And so it's like, yeah, no, Iam, I think, I, we deserve to be
paid appropriately given howmuch of our lives we've given
away.
I mean it's, I don't know ifaway is the word, but we've
(40:25):
given a lot.
Like, while my, my, my sister isa very successful CEO.
She's awesome.
I love her and she's had a lotmore fun than I ever had when we
were younger.
A lot more fun than I had,right?
Like I was studying when she waspartying.
She still is a very successfulCEO making a ton of money.
And I'm like, why not me?
(40:45):
And, and it's not about themoney.
I think if I were not in the USit wouldn't be about that.
I don't care, right?
Like, it's not about the money,but it's about, about how we
prove success.
And to me, that's one of the waythat we prove success.
Maryal Concepcion, MD (40:58):
I love that.
And your practice, is, is closeto 300 patients already and
you're already looking foranother doctor.
Again, go to Dr.
Emory's website.
Oh my goodness.
But when, when it comes to thepatients who have found you,
give us examples of what peopleare saying about your practice
(41:19):
because you, you have amazingGoogle reviews and a lot of
them.
And so, your patients arecheering you on even if it's not
in person all the time.
Isabel Amigues, MD (41:29):
So, sorry, I just realized that I only
replied to your first start yourfirst question because it is so
important to me.
As you can see patients arefinding me in different ways.
There are patients that arefinding me and, and honestly
like I'm looking for oncologistlike this, there is no
oncologist direct care inColorado, and I wish there was.
Because the la, my oncologistretired and I saw a new
(41:53):
oncologist and they looked atme, I think in the 40 minutes of
that we were together.
They looked at me only fiveminutes, and it was mostly to
ask me about France.
And so it's like, that's, oh mygosh, proper care.
And I'm not upset at them.
I think it's a system, but comeon.
So I want a direct careoncologist, if you have one, let
(42:13):
me know.
But yeah, basically they see me,they, they find me either on
Google.
I think I'm actually consideredthe first the best
rheumatologist in Denver.
And so, I've had some patients,I was like, how did you find us?
Well chat GPT.
I'm like, oh, great.
That's kind of funny.
I love it.
I'll take it.
And I do think that we have thebest rheumatology practice, and
(42:36):
it's not that I'm the bestrheumatologist, right?
I think that all of therheumatologists that I work with
and or that I've worked with aregreat.
I just think that our system isso much better.
And as you mentioned, I have abig team because every time I
see my team starting to fallbehind, I'm like, maybe we need
to hire someone.
Okay, let's hire.
Because at the end of the day, Iwant to have the best for my
(42:58):
patients, the best outcome, thebest con experience for my
patients.
They find me.
So through Google for charge,GPT ai I think some of them find
me with the YouTube videos thatwe do.
So they may be like looking, andthen some of the ones I think
are like cannot get in intorheumatology.
Within three months, they comein.
(43:18):
Some other one it because theycannot they, they have seen
someone and it just didn't workand they just, get tired of it.
I mean, it's not like there isthat many rheumatology practice
out here.
And so I think sometimes theywant an answer and that, that's
another thing is that, there isonly so many rheumatologists but
we have a lot of I think, andthis is my take on things, maybe
(43:40):
I'm wrong, but I think what'shappening is.
We are referring left and rightall of the time.
And because physicians don'thave the time, but also because
there's a lot of primary carethat's being now managed by a
physician assistant and nursepractitioner.
They don't know everything andso they refer a lot more.
And that's creating this thissystem where rheumatology
(44:03):
practice, I don't do that, butrheumatology practices have to
kind of like decide what theysee.
And so they are losing a lot oftheir time on figuring out what
they're gonna see and whatthey're not gonna see.
And the problem is that youdon't know, like the referral
might not be well done, and sothe patient is being refused.
And so I think that that was aproblem for me.
I was like like one, if apatient has lupus, I don't want
(44:26):
them to wait for a month.
That's ridiculous.
But at the same time, if apatient has a positive a NA and
it's a one of a 40.
They actually might have likesome other type of rheumatologic
disorder.
And the number of time Iactually find that and I'm like,
well, basically we don't know.
And so yeah, they all deserve tobe evaluated.
If you have scared one of ourpatients told them that they
(44:48):
need to see a rheumatologist,then we should be available to
them.
That is how I see it.
Totally.
Maryal Concepcion, MD (44:54):
Yeah.
I, I will say here a point offrustration with my own patients
is like, for example I had apatient who for years was going
to see a person that did tonsand tons of, of labs and would
give binders of results.
And then this is like, I thinkfour years later, this patient
comes to me, talks to me abouttheir family history, dah, dah,
(45:15):
dah.
It's like a two hour intake.
Yeah.
And I'm like, like somethingrheumatologic is going on.
And this patient ended up havingCrest syndrome and it's like,
out of the binders and bindersthat you got.
Never.
Did you actually get a thing totie these, these symptoms?
I know the physicalpresentations and all of the
labs that you paid thousands ofdollars for together, and but
(45:38):
then I have patients who I'mlike, I can literally get you in
with rheumatology nextWednesday.
Let's go to their website andpick a time.
And then they're like, oh, butit's cash.
And I'm like, remember that?
That's why you pay to be amember here because of access.
And I'm literally remindingthat, that you can get in next
Wednesday.
You are choosing to wait for thereferral to see if it's accepted
(46:00):
at uc Davis.
A hundred percent.
That happens all the time.
And it is, it is mind blowingsometimes that I'm like, but you
know, the value of having aphysician who works for you
directly.
And that can even mean more whenit comes to something like
rheumatological diagnoses.
So, it is, it is frustrating.
But I will say that again, I'mso glad that you're out there
(46:23):
and that patients are findingyou.
So I wanna ask here about yourclinic's name, because
Unabridged md just looking atthe logo and the reading the
name.
I'm just wondering if you cantell us about how the logo and
branding represents what you'redelivering to your patients and
your community.
Isabel Amigues, MD (46:41):
Absolutely.
So the idea was to offer thewhole version of me and to see
the whole version of thepatient.
So not look at just, thistechnical part of what, they
have joint pain and that's allI'm gonna look at.
But we're gonna look at, not,not that I look at trauma all of
the time, but you know, theother day I have this patient
(47:02):
she has, she has had basically,she has like an autoimmune
disorder, but she's trieddifferent stuff, but every time
she gets side effect and I waslike, have you ever thought of
this question of is there anyways that if you were in
remission your life would beharder and without stopping,
(47:23):
like, without missing a beach?
He's like, my husband would notbe happy if I'm in remission.
And I was like, let's talk aboutthis.
Let's, let's actually, let'stalk about this, and like how
much power you're giving yourhusband.
And and like, is it true?
Is it not true?
It's, it doesn't matter.
It's not, is it bad?
Is it good?
It, it is.
(47:44):
If you think that your life willbe more miserable if you're in
remission, then how are yougonna reach remission?
Your body is a whole, I can giveyou as much medication as I
want.
You're gonna not appreciatethem.
Right.
And so, the on Abridge md,that's, it's almost a method at
this point.
It's like, it's this vision ofthe patient as a whole, mind,
(48:07):
body and spirit.
It's really what is it and whatit is.
And yeah, I wanted to offer thewhole version of me.
And when I say that I love mypatient, I truly, truly love
them.
And I don't use that wordlightly.
I actually truly love them.
I want them to be in remission.
I want them.
To not need me and to choose.
Right?
Like that's a thing they chooseto continue to be with me.
(48:29):
Once they're in remission, theycould absolutely decide I'm
(49:06):
gonna go in the, in theinsurance based practice.
Absolutely do it.
Like, if you want, if this isyour choice, do it or choose to
be with me.
This is, this is, I don't wantyou to be in a place where
you're gonna be obliged to doone thing or the other.
Right?
Like, it's a choice.
And uh, yeah, that's, that'swhat the word is.
And uh, the logo, which is akind of like those circular that
(49:28):
are together and there's kind ofthis idea of onward forward.
It's the vision of the patientas a whole with the idea.
And I think that this is inmedicine, not just rheumatology.
The idea is that.
This is coming from discussion Ihad with my dad who's now
learned how to, he's a judgeoriginally, but now, and, and
retired.
(49:48):
But he's learned Chinesemedicine is really good as, and
I can puncture.
I don't think he's ever gonnause, but he, he wanted to learn
it.
So great.
And and when I was 18 I waslearning medicine.
It would have like those long,long I don't know if it was
email at the time or just, aletter.
'cause it was in Marsai.
They were in Marsai.
My family was in Marsai and Iwas in in Paris.
(50:09):
And it would be like, yeah, youknow, when someone is ill, they
are losing balance.
And your role as a physician isto help them get back into
balance and oh my goodness, how,how wise is that?
Right?
Because that's exactly this,your job is not to go against,
to fight a disease.
It's how do we help our patientsget back into balance?
(50:31):
And so that's the wholeness, thered, the, the, the, not the,
the, the circuit, onward forwardis this idea that you are not
going back to where you were.
You are actually going to abetter place than you ever were.
So it's not like I wa I wanna goto where I was before I had
rheumatoid arthritis.
(50:51):
No, no, no, no, no, no.
We want you to get in a placewhere this rheumatoid arthritis
has actually brought you so muchgood, because you've learned how
to say no because you've learnedwhat you wanted in life because
you've, you've learned theimportance of healing.
And I have a patient I, I justsaw yest, oh, I can't remember
yesterday.
(51:12):
And and after being diagnosedwith an autoimmune disorder and
being like, she's now inremission.
But the really cool thing aboutit is that she's not only in
remission, she's actually helpedher vagus nerve to be evaluated
to be.
Stimulated and so she actuallyhas less stress in her life.
Because of that.
And she feels better than shefor 10 years, for over 10 years.
(51:35):
And so that's, that's the,that's the goal.
I, I don't know that, I, ofcourse not everyone reaches
that, but that's my goal foreveryone.
So that's on average, MD foryou.
Maryal Concepcion, MD (51:45):
I love it.
And I'm wondering if you couldalso talk to us about how you so
the, the, this question iscoming from speaking with a, a
couple of other direct specialtycare rheumatologists, and when
it comes to.
Figuring out the challenges ofinsurance coverage for
medications.
I'm wondering if you can Yeah,if you can, if you can, oh my
(52:08):
gosh.
If you can chime in on that,because I, I feel that like,
there's certain things likeoncology medicines even, like
how do we crack the, the accessbarrier?
Isabel Amigues, MD (52:18):
It's super easy.
It's actually easier than it'sever been.
I have a pharmacist that thathelped me with getting prior
authorization in a record time.
So I don't take insurance as thephysician.
I think my value is a lot morethan what insurance thinks it
is.
So I'm like, Hmm, I don't wannawork with you when it comes to
(52:40):
my compensation.
I work for my patients and I'mnot employed to the insurance.
Now my patients have insuranceand we're gonna use.
Maximum of it.
And that's, that's basicallywhere I'm at and the medication.
I know exactly how to get all ofmy meds approved.
And it's approved.
And we, and, and what's reallycool also is that if a patient
(53:02):
has no insurance, I also knowhow to get the drug company to
pay for that medication for ourpatients.
So I've actually had, inessence, many patients who've
told me that coming to thepractice has actually saved them
thousands of dollars.
But I, yeah, I don't think thatthat's an issue.
And, I'll tell you, I actuallywanna reach out.
I, I'm gonna send her thisrecording.
(53:23):
I want my oncologist, myprevious oncologist, the one
that helped me go intoremission.
I want her to come into mypractice and and she was like,
well, but, oncology, we need tohave medication and all this.
I'm like.
I'm pretty sure we can find aninfusion center that will do
that and will help you get allof those.
So I'm actually, I think this issomething that I'm gonna do.
(53:45):
I'm gonna leave her get bored alittle bit for a little bit
until she realizes that being adoctor is so wonderful and
especially in the direct carepractice.
And then we'll have our firstoncologist in Colorado that's
direct care practice.
I mean, it's needed.
Like I don't wanna go to myinsurance based oncologist.
It's just not like, it's not, Idon't feel supported and it's
(54:08):
not their fault.
I think all doctors need to getout of their insurance system.
Maryal Concepcion, MD (54:14):
No argument from me, but I will
tell you also please I'll sendit to you afterwards, but
please, especially if you'realso like, oh my God, I would
love to hear a direct oncologystory.
Dr.
Laura Baio Kenney.
She was early on in the podcastin terms of years ago.
But I will say that she's agreat example of how you can
succeed in oncology as a directoncologist.
(54:36):
And so, as a direct specialtyoncologist.
So I definitely will say that'sa great one for your colleague
to listen to in addition to yourown, your own story, which is
amazing.
Yeah.
Continuing on that thread of.
Physicians who work for thesystem versus physicians who do
not work for the Insys for thesystem.
I'm wondering if you can talk tous about how you think about
(54:57):
other specialties who are doingDPC as a business model.
They're not necessarily primarycare, they could be, but for
specialists likerheumatologists, dermatologists,
even surgical specialists.
What do you think about thefuture of specialty care when it
comes to access?
Because clearly you've seen whatpatients are wanting and how
patients are even finding thatit's cheaper.
(55:18):
But what would you see ingeneral for the movement of
direct specialty care?
Isabel Amigues, MD (55:22):
I don't know that cheaper is the word that's
more valuable.
The special, I, I honestly thinkthat the system is burning to
the ground right now and I loveit.
Like every time.
So this is really funny.
Every time, look, I come frombeing a socialist in France and
I'm like in the US and now I'mtelling you, I'm not that I'm a
capitalist'cause I don't knowthat that's the word, but I want
(55:44):
to be very successful.
Mm-hmm.
I want, I, I want to prove thatphysician can be very successful
because I, I really love it somuch that I want my kids to say,
this is what I wanna do.
Right.
If they saw me, well, not me,but if they saw, anyone like,
their, their parents and theythink that their parents are
(56:04):
miserable, they will never wannabecome a physician, but I want
them to want to be physician.
Right.
Like, if they want to, of courseI'm not gonna force them.
But, it's it's this idea of, i,I think that right now it's been
so driven by money, theinsurance-based model, that
basically the only way forwardis to get advanced
(56:25):
practitioners.
So we're getting advancedpractitioners.
What's the next step?
Is going to go to be ai.
So you're gonna ask AI and thenit is gonna be so I don't know
if they're gonna remove all aall advanced practitioners and
then it'll be ai.
I have no idea.
What I can tell you is that Ithought open evidence was pretty
good until I started asking themabout their set, RA and all
(56:48):
this, and then they were like,this is not approved by the F
fda A I'm like, wait, what doyou mean it's not approved?
Like here are the data.
No, it's not approved.
And until I was like, this isthe FDA website and oh yes, it's
approved as if they had not toldme five times before that it was
not approved.
So I was like, okay, AI has alot to learn before I'm gonna
trust them fully.
But you know, the truth is thatit probably is the case that a
(57:12):
lot of AI are better than a newa PP.
Okay.
So that's the first thing.
Then the second thing is likeyou're trying to make money.
And so, apps are for now,there's a lot of them that are
new.
So they are not, they are notburnt out.
I think they're gonna be burntout.
One physician are much moreresilient than a nurse.
(57:32):
I, I, I'm not saying this in anegative way.
I think we have been sotraumatized during our training
that we know how to go throughit, which is not ideal at all.
But I think nurses have unionand so they are able to say no
much faster than we ever mm-hmm.
Worked.
Our ideas like, no, I can alwayssay yes, it's your ego talking.
(57:54):
Right.
So yeah, I think that that'sgonna burn to the ground and
it's super sad that the patientsare gonna suffer.
And this is where it's sad isthat I am in a position now that
I can't pay for a oncologist indirect care.
And my promise is that itdoesn't exist in Colorado.
But I would like to pay forthat.
And I think it's worth a lot ofmoney because someone that cares
(58:16):
for me.
And is gonna back my healththat's worth it.
Right?
Versus a doctor that's lookingat their computer because they
have, and, and I have no idea.
Maybe she's like so overwhelmed.
I cannot be upset at her, but Ijust don't want her in my care
because I want the best outcome.
That as that is valuable.
And so yeah, I think that thefuture, I have another of my
(58:37):
colleague that's opening aspecialty rheumatology practice.
One of my other colleague justopened infectious disease
practice.
I told you I want to show thatit's possible.
And so I'm rooting for them.
I have another rheumatologist.
This is in Colorado.
So one person is opening inDenver.
Another person is like this inpulmonary.
They're opening in Denver.
(58:57):
That might be the firstpulmonary specialty.
And they are not at a low price.
I started at low and then Iincreased as time went.
But I told them, don't make itcheap because otherwise you're
gonna be just as busy as beforeto make ends meet.
Right.
And yeah, and, and I think thatthe future of medicine is one
(59:18):
where p physician, like I Ithink five years ago I thought
that all physicians were gonnaleave being physician.
And thanks to you guys, welearned that there was another
way in medicine.
And so we're leaving theinsurance model, but we're
staying being physician, which Ithink is really cool.
And some of them probably willnot and become administrator
(59:41):
and, CEOs of different companiesand that's great too.
But at the end of the day, Ithink what's happening is that
we are, we are not being valuedby the society.
As much as we used to.
And so we're like, no, I don'twanna be there.
So that's, that's, that's mytake on things.
But it's, it's fun.
Every time I've, I have horriblecare in a specialty practice,
(01:00:03):
I'm like, Hmm, I don't have toworry about my future.
Yeah.
Maryal Concepcion, MD (01:00:06):
I love it.
So, after this podcast, wherecan people find you to connect
with you on YouTube, yourpodcast, and your website as
well?
Isabel Amigues, MD (01:00:14):
Yeah, pretty much everything is called on
Abridged md.
So if you go on on average MD inany like social media, they'll
find me.
And then, and I don't know if Ishould switch, but basically
it's under Doctor, it'srheumatology 1 0 1 that's, it's
it's linked on average md.
But yeah, rheumatology 1 0 1 byDr.
Isabel am because, I do likelives every, every week in
(01:00:39):
rheumatology.
And I, I like doing that too.
And then on the website, onAbridge md, so we have a
podcast, we have a live and aYouTube videos, and we have our
social media and blogs,
Maryal Concepcion, MD (01:00:49):
A lot.
Fantastic.
So I am so excited for people toconnect with you after this
podcast.
And thank you so much for comingon today and sharing your story.
Isabel Amigues, MD (01:00:59):
Thank you.
Maryal Concepcion, MD (01:01:03):
Thank you for listening to another episode
of my DBC story.
If you enjoyed it, please leavea five star review on your
favorite podcast platform.
It helps others find the show,have a question about direct
primary care.
Leave me a voicemail.
You might hear it answered in afuture episode.
Follow us on socials at thehandle at my D DPC story and
join DPC didactics our monthlydeep dive into your questions
(01:01:24):
and challenges.
Links are@mydpcstory.com forexclusive content you won't hear
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Join our Patreon.
Find the link in the show notesor search for my DPC story on
patreon.com for DPC news on thedaily.
Check out DPC news.com.
Until next week, this isMarielle conception.
Direct Primary care is an innovative
alternative path toinsurance-driven healthcare.
Typically, a patient pays theirdoctor a low monthly membership
and in return builds a lastingrelationship with their doctor
and has their doctor availableat their fingertips.
Welcome to the my DPC storypodcast, where each week.
(01:39):
You will hear the ever sorelatable stories shared by
physicians who have chosen topractice medicine in their
individual communities throughthe direct primary care model.
I'm your host, Marielleconception family physician,
DPC, owner, and former fee forService.
Doctor, I hope you enjoy today'sepisode and come away feeling
inspired about the future ofpatient care direct Primary
(02:02):
care.
Isabel Amigues, MD (02:07):
I can be the physician.
I've always imagined that Iwould be, and I can see the
outcome of my patients exactlythe way I wanted them to be.
So it's improved myrelationships with my patients
and to improve the relationshipthat I have with my own family,
and my own community.
Because I am more in charge ofmy life.
(02:28):
I'm creating what I want it tobe.
I'm Dr.
Isabel Ami, and this is my DSCstory.
Maryal Concepcion, MD (02:40):
Dr.
Isabel Amigues is arheumatologist based in Denver,
Colorado.
She honed her expertise bystudying in Paris as well as
Columbia University in New YorkCity.
At age 40, she was diagnosedwith stage four metastatic
breast cancer.
A timely meeting with anon-traditionally trained
practitioner taught her adifferent approach to disease
where she experienced the powerof meditation, visualization,
(03:02):
energy, healing and love.
Her journey through cancerinspired her to learn more about
these alternative techniques,and she now blends Western
medicine and Eastern techniquesinto her practice at
UnabridgedMD.
Today we're going back toColorado and highlighting what
is absolutely becoming a muchneeded specialty in the direct
(03:26):
specialty care world.
And Dr.
Ami is going to be talking withus about how she has built this
insanely successful rheumatologyclinic in the direct specialty
care space.
But also I'm super excited to bechatting with her because I
think it's, it's veryinteresting when a person is
delivering care in the way thatwe do after they've had a
(03:47):
significant experience as apatient themselves.
So thank you so much Dr.
Amid, for joining us today.
Isabel Amigues, MD (03:53):
Well, thank you for having me.
I've heard so much about you.
I'm super excited to be heretoday.
Maryal Concepcion, MD (03:58):
Awesome.
So I wanted to, really highlightthat you are so passionate about
bringing to your patients a wayof not just the western medicine
that most of us were taught in,but also really focusing on
resilience and healing and notdealing with the the, the, the
victimhood of being a patient.
(04:18):
And so I would love if you couldstart us off with telling us
about your experience as apatient that helped bring you to
this space as a physician witheven more empathy because of
what you've gone through.
Isabel Amigues, MD (04:30):
Yeah, absolutely.
Thank you.
That's such a cool question,right?
So.
At a little bit over 40.
I was diagnosed with stage fourbreast cancer.
And being a physician andparticularly optimistic
physician, when it, I thought itwas just stage three, I was
like, yeah, whatever.
I was like, not afraid.
I don't know why.
I was like, yeah, whatever.
And then when it was stage fourand I had metastasis to deliver
(04:52):
and the bone, then I was like,okay, you've got my attention.
And what's interesting is thatit happened when I was going for
my midlife crisis.
So I had repeated my training.
I come from France, and Irepeated my my residency.
I repeated my fellowship and Ireally love I love learning.
So it wasn't, I didn't, I, and Ididn't have student loans
because in France, being adoctor costs like$500 per year.
(05:17):
And yeah,$500.
Wow.
I know, right?
And then you get paid as aresident.
Actually, I thought I, I get, Igot paid as a medical student,
but it was less than if I hadbeen a babysitter, so I was mad.
And then I come to the US andI'm like, okay, I should not
have been mad.
So anyway, and, and so basicallyI finished all of this and I
(05:37):
was, I was, I was I had kids andand I basically went through
this really.
Like stereotypical midlifecrisis where I was like, what am
I doing with my life?
This is not where I, what Iwant.
And when you want something sobad that that's all you're
doing.
So just like wanted to be adoctor, wanted to be a a, a
(05:58):
rheumatologist, wanted to be arheumatologist in the us, wanted
to have kids, wanted to doresearch, and here I am, all of
it, right?
I, I've got all of it, but thenkind of like, yeah, but for
what?
Like, sure, what's the good?
And I'm not, I'm not happy nowthat I have all of this.
I'm feeling actually veryunhappy.
And, and then this diagnosiscame and what's really it's kind
(06:20):
of, it's sort of a blessing, isthat.
It's not sore.
It is a blessing.
It's because I was in thismidlife crisis.
I was already starting to reachout to my friends in France and
to my community basically.
And, and in France, a lot of myfriends are not physician
actually in the US too.
But basically I started justlike listening and, and sharing
(06:44):
how unhappy and sad I was andhaving phone calls where I was
just like crying for a wholetime.
And one of my friend was, I, Igot my diagnosis of breast
cancer in France.
'cause I had decided on my 40thbirthday that I was going to go
to France alone for four days.
And then I was offering this tomyself.
And at the time it was like abig decision'cause I was leaving
(07:04):
my twins that were like threeyears old with the au pair and
and my their dad.
And I felt so guilty.
But then I was like, it's my40th birthday.
I get to do this.
And then I saw the tumorbasically on a Saturday.
They got, and I had my ticketsto go to France on a Wednesday.
That was like two weeks after mybirthday.
(07:25):
So I had taken those ticketslike right away.
And at the time I remember theywere kind of like, why would you
want to go to France now whenyou just got diagnosed?
And we know that it's at leaststage three.
'cause the lymph nodes lookedreally bad.
And and I remember I was like,well, it's not gonna change
anything and I need mycommunity.
So I go to France and in France,while, they confirm the type of
(07:45):
cancer it is and, and you knowhow bad it is.
My friend basically are like,well, do you wanna talk to this
naturopath?
And what's really interesting isthat as a physician who's done a
lot of research, I had alwaysbeen like, what the heck is
this?
Like, like, like why are peopletrusting their naturopath more
than they're trusting me as aphysician?
I've done two trainings.
(08:06):
Why are they listening to this?
But I had seen this naturopathswork through my friend as more
of a talking and discussing thanany sort of like weird,
supplemental herbs.
Mm-hmm.
And so I went and what's reallycool is that I actually reached
out to this naturopath and Isaid, Hey look, I'm in France
only for like four days.
(08:27):
And really it's only like oneday that I'm gonna be in Lyon.
'cause that natural path wasn'tnew.
Is there any chance you can seeme during this 24 hour?
I think it was like eight hourperiod that I was there and she
actually opened her practice ona Saturday morning just to see
me.
Right.
Like just that by itself orlike, hold on.
(08:47):
Like this is.
This is amazing because I feellike as a physician, I realized
how much I had startedprotecting myself mm-hmm.
Against patients, and I'm usingthe word against because this is
how it felt.
I was like, I'm against, like,they are not my, my friends, now
they are my enemy.
Right.
Like, but it's not true.
Right.
But I'm, I was protecting myselfbecause of the way, and we'll
(09:10):
talk about this, like the, theway the system is.
Mm-hmm.
And so I go and what wasincredible is that I start just
talking and sharing how unhappyI was even before the cancer
diagnosis and that I was dyingeven before the cancer
diagnosis.
And here she is using the wordthat I would always remember and
the word in French.
But she's like, do not see thecancer as an enemy, but see the
(09:33):
cancer as a friend who's here toteach you something.
And like any good friend, whenthat time has come, we leave.
And I carry those word the wholetime.
Stage four is very scary.
And yet if you start thinking ofanything that's happening to you
as a friend, as an opportunityto grow, we are.
(09:55):
So, I had to come to terms,right?
Like now it's easy to say, ohyeah, I did all of this, but
like I went deep, I went, I wasvery vulnerable and I.
I had a real talk with myself,which didn't happen.
Just like that.
It's not like, oh, you have tohave a talk with yourself.
It took a long time to really belike, okay, do I actually want
(10:15):
to live?
And it's really interesting'cause from the outside, no one
would, I've imagined that Ididn't wanna live, but the truth
is that there was a moment whereI was like, well, I'm being
given this option of living andnot feel guilty, right?
Because yeah, I could leavethis, this and leave my kids and
not, and, and because it washard for me to be a mom, it's
(10:39):
still hard to be a mom.
But at that time I feltextremely guilty.
I had a lot of trauma.
The kids, it was very hard tohave kids.
And then they were very preemie.
And so I think I had a lot oftrauma and no, I don't think,
I'm sure.
And yeah, just going deep andstarting to like talk to myself,
(10:59):
talk to my body as if my bodywas yes, part of me, but also
its own entity.
It's very interesting.
Mm-hmm.
And then just not being in afight with myself, not being in
a fight with my body and Istarted just letting my ego go.
Because when you are potentiallyfacing death, I think it's much
(11:21):
easier to let your ego go.
And and basically I went deepand, and, and like, try to
figure out what I wanted for mylife, what I wanted, as a mom,
what I wanted as a physician,what I wanted as, all of this.
And and I did a lot ofmeditation, a lot of
visualization.
I did a lot of exercise.
I did, I changed my diet to bemuch more, much healthier and I,
(11:45):
surrounded myself with lovedones.
And and what's interesting is,and, and I was able to say no to
anything that I didn't feel wasright for me, which, is
incredibly, I, I, I know thatI'm very lucky.
But it was not an all ornothing.
It was just like, I want to seepatient.
This is important to me, but Ionly want to see three or four
(12:08):
hours of patients per day.
That's it, right?
And only three times a week.
That's it.
And I was able to do that.
So my institution was like supersupportive.
They were amazing.
And and then, as I healed, Iwent into full remission.
I started like going into the,the science of,'cause I wanted
the power of placebo.
At that time I was like, I'm notgonna look at if this is proven
(12:32):
or not.
I'm just gonna do it.
Right.
I even did like energy healing.
And this is where you realize,you're like, hold on.
As a physician, my job is toshare the data, right?
And what those naturopaths aredoing is that they are also
sharing love and caring and allof those.
(12:53):
Which there's no reason not forus to share it.
We just have to be supertransparent.
So I have been very transparentwith some of my patients where I
would be like, look, I dovisualization.
At the time when I was sharingthis, I would be like, I don't
know the data, but it's helpedme.
Now I'm like, there is data.
It's not the best data, butthere is data.
And that's the thing.
Like I, all of those things thatI was doing, I realized that
(13:16):
there were data to support them.
But of course it's not super,like, it's something that anyone
can share.
And so I think that physiciansdon't necessarily know about all
of those data'cause we have somuch to learn already.
Right?
So it's gonna be hard to go andlook at those data.
And then it's not like there isa, there is, there is no drug
company advertising meditation,right?
(13:40):
And it's probably just as goodas a biologic, but there is no
money to be made on this.
Maybe there is, I.
And so, right, who do we see inour practice?
We see, all those drug companiesand we don't, hear about
meditation, but there is dataand it's interesting, like
recently rheumatoid arthritis,the FDA approved a vagus nerve
(14:02):
stimulation for rheumatoidarthritis on a very limited
amount of patients.
So it's, to me, it's more of aproof to con, like it's the
proof to concept concept findvery, very interesting.
And that's the thing, right?
Meditation stimulates theparasympathetic system the same
way that it stimulates the vagusnerve.
So if you meditate, if you do ifyou exercise, if you put some
(14:24):
splash of cold water on yourface, if you are in a loving
environment, you are more likelyto heal.
And that's what I had done forthe cancer.
We know cancer is veryinflammatory.
I did, of course, all of thechemo and the biologics for my,
for the, for the breast cancer.
Of course.
And all of those.
And and I, in rn now we justprove that, I bet work we're
(14:48):
gonna be able to prove this inoncology as well.
And so because all of thosedisease, they are basically
pro-inflammatory, like they'reinflammatory, right?
And so I think that that'swhat's really cool is that I
basically started like thinkingdifferently as a patient in
addition to being a physician,as a researcher, in addition to
just being a physician and belike, hold on, when it comes to
(15:11):
actual clinical care, it's notjust about the hard data, the
randomized control, placebo,double-blinded trial, but it is
about do you have hope?
Like am I offering hope to your,and, and things like that.
And so that is, that is what Ihave done.
Like that's, that's basicallywhat I did as a patient and what
(15:32):
I started to do as a physician.
And I think that that prettymuch, encapsuled, the, the, the
way it started.
Maryal Concepcion, MD (15:40):
one, I'm so glad that you are in
remission.
I mean, that is to anybody whohas been through a such a scary
diagnosis like that, I am sograteful that you are doing what
you're doing and that you arehealthy To be able to do that is
such a, an amazing place to be.
But I also think that this iswhere it is so awesome that you
brought yourself and all ofthese things that you had
(16:05):
realized and learned andpracticed to your patients.
Because this is really gettingat the heart of why people seek
out practices like yours andmine.
They want to have a relationshipwith their doctor who treats
them like a human being.
Just like we are treatingourselves like human beings by
leaving the system and goinginto direct care.
(16:25):
So I am, so, so much applause.
I'm like trying to notphysically clap, so it's not in
the mic right now, but I am verygrateful that you and your
community are celebrating whatyou're doing.
So let's take a step back nowinto the fact that you trained
both in France as well as in NewYork at Columbia, because I
(16:46):
think about how we workourselves to death in the United
States of America.
And I think that, when peoplethink of France, they think of
the south of France.
They think of like, takingbetter care of yourself walking
places instead of, having touber around everywhere.
But I'm just wondering if youcan talk to us about also the
what you, what you experiencedas a person in training between
(17:10):
the two cultures.
Because I, I always think abouthow growing up in a very, family
centered Filipino family inSacramento, it was like my way
of interacting with patients wasvery much more it was always
very much more family medicineesque, if that makes sense.
And so I'm wondering if you cantalk to us about, how your
(17:30):
mindset was as you went throughtraining in the states, because
you were, you were already aphysician in a different
healthcare system before youcame here.
Isabel Amigues, MD (17:39):
Yeah, yeah.
Well, another incredibly goodquestion.
So the training in France is alot more clinical, it's very
clinical and basically, secondyear of medicine.
So we have six years, right?
So we start at 17, 18, and thenit's six years.
The first year is really justbasic.
(18:00):
Science there's a little bit,there's a little bit of ethics
actually as well.
And we did our heart art in the,in the, in our first year.
And basically everyone can getin, but not everyone can
continue.
And so we were like more than800, and then it was like 60
people can get to the secondyear so that it's a loss of of
time for some, because if youdon't get in right, it's like,
(18:23):
okay.
And and then the second year youstart having some clinical
training where, so you startlike learning, medicine.
And then you go into a servicelike a department of medicine in
in the hospital once a week.
In the morning, like, so I thinkit was every Wednesday morning
and then the year after youstart every day, every morning
(18:44):
you are in the service.
And then from then on until theend of your.
Of your training.
You are at least every morninguntil one or 2:00 PM inside a
service.
And then you are, you are evendoing nights and so on.
You're doing nights, you'redoing weekends.
So they, they rely on havingmedical students.
(19:05):
Mm-hmm.
Which is why I was telling you Iwas upset because we were
getting money, but for the hoursthat we were working, we were
not getting so much money.
So I just to say, I just to saythat it was very clinical and
you are being asked to be a goodclinician and you're being asked
to listen to patients tounderstand and so on.
And you're working at the sametime to study, to learn all of
(19:28):
this.
And and you know that you haveanother exam at the end of the
sixth year where again, everyoneis gonna pass an exam and it's
the exam that's gonna decide.
Where you're ranked and everyonechooses depending on their rank.
So the first in, so in the pastwhen it was mostly men, they
would choose surgery.
As the medicine has shifted to amore woman, surgery became
(19:52):
behind.
It's actually funny.
Right?
And so it has, it's been morelike actually rheumatology is
very difficult.
The same way that dermatologyis, uh mm-hmm.
Is pretty difficult.
And you choose where you wannabe and uh, and and the type of
medicine that you wanna practicedepending on what's left.
And so, that, like that trainingwas really, really good.
(20:13):
Very clinical.
Then you go, do residencyfellowship and it's like six
month training and there is acontinuity of care, right?
'cause you're like taking careof your patient for like six
months and they're always yourpatient.
It's not like it's only one weekand then you have someone else.
And like, this drove me crazywhen I came to the US and so
then I moved to the US right?
(20:33):
And I think the first thing thatreally bothered me, so it was
New York, and I know that thisis very different from all
different places.
But the thing that's reallybothered me was the absence of
continuity of care.
Mm-hmm.
And realizing that it didn'tmatter.
(20:54):
Like, and that this to me wasjust so diss, demonizing because
if there is no continuity ofcare, how do you create a
report?
You are basically talking abouta case and I don't know, I just,
I remember like one of the firstday I actually almost quit and
again went back to France andthe first interaction I remember
(21:17):
I had a patient who had hadradiation therapy for cancer of
his mouth.
And first of all I was like,wow, I'm an internal medicine
and I'm like dealing withanything and everything in
medicine.
Whereas in France it was likethis patient would've gone to
the ENT group or it would'vegone to the ology oncology group
or so on.
And in the US it's like.
(21:37):
Well, you can have a diabetesand then an hypertension case,
and then like a psychiatric,case.
And then I also like hipfracture, DVT, whatever, like,
it's just, it's just kind oflike whatever.
And this patient that had thisENT what could have been an ENT,
I remember like, he would noteat and I open his mouth and no
(21:57):
one had cleaned it for weeks.
And, and I just felt helpless.
Awful.
Like, just like as if we hadremoved the dity of the patient
and the process, my own as aphysician and just like the
(22:20):
absence of caring.
And it took me a while, tounderstand that it's not one
person that doesn't care, it'sjust a system.
Right.
And I start, like at first I wasbut to, but, but to head, I
don't know what that expressionis, but against the nurses,
because in France the nurseswere really caring of their
(22:41):
residents and.
And they were nurses that werein the rheumatology ward for
years.
So really they were kind of nps,but just didn't have that,
thing.
And they were doing nurses and anurse would never ever have
asked a resident to put an iv.
If you were called to put an IVto one of your patients, you are
(23:03):
putting a central line.
Mm-hmm.
So the first time I was calledto put an iv, I was like, whoa,
like I'm gonna put a centralline.
Okay, fine, I'm ready for that.
And then they're like, no, no,no, no, you need to put an iv.
And I'm like, wait, like that'syour specialty.
Like, I'm not to put a centralline, I actually am not really
good at putting IVs like crazy.
And and it took, yeah, that wasthe first time I was like, wow,
(23:25):
like this is awful.
Like this is, this is not care.
And I remember telling.
My, my partner and the reason,became my husband and the, the
dad of my kids.
And I was like, if I'm sick, Iwant you to send me on a plane
to France.
I don't wanna be in the us.
What's interesting is that I'velearned letter.
I, I had my babies at CornellUniversity and it was like
(23:47):
unbelievable care, but it wasjust this, it was a community
hospital at the time, and, and Ithink it, it depends where you
are and mm-hmm.
Which you have and.
So, yeah, it was, it was it was,it was rough.
It was rough.
And so that's the first thingthat was, I thought was rough.
The second is I was in, takingcare of patients in Harlem
(24:08):
Washington Heights, so a lot ofAfrican American, and I couldn't
understand why they didn't trustme in what I was telling.
And that was like weird.
I was like, why would, like, I,I was like, it's scratching my
head.
I'm like, wait, like why, why doI feel like they don't trust me
until I learn about, what is itlike oh, somehow the Tuskegee,
like the ies, how they wereputting Cies and African
(24:30):
American people and, and thenyou're like, oh yeah, no, no, I
understand why you don't trustme.
Like, like, and so, historyreally helps us understand a
lot, right?
And, and so then I was like,wow, I'm so sorry.
And I would actually use thefact that I was French to
explain, look.
I'm French, I'm, I'm, I'velearned to care for my people
(24:51):
like you are my people.
I care, this is the data.
I recommend this, but at the endof the day, it's your choice,
right?
And yeah, the number of patientsthat would come, and I have like
some really cool stories ofpatients who had horrible lupus
coma and then, totally, totallynormal.
And that patient who come andAfrican American have said, my
(25:12):
friends told me to stop theCellCept.
And I was like, Nope.
I trust my doctor and I'm gonnacontinue it.
And the number, like you canactually see that this is just
the tip of the asberg and he'stelling me the story.
But for this person that saysno, because he's educated,
because it trusts me how manyother patients did not believe
what their doctors wereprescribing, right?
(25:33):
And with the political climate,now, I don't know how many
people are gonna trust us.
F but you see, this is like,this was the second thing.
And then the third thing was, Ihad finished everything,
fellowship and all this inFrance, and I'm coming back as
an intern and Oh wow.
I think that there's trauma tobe had there because and I'm a
(25:54):
pretty strong personality, but Iremember I was like, I'm
basically the, I'm sorry forthis word, like the bitch of of
the resident and for what, likethis is crazy.
And that was really painfulbecause there is no such thing
in France.
You are the intern the wholetime.
You're not the intern or theresident, however you call it,
but there's not one residentthat's more like powerful than
(26:16):
the other.
And what it is, is that ifyou're a resident that have
that, that already has threeyears under the belt as a
resident, you just are moreknowledgeable.
And so the younger resident isgonna come to you as Q So there
is this.
Symbiotic relationship where theolder resident are really happy
to share that knowledge to theyounger residents.
(26:37):
And that didn't feel like thatat all.
It felt like, well, I, Iremember, oh my gosh, I was like
in the ER and there's thisresident that comes to me.
(27:30):
I had not seen the patient.
I think he is like, please do arecal exam on patient, blah,
blah, blah.
And I looked at him, I said, Iwanna make sure that of what you
just said, you are asking me tonot do an intake, to not have a
report with this patient, butliterally you're asking me to do
a physical exam where the onlything you want me to do as a
recile exam on this patient.
(27:51):
Is that correct?
Yes, that is correct.
I said, I'll do it.
And you're like, how dissingagain, is it for the patient?
It's, I don't care about Recileexam.
Like I'll do whatever, but like,come on.
And that was something that Ithought was like, we need to
change that because.
It's, it's traumatic.
It's, and there are internsthat, commit suicide.
(28:12):
They have like no sleep.
And they are finally, doingsomething and suddenly this is
what you're sharing them withthem.
And, and to me it's like whenyou're seeing a patient, you're
from A to Z and then you wannafollow up and what's going on
after.
'cause you learn so much fromthat.
So yeah, those, I'm sharingabout all of the things that are
(28:33):
negative.
There is a lot of good stufftoo, not gonna lie, but that,
that was the free trauma that Igot, like free trauma.
Maryal Concepcion, MD (28:42):
I, I do think that it really highlights
also as, as I tied, therelationship that your patients
are looking for when they joinyour practice.
Now, I, I, I pull from what youjust shared, how important it is
for us to be in existence.
So people who are coming up inthe ranks of medicine and who
are going into attendingpositions, see that you can
(29:03):
actually do medicine the waythat you're doing at your
rheumatology clinic and I'mdoing at my family practice
clinic.
Absolutely.
So I think that this is, so,it's important for people to
hear as, as crappy as it is andas, as it as, like, I will call
out, everyone who's listening isthinking about like their quote
unquote favorite resident whodidn't bother to help a dang
time when they were on call asthe first year, second year.
(29:26):
And you're like, seriously, whyare you even a doctor?
Because you're such a.
Fill in your expletive there.
Yeah.
And so it's like we've all hadthose experiences and it's also
maddening, but I will say forme, it makes me even more it
makes me even more lean into thecommunity of DPC when it comes
to supporting each other indoing this medicine.
(29:47):
So a hundred percent.
So I, I think about how you havethis rich history of knowing how
care is as a physician in twocountries, how, it, it was to be
a patient, but then also how youopened your own rheumatology
practice despite all of thethings that you had been exposed
to.
And so I'm wondering if you cantell us about this moment in
(30:11):
your career when you decided toshift to direct care
rheumatology as the first directcare rheumatologist in the state
of Colorado.
Isabel Amigues, MD (30:18):
And it's funny, I didn't actually, I
don't think I fought for, Ididn't think of it for myself at
first because I had the bestdeal possible in my institution.
I was working two or three days.
I can't remember, like maybe atthe time I was working three
half days or maybe I had fourhalf day clinic.
They had not decreased.
I, I really like, thank you formy institution.
(30:38):
They were amazing.
In fact, to the point that whenI said I'm leaving, they didn't
trust, they didn't believe me.
They were like, con contact usin two weeks and like, because I
didn't go, it's funny, the sameway that my marriage left, which
was very kind.
I was like, it just doesn't workfor me anymore.
And that doesn't, doesn't meanthat I don't love you and
respect you.
It just, this is not for me.
(31:00):
And that was exactly the same.
It's like, I love thisinstitution.
Mm-hmm.
I really, truly love it, butthis is not in alignment with
myself anymore.
And so I want out and I'mwishing you the best.
And truly, actually, trulywishing them the best.
And and when I started, I didn'tknow that I was gonna do this.
And what happened is that it wasafter COVID.
(31:21):
So I had, I, I was dealing withthe cancer before COVID, then
COVID hit I had finishedeverything actually by the time
COVID hit, but COVID hit.
And it was interesting to seepeople go through sort of the
same internal, dialogue.
I don't wanna say monologue'cause I don't think it's a
monologue, it's dialogue whatyou're saying about what you
(31:42):
wanna do and what the boundariesare.
And I had already done it.
So it was kind of cool to watchthis being done.
But also I was like, Hey, Iwanna live my life now.
Like, what's going on?
And and after COVID, a lot of mycolleagues at the institution I
was in were burned out, likeburnt out.
(32:03):
And I remember like one of my pamy one of my colleague came and
it's funny, she just opened.
A direct care specialtypractice.
So she opened it after meseeing, like, I think she wanted
to make sure that it can happen,right?
And it be doing, but she wouldcome and she would be like
crying and, and I was like,okay, let's do an exercise.
(32:24):
We're gonna visualize what wouldit take to be the best care?
What would we want to be thebest care?
And we started sharing like theimportance of community.
Like it was a free Peter thing.
And again, I didn't do thatalone.
I did it with her Dr.
Sergio.
I'm in Sergio.
But basically we were like,there would be healing of the
(32:44):
brain, like the mind healing ofthe body and healing of the
spirit.
And the way we thought about itwas your mind.
It's all the mind, the mind bodylike meditation, visualization,
prayers for some.
And so on.
The body would be the medicineand how we help our bodies.
And then the spirit would be thecommunity.
(33:06):
And so then we started doingcoexist, which is a meeting.
At first it was kind of likewhenever we wanted and now it's
like every month we and it'sfunny'cause this was all done
with her and then I think shewas like, you're doing it now.
So I did it.
But it's okay.
Like I thought it was helping somuch.
And basically those coexistmeeting, we bring someone from
(33:26):
the community and I interviewthem and we have a community.
And, and what's really wonderfulabout this community, I never
know how many people are gonnabe there.
And sometime it's like, 10 andsome other time it's like 40.
And it's always like someone isgonna bring someone else.
Like it's a plus one thing.
And it is been really wonderful.
And and yeah, and, and startingfrom there, what's really
(33:49):
interesting is I started likejust creating how my community
would start, like community andI, I really use the word
community'cause I think thatthat's what I'm creating would
feel like in terms of withpatients and, and the caring,
how much I cared.
And I didn't continue to carefor patients because I had to,
(34:11):
but because I really, trulywanted to and cared and got as
much as those interaction as Iknew I was giving them.
Like it was really a given andtake meaningful and that, that's
how I started.
And just one day.
What was the story?
I started reading a lot on thedirect care, rheumatoid direct
(34:33):
of DPC.
Actually I started like, readinga ton of DPC books and how that
was possible.
I also started looking at locumsand at that point I was single
mom.
'cause I had divorced, I wassingle mom and with my mortgage
and kids and, and I was like,well, how can I do this?
And I asked my ex-husband and Iwas like, he's a physician too.
(34:54):
And I was like, here is what I'mthinking.
We had the kids every other dayand then every other weekend and
I was like, if I do this, I willhave to travel one week at a
time.
Maryal Concepcion, MD (35:03):
Mm-hmm.
Isabel Amigues, MD (35:04):
For Locums when I'm beating that, are you
okay with that?
And he is like, absolutely, gofor it.
I'm totally in support of that,which is super, I'm super
grateful because he is, he, hecould have said no.
But yeah, that's been, I'dstarted the practice while I was
doing the locums and, and thenthe practice took off and, now.
Super, super.
Now I'm hiring someone, ifsomeone wants to say, if there
(35:24):
is a rheumatologist that wantsto come in my practice, plug in,
come in, I'm hiring.
Maryal Concepcion, MD (35:31):
I love it.
And I absolutely would say, the,the next question I wanna ask is
because, there, there has to be,I'm like sending all the good
juju out into the world also inthat form of visualization that
you know, that there is somebodylistening if not today, than
tomorrow or next month.
Because I do think that hearingmore about your practice is,
it's, it's unbelievablesometimes when you hear where
(35:56):
specifically rheumatology hascome from in the direct care
space to hear your story.
So, your, your practice grewfairly quickly.
You have multiple staff memberson your website.
Yeah.
And, I just, I love that thatyour clinic is so successful
because rheumatologic disease,rheumatologic diagnoses, it is
something that we see a lot ofin family medicine and primary
(36:18):
care especially, and especiallywith these diagnoses, it's so
important to have thatpersonalized care because
rheumatologic disease,rheumatologic diagnoses can lead
to so many different symptomsthat, can be passed off too
often in the, in the quick,quick, quick care of fee for
service.
Like, oh, you're just a woman.
(36:38):
Like, oh, it's not that bad.
And it's, this is, I think whatalso people are so frustrated
with, which, shows why Oneexample I, I guess would, is one
example of why they would go toyou and other direct care
specialists.
So tell us about how yourpractice has grown quickly.
Because how your practice hasgrown quickly and what people
(37:00):
are coming to you for.
Isabel Amigues, MD (37:03):
Well, I'm gonna share one of the value
that we have in the practice,which is really important.
And I share this with the team.
Almost every week I say we arehere to show that a different
type of care is possible.
It is not just about thepractice, it's also about, and
this is, this is where, again,remember where it came from.
(37:24):
It came from me sitting downwith one of my colleague to this
to discuss like, okay, whatwould a better practice look
like?
Mm-hmm.
If our institution cannot be it,how does this practice look
like?
And then at one point realizingit's not gonna be with
insurance, it is not possible inthe insurance system.
And so, because of all of this,right?
(37:47):
And because of who I am and howmuch I love medicine, like I
love it so much.
This is, this is my callingthis, I, I've been a
rheumatologist in France, I'm arheumatologist in the us.
That's how much I like it,right?
And just, just always, alwayssharing like, this is not just
about patients.
This goes beyond the patients.
We are showing that we are like,this system works and that it's
(38:11):
successful.
And so, to me, one of the reallyimportant thing is to show other
doctors that this is possible.
(39:02):
And it's, it's interesting'causeI could be totally okay.
I could have been six monthsago, I could have said, okay,
that's it.
I'm done.
Like, I don't need to increasemy prices.
I don't need to hire someone.
I could have been in a verycushioned part and I'm like, no,
we want to show that this issuccessful.
And how do I, I remember liketalking to a cardiologist who
(39:23):
told me, I like you are, becauseI said, what do you think would
success look like?
And he said, if you can if youcan pay a physician 500 K, then
your practice is successful.
And I said, game on.
I will be able to pay a, aphysician.
I'm not saying that that's howI'm, this is not where I am
right now, but but why not?
(39:44):
Right?
Like then, then let's push that.
Let's push that envelope.
And why would insurance basedpractice be the only one when
they are being paid, like reallynot good?
Why would they be the only onethat can make those salaries for
their doctors?
Which by the way, there's not alot of people who make that
much, but you know what I mean?
Like, I'm like, yeah, let's,let's make it happen.
(40:04):
Like physician used to be verywell paid and now.
We are paid much less than anyCEOs.
And so it's like, yeah, no, Iam, I think, I, we deserve to be
paid appropriately given howmuch of our lives we've given
away.
I mean it's, I don't know ifaway is the word, but we've
(40:25):
given a lot.
Like, while my, my, my sister isa very successful CEO.
She's awesome.
I love her and she's had a lotmore fun than I ever had when we
were younger.
A lot more fun than I had,right?
Like I was studying when she waspartying.
She still is a very successfulCEO making a ton of money.
And I'm like, why not me?
(40:45):
And, and it's not about themoney.
I think if I were not in the USit wouldn't be about that.
I don't care, right?
Like, it's not about the money,but it's about, about how we
prove success.
And to me, that's one of the waythat we prove success.
Maryal Concepcion, MD (40:58):
I love that.
And your practice, is, is closeto 300 patients already and
you're already looking foranother doctor.
Again, go to Dr.
Emory's website.
Oh my goodness.
But when, when it comes to thepatients who have found you,
give us examples of what peopleare saying about your practice
(41:19):
because you, you have amazingGoogle reviews and a lot of
them.
And so, your patients arecheering you on even if it's not
in person all the time.
Isabel Amigues, MD (41:29):
So, sorry, I just realized that I only
replied to your first start yourfirst question because it is so
important to me.
As you can see patients arefinding me in different ways.
There are patients that arefinding me and, and honestly
like I'm looking for oncologistlike this, there is no
oncologist direct care inColorado, and I wish there was.
Because the la, my oncologistretired and I saw a new
(41:53):
oncologist and they looked atme, I think in the 40 minutes of
that we were together.
They looked at me only fiveminutes, and it was mostly to
ask me about France.
And so it's like, that's, oh mygosh, proper care.
And I'm not upset at them.
I think it's a system, but comeon.
So I want a direct careoncologist, if you have one, let
(42:13):
me know.
But yeah, basically they see me,they, they find me either on
Google.
I think I'm actually consideredthe first the best
rheumatologist in Denver.
And so, I've had some patients,I was like, how did you find us?
Well chat GPT.
I'm like, oh, great.
That's kind of funny.
I love it.
I'll take it.
And I do think that we have thebest rheumatology practice, and
(42:36):
it's not that I'm the bestrheumatologist, right?
I think that all of therheumatologists that I work with
and or that I've worked with aregreat.
I just think that our system isso much better.
And as you mentioned, I have abig team because every time I
see my team starting to fallbehind, I'm like, maybe we need
to hire someone.
Okay, let's hire.
Because at the end of the day, Iwant to have the best for my
(42:58):
patients, the best outcome, thebest con experience for my
patients.
They find me.
So through Google for charge,GPT ai I think some of them find
me with the YouTube videos thatwe do.
So they may be like looking, andthen some of the ones I think
are like cannot get in intorheumatology.
Within three months, they comein.
(43:18):
Some other one it because theycannot they, they have seen
someone and it just didn't workand they just, get tired of it.
I mean, it's not like there isthat many rheumatology practice
out here.
And so I think sometimes theywant an answer and that, that's
another thing is that, there isonly so many rheumatologists but
we have a lot of I think, andthis is my take on things, maybe
(43:40):
I'm wrong, but I think what'shappening is.
We are referring left and rightall of the time.
And because physicians don'thave the time, but also because
there's a lot of primary carethat's being now managed by a
physician assistant and nursepractitioner.
They don't know everything andso they refer a lot more.
And that's creating this thissystem where rheumatology
(44:03):
practice, I don't do that, butrheumatology practices have to
kind of like decide what theysee.
And so they are losing a lot oftheir time on figuring out what
they're gonna see and whatthey're not gonna see.
And the problem is that youdon't know, like the referral
might not be well done, and sothe patient is being refused.
And so I think that that was aproblem for me.
I was like like one, if apatient has lupus, I don't want
(44:26):
them to wait for a month.
That's ridiculous.
But at the same time, if apatient has a positive a NA and
it's a one of a 40.
They actually might have likesome other type of rheumatologic
disorder.
And the number of time Iactually find that and I'm like,
well, basically we don't know.
And so yeah, they all deserve tobe evaluated.
If you have scared one of ourpatients told them that they
(44:48):
need to see a rheumatologist,then we should be available to
them.
That is how I see it.
Totally.
Maryal Concepcion, MD (44:54):
Yeah.
I, I will say here a point offrustration with my own patients
is like, for example I had apatient who for years was going
to see a person that did tonsand tons of, of labs and would
give binders of results.
And then this is like, I thinkfour years later, this patient
comes to me, talks to me abouttheir family history, dah, dah,
(45:15):
dah.
It's like a two hour intake.
Yeah.
And I'm like, like somethingrheumatologic is going on.
And this patient ended up havingCrest syndrome and it's like,
out of the binders and bindersthat you got.
Never.
Did you actually get a thing totie these, these symptoms?
I know the physicalpresentations and all of the
labs that you paid thousands ofdollars for together, and but
(45:38):
then I have patients who I'mlike, I can literally get you in
with rheumatology nextWednesday.
Let's go to their website andpick a time.
And then they're like, oh, butit's cash.
And I'm like, remember that?
That's why you pay to be amember here because of access.
And I'm literally remindingthat, that you can get in next
Wednesday.
You are choosing to wait for thereferral to see if it's accepted
(46:00):
at uc Davis.
A hundred percent.
That happens all the time.
And it is, it is mind blowingsometimes that I'm like, but you
know, the value of having aphysician who works for you
directly.
And that can even mean more whenit comes to something like
rheumatological diagnoses.
So, it is, it is frustrating.
But I will say that again, I'mso glad that you're out there
(46:23):
and that patients are findingyou.
So I wanna ask here about yourclinic's name, because
Unabridged md just looking atthe logo and the reading the
name.
I'm just wondering if you cantell us about how the logo and
branding represents what you'redelivering to your patients and
your community.
Isabel Amigues, MD (46:41):
Absolutely.
So the idea was to offer thewhole version of me and to see
the whole version of thepatient.
So not look at just, thistechnical part of what, they
have joint pain and that's allI'm gonna look at.
But we're gonna look at, not,not that I look at trauma all of
the time, but you know, theother day I have this patient
(47:02):
she has, she has had basically,she has like an autoimmune
disorder, but she's trieddifferent stuff, but every time
she gets side effect and I waslike, have you ever thought of
this question of is there anyways that if you were in
remission your life would beharder and without stopping,
(47:23):
like, without missing a beach?
He's like, my husband would notbe happy if I'm in remission.
And I was like, let's talk aboutthis.
Let's, let's actually, let'stalk about this, and like how
much power you're giving yourhusband.
And and like, is it true?
Is it not true?
It's, it doesn't matter.
It's not, is it bad?
Is it good?
It, it is.
(47:44):
If you think that your life willbe more miserable if you're in
remission, then how are yougonna reach remission?
Your body is a whole, I can giveyou as much medication as I
want.
You're gonna not appreciatethem.
Right.
And so, the on Abridge md,that's, it's almost a method at
this point.
It's like, it's this vision ofthe patient as a whole, mind,
(48:07):
body and spirit.
It's really what is it and whatit is.
And yeah, I wanted to offer thewhole version of me.
And when I say that I love mypatient, I truly, truly love
them.
And I don't use that wordlightly.
I actually truly love them.
I want them to be in remission.
I want them.
To not need me and to choose.
Right?
Like that's a thing they chooseto continue to be with me.
(48:29):
Once they're in remission, theycould absolutely decide I'm
(49:06):
gonna go in the, in theinsurance based practice.
Absolutely do it.
Like, if you want, if this isyour choice, do it or choose to
be with me.
This is, this is, I don't wantyou to be in a place where
you're gonna be obliged to doone thing or the other.
Right?
Like, it's a choice.
And uh, yeah, that's, that'swhat the word is.
And uh, the logo, which is akind of like those circular that
(49:28):
are together and there's kind ofthis idea of onward forward.
It's the vision of the patientas a whole with the idea.
And I think that this is inmedicine, not just rheumatology.
The idea is that.
This is coming from discussion Ihad with my dad who's now
learned how to, he's a judgeoriginally, but now, and, and
retired.
(49:48):
But he's learned Chinesemedicine is really good as, and
I can puncture.
I don't think he's ever gonnause, but he, he wanted to learn
it.
So great.
And and when I was 18 I waslearning medicine.
It would have like those long,long I don't know if it was
email at the time or just, aletter.
'cause it was in Marsai.
They were in Marsai.
My family was in Marsai and Iwas in in Paris.
(50:09):
And it would be like, yeah, youknow, when someone is ill, they
are losing balance.
And your role as a physician isto help them get back into
balance and oh my goodness, how,how wise is that?
Right?
Because that's exactly this,your job is not to go against,
to fight a disease.
It's how do we help our patientsget back into balance?
(50:31):
And so that's the wholeness, thered, the, the, the, not the,
the, the circuit, onward forwardis this idea that you are not
going back to where you were.
You are actually going to abetter place than you ever were.
So it's not like I wa I wanna goto where I was before I had
rheumatoid arthritis.
(50:51):
No, no, no, no, no, no.
We want you to get in a placewhere this rheumatoid arthritis
has actually brought you so muchgood, because you've learned how
to say no because you've learnedwhat you wanted in life because
you've, you've learned theimportance of healing.
And I have a patient I, I justsaw yest, oh, I can't remember
yesterday.
(51:12):
And and after being diagnosedwith an autoimmune disorder and
being like, she's now inremission.
But the really cool thing aboutit is that she's not only in
remission, she's actually helpedher vagus nerve to be evaluated
to be.
Stimulated and so she actuallyhas less stress in her life.
Because of that.
And she feels better than shefor 10 years, for over 10 years.
(51:35):
And so that's, that's the,that's the goal.
I, I don't know that, I, ofcourse not everyone reaches
that, but that's my goal foreveryone.
So that's on average, MD foryou.
Maryal Concepcion, MD (51:45):
I love it.
And I'm wondering if you couldalso talk to us about how you so
the, the, this question iscoming from speaking with a, a
couple of other direct specialtycare rheumatologists, and when
it comes to.
Figuring out the challenges ofinsurance coverage for
medications.
I'm wondering if you can Yeah,if you can, if you can, oh my
(52:08):
gosh.
If you can chime in on that,because I, I feel that like,
there's certain things likeoncology medicines even, like
how do we crack the, the accessbarrier?
Isabel Amigues, MD (52:18):
It's super easy.
It's actually easier than it'sever been.
I have a pharmacist that thathelped me with getting prior
authorization in a record time.
So I don't take insurance as thephysician.
I think my value is a lot morethan what insurance thinks it
is.
So I'm like, Hmm, I don't wannawork with you when it comes to
(52:40):
my compensation.
I work for my patients and I'mnot employed to the insurance.
Now my patients have insuranceand we're gonna use.
Maximum of it.
And that's, that's basicallywhere I'm at and the medication.
I know exactly how to get all ofmy meds approved.
And it's approved.
And we, and, and what's reallycool also is that if a patient
(53:02):
has no insurance, I also knowhow to get the drug company to
pay for that medication for ourpatients.
So I've actually had, inessence, many patients who've
told me that coming to thepractice has actually saved them
thousands of dollars.
But I, yeah, I don't think thatthat's an issue.
And, I'll tell you, I actuallywanna reach out.
I, I'm gonna send her thisrecording.
(53:23):
I want my oncologist, myprevious oncologist, the one
that helped me go intoremission.
I want her to come into mypractice and and she was like,
well, but, oncology, we need tohave medication and all this.
I'm like.
I'm pretty sure we can find aninfusion center that will do
that and will help you get allof those.
So I'm actually, I think this issomething that I'm gonna do.
(53:45):
I'm gonna leave her get bored alittle bit for a little bit
until she realizes that being adoctor is so wonderful and
especially in the direct carepractice.
And then we'll have our firstoncologist in Colorado that's
direct care practice.
I mean, it's needed.
Like I don't wanna go to myinsurance based oncologist.
It's just not like, it's not, Idon't feel supported and it's
(54:08):
not their fault.
I think all doctors need to getout of their insurance system.
Maryal Concepcion, MD (54:14):
No argument from me, but I will
tell you also please I'll sendit to you afterwards, but
please, especially if you'realso like, oh my God, I would
love to hear a direct oncologystory.
Dr.
Laura Baio Kenney.
She was early on in the podcastin terms of years ago.
But I will say that she's agreat example of how you can
succeed in oncology as a directoncologist.
(54:36):
And so, as a direct specialtyoncologist.
So I definitely will say that'sa great one for your colleague
to listen to in addition to yourown, your own story, which is
amazing.
Yeah.
Continuing on that thread of.
Physicians who work for thesystem versus physicians who do
not work for the Insys for thesystem.
I'm wondering if you can talk tous about how you think about
(54:57):
other specialties who are doingDPC as a business model.
They're not necessarily primarycare, they could be, but for
specialists likerheumatologists, dermatologists,
even surgical specialists.
What do you think about thefuture of specialty care when it
comes to access?
Because clearly you've seen whatpatients are wanting and how
patients are even finding thatit's cheaper.
(55:18):
But what would you see ingeneral for the movement of
direct specialty care?
Isabel Amigues, MD (55:22):
I don't know that cheaper is the word that's
more valuable.
The special, I, I honestly thinkthat the system is burning to
the ground right now and I loveit.
Like every time.
So this is really funny.
Every time, look, I come frombeing a socialist in France and
I'm like in the US and now I'mtelling you, I'm not that I'm a
capitalist'cause I don't knowthat that's the word, but I want
(55:44):
to be very successful.
Mm-hmm.
I want, I, I want to prove thatphysician can be very successful
because I, I really love it somuch that I want my kids to say,
this is what I wanna do.
Right.
If they saw me, well, not me,but if they saw, anyone like,
their, their parents and theythink that their parents are
(56:04):
miserable, they will never wannabecome a physician, but I want
them to want to be physician.
Right.
Like, if they want to, of courseI'm not gonna force them.
But, it's it's this idea of, i,I think that right now it's been
so driven by money, theinsurance-based model, that
basically the only way forwardis to get advanced
(56:25):
practitioners.
So we're getting advancedpractitioners.
What's the next step?
Is going to go to be ai.
So you're gonna ask AI and thenit is gonna be so I don't know
if they're gonna remove all aall advanced practitioners and
then it'll be ai.
I have no idea.
What I can tell you is that Ithought open evidence was pretty
good until I started asking themabout their set, RA and all
(56:48):
this, and then they were like,this is not approved by the F
fda A I'm like, wait, what doyou mean it's not approved?
Like here are the data.
No, it's not approved.
And until I was like, this isthe FDA website and oh yes, it's
approved as if they had not toldme five times before that it was
not approved.
So I was like, okay, AI has alot to learn before I'm gonna
trust them fully.
But you know, the truth is thatit probably is the case that a
(57:12):
lot of AI are better than a newa PP.
Okay.
So that's the first thing.
Then the second thing is likeyou're trying to make money.
And so, apps are for now,there's a lot of them that are
new.
So they are not, they are notburnt out.
I think they're gonna be burntout.
One physician are much moreresilient than a nurse.
(57:32):
I, I, I'm not saying this in anegative way.
I think we have been sotraumatized during our training
that we know how to go throughit, which is not ideal at all.
But I think nurses have unionand so they are able to say no
much faster than we ever mm-hmm.
Worked.
Our ideas like, no, I can alwayssay yes, it's your ego talking.
(57:54):
Right.
So yeah, I think that that'sgonna burn to the ground and
it's super sad that the patientsare gonna suffer.
And this is where it's sad isthat I am in a position now that
I can't pay for a oncologist indirect care.
And my promise is that itdoesn't exist in Colorado.
But I would like to pay forthat.
And I think it's worth a lot ofmoney because someone that cares
(58:16):
for me.
And is gonna back my healththat's worth it.
Right?
Versus a doctor that's lookingat their computer because they
have, and, and I have no idea.
Maybe she's like so overwhelmed.
I cannot be upset at her, but Ijust don't want her in my care
because I want the best outcome.
That as that is valuable.
And so yeah, I think that thefuture, I have another of my
(58:37):
colleague that's opening aspecialty rheumatology practice.
One of my other colleague justopened infectious disease
practice.
I told you I want to show thatit's possible.
And so I'm rooting for them.
I have another rheumatologist.
This is in Colorado.
So one person is opening inDenver.
Another person is like this inpulmonary.
They're opening in Denver.
(58:57):
That might be the firstpulmonary specialty.
And they are not at a low price.
I started at low and then Iincreased as time went.
But I told them, don't make itcheap because otherwise you're
gonna be just as busy as beforeto make ends meet.
Right.
And yeah, and, and I think thatthe future of medicine is one
(59:18):
where p physician, like I Ithink five years ago I thought
that all physicians were gonnaleave being physician.
And thanks to you guys, welearned that there was another
way in medicine.
And so we're leaving theinsurance model, but we're
staying being physician, which Ithink is really cool.
And some of them probably willnot and become administrator
(59:41):
and, CEOs of different companiesand that's great too.
But at the end of the day, Ithink what's happening is that
we are, we are not being valuedby the society.
As much as we used to.
And so we're like, no, I don'twanna be there.
So that's, that's, that's mytake on things.
But it's, it's fun.
Every time I've, I have horriblecare in a specialty practice,
(01:00:03):
I'm like, Hmm, I don't have toworry about my future.
Yeah.
Maryal Concepcion, MD (01:00:06):
I love it.
So, after this podcast, wherecan people find you to connect
with you on YouTube, yourpodcast, and your website as
well?
Isabel Amigues, MD (01:00:14):
Yeah, pretty much everything is called on
Abridged md.
So if you go on on average MD inany like social media, they'll
find me.
And then, and I don't know if Ishould switch, but basically
it's under Doctor, it'srheumatology 1 0 1 that's, it's
it's linked on average md.
But yeah, rheumatology 1 0 1 byDr.
Isabel am because, I do likelives every, every week in
(01:00:39):
rheumatology.
And I, I like doing that too.
And then on the website, onAbridge md, so we have a
podcast, we have a live and aYouTube videos, and we have our
social media and blogs,
Maryal Concepcion, MD (01:00:49):
A lot.
Fantastic.
So I am so excited for people toconnect with you after this
podcast.
And thank you so much for comingon today and sharing your story.
Isabel Amigues, MD (01:00:59):
Thank you.
Maryal Concepcion, MD (01:01:03):
Thank you for listening to another episode
of my DBC story.
If you enjoyed it, please leavea five star review on your
favorite podcast platform.
It helps others find the show,have a question about direct
primary care.
Leave me a voicemail.
You might hear it answered in afuture episode.
Follow us on socials at thehandle at my D DPC story and
join DPC didactics our monthlydeep dive into your questions
(01:01:24):
and challenges.
Links are@mydpcstory.com forexclusive content you won't hear
anywhere else.
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Find the link in the show notesor search for my DPC story on
patreon.com for DPC news on thedaily.
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Until next week, this isMarielle conception.
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