Dr. Kelsey Smith Talks About Building A Sustainable Practice: The Story of Pioneer Health DPC

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Maryal Concepcion (00:04):
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 you

(00:26):
will hear the ever so relatablestories shared by physicians who
have chosen to practice medicinein their individual communities
through the direct primary caremodel.
I'm your host, MarielleConception.
Family, physician, DPC, owner,and former fee for service.
Doctor, I hope you enjoy today'sepisode and come away feeling
inspired about the future ofpatient care direct primary

(00:49):
care.
I've said

Dr. Kelsey Smith (00:53):
this to, to other people, I think you expect
that the internal struggle we'redealing with is evident to
others.
And sometimes it's not eventhose that are closest to you
because we keep things so closeto the, to the chest and, and
were high performers.
And so, sometimes maybe myhusband just really thought I

(01:13):
was not a nice person, and, andit really was just that strain
and that that weight that you'recarrying that you just don't,
don't want to talk about.
And so I think the, the reverseis true as well.
When that weight is lifted andyou feel so much better about
what you're doing and aboutgoing to work each day, you

(01:34):
anticipate that others are gonnasee that, and they do, but it's
not as evident to them as it isto you on, on the inside.
And so what DPC has meant for meis.
A sustainability of a systemthat was previously draining me
to try to work in a system thatwas not made for my success or

(01:59):
the patient's success andtransferred that into something.
Yes, medicine is still hard.
It is still hard to be a doctor.
It is hard to tell patients badnews.
It is, it is hard to come upwith that diagnosis that eludes
you.
But it is now a practice that Ienjoy being a part of and I

(02:20):
enjoy seeing my patients everyday and going to work and, and
engaging with my employees.
So it is definitely worth it,even if from the outside looking
in, it looks like they're doingthe same job.
I'm Dr.
Kelsey Smith of Pioneer HealthDPC, and this is my DPC store.
Yay.

we are here live at the Free Market
Medical Association meeting2025.
Thank you so much, Dr.
Kelsey Smith for joining ustoday.
I'm so excited to,

to join you.
The FMMA has been something I'vebeen a part of for several
years.
Of course, I followed yourpodcast, been doing DPC for four
years, and so to bring all ofthis together is pretty special.

That's awesome.
And it's cool that, the, theaudio might sound a little bit
different to the listeners outthere.
We're in the, we're just takinga lunch break and doing this
outside of the conferenceitself.
And I think it's really evenmore appropriate that we are
doing this in your home statewhere you are a DPC doctor who
is serving fellow Oklahomans.
So this is, again, it's justextra special in that lens.

(03:22):
When, when it comes to yourpractice, I would love if you
could start us off with.
What was the model that you werepracticing in before you went
into your DPC journey?
Yeah, so I think

a little bit more unusual than the typical
DPC practice.
I was self-employed.
We were a five physician groupand four family medicine doctors
in one pediatrician.
We all had our separate LLCs,but we functioned under an
umbrella as a group.
And so it was eat what you kill.
None of the senior partners madeanything really off the junior
partners other than sharingoverhead and sharing call

(03:57):
because we did everything.
We all delivered babies.
The family medicine doctors did,and I was OB fellowship trained.
We all did operative ob, so wesaw our, our moms and babies in
the hospital and then any of ourmedicine patients or pediatric
patients that were admitted, wesaw those had a busy clinic
schedule and things like that.
And really, that wasn'tsomething I sought after was to

(04:19):
be an entrepreneur straight outof residency.
But I was looking at all thedifferent hospital contracts
that were available to me at thetime and.
Really thought that was what Iwould do until I was approached
by one of my old partners thatthey were looking for someone to
join their clinic.
And at the time he demonstratedto me that, hey, it's still
economically feasible to workfor yourself.

(04:39):
And I thought, well, gosh,that's what a novel concept.
So I was kinda introduced tothat by my old partners to even
think outside the box, itdoesn't, it just seems
ridiculous to think that owningyour own practice is outside the
box.
But so in 2007 I moved toStillwater and joined Stillwater
Family Care and wasself-employed as a part of that
group from 2007 until 2021,whenever I launched my DPC.

(05:02):
So

I think it is unique that you had that
experience because if you thinkabout the majority of us,
including myself, who are like,we don't even one, know that
there's a different way, buttwo, that you could actually run
a business even though you don'tnecessarily have an MBA.
I, I wonder if you could tell usa little bit more about that,
that discussion that you hadwith your history of already

(05:25):
seeing the hospital contracts,just not finding anything that
would work for you, but alsohearing and translating how this
could be, this idea of beingself-employed, could be
financially a, a, a solution towhat you needed without that
prior experience of, of abusiness ownership.
There's some of us who, dorealty on the side or whatnot,

(05:46):
but for a physician to go fromresidency into this I would
think that there's, there's,there has to be that translation
for how will what you've doneimproved work for my life.
Right.

Well,

I,

I couldn't have done it without the help of
my partners because they alreadyhad the business structure up
and running.
And the 14 years that I spent inprivate practice taught me a lot
of the just day-to-day, basicknowledge of running a business,
even though I don't have abusiness degree or an MBA, but I
just saw how things got done.
We had an amazing office managerthat she run, ran the clinic on

(06:22):
the business side the entiretime she was, she still is
there, she's been with theclinic since it was established
and continues to, to help managethat practice.
And she was a, a big reason forthe business success because as
many of the speakers here havepointed out the ever-changing,
like the resetting of thegoalposts for private practice,

(06:43):
well for any practice, but it'sset to make winners and losers
and private practice physiciansare always strategically, made
to be the losers in thatargument because the bigger
players are trying to monopolizethe healthcare system.
And so it makes it incrediblydifficult for small physician
groups to continue to compete.
And she was amazing at, okay,well.

(07:04):
Yes, but we can now bill forcare management.
So we need to hire a caremanagement nurse.
And now there are somealternative payment models out
there.
If we participate in that, wecan save some money here and
make a little extra by meetingcertain metrics.
Now MIPS and macro are comingalong, but we can be part of an
aco.
And, and so she really did helpkeep us afloat by helping us
play that game to the best ofour knowledge, at the time

(07:27):
because the rules are alwayschanging.
And so knowing all of that, I, Istayed in touch with, with her I
think when I was working theremore so than my other partners,
to kind of understand what gamesshe was having to play on our
behalf to make sure the practiceremains solvent.
Whereas the other partners, Ithink would have more happily

(07:47):
just stuck their head in thesand and been like, okay, we're
still making money'cause I'mstill bringing in so much
revenue per month or whatever.
They didn't really see thechanging climate as intimately
as I did'cause I helped withsome of those.
Alternative payment models, thecontinuous or comprehensive
primary care initiative CPCI, wewere one of the first practices
in the first wave of that totake part in it.

(08:08):
And, and I was naive enough whenthose initial initiatives came
out, I was like, this is great.
The powers that be are nowrefocusing on primary care and
it's, they're finally seeingthat we have worth and that we
have value.
And so for the first year or twoof those government initiatives,
it seemed like that was maybegonna play out.

(08:28):
But then it's after those firstyear or two where you come back
and you're like, yes.
See all these wonderful thingswe're doing.
And then we're like, yes, butthat's not enough.
Now you need to do this.
And so, like you say, the riskresetting of the goalpost is
just incredibly frustrating torealize you're never going to
reach what they consider to bequality care.

(08:48):
And so it was when MIPS andMacro came out and I realized
that this was not going to besustainable for our private
practice, the image that'sburned into my mind is just.
I think it's in one of the backto the future episodes where
there's this burning train thatlike plummets off of a cliff.
That scene just like replays inmy mind the insurance-based
model of healthcare, I feellike, is that train just headed

(09:09):
off the cliff and maybe almostin slow motion because the
people on the train don't evenrealize they're on it.
But once I knew that, that Ifelt like that's what was
happening, I felt like I had oneof two choices.
You either stay on the train andplummet with the burning
wreckage or you jump off andit's scary to jump off, but it

(09:29):
was the only solution thatreally made sense to me.
I first con, like I said,considered DPC when MIPS and
Macer came out.
I think that was 2015.
I might not have the yearsexactly right, but and I read
Doug's book, Doug Fargo's bookand I, I remember taking it to
my partners like, Hey, I thinkthis is what we need to do and
get out of these programs.
This is, one way we can continueto make it as private

(09:50):
practitioners.
And we live in a fairly smalltown.
I mean, it's, it's a 50,000population town with a major
university in town.
But they're like, no, that wouldnever fly here.
There's just not enough highwaywage earners.
They're kind of equating it withthe classic concierge type
model.
And I was like, no, I don't.
I think you're wrong.
I think you're wrong.
I think we could do this.
But like I said, our officemanager was really adept at

(10:12):
finding ways we could continueto function.
And so instead we signed up foran A CO and we kind of made
things work for a little bitlonger.
And it wasn't until really Covidcame along and, hospitals
really, really struggled.
Physicians in general struggled.
It got to be ridiculous to tryto go to the hospital and
deliver a baby during COVID ortreat any patients when you were

(10:32):
trying to juggle them inpatientand outpatient work.
And I was the youngest by a fewyears of my partners.
And I had not come to the pointthat I was gonna call it quits
necessarily with hospital basedmedicine.
But, but they did.
And they came, they're like, youknow what?
Basically like the.
I'm saying we're just gettingtoo old for this crap.
And so we let the hospital knowwe were gonna stop seeing
hospital patients.

(10:52):
We were gonna stop doingdeliveries.
But I thought, well, this is mychance.
'cause I, that was the one thingI didn't know how to structure
for my DPC practice.
I know there are definitely DPCpractices out there that offer
ob, but I did not know how tomake that work for my specific
situation because I relied on mycall group.
I had a lot of Medicaiddeliveries and things like that.
So once we decided and made thatleap that we are no longer going

(11:16):
to deliver babies, that's whenthe decision to do DPC was a
whole lot easier for me becauseI was like, you know what?
I, there's no reason for me notto.

Totally.
I, I wonder as, the, as youexplain how your office manager
really helped find creativeways, I also wonder if when you
look at your partners, yourformer partners, and you think
about how they weren'tnecessarily as engaged with
learning about the business, howit is staying afloat.
I'm wondering did your clinicmanager mention these things as

(11:47):
you were also asking them guys,you realize that this is not
necessarily going to be workingas easily as it might be today
because the goalpost isconsistently changing?

Yeah, no, for sure.
I mean, she became a bit of aone-man show as far as the
reporting processes go.
Anybody who kind of has livedthrough that timeframe knows
that, there are differentquarterly reports that had to be
reported.
And if you're not using theright EMR, it may not.
The boxes that you click maynot, actually populate the right
data points.
And so you may have gotten 90%of your patients their
mammograms that year, but theEMR only uploads to the federal

(12:20):
government that it only likehalf of the time, did you get
your mammograms.
And so it really didn't matterwhat care you delivered, if it
didn't check the right box, thenit didn't get reported to the
right entities.
And so she was really investedin staying up there till
midnight, some nights, thenights, before those reports
were due to make sure all ofthose structured data points got
into the right places, whetherthey were originally charted

(12:42):
that way or not, going back andlooking at raw data, making sure
the right things were clickedand that we were getting credit
for the work that was done.
So in that way she, she was veryintimately involved in that and
she would tell us a lot aboutthat and, and work by working
overtime and things like that.
She, she was compensated forthat extra work, but I don't
think anything can compensatefor just the frustration that,
that Yeah.
Causes.
And, and not to say that motherpartners weren't business savvy.

(13:04):
I mean, the senior partner inour practice was very business
savvy, but.
He knew that he did not have thebandwidth to deal with those
things, and our office managerdid such a good job that, he, he
focused more on other businessaspects of the practice.
So I learned a lot from theentire experience.
I wouldn't have it any otherway.

(13:24):
I admire people who start theirDPC right out of residency.
I don't think I could have itwas a big enough leap for me to
join a group that was doingprivate practice.
And, and I think that now thatthe DPC movement is growing,
that, that's probably a morefeasible option for people
looking to do DPC right out ofpractice is to find some of us
that have already done it andlearned the ropes from us.

(13:45):
So,

I totally agree, and I think that
sometimes, because I, I knowI've been there myself, even in
DPC sometimes when I'm like, itis so overwhelming for, whatever
it might be, like an entire,shipment from the wholesale,
whatever pharmacy came in andI'm like.
This is overwhelming.
I cannot face inventory today.
I'm going to do anything.

(14:07):
But yeah, when it comes tobusiness, that is a massively
different type of overwhelmbecause especially when you know
that financially it makes adifference at the end of the day
for yourself, but also it makesa difference for the future of
your profession.
And I, I wonder as we're talkingabout this especially as you
participate in a CO type stuff,where do you, how do you talk

(14:28):
about direct primary care versusvalue-based care?
Because it is a thing right nowthat people are saying, well,
DPC is value-based care.

It's so different.
I heard, I heard you say that inone of your previous podcasts
here recently.
And from an insider's view, likethey are totally non
equivalents, like they're indifferent ball fields.
I don't, I don't see where,because even though value-based
care, it sounds like what we doat DPC, we provide valuable
care, but the value-based carein.

(14:58):
As it's defined in the system, Ithink just generates this sense
of anxiety in my inner beingbecause it means, you're
considered a good or a baddoctor based on what metrics you
met.
And if there is that 90-year-oldlady that you've decided they
really don't need to have theirA1C, strictly controlled, well
now you're a bad doctor'causethat brought up your average A1C

(15:18):
score or whatever it may be.
So, I, I talk to my patientsabout this a lot when we're
talking about guidelines formaybe, whether it be, whether
they're due for their pap smearor their mammogram and the,
maybe whether they're choosingto do that that year or not.
And just the different intervalsthat things are recommended at
and why is that the case?
And, and that's what I'll tellthem is that, population based

(15:40):
recommendations are verydifferent than when you're
sitting face to face and talkingwith an individual.
And so, yes, population basedrecommendations can be very
valid.
But they may be completelyinvalid when you're talking to
that specific individual.
And so trying to, to take thoserecommendations with a little
bit of a grain of salt, becauseI think value-based care takes

(16:00):
those recommendations andblanketly just applies them to
every individual.
And I don't, I don't think thatthat's DPC at all.
I think it allows the physicianand patient to have an
individualized personalrelationship and decide, what is
most valuable for that patient'shealth.
And it may not be, getting amammogram every year.
I, I typically recommend amammogram manually rather than

(16:24):
every two to three years.
But for, certain situations, Ican't even think of what one
might be right now, but, it maynot be, we may be prioritizing
something else that year thatis, you know, because of limited
funds or whatever.
So, so there's, it's DPC isindividualized, whereas I feel
like value-based care is.
Definitely focused on thepopulation health measures that

(16:45):
don't always directly apply tothe individual.

Thank you for that.
And I think especially as youmentioned earlier, how you might
have done 90% pap smears Yeah.
According to the, the USP ftfSure.
Requirements.
But whether they got reportedYeah.
Say, and that is, that is, it'sso devastating when like you're
working your butt off to dowhat's best and to keep the

(17:08):
relationship personal.
And then you have an hour and ahalf of patients waiting in the
waiting room.
Right.
It's so tough.

Well, yeah, because you, you start to
realize with all the reportingmeasures that are out there,
you're like, wait, I did all ofthese, let's say pap smears,
like you said, or I ordered allof these mammograms or
colonoscopies or things thatwere being judged on how we
performed.
The payer paid for them.
So the payer already knows thatthey were performed because they

(17:35):
wrote the check.
But yet I have to prove to themthat I did them by reporting on
what they already know happened.
And so then you start realizingthat it really is a game like
Dr.
Norman IMEs was talking about,that you cannot win.
It's not designed for you towin.
There it's almost well,sometimes when you, it's tax
time.
And so, I've seen the meme outthere where it's like the IRS

(17:56):
says, we know how much money youmade and we know how much you
owe us.
And you're like, oh, great.
What is that number?
We're not gonna tell you.
Okay, well you're gonna have toguess and if you're wrong, you
go to jail.
It's yeah.
But it feels the same way withsome of the value-based care
incentives and primary care.
It's like you already know,which ones I ordered and what
you paid for which is differentnow in my practice, I, I always

(18:16):
kind of chuckle to myself just alittle bit when I get some of
those faxes from payers nowbecause they're like, oh, it
looks like your patient's nottaking their statin or their ace
inhibitor.
I'm like, yes, they are.
They're just getting it straightfrom me and you don't see that
transaction.
So those go straight in thetrash can.
But to be shredded.
Of course there's patientspecific information in there,
but but yeah, it's just theyhold all that information.

(18:39):
And I do try to sometimes tellpatients when I get those things
back, they're like, Hey, bigBrother just sent this for you.
Checking in on how you're doingaccording to national
guidelines.
And patients do start to, askthose questions then well how
did, how did they know that?
Yeah.
Why is it their business whetherI'm taking this or that
medicine?
And so it, that personalizationof care is not just, the feel

(19:00):
good type of medicine.
It really does take to somedegree Big Brother out of the
picture a little bit.
Yeah.

So let's get into your DPC transition.
Yeah.
Now, because you went from thisprivate practice where you were
working with your partners tonow, as I was commenting before
we even started recording aflip, an amazing, beautiful
building.
Oh, thanks.
And it is.
It is this journey that I'm sureyour, 10 years ago self would've

(19:27):
been like, no, no, we we're,that's not even possible.
No, exactly.
I'm just a Exactly

right.
Yeah, it, it was interesting'cause when I started to
consider DPCI still thought ofour group as, kind of a
collective entity.
And, and I considered myself, Iwas going to maybe be the Guinea
pig, but I really still canthought that we would stay
together as a group and everyonewould transition to DPC.
'cause I just, I had it in mybrain that there just really

(19:54):
wasn't any other logicalconclusion.
And obviously people havedifferent opinions on
everything, so that's notnecessarily the case.
But in 2020 when we, I startedthinking, okay, the timing is
basically ni there were noin-person meetings.
I did the Hint summit virtuallythat year and the DPC Alliance
was hosting masterminds.

(20:15):
Because trying to keep, largegatherings to a minimum, these
more intimate, smallergatherings were a solution that
they found in the Covid era.
And so I remember going out toAmy Walsh's practice in Raleigh
and meeting her and Dr.
Tom White and who else wasthere?
Gonna have to help me spark stopfires.
Julie Gunther was there.
So many of us that are like now,like common names, like

(20:41):
superstars in the DPC just eraor were there at that mastermind
largely because Doug was gettingready to retire.
And so my timing was impeccable.
Like I got to meet tons ofpeople who were already doing
this well.
We're leaders in the space andmeet them face to face.
Kissy, kissy Blackwell wasthere.
And I didn't even know at thetime, but I, I at least had read

(21:01):
Doug's book at the time and was,once I got introduced and didn't
realize who I was talking to, Iwas like, oh my gosh, I've read
his book.
And so it was really cool tothen have those people as
mentors.
Yeah.
And I remember I credit AmyWalsh with part of this'cause I
kept saying, I'm really, I'm thebasically the investigative
reporter for my group.
I'm coming to learn about thisso I can take it back and tell
the group and we're all gonna dothis together type of thing.

(21:24):
And I remember over lunch oneday during that mastermind
conference, Amy Walsh sat downand she said, yes, but what if
they don't decide to do it?
She's are you going to do it?
And I was like, well, I don't, Imean, we kind of make a
collective.
We, we make decisions together,right?
It was, and she's no put themaside.
Is this what you want to do?
And I was like, well, yeah, it'swhat I want to do, but why would

(21:46):
they not do it?
And then come home and kind of.
Sales pitch, everything that Iwas so enthusiastic about and to
kind of get a eh, ho humresponse.
I don't know.
It's, it's kinda like you think,I don't know.
We're sitting in Oklahoma, kindof wild west.
My, my DP C'S called PioneerHealth.
And I, I think in pictures a lotof times, so kinda think about

(22:07):
that, like pony, express, pony,like you just, you whip that
horse until it collapsesunderneath you.
And so, but it's the devil, youknow?
right.
So I feel like that's kind ofwhere my old partners at.
They see the flaws in thesystem, but they're like, the
horse is still running.
We know it might collapse, butwe're just gonna keep whipping
it until, it comes to ascreeching halt.

(22:28):
Yeah.
And I, and like I said with the,the burning train analogy, I was
gonna jump off.
I was just like, there's, Ican't, I can't follow this to
its eventual end.
So when I realized that, hey,they're willing to.
I guess tolerate me, maybe notsupport me, but they were okay
with me doing it, but they, theyhad no interest in at least
transitioning their practice atthe same time I did there.

(22:50):
It was still, it was not a hardno at that point.
But they were just like, eh,we'll see, kinda see how it goes
for you.
And so that's what I asked'em,you know, we, we owned our own
building that we practiced inand I said, you know, if, if I
transition to this differentbusiness model, is it okay if, I
stay here?
They really, I guess could havesaid no, but not necessarily.
'cause I was part owner in thebuilding, so how do you kick an

(23:10):
owner out?
But so I stay kept my, I, I hadthree exam rooms.
I transitioned down to two, keptmy ma she was on my personal
expenses anyway.
And then we had to just re divvyup the expenses.
'cause I was like, well I'm notpaying for our biller.
I'm not gonna pay for the frontdesk staff.
'Cause we're gonna take our ownphone calls.
And it, it gets a little stickybecause you know the very.

(23:34):
Granular things that you come upwith.
When people come in the door andthey come to the front desk and
they say, I'm here to see Dr.
Smith.
Well, my partners were like,that's taking time from our
staff.
We don't want to them to have totell you you have a patient
here, or you'll, or you'll needto pay a portion of their time.
Okay, that makes sense.
So, figure out creative workaround.
So it's you know what, we'lljust tell all our patients in

(23:54):
the text they receive, when it'stime to make an appointment,
there's a doorbell in the frontlobby, go straight to the
doorbell and ring it and itrings a doorbell in my office
and lets us know that you'rehere.
And that way, no, I'm not payingthe salary of the employees that
work for the overall practice,so they're no longer my
employees.
So we came up with things likethat to kind of help delineate

(24:15):
whose expenses were whose and,and it worked quite well because
I was delivering babies.
I didn't have an abrupttransition.
I didn't want to kick any of mypregnant women outta the
practice.
So as I was opening up my DPC, Istill had women who were
expecting.
So I had a six month timeframethere where I launched my DPC in
January of 2021.
Started taking enrollments, butI was still practicing in my old

(24:39):
model as well and billinginsurance companies with the
other LLC up through my lastdelivery at the end of July 1st
of July in 2021.
And so we had two completelyseparate EMRs, two completely
separate schedules.
And so if a patient was bookedon one schedule, you had to
block that time out on the otherschedule to make sure you didn't
end up double booked.

(25:00):
Of course, that doesn't alwayswork perfectly.
But that gave me the perfectopportunity for my busy family
practice base of patients to letthem know, Hey, you've got
plenty of time to check thisout.
And I could talk very openlyabout what I was doing, why I
was doing it.
I started a Facebook page andput together a few little basic
videos of, I'm really not doingthis as a money grab.

(25:20):
This is just how I feel like Ican sustain my practice and take
better care of my patients.
And, I really, really thought,'cause you hear it all the
different things.
When somebody's looking attransitioning a practice,
they're like, oh, you'll expect10 to 15% of your patients to
follow you.
I was like, no, I have takensuch great care of my patients.
I, I really just dunno how thisis gonna work.
I'm gonna have so many patients,I'm gonna have to start turning
people away because I'm gonna befull.

(25:41):
At the very beginning, I justhad this somewhat grandiose view
of the relationship I had withmy patients and certainly many
of them followed me, but it wasabout 10 to 15%.
Yeah.
And, and then you do, it issomewhat freeing then to realize
had some people say, it's likeyou've been just living and

(26:04):
dying on, taking care of some ofthese people who wouldn't cross
the street to help you.
And Yeah.
And, and maybe that's not thecase.
Sometimes they just don'tunderstand the model.
They're like, I even had somepatients tell me.
Dr.
Smith, were really worried thatyou could go to jail over this.
And I'm like, I promise it isnot illegal to pay your doctor.
You don't have to always useinsurance.

(26:25):
So, so there's that as well.
But it, but it, it is freeing torealize that the people who
followed me, they, they investedin the relationship that we had
already developed and, and otherpeople were willing to let that
go.
And so I had to be willing tolet that go as well.
And so it did let me focus onwhat's more important to me and
as a, person and a wife and amother and all of that rather

(26:49):
than just living and breathingby what happened at the office,

I just, I have this, as you're describing
the burning train, I'm like, youalso being this like fugitive on
the burning train when yourpatients are saying this.
So I'm like, that's so perfectbecause right along lots up
burning train.

Yeah.

Gives a whole new meaning

to Stockholm

syndrome.
Oh God, that's awesome.
I wanna ask here, because as youare seeing patients, even if it
was a 10 to 15% Yeah, those 10to 15% financially, it's what
the heck what was I doing the,for the years prior?
Because I, I, I don't know ifyou had this reaction where
you're like, wow, like itliterally is this many number of

(27:32):
patients at this rate per monthequals, and I didn't have to
code for any of that,

right?
Well have to say we played thegame very well, and so the
system financially rewarded mequite well for all the work that
we did.
But as a self-employed physicianfor most all of my career since
training, I like to, to justpoint out, like you can be
self-employed and still hateyour boss.
And so for those 14 years I wasa slave to the grindstone.

(28:02):
I mean, I would feel some sortof.
F validation just from the factthat when, and my husband's an
airline pilot, so when he'sgone, I'm a single parent.
When he's home, I have a stay athome dad.
So it's all or nothing.
But when my kids were little andI was delivering babies, there
might be a time where I had todrag them up to the hospital and
they sat in the physician callroom because I had to manage a

(28:23):
delivery and take care of thenewborn.
And then that was in the middleof the night, and then now it's
time for you guys to get toschool.
And I would, somehow get themfrom the call room to school in
time and then maybe changeclothes, probably not go
straight to clinic and start myclinic day.
And then, maybe I had somebodyelse in late.
You know, There were days whereI remember just vividly so much

(28:44):
happened that it seemed like nothumanly possible to get it all
done.
And then you like pat yourselfon the back for that.
You're like, look at all that Iaccomplished.
And you're like, why?
Why?
Why do we pride ourselves inthat?
Yeah.
That we are just runningourselves and our family to
death.
Mm-hmm.
Wow.
But, but it's what I did for 14years, my kids, and that's, I, I

(29:06):
kind of laugh to some degree.
I don't think my kids would everhave considered a career in
medicine just because of whatthey saw growing up.
My son has watched my DPCjourney and, and he actually is
thinking maybe medicine wouldn'tbe a bad idea.
He's, he's super funny thoughbecause he's like, is there a
part of medicine where you don'thave to see patients?

(29:28):
And I was like, actually,pathology, that's what he wants
to do.
So yes, now he's thinking aboutpathology, truthfully.
But oh my God, he's like, he's Icould cure cancer.
I could do all these things as apatho Anyway, so he's, he's
yeah, he's reinventing what his,perfect scenario of a career
looks like, but who knows whathe'll end up doing.
He also likes automotive and isat the vo-tech program with

(29:50):
that.
So, but it's just interestingto, to think through the
different, different ways peoplecan.
Can serve patients

well.
Yeah, totally.
I, I will say though, for thelisteners, especially like we
all know those people in ourmedical school classes who went
into pathology and that it waslike the best fit for them,
right?
Yeah.
And they wanted that for thosereasons.
I love it.
Exactly.
I love it.
That's awesome.
So when, when you were goingfrom this place of you have some

(30:17):
moms who were still about todeliver, you gave this six
month, sort of runway Yeah.
Between DPC and you're on twoEMRs.
What was it like when you were,fully into DPC, especially as
you had, like you had access toyour old records.
Mm-hmm.
You, you had your MA come withyou.
Yeah.
Do you have any tips for otherpeople who are transitioning

(30:38):
their own patients from fee forservice into direct primary
care?

If you can educate your patients, do so.
I mean, I know that that isrestricted in so many, scenarios
where maybe you're not evensupposed to tell them you're
leaving until your last day orwhatever, but if you can
educate, educate, whether that'sin person or through social
media or a, some sort of emailthat you send out to people as a

(31:03):
newsletter.
Just letting them think thatover.
Because I think there are veryfew people who are going to say
yes the first time they hear it.
There are a few of my patientswho I told them what I was
doing.
They're like, yeah, none of thatmade sense, but I don't wanna
lose you as a doctor, so wheredo I sign?
But the majority of folks werelike, huh, okay, let me think

(31:26):
about this.
And so the earlier, as you'retransitioning your practice, you
can introduce the model topatients, because at least in
this part of the country, it isstill unusual that we have
somebody calling that reallyunderstands what direct primary
care is.
My.
Yeah, well, I say she's my frontoffice staff, but everybody's
kind of multi trained to doeverything in my practice.

(31:46):
But she took a phone call theother day and I could hear her
talking to this individual andit's typical that we, how did
you find us?
Do you know what our practiceis?
Based on what our business modelis.
And, and she was starting toexplain, and you could just tell
the person on the other end cuther short.
And she was like, no, Iunderstand.
You know what DPC is.
And she's oh, okay, so you'removing here and you had DPC in

(32:06):
your old hometown.
She's okay, so you get it?
And she's like, yeah, Ibasically cut her short.
And it's like, you don't have tosell it.
Yes, I know what I want.
So that, but that's unusual.
It doesn't.
You, I think one of the otherpresenters here said it, if you
build it, they won't necessarilycome.
You do have to do some marketingthat is not a, a four letter
word, but you don't have to do.

(32:27):
Massive amounts of marketing theway that people think of it.
You don't have to go hire an adfirm and spend, tens of
thousands of dollars onmarketing, depending on where
you're at.
Usually that's more grassroots.
Join your Chamber of Commerceand let them know what you're
doing.
And if you are transitioning apractice, they may already know
who you are.
And then they're more interestedin like, well, why aren't you

(32:47):
doing what you've been doing thepast five, 10 years?
And so they have a genuinecuriosity.
Everybody likes a good story.
And, not that you want peoplenecessarily gossiping about you,
but it's not necessarily a badthing to be on the mom's forums
in your, your community onsocial media.
Or as you start to transitionsome patients at, it's been said

(33:08):
before, but it's true.
Your patients are your bestmarketers.
Mm-hmm.
And so I love it when I look atour community Facebook page for
our small town, and it's notuncommon.
People ask who, who's the bestdoctor in town?
Blah, blah.
Who should I go see as myprimary care?
And then to see my patientsreally go to bat for me.
'cause I don't ever post it.
Hey, you should come see me.

(33:28):
But they will, they'll be like,Hey, my doctor's the best.
She, takes cash pricing, youshould go see her.
And of course I see peoplerecommending my old partners and
things too, which is great.
They're wonderful physicians,but your, your patients, once
they figure it out and have kindof seen the light for themselves
will do the marketing for you.
Yeah, absolutely.

And I wonder, as you were getting
people really understanding whatyou do, because you were just
being a doctor and you were freeof these coding requirements.
Mm-hmm.
How did you either change orfurther, optimize the way that
you're practicing or how youwere talking to people based on
what you were hearing from yourpatients in the, in that first

(34:08):
year?

Yeah.
So your elevator pitch is not astatic thing.
Right.
Because you do need to becomemore perceptive as to what the
individual you're talking to,what their needs are.
And so for one person it may bethat, hey, you don't have to
have insurance if you knowyou're not covered by any

(34:28):
program.
We're accessible to you at acash based price.
And other people are like, youknow what?
I don't care about that part ofit.
The next, some people are like,well, do you take my insurance?
And then you have to kind ofpivot that and be like, we see
patients of all different kindsof insurances, but we don't
necessarily, well we don't, wedon't get paid by them.
And that's to your advantagebecause we help you to negotiate

(34:51):
how to best use your insurance.
Mm-hmm.
'Cause I'm not paid by them.
I work for you to help youdecide is that MRI best to be
paid for by insurance and jumpthrough their hoops to get it?
Or is it better to use your HSAmoney and just go pay for it?
And so you have to kind of knowthe patient.
And so I would say with anelevator pitch, you, you develop
a lot of different trains ofthought in your brain.

(35:13):
But I think it's smart to alwaysask.
Whoever you're wanting to pitchto.
A few questions to begin with,to find out where, where they're
coming from.
Are they an employer?
Are they looking to bring fiveor 10 lives to your practice?
Are they a mom?
Are they in a healthcare crisisright now, what are the things
that are gonna speak to themthat they need?
Because they can tell you what'sbroken in the US healthcare

(35:36):
system for them.
There's so many points wherethere's pain points for people,
but they're not the same foreach individual.
Totally.
So if you can tailor what yourspiel is to what their
experience has been, you'regonna be much more successful
then if you just always spoutthe same information and it may
hit the target or not.

Totally.
I love that.
And I completely agree.
One of our most helpfulquestions that we have on our
applying to be a member at ourpractice form is what are you
looking for in primary care?
Yeah.
And it's a very open-endedquestion, and we will get, just
like you're saying, the answerof what type of personal
medicine they're looking for.
Mm-hmm.
In their own words.
And so it really cuts down onlength of time you need to spend

(36:15):
on a meet and greet.
But also you have, this is whatI love about DBC, is that like
every time you have aconversation about your own
practice, you hear a differentway people are translating it.
Yeah.
So as you have more, moreconversations, you can bring up
these examples for people whoare similar to your existing
patients, which I think is sojust reinforcing that
personability of our model.

(36:36):
Yep.
Yeah.
in terms of Oklahoma inparticular, I mean we, we've
talked a little bit about how itis unique.
One of those things that youmentioned is that it's not maybe
as well known DPC is not maybeas well known as somewhere like
Texas, like Houston, wherethere's a gazillion what else
about Oklahoma do you find isunique about practicing as a DPC
physician?

So, I think Oklahoma is, as far as like the
regulatory climate, thepolitical climate is very open
to DPC.
There.
It is a long history in Oklahomaof just being a self-made
person.
A self-made man.
And so I think people, once theyfigure out what DPC is, they're
very supportive of that.
And I think the politicalclimate is very supportive of
that.
But those people who have thatidea of, you can make it on your

(37:20):
own, I think will invest morebecause they have kind of an
inherent distrust for systems.
They don't feel like the man hastheir best interest at heart.
And truthfully, that's, there'sa lot of truth in that.
But because of that, I thinkpeople who even have great
insurance, whatever that is, andonce you get their attention,
are more likely to support DPCjust because of kind of the

(37:42):
climate that's here.
Yeah.

And given that we're at the Free Market
Medical Association conference,this is definitely a space where
people who are not necessarilyphysicians, but people who are
building self-funded plans,they're looking at community
owned health benefits.
Yeah.
They're all, talking amongstpeople like yourself and myself
who are the physicians givingthe care.
When you think about directmember care and where it

(38:05):
intersects with medicineprovided to an employee by their
employer.
How has employer sponsored DPCcome into your practice at
Pioneer?

Yeah, so, I mean, more to the specific
nature of Oklahoma based DPC, Imean, we are so fortunate to be
the birthplace of the FreeMarket Medical Association with
Dr.
Keith Smith and Dr.
Steve Lanier, who co-founded thesurgery Center of Oklahoma, Jay
Kempton, who then helpedco-found the FMMA with Dr.
Keith Smith.

(38:34):
So we've got such a heritagehere of kind of.
Being a warehouse of justinnovation and ideas that has
spread nationwide.
So that is super cool and havebeen able to make those
connections early in my careerhas been incredibly valuable.
And then the scalability of DPCis strangely controversial

(38:57):
amongst DPCs.
I mean, some people really don'tfeel like it should be scaled.
Other people see the opportunityto just scale beyond our wild,
wildest dreams.
And so I've tried to hit a kindof a happy medium there, kind of
Goldilocks wise.
But know Dr.
Kyle Richner is here fromOklahoma.
He's made a great brand withprimary health partners and has

(39:18):
saved so many physicians fromthe systems in this area who
wanted to practice DPC, but didnot necessarily wanna be
practice owners.
And I think that is.
A huge accomplishment and I lovethat.
But he has also been superrespectful both he and Chris
Eth, who is the owner of RemedyHealth who has also kind of

(39:38):
scaled DPC in the Tulsa area.
I was, I had discussions withboth of them early on as far as
when I was getting ready to openmy practice and, even though
they've scaled their practicesand obviously could have just
said, well, you can work for us,but we're not gonna share with
you, the secret sauce.
Neither one of them were thatway at all.
They're like, I can see that youkind of wanna do this on your

(40:00):
own, and that's perfectly fine,but if you decide you wanna be a
part of Remedy Health or part ofPHP, we're always here If you,
you want to be an employee.
And, and I didn't, but, but thatwas great.
I mean, we are close friends tothis day on both sides of that
divide.
But.
With, with PHP, they have beensuccessful in talking with
employers.
And the very first employergroup that Dr.

(40:21):
Ner was able to recruit is alocal, well, and several other
people in other areas of thecountry probably have heard of
it too.
But Life Church is based out ofOklahoma City and it's a
televised church broadcast.
And you have your local churchstaff, but then the main sermon
is televised from the maincampus here in Oklahoma City.
And so Dr.
Richner attends that localchurch here.

(40:43):
And he was telling the staff,you know, I really think that
this would be something greatthat we could offer to the
church employees.
And they're like, yeah, that'sgreat, but we have 26 campuses.
We can't offer something to themain campus that we can't offer
Nationwide.
And, and he put together agrassroots roots network of DPCs
in each of those locations tosay, no, here, you need to offer

(41:04):
this to your employees.
And I've already got the doctorsin place to be able to do that.
And, and we were connectedthrough Hint, so.
That has been, I have the hintwhat is it where you can get
employers through Hint, hintConnect.
Yeah.
Hint connect.
Mm-hmm.
But then I also have through PHPas an affiliate, I have kind of
a second stream through Hint forthat.
But, but as a primary HealthPartners affiliate, not an

(41:24):
employee if they have anemployer that has overflow into
my area, they know that they'regonna be taken care of.
So I started off with those LifeChurch employees, but now I have
probably I think probably 10different employers as a PHP
affiliate that I help take careof the people in my area.
The University of CentralOklahoma has direct primary care
benefits, and they're a fairlylarge university here in the

(41:47):
Oklahoma City area, Edmond.
But yet some of their professorsdrive from my town in Stillwater
to work in Edmond.
So I take care of the ones thatlive in Stillwater, if they
choose to take care, takeadvantage of those benefits.
And so that's one way I'vegotten a lot of employer access.
The other is just.
By talking with patients andlocal businesses that have
signed up with me directly.

(42:07):
And that has typically beensmaller businesses not the
people that have multi-sitelocations and things like that,
but just your mom and pop, likeplumbing office or construction.
We have one that's an oil wellservice that are all signed up
with us directly for our DPCservices.
But you know, when you get theirattention, and there's one

(42:27):
company that I take care of, hejust really wanted to invest in
his employees.
He was like, I can't offer themfull benefits.
He's but I want, I want them tobe taken care of and I can
afford this.
And I think it's more valuableto them and to me as a business
owner.
So, you, I give that gift toyour employees, which gives back
to the employer because they'reable to be at work more, but yet

(42:51):
they're healthier and, you getmore bang for your buck.
So it, it does make sense.
But I know there's people outthere that just.
Feel like an employer is thesame as a third party.
And there's probably some somebenefit to that argument, some,
some truth to that argument aswell.
There's occasionally timespeople don't see the benefit of
their membership because someoneelse is paying for it.

(43:12):
Maybe they don't value it asmuch personally but people just
kind of expect in today'sclimate that their healthcare is
covered by their employer.
Mm-hmm.
So, so I, I don't know.
I have, like I said, tried tostrike a happy medium between,
you know what I, I really likeit when people find me as an
individual, but I wanna be ableto work with employers to to, to
help them feel like they're notstuck in the same burning train

(43:35):
that yeah,

that doctors work.
And I think that what's uniqueabout it when we zoom out on any
DBC who works with an employeris that you are the DBC doctor
at the table helping themunderstand as employers, but
also you're the one deliveringthe care.
Versus in the fee for servicesystem, we just signed our names
to contracts.
Yeah.
Not in your case necessarilybecause you were a private
practice, but like in thetypical fee for service journey,

(43:58):
you don't know who the hecktalking.
Yeah.
You still have no negotiating

power though.
Yeah.
I mean, they just bring it toyou and say, we're cutting your
reimbursement.
Yeah.
And you have no, have norecourse to that.
Yeah.
So yeah, it is, it isinteresting'cause there'll be
some employers who maybe decidethat's not the way they want to
go.
Mm-hmm.
But but you can, you can set thetone and negotiate what might
work best for you and, and forthem.
So.

And have you ever put on your intake
forms?
Do you own a small businessperson applying to my practice
as an independent patient?
Yeah.

my intake forms are pretty standardized.
I don't have the opportunity toadd anything to that, but but
when they come in for theirfirst visit, of course that's
something that, we kind of talkabout and how did you find us
and what do you do and, and allof that.
So sometimes that will.
Kind of naturally evolve intothose kinds of

Dr. Maryal Concepc (44:40):
discussions.
Yeah.
And for those people who arelike the, the the oil company
that you mentioned mm-hmm.
And these smaller employers thatdo buy their, buy their
healthcare through you as aprivate physician.
Yeah.
How did those conversations go?
Do you have any tips for peoplewho are like, I, there is a
mechanic off mechanic shopliterally down the street.

(45:00):
I don't even know how to, toapproach that mechanic shop.

Truthfully, I, I was busy enough.
I did not put boots to theground to like just go out and,
knock on their door and, and askfor a conversation.
Mm-hmm.
Most of those conversations cameto me and typically either
through someone that workedthere, that was a patient who
went back and told their boss,this is amazing and you guys

(45:25):
should cover it for us becauseit has been such a great deal
for me.
Or the, the boss themselves.
Chose to, be a member of thepractice and then was like, huh,
so we can, we can offer this asa benefit.
And, and they, so truthfully, Ididn't sell it all that much.
My, my growth was, was rapidenough and, and praise God for

(45:46):
that.
But it, I didn't really have todo a lot of knocking on doors to
go find people.
Which is, is why, I always kindof chuckle because, I think when
you first start your DPC, you'relike, okay, what's my ideal
number mm-hmm.
Of patients and, when can I befull?
When will I break even?
What's my ideal, patient volumeall of that type of thing.

(46:09):
And I, I didn't know, I mean, Iwas like, knowing that I was
currently taking care of like2,500 to 3000 patients in the
system, I was like, well, Ishould be able to take care of a
thousand patients.
Easy.
I mean, that's like less thanhalf of the work.
But then you start to realize,oh no, there's a lot more that
goes on when you're doing allthe things and you wear all the
hats, and it makes it a wholelot harder to take care of those

(46:31):
folks.
But we grew with myself and myma between 2021 and 2023, we had
grown to 600 patients.
And I remember my ma telling me,she was like, we have to start a
wait list.
Mm-hmm.
Or I'm leaving you.

(46:52):
And so we started a wait list.
But then I was able tothankfully get more help.
I had a second employee thatjoined the practice.
She came to me saying she hadworked in the healthcare system
in the local hospital too long.
And she said, I just, I can't doit anymore.
But I see what you're doing andI want to be a part of it.
Can I come work for you?

(47:12):
And I was like, you have allthis experience.
She was a scheduler with thesystem.
She'd worked in the ER in thesystem, she'd done all, she'd
worn a ton of different hats forthe system as well.
And I was like, I can't affordyou.
She's I will take a pay cut tocome work for you.
She's I believe in what you'redoing.
I see it from a distance and Iwant to be a part of it.
And now, a year and a halflater, she's an integral part of

(47:33):
the practice as well.
Kind of functions somewhat asthe administration or front desk
staff.
While Joanie, my ma she has beenwith me for 18 years now.
And so she's my right handperson that really is my closest
clinical assistant.
Although Angie can do all of theclinical things really too.
They can both draw blood, theycan all know the referral

(47:54):
techniques and the referralsources and things and ways to
do everything.
So I, I couldn't have grown likeI did with, without that help.
Mm-hmm.
And so with that, our.
Wait list didn't stay closedvery long.
Joan didn't quit and she didn'tquit.
So yeah, we continued to grow upto 800 patients and now

(48:14):
thankfully I have a seconddoctor coming on who can be a
pressure relief valve of sortsto me, and she can start
building her practice because I,that's the other thing, Joanie
knowing me as long as she has,we, we joke a little bit
because, our workingrelationship has lasted longer
than a lot of marriages.
And she's like, you don't wannarecreate the beast.
You're, you're doing it again,kind of thing.

(48:35):
You might tell your husband orwife and I'm like, I know, but
there's people that need takencare of and I could do it.
And she's yeah, yeah, you could.
But anyway, so, so I ha have tolisten to those people in your
life that know you well to makesure you're not falling into the
rut of that same old habits thatyou know, you, where you've
become a workaholic and workyourself to death.

(48:57):
But,

yeah.
And be proud of it.
Like you said before, like youwould kill yourself over all of
these things, taking your kidsto the hospital mm-hmm.
To put them in the physicianlunch so that you could survive.
And you're like, and I did thislike it's a pride thing.
Like it's, I, I think it's, it'sa habit almost that we, we can
fall back into.
When it comes to the, theentrepreneurial, the physician

(49:19):
entrepreneurial journey, you andI don't have MBAs like we've
said during this interviewalready, but when you think
about maybe like the top threeemotions or experiences that
evoke emotions that you wentthrough, that you've been
through so far in your DPCjourney, what are like the top
three most surprising thingsthat you would never have known?

(49:42):
Because you, you don't knowuntil you do it.
Yeah.

No, I.
And I think that's just, it is,I think that's what hinders a
lot of people from making thatjump is they're like, well, I
don't know enough.
I don't know how to do this.
And I, I'm, I think back to allof us tend to have silly things
we worry about, but I have thisvivid memory of being like a, I
don't know, sixth or seventhgrader.
I think, and my mom might noteven remember this, but I

(50:05):
remember I was in bed one nightand I was like crying myself to
sleep.
And I was just like sittingthere anxious and worried.
And my mom comes in and she'swhat is the matter?
What is going on?
And I was like, I just don'tknow how I'm gonna pay taxes
when I grow up and I don't knowhow that works and I'm gonna end
up in jail because I don't knowhow to do tax.

(50:26):
I don't know if I'd heard myparents talking about it being
tax time or what, I have noidea.
But I was literally obsessingover something that I didn't
have to worry about for 10, 15years.
Yeah.
Down the road.
And I think that's what peopledo when they start anticipating
being an entrepreneur.
They're like, yeah, but I don'tknow about how to do
unemployment.
And I don't know how to do thisand I don't know how to do that.
And what about retirement andhow am I gonna manage all these

(50:48):
things?
And it's you know what?
You figure it out.
Everything is figureoutable.
And so, I don't know how a lotof people would do it without a
background in faith.
And as a Christian physician, Ifelt like my calling is to take
care of people.
But I also felt like the planset before me is higher than,

(51:08):
than my individual aspirations.
And so having just that faiththat, you know what, I really
feel like I'm called to do thisand to make this leap and it's
gonna be okay.
And, and relying on that faiththat yes, there are gonna be
problems, but I have a God thatis, wiser than I am.
And, and there's gonna be a wayto, to figure it out.

(51:29):
What is in the sound of music?
Sister Maria says, every timeGod open closes the door, he
opens a window.
Yep.
And so.
Kind of feel like that feelingof, I don't, I really know how
we're gonna cross that bridgewhen we come to it, but we'll
figure it out.
We'll build the bridge if weneed to.
So I feel like from thatstandpoint of just having faith
that we can, we can find theresources, we can, I don't

(51:54):
really take care of my ownpayroll.
I have an accounting firm thatdoes that.
I know there's definitelydoctors out there who they
really pride themselves on doingtheir own Quicken account and
all that kinda stuff.
No, I don't do that.
I pay for that to be done.
So, you figure out what you wantto focus your time and efforts
on and what you want to, to kindof source out.
So that, that aspect of, justkind of the faith that this is

(52:16):
the direction I needed to go waswas huge.
There's definitely days where Ishow up to work and I'm like,
what have I done?
There's, several things bloomingto get taken care of and you're
like, oh my gosh, I can't, sothere's still days you feel
overwhelmed.
But those are so far betweencompared to where they used to
be.
I think.
We were talking earlier beforethe podcast that I stopped by

(52:36):
the office before I drove backdown here to Oklahoma City this
morning, and Joani and Angiewere saying, I didn't think you
were even supposed to be here.
I was like, yeah, I know, but Ineeded to sign a check for you
guys to leave for somebodyanyway, just had some, little
administrative things to do.
And I said, but this is my happyplace.
I don't wanna leave you guys.
And they're like, go to yourconference.
And so, I think back to, youknow, you find yourself in, I

(52:59):
think, not just medicine, but ina lot of work situations.
You work for the weekend oryou're always working for that
next vacation because you can't,can't wait to get out of the day
to day the grind.
And when you find your idealworking situation, I mean, it's
still hard work, but I love togo to work.
Was it one of the, theendocrinologists that you spoke

(53:21):
with on your panel.
She said, the one of the girlsthat she hired says, I don't get
the Sunday scaries anymore.
And so to not dread going backto that place that drains the
soul and life out of you whileyou're trying to breathe life
into others mm-hmm.
Just doesn't work.
It's not compatible with a longterm survivability.
And so, yeah.
I mean, just,

yeah.
Yeah.
It's, I'm sure there are peoplewho are just, taking what you
just said and emotionallyexperiencing it.
Yeah.
Because there have been morethan one, and this is terrible,
but this is the reality.
There have been more than onephysician, there have been
multiple physicians on thispodcast who have shared that
they, that the Sunday scaries tothem was crying before going

(54:04):
into work.
Yeah.
Dr.
NamUs Bradley said at thebeginning of the season people
who would just like, Dr.
Liz Ortiz said she had gutissues that were like mm-hmm.
Totally gone.
Once she transitioned out of thefee for service world.
So those, those Sunday scaries,it absolutely is unique for
everybody, but that's real, andthat is definitely something to
pay attention to as you mightnot know what the alternative is

(54:28):
going to look like.
Exactly.
And that is uncomfortable for uswho are like, if this, if, if
this, if step says a yes, you goto yes or no, and we follow the
algorithms, but that's not howlife is.
Mm-hmm.
And I, I do agree that there is,there is a portion of it is what
it is, and you don't have powerover every single thing.
You can't control every singlething.

(54:49):
Yeah.
When it comes to you talking topeople who are coming up, like
there's a, a, a wonderful doctorfrom Minnesota who's here
learning about DPC.
Mm-hmm.
Right on the cusp of opening.
What are some of the things thatyou love telling other people
who are in this space of almostthere.
Not there yet.
To empower them, but also tohelp them have something that

(55:13):
they root in, that they, thatthey're rooted in, that I, that
they identify with and only theycan identify with as they go
forward in their DPC journey.
Yeah.

Well, I think it's, it's interesting, I've
been asked the kind ofopen-ended question of zero to
10, how much would you recommendDPC to other physicians?
And, you would think if you're ahappy DPC physician, maybe you
would always say 10, but I, Iwouldn't, I mean, I don't think
DPC is for everybody.
Yeah.
And so I, I've, I've rated thata seven, if you're looking at

(55:43):
physicians as a whole, but whenyou're talking to individuals
and you can kind of see wherethey are struggling and
truthfully, I mean, I know ithappens to male physicians as
well, but I really feel like thesystem preys upon female
physicians more so than, thanmen just in our unique practice
styles as.
Female physicians, and I knowI'm generalizing with that as

(56:03):
well, but there are so many morefemale physicians who I think
are feeling that crunch more sothan our male colleagues.
And so trying to speak to themthat, you are more than just a
cog in the wheel.
You have value, and you, it isnot a sin to talk to your
patients about that value, evenin monetary terms.
Because I think we become sohumble to the point of it being

(56:28):
a a hindrance to our, we, wethink we have no value and that
everything we do is, is aservice.
And oh, thank you, dear hospitalsystem for my paycheck every two
weeks because I know what I dohas no value.
No you have value.
And I think once you start torealize your value, you start to
realize really how, you know youcan't pour from an empty cup,

(56:49):
right?
Mm-hmm.
And so once you realize your ownvalue, and that may not mean.
Okay.
Self care and kind of the modernway we think about it.
Oh, get, go, get a pedicure.
Go take a vacation.
No, you can still be at work andgetting your cup filled.
It does, work should not alwaysdrain your life out of you.
And I think once you can showthat to others, and like I said,

(57:10):
there's, there's just, I don'tknow, a different field.
And whenever you get directprimary care physicians together
in a room that someone who isconsidering it, it's just a
entirely different experience.
They're like, what is differentabout you guys?
Yes.
And so I think once they'veexperienced that and felt it

(57:31):
that you guys are happy, you,you feel like there's value in
what you do and that you'redoing good for your patients and
for yourself, they're like, tellme more.
Yeah.
So I think once you've felt thatin your soul, like there's no
going back,

it's amazing.
Well, thank you so much forsharing about Pioneer and your
journey as a physician who wentfrom residency to being a
private physician to being aprivate DPC physician.
And I am so excited for otherpeople to take your words and
put it on, put, put your adviceto their own lives.

(58:08):
So thank you so much.
That's Thank you for listeningto 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

(58:30):
join DPC didactics our monthlydeep dive into your questions
and challenges.
Links are@mydpcstory.com forexclusive content you won't hear
anywhere else.
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.

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