Inside the Fight for Equitable Healthcare and Physician Freedom with Dr. Michelle Cooke

Episode Transcript
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Maryal Concepcion, MD (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.

Michelle Cooke, MD (00:53):
So starting my DPC certainly was scary,
right?
And it's okay to have fear, butI think what's more scary than
starting A DPC is imagining aworld without DPC.
And I think we're at that pointin healthcare where if we don't
jump to it as doctors and startto rescue ourselves and rescue

(01:15):
our patients, we don't wanna seewhat that world looks like.
So that's much scarier thanstarting your DPC.
I'm Dr.
Michelle Cooke of Sol DirectPrimary Care, and this is my DPC
story.

Dr.
Michelle Cooke is a boardcertified family physician and
founder of Sol Direct PrimaryCare in East Point, Georgia, a
practice uniquely dedicated toblack women's health and
wellness.
Recognized as a top doctor byAtlanta Magazine and Castle
Connolly, Dr.
Cooke is passionate abouttransforming healthcare through
personalized patient-centeredcare.
A proud graduate of SpellmanCollege and Morehouse School of

(01:51):
Medicine.
She has built her career onaddressing the needs of women in
the black community with aspecial focus on eliminating
health disparities.
Her expertise includes treatingobesity, metabolic disease,
cardiovascular health, andproviding compassionate
menopause care.
Dr.
Cooke is committed to empoweringher patients to achieve optimal
health through lifestylemedicine.
In addition to caring forpatients, Dr.

(02:12):
Cooke is a passionate advocatefor the Direct Primary Care
movement, believing thatphysician wellness and autonomy
are essential to providing highquality patient care.
She firmly believes the directcare model is the optimal
approach for deliveringpersonalized, accessible care.
Dr.
Cooke speaks both nationally andlocally about DPC.
Encouraging her physiciancolleagues to explore this
viable practice model andconsider starting their own DPC

(02:34):
practices.
She has contributed as a writerfor DPC News and runs her own
newsletter and podcast buildingDPC, which helps physicians
learn more about the benefits ofthe DPC model.
Welcome to the podcast, Dr.
Cook.

Thank you for having me, Marielle.
I've been waiting for this.
My DPC story has been so big.
And my journey to DPC I rememberlistening and imagining one day
I'm gonna have my own DPC story.
So this is like a dream cometrue.

Well, I'm so glad, and it was never a
doubt in my mind.
I remember when I met you forthe very first time with your
son and your husband at Dr.
Krista Springsteen's reopenhouse, and it was so fantastic
and I, I just loved, loved,loved what you said about how
you networked and how you wentabout escaping your pre DPC

(03:25):
world to go to DPC.
And and you haven't listened,Dr.
Cook has her podcast.
building DPC, so definitely takea, listen.
It's 10, 10 episodes, correct.
10 episodes and a bonus.
Okay, awesome.
So it's 10 episode plus a bonuswhere she goes into even more
detail.
So definitely make sure youlisten to that afterwards.
You can find it on Spotify,correct?
On Spotify.
That's correct.

(03:45):
Correct.
You can find it on Spotify, butorigin stories, let's get into
it.
So you.
We're not necessarily originallyfrom the Georgia area, but
you've been there for quite sometime.
You went from graduatingMorehouse School of Medicine
into this world of I want to dothe best for my community with
all of the, all of the tools andlessons that I've learned as a

(04:08):
physician.
But it didn't, you didn't stayin fee for service.
So tell us about that.

My goodness.
So you're correct.
I'm not originally from Georgia.
I'm actually from the GreaterBoston area.
That's where I grew up.
But I came down here at the ageof 17 to come to college,
Spelman College, which I'm soproud of.
And that's kind of where myjourney with having.
I guess the best Spelman, ifpeople don't know Spelman, it's
a historically black collegeuniversity.
It's one of those schools andit's one of the few that's only

(04:34):
for women.
And so coming to a place thatwas so empowering for young
women as a young black girlgrowing up in Boston, it was
very difficult for me because Ioften felt like an outsider.
If you're smart, there wasn'treally communities for you.
There was a lot of being otheredgrowing up.
There was a lot I love aboutgrowing up in the city, but
there was a lot that was veryhard for me.
And coming to Spelman, I call itone of my top three decisions in

(04:55):
line with marrying my husband.
It's one of my top threedecisions because it finally
gave me a place where I could beMichelle and not the black girl
in class and be myself andflower academically.
So I'm very, very happy about mySpelman experience, one of the
best experiences of my life.
And then after I finishedSpelman, I crossed the street
and went to Morehouse School ofMedicine.
And Morehouse School of Medicineis also an a historically black

(05:16):
college university at thegraduate level.
And it was a differentexperience from Spelman, but
also a very incredibleexperience because, I mean, if
you pay attention to the historyof this country, we've had a
problem with racism for a verylong time.
And up until today, very recenthistory.
I say that to say a lot of theprofessors I worked with there
had been the first black doctorto do so many things.

(05:37):
Like the first black doctor,first black pediatric surgeon
was there, when many of thesedoctors started, our hospital
system was segregated.
So they remember these storiesof what it was like fighting to
be a physician and to have thatbacking you was incredible.
And their mission was alwaysserve the underserved.
We're here to serve theunderserved.
That's the mission of what we doat Morehouse School of Medicine.

(05:57):
So we're, or for being a at theMorehouse culture is also very
powerful for me and veryimportant for me to carry that
mission as I went forward.
So after I left Morehouse, Itrained at a um, at a at a
residency program that's nowcollapsed and it's part of the
reason why I'm in DPC.
Called the Atlanta MedicalCenter.
I did my, my three years offamily medicine residency there
in the heart of the city, veryclose to Morehouse School of

(06:19):
Medicine.
And when I finished there, Iremember looking for my first
job opportunities.
And I came out of residency in2014.
And at that point, I mean,you're not, you're kind of in
that range.
Two Marielle, I don't thinkanybody was talking about
private practice.
Like we're watching privatepractices fall.
They're being bothered byhospital systems.
No one ever said, do privatepractice.
You're gonna fall.

(06:39):
You're just a doctor.
You can't learn business.
Let the business folks do it foryou.
You just need to figure out away to practice medicine.
And honestly, that sounded goodto me too.
I'm like, I don't wanna figureout the business.
Let me just go treat thepatients and do it the way I
wanna do it.
What was funny was when I firststarted looking for
opportunities, I had thisopportunity and it was gonna be
in like one of the mostexpensive, one of the wealthiest
neighborhoods of Atlanta.

(07:01):
And the office was beautiful.
It was interesting.
It was, it seemed like it mightbe a good deal.
I remember thinking, I was like,you're from Morehouse School of
Medicine and we're here to servethe underserved, and what are
you doing on one of the mostexpensive streets of Atlanta?
So not to say that these folksout here don't need service, but
I think your, your skillset isbetter served in another part of
the community.
So I dedicated my time to beingin the southwest Atlanta

(07:21):
community, which is ahistorically black community of
Atlanta.
It houses Spelman College,Morehouse School of Medicine a
lot of graduates and just, it'sa very historic place in Atlanta
and this is where I reallywanted to serve.
And so I tell folks that when Igot into fee for service, it was
still very mission driven.
I wanted to be in the community.
I thought it was best to serveand I loved it.
Initially, I had this smallpractice, they were doing this

(07:43):
doc in the box model.
There was like one doctor perpractice.
So I, I felt like I had a lot ofautonomy initially, but the goal
just became numbers, numbers,numbers, numbers, numbers.
The other thing that happened isthere was a shakeup and my
original practice was bought outby another medical facility.
It was a not-for-profithospital.
I went from a a for-profitsystem to a not-for-profit.
Which I thought was going to begreat, but as we're learning

(08:04):
now, not for not for profit justmeans that on paper only, they
behave very much like aggressivecorporate machines that are for
profit.
And so I thought everything wasgonna be good, but things just
continually got worse and worsein terms of the requirements of
what I was supposed to do.
And then even worse with justhow much say I had.
So, like a lot of doctors whoin, in fee for service, I had no

(08:25):
control over my appointmenttimes, 15 minutes per
appointments.
Sometimes 30 for some physicals,but you're often overbooked.
So it ended up being 15 minuteappointments.
I always felt like I wasdrowning.
And what made it feel reallyhard too is I don't, at the
time, I felt like a lot of otherdoctors would complain about how
frustrating their jobs were.
But I don't think anybody elseto my feeling really expressed

(08:47):
how difficult it was.
Like I felt heartbroken.
I was like, I'm looking atpeople in the eye saying this.
You've got nuanced diabetes andhaving to run out the room or
you've got cancer and having torun out the room.
And what that was doing to mysoul was crushing me every day.
So you're doing your best toshow up for your patients, but
you're asked to do theimpossible over and over, and it
just does not feel good.
Then you add on top of that justthe amount of administrative

(09:08):
load, so your notes aren't done.
You're staying until 8, 9, 10o'clock to get things done.
You're working all yourweekends, you're trying to reply
to MyChart messages.
You're just trying to stay ontop of this train.
It just won't stop running.
I used to describe it as likebeing in the ocean, being like
knocked down by a wave andhopefully you can stand up long
enough before you get hit again,but the only inevitability is
you're gonna get hit again.

(09:29):
So you better hope you get upbecause if you can't get up,
like you're gonna be washed adestroy and just like fumbling
around.
And so I always felt that way.
And then things justincreasingly got worse and worse
where again, not enough timewith patients, not enough time
to handle my personal mypersonal life couldn't show up
for my son the way that I wantedto.
Missed all kinds of events atschool because they would tell

(09:49):
us like three weeks in advancethey're having the school play,
but I'm booked out six months,so I just couldn't make that
barter anymore.
And it was really, reallychallenging.
To me, what ended up being thenail in the coffin, or one of
the nails in the coffin is Ireally tried to get into
leadership.
I'm still that, that personthat's so hopeful I can make a
change.
Maybe if I get into the rightcircles, maybe I can help fight
this and fight for doctors.

(10:10):
But as I got into leadership andI was the regional director for
my area I started to see it fromthe other side.
I'm glad I got the experience,but it really just solidified
my, my desire not to wanna stayin this type of field of
medicine.
But in leadership, the languageI was hearing about doctors was,
it was quite, quite frankly, itwas disgusting to me.
It was, they don't wanna work totheir capacity.

(10:31):
All they wanna do was complain.
People wanna cut off theirschedules, we gotta get them
working harder, working faster.
All of this stuff.
I was set to do all theseperformance improvement plans
for doctors who had fallenbehind on charting.
And instead of really beingcompassionate towards this
position, I feel like I wasthere to crack the whip and make
people perform better when Itried to bring up real issues
like our lab keeps closing tooearly, we can't get our patients

(10:54):
to get their lab work done likethat fell on deaf ears.
When I tried to talk about thechallenges, and you guys may
hear me talk about this before,were playing inappropriate music
in the office, like that fell ondeaf ear.
So every small problem just wasunsolvable.
And the bigger problems ofhounding physicians became more
and more real.
And I just knew I didn't wannaplay that anymore.
So I'm rambling a bit here.

(11:15):
But I will conclude this becausewe're gonna talk more in the
interview.
But as things got tighter andtighter and tighter and there's
a pressure point coming, thebiggest thing that happened was
my hospital system ended upcollapsing in the city of
Atlanta.
So in Atlanta and SouthwestAtlanta specifically, it's a
major hospital system.
Think about a Mayo Clinic orsomething like that.
Well, not quite that level, buteverybody has these like big,

(11:35):
local hospital systems and theyhave multiple hospitals,
multiple clinics, and they shutdown in our region.
They never had said a hundredpercent why they closed.
But you know, we hear peopletalk about like low
reimbursement rates, poor payermixes, patients not being able
to pay enough, our ER beingoverutilized or losing all this
money on uncompensated care.
So even though we had so muchcare to deliver, the model

(11:57):
wasn't making sense and itcaused us to collapse.
What made me, what broke myheart was that it collapsed in,
my community in the, the blackcommunity of Atlanta.
That was one of the mostunderserved communities of
Atlanta.
This whole system is gonnastand, but we're getting left
behind.
And so that was a wake up callto me that this is not working.
I don't wanna plan anymore.
I fought as hard as I can tomake it work, and it just wasn't

(12:19):
going anywhere.
So, after that, they, theyterminated all of our positions,
not for like any, any qualityissues, but just saying, we're
gonna shut down this community,come with us back to that fancy
side of town that I originallydeclined.
And I decided, nope, now it'sthe time for DPC.
I had been kind of looking atthe movement for a while, and
when that happened, I knew I hadto take the leap.

So I think about, the, the.
Richer part of the neighborhoodis probably going to also have
different codes compared to,where you guys were practicing
and taking care of yourcommunity, which is disgusting
and of itself.
But I wanna ask about this timewhere you tried to go into
leadership, many of us whoeventually do DPC take that

(13:01):
route.
Right.
And I would love, you, youmentioned how you saw, from the
inside of the beast, whatphysicians were viewed as we,
all of these, we arecomplainers, we're the people
who just need to work harder.
We need to just shut up and becoders.
Right.
Basically, is what I take fromthat, which is unfortunately
very true in a lot of corporatesituations.
I'm, I'm wondering if you as youtalk about your practice and as

(13:26):
you talk about your desire toserve the community,
specifically the blackcommunity, especially where you
were, where you weregeographically located.
Mm-hmm.
I'm just wondering about, didyou.
Take that idea, take that hat ofI want to be a leader and try to
morph it into something else.
As your hospital system wasclosing, did you look at other
ways to be administrativelyinvolved in policy or, things in

(13:50):
your neighborhood?
To, to, yes.
Be a doctor as part of Dr.
Cook's training and abilities,but also to speak for the
greater community of physiciansin your area.
Because I think, especially whenyou talk about that your
hospital system closed, I, itjust, it makes me, and I'm sure
it makes many of the listenersjust very, very upset and

(14:13):
frustrated because especiallypeople like you and I who go
into family medicine, right?
Community, community driven workis at the core of what we do.
And so I'm just wondering ifthere was a part of you that
said what else can I do inaddition to becoming, my own
physician in my own clinic.
What else can I do for thegreater community of physicians
around me?

It's excellent question.
So I think there's a couple waysto answer that.
And I'm, I'm hesitating becauseas that transition point was
coming, I feel like I was in avery dark head space myself, so
I think the spirit that you seeright now of I wanna be a
fighter and I wanna make surethat all physicians have
options.
It was still there, but it was,it was really questioning

(14:57):
whether I even really wanted tostay in medicine.
Everything I saw was like, youwondered, is this really worth
it?
Is this really, I worked so hardfor personally, I'd just taken
so many hits, like giving somuch of myself to my job, having
my family suffer.
It was really a strain on mymarriage in a way I never
expected it to be.
So as much as I wanted to keepadvocating, I realized that as I
was leaving the system, I neededto heal.

(15:17):
Like the burnout wasastronomical.
And I didn't realize how bad theburnout was until you get out of
it.
You don't realize how bad, likethe fire it is until you, until
you can cool down and say, oh mygosh, it really was hot in
there.
And so I say that to say atfirst I think I was just
thinking about survival and howI was going to continue to do
something to earn income thatwasn't going to make me feel

(15:38):
like a crazy person or, or, orburn me out so much.
And advocacy was second, likethat fire was still there, but
I, I was really questioningwhether I wanted to keep fueling
that fire because it burned meso badly before.
But when I talk about otherefforts, I would say the other
efforts is just continuing tonetwork with physicians locally.
You may know that when I learnedabout DPC and I was going into

(15:59):
this pathway, I wanted to makesure other physicians knew about
it.
'cause a lot of people didn't.
So, even very early into my DPCjourney, we did a DPC mixer here
in Atlanta that now we've doneannually.
It was odd to do that becauselike I was barely even in DPC
myself and I'm like, look, guys,come together.
There's a secret and we need totell other positions about
what's going on.
Christa Springs was there, Anandwas there.
Anon meta people who I listenedto their DPC stories.

(16:21):
So building community was veryimportant.
I wanted to do it in a veryorganic way.
Not when it had to be superformal or super professional, or
not necessarily even connectedto any medical society, but just
building community.
The second thing I did is I didwanna try to keep up my skills.
And I remember doing somevolunteer work with Morris House
School of Medicine, which Istill do quite a bit of working

(16:41):
with medical students.
They have a student led clinicthat I go to volunteer at, still
continuing to give care largelythe people that don't have
insurance or who are underservedby their insurance.
And being there has been a wayI've been able to continue
serving my community.
One funny thing about working atthat student clinic is I, I
tried to do some work there whenI was still in fee for service,
but I was so overwhelmed Icouldn't give my time.

(17:01):
And I remember working with amedical student one day and, we
were talking about a patient andtalking about, just the case and
everything and, and she's medschool is so, so hard.
And she looked at me, she's itgets better after you get out,
right?
And I remember staring at herand that was a really critical
moment for me.
I remember thinking, I can't lieto this poor girl.
I was like, but I'm absolutelymiserable what I do outside of

(17:22):
here.
Like being in this clinic andworking with patients who are
appreciative to be here, thatvalue our opinion, that we have
some autonomy of the flow islike the best part of my week.
And it just, it was a wake upcall to me that so many things
are wrong.
And so as I moved into this,like my, my giving back has just
been trying to do more advocacyand making sure the word is out
there, not only for otherphysicians, but for patients,
for medical students, letting'emknow that there's another way.

(17:44):
So that's a weird way to answerthe question, but it's, it was
definitely marred by the factthat in, in coming out, I was
still dealing with a lot of myown burnout.

And I'm so grateful that you shared that
also, because there are so manylisteners out there who are in
the throes of, but.
I'm supposed to do this.
This is my job.
I'm supposed to show up for thepatients.
I I just have to make it work.
And that's very real.
What you described, the, theburnout was astronomical.

(18:12):
The burnout was such that youcouldn't even realize what it
feels to not be burned outRight.
Until you were not burned outanymore.
And so I, I hope that that iseyeopening for a lot of people.
When you talk about the talkingto the medical student, I
remember the very first timethat we met, you mentioned that
to me.
And, ever since then, I'veliterally looked at when, when

(18:33):
residents are getting awards andwhatnot and they're going into
their first year residency.
It's really messed up.
But in my mind I'm like, whydoes this feel like the Hunger
Games unless we prepare people?
Yeah.
And it's terrible, but it's likeliterally this is how Muriel's
mind thinks.
'cause I'm like, if you do notprepare people for the options
that are out there, you are notdoing anything.
But literally sending people tothe wolves.

(18:54):
Right.
So on that note, when youstarted networking with your
community and, telling otherpeople, I just laugh because
people like Dr.
Depo Baa, who's been on thepodcast, was your attending and
she learned about DVC talking toyou and other people.
And then you have other peoplewho you trained with who are
also doing DPC or planning to doDPC, which is fantastic.

(19:18):
But I wanna ask about when youwent from this, Dr.
Cook, who is, who, who was doingthe fee for service thing,
wanting to just, take care ofyourself in, in enable in order
to be able to flourish goingforward, how did you go from
that person, that burned outperson, getting out of that

(19:40):
model to.
I have a different mindset.
'cause mindset is a big wordthat I, I love when you talk
about, but I, I'm wondering ifyou can share with the listeners
how your mindset's shiftedbecause you could have very much
not gone into medicine like youwere thinking about but you
stayed in,

right.
Wow.
And, and mindset.
It's funny'cause I think peoplekind of think of like mindset
work as like the woo woo work.
Like it's kind of hippie dippyand doesn't make a lot of sense,
but it's so powerful.
It is so powerful.
And none of this happenedovernight.
In fact, I would say a lot of itstarted when I was still in fee
for service.
And I would say the first thingthat really got me working on

(20:19):
mindset changes was working withmy own therapist and I still see
a therapist.
I actually started doing therapymore intently when the pandemic
hit.
If we guys can remember back tothat march April timeframe when
the shutdown was happening.
It was funny because like thingsshut down enough for me to say I
haven't mean to do therapy for awhile.
Lemme actually look somebody up.
Like I've been putting it off.
But finally I had a littlewindow to take care of it.

(20:40):
I remember working with mytherapist and talking about the
work stresses that was going on,and I remember her saying
something to me, or I saidsomething like, there's no way
to be a good physician and stillkeep your heart about you.
In order to do this, like youhave to become hardened.
Like you have to stop caringabout people.
Like you can't be a goodphysician and be a good person.
And I remember her saying, well,that's a thought, like that's a

(21:01):
mindset issue.
That is a, a, a limiting beliefthat you have.
And I think there's ways aroundit.
And I thought she was absolutelyinsane.
I was like, you have no cluewhat it's like on this side.
There's no way you can likepractice this kind of medicine
15 minute, 15 minute like, andshort people all day and be like
a good person anymore.
Like I just didn't believe thatthere was a way around this.
There was a way to practicemedicine and do it holistically.

(21:22):
And I remember just thinking shewas absolutely insane.
And at that point, DPC wasn'teven on my mind, but I remember
that thought of like, how doesshe think that you can practice
medicine and not have it be soulcrushing or not become like a
hardened person or not?
Have it just affect your soul.
But as I started to introducethe idea of what if, a lot of
people say what if you don'teven have to believe it yet.
But just what if you couldimagine a different reality?

(21:44):
What if you could think aboutthis differently?
If you weren't afraid to fail,what would you do differently?
And I think if you can giveyourself permission to just even
explore the possibility so muchmore becomes available for you.
And so I started playing withthose ideas of what if, or how
can you do this differently?
And then listening to peoplewho've done it differently,
which is why my DPC story is sopowerful because you hear other

(22:06):
people who are in the same boatthat you were in find ways to do
it differently.
So a couple of things I'vehelped.
One, I started focusing on myown self-care a lot more.
Sometimes even at the detrimentof my practice, like my practice
of as being in fee for serviceat the time, doing a lot more
yoga.
I invested in like doing morerunning.
I, I never thought I'd be arunner, but again, just given

(22:27):
myself that thought, what, whatYou did run a 5K run.
We did run a 10 K and liketraining towards that and giving
my brain something else to focuson that wasn't medicine just
allowed me to understand that Ihad this plasticity of my brain
that if I wanted to apply it todifferent things, I can do that.
And that becomes intoxicatingbecause I think at one point
everything was like patient'snotes, patient's notes, a little

(22:48):
bit of sleep, patient's notes.
Like you, you were in this site,this hamster wheel, you can't
get off of it.
You didn't even have room toexplore other things that might
be interesting, but giving upspace for what if was really,
really powerful for me.
And so it went down this rabbithole of like listening to more
podcasts and my DPC story was upthere.
Dr.
Una is one I highly recommend.
Meditative story.

(23:08):
I dunno if you've heard of thatone, but it's like people doing
interesting things.
There's this other great podcastcalled wild Ideas about people
that do things in the naturespace and take wild ideas and
commit to them.
So hearing these other storiesof people that just take these
wild leaves, let me know this.
You're not so different.
Like you may feel like your lifecan't be different, but you're
not so different.
I can challenge my body to dothings I never thought I could

(23:29):
do.
I can challenge my mind to dothings I never thought I could
do.
And so the more I was able toopen my mind about different
things, like that's where themindset shift started happening.
And really asking myself thethings that I believe so
strongly are they really true?
And again, it sounds veryfruitful, but is it true or can
you substitute a differentthought and can you think about
this differently?
So years of that type of mindsetwork has gotten me to a place

(23:50):
where I still have more mindsetwork to do.
But I think allowing yourself tobelieve that there can be a
different way for things to bedone holding fast to things that
you think are so true.
Can be more detrimental.
I was actually listening to an apodcast last night by Dr.
Benjamin Hardy, who wrote thebook 10 X is Easier Than Two X.
And he quotes Mark Quain sayingit ain't what you don't know

(24:10):
that will hurt you.
It's what you know for sure.
That just ain't so.
And that's so powerful.
'cause there's things, I thinkwe believe in medicine, like
there's no way you could be agood doctor, and do medicine.
Or there's no way that you couldleave fee fee for service and
not, rip people off.
There's no way that you could,like these, we have all these
things that we're so fixed inour beliefs about, but they just
think so, and, and that's reallywhat's gonna hold us back.

(24:31):
So I think just being willing tothink differently.

And I think that even just zooming out
into the entrepreneur space, youhave.
All of the baggage, all of theexperiences to take with you
into how to do it differently,how to do it better.
And when you're able to havethat freedom and the time to be
an entrepreneur as well as aphysician, you can picture doing
different things.

(24:54):
And I'm so excited because we'regonna talk about how your
practice sole DPC, has blossomedfrom, one, one doctor to one
doctor with multiple staff andmultiple things that you're
bringing to the your community.
So let's talk about.
Your practice, you go to yourwebsite.
I mean, and I'm just gonna cheatreally fast here'cause I have it
up and then I'm like, I don'twanna mess it up.

(25:16):
You, you go to your website andit literally above the fold says
the sacred space for BlackWomen's Health and Wellness.
And given what you alreadyshared, I'm flipping in love
with your website already.
Like I, I just need an, I justneed to note that, but also the
fact that you have really honedin on a practice really centered
around your mission that youwent, to medical school for, and

(25:38):
you, discovered along yourjourney at Spelman and at
Morehouse.
So tell us about centering adirect primary care c your
direct primary care clinicaround the health and well and
health and wellness of blackwomen in particular.

Absolutely.
I love that question.
And that was a journey becausewhen I came into this, I've
always known like who I think Ican best serve.
I've always known that in theback of my mind.
I think when you go intoespecially a field like family
medicines, like we do everythingright?
There's nothing that we can'ttouch.
It's hyper inclusive, which Ithink is great because I think
what's great about familymedicine is that we can do that

(26:13):
URI potent stem cell, like wecan turn into anything, right?
But I think sometimes in familymedicine we feel like we have to
take care of everything andeverybody.
And if we're not doing that,then we're not really fulfilling
the heart of family medicine.
And so when I was in fee forservice, every patient that we
can touch was a potentialpatient.
So a lot of patients wereattracted to me because I was a
black woman.
I think a lot of people wannasee themselves in their doctor,

(26:35):
but you know, anybody andanybody could come and I'd be
happy to take care of all thosepeople.
But when I'm really thinkingabout in the back of my head,
who I think I can best serve, itis women.
I know that, that have my storythat come from where I've come
from, who have feltdiscrimination in medicine, the
way that I felt discrimination.
Like I feel like I can servethat community uniquely.
And DPC finally gave me for thepermission to do so.

(26:58):
And it's especially interest inthis conversation about what's
going on with DEI in thiscountry.
And it's very controversial andI'm kind of leaning into that
controversy.
DEI work has been very importantto me, but I've also been a
little skeptical of it.
I do think that we need toembrace diversity, but forcing
people to embrace diversity thatdon't wanna embrace diversity,
those aren't the people I wantin my circle.

(27:18):
So I kind of feel like I'mputting my flag in the ground of
this is what I stand for and ifyou love it, support me.
And if you don't get outta myway, like I just, just don't
stop me.
Like just get outta the way.
Which is a very controversialthing to say that I don't think
Michelle if five years agowould've ever said that, but
it's like there are people outthere who feel unheard and you
need to call to them and youneed to create a safe and sacred

(27:40):
space.
And for so long I was so afraidto do that.
'cause is this racist?
Are people gonna say, this isreverse racism?
No, I'm calling out to thecommunity that really needs my
support.
Doesn't mean I won't see anybodyelse.
Absolutely not.
If you want my support, I'm herefor you.
But we are mission driven andwhat helped this again was the,
the beauty of DPC, you couldnever say this if you were in a

(28:00):
big network,'cause of all thelegal and we're gonna, upset
somebody.
This is anti DEI for DEI, wedon't know.
But it gets messy in thosespaces.
But when you have a smallprivate practice, you can stand
for what you stand for andnobody can stop you from doing
that.
The other thing that helped meunderstand that was the beauty
of marketing.
I never knew a thing aboutwhich, what I thought I knew
about marketing just wasn't soright.
So what I thought I understoodabout marketing I've learned so

(28:23):
much being in the DPC space andwhat I've learned, particularly
for small business owners, likehaving a niche is so important.
It's like you can't compete on abig scale.
I can't compete with a Mayosystem or a Cleveland Clinic.
Like we can't be going after thesame pot.
But if I can say this is what Ido so well that nobody else can
do this, like Cleveland Clinicand I'm just using them just
'cause they're big terms,hopefully that's not.

(28:43):
Like off limits here with my DPCstory, but like the big
healthcare system can't get thatniche because they just, they
just can't.
And so that ends up being yoursuperpower.
And I love seeing that with DPCsacross the country.
So there's a doc, Dr.
Anna Myra, she's in in Minnesotaor wi I'm gonna mess it up, but
she's in the Midwest.
Lemme just say that.
And she's neurodivergent and herwhole practice is based on

(29:05):
neurodivergent.
She was like, I think verydifferently.
I hate going to places where thelights are too bright, the
sounds are too loud and mypractice is gonna be perfect for
the neurodivergent person.
That's incredible.
So I love how DPC allows whatdoctors do best to really
flourish.
And I think that's how we'regonna best serve the community,
not by making us these likerobots that have to take care of

(29:25):
everything the same way.
'cause we're just not that way.
I think if you can allow doctorsto really bring forth what makes
them special and bring thepatients to them that need that
specialty, we're gonna bestserve our communities.
So going from kind of like ageneric, Hey, this is sole
direct primary care.
Anybody come to say we are Thesacred space for black women's
health and wellness has reallyhelped my practice explode

(29:46):
because finally women aresaying, oh my gosh, I've been
looking for you for so long.
I felt so unseen.
I didn't know if I was safehere.
I didn't know if I was gonna beokay walking into the spaces of
black woman, and I know thatcoming here, I'm gonna be okay.
So it was, it was one of themost powerful things I did.
It's one of the mostcontroversial things I did.
But again, leaning into thatcontroversy, so stand with me or
just, just don't, just don't getin my way.

And I think it's sad that to anybody,
it would be controversialbecause it's your practice.
You do with it what you want.
And I think that it absolutelyspeaks to why we have big box
stores to shop at, but in, inthis time, a lot of people are
purposefully finding other waysto get things.
It might be a little bit morepricey, but get things to their
door to support, to supportsmall business owners.

(30:31):
I know that intentionally I'mdoing things like fantasy Island
Toys is a mom and pop store inFairview Alabama.
And she, the, the owner is agood friend of mine, and I'm
like, that's where I'm gonnaorder my Easter baskets from in
the future.
And it's little things like thiswhere.
The I think that as a country weare seeing people want

(30:51):
personalized care and you aredoing just that.
And for those who think it'scontroversial, absolutely you're
entitled to your opinion.
But I am so excited that youhave discovered, this, this is
your marketing jam and this isyour community and how to speak
that you're already doing thatto the community of patients you
want to see in your practice.
So tell us though, we're doingthis interview at such a time

(31:13):
when when diversity and equityand inclusion is something that
ruffles a lot of feathers.
Mm-hmm.
And as a person whose parents,my dad immigrated here and
didn't even speak English whenhe came in the sixties and he,
he.
He showed me a way of when youwork hard, you can do different
things.
Like you can do lots of things.
And it's just heartbreaking tothink about the services that

(31:36):
went away when your hospitalsystem closed and when it comes
to having personalized care.
You, you spoke to it exactly.
You, it really helps to havesomebody who looks and
experiences life similar to you.
So tell us about serving theblack woman in particular.
What is the health access like,in the greater Atlanta area,
especially in Southwestern isSouthwestern, right?

(31:59):
Southwestern.
Mm-hmm.
Southwestern Atlanta.
And especially in southwesternAtlanta.
And how has that changed becauseof sole direct primary care
being in existence?

It's, the landscape is horrible.
I mean, that's, even before thehospital system closed, we were
already like a healthcaredesert.
We didn't have enough services.
We were very un, un underserved,unmet need area.
And the hospitals are really alifeline.
And across the nation, we knowthat black women suffer
disproportionate mortality,especially when it comes to

(32:28):
maternal health.
Or obstetric health, like we dieat much higher rates.
Even that's seen in, indeveloped world, like it's
pretty, pretty awful and prettyabysmal.
With the closure of those twohospitals, we actually lost two
maternity wards in thiscommunity.
So we're traveling much furtherto have our babies and
oftentimes getting substandardcare.
So, I'm networked with a lot ofthe black female physicians in

(32:48):
this community, and almost allof them have horrible birth
stories.
We're talking about physicianshere.
We're not talking about peoplewho don't have access to s and
they don't have, don't have sometype of access.
These people have all the accessand they're still getting
substandard care.
Now, I don't do obstetric careanymore, but life caring for the
whole woman matters.
The more she gets prepared forpregnancy, like the better her
pregnancy will be.

(33:09):
Like even if, there's factors wecan't control, the healthier she
is, I feel like I can help thatmoving forward.
All of that to say, I mean, wehad so little before, and those
two hospitals were big anchorpoints for us.
And with those hospitalscollapsing, it took tons of care
with it.
If you think about the clinicsthat feed the, those op, those
hospitals, they sufferedgreatly.
Like the OB offices are nearby.

(33:29):
We had a, a really amazingorthopedic office that operate
at those two practices that shutdown because they had no place
to operate anymore.
So the care has been abysmal.
We're starting to see otherplaces pop up, so there's
actually two new practices byblack women in the area that are
opening, which I'm now just sothrilled for.
At one point I might see, oh mygosh, this is competition, but
I'm like, no, we're so farbehind the eight ball that we

(33:50):
need everybody here trying tostart these practices to help
move the ball forward.
But the, the landscape has beenterrible.
And people are traveling so muchfurther to get good care.
Some people just aren't gettingcare.
I do a lot of community events,I do I was just at the hair
show, black women, we love ourhair.
So we set up a booth at the hairshow to tell people about Soul
Direct Primary Care.
And I can't tell you how manywomen stop by.

(34:12):
It's oh my gosh, I haven't seena doctor for four years.
I haven't had a pap smear forfive years.
I haven't, had my blood pressurechecked.
Oh my gosh, can we get anappointment with you?
Like people are just neglectingtheir care.
So we're, I'm, I'm devastated atwhat's happened.
I always say, I don't thinkwe're gonna solve this problem
in my lifetime, but we gotta geta head start.
We gotta get on it now.
And that's exactly what mypractice is doing.

I love it.
So you opened in May of 2023 andyou've already gone above and
beyond 230 patients, which isincredible by the time of this
interview.
And so I'm wondering in terms ofscaling as you.
As you not only went fromphysician to physician,
entrepreneur, you've scaledpretty quickly.

(34:52):
So my question would be what areyour top tips for those people
who are wanting to scale, butalso wanting to remain
intentional about their practiceand personalized care as they're
scaling in terms of sheernumbers of members of the
practice?

Absolutely.
Well, I will say that I had ahuge headstart in that I had
been a physician in thecommunity for a long time.
So my name was pretty wellknown.
Even when I was in fee forservice, there were a lot of
people like, oh my gosh, I wannasee Dr.
Cook, but I can't get under aschedule.
It's a six month, one year wait.
So it did help to be of thecommunity.
So I think if you, if there's aplace you know, you wanna be
like, get your name known there,stay there and try to sit up

(35:29):
there as close as possible.
Another great thing, or great ifyou will, is because the
hospital system where I was ateffectively closed in the area.
It did release me from mynon-compete.
I had to do a lot of legalfinagling and pay a lot of money
to figure that out.
I was able to set up shop prettyclose to where I was practicing
originally.
So staying in that samecommunity made a big difference
for me.
So when I opened the practice, Ihad about 60 people that

(35:51):
pre-registered that got mestarted.
So I got a really greatheadstart.
That being said, there is churnin direct primary care.
People come in, they're like,oh, this is exciting, this is
great.
And then, they fall on hardtimes or something happens and,
and they fall off.
And so I think the way that youcan start to grow and scale,
number one, I think the mostimportant thing I did was create
that patient avatar and reallyniche down the practice and

(36:13):
become mission-driven fordoctors who are coming from fee
for service.
I think it's hard to imaginethat patients won't be beating
down your door once you open it.
When you're in fee for service,like there's so many patients
you don't know what to do.
There's all these you areoverwhelmed with patients.
And I think you get this mindsetof if I'm a doctor, people will
come.
And that is just not the truth.
I think I'm a darn good doctor,but I still don't have the

(36:34):
numbers that I want yet.
Right.
And it's been very hard to getpeople to come through the door,
but I say that because.
DPC, especially with most smallbusinesses, it's not just a
numbers games, it's a matchgame, right?
You wanna get the people who notonly wanna be in your practice,
but wanna be committed to yourpractice.
And so you're gonna get a lot ofnos before you get yeses, but

(36:54):
when you really define whoyou're looking for, and for me,
we're looking for a veryspecific patient.
Now, other people that believein us, we want them too, right?
But when I'm looking for thatvery specific patient, when she
commits to my practice, I knowshe's committing.
She was like, I don't wanna gowithout Dr.
Cook's care because this is soimportant to me.
So I'm not worried about thatperson leaving, as opposed to
the person that's oh my gosh,I'm in distress.

(37:16):
I woke up with strep throat.
The urgent care is packed.
Like you're my only deal in townnow.
Yes, we'll help that person too,but you're less like, that
person's less likely to becommitted to you.
Direct primary care is anongoing relationship.
You wanna make it a good match.
You're kind of getting marriedto these people and you wanna
make that commitment goingforward.
So I think the more specific youcan be about who you're calling
out to, the better.

(37:37):
And sometimes reaching out toeverybody kind of works against
you because if you're not uniqueor your practice isn't special,
or have a special meaning insomeone's heart, they're gonna
drop you.
The minute they get likeinsurance oh, I was uninsured
and now I have insurance, I'mgonna leave your practice.
Or, there's someplace a littlebit closer, so I'm gonna go to
that place.
You want it to mean something topeople.
But there's no place else inAtlanta that says they're the,

(37:57):
the, the sacred space for blackwomen's health and wellness.
So you can leave if you want to,right?
But you're not gonna find thislevel of care anyplace else you
go.
So I think really making yourpractice mission driven,
defining who you're looking formakes a huge difference.
And then telling the story,whenever I get a chance to talk
about DPC, I talk about DPC.
And when you're starting yourpractice, you feel this pressure

(38:18):
like fill quickly.
So you, you feel like you'retrying to drive the deal a
million times.
Oh my gosh join my practice,join my practice.
I had to let go of the pressureof that get used to people
saying no, not wanting, gettingon board, but really just making
sure they understand what yourmodel is about, hearing it time
and time again.
So again, I've learned a lotabout marketing.
I've learned that people need tosee something at least seven
times before they make acommitment.

(38:39):
So you have to make seventouchpoint, right?
So that first touch point,expect them to say no.
That second touch point, expectthem to say no.
Third touch point, expect themto say no.
You've gotta keep telling thestory.
And the more you can get otherpeople to tell the story, that's
gonna be another touch point.
So, for instance, if I meetsomebody at a health fair and
they're like, oh, so, oh, thisis a non-insurance based
practice.
That's weird.
I don't wanna hear about it.

(39:00):
But then, their friend is amember and they go back and they
say, oh, I saw Dr.
Cook at, so Oh, you mean thatnon-insurance based practice.
Oh, that's cool.
You kind of get the buzz goingbecause people hear about it
more and more and more.
So I talk about it every chanceI get.
When I'm invited to do podcasts,I do it community events where I
think my, my ideal patient'sgonna be there, I'm gonna be
there.
Opportunities to speak, likeyou've gotta keep pushing for

(39:21):
your practice, but also for themovement.
I want people to join mypractice, but if they don't join
me and they join Dr.
Baby and Marietta or they joinDr.
Meta who's in Marietta, or theyjoin Dr.
Springsteen and, and PeachtreeCity because they believe A DPC,
that's a win for all of us.
And each of those people thattell the story is gonna make it
easier and easier.
So touch points matter.
Like I said going to communityevents, word of mouth,

(39:43):
encouraging my patients to leavereviews so that people go to the
website, they hear other peopletalking about it.
And even though it can be areal, I'm not gonna say a pain,
but it can be work to do it.
I think a newsletter is very,very powerful.
So I have a lot of people, I, Ihave 247 members as of as of
yesterday.
But I have over a thousandpeople on my mailing list.

(40:05):
And so those patients arehearing about DPC all the time
and sometimes they're not readyto join, but if we do an event,
they show up, or if we have aspecial offer we're doing, we're
did, we did a, a researchproject where we did free blood
draws.
They showed up.
So even though they're not hereyet, they're lurking.
Right?
Get them in your circle.
I think.
Dr.
Oh, what's his name?
Phil Boucher talks about peoplehaving people in your orbit, get

(40:27):
them in your orbit'cause they'rewatching and then one day they
may actually convert and becomea member.

Love it.
Now you went from being a solodoctor, no staff, to a totally
different space.
It's absolutely gorgeous.
Make sure you go to soul dpc.organd watch Dr.
Cook's video.
It's beautiful.
But tell us, because sinceyou've opened, you've added both
Toya and Brie to your practice.
Mm-hmm.
And I'm wondering if you haveany best tips on hiring people,

(40:55):
especially finding the rightpeople who are, going to be
quote unquote married to yourpractice as much as your
patients are.

Yeah, this is a fun story.
So, I started with a virtualassistant who's still with me.
Joy is my heart and soul.
Like she's my ride or die.
I love joy.
So starting with her has been sogood.
And I would say sometimes withDPC we get this mindset of do it
yourself.
It's all DIY, it's all DIY.
The more you get better at beingable to delegate, the more
you're gonna be able to do.
Like, As a doctor, you do wannado most of the doctoring and not

(41:24):
all the other administrativestuff.
That's how you're gonna servemore patients is if you have
help to do the other things.
So I came on, I had a virtualassistant, which was a very big
learning curve, like learninghow to train somebody who's
remote, how do you have, allthose touch points to, to make
sure they do what they're doing,what they're supposed to, how do
you evaluate that they're doingwhat they're supposed to do.
It's a very different skillset.

(41:44):
So picking the right personmatter.
When I interviewed my va, a lotof the companies will have you
interview different people, andI really paid attention, not so
much to how she answeredquestions that I asked, but how
she asked questions back to meand my VA stood out because I
remember her saying things like,well, if you're not using
insurance, like, how do you sendreferrals?
Or what happens with medication?
I was like, that's why I want,because she's thinking my

(42:06):
patients, like all the questionsmy patients are gonna ask, like
she's already thinking like themand she's gonna be able to
assist them because she's, she'sunderstanding what that gap is
going to be and it's been aperfect fit.
So starting with a VA was so, socritical.
And then when I started mypractice, I was subleasing from
another doctor.
So I had a room in the office,like an office space, and I had
an exam room.
So I had two rooms in that placethat I controlled and I did

(42:28):
everything.
So I was doing vital signs, Iwas doing check-in, checkout,
like all the stuff on the floorI was doing, which is a lot of
fun.
It can be exhausting.
Now granted, when you're onlyseeing a couple patients a day,
three, four patients a day, it'sdoable.
But if you do wanna get to thepoint where you're seeing 7, 8,
9 patients, it's just not doableanymore.
So as the practice grew, I knewwe needed more space and so we
found a space that was larger.

(42:49):
I'm in a, about a 1700 squarefoot building right now, and I
just couldn't be in here bymyself.
I feel like there kind of needsto be other folks.
And so my bridge to gettingstaff is when I moved here, I
moved in May of 24, so May of23.
I started May of 24, I moved tomy new space, perfect time
because college students werenow available.
So I created an internship, tohave somebody on board.

(43:11):
And yes, it was a goodexperience for the students, but
I really needed some cheap laborand I needed people who were,
who were ready to go, who weremotivated.
So that was a great move and italso kind of helped me get used
to what it was gonna be like totrain somebody on site.
So I got students and who helpedme for the summer.
They were phenomenal.
They are so passionate, theywanna please you.
They were excited to get thisopportunity.

(43:31):
So work with students, work withinterns if you can.
They can be a great value add tothe practice.
But then when I was looking forwho I wanted in the practice I
wanted an office manager.
One because I wanted additionalhelp with the admin.
And as Marielle and people who,who know me well, I do a lot
more beyond what happens behindthese walls.
We're always doing advocacy,we're doing events, we're doing,

(43:51):
we're just doing all the things.
We're always out in thecommunity.
So I wanted somebody that wouldreally help broker some of those
community relationships andthings that happen outside the
practice as well as inside thepractice.
When I started to look at whatit would cost to bring on like
an office manager, I was like,oh, I dunno if I can really
afford that, right?
This is pretty expensive.
People that have experience inthe medical space that might be

(44:12):
hard to bring on.
And so I started to think aboutwhat is the skillset I'm looking
for?
Like maybe I don't wanna hire onposition, I wanna hire on
skillset.
So what I did is I went toLinkedIn and I got one of those
recruiter accounts.
So I upgraded my account toLinkedIn and I just started
lurking.
I didn't really post a positionand one of the reasons I didn't
post is'cause I was hearingother doctors say they post on

(44:33):
LinkedIn, they post on Indeedand they get a ton of responses,
but there's a lot of garbage inthere and you have to sort
through a lot.
I didn't wanna sort through, Iwanted to kind of like laser in
on who I thought might be goodand just make an offer to them.
So I was browsing differentthings and I realized that the
skillset that I really wantedwas somebody who was an
executive assistant.
You know, You support anexecutive, you do all the

(44:53):
things, like you kind of have toknow how to do a lot of
different skill sets, stayorganized.
And I was like, I think I cantake an executive assistant and
make them an office manager,right?
And so that's what I looked for.
I started browsing for executiveassistants, people who are in
the area, and I started kind ofcold contacting them.
I was like, you don't know me.
I'm this doctor that has thiscrazy idea that we're gonna
change medicine.
I have this, growing practice.

(45:14):
What do you think?
And I got about four or fivepeople to do an interview with
me.
And Brie, who's now my officemanager, stood out immensely.
She was ready to take a leap.
She loved her job as an ea, butfelt like she wasn't really
growing, wanted a newopportunity, and she was a
wedding planner.
So I was like, girl, you knowhow to do events and that's what
we do here at, so, so I need youon board.
And again, one of the bestdecisions, she's been so

(45:35):
dedicated.
I was able to get her, I pay hera very competitive rate, a lot
more than I ever thought I wouldpay, but a lot less than what
someone who comes with workexperience.
And what I love is that she'sbeing grown from, from the
inside, right?
It's nice to bring in someoutside blood'cause they bring
new perspectives, but sometimesthey're not willing to think
differently, which is what wehave to do here at seo.
Look at things differently.

(45:56):
I don't think we do.
I think a lot we do in medicineis wrong, right?
The way we treat patients andrescheduling and grace periods
and a lot of it's not right.
And bringing somebody with fresheyes has made all the
difference.
And then after Brie, I broughton Toya, who is our medical
assistant.
Quite frankly, because I wantedto offload those medical
assistant duties, I wanna domore of the doctor stuff, taking
the vital signs, I can do it,drawing the blood, I can do it,

(46:18):
but if I can get help, I can bea lot faster and I can serve
more patients.
So same thing with Toya.
I went through, I kind of lookedat different people.
Medical assistants, whilethey're not super expensive,
they are in higher demand, andso they were, they were a lot
more expensive to hire.
Toya is actually a phlebotomist.
She has phlebotomy training,which again, I look, looked for
skillset like the one thing Ireally would love to offload is

(46:39):
drawing blood.
So I'd look for a phlebotomist.
She does not have a medicalassistant certification, but if
I could train a, a collegestudent to be my medical
assistant, then I coulddefinitely train a phlebotomist.
And she had some experience withthat.
She worked at some offices whereshe did some EKGs and vital
signs.
I'm like, that's the skillset.
I don't really need a title.
I need a skillset.
And I needed someone who'swilling to learn.
So Toya, same thing.

(47:00):
She came in, she was excited,her son goes to school like a
mile from the practice.
She's this is like a match madein heaven.
So I got people who reallyweren't invested in the mission,
willing to learn and had askillset that we could work
with.
And that's how I, how I kind ofbuilt up my team in a more
non-traditional way.
And if I had to go at it again,I'd probably use the same
technique, go and kind of lurkon LinkedIn and see, see who

(47:20):
might work out.
And then try to try to pull theminto the, the spears full, sole,
direct primary care.

I love it.
Now I wanna shift theconversation to tech because
this is something that, we areat a time where my DPC story has
released the Battle of the EHRs.
If you have not participatedyet, just know it is a way for
you to anonymously participatein a survey to say, what EHR do
you use?
What do you love?
What do you want to seeimproved?

(47:47):
And it's a way for us to presentto the EHR community out there.
This is what as a community DBCdoctors are looking for.
So please go to my dbcstory.com, click on Battle of
the EHRs and vote and put inyour, put in your input.
But for you, one of the things,one of the reasons why I wanted
to bring you onto the podcast,especially in the month of June

(48:07):
when we're doing this survey, isthat you are a person who's
switched between different EHRs.
And I think that that'ssomething that, when people are
on the Facebook groups, whenpeople are networking events,
they're asking about like, howdid you choose an EHR?
How did you choose an EHR?
And you've chosen not only once,but more than one time.
And so I'm wondering in terms ofyour, Dr.

(48:30):
Cook who was starting out withan EHR and Dr.
Cook who has changed EHRs isthere a difference in how you
looked at EHRs similar to howyou would not redo how you're
selecting your team?
What would you say was yourmindset when you selected your
first hr?
And would you, and was thatsimilar to how you chose your
second?

Absolutely.
So.
This is such a good topic andthank you for doing Battle of
the EHR.
So after we get off of this thisinterview, I'm going to go and
do my vote because I have a lotto say about this, but you're
correct.
I switched three different timesand what I see from my peers in
DPC, a lot of us are coming,most of us are using Epic,
right?
And they're robust, like it'sannoying, but they do everything

(49:11):
right.
And so I think we come into itthinking if you pick an EHR,
it's probably gonna do that.
And so you just wanna get thecheapest one.
So a lot of it's like cost,cost, cost.
What's the cheapest?
What's the cheapest?
And I think that's the firstfatal flaw is that we're looking
at cheap and not always lookingat functionality.
We're moving in a much more techforward world.
And I'm not a tech person.
Like I, I try not to say thesethings like what I'm not, but

(49:32):
I'm not, I don't lean into tech,but I understand that's where
we're going and if we canleverage it, we can do so well.
Especially with small practicestouching a lot of people.
Tech can help make us much moreefficient.
So we shouldn't always belooking at what's the cheapest.
We have to look at what's goingto give us what we need and
what's gonna make us efficient.
So I went with an initial EHRthat looked like it had all the

(49:53):
bells and whistles and thingsthat, that were gonna make me
efficient.
It had this all in one typestuff and I was really excited
about it.
The challenge with my first EHRis that they were launching when
I was launching, so they weredoing a big.
Launch or like merger as I cameon board.
And so everything was super,super glitchy and I kept calling
tech for help and nothing wasworking.
I was like, I, this is unstable.
I can't stand on this.

(50:14):
So I switched to another EHRthat was very popular, but very,
very, very basic.
And it was affordable.
Affordability is great, butagain, affordability is not the
most important thing.
If it's affordable, but it's notdoing what you need it to do,
you're going to have problems.
Am I mad that I made thatswitch?
No, because on each transition Ilearned something really
critical about what I needed inmy tech stack.

(50:34):
But when I got to the next EHR,there were just some critical
things I didn't have that Ineeded.
One was like a more robustpatient portal.
The ability for patients to beable to schedule appointments.
The, the portal is probably thebiggest one, but there were
several other things.
The way you sent prescriptions,the way you wrote notes, like
there's a lot of other littlethings that made it not the one
to work with and honestly mademe less efficient.

(50:54):
And when I started to imaginethe practice growing with this
tool, it was gonna hamper me.
So if something is taking youfive steps, that should be one
or two.
Like when you start to scale,those five steps really add up.
Like in the beginning you dohave, a lot of times you're
willing to kind of deal with alittle bit of inefficiency, but
you have to think about thefuture.
And so as I was getting bigger,I'm like, this is not working.
Like my patients can't schedule.

(51:15):
I'm gonna have to hire morestaff just to make more
appointments.
That's not the way I wanted towork.
And so I went back to thedrawing board and again, started
asking my peers and did someshadowing.
But I do think it's helpful touse your EHR first or, or watch
how someone else uses their EHR.
Like I think if you can do that,that really helps.
'cause you don't know what's notthere until you start using it.
A lot of them will sell you andthey'll give you the demos and

(51:35):
you're like, oh, I'm pressingbuttons.
And things happen.
But you don't really know whatthe workflow is like until you
go through the workflow.
So if you're not gonna demoeverything, I would try to like
pair with a doctor and see howthey use their EHR, like spend a
half a day with them, they seehow they flow through it and see
if you could see yourself doingthat.
And you'll start to see some keydifferences.
But for me having a reallyrobust patient portal easy to do

(51:57):
virtual communication was veryimportant.
Ease of sending prescriptionswas very important.
Billing was very important.
The fact that that could happenseamlessly, like all those
things really mattered.
So, am I using the cheapest EHR?
No, I'm not.
And do I wish it were a littlebit more affordable?
Yes.
When I think about what I wouldsave and cost, like what it
would cost me, and headachesjust isn't worth it.

(52:18):
And so I think a lot of DPC docshave to think about that.
I do love that in the DPC space,there's more options that are
available, there's morecompetition.
So I absolutely would go aheadand do the battle of the EHRs
because we need for them to getbetter.
This is gonna be the backbone ofhealthcare, but EHR is so, so,
so critical.
Don't always go for what'scheap, go for what you need,
because a lot of times you'regonna end up piecemealing things

(52:40):
that that that aren't gonna,they're gonna cost you more in
the long term in terms of your,in terms of your mental sanity.

I love that, and I think that that is
so insightful to talk about yourpractice as you envision your
practice, not your practice onday one, when there might not
be, many patients to manage inyour EHR.
When you're talking about those,five extra steps adding up it.
Absolutely.
I completely agree.
It absolutely impacts the amountof time you're spending per

(53:07):
patient to get the job done.

Absolutely.
And I, I, I can't remember whatepisode, maybe episode five of
building DPC, the podcast Imade, I did a whole episode
about EHRI talk about myjourney.
So go check that out if you'restuck on your EHR.
It's a big decision and I, Idon't like the fact that I
changed EHR, but another mindsetshift in, in, in the
entrepreneur space is thatsometimes in DPC when we're
making these decisions, we feellike this is just the be all end

(53:32):
all right?
I've gotta make the rightchoice.
In business, you can alwayspivot and you're gonna have to
pivot.
And the better you pivot, thebetter you you're gonna be as an
entrepreneur.
So while I don't wanna keepswitching EHRs, I don't feel
like if you're stuck someplacethat you can't get outta that.
So that that relationship,there's always a different way.

Love that.
Now when it comes to one of thefeatures that you mentioned
about your EHR, and one of thethings that you really lean into
is the ability for a patient toself schedule as well as the
patient portal.
Which patient portal is amassive thing in my world also.
But you have also leveraged yourEHR to be able to do things at

(54:10):
your practice specifically, takecare of patients on the daily,
but also you are very focused onobesity, medicine, metabolic
health.
And the other thing that I loveis that, and I mentioned this in
your bio, but you are bringingcompassionate menopause care as
a woman to your female patients.
And so I'm wondering how youlook to your EHR to support you

(54:31):
in streamlining your workflows,but also to help you personalize
these different ways that youare delivering care to your
patients.

Absolutely.
Personalization andcustomization is it's, it's like
a double edged sword for me,right?
Again, I'm not necessarily atech forward person, but you do
wanna have the ability tocustomize, right?
So what do I mean by that?
And the world of the big EHRs,you can kind of create these
order sets or create thesethings that you can do.
It's okay, if I, if I have a waythat my brain works and every

(55:02):
time I see an obesity basedpatient or a menopause patient,
I wanna order this set of labs.
I wanna do these, this manyhandouts for them.
I wanna have this type ofpatient education for them.
Like you wanna be able to bundlethat together and then be able
to modify those things perpatient because it's
individualized care, but youdon't wanna keep reinventing the
wheel and having an EHR thatallows you kind of like build

(55:22):
those bundles, like work withthe way that you think helps you
move faster and helps you kindof have a way that to approach
each patient in a way that makessense, but then customize it for
that patient.
So I used to think that I liketo just be able to, to be told
how to do something and just doit.
But I'm like, no, but I actuallylike to do it better this way.
Do it better that way.
And you can do that if you havean EHR that will lie to do that.
So when I think about like mymenopause care, there's stuff I

(55:44):
don't wanna think about twice,right?
Like these are my, the threebiggest estrogens I use.
I'm gonna save them.
These are the progesterones Iuse, I'm gonna save them.
My patients always ask thisquestion about menopause, or
here's my FAQ sheet.
Like I have that all together sothat when people need something,
they're ready to go.
I have forms that they cancomplete about that.
So I have my menopause healthquestionnaire.
I can send that to my patientsthrough the portal.

(56:06):
They complete it.
So by the time they come in, I'mlike, oh my gosh, your sports
14.
Here are the things we have totalk about.
So using that technology to evenhelp with the patient flow is
really, really powerful.
So you need some customization.
You have to lean into it.
'cause again, I'm not the personthat likes to figure out how to
do those nuances, but once youfigure it out, set it, forget
it, and then you can adjust itif you need to, which is really
nice.

I love it.
And going back to serving yourcommunity and your community's
needs, I'm wondering if you cantalk to us about obesity,
medicine, and metabolic healthand menopause care, how you've,
how, how that's manifesting atsole GPC, because as you talk
about, there's algorithms andwhatnot, there's also the actual
conversation that you have tohave with the patient who has

(56:46):
these diagnoses or is concernedabout these diagnoses.

Yeah.
So I, I'd like to answer thatwith just again, the freedom of
DPC.
We know that these conditionsare so challenging to manage and
it's not gonna just happen inthe exam room.
So I think one of the thingsthat DPC has allowed me to do is
give patients more than justwhat happens in the exam room.
So we mentioned the fact that Ihave a newsletter.
I often will do stories in thenewsletter about obesity, about

(57:11):
patients who've, who've hadobesity challenges about my own
obesity journey.
You all will also know I'm veryactive on social media.
I've had my own obesity.
Story like dealing with obesityand weight gain has been a
problem my whole life and I'vegotten the handle of it.
So I share that very openly.
I talk about it on social media.
What else?
We do events in the practice.
Just this weekend we did a yogaevent, so managing stress.

(57:33):
We know that people are notmanaging their stress.
Their cortisol's up, they're notsleeping well.
They're going to eat a lot more.
So.
What I do in the office issupported by some of the other
activities that I just was notgonna be able to do when I was
in fee for service.
I was just too burned out.
I'm not gonna be gonna socialmedia talking about things
because it's too much work andor, I'm gonna get fired because

(57:53):
I'm gonna violate the policy ofmy institution.
I'm not gonna put on a yogaevent.
'cause maybe I'm gonna have togo through all these different
channels.
Like I can hit people indifferent ways.
I'm sure a lot of us hate thefact when patients come in,
they're like, oh my gosh, I sawon TikTok that if you take,
green tea vitamins, that you'regonna lose 20 pounds in two
weeks.
You're like, oh my gosh.
There's so much crazyinformation on TikTok.
But now my patients come in Isaw this thing you did on

(58:15):
TikTok, Dr.
Cook, right?
Like they're seeing their doctoron TikTok and they're like, oh,
I'm actually getting some validinformation.
I'm hitting them in differentways that help support their
care.
And that's the flexibility ofDPC.
That doesn't all have to happenin the exam room.
Like it can happen from some ofthese other channels that you
do.
Are kind of a part of themembership, right?
Like some of that stuff is freefor the public as well, but it

(58:35):
helps me reach my members inreally unique ways that I think
has sometimes been moreimpactful than what I'm able to
do in the, in the exam room.

I love that.
And when it comes to the impactof the exam room, I also think
about the impact that yourpatients take with them and they
tell other people about, and I'msure like, and this is how DPC
grows with that personalizedcare because your patients are
interpreting what you're doingin their own way and they're
share sharing that with theirfriends and neighbors.

(59:03):
So it's, it's, it's like amulti-fold wave of effect that
you have when you just are ableto be a doctor.
It's amazing.

Yes.
And I have to add to thatMaryelle, especially those of
you that do obesity medicine, itis so nice to do it in the DPC
space because.
When it comes to especiallymedications, we're in this age
of GLP, which I do think iswonderful.
They do amazing things forpeople.
The one place where I have tospend too much time with
insurance company is priorauthorization for glp, right?
But when it comes to the examspace, you're kind of free.

(59:35):
I remember in fee for service,some people would wanna come in
just to talk about obesity, butthen the billing department
would slap you on the wrist.
You can't just talk about that.
We can't bill 9, 9, 2, 1, 3 orfour for that.
Did they have hypertension aswell?
Make sure to put that as thefirst diagnosis.
And obesity, like all thatnonsense is gone.
Right?
Maybe they wanna know, is myvitamin D playing a role here

(59:55):
but I couldn't order vitamin T?
'cause sometimes fatigue won'tcover, like you're going through
all these games just to reachthe patient.
I can put whatever diagnosis Iwant to order my vitamin D level
now.
Right?
If they, if I just wanna putobesity, it doesn't matter if it
matches or not because it's allcash based.
So I think it's actually allowedme to o offer more comprehensive
care.
I can get the games out of theway.
I still have to play some gameswith insurance companies in the

(01:00:17):
realm of prior authorizations.
But the care is just so mucheasier.
I think we've made obesity careso complicated just like we've
made the rest of medicinebecause you gotta figure out the
codes first before you even getto the patient.
And sometimes the coding is soridiculous, it's not even worth
spending the time with thepatient.
'cause if they come and theywanna talk about weight loss,
that's not gonna be paid.
I'm not gonna pay attentionhere, so I'm just gonna brush
them over.

(01:00:38):
But now it makes all the careequitable.
Right?
Your membership covers whateveryou think is important to you,
and I'm gonna help you throughthat regardless of what the
codes are.

Maryal Concepcion, MD (01:00:47):
Love it.
So let's talk about you, beingon the side of doing the prior
auths for the patients andunderstanding the frustrations
that patients have andunderstanding the frustrations
that a physician has in fee forservice.
Yeah, you have.
Been able to break free fromthat, open your own practice,
heal, continue healing, and nowyou're also advocating for not

(01:01:09):
only your patients, but also themodel of DPC, which is amazing
and much needed.
So definitely, I hope thelisteners out there are
listening to Dr.
Cook's Word and gettingactivated because this is what
we need to be able to speak forour profession and for our
patients and for the way goingforward with healthcare in the
United States.
What is at the core of what youtell every single person,

(01:01:32):
whether it be the person who youmeet at the grocery store or the
person on the national front?

Michelle Cooke, MD (01:01:38):
Good question.
I think that's a hard questionto answer because I think it
depends on what theirperspective is.
There's some people you talk toand you talk about DPC, you
explain it and they get itimmediately.
They're like, why isn'teverybody doing this?
Right?
And then you have some peoplewho are gonna look really
sideways and they don'tunderstand and they just don't
quite get it.
Coming from fee for service, Ifeel like there's a lot of us

(01:02:00):
that are afraid to doD-P-C-D-P-C'cause we feel like
we're gonna hurt access.
You hear a lot of people say,well, people need to use their
insurance to access care and ifI don't take their insurance,
I'm limiting access.
And again, I will ch I willsubmit to those doctors that
that is a limiting belief.
It's a limiting belief.
And in some ways doing DPC hashad made me reevaluate the

(01:02:22):
healthcare system in a way thatI couldn't do when I was like in
the nonsense.
'cause you're trying to figureout how to make things work, but
when you step outside of it andwatch what's going on, you're
like, this is insane.
And honestly, it's wrong.
It's wrong.
And while, do we need mechanismsto make sure people can access
care?
Yes, we do.
Does insurance have to be thatmechanism?

(01:02:42):
When it comes to primary care, Ican now firmly say I don't
believe in it needs to bethrough insurance.
Right?
Insurance, by its definition, issupposed to cover catastrophic
and unusual events.
That is a total opposite ofprimary care.
Primary care is the usual.
It's the common, it's theexpected, right?
Everybody should get a physicalonce a year.

(01:03:02):
Everybody's probably gonna havea URI at some point.
They see their doctor for it.
Everybody like everybody needsprimary care.
So that is not the rightmechanism to use insurance to
access this care.
If we've all have ever had tofile a claim because you had a
car accident or flood insurance,like we know how frustrating
that process is.
And to think that we're gonnafile claims for care, that's

(01:03:24):
like a couple hundred dollarsdoesn't make any sense.
You see 25 patients a day,you're making 25 claims a day.
That's the bloat in healthcare.
If you take those claims out,like how many more patients
could you take care of and do itbetter by removing this very
burdensome mechanism.
Now in the surgical space, itmight make more sense, right?

(01:03:45):
Not everybody's gonna needsurgery maybe once in or twice
or three times in theirlifetime, but that's not a usual
event.
It's much higher ticket.
So it's probably worth it tospend half a day filing a claim
to get it fi to get it paid forin primary care, not at all.
Now, saying that, I think thereare some mechanisms even in
surgery and high, high levelcare that doesn't need overhaul
and benefits from the directcare space.
But when it comes to primarycare, like we have to uncouple

(01:04:07):
that.
We have to uncouple because Ihave patients talk to me.
I'm gonna use number here, OrI'll use myself.
My family has a$12,000deductible.
So we're functionally uninsuredif you ask me.
Right?
So my practice at our pricepoint, the average adult will
pay$1,800 a year.
So like a fraction of what thedeductible is.
So when people say, I'minaccessible because I'm not

(01:04:29):
using insurance, it's simply isnot true.
It simply is not true.
In fact, I find that more of mypatients that have insurance
don't access care becausethey're afraid of the pricing,
right?
They go to that visit, they havethis pre-concept notion, I pay
four or 500 a month ininsurance.
Of course it's covered.
And then they get the bill forthe doctor, and then they get
the bill for the lab, and thenthey get a facility fee, and

(01:04:51):
that one visit is now a thousanddollars that they weren't
expecting.
So I feel like what's happeningin the healthcare space, the
fact that we're not pricetransparent, the fact that
meaning insur using insuranceoften means nothing.
You and I are probably in a lotof the same Facebook groups with
doctors who are like, where arethese medical bills come coming
from?
I'm covered.
Why?

(01:05:11):
Why am I being billed a hundreddollars or$500 for my, my office
visit?
And then everybody's bickeringabout, well, you, you asked a
question.
Are you like, no.
If doctors can't figure it out,we're in trouble.
And so direct primary care makesit transparent.
It makes it transparent.
Yes, there's prices involved,which sometimes makes us feel
icky as doctors, but we have toget used to talking about what

(01:05:32):
things cost, because not talkingabout it has allowed the fat
cats and insurance companieslike go to the, the depths of
the extreme that they shouldhave never gone to because we're
afraid to have the conversation.
So I always tell people when itcomes to my practice and they
look at my fees, and they mighthem and haw, they're making an
informed choice.
To me that's means so much.
'cause a lot of times they'llwalk into urgent care and

(01:05:54):
they'll walk into primary careoffices and maybe they get an
estimate.
Right.
But that estimate can balloonout to God knows what.
If patients come to me, what'son the papers?
What you're gonna pay no more,no less if we do more, here's
the price for that.
If you don't wanna do it, youdon't have to do it.
But finally we get to that levelof price transparency.
So that was a roundabout way ofsaying I think that a lot of

(01:06:14):
times people think like cashpace care is ugly, but it's no
more ugly than cash based to goto the grocery store.
Right.
It's like we, that's anessential need.
Everybody has to eat.
We pay cash to get that.
And are there members of oursociety that don't have enough
for groceries?
No.
And they, there are people andthey use food stamps, which is
effectively is treated as cash.
We don't ask the grocer to dofile a claim because somebody

(01:06:37):
wants to get, a bag of groceriesfor the week.
I think we should look a lotmore like that.
And so getting from that mindsetof I'm gonna hurt people by not
taking insurance to actually,I'm helping more people by
saying we can't play thisunethical, non-transparent game
anymore, I think is what's moreimportant.
So again, it just, it, itdepends on how people come at
me.
Some people are on board rightaway.

(01:06:58):
Some people are very confused,some people need more
information.
But I do preach the gospel of, Ireally think this is the most
ethical way to practice primarycare.
I think that might be true evenin specialty care, but
definitely in primary care.
I think using insurance hasactually hurt us so much more
than it's helped us.

And I would, I would especially
encourage anybody who speaks topeople who might not be
physicians or they arephysicians speaking to
healthcare policy to listen toDr.
Cook's episode here, becausethis is what is also frustrating
on so many fronts when we'respeaking at, local
organizations, largerorganizations, and to only fight

(01:07:33):
for the insurance-basedhealthcare system is doing
everybody wrong.
It's doing us as physicianswrong because it is not allowing
us to advocate and do the bestby our training and our
profession.
And it, and it also does notlook out for the health and
wellbeing of our communitiesbecause when you're doing the
bloat, as you just put itbeautifully, that is exactly

(01:07:54):
what people are fighting forwhen they only stand for health
policy related to insurance.
Right.
To, to the insurance systems wehave right now, blue Shield
United, Cigna, Aetna.
Yeah.
At this time in our nation'shistory, healthcare and access
to quality healthcare is sobipartisan.
It's so refreshing to know thatit's so bipartisan.

(01:08:16):
But this is also where you havea voice, whether you're planning
A DPC, whether you've been openfor years, this is where
speaking up to what you'redoing, just sharing the stories
of what you are doing for yourpatients, that's what sticks and
that's what helps impact policygoing forward.
And this is a time when, sspeaking up can really help that
bipartisan vote go forward foreverybody's Ben, for everybody's

(01:08:38):
benefit.

Absolutely.
Absolutely.
And it's amazing even in the DPCspace where I think.
There can be in this time we'rejust so politically divided.
But it's amazing how DPC hasbeen very non-partisan.
And there are people I've met atDPC conferences who have just
like very extreme beliefs fromwhere I am.
But we still connect so much.
I'm like, no, but we're here forthe patient.
We're here for fairness, we'rehere for transparency.

(01:09:01):
It's, this has actually helpedme bridge a lot more gaps than I
thought I would like being atsome of these DPC conferences
and connecting with people thatI'm so opposite of.
Philosophically, there's somepeople who really don't believe
in what I'm doing.
They're like, you're doing ablack woman's practice.
That's crazy.
But they get it and they stillback me.
'cause they understand that myheart is with the patient.
Right?
And so I think this is verytransformative work.

(01:09:22):
As much as I hate what's goingon in our country right now with
the divisiveness and, lack offunding and DEI takedown, I
think it's, it's finally thebreeding ground or DP DPC is
going to thrive because peopleare looking for a solution that
makes sense and that really hasa patient at heart and protects
the healthcare providers aswell.

Amen.
So, speaking to those physiciansin the audience who are
thinking, wow, I, I'm actuallyjust as I'm listening to this
podcast, I am acknowledging myburnout.
I'm acknowledging my fear toleap into entrepreneurship
because I'm only a doctor.

(01:10:01):
I'm just a doctor.
I say those facetiously'causebeing a doctor, there's not too
many of us and there's not toomany of us that are able to
practice at the highest level ofour training, especially when
we're in corporate medicine.
So what would you say to thosephysicians out there who might
be scared about physicianentrepreneurship and who might
be sitting there acknowledgingtheir own burnout Right now?

I think the first thing is to acknowledge
your burnout and understand it'snot normal.
It's not normal.
And I think that's what I wishsomeone told me.
Because I feel like there's, itwas, it was normalized.
Oh, everybody does it.
Everybody sees 25 patients aday.
Like just kind of stick with it.
It's not normal, it's nothealthy.
Second thing I would say that ittook me a while to get to is
that being an entrepreneur,small business owner, it's

(01:10:45):
figureoutable.
I think I read a book calledlike it's All Figureoutable or
something like that.
But I had to tell myself like,there are so many small business
owners who have a fraction ofthe education we have.
Think about your hairstylist.
The guy that mows my lawn, thelaundry, the, the dry cleaners,
like most of these people arenot doctorates and they figured
out a way to do a smallbusiness.

(01:11:05):
And so I say that to say if wecan figure out, like people say
the Kreb cycle, if we can figureout how to intubate people, if
we can figure out how to titrateinsulin, like you can figure out
how to start a practice.
And the other thing I would sayis that in medicine, there's
always this fear of litigation.
There's a fear of risk.
There's a fear that a patient'slife is on the line.
The rest of the world doesn'tthink like that.

(01:11:26):
It's kind of hard to imaginethat, like we're not always
thinking in this risk mindset,but when you get to the business
side and you start likelistening differently, hearing
different thought leaders, it'sif you're not failing, then
you're not trying hard enough.
There's an acceptance offailure.
There's an acceptance of you'regonna get it wrong and you're
gonna learn.
That's the best way to learn.
And there's always a way to pickyourself back up on your feet.
I'm very passionate about what Ido and I think sometimes that

(01:11:47):
translates to people as thinkingthat I know what I'm doing.
I dunno what I'm doing half thetime, right?
But I always lead on this factthat whatever's there, I'm gonna
figure it out.
Like I just gotta figure it out.
There's always a way, there'salways a path forward.
And I would encourage people toeven listen to the building DPC
podcast because I'm verytransparent about the fact that
I was scared.
I didn't know how to hirepeople.

(01:12:08):
I still get help habitations.
I look at my QuickBooks, there'sstill a lot that I don't know
and I'm not good at, and maycome to bite me at some point.
But the, the, but thealternative was worse.
The alternative is worse.
Like this is, this is what I'mchoosing.
Because it makes more sense.
I'm actually passionate aboutwhat I do.
My hardest days, don't hold acandle to what my hardest day
were in the fee for service.

(01:12:29):
Like my worst days here justalmost didn't even touch my best
days when I was there.
So it can feel really scary, butit's figureoutable.
You're expected to fail.
And in those moments where I, Idoubt myself, I go back to the
stories, stories are sopowerful.
Listen to my DPC story.
If you listen to otherentrepreneurs, like they've
fallen flat on their face amillion times, but they just

(01:12:51):
keep getting back up becausethey're so mission-driven.
So I think it, it's not aboutperfection.
It's not about getting it right,it's loving the journey more
than the destination.
And like we have, if you stillhave gas left in the tank and
years left to live you want thatjourney to be fulfilling.
Like you're not just trying toget somewhere.
I feel like when I was in feefor service, I was always just
trying to get to vacation, likealways trying to get to my next

(01:13:11):
day off, right?
Because I, I, I wanted a breakfrom life.
But when life feels great, whenlife is I come in with my team
and we huddle every morning andwe're excited about the wins we
had and we're gonna see somepatients who need us and we can
do it in a no nonsense way.
Every day feels good.
I feel good about what I doevery day.
And And that's priceless.
It's priceless.
And so it does cost a little bitof courage.

(01:13:34):
It costs a little bit of beingafraid, but if you can get past
that part, which if you were anactive physician, you've gotten
past that part.
'cause all of us have been oncall by ourselves that first
night, or taken that page anddidn't know like your intern
year, like what the dose ofTylenol was that the nurse
called you for.
Like we've all been there andfigured it out.
And if you can face that, youcan face this.
It's not easy, but it's sorewarding and it just makes so

(01:13:56):
much sense.

And on that note, tell us where people
can listen to building DPC andfind you.

Absolutely.
So building DPC right now isonly on Spotify.
It's a 10 episode series.
There's a bonus episode aboutlegal matters and DPC.
So check it out on Spot Spotify,take a listen and you can jump
around to see which episodeworks best for you.
But each episode kind ofoutlines a different part of the
DPC journey, so choosing yourEHR marketing hiring staff.
So it really, really helpful forthose of you that just feel like

(01:14:26):
completely lost.

Love it.
Well, thank you so much Dr.
Cook.
I'm so excited to have you backon the podcast and to hear a
longer interview from you thistime.

Absolutely.
This was so much fun, Marielle.

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

(01:15:01):
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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