August 10, 2025 • 54 mins
Today Dr. Karl Hanson and Dr. Samia Suleman of Infinity Health Direct Primary Care in Kenner, Louisiana share about their DPC journey. They share their experiences transitioning from insurance-based models, and the evolution and benefits of DPC. Dr. Hanson and Dr. Suleman discuss the challenges of establishing and joining a DPC practice, their personal motivations, and the importance of physician autonomy. The episode also covers the partnership between the doctors, the structure of their practice, and their future plans, including efforts to educate medical residents about DPC. Additionally, the formation and goals of the Louisiana Direct Primary Care Coalition are highlighted, emphasizing the potential of DPC to transform healthcare across the state.
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Transcript
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 fingertip.
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.
Dr. Samia Suleman (00:53):
DPC means to me, freedom, autonomy, and
having the best care for mypatients.
Dr. Karl Hanson (01:01):
Direct primary care has the potential to change
medical care in the UnitedStates, like no other
institution or facility can.
Primary care physicians have theunique ability to break away, to
start their own practice, toreject the notion that big
(01:22):
hospital systems are necessary,big insurance companies are
necessary, and maybe even thatthey're hurtful.
That we can reestablish therelationship with the patient on
an individual basis.
And we as a group of primarycare physicians in the direct
primary care model, can guidethe country to the healthcare
(01:44):
that we think is best.
We know best.
We see people every day.
Dr. Samia Suleman (01:48):
I'm Dr.
Samia Solman
Dr. Karl Hanson (01:50):
this is Dr.
Carl Hansen of Infinity HealthDirect Primary Care, And this is
our DPC story.
Dr. Maryal Concepcion (01:56):
Welcome to my DPC story this week, guys.
I'm so excited because I amdoing this interview in person
with Dr.
Carl Hanson and Dr.
Samia Suleman, who are atInfinity Health, DPC here in Can
Louisiana.
I have not been to Louisianabefore this trip, and it is so
exciting that we get to chatright after the energy of the
DPC summit.
(02:16):
So thank you both so much forjoining us today.
Dr. Karl Hanson (02:19):
Thank you for having us.
Dr. Samia Suleman (02:20):
We're so happy to be here.
Dr. Maryal Concepcion (02:21):
Dr.
Hanson, I'd love to start withyour story of the, the, the day
that you opened DPC inLouisiana.
What was the environment like?
Because there's a lot more DPCsnow than there were when you
opened
Dr. Karl Hanson (02:35):
it.
It was an adventure.
It was not a common thing inLouisiana.
There may have been just oneother DPC practice that was
opened a few months before Iopened Infinity Health.
Wow.
So there was, some discussionabout it.
But quite honestly, at the timeI opened my practice, literally
the previous year, I knewnothing about direct Primary
care.
Dr. Maryal Concepcion (02:55):
And what year did you open?
Dr. Karl Hanson (02:57):
2016.
Yeah.
Is when I converted from myinsurance based practice to
direct primary care.
Dr. Maryal Concepcion (03:02):
And your insurance based practice, was
that a private practice whereyou part of a group?
Dr. Karl Hanson (03:07):
It was private practice.
I was in solo insurance basedpractice.
Yep.
Dr. Maryal Concepcion (03:10):
And what was your scope of practice and
how many years were you in thatprivate practice before
transitioning?
Dr. Karl Hanson (03:17):
I've been in solo practice since 1990.
Mm-hmm.
Spent a couple years outtaresidency working for a, a
multi-specialty clinic and thengot irritated at that and went
solo.
And I've been in the insurancebased practice ever since.
Yeah.
As a solo practitioner.
Dr. Maryal Concepcion (03:32):
because of that history, especially with
you going from a multi-specialtygroup to solo.
What did you see in terms of howinsurance was changing over time
at your practice and for yourpatients before you went to DPC?
Dr. Karl Hanson (03:49):
Well, there's a, a big story to that is I'm
actually one of the foundingphysicians of a Medicare
Advantage plan in the state ofLouisiana, and that started in
the late nineties as we builtthat plan.
In the process of being part ofthat plan, I was witnessing more
how the sausage was made.
(04:09):
About the different regulatoryburdens that are gets placed
upon us.
And how it kind of became a, abehemoth, and then that just
amplified some of the.
The, the game, I never gotinvolved in the RVU game.
Because I was never employed,but I did get to see more and
more that the whole CPTchallenging game was just not
(04:30):
something I wanted to continueto do.
Dr. Maryal Concepci (04:32):
Absolutely.
And how did you see it affectingaccessibility for your patients
once Medicare Advantage wentlive and once insurance, did
what it did over the last coupleof decades?
Dr. Karl Hanson (04:43):
Well, accessibility.
I even at the insurance days, Ihad a relatively small practice,
so I was able to see peoplewhenever I wanted to remember I
was my own boss.
So I could do that whenever Ipleased.
So accessibility was not a bigconcern of mine.
the major concern was that Ireally wanted to do primarily
(05:06):
patient care.
Yeah.
And not even be concerned aboutthe the administrative game that
we've all acquiesced to.
Dr. Maryal Concepci (05:13):
Absolutely.
So now I'll turn the mic over toDr.
Soloman because I'd love to hearyour, your foundational story
when it comes to what was lifebefore life at Infinity for you?
Dr. Samia Suleman (05:26):
Well, so I had the good fortune of meeting
Dr.
Carl relatively early in mycareer.
After residency I spent a year,my husband and I in Ireland.
I spent two years practicingmedicine out there.
So that was quite the changeand, it was a great learning
experience for the both of us.
Returning here I again, had thegood fortune of meeting Dr.
Carl and I was doinginsurance-based practice as well
(05:48):
as dabbling in a little bit ofDPC.
Mm-hmm.
Having a hybrid practice alittle bit.
Wow.
So we shared an office and I gotto learn a lot more about DPC,
how it works and I could seefirsthand all the troubles of
the insurance based practice thehassles, the, chasing after
trying to get paid, things likethat.
So, um, it was a, a greatlearning experience.
(06:11):
We joined forces about a yearand a half ago.
that was a great turning pointfor me.
I enjoy what I do so much now.
Dr. Maryal Concepcion (06:17):
I would love to hear what you saw and if
anything that you saw overseasin a different healthcare system
also impacted the way that youlooked for how you would
continue to practice when youwent back stateside.
Dr. Samia Suleman (06:32):
Well there was a lot of autonomy, so I
thought that was great.
There was a lot of room forlearning Where I was working.
I was at the University HospitalLimerick.
And it was an acute medicalunit.
It was a mixture.
You would have some people thathad insurance and then some
people that were funded by thestate.
You really didn't turn peopleaway which was great.
That included, seeing patientsfor DBTs, seeing, working up mis
(06:53):
it was a hospital-basedpractice.
Dr. Maryal Concepcion (06:55):
And when you talk about that you knew Dr.
Carl early on, I would love tohear what you saw from your eyes
and your perspective, because Ithink that this is a time where
medical students and residentsare really seeing what we're
doing because there's so manymore of us.
It's easier to find resourcescompared to when, when you
opened Dr.
(07:15):
Hanson.
So I would love to hear what itwas that was impactful for you
to see.
Especially for those listenerswho are new to this movement
whether they're, talking totheir friends or seeing their
attendings do DPC, what did yousee that helped inspire you to
eventually be a DPC doctorfull-time?
Dr. Samia Suleman (07:33):
During residency you had the option of
rotating with Dr.
Hanson.
I graduated 2014.
It was a new concept.
It was enticing.
It was, can this really happen?
So it was, it was a lot ofdifferent emotions
Dr. Maryal Concepcion (07:45):
Dr.
Hansen, I wanna turn the micover to you now because this is
fascinating to hear.
And you're you went to LSU forresidency yourself, correct?
Dr. Karl Hanson (07:53):
I did.
I went to LSU Medical School andthen LSU Family Medicine
Residency.
Yeah.
Yeah.
Dr. Maryal Concepcion (07:57):
And so I'm wondering similarly how I
asked about the insurance overtime engaging with residents
over time.
What have you heard from them interms of what am I going to do
after residency?
What is out there?
Am I able to be, you know, afull scope doctor if I wish to?
What are, what are some of thethings that you've heard from
residents because Dr.
(08:17):
Soloman was one of yourresidents before?
Dr. Karl Hanson (08:19):
Yeah.
In, well, when I talk toresidents and, and I'll go to
residency programs and give atalk and I don't talk about.
Thrombocytopenia.
Sure.
Or Antiga.
I talked to them specificallyabout how to start a practice.
Yeah.
Talk about the, the, the joys ofprivate practice and owning your
own business.
So that's actually been my focuswith interacting with residents.
(08:40):
The, the, what I tried totransmit to them is, again, a
lot of times as we're gettingclose towards the end, they talk
about finding a job.
Yeah.
And I just reiterate, reiterate,you do not define a job because
you make your own job.
That we have to quit looking atourselves, coming from a, from a
sense of, of barrenness orhelplessness, et cetera.
(09:02):
Mm-hmm.
That we need to assert ourselvesbecause we are the main cog in,
in, in taking care of patients.
So that has always been myfocus.
Biggest obstacle is that ofcourse, these guys and gals have
probably never run a smallbusiness.
Sure.
They're petrified, they're, theyhave debt overhanging.
There's nobody else thatsurrounds them, meaning in
(09:23):
academia or their hospitalrounds, who is giving them
information on how to start aprivate practice.
Yeah.
And the fact that not only is itpossible, but it's ideal.
Dr. Maryal Concepcion (09:34):
And when people are, mentioning these
fears about finances, about, Idon't have an MBA, how do you
start breaking down that, thatmindset of I'm just a physician.
I, I'm not a business owner.
Dr. Karl Hanson (09:47):
Right.
Yeah.
I, the main thing I say to run asmall business, you don't have
to have an MBA.
Mm-hmm.
You just have to be able to payattention to detail.
And the fact that you've made itthrough pre-med med school and a
residency.
Probably one of the things inyour talent stack is it'll be
able to pay attention to detail.
And know also that probably someof the people that you went to
high school with went, didn't goto college and right now are
(10:11):
running their own smallbusiness.
Totally.
So don't, don't diminishyourself, don't mean yourself.
And then just giving them therealization that, to become a
physician, you sort of haveblinders on.
You're not paying attention tosome of these business things
out there.
It doesn't mean though that youcan't pick it up in short order.
The first bit of advice I giveto them, when you're thinking
(10:31):
about doing a small business,don't think about the small
business and that fine detail.
Yeah.
Do baby steps.
Start a process first.
Think about what do you wannacall your practice and your
logo.
Sure.
And that's all.
Yeah.
And don't think, and once thatseed sort of gets planted, then
you're gonna start.
Inching up and learning bit bybit what goes on.
(10:51):
Then also I, it, I have an openinvitation if any of them want
to start a small business, smallpractice, I'll personally help
them.
With no consult fee or anything.
Just to walk through everything.
Yeah.
So
Dr. Maryal Concepcion (11:05):
that's incredible.
So, Dr.
Soloman after coming back fromIreland, what made you go the
route of leaning more and moreinto DPC versus opening your own
DPC versus just going fee forservice?
Urgent care?
There's so many pathways that wecan take as physicians, and I
also intentionally say thatbecause if you are worried about
DPC financially, definitelyhaving a side gig is one of the
(11:28):
ways to help finance A DPC.
But for you, what was yourjourney in how you made the
decision to become a doctor atInfinity?
So,
Dr. Samia Suleman (11:38):
I also come from a family of physicians.
My father's a surgeon.
My mother's a pediatrician.
My sister's an ob, GYN.
they all were in, very much insupport of me being in an
independent practice.
Sure.
My father's always been inprivate practice throughout, and
he has kind of been the heldout, not being bought out by the
hospital.
Yeah.
I do do wound care as well.
So I have a side gig amazingwith nursing homes and, and
(12:00):
doing some wound care there.
But the way I chose doing DPC isI had started with having some
insurance-based, patients andthings like that.
It was just the ease Sure.
And the attraction of not havingto worry about paperwork.
Not having to worry about allthis overhead, getting all these
prior auths, having all this,all this trouble with being
(12:24):
regulated so much.
And I would see the way Dr.
Carl would work and and hispatients everyone's happy, at
the end of the day.
And I would still have paperworkand stuff going on.
Sure.
And I was just starting.
Yeah.
So it was kind of, seeing somuch so much ease
Dr. Maryal Concepcion (12:40):
and I'm wondering if you could both talk
to, any, concerns, fears, orchallenges that you had after
deciding to start DPC?
Because Dr.
Hanson, you, at the time, likeyou mentioned, DPC was not as
much of a thing as it is now.
And Dr.
Suleman, you you're, yes, you'reseeing a better way to do
things, but especially forsomebody who's graduating
(13:00):
residency when most people go toemployed medicine in a corporate
situation I, I would wonder ifeach of you could share any
challenges or fears you hadbefore you started your DPC
journeys?
Dr. Karl Hanson (13:12):
the challenges and fears I had.
The apprehensions, let's say,were that you were taking a.
Steady book of business.
Mm-hmm.
'cause you have to run a smallbusiness, means you have to pay
bills and et cetera.
And I was going to just throwall those 10 90 nines away from
the CCAs and, and just trust andhope.
(13:35):
That a sizable fraction of mypatients would stay, sign up
with me.
So some of it is a personalreflection is that if, what if
nobody signs up?
That's not just a monetaryinsult Of course.
But that could be sort of apersonal gut punch that nobody
wants to stay with you.
So when I made the decision,which was a relatively rapid
decision after going to the 2015DPC summit, after two months, I
(13:59):
was all in.
Primarily, most of the anxiety Ithink was my wife was.
Not quite comfortable.
And we were both nervous, maybenot nail biting, but there was
that apprehension about takingan established business and
leaving and changing the model.
Yeah.
I think that was a majorapprehension.
Otherwise the, the positiveaspects of it was what
(14:22):
maintained the drive to continueand actually pull the trigger on
it.
Dr. Maryal Concepcion (14:25):
That's awesome.
And I will ask here, what endedup happening once you
transitioned to DPC?
How many of your patients said,great, what you just tell me
where I need to sign, what Ineed to pay and how many of
those people were, asking about,like, what are you doing and how
many of those people weresaying.
Nope, no insurance.
Not going
Dr. Karl Hanson (14:45):
well, the first several months leading up to the
actual check, when I put out theannouncement, I would casually
talk to my patients,hypothetically if somebody does,
et cetera.
So I was getting it a vibe or afeel for it before I really came
on the final decision.
So, it's hard to give apercentage Because you don't
know, if you see a person once ayear, once every three years,
(15:05):
are they your patient?
But I, I know it was, it wasrevenue neutral for sure.
In other words, the income Ilost from 10 90 nines.
Yeah.
Not coming in from Medicare andet cetera.
Compared to the enrollment thatI have, it was, it was a little
north of actually revenueneutral.
So I don't know.
I never actually went back andcalculated.
(15:26):
I'd probably say maybe I had a.
35% conversion rate, maybe 30%.
That's fantastic.
But I never really drilled downon it'cause it didn't matter.
Yeah.
Just moving forward.
Dr. Maryal Concepci (15:36):
Absolutely.
And how many patients did youstart with on day one?
Or did you, onboard them slowlyso you didn't have all of your
patients just transitioningover?
Because some of those, somepeople out there are concerned
about that in terms oftransferring their private
practice to DPC, like Dr.
Michael Chun has shared on thepodcast before.
But what was it like for you,because you owned your business,
(15:59):
you owned those records, andthen you just were doing a
different business model?
Dr. Karl Hanson (16:04):
The bulk of my patients at the first month or
first instant of direct primarycare practice were patients that
I already had charts on whoalready had a relationship that
were just moving over from myprior sole proprietorship to my
to Infinity Health.
So these were people that.
(16:25):
Didn't have to be all of asudden taken in on the first
month.
Mm-hmm.
So the people that signed up, Imay have actually just seen them
literally a month before in theinsurance based model.
I didn't face that challenge ofa, a large volume of people
coming in that were new to me oranything.
Dr. Maryal Concepcion (16:43):
That's really helpful because as, as we
go forward, there will be peoplewho are wearing very similar
shoes as you were when youtransitioned into DPC.
So, Dr.
Silverman, you're graduating andyou're looking at your
co-residents, you're looking atthe classes before you you're.
Probably hearing a lot ofphysician recruiters'cause I
sure did.
(17:03):
What was going on in your mindwhen it comes to challenges or
fears or apprehensions about theworld ahead of you when it came
to DPC?
Dr. Samia Suleman (17:11):
I had done my year in Ireland two years in
Ireland.
And so I had come back once Ihad came back and so.
My apprehensions beforetransitioning to DPC.
Were, is anyone gonna join?
Is anyone gonna continue?
Yeah.
Took a lot of deep breaths.
I remember walking outside and,can I do it?
Can I pull the trigger?
It was, and I, I'm still workingon this and it's, it's not
(17:32):
selling yourself short.
And a wise person tells me that.
And that echoes with me all thetime.
And it's remembering not to tellyourself short.
It's completely a journey.
And I think you get thereaffirmation once you see your
patients.
Yeah.
And once you get the, theaffirmation from them that they
are so happy.
Yeah.
They're so thankful.
They are so grateful and itpushes you forward and it says,
(17:55):
I am doing a great service.
They are happy and it
Dr. Maryal Concepcion (17:59):
just keeps you going.
Amazing.
And Dr.
Hanson, I'll ask the samequestion of you.
When did the discussions withyour wife change in terms of we
got this.
Dr. Karl Hanson (18:09):
Well, the, the DPC summit I'm referring to was
in the summer of 2015.
Mm-hmm.
And may mentioned before thatwhen I was there, I was telling
myself, I'm not doing this.
This is not for me.
And within 30 days, 60 days,that turned 180 degrees.
Yeah.
And of course we talked a lot.
My wife and I talked a lot aboutit.
(18:30):
And, fortunately she's excellentlistener and, and excellent
advice giver.
And good advice, not just anyadvice.
So, we came to our conclusionpretty rapidly.
Mm-hmm.
Within the first few monthsafter the summit.
Then there was a bit of theangst about the, the, the bells
and whistles and the particularsof setting it up and how to
(18:50):
write the letter and when to,that kind of minutia, if you
will.
But the, the major, the majorpsychological transition took
place within.
A few months after the summit.
Dr. Maryal Concepcion (19:04):
And I'm wondering here if now you guys
can talk to us about Louisianabecause Louisiana is different
from Ohio, is different fromCalifornia, when it comes to
what the healthcare access islike, what the quality of care
is like, who provides thehealthcare?
So talk to us about Louisiana asa state in terms of, what, what
(19:25):
is the medical care like aroundhere, and especially around
Kenner and New Orleans area.
Dr. Karl Hanson (19:29):
Medical care in Louisiana, Louisiana's primary
rural, of course you could saythat about a lot of states.
there's, there's a fairlysignificant Medicaid population.
And the, in the suburban area ofNew Orleans, which is where we
are there, there's been anadequate selection of primary
care physicians.
I think that that's been okay.
(19:50):
Mm-hmm.
I think the, the change has beenmore recently where hospital
systems have, have gobbled uppractices and have also changed
their model to a nursepractitioner based type of
primary care where it, it'sdifficult for patients to
(20:13):
actually Interact with their MDor do mm-hmm.
Without some layer ofinsulation.
And then of course urgent carespop up the, with, with, with is
a poor model because you'reenticing people to, to get
lesser care Medicaidindividuals.
I would say, and, and I wouldpreface it, Medicaid individuals
(20:36):
are some of the most fun folksto take care of because a lot of
people who have Medicaid, theymay not be able to get an
appointment with their, withtheir physician for a month.
Yeah.
Or three weeks at the soonest.
And so, we all know in themedical world what that can lead
to.
So it's nice to be able toreally help somebody that on
(20:57):
the, on the day of theirillness, not three weeks after
their illness.
Dr. Maryal Concepci (21:01):
Absolutely.
And how about you, Dr.
Soloman, when it comes to whoyou saw in residency?
Because as Dr.
Hansen's talking about morerecently.
Nurse practitioner,non-physician provider models.
That is absolutely a thing we'reseeing in most states.
And when it comes to Medi-Caland California Medicaid around
the country how was it for youin residency just
Dr. Samia Suleman (21:23):
It was a mixed population that we saw in
residency.
Mm-hmm.
But it majority were Medicaidand, yeah.
And, and and just to talk abouthow that translates to DPC
practices.
We have a mixture of patients.
Mm-hmm.
So we have patients with deepMedicare, Medicaid, Medicare no
insurance at all.
So what I love about DPC is youcan see a wide range.
It's not just, that we areseeing like a concierge model
(21:46):
that it, we're only seeing superwealthy patients mm-hmm.
Or anything like that at all.
We're seeing a wide range ofpatients who are interested in
Dr. Maryal Concepcion (21:54):
great care.
Dr. Karl Hanson (21:56):
Yeah.
Dr. Maryal Concepcion (21:57):
And yes, I, I love that because it really
highlights how insurance is nothealthcare.
Right.
And that is something that weare educating people about every
single day so I would love ifyou guys could talk about new
patient coming to the practice,has maybe ish heard about direct
primary care.
But is very much still, like, Ibelieve insurance is healthcare.
(22:18):
How do you guys talk to them?
A lot of people are, we'repracticing their elevator
pitches at the DPC summit, so Ilove how you guys talk to new
patients about this practiceversus the fee for service
world.
Dr. Karl Hanson (22:30):
So talking to new patients, people that have
joined us somehow or another,they've already had the
discussion or, or talked to, notnecessarily us.
Mm-hmm.
But a friend or family member.
Sure.
Who's engaged with us.
So somehow or another out therethe friend or family member has
already done the elevator speechfor us.
(22:50):
So at that point now when theycome in for their initial visit,
sometimes it's meet and greet.
Yeah.
But usually they'll just join.
Yeah.
They know.
And, and now we're just sort ofembellishing and enhancing what
the specific details are aboutthis.
'cause maybe they have somemisconception or something like
that.
But I, yeah.
A lot of the ones that getreferred by others, the, the
(23:11):
others have done a fairly goodjob, word of mouth of bringing
them up to speed.
That's, and that's really great.
Now the sale.
If you will, to individuals whohave no contact.
Yeah.
We all know that game becausethat's, it is sort of like three
levels of elevator speech, sothe one between floors one
through 10, 10 to 20, 20 to 30.
(23:33):
So there is a bit of a challengein that.
Yeah.
We still have people that whenyou briefly mention it to,
they'll say, oh yeah, I have afriend of that.
You're M-D-V-I-P.
And so sure we all have to facethat battle as of doing that
part.
But yeah, the patients that comein, they've been, they've been a
little education already fromtheir friends or family member.
(23:54):
Yeah.
Dr. Maryal Concepcion (23:55):
And on that point, the M-D-V-I-P-I,
I've definitely heard that a lotmore while in Louisiana compared
to in California.
And I'm wondering how do youguys differentiate?
Because in usually we hear, oh,it's concierge, but how do you
guys specifically talk to thedifferences between M-D-V-I-P
and direct primary care throughindependent physicians?
Dr. Karl Hanson (24:14):
Yes.
The thing is he said, oh yes, Ihear Dr.
Hansen that you're, I see you'rein concierge.
So I have to say, well, maybethe umbrella term concierge, but
probably you're referring to amodel that's a national company
called M-D-V-I-P.
Yep.
And then they'll acknowledgethat and I, and I'll just tell
them we don't double dip.
(24:35):
Yeah.
We only get the monthly feefrom, from the patient as per
contract.
And that includes all services.
Mm-hmm.
We do not do any extra billingor collecting for, for visits.
And specifically in Louisiana,by law, we do not collect, we do
not bill any third party.
(24:55):
Mm-hmm.
We do not bill insurances.
So it doesn't matter to us whatyour insurance is.
Yep.
I'm not sure that that promotesdirect primary care so much.
That's kind of more of atechnical definition.
But yeah, we do have to addressthat.
When we get lumped into everyother form of concierge.
Sure.
Dr. Maryal Concepcion (25:13):
And I think it's important, especially
now with the passing of thePrimary Care Enhancement Act as
part of the quote, big beautifulBill.
This is where, Jake Hess of theDPC coalition has said, and I
agree this is where the workstarts, because now that we're,
even more visible than beforenow that HSAs can be used
without question for DPC memberagreements this is where I
(25:37):
believe we have to keep fightingfor this is what we actually do.
We are not the same as fee forservice.
We are not the same as conciergemedicine.
And this is for everydayAmericans to access the same
level of care without having aseven figure salary or without
having to go through youremployer.
So, Dr.
Sillman, how about you?
Because as Dr.
Hanson's speaking and, and youdid have you, you mentioned the
(26:00):
concern about like, willpatients join.
How has your elevator pitch, soto speak, changed over time?
Because I, I'm, I'm assuming youhave to have some patients who
knew Dr.
Hansen's model, who said, oh mygoodness, like there's a new
doctor.
He might be on a waiting list.
Like, I, now I have a chance andI'm sure is heck gonna take it.
Dr. Samia Suleman (26:20):
Yeah.
So my elevator pitch is everevolving but essentially it's it
goes with we provide theservices that you need.
I'll start off with the issue.
Are you having trouble speakingto your, getting in with your
physician?
Are you having trouble?
Do you find that it's hard toget an appointment when you need
an appointment?
And we present the problem, tothem and they'll say yes,
(26:41):
actually.
My mom, I can't get her in.
And by the time it is time forher to get in, it's, she has to
be admitted.
So, I start with, I start withthat, and then I work around,
well do, with, with DPC what wecan do is, you have access to
your physician seven days aweek.
You have a personal physician.
It's bringing back the, thedoctor patient relationship
(27:02):
essentially.
Yeah.
And they're very attracted tothat.
And most of my patients love thefact that they can message me,
Hey, Dr.
Tillman, I'm having sinusitis.
Sure.
I'm having, I feel like I'mhaving an ear infection or, and
I will respond to them rightaway.
You can come in.
We have same day, next dayvisits.
We have a very affordablemembership fee and along with
(27:23):
that we include our labs and wealso dispense.
So there's so many perks and.
They are just, they, they lovethat.
Dr. Maryal Concepcion (27:31):
Yeah.
And when you talk aboutmembership fee, how did you Dr.
Hanson create the membership feeand has it changed over time?
Because nowadays people saylike, oh, the, three clinics
around me they charge this much,so that's about what I'm gonna
do.
But how did it work for you
Dr. Karl Hanson (27:47):
At the time that I was doing the, the
transition into direct primarycare?
I recall seeing some publisheddata, what the average fee was
throughout the country.
Mm-hmm.
And I was, as I recall, it was$77.
Mm-hmm.
Something to that effect.
And then I factored in.
Okay, well that also includesplaces in the northeast and the
(28:10):
coast and stuff like that, wherejust things are more expensive.
I chose less than that.
Mine was$65 a month.
Mm-hmm.
I maintained that for a longtime.
About two years ago, I increasedit to$75 a month.
And I don't want to go more thanthat because part of this, I, I
(28:30):
do know that I, that we could becharging more.
I do know that.
But part of the concept is that,do you want to keep this at the
level that is attractive topeople?
That separates us from thetypical concierge model and that
the average person would find itclearly affordable.
(28:50):
Mm-hmm.
And anyway, so I, that's how itstarted.
It was probably because I lookedat the, what the average was in
2015.
Sure, sure.
Whoever published that, I don'trecall who that was.
Yeah.
Dr. Maryal Concepcion (29:02):
And in terms of the concern about
affording direct primary care,we've had Dr.
Stephanie Phillips on thepodcast, she's in the poorest
region of all of Georgia, andher patients are paying on
average$75 per month to makesure they have access, as Dr.
Silverman talked about to theirdoctor who they know, versus one
trip to the ER is more than 12months at$75.
(29:24):
So, can you guys talk to usabout the, the money
conversation when it comes tothe patient who says I, that's
too much.
I, I can't afford that.
Dr. Samia Suleman (29:33):
definitely talk about how your Netflix
bill, your your electricity,just, just things that you do or
going out to dinner or thingsadd up and you don't even
realize it.
But also there are paymentplans.
There are things we can do to,to prioritize and we try to make
sure that we emphasize that yourhealth is a priority mm-hmm.
(29:55):
For patients.
And once they realize, what thebenefits outweigh, saving a
little bit more so that I canspend on my health, it makes a
big difference and it goes along way for them.
Dr. Maryal Concepcion (30:06):
Mm-hmm.
And.
Have you guys heard the, well,healthcare's too expensive
because I usually have to pay$200 for a thyroid lab.
Like, I, I, I can't add anothermembership fee on top of that.
What do you say to those people?
Because they aren't necessarilyaware that you can purchase lab
and imaging at, prices that arewholesale like you could at the
grocery store.
Dr. Samia Suleman (30:25):
Right.
Dr. Maryal Concepcion (30:26):
So we,
Dr. Samia Suleman (30:26):
we do have contracts with, with the labs
and we do let our patients knowthat.
And a lot of times our patients,that that is a big draw for
them.
But there are people who do havean issue with the the comp, the,
the monetary aspect.
And for them it might not be agood fit at this time, but
(30:47):
they're always, they always haveyou in the back of their mind.
And that's the other thing isthat.
Not everybody.
It's not for everybody.
Not saying that, I mean, we do,do, we do will make concessions
for people and like, again, likepayment plans, things like that
are always options.
But if someone truly has aproblem and, and can't, it's
nothing that we had to force onthem.
Dr. Maryal Concepcion (31:08):
Yeah.
Dr. Samia Suleman (31:09):
And
Dr. Maryal Concepcion (31:09):
I think this is really powerful because
we own our own businesses.
We're able to not have to waitfor, 16 committees to tell us
it's okay or for some code tochange to have a covered
service.
It, it's when I remember when Iwas in fee for service, I would
just call a family because theirfamily member was just diagnosed
with cancer and they're the careprovider and they're losing
(31:30):
their minds as well as thepatient.
It's like, I have no idea whatcode that is, and now I'm
grateful that I don't have tocare.
Yeah.
It just do the things and youjust get to be a doctor.
So I'm, I'm wondering here interms of.
You guys partnering together?
I love this because we need moreDPC doctors out there.
There's not enough and it is notthat we are creating the
(31:51):
shortage.
The short is being, shortage isbeing created, a physicians
being out there because of thesystem a hundred percent.
If you do not agree with that,please leave me a voicemail.
But when it comes to you guyspartnering together this is
absolutely a thing.
You do not have to open up yourown DBC.
It is not shameful to justpartner on with somebody.
(32:11):
There's people doing just locumscoverage.
Dr.
Brewer Everly had somebody comeon at Fisher Health Clinic and
cover as a locums while he waswaiting to graduate residency.
And so, I'd love if you guyscould talk to us about how you
guys made this partnership atInfinity Work and decide to do
it.
Take that,
Dr. Karl Hanson (32:32):
yeah, I'll take this.
The.
So I really believe in directprimary care and that it's a
wonderful privilege to be ableto take care of somebody.
Yeah.
And I did want to see directprimary care expand mm-hmm.
To have more offerings.
And technically I wasn't what Iwould consider full, but I knew,
(32:55):
I knew Dr.
Samia from before.
Mm-hmm.
And their, her work ethic andher just ethic in general.
And even though she didn't havea, this large subset of patients
to import to the practice, Isaid I wanted to get somebody
that was, that was conscientiousSure.
And kind of understood, what theproblem was out there.
(33:18):
So that was really the genesisof the of the partnership.
You want to get somebody who's apartner that you can trust who
shares the same ethic.
That's kind of more importantas.
As opposed to what residencythey came from or this kind of
thing.
Yeah.
So that was the genesis part.
So we could, we could expand theofferings of, of, at that time,
my company, infinity Health,expand it to, to other people
(33:42):
out there in the world.
So that was, that was really thegenesis from me.
Dr. Maryal Concepcion (33:46):
Yeah.
And how about for you, Dr.
Soloman?
Because when a person is lookingto join a DPC I, I, I wonder
what your thoughts were.
Oh, I, this apprehension is lessbecause he's already open.
What, what, what were examplesof things you were thinking
about when you were when youwere looking to, and when you
(34:06):
finally decided to partner on aninfinity?
So, I, I brought over maybeeight
Dr. Samia Suleman (34:11):
patients from when I transferred over.
And but having a great mentorlike Dr.
Carl was, was.
Is key.
Absolutely.
'Cause I could see how how hewas working with his patients
and how his patients areextremely loyal and, he has a
great following.
And for me it's an inspirationto work with him and to, to
(34:32):
share, to be partners and be inthis partnership with seeing the
work ethic and seeing how, how Itreat my patients.
And it didn't, it's, it'staking, it does take it, it is
taking longer than I hadexpected, but my panel is
growing and I'm happy to saythat my patients are very
satisfied.
And, they give theirtestimonials and they, they're
(34:54):
very pleased with the model.
It is just a lot of more ofawareness that we have to get
out that DPC does exist and thatthere are different options
other than the insurance basedmodel.
And I think that's somethingthat we all need to work on.
Yeah, absolutely.
Dr. Maryal Concepcion (35:09):
And I would love, because you are
partnering I would love if youcould talk to the audience about
what things do you recommendpeople either think about when
they're joining on or thinkabout when they're hiring.
Dr. Karl Hanson (35:23):
it's like EMR software.
No matter how many times youlook at the demo, you never
really know until you're threemonths into it.
And then you say, what justhappened?
And, and that's the same waywith with finding out who's a
good partner.
So again, my advantage was, isthat I had known Dr.
Samia for years one way or theother before this.
(35:46):
Mm-hmm.
So you, you get a better sense.
So I would say in looking for apartner is to look somebody who
shares the work ethic and theethic towards patient care.
Mm-hmm.
And it's, I, I, I didn't giveher a quiz.
I didn't have her take the uh,licensing exam again or anything
(36:09):
like that.
So you can't really go with thatbecause it's a direct primary
care is a mindset, it's anattitude, it's an
acknowledgement of what's wrongwith the system.
Yep.
And who the players are who aredegrading the system.
Mm-hmm.
It's a bit of a rebelliousattitude.
So you, you're looking more forpersonality characteristics in,
(36:30):
in my opinion,
Dr. Maryal Concepcion (36:31):
and how about you in terms of what
questions would you recommendpeople asking if they're looking
to partner on at an existingDPC?
Dr. Samia Suleman (36:39):
Again, I wouldn't say there's questions
to ask, but more is it a goodfeel?
Is it a good mix?
Do you, do you get along?
Do you feel like there's amutual respect?
It's more of a feeling.
Dr. Maryal Concepcion (36:50):
I think that, than any questions.
And I'm wondering if you guyscan Talk to us about the legal
structure of the DPCpartnership.
Did you guys partner or is oneof 10 99
Dr. Karl Hanson (37:01):
it a full partner?
Yeah.
The, the, when I invited her in,it was the full partnership.
There, there were those, and,and I did research employee 10
99 type of relationship.
Mm-hmm.
But I, I felt that.
I, I just felt like it wasbetter just to demonstrate that,
(37:23):
that confidence and that trustmm-hmm.
By taking, taking, creating afull partnership.
And, and I'm glad it it's beenthat way.
I mean, I, I, I don't, but thatagain, that's because I've had a
chance to know her before,wasn't an acute situation where
I had to take time to assesssomebody's character, if you
will.
Dr. Maryal Concepci (37:43):
Absolutely.
And Dr.
Tom White, very similarsituation as he intentionally
looked for partners and notemployees.
Just because that, that's alsowhat he believed in, in terms of
somebody having a career that isliterally just DPC and they have
the autonomy same as us who openour DPCs on our own.
When it comes to benefits foryourselves health plan benefits
(38:05):
retirement, how do you guysaddress that at Infinity?
Dr. Karl Hanson (38:09):
Well, I am.
66.
So I'm a Medicare.
Before that I was on a healthshare Uhhuh.
I used to be on, my wife and Iused to be on one of the typical
Bcca policies.
Yep.
And we jettisoned that several afew years ago.
Mm-hmm.
And joined one of the healthshares.
My wife has still on the healthshare, but I aged into Medicare.
(38:33):
So, and I have not joined aMedicare Advantage plan.
I'm just trying Medicare.
So, that's, that's how I handle
Dr. Maryal Concepcion (38:40):
And what about savings for retirement?
Dr. Karl Hanson (38:42):
I'm A-D-P-C-D doctor, why would I wanna
retire?
The saving, well, I've long hadas a solo practitioner, a simple
IRA and that's what we havehere.
Yeah.
So now we're all, we all are inthe, the simple IRA.
Dr. Maryal Concepcion (38:56):
Yeah.
Fantastic.
And how about you, Dr.
Silverman, for your healthcare?
And also did it provide you asense of security knowing that
there was this addressing of anIRA?
Because some people are comingon and they're like, we don't
offer a 401k, we don't offer anyretirement.
We don't offer healthcare.
How was it for you?
Yeah, for my
Dr. Samia Suleman (39:14):
family we do have insurance currently not
very happy with it, but youknow, we're looking at health
shares and things like that now.
Mm-hmm.
As far as of course there'ssecurity and, and the having a
retirement plan and things likethat.
So that, that's always anattraction also.
It gives you a sense ofsecurity.
It gives you a sense of this issomething that I'm working
(39:34):
towards and this is for myfuture and for my family's
future.
Yeah.
Awesome.
Dr. Maryal Concepcion (39:39):
Now, this weekend, not only was it the DPC
summit, but also the LouisianaFamily Academy of Family
Practice Medicines state Summit,which is Dr.
Hanson and I talked about thisbefore that, this is probably
unusual that they have a stateand a national event at the same
weekend, but you were goingbetween the two.
(39:59):
And I'm wondering if you cantalk to us about.
What it's like on the LAFP, Ialmost said CAFP, the LAFP side
of things because I wanna likeenvisioning, just asking you
that I'm like, there's strangerthings and then there's the
upside down.
So I would love if you couldtell us your experience.
Dr. Karl Hanson (40:20):
Okay.
So this would be the the secondpodcast.
The, the LAFP.
So I've been a member of theLouisiana Academy of Family
Physicians for 41 years, and I'minvolved with them, not
administratively, but I'mactually in charge of a program
of developing a module, kind ofa go-to module for people that,
(40:43):
that physicians that wanna startan independent practice.
Fantastic.
Whether that's coming outtaresidency or whether it's
leading, leaving the, indenturedSI mean, employment.
So I, I have a lot ofinvolvement with the LAFP and
lots of friends over there.
And it's kind of my homeorganization, if you will.
It was kind of fun going backand forth between that and a
(41:04):
direct primary care conference.
'cause there's quite a contrast,quite a contrast.
The everything from theexhibitors to the atmosphere to
the presentation.
Now granted, one's a nationalorganization, one's a state
organization, and the stategroup does a very good job at
their, at their assembly.
But yeah, it's a different vibe.
(41:25):
There's so many ways to describeit as a different vibe, but both
are valuable.
But the, the DI Direct PrimaryCare summit just kind of has a
way different energy.
Yeah.
But that's probably the best wayI could describe it.
I, I, I, I think that.
There was just a mistake withthe A FP that they scheduled it
(41:48):
the same day and it's neverhappened before.
Sure.
And it's not that way next year.
Yeah, they're separated nextyear.
Yep.
Dr. Maryal Concepcion (41:53):
And how about you, Dr.
Soman, because clearly you wereat the summit as well, but when
it comes to talking tocolleagues it, it is a very
different conversation.
Sometimes it's reallyuncomfortable to have talks
about DPC because some peopleI've heard, like they literally
will say it's because of DPCthat we don't have enough
physicians.
It's because of DPC.
And I'm like.
(42:15):
Say, say all the things, say allthe things, and we can prove as
a movement that these things arenot correct.
I actually have not
Dr. Samia Suleman (42:21):
run into that at this point yet.
People are actually fascinatedby our model and, and what we're
doing.
So I get a lot of positivefeedback and I'll get a lot of
questions about how does it workand, how does one transition and
things like that.
A lot of a lot of doctors arefed up with the system.
Absolutely.
Dr. Maryal Concepcion (42:39):
Yep.
So, Dr.
Hansen, this is definitely aquestion for you because of your
involvement 41 years at the asan LAFP member I, I definitely
see now, way more education onthe California side of things of
what DPC is, especially for thepeople who are, very seasoned in
fee for service.
Very, we only do fee forservice.
(43:00):
We could never do DPC.
Kaiser will never shut down thenaysayers.
When it comes to.
The challenge of getting DPCrepresentation at the state
level.
When it comes to even inclusionin conferences, how do you bring
the voice of representation ofdirect primary care physicians
(43:21):
and what direct primary carephysicians in existence means
for this academy.
And how do we help DPC doctorsin addition to you creating
education resources about themodel at your state level?
Dr. Karl Hanson (43:36):
I think the major hurdle at the Louisiana
Academy Family Physicians is, isfor them to weave DPC in as a,
as a forefront model.
Mm-hmm.
There are, there are certainthings that would be in conflict
(43:58):
with, for example, the typicalsponsors mm-hmm.
That are at that, for example,of course at the LAFP event,
some of the exhibitors includedinsurance companies, employers,
et cetera.
Obviously there was none of thatat the Direct Primary Care
Summit.
Yeah.
And I think.
Sponsorship may play a role inthat.
(44:19):
Sure.
I've tried to address that andprobably I should be a bit more
aggressive in a polite way with,with the local academy about
bringing up practice modelsmore.
However, like I said theresolution that I presented to
the academy two years ago todevelop this independent
practice model, it was wellreceived.
(44:41):
That's great.
And it was, it was embraced, Iwould think.
And we're working on it.
It's not ready for prime timeyet.
And I wish I probably could havedone it on my own in less than a
year, but you have to go throughthis system.
So I think it's getting there.
Also recognize there's a lot ofdocs in employed practice that
(45:02):
are in the Stockholm syndrome.
Mm-hmm.
And, and part of the Stockholmsyndrome is that you almost deny
the existence that there'ssomething better to do.
Yeah.
And.
You certainly don't wanna, at notime do I demean anybody who's
an employed practice.
'cause it's almost acompassionate empathy Sure.
(45:23):
About what they're goingthrough.
So you, you don't want to beaggressive.
You kind of want to just keepyourself out there, offer
yourself as a resource.
It's kind of like, I'm here ifyou need me.
Mm-hmm.
Type of thing in private.
And I had, I had two employedphysicians come talk to me at
the LAFP in private about whatis this?
(45:44):
Yeah.
And what can I do to get there?
So that's kind of what the levelis now that, we're there for you
if you need us.
I'm not gonna berate you.
We understand we've been there.
So, that's kind of the level ofposition I take.
Dr. Maryal Concepcion (45:58):
Yeah.
And I, I love this because nextI wanna ask about the Louisiana
Direct Primary Care Coalition,because I think that what Oz, we
are resources out there.
I think that there's such aswell in the desire to know
about DPC from physicians, newexisting attendings, attendings
who've been in practice fordecades.
And this is why, like we createdour California DPC summit.
(46:22):
Extremely important to know howdo you do DPC in your state.
And so tell us about theLouisiana Direct Primary Care
Coalition and where do you seethat going in the future?
Dr. Karl Hanson (46:32):
When I started infinity Health in 2016, the
following year, I created acoalition.
We only had probably half adozen DPC doctors in the state
at that time.
And so I, I created theorganization but did nothing
with it.
'cause I felt like we didn'thave any critical mass.
Mm-hmm.
And it, I converted to a a 5 0 1C3, but it's still, nothing has
(46:56):
taken place with it.
Well, right now in the state, wehave 20 physicians that provide
direct primary care to theirpatients.
Probably 17 or 18 practices, butsome of those practices have, a
couple or few physicians.
And then also with the fact thatthe, when the big beautiful bill
was debated, there was adiscussion about Medicare.
(47:18):
Mm-hmm.
Medicaid, excuse me, and DPC.
Mm-hmm.
And then of course there was thewhole HSA insertion into that
law.
And so this year I felt it wasworthwhile to actually, that we
had the critical mass to getthat going.
So the coalition it and we'reforming our board as we speak,
the coalition is, is there topromote direct primary care.
(47:41):
In Louisiana to demonstrate toLouisiana Department of Health
that we can provide excellentservices to the Medicaid
population and make their healthbetter and save the state money.
And also to promote theproliferation or adoption or
(48:01):
education of direct primary carewithin our academic facilities.
So it's not a coalition that'sgonna be setting rates or
telling what DPC doctors do.
Mm-hmm.
That's not our vibe.
Yep.
We're, we're, we're all lionsand cats, not sheep, so we don't
want people telling us what todo.
Sure.
The coalition's certainly notgoing in that direction.
(48:22):
But anyway, the major focus isto promote DPC in the state.
And to offer our services anddemonstrate to the state.
And finally, in Louisiana, wehave a, the Department of Health
is very friendly to that andvery look forward looking.
Was really great to talk to theSurgeon general and the
assistant surgeon generalamazing discussions and we want
(48:45):
to go ahead and promote that.
'cause we think we have a lot tooffer.
Dr. Maryal Concepcio (48:48):
Fantastic.
And where do people go to learnmore about specifically the
Louisiana Direct Primary CareCoalition and does it also
accept medical students andresidents?
Dr. Karl Hanson (48:58):
Right now we don't have membership.
The website is a d pcc.com.
But, and we, we, we don't evendo dues or anything like that.
So, there's gonna be more tocome, if you will.
Once we, once we have some.
Sort of strategy meetings andfigure out where we want to go.
Mm-hmm.
(49:19):
But the, the website is open, Imean, any, and there's a contact
email address, et cetera.
So, And people have contacted methrough that to discuss direct
primary care in general.
Dr. Maryal Concepcion (49:29):
That's great.
And I think it's so important,especially now because.
That was lovely that two peopletalked with you in private at
the LAFP summit, but it is soimportant to have resources out
there.
So many people find rotationsjust networking through our cali
dpc.com site for our CaliforniaDirect Primary Care Coalition.
So I think it's so importantthat if you're listening and
(49:51):
you, are having thesediscussions anyways, it's really
great to come together because Ithink that even more so in the
future, again, like I mentioned,the work really starts now.
This is how we really cometogether as physicians
protecting the physician patientrelationship.
So, I would, I
Dr. Karl Hanson (50:08):
would love to graduate to where you all are,
where you're having a CaliforniaDPC summit.
So I'll be reaching out to youall to figure out what I don't
need to reinvent the wheel, whattips and tricks that you may
have.
Dr. Maryal Concepci (50:22):
Absolutely.
So can you tell us what do yousee for the next, year, three
years, five years at InfinityHealth DPC?
Dr. Karl Hanson (50:30):
once, once our panels get full or are starting
to approach that I would likefor Infinity Health Direct
Primary Care to be more involvedwith, with teaching residents.
Mm-hmm.
To create a center of excellenceof some type here where, where
residents can rotate with us inmore depth and detail.
(50:54):
Of course, a lot of that'scontrolled by the the graduate
medical age education board howmuch, what residents have to do.
And some of that's actuallygotten, we're a little bit worse
this past year.
So we're gonna be, have tofighting that battle.
But it's, it's the same thingabout talking to other
practicing physicians, talkingto residents and just say, look,
hey you, you don't have to juststart signing up with big boxes.
(51:18):
There's a real option that youcan go through, and there are a
ton of people out here,including Infinity Health and
myself and Dr.
Samia, that we will help youevery step of the way in
developing your business anddeveloping your practice
Dr. Maryal Concepci (51:34):
Incredible.
Dr.
Sullivan had to step out, butthank you so much on behalf of
my DPC story for both Dr.
Hanson and Dr.
Sullivan.
Thank you guys so much forsharing your story today.
Dr. Karl Hanson (51:43):
Oh, thanks for having me.
This was, this was excellent.
Dr. Maryal Concepcion (51:48):
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
(52:09):
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.
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 fingertip.
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.
Dr. Samia Suleman (00:53):
DPC means to me, freedom, autonomy, and
having the best care for mypatients.
Dr. Karl Hanson (01:01):
Direct primary care has the potential to change
medical care in the UnitedStates, like no other
institution or facility can.
Primary care physicians have theunique ability to break away, to
start their own practice, toreject the notion that big
(01:22):
hospital systems are necessary,big insurance companies are
necessary, and maybe even thatthey're hurtful.
That we can reestablish therelationship with the patient on
an individual basis.
And we as a group of primarycare physicians in the direct
primary care model, can guidethe country to the healthcare
(01:44):
that we think is best.
We know best.
We see people every day.
Dr. Samia Suleman (01:48):
I'm Dr.
Samia Solman
Dr. Karl Hanson (01:50):
this is Dr.
Carl Hansen of Infinity HealthDirect Primary Care, And this is
our DPC story.
Dr. Maryal Concepcion (01:56):
Welcome to my DPC story this week, guys.
I'm so excited because I amdoing this interview in person
with Dr.
Carl Hanson and Dr.
Samia Suleman, who are atInfinity Health, DPC here in Can
Louisiana.
I have not been to Louisianabefore this trip, and it is so
exciting that we get to chatright after the energy of the
DPC summit.
(02:16):
So thank you both so much forjoining us today.
Dr. Karl Hanson (02:19):
Thank you for having us.
Dr. Samia Suleman (02:20):
We're so happy to be here.
Dr. Maryal Concepcion (02:21):
Dr.
Hanson, I'd love to start withyour story of the, the, the day
that you opened DPC inLouisiana.
What was the environment like?
Because there's a lot more DPCsnow than there were when you
opened
Dr. Karl Hanson (02:35):
it.
It was an adventure.
It was not a common thing inLouisiana.
There may have been just oneother DPC practice that was
opened a few months before Iopened Infinity Health.
Wow.
So there was, some discussionabout it.
But quite honestly, at the timeI opened my practice, literally
the previous year, I knewnothing about direct Primary
care.
Dr. Maryal Concepcion (02:55):
And what year did you open?
Dr. Karl Hanson (02:57):
2016.
Yeah.
Is when I converted from myinsurance based practice to
direct primary care.
Dr. Maryal Concepcion (03:02):
And your insurance based practice, was
that a private practice whereyou part of a group?
Dr. Karl Hanson (03:07):
It was private practice.
I was in solo insurance basedpractice.
Yep.
Dr. Maryal Concepcion (03:10):
And what was your scope of practice and
how many years were you in thatprivate practice before
transitioning?
Dr. Karl Hanson (03:17):
I've been in solo practice since 1990.
Mm-hmm.
Spent a couple years outtaresidency working for a, a
multi-specialty clinic and thengot irritated at that and went
solo.
And I've been in the insurancebased practice ever since.
Yeah.
As a solo practitioner.
Dr. Maryal Concepcion (03:32):
because of that history, especially with
you going from a multi-specialtygroup to solo.
What did you see in terms of howinsurance was changing over time
at your practice and for yourpatients before you went to DPC?
Dr. Karl Hanson (03:49):
Well, there's a, a big story to that is I'm
actually one of the foundingphysicians of a Medicare
Advantage plan in the state ofLouisiana, and that started in
the late nineties as we builtthat plan.
In the process of being part ofthat plan, I was witnessing more
how the sausage was made.
(04:09):
About the different regulatoryburdens that are gets placed
upon us.
And how it kind of became a, abehemoth, and then that just
amplified some of the.
The, the game, I never gotinvolved in the RVU game.
Because I was never employed,but I did get to see more and
more that the whole CPTchallenging game was just not
(04:30):
something I wanted to continueto do.
Dr. Maryal Concepci (04:32):
Absolutely.
And how did you see it affectingaccessibility for your patients
once Medicare Advantage wentlive and once insurance, did
what it did over the last coupleof decades?
Dr. Karl Hanson (04:43):
Well, accessibility.
I even at the insurance days, Ihad a relatively small practice,
so I was able to see peoplewhenever I wanted to remember I
was my own boss.
So I could do that whenever Ipleased.
So accessibility was not a bigconcern of mine.
the major concern was that Ireally wanted to do primarily
(05:06):
patient care.
Yeah.
And not even be concerned aboutthe the administrative game that
we've all acquiesced to.
Dr. Maryal Concepci (05:13):
Absolutely.
So now I'll turn the mic over toDr.
Soloman because I'd love to hearyour, your foundational story
when it comes to what was lifebefore life at Infinity for you?
Dr. Samia Suleman (05:26):
Well, so I had the good fortune of meeting
Dr.
Carl relatively early in mycareer.
After residency I spent a year,my husband and I in Ireland.
I spent two years practicingmedicine out there.
So that was quite the changeand, it was a great learning
experience for the both of us.
Returning here I again, had thegood fortune of meeting Dr.
Carl and I was doinginsurance-based practice as well
(05:48):
as dabbling in a little bit ofDPC.
Mm-hmm.
Having a hybrid practice alittle bit.
Wow.
So we shared an office and I gotto learn a lot more about DPC,
how it works and I could seefirsthand all the troubles of
the insurance based practice thehassles, the, chasing after
trying to get paid, things likethat.
So, um, it was a, a greatlearning experience.
(06:11):
We joined forces about a yearand a half ago.
that was a great turning pointfor me.
I enjoy what I do so much now.
Dr. Maryal Concepcion (06:17):
I would love to hear what you saw and if
anything that you saw overseasin a different healthcare system
also impacted the way that youlooked for how you would
continue to practice when youwent back stateside.
Dr. Samia Suleman (06:32):
Well there was a lot of autonomy, so I
thought that was great.
There was a lot of room forlearning Where I was working.
I was at the University HospitalLimerick.
And it was an acute medicalunit.
It was a mixture.
You would have some people thathad insurance and then some
people that were funded by thestate.
You really didn't turn peopleaway which was great.
That included, seeing patientsfor DBTs, seeing, working up mis
(06:53):
it was a hospital-basedpractice.
Dr. Maryal Concepcion (06:55):
And when you talk about that you knew Dr.
Carl early on, I would love tohear what you saw from your eyes
and your perspective, because Ithink that this is a time where
medical students and residentsare really seeing what we're
doing because there's so manymore of us.
It's easier to find resourcescompared to when, when you
opened Dr.
(07:15):
Hanson.
So I would love to hear what itwas that was impactful for you
to see.
Especially for those listenerswho are new to this movement
whether they're, talking totheir friends or seeing their
attendings do DPC, what did yousee that helped inspire you to
eventually be a DPC doctorfull-time?
Dr. Samia Suleman (07:33):
During residency you had the option of
rotating with Dr.
Hanson.
I graduated 2014.
It was a new concept.
It was enticing.
It was, can this really happen?
So it was, it was a lot ofdifferent emotions
Dr. Maryal Concepcion (07:45):
Dr.
Hansen, I wanna turn the micover to you now because this is
fascinating to hear.
And you're you went to LSU forresidency yourself, correct?
Dr. Karl Hanson (07:53):
I did.
I went to LSU Medical School andthen LSU Family Medicine
Residency.
Yeah.
Yeah.
Dr. Maryal Concepcion (07:57):
And so I'm wondering similarly how I
asked about the insurance overtime engaging with residents
over time.
What have you heard from them interms of what am I going to do
after residency?
What is out there?
Am I able to be, you know, afull scope doctor if I wish to?
What are, what are some of thethings that you've heard from
residents because Dr.
(08:17):
Soloman was one of yourresidents before?
Dr. Karl Hanson (08:19):
Yeah.
In, well, when I talk toresidents and, and I'll go to
residency programs and give atalk and I don't talk about.
Thrombocytopenia.
Sure.
Or Antiga.
I talked to them specificallyabout how to start a practice.
Yeah.
Talk about the, the, the joys ofprivate practice and owning your
own business.
So that's actually been my focuswith interacting with residents.
(08:40):
The, the, what I tried totransmit to them is, again, a
lot of times as we're gettingclose towards the end, they talk
about finding a job.
Yeah.
And I just reiterate, reiterate,you do not define a job because
you make your own job.
That we have to quit looking atourselves, coming from a, from a
sense of, of barrenness orhelplessness, et cetera.
(09:02):
Mm-hmm.
That we need to assert ourselvesbecause we are the main cog in,
in, in taking care of patients.
So that has always been myfocus.
Biggest obstacle is that ofcourse, these guys and gals have
probably never run a smallbusiness.
Sure.
They're petrified, they're, theyhave debt overhanging.
There's nobody else thatsurrounds them, meaning in
(09:23):
academia or their hospitalrounds, who is giving them
information on how to start aprivate practice.
Yeah.
And the fact that not only is itpossible, but it's ideal.
Dr. Maryal Concepcion (09:34):
And when people are, mentioning these
fears about finances, about, Idon't have an MBA, how do you
start breaking down that, thatmindset of I'm just a physician.
I, I'm not a business owner.
Dr. Karl Hanson (09:47):
Right.
Yeah.
I, the main thing I say to run asmall business, you don't have
to have an MBA.
Mm-hmm.
You just have to be able to payattention to detail.
And the fact that you've made itthrough pre-med med school and a
residency.
Probably one of the things inyour talent stack is it'll be
able to pay attention to detail.
And know also that probably someof the people that you went to
high school with went, didn't goto college and right now are
(10:11):
running their own smallbusiness.
Totally.
So don't, don't diminishyourself, don't mean yourself.
And then just giving them therealization that, to become a
physician, you sort of haveblinders on.
You're not paying attention tosome of these business things
out there.
It doesn't mean though that youcan't pick it up in short order.
The first bit of advice I giveto them, when you're thinking
(10:31):
about doing a small business,don't think about the small
business and that fine detail.
Yeah.
Do baby steps.
Start a process first.
Think about what do you wannacall your practice and your
logo.
Sure.
And that's all.
Yeah.
And don't think, and once thatseed sort of gets planted, then
you're gonna start.
Inching up and learning bit bybit what goes on.
(10:51):
Then also I, it, I have an openinvitation if any of them want
to start a small business, smallpractice, I'll personally help
them.
With no consult fee or anything.
Just to walk through everything.
Yeah.
So
Dr. Maryal Concepcion (11:05):
that's incredible.
So, Dr.
Soloman after coming back fromIreland, what made you go the
route of leaning more and moreinto DPC versus opening your own
DPC versus just going fee forservice?
Urgent care?
There's so many pathways that wecan take as physicians, and I
also intentionally say thatbecause if you are worried about
DPC financially, definitelyhaving a side gig is one of the
(11:28):
ways to help finance A DPC.
But for you, what was yourjourney in how you made the
decision to become a doctor atInfinity?
So,
Dr. Samia Suleman (11:38):
I also come from a family of physicians.
My father's a surgeon.
My mother's a pediatrician.
My sister's an ob, GYN.
they all were in, very much insupport of me being in an
independent practice.
Sure.
My father's always been inprivate practice throughout, and
he has kind of been the heldout, not being bought out by the
hospital.
Yeah.
I do do wound care as well.
So I have a side gig amazingwith nursing homes and, and
(12:00):
doing some wound care there.
But the way I chose doing DPC isI had started with having some
insurance-based, patients andthings like that.
It was just the ease Sure.
And the attraction of not havingto worry about paperwork.
Not having to worry about allthis overhead, getting all these
prior auths, having all this,all this trouble with being
(12:24):
regulated so much.
And I would see the way Dr.
Carl would work and and hispatients everyone's happy, at
the end of the day.
And I would still have paperworkand stuff going on.
Sure.
And I was just starting.
Yeah.
So it was kind of, seeing somuch so much ease
Dr. Maryal Concepcion (12:40):
and I'm wondering if you could both talk
to, any, concerns, fears, orchallenges that you had after
deciding to start DPC?
Because Dr.
Hanson, you, at the time, likeyou mentioned, DPC was not as
much of a thing as it is now.
And Dr.
Suleman, you you're, yes, you'reseeing a better way to do
things, but especially forsomebody who's graduating
(13:00):
residency when most people go toemployed medicine in a corporate
situation I, I would wonder ifeach of you could share any
challenges or fears you hadbefore you started your DPC
journeys?
Dr. Karl Hanson (13:12):
the challenges and fears I had.
The apprehensions, let's say,were that you were taking a.
Steady book of business.
Mm-hmm.
'cause you have to run a smallbusiness, means you have to pay
bills and et cetera.
And I was going to just throwall those 10 90 nines away from
the CCAs and, and just trust andhope.
(13:35):
That a sizable fraction of mypatients would stay, sign up
with me.
So some of it is a personalreflection is that if, what if
nobody signs up?
That's not just a monetaryinsult Of course.
But that could be sort of apersonal gut punch that nobody
wants to stay with you.
So when I made the decision,which was a relatively rapid
decision after going to the 2015DPC summit, after two months, I
(13:59):
was all in.
Primarily, most of the anxiety Ithink was my wife was.
Not quite comfortable.
And we were both nervous, maybenot nail biting, but there was
that apprehension about takingan established business and
leaving and changing the model.
Yeah.
I think that was a majorapprehension.
Otherwise the, the positiveaspects of it was what
(14:22):
maintained the drive to continueand actually pull the trigger on
it.
Dr. Maryal Concepcion (14:25):
That's awesome.
And I will ask here, what endedup happening once you
transitioned to DPC?
How many of your patients said,great, what you just tell me
where I need to sign, what Ineed to pay and how many of
those people were, asking about,like, what are you doing and how
many of those people weresaying.
Nope, no insurance.
Not going
Dr. Karl Hanson (14:45):
well, the first several months leading up to the
actual check, when I put out theannouncement, I would casually
talk to my patients,hypothetically if somebody does,
et cetera.
So I was getting it a vibe or afeel for it before I really came
on the final decision.
So, it's hard to give apercentage Because you don't
know, if you see a person once ayear, once every three years,
(15:05):
are they your patient?
But I, I know it was, it wasrevenue neutral for sure.
In other words, the income Ilost from 10 90 nines.
Yeah.
Not coming in from Medicare andet cetera.
Compared to the enrollment thatI have, it was, it was a little
north of actually revenueneutral.
So I don't know.
I never actually went back andcalculated.
(15:26):
I'd probably say maybe I had a.
35% conversion rate, maybe 30%.
That's fantastic.
But I never really drilled downon it'cause it didn't matter.
Yeah.
Just moving forward.
Dr. Maryal Concepci (15:36):
Absolutely.
And how many patients did youstart with on day one?
Or did you, onboard them slowlyso you didn't have all of your
patients just transitioningover?
Because some of those, somepeople out there are concerned
about that in terms oftransferring their private
practice to DPC, like Dr.
Michael Chun has shared on thepodcast before.
But what was it like for you,because you owned your business,
(15:59):
you owned those records, andthen you just were doing a
different business model?
Dr. Karl Hanson (16:04):
The bulk of my patients at the first month or
first instant of direct primarycare practice were patients that
I already had charts on whoalready had a relationship that
were just moving over from myprior sole proprietorship to my
to Infinity Health.
So these were people that.
(16:25):
Didn't have to be all of asudden taken in on the first
month.
Mm-hmm.
So the people that signed up, Imay have actually just seen them
literally a month before in theinsurance based model.
I didn't face that challenge ofa, a large volume of people
coming in that were new to me oranything.
Dr. Maryal Concepcion (16:43):
That's really helpful because as, as we
go forward, there will be peoplewho are wearing very similar
shoes as you were when youtransitioned into DPC.
So, Dr.
Silverman, you're graduating andyou're looking at your
co-residents, you're looking atthe classes before you you're.
Probably hearing a lot ofphysician recruiters'cause I
sure did.
(17:03):
What was going on in your mindwhen it comes to challenges or
fears or apprehensions about theworld ahead of you when it came
to DPC?
Dr. Samia Suleman (17:11):
I had done my year in Ireland two years in
Ireland.
And so I had come back once Ihad came back and so.
My apprehensions beforetransitioning to DPC.
Were, is anyone gonna join?
Is anyone gonna continue?
Yeah.
Took a lot of deep breaths.
I remember walking outside and,can I do it?
Can I pull the trigger?
It was, and I, I'm still workingon this and it's, it's not
(17:32):
selling yourself short.
And a wise person tells me that.
And that echoes with me all thetime.
And it's remembering not to tellyourself short.
It's completely a journey.
And I think you get thereaffirmation once you see your
patients.
Yeah.
And once you get the, theaffirmation from them that they
are so happy.
Yeah.
They're so thankful.
They are so grateful and itpushes you forward and it says,
(17:55):
I am doing a great service.
They are happy and it
Dr. Maryal Concepcion (17:59):
just keeps you going.
Amazing.
And Dr.
Hanson, I'll ask the samequestion of you.
When did the discussions withyour wife change in terms of we
got this.
Dr. Karl Hanson (18:09):
Well, the, the DPC summit I'm referring to was
in the summer of 2015.
Mm-hmm.
And may mentioned before thatwhen I was there, I was telling
myself, I'm not doing this.
This is not for me.
And within 30 days, 60 days,that turned 180 degrees.
Yeah.
And of course we talked a lot.
My wife and I talked a lot aboutit.
(18:30):
And, fortunately she's excellentlistener and, and excellent
advice giver.
And good advice, not just anyadvice.
So, we came to our conclusionpretty rapidly.
Mm-hmm.
Within the first few monthsafter the summit.
Then there was a bit of theangst about the, the, the bells
and whistles and the particularsof setting it up and how to
(18:50):
write the letter and when to,that kind of minutia, if you
will.
But the, the major, the majorpsychological transition took
place within.
A few months after the summit.
Dr. Maryal Concepcion (19:04):
And I'm wondering here if now you guys
can talk to us about Louisianabecause Louisiana is different
from Ohio, is different fromCalifornia, when it comes to
what the healthcare access islike, what the quality of care
is like, who provides thehealthcare?
So talk to us about Louisiana asa state in terms of, what, what
(19:25):
is the medical care like aroundhere, and especially around
Kenner and New Orleans area.
Dr. Karl Hanson (19:29):
Medical care in Louisiana, Louisiana's primary
rural, of course you could saythat about a lot of states.
there's, there's a fairlysignificant Medicaid population.
And the, in the suburban area ofNew Orleans, which is where we
are there, there's been anadequate selection of primary
care physicians.
I think that that's been okay.
(19:50):
Mm-hmm.
I think the, the change has beenmore recently where hospital
systems have, have gobbled uppractices and have also changed
their model to a nursepractitioner based type of
primary care where it, it'sdifficult for patients to
(20:13):
actually Interact with their MDor do mm-hmm.
Without some layer ofinsulation.
And then of course urgent carespop up the, with, with, with is
a poor model because you'reenticing people to, to get
lesser care Medicaidindividuals.
I would say, and, and I wouldpreface it, Medicaid individuals
(20:36):
are some of the most fun folksto take care of because a lot of
people who have Medicaid, theymay not be able to get an
appointment with their, withtheir physician for a month.
Yeah.
Or three weeks at the soonest.
And so, we all know in themedical world what that can lead
to.
So it's nice to be able toreally help somebody that on
(20:57):
the, on the day of theirillness, not three weeks after
their illness.
Dr. Maryal Concepci (21:01):
Absolutely.
And how about you, Dr.
Soloman, when it comes to whoyou saw in residency?
Because as Dr.
Hansen's talking about morerecently.
Nurse practitioner,non-physician provider models.
That is absolutely a thing we'reseeing in most states.
And when it comes to Medi-Caland California Medicaid around
the country how was it for youin residency just
Dr. Samia Suleman (21:23):
It was a mixed population that we saw in
residency.
Mm-hmm.
But it majority were Medicaidand, yeah.
And, and and just to talk abouthow that translates to DPC
practices.
We have a mixture of patients.
Mm-hmm.
So we have patients with deepMedicare, Medicaid, Medicare no
insurance at all.
So what I love about DPC is youcan see a wide range.
It's not just, that we areseeing like a concierge model
(21:46):
that it, we're only seeing superwealthy patients mm-hmm.
Or anything like that at all.
We're seeing a wide range ofpatients who are interested in
Dr. Maryal Concepcion (21:54):
great care.
Dr. Karl Hanson (21:56):
Yeah.
Dr. Maryal Concepcion (21:57):
And yes, I, I love that because it really
highlights how insurance is nothealthcare.
Right.
And that is something that weare educating people about every
single day so I would love ifyou guys could talk about new
patient coming to the practice,has maybe ish heard about direct
primary care.
But is very much still, like, Ibelieve insurance is healthcare.
(22:18):
How do you guys talk to them?
A lot of people are, we'repracticing their elevator
pitches at the DPC summit, so Ilove how you guys talk to new
patients about this practiceversus the fee for service
world.
Dr. Karl Hanson (22:30):
So talking to new patients, people that have
joined us somehow or another,they've already had the
discussion or, or talked to, notnecessarily us.
Mm-hmm.
But a friend or family member.
Sure.
Who's engaged with us.
So somehow or another out therethe friend or family member has
already done the elevator speechfor us.
(22:50):
So at that point now when theycome in for their initial visit,
sometimes it's meet and greet.
Yeah.
But usually they'll just join.
Yeah.
They know.
And, and now we're just sort ofembellishing and enhancing what
the specific details are aboutthis.
'cause maybe they have somemisconception or something like
that.
But I, yeah.
A lot of the ones that getreferred by others, the, the
(23:11):
others have done a fairly goodjob, word of mouth of bringing
them up to speed.
That's, and that's really great.
Now the sale.
If you will, to individuals whohave no contact.
Yeah.
We all know that game becausethat's, it is sort of like three
levels of elevator speech, sothe one between floors one
through 10, 10 to 20, 20 to 30.
(23:33):
So there is a bit of a challengein that.
Yeah.
We still have people that whenyou briefly mention it to,
they'll say, oh yeah, I have afriend of that.
You're M-D-V-I-P.
And so sure we all have to facethat battle as of doing that
part.
But yeah, the patients that comein, they've been, they've been a
little education already fromtheir friends or family member.
(23:54):
Yeah.
Dr. Maryal Concepcion (23:55):
And on that point, the M-D-V-I-P-I,
I've definitely heard that a lotmore while in Louisiana compared
to in California.
And I'm wondering how do youguys differentiate?
Because in usually we hear, oh,it's concierge, but how do you
guys specifically talk to thedifferences between M-D-V-I-P
and direct primary care throughindependent physicians?
Dr. Karl Hanson (24:14):
Yes.
The thing is he said, oh yes, Ihear Dr.
Hansen that you're, I see you'rein concierge.
So I have to say, well, maybethe umbrella term concierge, but
probably you're referring to amodel that's a national company
called M-D-V-I-P.
Yep.
And then they'll acknowledgethat and I, and I'll just tell
them we don't double dip.
(24:35):
Yeah.
We only get the monthly feefrom, from the patient as per
contract.
And that includes all services.
Mm-hmm.
We do not do any extra billingor collecting for, for visits.
And specifically in Louisiana,by law, we do not collect, we do
not bill any third party.
(24:55):
Mm-hmm.
We do not bill insurances.
So it doesn't matter to us whatyour insurance is.
Yep.
I'm not sure that that promotesdirect primary care so much.
That's kind of more of atechnical definition.
But yeah, we do have to addressthat.
When we get lumped into everyother form of concierge.
Sure.
Dr. Maryal Concepcion (25:13):
And I think it's important, especially
now with the passing of thePrimary Care Enhancement Act as
part of the quote, big beautifulBill.
This is where, Jake Hess of theDPC coalition has said, and I
agree this is where the workstarts, because now that we're,
even more visible than beforenow that HSAs can be used
without question for DPC memberagreements this is where I
(25:37):
believe we have to keep fightingfor this is what we actually do.
We are not the same as fee forservice.
We are not the same as conciergemedicine.
And this is for everydayAmericans to access the same
level of care without having aseven figure salary or without
having to go through youremployer.
So, Dr.
Sillman, how about you?
Because as Dr.
Hanson's speaking and, and youdid have you, you mentioned the
(26:00):
concern about like, willpatients join.
How has your elevator pitch, soto speak, changed over time?
Because I, I'm, I'm assuming youhave to have some patients who
knew Dr.
Hansen's model, who said, oh mygoodness, like there's a new
doctor.
He might be on a waiting list.
Like, I, now I have a chance andI'm sure is heck gonna take it.
Dr. Samia Suleman (26:20):
Yeah.
So my elevator pitch is everevolving but essentially it's it
goes with we provide theservices that you need.
I'll start off with the issue.
Are you having trouble speakingto your, getting in with your
physician?
Are you having trouble?
Do you find that it's hard toget an appointment when you need
an appointment?
And we present the problem, tothem and they'll say yes,
(26:41):
actually.
My mom, I can't get her in.
And by the time it is time forher to get in, it's, she has to
be admitted.
So, I start with, I start withthat, and then I work around,
well do, with, with DPC what wecan do is, you have access to
your physician seven days aweek.
You have a personal physician.
It's bringing back the, thedoctor patient relationship
(27:02):
essentially.
Yeah.
And they're very attracted tothat.
And most of my patients love thefact that they can message me,
Hey, Dr.
Tillman, I'm having sinusitis.
Sure.
I'm having, I feel like I'mhaving an ear infection or, and
I will respond to them rightaway.
You can come in.
We have same day, next dayvisits.
We have a very affordablemembership fee and along with
(27:23):
that we include our labs and wealso dispense.
So there's so many perks and.
They are just, they, they lovethat.
Dr. Maryal Concepcion (27:31):
Yeah.
And when you talk aboutmembership fee, how did you Dr.
Hanson create the membership feeand has it changed over time?
Because nowadays people saylike, oh, the, three clinics
around me they charge this much,so that's about what I'm gonna
do.
But how did it work for you
Dr. Karl Hanson (27:47):
At the time that I was doing the, the
transition into direct primarycare?
I recall seeing some publisheddata, what the average fee was
throughout the country.
Mm-hmm.
And I was, as I recall, it was$77.
Mm-hmm.
Something to that effect.
And then I factored in.
Okay, well that also includesplaces in the northeast and the
(28:10):
coast and stuff like that, wherejust things are more expensive.
I chose less than that.
Mine was$65 a month.
Mm-hmm.
I maintained that for a longtime.
About two years ago, I increasedit to$75 a month.
And I don't want to go more thanthat because part of this, I, I
(28:30):
do know that I, that we could becharging more.
I do know that.
But part of the concept is that,do you want to keep this at the
level that is attractive topeople?
That separates us from thetypical concierge model and that
the average person would find itclearly affordable.
(28:50):
Mm-hmm.
And anyway, so I, that's how itstarted.
It was probably because I lookedat the, what the average was in
2015.
Sure, sure.
Whoever published that, I don'trecall who that was.
Yeah.
Dr. Maryal Concepcion (29:02):
And in terms of the concern about
affording direct primary care,we've had Dr.
Stephanie Phillips on thepodcast, she's in the poorest
region of all of Georgia, andher patients are paying on
average$75 per month to makesure they have access, as Dr.
Silverman talked about to theirdoctor who they know, versus one
trip to the ER is more than 12months at$75.
(29:24):
So, can you guys talk to usabout the, the money
conversation when it comes tothe patient who says I, that's
too much.
I, I can't afford that.
Dr. Samia Suleman (29:33):
definitely talk about how your Netflix
bill, your your electricity,just, just things that you do or
going out to dinner or thingsadd up and you don't even
realize it.
But also there are paymentplans.
There are things we can do to,to prioritize and we try to make
sure that we emphasize that yourhealth is a priority mm-hmm.
(29:55):
For patients.
And once they realize, what thebenefits outweigh, saving a
little bit more so that I canspend on my health, it makes a
big difference and it goes along way for them.
Dr. Maryal Concepcion (30:06):
Mm-hmm.
And.
Have you guys heard the, well,healthcare's too expensive
because I usually have to pay$200 for a thyroid lab.
Like, I, I, I can't add anothermembership fee on top of that.
What do you say to those people?
Because they aren't necessarilyaware that you can purchase lab
and imaging at, prices that arewholesale like you could at the
grocery store.
Dr. Samia Suleman (30:25):
Right.
Dr. Maryal Concepcion (30:26):
So we,
Dr. Samia Suleman (30:26):
we do have contracts with, with the labs
and we do let our patients knowthat.
And a lot of times our patients,that that is a big draw for
them.
But there are people who do havean issue with the the comp, the,
the monetary aspect.
And for them it might not be agood fit at this time, but
(30:47):
they're always, they always haveyou in the back of their mind.
And that's the other thing isthat.
Not everybody.
It's not for everybody.
Not saying that, I mean, we do,do, we do will make concessions
for people and like, again, likepayment plans, things like that
are always options.
But if someone truly has aproblem and, and can't, it's
nothing that we had to force onthem.
Dr. Maryal Concepcion (31:08):
Yeah.
Dr. Samia Suleman (31:09):
And
Dr. Maryal Concepcion (31:09):
I think this is really powerful because
we own our own businesses.
We're able to not have to waitfor, 16 committees to tell us
it's okay or for some code tochange to have a covered
service.
It, it's when I remember when Iwas in fee for service, I would
just call a family because theirfamily member was just diagnosed
with cancer and they're the careprovider and they're losing
(31:30):
their minds as well as thepatient.
It's like, I have no idea whatcode that is, and now I'm
grateful that I don't have tocare.
Yeah.
It just do the things and youjust get to be a doctor.
So I'm, I'm wondering here interms of.
You guys partnering together?
I love this because we need moreDPC doctors out there.
There's not enough and it is notthat we are creating the
(31:51):
shortage.
The short is being, shortage isbeing created, a physicians
being out there because of thesystem a hundred percent.
If you do not agree with that,please leave me a voicemail.
But when it comes to you guyspartnering together this is
absolutely a thing.
You do not have to open up yourown DBC.
It is not shameful to justpartner on with somebody.
(32:11):
There's people doing just locumscoverage.
Dr.
Brewer Everly had somebody comeon at Fisher Health Clinic and
cover as a locums while he waswaiting to graduate residency.
And so, I'd love if you guyscould talk to us about how you
guys made this partnership atInfinity Work and decide to do
it.
Take that,
Dr. Karl Hanson (32:32):
yeah, I'll take this.
The.
So I really believe in directprimary care and that it's a
wonderful privilege to be ableto take care of somebody.
Yeah.
And I did want to see directprimary care expand mm-hmm.
To have more offerings.
And technically I wasn't what Iwould consider full, but I knew,
(32:55):
I knew Dr.
Samia from before.
Mm-hmm.
And their, her work ethic andher just ethic in general.
And even though she didn't havea, this large subset of patients
to import to the practice, Isaid I wanted to get somebody
that was, that was conscientiousSure.
And kind of understood, what theproblem was out there.
(33:18):
So that was really the genesisof the of the partnership.
You want to get somebody who's apartner that you can trust who
shares the same ethic.
That's kind of more importantas.
As opposed to what residencythey came from or this kind of
thing.
Yeah.
So that was the genesis part.
So we could, we could expand theofferings of, of, at that time,
my company, infinity Health,expand it to, to other people
(33:42):
out there in the world.
So that was, that was really thegenesis from me.
Dr. Maryal Concepcion (33:46):
Yeah.
And how about for you, Dr.
Soloman?
Because when a person is lookingto join a DPC I, I, I wonder
what your thoughts were.
Oh, I, this apprehension is lessbecause he's already open.
What, what, what were examplesof things you were thinking
about when you were when youwere looking to, and when you
(34:06):
finally decided to partner on aninfinity?
So, I, I brought over maybeeight
Dr. Samia Suleman (34:11):
patients from when I transferred over.
And but having a great mentorlike Dr.
Carl was, was.
Is key.
Absolutely.
'Cause I could see how how hewas working with his patients
and how his patients areextremely loyal and, he has a
great following.
And for me it's an inspirationto work with him and to, to
(34:32):
share, to be partners and be inthis partnership with seeing the
work ethic and seeing how, how Itreat my patients.
And it didn't, it's, it'staking, it does take it, it is
taking longer than I hadexpected, but my panel is
growing and I'm happy to saythat my patients are very
satisfied.
And, they give theirtestimonials and they, they're
(34:54):
very pleased with the model.
It is just a lot of more ofawareness that we have to get
out that DPC does exist and thatthere are different options
other than the insurance basedmodel.
And I think that's somethingthat we all need to work on.
Yeah, absolutely.
Dr. Maryal Concepcion (35:09):
And I would love, because you are
partnering I would love if youcould talk to the audience about
what things do you recommendpeople either think about when
they're joining on or thinkabout when they're hiring.
Dr. Karl Hanson (35:23):
it's like EMR software.
No matter how many times youlook at the demo, you never
really know until you're threemonths into it.
And then you say, what justhappened?
And, and that's the same waywith with finding out who's a
good partner.
So again, my advantage was, isthat I had known Dr.
Samia for years one way or theother before this.
(35:46):
Mm-hmm.
So you, you get a better sense.
So I would say in looking for apartner is to look somebody who
shares the work ethic and theethic towards patient care.
Mm-hmm.
And it's, I, I, I didn't giveher a quiz.
I didn't have her take the uh,licensing exam again or anything
(36:09):
like that.
So you can't really go with thatbecause it's a direct primary
care is a mindset, it's anattitude, it's an
acknowledgement of what's wrongwith the system.
Yep.
And who the players are who aredegrading the system.
Mm-hmm.
It's a bit of a rebelliousattitude.
So you, you're looking more forpersonality characteristics in,
(36:30):
in my opinion,
Dr. Maryal Concepcion (36:31):
and how about you in terms of what
questions would you recommendpeople asking if they're looking
to partner on at an existingDPC?
Dr. Samia Suleman (36:39):
Again, I wouldn't say there's questions
to ask, but more is it a goodfeel?
Is it a good mix?
Do you, do you get along?
Do you feel like there's amutual respect?
It's more of a feeling.
Dr. Maryal Concepcion (36:50):
I think that, than any questions.
And I'm wondering if you guyscan Talk to us about the legal
structure of the DPCpartnership.
Did you guys partner or is oneof 10 99
Dr. Karl Hanson (37:01):
it a full partner?
Yeah.
The, the, when I invited her in,it was the full partnership.
There, there were those, and,and I did research employee 10
99 type of relationship.
Mm-hmm.
But I, I felt that.
I, I just felt like it wasbetter just to demonstrate that,
(37:23):
that confidence and that trustmm-hmm.
By taking, taking, creating afull partnership.
And, and I'm glad it it's beenthat way.
I mean, I, I, I don't, but thatagain, that's because I've had a
chance to know her before,wasn't an acute situation where
I had to take time to assesssomebody's character, if you
will.
Dr. Maryal Concepci (37:43):
Absolutely.
And Dr.
Tom White, very similarsituation as he intentionally
looked for partners and notemployees.
Just because that, that's alsowhat he believed in, in terms of
somebody having a career that isliterally just DPC and they have
the autonomy same as us who openour DPCs on our own.
When it comes to benefits foryourselves health plan benefits
(38:05):
retirement, how do you guysaddress that at Infinity?
Dr. Karl Hanson (38:09):
Well, I am.
66.
So I'm a Medicare.
Before that I was on a healthshare Uhhuh.
I used to be on, my wife and Iused to be on one of the typical
Bcca policies.
Yep.
And we jettisoned that several afew years ago.
Mm-hmm.
And joined one of the healthshares.
My wife has still on the healthshare, but I aged into Medicare.
(38:33):
So, and I have not joined aMedicare Advantage plan.
I'm just trying Medicare.
So, that's, that's how I handle
Dr. Maryal Concepcion (38:40):
And what about savings for retirement?
Dr. Karl Hanson (38:42):
I'm A-D-P-C-D doctor, why would I wanna
retire?
The saving, well, I've long hadas a solo practitioner, a simple
IRA and that's what we havehere.
Yeah.
So now we're all, we all are inthe, the simple IRA.
Dr. Maryal Concepcion (38:56):
Yeah.
Fantastic.
And how about you, Dr.
Silverman, for your healthcare?
And also did it provide you asense of security knowing that
there was this addressing of anIRA?
Because some people are comingon and they're like, we don't
offer a 401k, we don't offer anyretirement.
We don't offer healthcare.
How was it for you?
Yeah, for my
Dr. Samia Suleman (39:14):
family we do have insurance currently not
very happy with it, but youknow, we're looking at health
shares and things like that now.
Mm-hmm.
As far as of course there'ssecurity and, and the having a
retirement plan and things likethat.
So that, that's always anattraction also.
It gives you a sense ofsecurity.
It gives you a sense of this issomething that I'm working
(39:34):
towards and this is for myfuture and for my family's
future.
Yeah.
Awesome.
Dr. Maryal Concepcion (39:39):
Now, this weekend, not only was it the DPC
summit, but also the LouisianaFamily Academy of Family
Practice Medicines state Summit,which is Dr.
Hanson and I talked about thisbefore that, this is probably
unusual that they have a stateand a national event at the same
weekend, but you were goingbetween the two.
(39:59):
And I'm wondering if you cantalk to us about.
What it's like on the LAFP, Ialmost said CAFP, the LAFP side
of things because I wanna likeenvisioning, just asking you
that I'm like, there's strangerthings and then there's the
upside down.
So I would love if you couldtell us your experience.
Dr. Karl Hanson (40:20):
Okay.
So this would be the the secondpodcast.
The, the LAFP.
So I've been a member of theLouisiana Academy of Family
Physicians for 41 years, and I'minvolved with them, not
administratively, but I'mactually in charge of a program
of developing a module, kind ofa go-to module for people that,
(40:43):
that physicians that wanna startan independent practice.
Fantastic.
Whether that's coming outtaresidency or whether it's
leading, leaving the, indenturedSI mean, employment.
So I, I have a lot ofinvolvement with the LAFP and
lots of friends over there.
And it's kind of my homeorganization, if you will.
It was kind of fun going backand forth between that and a
(41:04):
direct primary care conference.
'cause there's quite a contrast,quite a contrast.
The everything from theexhibitors to the atmosphere to
the presentation.
Now granted, one's a nationalorganization, one's a state
organization, and the stategroup does a very good job at
their, at their assembly.
But yeah, it's a different vibe.
(41:25):
There's so many ways to describeit as a different vibe, but both
are valuable.
But the, the DI Direct PrimaryCare summit just kind of has a
way different energy.
Yeah.
But that's probably the best wayI could describe it.
I, I, I, I think that.
There was just a mistake withthe A FP that they scheduled it
(41:48):
the same day and it's neverhappened before.
Sure.
And it's not that way next year.
Yeah, they're separated nextyear.
Yep.
Dr. Maryal Concepcion (41:53):
And how about you, Dr.
Soman, because clearly you wereat the summit as well, but when
it comes to talking tocolleagues it, it is a very
different conversation.
Sometimes it's reallyuncomfortable to have talks
about DPC because some peopleI've heard, like they literally
will say it's because of DPCthat we don't have enough
physicians.
It's because of DPC.
And I'm like.
(42:15):
Say, say all the things, say allthe things, and we can prove as
a movement that these things arenot correct.
I actually have not
Dr. Samia Suleman (42:21):
run into that at this point yet.
People are actually fascinatedby our model and, and what we're
doing.
So I get a lot of positivefeedback and I'll get a lot of
questions about how does it workand, how does one transition and
things like that.
A lot of a lot of doctors arefed up with the system.
Absolutely.
Dr. Maryal Concepcion (42:39):
Yep.
So, Dr.
Hansen, this is definitely aquestion for you because of your
involvement 41 years at the asan LAFP member I, I definitely
see now, way more education onthe California side of things of
what DPC is, especially for thepeople who are, very seasoned in
fee for service.
Very, we only do fee forservice.
(43:00):
We could never do DPC.
Kaiser will never shut down thenaysayers.
When it comes to.
The challenge of getting DPCrepresentation at the state
level.
When it comes to even inclusionin conferences, how do you bring
the voice of representation ofdirect primary care physicians
(43:21):
and what direct primary carephysicians in existence means
for this academy.
And how do we help DPC doctorsin addition to you creating
education resources about themodel at your state level?
Dr. Karl Hanson (43:36):
I think the major hurdle at the Louisiana
Academy Family Physicians is, isfor them to weave DPC in as a,
as a forefront model.
Mm-hmm.
There are, there are certainthings that would be in conflict
(43:58):
with, for example, the typicalsponsors mm-hmm.
That are at that, for example,of course at the LAFP event,
some of the exhibitors includedinsurance companies, employers,
et cetera.
Obviously there was none of thatat the Direct Primary Care
Summit.
Yeah.
And I think.
Sponsorship may play a role inthat.
(44:19):
Sure.
I've tried to address that andprobably I should be a bit more
aggressive in a polite way with,with the local academy about
bringing up practice modelsmore.
However, like I said theresolution that I presented to
the academy two years ago todevelop this independent
practice model, it was wellreceived.
(44:41):
That's great.
And it was, it was embraced, Iwould think.
And we're working on it.
It's not ready for prime timeyet.
And I wish I probably could havedone it on my own in less than a
year, but you have to go throughthis system.
So I think it's getting there.
Also recognize there's a lot ofdocs in employed practice that
(45:02):
are in the Stockholm syndrome.
Mm-hmm.
And, and part of the Stockholmsyndrome is that you almost deny
the existence that there'ssomething better to do.
Yeah.
And.
You certainly don't wanna, at notime do I demean anybody who's
an employed practice.
'cause it's almost acompassionate empathy Sure.
(45:23):
About what they're goingthrough.
So you, you don't want to beaggressive.
You kind of want to just keepyourself out there, offer
yourself as a resource.
It's kind of like, I'm here ifyou need me.
Mm-hmm.
Type of thing in private.
And I had, I had two employedphysicians come talk to me at
the LAFP in private about whatis this?
(45:44):
Yeah.
And what can I do to get there?
So that's kind of what the levelis now that, we're there for you
if you need us.
I'm not gonna berate you.
We understand we've been there.
So, that's kind of the level ofposition I take.
Dr. Maryal Concepcion (45:58):
Yeah.
And I, I love this because nextI wanna ask about the Louisiana
Direct Primary Care Coalition,because I think that what Oz, we
are resources out there.
I think that there's such aswell in the desire to know
about DPC from physicians, newexisting attendings, attendings
who've been in practice fordecades.
And this is why, like we createdour California DPC summit.
(46:22):
Extremely important to know howdo you do DPC in your state.
And so tell us about theLouisiana Direct Primary Care
Coalition and where do you seethat going in the future?
Dr. Karl Hanson (46:32):
When I started infinity Health in 2016, the
following year, I created acoalition.
We only had probably half adozen DPC doctors in the state
at that time.
And so I, I created theorganization but did nothing
with it.
'cause I felt like we didn'thave any critical mass.
Mm-hmm.
And it, I converted to a a 5 0 1C3, but it's still, nothing has
(46:56):
taken place with it.
Well, right now in the state, wehave 20 physicians that provide
direct primary care to theirpatients.
Probably 17 or 18 practices, butsome of those practices have, a
couple or few physicians.
And then also with the fact thatthe, when the big beautiful bill
was debated, there was adiscussion about Medicare.
(47:18):
Mm-hmm.
Medicaid, excuse me, and DPC.
Mm-hmm.
And then of course there was thewhole HSA insertion into that
law.
And so this year I felt it wasworthwhile to actually, that we
had the critical mass to getthat going.
So the coalition it and we'reforming our board as we speak,
the coalition is, is there topromote direct primary care.
(47:41):
In Louisiana to demonstrate toLouisiana Department of Health
that we can provide excellentservices to the Medicaid
population and make their healthbetter and save the state money.
And also to promote theproliferation or adoption or
(48:01):
education of direct primary carewithin our academic facilities.
So it's not a coalition that'sgonna be setting rates or
telling what DPC doctors do.
Mm-hmm.
That's not our vibe.
Yep.
We're, we're, we're all lionsand cats, not sheep, so we don't
want people telling us what todo.
Sure.
The coalition's certainly notgoing in that direction.
(48:22):
But anyway, the major focus isto promote DPC in the state.
And to offer our services anddemonstrate to the state.
And finally, in Louisiana, wehave a, the Department of Health
is very friendly to that andvery look forward looking.
Was really great to talk to theSurgeon general and the
assistant surgeon generalamazing discussions and we want
(48:45):
to go ahead and promote that.
'cause we think we have a lot tooffer.
Dr. Maryal Concepcio (48:48):
Fantastic.
And where do people go to learnmore about specifically the
Louisiana Direct Primary CareCoalition and does it also
accept medical students andresidents?
Dr. Karl Hanson (48:58):
Right now we don't have membership.
The website is a d pcc.com.
But, and we, we, we don't evendo dues or anything like that.
So, there's gonna be more tocome, if you will.
Once we, once we have some.
Sort of strategy meetings andfigure out where we want to go.
Mm-hmm.
(49:19):
But the, the website is open, Imean, any, and there's a contact
email address, et cetera.
So, And people have contacted methrough that to discuss direct
primary care in general.
Dr. Maryal Concepcion (49:29):
That's great.
And I think it's so important,especially now because.
That was lovely that two peopletalked with you in private at
the LAFP summit, but it is soimportant to have resources out
there.
So many people find rotationsjust networking through our cali
dpc.com site for our CaliforniaDirect Primary Care Coalition.
So I think it's so importantthat if you're listening and
(49:51):
you, are having thesediscussions anyways, it's really
great to come together because Ithink that even more so in the
future, again, like I mentioned,the work really starts now.
This is how we really cometogether as physicians
protecting the physician patientrelationship.
So, I would, I
Dr. Karl Hanson (50:08):
would love to graduate to where you all are,
where you're having a CaliforniaDPC summit.
So I'll be reaching out to youall to figure out what I don't
need to reinvent the wheel, whattips and tricks that you may
have.
Dr. Maryal Concepci (50:22):
Absolutely.
So can you tell us what do yousee for the next, year, three
years, five years at InfinityHealth DPC?
Dr. Karl Hanson (50:30):
once, once our panels get full or are starting
to approach that I would likefor Infinity Health Direct
Primary Care to be more involvedwith, with teaching residents.
Mm-hmm.
To create a center of excellenceof some type here where, where
residents can rotate with us inmore depth and detail.
(50:54):
Of course, a lot of that'scontrolled by the the graduate
medical age education board howmuch, what residents have to do.
And some of that's actuallygotten, we're a little bit worse
this past year.
So we're gonna be, have tofighting that battle.
But it's, it's the same thingabout talking to other
practicing physicians, talkingto residents and just say, look,
hey you, you don't have to juststart signing up with big boxes.
(51:18):
There's a real option that youcan go through, and there are a
ton of people out here,including Infinity Health and
myself and Dr.
Samia, that we will help youevery step of the way in
developing your business anddeveloping your practice
Dr. Maryal Concepci (51:34):
Incredible.
Dr.
Sullivan had to step out, butthank you so much on behalf of
my DPC story for both Dr.
Hanson and Dr.
Sullivan.
Thank you guys so much forsharing your story today.
Dr. Karl Hanson (51:43):
Oh, thanks for having me.
This was, this was excellent.
Dr. Maryal Concepcion (51:48):
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
(52:09):
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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