October 12, 2025 • 41 mins
In this episode of the My DPC Story Podcast, Dr. Lisa Tritto shares her inspiring journey from general pediatrics to specializing in pediatric obesity medicine through the Direct Primary Care (DPC) model. As the first physician at Evora for Kids in St. Louis, Dr. Tritto discusses why DPC reignited her passion for medicine, allowing for longer, more meaningful patient visits and personalized weight management care for children and adolescents. She dives into her advanced training in pediatric obesity, the challenges of traditional insurance-based models, and how DPC empowers her to make a real impact on families’ health. Discover tips for building a successful DPC pediatric practice, navigating complex patient needs, and the importance of compassionate, evidence-based weight care. Whether you’re a pediatrician, DPC physician, or a parent seeking holistic weight management for your child, this episode offers practical insights and resources. Perfect for those exploring Direct Primary Care, pediatric obesity medicine, or innovative approaches to child wellness.
Get the FREE workbook to go along with our January RESET series HERE.
Learn how Zion HealthShare can pair with DPC to protect patients and physicians without returning to traditional insurance. Read more in the Toolkit, our DPC magazine, today.
If hiring feels like one of the most intimidating parts of growing your DPC practice, read the Winter issue of The Toolkit, our DPC Magazine that includes an educational, step-by-step hiring guide from the Cooperative of American Physicians designed to replace guesswork with clarity.
Leave Maryal a voicemail @ https://mydpcstory.com/contact
GET your FREE MONTHLY BUSINESS TOOL DOWNLOAD
Become A My DPC Story PATREON MEMBER!
SPONSOR THE POD
My DPC Story VOICEMAIL! DPC SWAG!
FACEBOOK * INSTAGRAM * LinkedIn * TWITTER * TIKTOK * YouTube
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Maryal Concepcion (01:18):
Direct Primary care is an innovative
alternative path toinsurance-driven healthcare.
Typically, a patient pays theirdoctor a low monthly membership
and in return builds a lastingrelationship with their doctor
and has their doctor availableat their fingertips.
Welcome to the my DPC storypodcast, where each week.
(01:39):
You will hear the ever sorelatable stories shared by
physicians who have chosen topractice medicine in their
individual communities throughthe direct primary care model.
I'm your host, Marielleconception family physician,
DPC, owner, and former fee forService.
Doctor, I hope you enjoy today'sepisode and come away feeling
inspired about the future ofpatient care direct Primary
(02:02):
care.
Dr. Lisa Tritto (02:06):
DPC for me has reinvigorated my love of
medicine and helping people andreally feeling like I'm making
an impact.
Having control over my life andpracticing the way I think works
best for me and my patients.
I'm Dr.
Lisa Reto with Vora for Kids,and this is my DPC story.
Dr. Maryal Concepcion (02:32):
Dr.
Lisa Tritto is a pediatricianwith advanced expertise in
childhood and adolescent weightand wellness care after more
than 20 years in generalpediatrics.
She completed a fellowship inpediatric obesity medicine at
the University of Minnesota,making her one of the few
physicians in the country withthis specialized training.
Dr.
Tritto has now dedicated herpractice exclusively to
(02:53):
pediatric weight management,where she blends evidence-based
medicine with a compassionate,non-judgmental approach that
helps children and familiesbuild sustainable habits and
improve long-term health.
She earned her medical degreefrom St.
Louis University and trained inpediatrics at Case Western
Reserves, rainbow Babies, andChildren's Hospital.
Beyond the clinic, Dr.
Tritto has served as a coach forgirls on the run, raised funds
(03:14):
running the Chicago Marathon,and enjoys hiking, cooking,
traveling, and cheering on herfavorite sports teams.
Originally from California.
She now calls St.
Louis home.
Welcome to the podcast, Dr.
Reto.
Hi.
Nice to be here.
So I love this.
We were just going overpronunciation of names before we
started recording, and I willsay Dr.
(03:34):
Lisa Reto, like Cheeto wasamazing and helpful for me, but
I also think it's superappropriate and ironic for this
conversation because we'retalking about pediatrics.
I know lots of Cheeto talks thatI've had in pediatric visits,
but also about how you have gonefrom pediatrics to specializing
in pediatrics, in obesitymedicine in in particular with
(03:56):
Vora.
And so I will say that if youhave not listened to Dr.
Becky Lin's episode Vora starteda very long time ago, and Dr.
Reto has been with Aurora nowfor almost a year.
We're approaching a year thisDecember.
Mm-hmm.
And so it's so exciting to seethe growth of the practice
through your lens.
So again, thank you so much forjoining us today.
Sure.
My pleasure.
(04:16):
I wanted to start with yourbackground because you went to
school in California where I'mpodcasting from, and then you
left California.
And so I'm wondering if youcould talk to us about how your
journey even brought you to theMidwest right now, where you are
today.
Dr. Lisa Tritto (04:33):
Yeah.
Yeah, I grew up in California,in the Bay Area and went to
college there and left formedical school.
I came to here to St.
Louis, St.
Louis University with theintention of going right back to
California.
But I met a boy and you know howthat goes.
And he was from the Midwest andso I pretty much ended up in the
(04:54):
Midwest for the rest of my,well, my life more than half of
my life now.
And for a variety of reasons.
I've sort of been in a coupledifferent states throughout my
career, and now I've, I'veactually just returned back to
St.
Louis just about a year ago now,where one of my kids lives here.
So.
I love
Dr. Maryal Concepcion (05:14):
that.
Yeah.
Dr. Lisa Tritto (05:15):
And
Dr. Maryal Concepcion (05:15):
I, I love the you, you know the
story, ya meet a boy.
That's definitely what happenedwith, with my husband and I,
except he was from California,so it worked out.
But oh, good for you.
I, so when, when we think abouthow you have gone into pediatric
specialty, I love people likeDr.
Mina Jula poll, pediatricdermatologists have been on the
podcast before.
(05:35):
But I wanna highlight that priorto being a specialist, you were
a generalist and seeing thingsat different medical centers
like Rush Medical Center, aswell as in Cleveland.
And so I'm wondering if you cantell us about, when you started
practicing up until lastDecember, when you, when you
joined Aurora, I'm wonderingwhat were the things that you
(05:57):
saw that ultimately made youmake the transition to DPC.
Dr. Lisa Tritto (06:02):
Yeah, I've, I've had the opportunity to work
in a variety of differentsettings.
So I was in sort of a universityaffiliated practice and my
patient population was fromrural to suburban.
And then I was in Chicago atRush, and then that was more
urban.
And I, I was fairly happy in my,my group practice, it was
(06:26):
university affiliated becausethe doctors did own their, own
the practice.
And so we were able to make someof our own decisions.
But then I, when I went to theacademic setting, the the layers
of bureaucracy and lack ofcontrol over my schedule, just,
kind of did it for me.
(06:47):
Things like, they would wantyour schedule to be full, full,
full, full, full.
And then you couldn't see a kidwith an ear infection.
And thankfully at this point inmy career, I was like, no, this
is not acceptable.
We cannot practice this way.
At the same time, I was going toother, through some other life
transitions, and I had beeninterested in weight management
for a long time, had beenfrustrated with not being able
(07:09):
to help my patients very well,and I, and I learned about this
fellowship opportunity inMinnesota.
And so then I went to anotherMidwest state for a year and did
my training there.
And then, like I said, ended upback here in St.
Louis.
So, so I just think about, you
Dr. Maryal Concepcion (07:25):
know, the the, the laughter to, to
release the, the steam offrustration when we think about
those memories about what ourpatients and ourselves have gone
through.
Because it's like.
You can't do anything but laughor cry sometimes and at the
ridiculousness of it.
But I, I wonder if you can tellus specifically when it comes to
(07:49):
health of kids.
Absolutely.
Obesity, medicine, weightmanagement bullying, all of the
things happen, especially inpediatrics.
Experiences that we have as kidsare so formative in how we are
as adults in the world.
And I'm just wondering if youcan, give us examples of a.
How you really turn to thisfellowship to be able to make a
(08:11):
difference in kids' lives whenit comes to healthy bodies, when
it comes to trying to do betterfor your patients, because what
you were seeing was notsufficient for them.
To, to be in a space where youcan talk about health and your,
(09:09):
like how many minutes perpatient, right.
Dr. Lisa Tritto (09:12):
Yeah.
Ab absolutely.
I, I would say in generalpediatric practice, of course
time was always, always afactor.
And this is this is a topic thattakes a lot of time and that's
also why I've chosen this DPCtype of route.
Because I can spend, I spendabout 90 minutes with my, my
(09:33):
patient for the first time goingthrough their medical records,
their life story, their bullyingstory, their.
Whatever their social dynamics,it's a very deep dive.
I feel like I know them verywell by the time by the time
they leave.
In the space and time that I hadin general pediatrics, I just
could not, I, I could not allowthe amount of time that I needed
(09:56):
to do sort of the deep dive andsee what's going on in these
kids' lives, or I couldn't getthem in soon enough for follow
up or, any of those things.
I couldn't carve out timespecifically for dealing for
dealing with weight.
Those were the kind of thingsthat happened.
Dr. Maryal Concepcion (10:13):
What was it about this fellowship that
drew you to Minnesota versus notdoing a fellowship?
Dr. Lisa Tritto (10:20):
Yeah.
The, the whole science and fieldof obesity is so fascinating and
complex and I really felt like Iwanted that, that level of the
level of education to helpunderstand, but that hands-on
experience with people that aredoing it every day, that's what
(10:40):
that fellowship provided to me.
I probably could have pieced ittogether and it would've taken
me a long time to feel asconfident in what I do on my
own.
It probably would've taken a fewyears, but this opportunity just
like to be intensive is why Ichose to do it.
I the University of Minnesotaputs on a CME conference every
(11:03):
year specific on pediatricobesity, and I had to tend to
that.
And that was sort of where I,decided I really would like to
go to go and just really learnit and dedicate myself and not
try to do both
Dr. Maryal Concepcio (11:18):
incredible and so needed just because.
Pediatric obesity is such ansuch an issue, but also an issue
that's guaranteed to get worse,given that if people are going
to have restrictions on foodaccessibility.
I think I mentioned this on thepodcast recently, but in our
county very rural 4,000 peopleare getting CalFresh benefits.
(11:40):
So fresh food benefits and 1500of those people are going to
lose their benefits as ofFebruary of 2026.
Yeah.
And then on top of that, therest of them are going to have
to do proof of work, et cetera,et cetera, proof of citizenship,
whatever the, the BS is of the,the day.
Yeah.
But I will say that when itcomes to, wanting to eat Whole
(12:01):
Foods and things.
It's like, is that an option?
Will that be an option in thefuture?
Is definitely something that I,I didn't have to think as hard
about prior to yeah.
The changes that are coming.
So let me ask you here, when youtalk about this fellowship and
when you talk about how you wereable to have super concentrated
(12:21):
education on pediatric obesitymm-hmm.
I'm wondering how did you leavefellowship?
Because it's almost like DPC,once you see it, you can't unsee
it.
And so I'm wondering, once yousaw the way that you could
practice in fellowship, how soonafter did you, start itching for
something like DPC?
Dr. Lisa Tritto (12:43):
I knew, I knew before I even went into
fellowship that that was, well,I, I was pretty sure that was
what I would wanna do when Icame out and sort of be able to
do it in my own way.
And in fellowship we did, wewere allowed, we were allowed a,
a fair amount of time, but thethe opportunity to have follow
(13:05):
ups at a timely manner, WA wasvery limited.
And it's that way at all of thepediatric weight centers around
the country.
Extremely long wait to get inand not enough time to spend
with your patients.
Yeah.
Dr. Maryal Concepcion (13:20):
And can you tell us about some of the
patients who you would see?
Because I think about, Dr.
Andy Burkowski, he's the, thequaternary specialist that the
people who have restless legsyndrome.
In particular, we'll go todifferent clinics at Cleveland
and Mayo, I believe, and thenthey go to him.
So I, I'm thinking about when wehave pediatric obesity in the
family practice clinic in thegeneral pediatrician clinic who
(13:42):
are the patients that you wouldsee and what would, what would
get them to you?
Like, would it be certain thingsthat were screened for to get
them to your fellowship clinics?
Or was it just general, concernabout pediatric obesity?
From general physicians?
Dr. Lisa Tritto (14:01):
Yeah.
I think the majority of thepatients were having problems
related to weight.
So pre-diabetes liver disease.
Depression, anxiety, just weightcould not stop gaining weight.
That would be a lot of ourreferrals and, but there would
(14:21):
be some families that sought usout on their own and who felt
actually dismissed by theirgeneral doctor or shamed or,
just unhappy with their primarycare experience and sought us
out on their own.
We did have a very largeMedicaid population up there
(14:45):
too.
I mean, obesity does, it is moreprevalent in a, an underserved
community.
Absolutely,
Dr. Maryal Concepci (14:51):
definitely.
And I'm wondering when you talkabout how even in fellowship it
was, sometimes it was difficultto get the follow-ups.
And I'm wondering if you couldbring us to, maybe a, a patient
example or where you had done,good work conversation with the
family and the patient, and thenbecause of follow up not being
(15:13):
what it needed to be the, thedifferences that you had hoped
for were not being made.
Dr. Lisa Tritto (15:20):
Right.
It, it can be hard.
Particular if they're onmedication and we need to follow
for side effects, we, what wewould end up doing is a lot of,
myChart messaging and spent anextraordinary amount of time
trying to manage side effectsand so on in between visits.
Or they would run out of theirmedication and not realize that
(15:42):
they could call, call and get arefill and they come to us
however many months later havegone off and gained weight again
and that sort of thing.
So, that is, that is definitelyone of the restrictions because,
we are now prescribingmedications like this GLP one
that really need closemonitoring and mm-hmm.
Write a prescription for thatand say, see you in three or
(16:05):
four months.
That's just not good medicine,yeah.
Dr. Maryal Concepcion (16:53):
And just as we're talking about GLP ones,
I'm wondering what is theaccessibility.
For a GLP one in the pediatricpopulation, if you are a
Medicaid Medi-Cal patient versussomeone who's privately insured.
Because in the adult world, it'sdefinitely an ongoing struggle,
no matter how many gold, tripleplatinum insurance plans a
(17:14):
person has.
Dr. Lisa Tritto (17:15):
Yeah.
It is definitely statedependent.
We were fortunate in Minnesotathat Medicaid did cover them,
although sometimes the hoopswere pretty, there were a lot of
hoops to jump through.
Yes, we cover them, but we'regonna deny, deny, deny.
We had to appeal, appeal, appealuntil they were eventually
cover.
Here in Missouri, actually, justat the beginning of this year,
(17:37):
they became approved in a weirdway.
Like they want us to use the Abrand that's, that would be off,
off label for kids.
Mm-hmm.
But they will cover them withouta prior authorization even,
which is amazing.
So it is very state dependentand from what I understand in
California, that California hasbeen very good about coverage
(17:59):
for kids at least.
I don't know about adults.
Dr. Maryal Concepcion (18:01):
as you say this, I, I am just like, I
wonder what the PBM politics arebehind the oh yeah.
The availability of me medicinesin Missouri versus other states.
It's crazy.
Yeah.
So when it comes to you leaninginto fellowship, you going to
fellowship did you have any,pressure from your prior
(18:21):
colleagues or just, people youwent to medical school or
residency with?
To stay in general pediatrics?
Because I, I think about in the,the, I think about the
comparison of people who are, inthe fee for service world that
they'll say things like, oh,well, if you leave to do DPC,
you're gonna create a shortage.
And so I'm wondering if you gotany similar pressures from going
(18:44):
between general pediatrics andspecializing in pediatrics in
your world.
Dr. Lisa Tritto (18:50):
No, no, I didn't, but I wasn't asking for
anybody's opinion either.
And, and, and I, and, and I, I,I do, I do sometimes struggle
with, should I be doing morefor, certain populations, but I
also will look back and say,I've, I've been doing pediatrics
for over 20 years and I haveserved those populations and I
(19:12):
can find ways to help in, inother avenues.
So, for example, I'll do, oneday a month where I will see
anybody regardless of theirability to pay or I'm on a lot
of committees in the, in thecommu, in the community.
And I'm like reaching out andtrying to educate people on
social media and whatever.
(19:33):
So I feel like I'm still making,making a contribution
Dr. Maryal Concepcion (19:37):
that way.
I love that it's very much inalignment with the culture of
Aurora that Dr.
Becklin talked about when shewas on.
But also, just that you're gonnabe in a mental space where you
can feel good about the careyou're giving your patients, as
well as that you can have time.
Not that it's a, it's a it's aduty to, to volunteer to do
(19:58):
anything, but it's like if youget excited to, and you have the
bandwidth to a fricking men.
Right.
So That's awesome.
And I, I wonder now, when youleaned into DPC, we're recording
this close to one year of youbeing at Vora.
Was the, and I don't know this,so this is, this is a, a
definitely honest question.
Was Vora for kids in existencebefore you came on at Aurora as
(20:24):
well?
Dr. Lisa Tritto (20:25):
No, it was started for me.
Yeah, I met, I met Becky and Iwas actually, I wasn't quite
sure how I was gonna start mypractice when I met her at the
St.
Louis Obesity Society meetingwhen I first moved there.
And then she called me a coupleweeks later and she says, Hey,
why don't you join us?
And I thought, oh, this isamazing.
(20:47):
You've already figured out howto do everything and I'll just
slot right in.
And so she, I was very fortunatethat I was able to come into a
system that was already in placewhere they, they knew how to
market and they, they knew howto make a webpage.
All of that was so completelyforeign to me.
I probably would've still beentrying to figure it out.
(21:10):
such a learning curve.
Yeah.
Yeah,
Dr. Maryal Concepcion (21:11):
totally.
And I think it's awesome becauseespecially Dr.
Dr.
Becklin does does marketing likethat, that is a thing that she
loves also.
So in addition to clinicalpractice, like just speaks to my
heart when, when we get to dolots of different things that we
love.
But I'm wondering because thisis a very real space that a lot
of people are finding, and thatthey don't have to start their
DPCs from the ground up.
(21:33):
Talk to us more about what yousaw in Aurora building off of
what you mentioned that made youmore confident in, hey, like
this type of practice couldactually work in that, I'm not
taking insurance and I can spendtime with my patients.
Because it, it is sadly, it isreally challenging and foreign
sometimes to, to have people,see DPC and they understand DPC,
(21:59):
like tho those are two differentthings,
Dr. Lisa Tritto (22:01):
right?
What she has built here isreally just, inspiring.
She started by herself and thenshe her patients needed
perimenopause and menopausecare.
So she learned about that andgot certified and then they
needed weight management.
So then she learned about thatand got her obesity medicine
certification and then they needa dietician.
(22:22):
So she brought on her owndietician'cause she couldn't get
anybody in.
And then they need a therapy.
So she, then she brought in atherapist and now we have that.
We have an internal medicinedoc, we have a psychiatrist, we
have a chiropractor, we have apersonal trainer.
It's just like this, she'sdefinitely a success story.
She started, the practice is alittle over five years old now.
(22:43):
She had started it.
She tried to, she's tried tostart it in February of 2020.
And you know what, what happenedin March of 2020?
Pretty
Dr. Maryal Concepcion (22:52):
pretty hard to forget that one for
sure.
But yes, I definitely, again,encourage anybody who has not
definitely go listen to the,the, the history of Aurora when
Dr.
Becky Lynn came on as the, thesolo doc.
So I absolutely love that.
This is, a fast forward into thefuture when it comes to in
December of 2024 when youstarted it's my understanding
(23:14):
that you started with 10patients, were there ever any
concerns about how rapid youwould be growing?
Because like you're mentioning,it's so needed for a kid and
their family to have the abilityto talk with a doctor, with the
time that you provide now whenit comes to weight and when it
comes to health.
And so I'm just wondering, wasthat ever a concern for you
(23:35):
because your services are soneeded?
Right.
It was
Dr. Lisa Tritto (23:39):
still a concern because I, what I didn't know
is, how willing people or ablepeople would be to, to pay out
of pocket and not use theirinsurance.
I definitely, I know thatthere's a need, and my other
concerns were I hadn't lived inSt.
Louis in a very long time, andso I don't have the connections
that I had in Cleveland orChicago where there, I just,
(24:01):
like, for example, Cleveland, Ifelt like I knew every general
pediatrician and I would havehad a pra, a full practice in no
time.
But here I have had to workreally hard on making
connections in the, in thecommunity.
So I mean, I did, fear, like,will I be busy enough to, pay
the bills and it's stillgrowing.
(24:23):
I'm not where I need to be yet,but I do, I'll do some other
things to sort of, supplement myincome, like.
Tele, and a few other littleside gigs.
Dr. Maryal Concepcion (24:34):
When it comes to expanding your reach in
the community where you are nowin St.
Louis, how are you going aboutmaking community connections so
that people are aware of yourservices?
And so people, especially in thehealthcare realm, are aware of
you and referring people to youas an option?
Dr. Lisa Tritto (24:51):
Mm-hmm.
I like on foot going, walkinginto general pediatric offices,
leaving materials attendinggrand rounds at one of the local
children's hospitals.
I connected with some peoplethere.
And really in any space where mypatients potential patients
might exist, I I've had a greatconnection with the, mental
(25:16):
health community becauseprobably 95% of my patients
carry at least one diagnosis inthe mental health realm.
Eating disorders community.
There's some, there's sometelehealth network groups that
do pediatric weight managementand so on.
So that, those are sort of mythings.
And then face, then face throughFacebook as well.
Dr. Maryal Concepcion (25:39):
I'm wondering if you Can also talk
to us about word of mouthdownstream effects from people
who have been to Vora and nowthey realize that, oh, there's a
service that my kids couldpartake in as well.
Dr. Lisa Tritto (25:51):
Sure, yeah, definitely.
I've had patients, new patientsthat are children of parents
here.
Yeah.
Dr. Maryal Concepcion (25:58):
That's fantastic.
And yeah, it's, it's so funnywhen a person who knows of one
of our patients comes the, theonboarding call's very different
in, in, in our experience.
It's like we can skip to the,skip to the good part like the
song says because they alreadyknow what they are looking for
when they take that call.
That's awesome.
Yeah.
And how about when you mentionyour, you're doing telemedicine,
(26:20):
you also offer multi-statetelehealth when it comes to your
practice at Aurora.
So tell us about who do you haveon your panel when it comes to
in-person patients versus thoseyou take care of in other
states?
Virtually.
Dr. Lisa Tritto (26:34):
I have been struggling to connect in the
other states, so most of, I onlyhave a couple of patients that
are entirely remote, so for themajority of the, they are coming
in, I may do telehealth visits.
If there's somebody I've beenfollowing over time, I might not
make them come in every month.
Or they have, kids that are verybusy with school.
(26:55):
And then I do have a couple thatare just completely remote.
Yeah.
Dr. Maryal Concepcion (26:59):
And please tell us, for listeners
out there who are wonderinglike, where can I send my
patients?
How can I get in touch with Dr.
Reto?
What states are you licensed in?
So, under your practice rightnow?
Dr. Lisa Tritto (27:11):
Yeah.
Illinois, Indiana Minnesota,Missouri and Ohio.
Those are all the five statesI've lived in since I left
California.
Dr. Maryal Concepcion (27:23):
I'm just totally throwing this out there,
but I vote that you go to theOhio DPCN summit in February of
2026.
All right.
And, and talk there, especiallybecause I didn't know about
that.
Yes.
Yeah.
Yeah.
It, it's a, it's a great placefor the Ohio DPC community to
connect.
Okay.
So, for those of you also whodidn't know please check it out.
And people like Dr.
(27:43):
Lily White and Dr.
Pat Jonas are the organizers ofthat one.
Okay.
Awesome.
On your website you have apicture of the Grand Canyon.
I have a great story to shareabout that, but I will leave
that for a different podcastdifferent day.
But I just think about what hasDPC, changed for you in your
life on the day to day?
Dr. Lisa Tritto (28:02):
Yeah, I mean, just the ability to.
Schedule a doctor's appointmentor actually have lunch with a
friend where I can just, lockoff some time and not have to do
that six weeks in advance oreight weeks in advance.
That type of, that kind offlexibility and my schedule is
really great and I really canmake, make the schedule whatever
(28:24):
I want it to be.
And that's, that part has beenjust amazing.
Dr. Maryal Concepci (28:28):
Incredible.
And I, I hope that it makespeople, especially those who are
planning or starting out orwithin their first year just
reflect on their own time thatthey're able to spend doing
whatever the heck they want.
I was texting with Dr.
Deanna Berry this morning and Iwas like, Hey, do you wanna do
you wanna connect now?
I'm walking our dog and she'slike, I'm going into yoga.
(28:49):
And I'm like, I love that we'redoing self-care over here.
So yes.
Because we can.
So, absolutely.
It's amazing to hear that you'veexperienced that as well.
Yeah.
And just being able to fill ourcups, it's amazing.
So when, when it comes to youmentioning the opportunities
that is that a patient has atAurora, because there's so many
(29:11):
different branches of, of waysto deliver care even though
your.
At, at vora for kids, do yourpatients also have access to the
nutritionist, to the therapistto add an even more robust
holistic layer to the care thatyou are delivering?
Dr. Lisa Tritto (29:29):
Yes.
Our dieticians do see kids, andwe have a therapist who does
also see kids, and she's reallygreat.
She actually used to work in theschool system, and so, yeah, so
she's an awesome, like, resourcefor us.
Dr. Maryal Concepcion (29:43):
And how does that work in terms of
making sure that the patient,the notes are not, lost between
hospital EHRs or, if you canfind something or not?
Because you guys are your ownecosystem.
How do you guys collaborate fora patient?
Dr. Lisa Tritto (29:58):
We just talk to each other.
Imagine that.
Wow, we don't write a, a, a 20minute instant message to one
another.
No Tiger text going on.
No, no, that, and that's, that'sanother thing that I love is
that, our patients will sign athing that allow us to
(30:20):
communicate by email with them.
And so it's so much easier tocommunicate with patients and
for them to have access to usand for me to quickly relay some
information to them.
So just, yeah.
Dr. Maryal Concepcion (30:33):
I love it.
And tell us about the generalday in your practice because
you, you, again, you get todetermine how much time each
patient needs for their visitswith you.
Dr. Lisa Tritto (30:44):
Yeah, I mean, like I said, my first visit, my
initial visit with them is about90 minutes long, and then my
follow-ups are 45 minutes.
So, that's pretty much what itlooks like.
It's, it's the family comes inhaving, already completed like
questionnaires and we make surethat they're done before they
actually arrive.
That's another thing that wouldnever happen in a bigger
(31:06):
practice.
We can, we have the staff thatcan, keep texting and reminding
them until they, until they doit, and that makes the visit go
so much more smoothly.
Yeah.
Dr. Maryal Concepcion (31:16):
That's awesome.
And what does your schedule looklike throughout the week?
Dr. Lisa Tritto (31:21):
My schedule, I start late on Mondays.
I take Monday mornings off andFriday afternoons are off.
That way if I wanna travelsomewhere for the weekend, I've
got some more flexibility in myschedule.
Otherwise it's more, it's nineto five ish, but I will adjust
for patients.
So I have.
A regular, a regular patient andlike, she's probably the same
(31:44):
girl that I do the telehealthwith, that she know she's in
volleyball till six o'clockevery night.
So once in a while I'll just doa, follow up with her remotely
maybe from home even because I,I can and, and mean my life is
different now.
My children are older, so likedoing an evening appointment is
like no big, no big dealanymore.
Dr. Maryal Concepcion (32:04):
I love that.
But I will say, I got my signidea by appointment only from
Dr.
Janine Roddas who had that onher door.
But I will say Dr.
Reto just dropped a great one,like nine to five ish.
That's freaking amazing.
So, yes, I, I love that.
It's a great, it's a, it'sanother idea to write that on
your assign for those of youdoing DVC out there.
(32:24):
I love it.
So let's talk about howcomorbidities also play into the
health of your patients,specifically when it comes to
neurodiversity and A DHD.
I'm wondering how do yourappointments, pivot or move with
a patient who has a comorbiditywhere you might need more
(32:46):
appointments with them if youknow there is a mental health
crisis going on or something?
Because it's not just like.
The typical, well, we see youand then we'll see you in how
many months later if you comeback, type of thing anymore.
Dr. Lisa Tritto (33:00):
Right, right.
Yeah, so I mean, this is where,when I say I'm not doing general
pediatrics anymore, I guess I'mreally lying because I am still
doing general pediatric.
It's, it's just that, so, so forexample, A DHD many, many
patients, especially the youngerones come in, they have a DHD
and they have obesity, or theyhave autism, they have obesity,
(33:21):
or they have all, they have allthree.
And so sometimes I am they'venever been diagnosed or their
general pediatrician doesn't dothat, and I have plenty of
experience with that.
So then we may have them comeback, I'd have'em come back.
I have somebody this week whowas a new patient and mom thinks
he might have a DHD.
And so I'm just doing theirevaluation and they're coming in
in two weeks and they'll have a,we'll have it figured out
(33:42):
probably by then.
So, yeah.
And then I had the flexibilityin my schedule to do that right?
Where as before, it probablywould be three months before I
had an appointment where I coulddo a full A DHD evaluation.
And then if there's like an, anurgent situation, like, if a
patient who's on a medication iscausing her a lot of, she's
(34:03):
complaining about her, stomachhurting all the time, and we
don't know if it's hermedication or not.
They, I can just tell them,come, come in today, tomorrow,
whatever, have lots of contactwith the parent and decide, what
needs to be done.
So that's been, that's beenreally nice to be able to do
that too.
And.
Dr. Maryal Concepcion (34:18):
Just because, we, we see our patients
typically just having acompletely different outlook on
their healthcare once theybecome a DPC member because they
don't have the stressors thesame as they did in fee for
service, in terms of trying toget in, trying to get in with
the same person every time.
Right.
Fill in the blank.
(34:38):
There's lots of differencesbetween DBC and fee for service,
but when it comes to yourpractice, have you had to
reinforce boundaries withpatients?
And if so, how do you do that?
Because definitely we've heardon the podcast where some
patients, there'll be quoteunquote high utilizers and,
messaging every 10 minutesbecause they can.
But have you had an example of ahigh utilizer or somebody in
(35:01):
your practice where you've hadto set boundaries?
Dr. Lisa Tritto (35:03):
I think because I'm still building, I've been a
bit more lenient.
And so, for example, I had apatient that I was seeing for
weight management, but then theywere taking a trip to Africa and
could I please just do their,their travel medicine visit?
And I did.
And then they were moving andcould I just please fill out her
physical form because you'vebeen examining her every month?
And I did.
(35:23):
So, I think if I were busier, Iprobably would've had to like
kind of draw the line on what Iwould do, sort of outside of
their usual, agreement of whatwe're doing.
Dr. Maryal Concepcion (35:33):
What are your favorite resources that you
recommend for physicians to leaninto, to also recommend to their
patients?
If, they're seeing a pediatricpatient who is struggling with
obesity as well as possiblyother comorbidities
Dr. Lisa Tritto (35:47):
I do, on my website, I have a blog where I,
I have discussions about a lotof these topics like reducing
like internal bias and shame andstigma and how to talk about.
Bodies and health instead ofweight.
I have a lot of that on thewebsite blog.
And then I do have some YouTubevideos where they were more most
(36:09):
of them were community talks,although there was one directed
towards physicians.
And, but there's goodinformation in there for
everybody about, some, some ofthe basics about obesity as a
disease.
And I think sometimes if we canunderstand that, that that
biochemistry, that physiology,it can help us be much more
sympathetic to our patients orempathetic to our patients and
(36:32):
less judgy, so to speak.
So those are, those are greatresources.
And then there are a, a few CMEkind of resources around, like
from University of Minnesotawhere I train, they do that
conference every year.
And American Academy ofPediatrics has a nice.
Website on it's called theInstitute for Healthy Weight,
something like that.
Dr. Maryal Concepcion (36:52):
When you think about pediatric obesity
medicine I wonder what isprobably one of the biggest
things that you think ismisunderstood about the
specialty?
Because you've, you're doinggeneral pediatrics, like you
said.
Yeah.
You continue to do along withspecializing in obesity
management for kids.
Dr. Lisa Tritto (37:13):
I think one of the big misconceptions is that
it's very prescriptive thatthey're going to be told exactly
what to eat and how much toweigh.
And actually just last night, I,I was on this panel with eating
disorders specialists.
And so we were talking about howwe approach a child, with weight
and they were really surprisedabout how I talk about things
(37:36):
and how it really is moreleaning towards a intuitive
eating model and even a healthat every size model because we
don't set a goal, we don'texpect everybody to get into
the, quote, normal BMI range.
We just need to get them out ofhealth consequences and feeling
better.
We don't, not everybody can.
(37:56):
Not everybody's gonna make it tothat in a healthful way.
So, I think that's the biggestmisconception is that, that
people come in here and theyleave with your, being told that
they're 30 pounds overweight andthat they need to count
calories.
Like, I think that's what peopledon't realize.
Yeah.
Dr. Maryal Concepcion (38:15):
And I will say too, I, I, this is
like, as I'm excited to hearyour.
Addition to the Aurora story, Ijust, I, I would love to be able
to, pull it back to the future,ride in a DeLorean and like,
hear how these kids' lives aretotally transformed because of
how you're talking with them andhow you're talking with their
(38:36):
families.
So I just like, I I, I, I knowthat that's coming.
We can't write in the DeLoreantoday, but it's, it's so awesome
the impact you're making.
So when you think about otherphysicians who are listening and
who are either, in pediatricswhere the A API would say is not
as vocally supportive of the DPCmodel compared to like the A A
(38:58):
FP at this time.
Hope that changes.
What would you say topediatricians, especially who
are thinking about DPC or forthose, for those who are
pediatricians looking to dospecialty pediatrics, just like
you have,
Dr. Lisa Tritto (39:13):
You won't regret it.
I think it might take a minuteto kind of get up to where you
need to be, but you can still bemaking an impact and you, and,
and, and maybe even a moreeffective impact when you're
seeing fewer, seeing fewerpatients.\
Dr. Maryal Concepcion (39:29):
I love that.
Thank you for listening toanother 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
(39:49):
join DPC didactics our monthlydeep dive into your questions
and challenges.
Links are@mydpcstory.com forexclusive content you won't hear
anywhere else.
Join our Patreon.
Find the link in the show notesor search for my DPC story on
patreon.com for DPC news on thedaily.
Check out DPC news.com.
Until next week, this isMarielle conception.
Direct Primary care is an innovative
alternative path toinsurance-driven healthcare.
Typically, a patient pays theirdoctor a low monthly membership
and in return builds a lastingrelationship with their doctor
and has their doctor availableat their fingertips.
Welcome to the my DPC storypodcast, where each week.
(01:39):
You will hear the ever sorelatable stories shared by
physicians who have chosen topractice medicine in their
individual communities throughthe direct primary care model.
I'm your host, Marielleconception family physician,
DPC, owner, and former fee forService.
Doctor, I hope you enjoy today'sepisode and come away feeling
inspired about the future ofpatient care direct Primary
(02:02):
care.
Dr. Lisa Tritto (02:06):
DPC for me has reinvigorated my love of
medicine and helping people andreally feeling like I'm making
an impact.
Having control over my life andpracticing the way I think works
best for me and my patients.
I'm Dr.
Lisa Reto with Vora for Kids,and this is my DPC story.
Dr. Maryal Concepcion (02:32):
Dr.
Lisa Tritto is a pediatricianwith advanced expertise in
childhood and adolescent weightand wellness care after more
than 20 years in generalpediatrics.
She completed a fellowship inpediatric obesity medicine at
the University of Minnesota,making her one of the few
physicians in the country withthis specialized training.
Dr.
Tritto has now dedicated herpractice exclusively to
(02:53):
pediatric weight management,where she blends evidence-based
medicine with a compassionate,non-judgmental approach that
helps children and familiesbuild sustainable habits and
improve long-term health.
She earned her medical degreefrom St.
Louis University and trained inpediatrics at Case Western
Reserves, rainbow Babies, andChildren's Hospital.
Beyond the clinic, Dr.
Tritto has served as a coach forgirls on the run, raised funds
(03:14):
running the Chicago Marathon,and enjoys hiking, cooking,
traveling, and cheering on herfavorite sports teams.
Originally from California.
She now calls St.
Louis home.
Welcome to the podcast, Dr.
Reto.
Hi.
Nice to be here.
So I love this.
We were just going overpronunciation of names before we
started recording, and I willsay Dr.
(03:34):
Lisa Reto, like Cheeto wasamazing and helpful for me, but
I also think it's superappropriate and ironic for this
conversation because we'retalking about pediatrics.
I know lots of Cheeto talks thatI've had in pediatric visits,
but also about how you have gonefrom pediatrics to specializing
in pediatrics, in obesitymedicine in in particular with
(03:56):
Vora.
And so I will say that if youhave not listened to Dr.
Becky Lin's episode Vora starteda very long time ago, and Dr.
Reto has been with Aurora nowfor almost a year.
We're approaching a year thisDecember.
Mm-hmm.
And so it's so exciting to seethe growth of the practice
through your lens.
So again, thank you so much forjoining us today.
Sure.
My pleasure.
(04:16):
I wanted to start with yourbackground because you went to
school in California where I'mpodcasting from, and then you
left California.
And so I'm wondering if youcould talk to us about how your
journey even brought you to theMidwest right now, where you are
today.
Dr. Lisa Tritto (04:33):
Yeah.
Yeah, I grew up in California,in the Bay Area and went to
college there and left formedical school.
I came to here to St.
Louis, St.
Louis University with theintention of going right back to
California.
But I met a boy and you know howthat goes.
And he was from the Midwest andso I pretty much ended up in the
(04:54):
Midwest for the rest of my,well, my life more than half of
my life now.
And for a variety of reasons.
I've sort of been in a coupledifferent states throughout my
career, and now I've, I'veactually just returned back to
St.
Louis just about a year ago now,where one of my kids lives here.
So.
I love
Dr. Maryal Concepcion (05:14):
that.
Yeah.
Dr. Lisa Tritto (05:15):
And
Dr. Maryal Concepcion (05:15):
I, I love the you, you know the
story, ya meet a boy.
That's definitely what happenedwith, with my husband and I,
except he was from California,so it worked out.
But oh, good for you.
I, so when, when we think abouthow you have gone into pediatric
specialty, I love people likeDr.
Mina Jula poll, pediatricdermatologists have been on the
podcast before.
(05:35):
But I wanna highlight that priorto being a specialist, you were
a generalist and seeing thingsat different medical centers
like Rush Medical Center, aswell as in Cleveland.
And so I'm wondering if you cantell us about, when you started
practicing up until lastDecember, when you, when you
joined Aurora, I'm wonderingwhat were the things that you
(05:57):
saw that ultimately made youmake the transition to DPC.
Dr. Lisa Tritto (06:02):
Yeah, I've, I've had the opportunity to work
in a variety of differentsettings.
So I was in sort of a universityaffiliated practice and my
patient population was fromrural to suburban.
And then I was in Chicago atRush, and then that was more
urban.
And I, I was fairly happy in my,my group practice, it was
(06:26):
university affiliated becausethe doctors did own their, own
the practice.
And so we were able to make someof our own decisions.
But then I, when I went to theacademic setting, the the layers
of bureaucracy and lack ofcontrol over my schedule, just,
kind of did it for me.
(06:47):
Things like, they would wantyour schedule to be full, full,
full, full, full.
And then you couldn't see a kidwith an ear infection.
And thankfully at this point inmy career, I was like, no, this
is not acceptable.
We cannot practice this way.
At the same time, I was going toother, through some other life
transitions, and I had beeninterested in weight management
for a long time, had beenfrustrated with not being able
(07:09):
to help my patients very well,and I, and I learned about this
fellowship opportunity inMinnesota.
And so then I went to anotherMidwest state for a year and did
my training there.
And then, like I said, ended upback here in St.
Louis.
So, so I just think about, you
Dr. Maryal Concepcion (07:25):
know, the the, the laughter to, to
release the, the steam offrustration when we think about
those memories about what ourpatients and ourselves have gone
through.
Because it's like.
You can't do anything but laughor cry sometimes and at the
ridiculousness of it.
But I, I wonder if you can tellus specifically when it comes to
(07:49):
health of kids.
Absolutely.
Obesity, medicine, weightmanagement bullying, all of the
things happen, especially inpediatrics.
Experiences that we have as kidsare so formative in how we are
as adults in the world.
And I'm just wondering if youcan, give us examples of a.
How you really turn to thisfellowship to be able to make a
(08:11):
difference in kids' lives whenit comes to healthy bodies, when
it comes to trying to do betterfor your patients, because what
you were seeing was notsufficient for them.
To, to be in a space where youcan talk about health and your,
(09:09):
like how many minutes perpatient, right.
Dr. Lisa Tritto (09:12):
Yeah.
Ab absolutely.
I, I would say in generalpediatric practice, of course
time was always, always afactor.
And this is this is a topic thattakes a lot of time and that's
also why I've chosen this DPCtype of route.
Because I can spend, I spendabout 90 minutes with my, my
(09:33):
patient for the first time goingthrough their medical records,
their life story, their bullyingstory, their.
Whatever their social dynamics,it's a very deep dive.
I feel like I know them verywell by the time by the time
they leave.
In the space and time that I hadin general pediatrics, I just
could not, I, I could not allowthe amount of time that I needed
(09:56):
to do sort of the deep dive andsee what's going on in these
kids' lives, or I couldn't getthem in soon enough for follow
up or, any of those things.
I couldn't carve out timespecifically for dealing for
dealing with weight.
Those were the kind of thingsthat happened.
Dr. Maryal Concepcion (10:13):
What was it about this fellowship that
drew you to Minnesota versus notdoing a fellowship?
Dr. Lisa Tritto (10:20):
Yeah.
The, the whole science and fieldof obesity is so fascinating and
complex and I really felt like Iwanted that, that level of the
level of education to helpunderstand, but that hands-on
experience with people that aredoing it every day, that's what
(10:40):
that fellowship provided to me.
I probably could have pieced ittogether and it would've taken
me a long time to feel asconfident in what I do on my
own.
It probably would've taken a fewyears, but this opportunity just
like to be intensive is why Ichose to do it.
I the University of Minnesotaputs on a CME conference every
(11:03):
year specific on pediatricobesity, and I had to tend to
that.
And that was sort of where I,decided I really would like to
go to go and just really learnit and dedicate myself and not
try to do both
Dr. Maryal Concepcio (11:18):
incredible and so needed just because.
Pediatric obesity is such ansuch an issue, but also an issue
that's guaranteed to get worse,given that if people are going
to have restrictions on foodaccessibility.
I think I mentioned this on thepodcast recently, but in our
county very rural 4,000 peopleare getting CalFresh benefits.
(11:40):
So fresh food benefits and 1500of those people are going to
lose their benefits as ofFebruary of 2026.
Yeah.
And then on top of that, therest of them are going to have
to do proof of work, et cetera,et cetera, proof of citizenship,
whatever the, the BS is of the,the day.
Yeah.
But I will say that when itcomes to, wanting to eat Whole
(12:01):
Foods and things.
It's like, is that an option?
Will that be an option in thefuture?
Is definitely something that I,I didn't have to think as hard
about prior to yeah.
The changes that are coming.
So let me ask you here, when youtalk about this fellowship and
when you talk about how you wereable to have super concentrated
(12:21):
education on pediatric obesitymm-hmm.
I'm wondering how did you leavefellowship?
Because it's almost like DPC,once you see it, you can't unsee
it.
And so I'm wondering, once yousaw the way that you could
practice in fellowship, how soonafter did you, start itching for
something like DPC?
Dr. Lisa Tritto (12:43):
I knew, I knew before I even went into
fellowship that that was, well,I, I was pretty sure that was
what I would wanna do when Icame out and sort of be able to
do it in my own way.
And in fellowship we did, wewere allowed, we were allowed a,
a fair amount of time, but thethe opportunity to have follow
(13:05):
ups at a timely manner, WA wasvery limited.
And it's that way at all of thepediatric weight centers around
the country.
Extremely long wait to get inand not enough time to spend
with your patients.
Yeah.
Dr. Maryal Concepcion (13:20):
And can you tell us about some of the
patients who you would see?
Because I think about, Dr.
Andy Burkowski, he's the, thequaternary specialist that the
people who have restless legsyndrome.
In particular, we'll go todifferent clinics at Cleveland
and Mayo, I believe, and thenthey go to him.
So I, I'm thinking about when wehave pediatric obesity in the
family practice clinic in thegeneral pediatrician clinic who
(13:42):
are the patients that you wouldsee and what would, what would
get them to you?
Like, would it be certain thingsthat were screened for to get
them to your fellowship clinics?
Or was it just general, concernabout pediatric obesity?
From general physicians?
Dr. Lisa Tritto (14:01):
Yeah.
I think the majority of thepatients were having problems
related to weight.
So pre-diabetes liver disease.
Depression, anxiety, just weightcould not stop gaining weight.
That would be a lot of ourreferrals and, but there would
(14:21):
be some families that sought usout on their own and who felt
actually dismissed by theirgeneral doctor or shamed or,
just unhappy with their primarycare experience and sought us
out on their own.
We did have a very largeMedicaid population up there
(14:45):
too.
I mean, obesity does, it is moreprevalent in a, an underserved
community.
Absolutely,
Dr. Maryal Concepci (14:51):
definitely.
And I'm wondering when you talkabout how even in fellowship it
was, sometimes it was difficultto get the follow-ups.
And I'm wondering if you couldbring us to, maybe a, a patient
example or where you had done,good work conversation with the
family and the patient, and thenbecause of follow up not being
(15:13):
what it needed to be the, thedifferences that you had hoped
for were not being made.
Dr. Lisa Tritto (15:20):
Right.
It, it can be hard.
Particular if they're onmedication and we need to follow
for side effects, we, what wewould end up doing is a lot of,
myChart messaging and spent anextraordinary amount of time
trying to manage side effectsand so on in between visits.
Or they would run out of theirmedication and not realize that
(15:42):
they could call, call and get arefill and they come to us
however many months later havegone off and gained weight again
and that sort of thing.
So, that is, that is definitelyone of the restrictions because,
we are now prescribingmedications like this GLP one
that really need closemonitoring and mm-hmm.
Write a prescription for thatand say, see you in three or
(16:05):
four months.
That's just not good medicine,yeah.
Dr. Maryal Concepcion (16:53):
And just as we're talking about GLP ones,
I'm wondering what is theaccessibility.
For a GLP one in the pediatricpopulation, if you are a
Medicaid Medi-Cal patient versussomeone who's privately insured.
Because in the adult world, it'sdefinitely an ongoing struggle,
no matter how many gold, tripleplatinum insurance plans a
(17:14):
person has.
Dr. Lisa Tritto (17:15):
Yeah.
It is definitely statedependent.
We were fortunate in Minnesotathat Medicaid did cover them,
although sometimes the hoopswere pretty, there were a lot of
hoops to jump through.
Yes, we cover them, but we'regonna deny, deny, deny.
We had to appeal, appeal, appealuntil they were eventually
cover.
Here in Missouri, actually, justat the beginning of this year,
(17:37):
they became approved in a weirdway.
Like they want us to use the Abrand that's, that would be off,
off label for kids.
Mm-hmm.
But they will cover them withouta prior authorization even,
which is amazing.
So it is very state dependentand from what I understand in
California, that California hasbeen very good about coverage
(17:59):
for kids at least.
I don't know about adults.
Dr. Maryal Concepcion (18:01):
as you say this, I, I am just like, I
wonder what the PBM politics arebehind the oh yeah.
The availability of me medicinesin Missouri versus other states.
It's crazy.
Yeah.
So when it comes to you leaninginto fellowship, you going to
fellowship did you have any,pressure from your prior
(18:21):
colleagues or just, people youwent to medical school or
residency with?
To stay in general pediatrics?
Because I, I think about in the,the, I think about the
comparison of people who are, inthe fee for service world that
they'll say things like, oh,well, if you leave to do DPC,
you're gonna create a shortage.
And so I'm wondering if you gotany similar pressures from going
(18:44):
between general pediatrics andspecializing in pediatrics in
your world.
Dr. Lisa Tritto (18:50):
No, no, I didn't, but I wasn't asking for
anybody's opinion either.
And, and, and I, and, and I, I,I do, I do sometimes struggle
with, should I be doing morefor, certain populations, but I
also will look back and say,I've, I've been doing pediatrics
for over 20 years and I haveserved those populations and I
(19:12):
can find ways to help in, inother avenues.
So, for example, I'll do, oneday a month where I will see
anybody regardless of theirability to pay or I'm on a lot
of committees in the, in thecommu, in the community.
And I'm like reaching out andtrying to educate people on
social media and whatever.
(19:33):
So I feel like I'm still making,making a contribution
Dr. Maryal Concepcion (19:37):
that way.
I love that it's very much inalignment with the culture of
Aurora that Dr.
Becklin talked about when shewas on.
But also, just that you're gonnabe in a mental space where you
can feel good about the careyou're giving your patients, as
well as that you can have time.
Not that it's a, it's a it's aduty to, to volunteer to do
(19:58):
anything, but it's like if youget excited to, and you have the
bandwidth to a fricking men.
Right.
So That's awesome.
And I, I wonder now, when youleaned into DPC, we're recording
this close to one year of youbeing at Vora.
Was the, and I don't know this,so this is, this is a, a
definitely honest question.
Was Vora for kids in existencebefore you came on at Aurora as
(20:24):
well?
Dr. Lisa Tritto (20:25):
No, it was started for me.
Yeah, I met, I met Becky and Iwas actually, I wasn't quite
sure how I was gonna start mypractice when I met her at the
St.
Louis Obesity Society meetingwhen I first moved there.
And then she called me a coupleweeks later and she says, Hey,
why don't you join us?
And I thought, oh, this isamazing.
(20:47):
You've already figured out howto do everything and I'll just
slot right in.
And so she, I was very fortunatethat I was able to come into a
system that was already in placewhere they, they knew how to
market and they, they knew howto make a webpage.
All of that was so completelyforeign to me.
I probably would've still beentrying to figure it out.
(21:10):
such a learning curve.
Yeah.
Yeah,
Dr. Maryal Concepcion (21:11):
totally.
And I think it's awesome becauseespecially Dr.
Dr.
Becklin does does marketing likethat, that is a thing that she
loves also.
So in addition to clinicalpractice, like just speaks to my
heart when, when we get to dolots of different things that we
love.
But I'm wondering because thisis a very real space that a lot
of people are finding, and thatthey don't have to start their
DPCs from the ground up.
(21:33):
Talk to us more about what yousaw in Aurora building off of
what you mentioned that made youmore confident in, hey, like
this type of practice couldactually work in that, I'm not
taking insurance and I can spendtime with my patients.
Because it, it is sadly, it isreally challenging and foreign
sometimes to, to have people,see DPC and they understand DPC,
(21:59):
like tho those are two differentthings,
Dr. Lisa Tritto (22:01):
right?
What she has built here isreally just, inspiring.
She started by herself and thenshe her patients needed
perimenopause and menopausecare.
So she learned about that andgot certified and then they
needed weight management.
So then she learned about thatand got her obesity medicine
certification and then they needa dietician.
(22:22):
So she brought on her owndietician'cause she couldn't get
anybody in.
And then they need a therapy.
So she, then she brought in atherapist and now we have that.
We have an internal medicinedoc, we have a psychiatrist, we
have a chiropractor, we have apersonal trainer.
It's just like this, she'sdefinitely a success story.
She started, the practice is alittle over five years old now.
(22:43):
She had started it.
She tried to, she's tried tostart it in February of 2020.
And you know what, what happenedin March of 2020?
Pretty
Dr. Maryal Concepcion (22:52):
pretty hard to forget that one for
sure.
But yes, I definitely, again,encourage anybody who has not
definitely go listen to the,the, the history of Aurora when
Dr.
Becky Lynn came on as the, thesolo doc.
So I absolutely love that.
This is, a fast forward into thefuture when it comes to in
December of 2024 when youstarted it's my understanding
(23:14):
that you started with 10patients, were there ever any
concerns about how rapid youwould be growing?
Because like you're mentioning,it's so needed for a kid and
their family to have the abilityto talk with a doctor, with the
time that you provide now whenit comes to weight and when it
comes to health.
And so I'm just wondering, wasthat ever a concern for you
(23:35):
because your services are soneeded?
Right.
It was
Dr. Lisa Tritto (23:39):
still a concern because I, what I didn't know
is, how willing people or ablepeople would be to, to pay out
of pocket and not use theirinsurance.
I definitely, I know thatthere's a need, and my other
concerns were I hadn't lived inSt.
Louis in a very long time, andso I don't have the connections
that I had in Cleveland orChicago where there, I just,
(24:01):
like, for example, Cleveland, Ifelt like I knew every general
pediatrician and I would havehad a pra, a full practice in no
time.
But here I have had to workreally hard on making
connections in the, in thecommunity.
So I mean, I did, fear, like,will I be busy enough to, pay
the bills and it's stillgrowing.
(24:23):
I'm not where I need to be yet,but I do, I'll do some other
things to sort of, supplement myincome, like.
Tele, and a few other littleside gigs.
Dr. Maryal Concepcion (24:34):
When it comes to expanding your reach in
the community where you are nowin St.
Louis, how are you going aboutmaking community connections so
that people are aware of yourservices?
And so people, especially in thehealthcare realm, are aware of
you and referring people to youas an option?
Dr. Lisa Tritto (24:51):
Mm-hmm.
I like on foot going, walkinginto general pediatric offices,
leaving materials attendinggrand rounds at one of the local
children's hospitals.
I connected with some peoplethere.
And really in any space where mypatients potential patients
might exist, I I've had a greatconnection with the, mental
(25:16):
health community becauseprobably 95% of my patients
carry at least one diagnosis inthe mental health realm.
Eating disorders community.
There's some, there's sometelehealth network groups that
do pediatric weight managementand so on.
So that, those are sort of mythings.
And then face, then face throughFacebook as well.
Dr. Maryal Concepcion (25:39):
I'm wondering if you Can also talk
to us about word of mouthdownstream effects from people
who have been to Vora and nowthey realize that, oh, there's a
service that my kids couldpartake in as well.
Dr. Lisa Tritto (25:51):
Sure, yeah, definitely.
I've had patients, new patientsthat are children of parents
here.
Yeah.
Dr. Maryal Concepcion (25:58):
That's fantastic.
And yeah, it's, it's so funnywhen a person who knows of one
of our patients comes the, theonboarding call's very different
in, in, in our experience.
It's like we can skip to the,skip to the good part like the
song says because they alreadyknow what they are looking for
when they take that call.
That's awesome.
Yeah.
And how about when you mentionyour, you're doing telemedicine,
(26:20):
you also offer multi-statetelehealth when it comes to your
practice at Aurora.
So tell us about who do you haveon your panel when it comes to
in-person patients versus thoseyou take care of in other
states?
Virtually.
Dr. Lisa Tritto (26:34):
I have been struggling to connect in the
other states, so most of, I onlyhave a couple of patients that
are entirely remote, so for themajority of the, they are coming
in, I may do telehealth visits.
If there's somebody I've beenfollowing over time, I might not
make them come in every month.
Or they have, kids that are verybusy with school.
(26:55):
And then I do have a couple thatare just completely remote.
Yeah.
Dr. Maryal Concepcion (26:59):
And please tell us, for listeners
out there who are wonderinglike, where can I send my
patients?
How can I get in touch with Dr.
Reto?
What states are you licensed in?
So, under your practice rightnow?
Dr. Lisa Tritto (27:11):
Yeah.
Illinois, Indiana Minnesota,Missouri and Ohio.
Those are all the five statesI've lived in since I left
California.
Dr. Maryal Concepcion (27:23):
I'm just totally throwing this out there,
but I vote that you go to theOhio DPCN summit in February of
2026.
All right.
And, and talk there, especiallybecause I didn't know about
that.
Yes.
Yeah.
Yeah.
It, it's a, it's a great placefor the Ohio DPC community to
connect.
Okay.
So, for those of you also whodidn't know please check it out.
And people like Dr.
(27:43):
Lily White and Dr.
Pat Jonas are the organizers ofthat one.
Okay.
Awesome.
On your website you have apicture of the Grand Canyon.
I have a great story to shareabout that, but I will leave
that for a different podcastdifferent day.
But I just think about what hasDPC, changed for you in your
life on the day to day?
Dr. Lisa Tritto (28:02):
Yeah, I mean, just the ability to.
Schedule a doctor's appointmentor actually have lunch with a
friend where I can just, lockoff some time and not have to do
that six weeks in advance oreight weeks in advance.
That type of, that kind offlexibility and my schedule is
really great and I really canmake, make the schedule whatever
(28:24):
I want it to be.
And that's, that part has beenjust amazing.
Dr. Maryal Concepci (28:28):
Incredible.
And I, I hope that it makespeople, especially those who are
planning or starting out orwithin their first year just
reflect on their own time thatthey're able to spend doing
whatever the heck they want.
I was texting with Dr.
Deanna Berry this morning and Iwas like, Hey, do you wanna do
you wanna connect now?
I'm walking our dog and she'slike, I'm going into yoga.
(28:49):
And I'm like, I love that we'redoing self-care over here.
So yes.
Because we can.
So, absolutely.
It's amazing to hear that you'veexperienced that as well.
Yeah.
And just being able to fill ourcups, it's amazing.
So when, when it comes to youmentioning the opportunities
that is that a patient has atAurora, because there's so many
(29:11):
different branches of, of waysto deliver care even though
your.
At, at vora for kids, do yourpatients also have access to the
nutritionist, to the therapistto add an even more robust
holistic layer to the care thatyou are delivering?
Dr. Lisa Tritto (29:29):
Yes.
Our dieticians do see kids, andwe have a therapist who does
also see kids, and she's reallygreat.
She actually used to work in theschool system, and so, yeah, so
she's an awesome, like, resourcefor us.
Dr. Maryal Concepcion (29:43):
And how does that work in terms of
making sure that the patient,the notes are not, lost between
hospital EHRs or, if you canfind something or not?
Because you guys are your ownecosystem.
How do you guys collaborate fora patient?
Dr. Lisa Tritto (29:58):
We just talk to each other.
Imagine that.
Wow, we don't write a, a, a 20minute instant message to one
another.
No Tiger text going on.
No, no, that, and that's, that'sanother thing that I love is
that, our patients will sign athing that allow us to
(30:20):
communicate by email with them.
And so it's so much easier tocommunicate with patients and
for them to have access to usand for me to quickly relay some
information to them.
So just, yeah.
Dr. Maryal Concepcion (30:33):
I love it.
And tell us about the generalday in your practice because
you, you, again, you get todetermine how much time each
patient needs for their visitswith you.
Dr. Lisa Tritto (30:44):
Yeah, I mean, like I said, my first visit, my
initial visit with them is about90 minutes long, and then my
follow-ups are 45 minutes.
So, that's pretty much what itlooks like.
It's, it's the family comes inhaving, already completed like
questionnaires and we make surethat they're done before they
actually arrive.
That's another thing that wouldnever happen in a bigger
(31:06):
practice.
We can, we have the staff thatcan, keep texting and reminding
them until they, until they doit, and that makes the visit go
so much more smoothly.
Yeah.
Dr. Maryal Concepcion (31:16):
That's awesome.
And what does your schedule looklike throughout the week?
Dr. Lisa Tritto (31:21):
My schedule, I start late on Mondays.
I take Monday mornings off andFriday afternoons are off.
That way if I wanna travelsomewhere for the weekend, I've
got some more flexibility in myschedule.
Otherwise it's more, it's nineto five ish, but I will adjust
for patients.
So I have.
A regular, a regular patient andlike, she's probably the same
(31:44):
girl that I do the telehealthwith, that she know she's in
volleyball till six o'clockevery night.
So once in a while I'll just doa, follow up with her remotely
maybe from home even because I,I can and, and mean my life is
different now.
My children are older, so likedoing an evening appointment is
like no big, no big dealanymore.
Dr. Maryal Concepcion (32:04):
I love that.
But I will say, I got my signidea by appointment only from
Dr.
Janine Roddas who had that onher door.
But I will say Dr.
Reto just dropped a great one,like nine to five ish.
That's freaking amazing.
So, yes, I, I love that.
It's a great, it's a, it'sanother idea to write that on
your assign for those of youdoing DVC out there.
(32:24):
I love it.
So let's talk about howcomorbidities also play into the
health of your patients,specifically when it comes to
neurodiversity and A DHD.
I'm wondering how do yourappointments, pivot or move with
a patient who has a comorbiditywhere you might need more
(32:46):
appointments with them if youknow there is a mental health
crisis going on or something?
Because it's not just like.
The typical, well, we see youand then we'll see you in how
many months later if you comeback, type of thing anymore.
Dr. Lisa Tritto (33:00):
Right, right.
Yeah, so I mean, this is where,when I say I'm not doing general
pediatrics anymore, I guess I'mreally lying because I am still
doing general pediatric.
It's, it's just that, so, so forexample, A DHD many, many
patients, especially the youngerones come in, they have a DHD
and they have obesity, or theyhave autism, they have obesity,
(33:21):
or they have all, they have allthree.
And so sometimes I am they'venever been diagnosed or their
general pediatrician doesn't dothat, and I have plenty of
experience with that.
So then we may have them comeback, I'd have'em come back.
I have somebody this week whowas a new patient and mom thinks
he might have a DHD.
And so I'm just doing theirevaluation and they're coming in
in two weeks and they'll have a,we'll have it figured out
(33:42):
probably by then.
So, yeah.
And then I had the flexibilityin my schedule to do that right?
Where as before, it probablywould be three months before I
had an appointment where I coulddo a full A DHD evaluation.
And then if there's like an, anurgent situation, like, if a
patient who's on a medication iscausing her a lot of, she's
(34:03):
complaining about her, stomachhurting all the time, and we
don't know if it's hermedication or not.
They, I can just tell them,come, come in today, tomorrow,
whatever, have lots of contactwith the parent and decide, what
needs to be done.
So that's been, that's beenreally nice to be able to do
that too.
And.
Dr. Maryal Concepcion (34:18):
Just because, we, we see our patients
typically just having acompletely different outlook on
their healthcare once theybecome a DPC member because they
don't have the stressors thesame as they did in fee for
service, in terms of trying toget in, trying to get in with
the same person every time.
Right.
Fill in the blank.
(34:38):
There's lots of differencesbetween DBC and fee for service,
but when it comes to yourpractice, have you had to
reinforce boundaries withpatients?
And if so, how do you do that?
Because definitely we've heardon the podcast where some
patients, there'll be quoteunquote high utilizers and,
messaging every 10 minutesbecause they can.
But have you had an example of ahigh utilizer or somebody in
(35:01):
your practice where you've hadto set boundaries?
Dr. Lisa Tritto (35:03):
I think because I'm still building, I've been a
bit more lenient.
And so, for example, I had apatient that I was seeing for
weight management, but then theywere taking a trip to Africa and
could I please just do their,their travel medicine visit?
And I did.
And then they were moving andcould I just please fill out her
physical form because you'vebeen examining her every month?
And I did.
(35:23):
So, I think if I were busier, Iprobably would've had to like
kind of draw the line on what Iwould do, sort of outside of
their usual, agreement of whatwe're doing.
Dr. Maryal Concepcion (35:33):
What are your favorite resources that you
recommend for physicians to leaninto, to also recommend to their
patients?
If, they're seeing a pediatricpatient who is struggling with
obesity as well as possiblyother comorbidities
Dr. Lisa Tritto (35:47):
I do, on my website, I have a blog where I,
I have discussions about a lotof these topics like reducing
like internal bias and shame andstigma and how to talk about.
Bodies and health instead ofweight.
I have a lot of that on thewebsite blog.
And then I do have some YouTubevideos where they were more most
(36:09):
of them were community talks,although there was one directed
towards physicians.
And, but there's goodinformation in there for
everybody about, some, some ofthe basics about obesity as a
disease.
And I think sometimes if we canunderstand that, that that
biochemistry, that physiology,it can help us be much more
sympathetic to our patients orempathetic to our patients and
(36:32):
less judgy, so to speak.
So those are, those are greatresources.
And then there are a, a few CMEkind of resources around, like
from University of Minnesotawhere I train, they do that
conference every year.
And American Academy ofPediatrics has a nice.
Website on it's called theInstitute for Healthy Weight,
something like that.
Dr. Maryal Concepcion (36:52):
When you think about pediatric obesity
medicine I wonder what isprobably one of the biggest
things that you think ismisunderstood about the
specialty?
Because you've, you're doinggeneral pediatrics, like you
said.
Yeah.
You continue to do along withspecializing in obesity
management for kids.
Dr. Lisa Tritto (37:13):
I think one of the big misconceptions is that
it's very prescriptive thatthey're going to be told exactly
what to eat and how much toweigh.
And actually just last night, I,I was on this panel with eating
disorders specialists.
And so we were talking about howwe approach a child, with weight
and they were really surprisedabout how I talk about things
(37:36):
and how it really is moreleaning towards a intuitive
eating model and even a healthat every size model because we
don't set a goal, we don'texpect everybody to get into
the, quote, normal BMI range.
We just need to get them out ofhealth consequences and feeling
better.
We don't, not everybody can.
(37:56):
Not everybody's gonna make it tothat in a healthful way.
So, I think that's the biggestmisconception is that, that
people come in here and theyleave with your, being told that
they're 30 pounds overweight andthat they need to count
calories.
Like, I think that's what peopledon't realize.
Yeah.
Dr. Maryal Concepcion (38:15):
And I will say too, I, I, this is
like, as I'm excited to hearyour.
Addition to the Aurora story, Ijust, I, I would love to be able
to, pull it back to the future,ride in a DeLorean and like,
hear how these kids' lives aretotally transformed because of
how you're talking with them andhow you're talking with their
(38:36):
families.
So I just like, I I, I, I knowthat that's coming.
We can't write in the DeLoreantoday, but it's, it's so awesome
the impact you're making.
So when you think about otherphysicians who are listening and
who are either, in pediatricswhere the A API would say is not
as vocally supportive of the DPCmodel compared to like the A A
(38:58):
FP at this time.
Hope that changes.
What would you say topediatricians, especially who
are thinking about DPC or forthose, for those who are
pediatricians looking to dospecialty pediatrics, just like
you have,
Dr. Lisa Tritto (39:13):
You won't regret it.
I think it might take a minuteto kind of get up to where you
need to be, but you can still bemaking an impact and you, and,
and, and maybe even a moreeffective impact when you're
seeing fewer, seeing fewerpatients.\
Dr. Maryal Concepcion (39:29):
I love that.
Thank you for listening toanother 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
(39:49):
join DPC didactics our monthlydeep dive into your questions
and challenges.
Links are@mydpcstory.com forexclusive content you won't hear
anywhere else.
Join our Patreon.
Find the link in the show notesor search for my DPC story on
patreon.com for DPC news on thedaily.
Check out DPC news.com.
Until next week, this isMarielle conception.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
The Joe Rogan Experience
The official podcast of comedian Joe Rogan.
Two Guys, Five Rings: Matt, Bowen & The Olympics
Two Guys (Bowen Yang and Matt Rogers). Five Rings (you know, from the Olympics logo). One essential podcast for the 2026 Milan-Cortina Winter Olympics. Bowen Yang (SNL, Wicked) and Matt Rogers (Palm Royale, No Good Deed) of Las Culturistas are back for a second season of Two Guys, Five Rings, a collaboration with NBC Sports and iHeartRadio. In this 15-episode event, Bowen and Matt discuss the top storylines, obsess over Italian culture, and find out what really goes on in the Olympic Village.