September 7, 2025 • 43 mins
In this episode of the My DPC Story Podcast, Dr. Lisa Lucas of Fulcrum Family Health in Maine shares her journey from fee-for-service medicine to owning a thriving Direct Primary Care (DPC) practice. Dr. Lucas, a board-certified osteopathic family physician specializing in obesity medicine and menopause, discusses how DPC empowers her to provide relationship-based, patient-centered care—especially valued in Maine’s tight-knit communities. She highlights the importance of building trust, prioritizing personalized care plans, and creating a welcoming clinic environment. Dr. Lucas also offers insights into navigating finances, transitioning out of insurance-based models, and collaborating with her partner, Dr. Romeo Lucas, in direct specialty care. The episode covers the impact of recent legislative changes expanding healthcare access in Maine, the future of DPC with wraparound insurance plans, and how DPC is attracting the next generation of primary care doctors. Tune in to learn why DPC is revolutionizing family medicine, making healthcare more accessible, and restoring joy for both patients and physicians.
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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 fingertips.
Welcome to the my DPC storypodcast, where each week.
(00:26):
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
(00:49):
care.
Dr. Lisa Lucas (00:53):
Direct primary care is the answer from patients
and physicians alike of there'sgotta be a better way.
DPC is restoring the trustbetween physicians and patients
and teaching the next generationthat primary care is valuable
and necessary for all people.
I'm Dr.
Lisa Lucas of Fulcrum FamilyHealth, and this is my DPC
story.
Dr. Maryal Concepcion (01:18):
Dr.
Lisa Lucas is an osteopathicfamily physician with more than
10 years of experience caringfor patients in community
hospitals.
Certified in both obesitymedicine and menopause
treatment.
She focuses on primary care andmetabolic health, helping
patients manage and even reverseconditions like obesity,
diabetes, and PCOS.
In 2019, she stepped away fromthe insurance-based system to
(01:40):
open her own clinic, fulcrumFamily Health, where she
delivers patient-centered careand.
Specialized programs for weightmanagement, hormone support, and
women's health outside ofmedicine.
Dr.
Lucas lives in Cumberland, Mainewith her husband, Dr.
Romeo Lucas, also a physicianand their three children, Sophie
and Henry and Oliver, who happento be twins.
She loves bringing her ownparenting experience into her
(02:01):
work, offering familiespractical and compassionate
approaches to buildinghealthier, happier lives.
We are recording here at FulcrumFamily Health in Maine.
Oh my goodness.
So thank you so much for comingon
Dr. Lisa Lucas (02:14):
oh, I'm thrilled to be here.
This is, this is a blast.
I feel like I've been thinkingabout this for years and we're
just continually crossing paths.
So this is about time.
Dr. Maryal Concepcion (02:21):
You're originally from New York, your
husband's originally from NewJersey.
We will we will parking lot yourhusband's episode for another
time because he's doing his ownthing in direct specialty care.
But for you, what even broughtyou to Maine?
Dr. Lisa Lucas (02:36):
Oh sure.
I joke all the time that I waslike slowly creeping up the
coast.
Starting in New York.
I was born and raised inRockland County, just like 20
miles north of the city.
So, we still call it the city'cause it's in our mind, still
the only city.
But regardless, I then went tocollege at Holy Cross in
Worcester, mass.
And so then I was in CentralMass, then I lived in Boston,
then I lived in New Hampshire.
And when I was looking atschools I lived at university of
(02:59):
England, which is in, it wasthat time in Biddeford Has since
moved to Portland.
Yeah.
And I.
I don't wanna go to Maine.
That sounds, that sounds toofar.
And then I came up here and Ijust fell in love with it.
And, and then we went to schoolhere, met my husband here and I
ended up going back to NewJersey for a while for training,
but we moved back when we hadkids.
Yeah.
'cause it's a great place toraise
Dr. Maryal Concepcion (03:16):
kids.
When it comes to Maine, I wouldlove also if you could tell us
here, what has healthcare beenlike because the building that
we're sitting in, you're, youguys have been here for over
three years.
You've been in Maine long enoughthat you've seen the transition
and now with the quote unquotebig beautiful bill having
passed.
I'm wondering if you could alsotie in what is on the cusp of
(03:39):
happening for Mainers when itcomes to healthcare in the
future.
Dr. Lisa Lucas (03:43):
Sure.
Probably similar to lots oflocations.
We are we are a state that has acouple of established.
Healthcare entities.
Mm-hmm.
So they have multiple hospitalsand clinics that are run by the
hospitals, and so we kind ofhave to deal with the, the
business and bureaucracy thatgoes along with that.
So I think patients here havebeen looking for an alternative
for a while.
(04:04):
When I first started in 2019 Ididn't really know the landscape
very well because I worked onlyrandomly as a hospitalist and
then I worked in a, in aresidency, but.
Mainly trying to work around myhusband's schedule and take care
of our kids.
Yeah.
And so I didn't really know whatit was like to train here.
I didn't know all thespecialists here.
I feel like over the past, whatnow?
(04:24):
Six years, I have been able tosort of.
Really observe what Mainers arelooking for.
I think we would joke here thatMainers are sort of known for
wanting to do things on theirown.
They want to pull themselves up,but they're bootstraps.
They want to be able to, likethey're farming and running into
their eighties.
I mean, they really want to beindependent.
Yeah.
And I think that they appreciatethe independent nature of direct
primary care.
And so I think that they come tous.
(04:45):
We get some people that come tous just for that.
But I think when it comes tochanges.
We're recognizing thelimitations that comes along
with a hospital owned entity.
And I think that really showedits face at during COVID, which
I think is probably the same formost other locations.
I opened my practice the Junebefore COVID and I got so many
patients that just werefrustrated that couldn't get in,
(05:07):
just again, the bureaucracy ofit all.
And so they just wanted thatrelationship based care and so I
really didn't have to market inthe beginning.
It was hard, but it was stillgreat.
It just worked out beautifully.
But I think people here arereally looking for
relationships.
They very much value that.
And again, I'm sure that's verysimilar to other places around
the country, but they're tiredof being a number.
Even the independent practicesare too big.
(05:27):
Mm-hmm.
That they just feel like mills.
And I think that when patientscome into our space, they just,
common amount, it just feelslighter in here.
Everything feels calmer.
My blood pressure feels better.
I know that if I call you,you're gonna answer.
We get that sort of responseoften, which is really
reaffirming.
Yeah.
So when it comes to, nowobviously with all these changes
(05:48):
and this bill that's going toimprove access when it comes to
payment, when it comes to HSAand such, I do think we are
going to have a lot of Mainersthat, are, have been on and off
what we call main care or, ummm-hmm.
Or Medicaid and, and they're notgonna know where to go.
Yeah.
And I think luckily since.
We have, we have exploded herewith direct primary care.
Mm-hmm.
People know we exist.
(06:09):
And I think that we are gonnatry to find these patients and
just tell them that there isanother way for us to be able to
give them their care.
But I, I do expect us to havemore people knocking on our
door.
Dr. Maryal Concepcion (06:19):
That's fantastic and, and so relatable
to so many places.
But also I just wanna highlightthe relationship of your office.
Like for the audience out therewho weren't present.
When my 4-year-old walked in andneeded to use the potty it was
like, hello with me with my darksunglasses.
Nobody knows who the hell I am.
And then Dr.
Lucas was here and she was like,okay, yeah, like she's cool.
(06:39):
Like she's not just somestranger, but like literally
there's children's toys and youoffered my boys seltzer water.
I mean it literally from the getgo.
The opposite I think about islike the carpet squares that
can't even be glued correctly ina Medi-Cal clinic.
In our world, it's Medi-Cal andnobody cares.
It's like it's decent enough.
Or could we try to make therelationship.
(07:01):
At the forefront of care, andso, no matter what state, you're
exactly right, no matter whatstate you're in, people all over
this country, rural, urban,doesn't matter, are really
asking for, but I want a, I wanta doctor, I actually want
somebody who knows me.
And I'm not just, gettingprocessed by somebody who will
just ultimately send me to theemergency room or make me wait
(07:22):
eight to 12 months, or not evengo in because it's not worth my
time.
So I, I love that, all of thethings that Direct Primary Care
is known and loved for arereally, coming to fruition.
And especially the fact that thecommunity is growing in Maine.
And by sharing your story,you're helping empower people to
know that yeah, sure as heck inMaine, but also sure as heck,
(07:42):
anywhere where, where a patientwants a relationship with
somebody, that's where DBC canthrive.
So amazing.
I'm, I'm so glad that you're,you're sharing more of the main
journey on the podcast.
Dr. Lisa Lucas (07:53):
Thanks.
Yeah, we are very careful abouthow we curate the right type of
environment here.
Yeah.
I think it makes a bigdifference with our patients.
You met some of our front staffthat are phenomenal.
We have Emily, that's aregistered nurse who's worked in
all aspects of healthcare.
Kristin, who has worked indifferent offices and is just
the person you want on the otherend of the phone when you have a
(08:13):
problem.
And, and Camille who just joinedus as a medical assistant who
graduated medical school and istaking a bit of break before she
starts.
And so it just happened to allbe women, but that all worked
out for us.
Yeah.
Which So I just, I think we wantpeople to feel like everyone
that is an extension of usmm-hmm.
Is there for them.
Totally.
And we really do feel we getthat feedback all the time.
Yeah.
And I think it's reallyimportant to find the right
people Yeah.
When you're hiring.
(08:34):
Yeah.
Amazing.
Dr. Maryal Concepcion (08:35):
Tell us about what was going on before
you opened, because as many ofus know fee for service is, the,
the biggest option out there interms of number of jobs, but you
didn't choose to stay in fee forservice.
Mm-hmm.
Dr. Lisa Lucas (08:48):
Yeah, I think like a lot of us, I, I stalked
the idea of DPC for a while.
I, I knew about it ever since,probably around 2012 when I
graduated residency, and I keptsaying, yeah, at some point I'll
do it at some point.
And then it never really madesense.
I had my.
First child in 2012, and then Iended up having twins in 2014.
And, and really I don't think, Imean, having three kids under
(09:09):
two is probably just, justbecame the priority, right?
And so the thought of thatagain, just became an in in the
future.
And then I worked at a residencyin New Jersey, the residency I
went to, which was wonderful,still did inpatient, outpatient.
I kept saying at some pointwe're going to do it, and then
we decided to move to Maine.
And then again, it's like, well,I don't wanna start a new panel.
I don't know where we're gonnaland.
And so there's a lot of thoseconversations.
Totally.
(09:29):
Again, my husband is a he's aphysician as well, and he's a
ob.
GYN trained at that point was,was working in full spectrum ob
and not that his job became apriority, it was just more that
his hours were so difficult tonavigate and I just became the
flexible one.
Yeah.
Hence the hospital work and, andsuch, which worked fine.
And I worked with the medicalschool, but I really loved
teaching.
I think that was a huge part ofjust a big part of, of, I think
(09:51):
the way I expressed myself inmedicine.
And so I went and actuallyworked up at Mean Dartmouth in
Augusta.
Nice.
Which was wonderful.
And staff is wonderful and Ilove teaching.
But we just ended up, my husbandand I were passing each other on
the highway with children and wedon't have support here, so that
just, it got hard.
And we said, you know what,again like, maybe, maybe I'll
start a practice.
And again, just didn't feel likea great time.
(10:12):
And my mother had moved up herewith us.
My mother is a French andSpanish teacher at that point,
retired, but you know, just,just loved, wanted to be near
the babies and she had ms.
It was really hard for her toget around.
And so we would, we were a scenegoing anywhere.
It was like two little babies,another toddler and my mom in
the wheelchair so it was hardfor her to get around and we
would talk all the time aboutthe day I was gonna open my own
practice.
(10:33):
I think she was just a reallybig inspiration for me because
as most people know, when youhave a MS or another chronic
disease, it's just really hardto, to be mobile.
Mm-hmm.
And so she would getintermittent fevers or.
Any sort of ailment and justwanna talk to, I mean, not only
the same person, but a person.
And they would say she had tokeep coming in and, and then we
would just sit there andcomplain about, oh, why do I
(10:54):
have to keep coming in?
Why can't someone talk to me?
And then there was me with mythree kids trying to navigate if
one has strap, the other do too,and so we just talked about how
the system just didn't makesense.
And so it was always a plan.
And unfortunately my mom, uh, mymom just got, she got she
progressed a little bit faster'cause in addition to ms, she
also had breast cancer, which issomething that runs in our
(11:15):
family.
So my grandmother died at 57.
And my mom, unfortunately shegot pretty sick while I was
working at the residency.
And so, obviously we handled,the acute illness and then we
realized we needed to take herhome on hospice.
And so, so she was home onhospice in my house, and there
was no other place I wanted tobe, but I was stuck working.
And I said, well, then I thinkI, I think we're done here.
(11:37):
And so I think that was themoment I, I really decided I
needed to do it.
And, and I had plenty of timewith her, but of course you
always want more.
And so she ended up passing inmy house.
I went and got a prophylacticmastectomy to make sure I was
safe after many scares.
Sure.
Getting mammograms.
I tell the story'cause I thinkit's, I think it's important to,
to realize that the dedicationis, needs to be there.
(11:59):
Like you, there has to besomething that makes you so
angry.
Yeah.
Right.
And I think we've all had thoseexperiences.
Whereas I was healing from mymastectomy and couldn't really
lose my arms.
I was making my website andsaying, I gotta be out, and so
my mom motivated me, mychildren, my husband was very
supportive throughout the wholeprocess, and we were lucky in
that he still could work.
I calculated exactly how muchmoney I had to make to make sure
(12:20):
it wasn't a strain.
And I opened in June of 2019 andI got about, I got about what,
six to eight months in beforeand before everything changed
and I, I sent my opt out noticein after having my wait list for
Medicare, and it was March of2020.
And man, I mean, everyone knowshow it changed after that, but I
will say, I think it actuallysaved us because if I didn't, if
(12:42):
I hadn't have started mypractice I would not have able
to be home for my children.
Sure.
So I had two kindergartners anda second grader, and as many
parents know, you had to bethere while they were on the
screen.
And so I was doing, nighttime.
It's urgent care, taking care ofpatients in Minnesota and
Arkansas through telehealth and,and being there for my kids
(13:02):
during the day.
So homeschooling and all thethings.
That was, that was a lot.
But, but otherwise one of uswould've had to quit and it
probably would've been me.
Yeah.
Which again, I would've doneobviously for my family, but it,
the timing actually, when youlook back, it was perfect.
Yeah.
And so it worked out.
Dr. Maryal Concepcion (13:17):
Well, and that everybody is badass.
Dr.
Lisa Lucas.
My God, as my dad has passedalso, I just, I think about that
both of our parents are justlike giving us high fives.
Even having this conversation,because we are telling more and
more about the direct primarycare experience and also how you
were at this crossroads and you,like you said, you, you, you
(13:39):
figured it out that.
I can't do this anymore.
I'm pissed off enough to notkeep doing this because I don't
wanna be complicit in treatingother people the way that the
fee for service world treatspeople.
It's beautiful.
It's bittersweet for sure.
Mm-hmm.
But when it comes to this timeof you could have quit, but you
opened and yes that time wascrazy for so many people who
(14:02):
opened.
I'm assuming your husbandcontinued on his practice.
I'd love if you could talk to usabout how you guys.
Had any discussions about,growing the practice.
Now he's direct specialty careas well.
Did you guys talk about it thento have him possibly join you?
Because I, I think about,there's listeners out there who
are partners with a physician orpartners with a physician and
(14:25):
they're, they're thinking aboutD pc, but.
One of the things that ismentioned so many times, is,
financially, I don't think thisis gonna work.
Dr. Lisa Lucas (14:33):
Yeah, I think this is probably the biggest
question we get and especiallynow that my husband is open to
some practice, but I think evenmore so, there's just a lot of,
well, it was easy for youbecause your partner had, he was
working and, and Yes.
Did it make it easier?
Absolutely.
He had health insurance, he hadhis.
His salary and it did make iteasier, but, our salaries
mattered also.
You gotta get real deep on yourfinances.
(14:54):
Yeah.
You gotta, you gotta make thespreadsheet, you gotta find out
exactly how much you have tomake.
And if it is worth it to you,you will find a way to do it.
Yeah.
You do have to get a littlecreative.
Right.
I mean, I think I held onto my,I still did hospital work
mm-hmm.
After I left for a while andfound out again exactly how much
I had to make to make sure thatthis was gonna work.
Yeah.
I could have done it longer andhe would've been very supportive
of me if I wanted to do that.
(15:15):
But I think sometimes you haveto pare down a little bit.
Sometimes you don't.
I think it just depends on yoursituation.
Yeah.
And what it's a valueproposition, kind of just like
with direct primary care, we'retrying to say like, is something
worth it to you?
If so, then you'll find a way todo it.
Yeah.
And I think it just, it's, it'sthe fear I think that holds
people back.
Mm-hmm.
But it absolutely is doable.
And of course, remember when youown a business.
(15:36):
Their salary that you're makingis different than what you'd be
making as a W2.
Sure.
And so I think that sometimespeople don't fully understand
that and they just hear a numberand that gets scary.
And so I think finding someoneto kind of walk you through it
is, is nice because then theycan show you, well that's
exactly the way it's supposed tobe, and let's work on the
numbers and let's.
Kind of take a differentperspective.
Mm-hmm.
And when you talk through itwith people, they go, oh, well,
(15:58):
well that makes sense.
Right?
Yeah.
But I think as physicians, we'renot taught these things.
It's not something that's aclass in school.
They, if anything, I rememberspecifically someone saying,
well, you're never gonna dothat.
'cause that's not possible.
Yeah.
Don't even bother.
Even though I, I graduatedresidency in a time where an
independent doctor stillexisted.
And in New Jersey, my programdirector Yeah.
(16:18):
Was on practice for a long time.
Wow.
And so.
That changed very much when wecame out.
And so I think, I think it'sjust, it's fear.
Just like with our patients is,is a driving motivator and our
population in general.
And so it's the same withphysicians and we're used to a
certain level of living andthat's not meant to be a
judgment, but I think sometimeswe just have to say, well,
what's important and
Dr. Maryal Concepcion (16:38):
mm-hmm.
Dr. Lisa Lucas (16:38):
And truth be told is you can make a, a fine
living, working less and doing abetter job for your patients.
Dr. Maryal Concepcion (16:45):
Yeah, totally.
When you talk about better jobfor your patients, I'm wondering
if you give some examples.
I mean, I'm literally sitting ina very inclusive chair.
I commented on that before westarted recording, but it's like
the, the way that you've builtyour practice, you've been
intentional about everythingthat you've put in, how you've
designed everything, when itcomes to actual care plans,
(17:05):
coordination, what are someexamples of how you've done
things in DPC that you couldnever have done in fee for
service?
Dr. Lisa Lucas (17:12):
That's a great question.
'cause I think that that issomething that.
A lot of physicians will respondto where I say I am board
certified in obesity medicine.
And I also am a do so I doosteopathic manipulation.
And I also then went on to geta, a special a separate
menopausal certificate becauseat the end of the day, that
transition all happened becauseI kept talking to patients.
(17:33):
Mm-hmm.
And.
Either I felt like I didn't havethe exact knowledge, or I wanted
some more framework, but Ireally, in the end just wanted
more time.
Yeah, because I, I'm a formerchemistry major, a big, big old
nerd.
And I really like, I like thescience of it all, and I think
that very much rooted inevidence-based medicine, and I
think that if we have enoughtime with patients mm-hmm.
That they've, they appreciatethat approach.
I think unfortunately theInstagram influencer world that
(17:56):
we're in is fast and easy, butreally when you sit and chat
with them for a while, theyappreciate the comprehensive
approach.
And so here, I think I was justalways trying to create and be
the doctor I wanted.
Mm-hmm.
And I, everything down to,again, the chair you're sitting
in and where are the childrengonna go?
Yeah.
And that they can color on thatspecial part on the wall and the
toys that are behind me.
(18:16):
Because again, I always wantedthat.
Mm-hmm.
I couldn't even fit my strolleraround the corner.
It was so difficult.
But when it comes to patientsnow, I mean, I very much focus
on.
Metabolic health.
Mm-hmm.
And again, now hormonal aspectsof that.
'cause you can't, not, it's partof medicine.
Totally.
But when I see patients either,again, that are direct primary
care patients, but I do also dosome separate hormonal consults.
It's, it's a full hour of Yeah.
(18:38):
Of a, a pretty comprehensivehistory and walking them through
how all of it matters.
Mm-hmm.
And I want to hear their wholestory and really showing them
that you're feeling all of thesethings.
And I'm sorry that you've beendismissed.
I feel like some of it is we'redoing a little bit of therapy
when they come in, they've beenYeah, totally.
They have been dismissed andthey're frustrated and you have
to build that trust back up.
Right.
But it's so therapeutic and it'sso worthwhile.
(19:01):
And then they very much are opento listen and understand and
they know they're not beingshamed here.
This is, we just meet peoplewhere they are.
So in our office we'll docomprehensive intakes.
We do nutrition audits.
We educate them on thephysiology of obesity and, and
sometimes, thin people havemetabolic health issues, right?
Sure, absolutely.
(19:22):
So, so we're kind of teachingthem through about all of these
things and we use bodycomposition and talk to'em about
why this matters and why is thisbeing suggested.
And, and and they just, they'relistening.
Their ears are wide open.
And I, when we see them comeback after doing an intensive
three month program with them,which we've started to develop
some and see that they arehappier mm-hmm.
They feel better.
(19:42):
They're sleeping a ton ofnon-scale victories, right.
Where they just, they feel sogood about themselves, they
accomplish something.
And they also lost visceral fat,which is something that is
really, obviously we hear aboutthat all the time with
inflammation, right?
The vapor inflammation, but,which is important, but this is
consistency and support.
Outside of direct primary care.
There's just not enough time.
And I'm lucky enough to haveEmily as our registered nurse
(20:04):
who is basically an extensionand she, and I'll talk about
patients and, and really meetthem where they are and just
really try to support them andshe'll help coach with them and.
It's just been amazing.
Like I would never go back andwhen people experience that,
they, they don't
Dr. Maryal Concepcion (20:18):
want to go back.
Dr. Lisa Lucas (20:19):
Yeah.
Dr. Maryal Concepcion (20:19):
It's, it's so interesting'cause I just
recently, the future of familymedicine conference happened and
I was making a comment to one ofthe presenters about, how, how
are you talking about lifestylemedicine in a fee for service
dominant world?
I mean, it's very interesting'cause I'd love to hear.
How that's actually going to sayit very facetiously and
sarcastically.
I literally am wondering like,how is that going?
(20:40):
I absolutely firmly believe 110%what you're saying.
I think that it is somethingthat especially the.
Medical students and residentsare really waking up to.
So on that note, I'd love if youcould talk to us about what
you're seeing on the ground,what you're hearing, because
teaching is so much of like howyou, how you exist in medicine
what are the, the futuregenerations saying
Dr. Lisa Lucas (21:02):
yeah, I think I, I've stood by this for, for
years and I, I feel like it'sfinally coming true.
I, I've worked with medicalstudents and residents in, in
every level.
And I truly think that mostpeople go into medicine because
they actually do wanna havesomething like what we have
here.
They want to.
Really get to know patients,especially in family medicine.
They can see like we have actualrelationships with patients.
(21:24):
There's definitely some medstudents where this is just not
for them.
I get it.
They want to do surgery orwhatever it might be.
Sure.
But when you really talk tothem, that is what they want.
What they don't want is to beseeing 30 patients a day and
doing chart audits and click inboxes.
Right?
Yeah.
And so when they see thatthey're turned off immediately
and then they hear things like,you're too smart for family
medicine.
And, but when you really sitdown one-on-one and when you
(21:46):
show them what it's like here.
We've had a couple patients,actually we have a couple
medical students and residentsthat have come through,
especially because my partner isan ob, GYN, and so they're kind
of doing the, oh, can I, howabout I get to spend time with
him and I get to spend time withyou?
And they do a lot of, what's thedifference and why would I do
this over, OB, GYN?
And again, I don't ever wannadissuade anyone there are a lot
(22:07):
of people that really want to dofamily medicine with a focus on
women's health.
Mm-hmm.
So we always say, if you wantsurgery, then you go that way.
Right?
But if you want, like there is aworld where you can very much
take care of patients Yeah.
In this intimate way.
And you don't have to go downthat route.
So I've recruited a fewstudents, which has been really
lovely.
And then they follow up with melater on and say, I'm so happy I
(22:28):
made this choice.
And then they start asking meabout my practice and how can
they do that?
And so I think it's modeling.
Yeah, absolutely.
So I don't unfortunately get toteach as much, but I am gonna
start going back to our medicalschool that's now moved closer
by and we're gonna start doingsome case-based learning and
chatting with them and showingthem like we know a lot, we see
a lot, it's not coughs andcolds.
Like we have very complicatedpatients and, and it's really
(22:51):
fulfilling.
Yeah.
And I do think that's actuallywhat they want, but we have to
show them that it also is fun.
And they're gonna like it.
Yeah,
Dr. Maryal Concepcion (22:58):
totally.
I, I love that.
'cause even just when you saythat, I think about the people
who, even though it was fee forservice, the attendings who
loved their jobs were prettymuch the people who have been
generational doctors, liketypical rural family doctors who
are like, oh my God, we get todo this, I delivered their,
there's their generation.
And I'm like, oh my God.
But it's, it totally makes adifference when you have
(23:19):
something modeled.
Also in alignment with yourgoals, what you think you're
gonna actually achieve inmedical school and residency.
And I do, I encourage anybodywho's out there, even if you're
not a medical student orresident, if you're an attending
who's has their own job, you canstill call one of us and just
say like, Hey, I'd love to knowmore.
That's absolutely something thatis happening all over the
country, Tell us about justcomments in general that you're
(23:41):
hearing from people who are inpractice and who are.
Looking to DPC for a way out.
I think about the fallacy thatDPC is gonna cause a physician
shortage.
These are from people whobelieve that the fee for service
system typically is not thething causing the physician
shortage.
Dr. Lisa Lucas (23:57):
Oh yeah.
I think the system is causing aphysician shortage.
I think it's specificallycausing a primary care shortage.
Mm-hmm.
It's, it's not fun.
It's, it's miserable and, we areall too smart and we are all too
accomplished and dedicated to beput in those positions.
And I, I, I like to think thatwe are, that the society is
starting to see that and thatthese alternatives are popping
up and they're recognizing thatthis is the way it should be.
(24:18):
But I've spent way too muchtime.
I've missed way too manybirthdays, way too many
vacations firsts with my kids,right?
Where I think I'm not gonna do,I don't have to do this.
Yeah.
And I think what's interestingis we get phone calls all the
time from.
Non-primary care doctors.
And so some of these arespecialists, right?
Er doctors and, and differentspecialists that just say, how
(24:38):
are you?
What are you doing?
Mm-hmm.
How are you doing this?
And, and truthfully, I hear intheir voice some jealousy,
right?
Yeah.
Where they're thinking, man, Ikind of wish I did that.
And so, sometimes it's possiblefor them and sometimes it's not.
But you kind of hear them almostsay, I kind of wish I had
thought of that.
And, and now they're stuck,maybe where they are or they
feel like they're stuck.
So it depends on the person.
But I think that, there's justthis opportunity to show that
(25:01):
medicine in its bare bones, isjust a beautiful thing.
And, and people really enjoy it.
And I think that if we can provethat, and honestly just by, just
by doing what we're doing, youdon't have to do anything else
but just, telling whoever youcan tell and letting them see
you.
I think that we're gonna showlike, this is really the
direction we need to be goingin.
Totally.
We need more of us.
We don't need as many,especially with right.
(25:23):
AI and software and all theseother things, like we need more
people.
With more experience with abroad breadth of experience to
be able to really like, sitacross the table from a patient
and put hands on a patient.
So we just, I, I think we'regonna win in the end.
We're playing the long game inthe end, right?
Yeah,
Dr. Maryal Concepcion (25:38):
It also goes back to your comment on
modeling.
If you have, the model is that,oh, you don't do anything but
just ai, whatever, or just hirea non-physician provider for
whatever.
It's like where is the knowledgegoing to go at some point?
And so by modeling that, thisis.
A a very sustainable way ofpractice.
And it's the, it's the desirableway of practice.
It's not concierge medicine forpeople with seven figure
(26:00):
salaries.
That I, I am absolutely withyou.
And that this is, this is theway of the future.
You have an interesting view ofthis whole ecosystem also
because you are a medicaldirector of a, of a plan that is
a CA compliant that allows aperson to have the DBC
membership paid for as part ofthe insurance plan, which you,
you and I have definitely seenthe conversations online about
(26:21):
oh.
Which said DPC and insurance inthe same sentence.
So tell us what your, what yourtake on this plan, being very
mindful of no one is wanting togo back to what we have right
now and how when we're at thetable, we can actually craft a
different future
Dr. Lisa Lucas (26:39):
Mm-hmm.
Yeah, I think, I think, yourlisteners are obviously a mix of
people that are thinking aboutit and then some people that are
already doing it.
Mm-hmm.
And I think after doing thesefor this for a while, I think
what we're recognizing is thatwe have something really
special.
And I think the way you knowthat is by it's like directly
related to the amount of phonecalls you get from either
venture capital or somebodywho's got their handout right
(27:00):
now.
Everybody wants a piece.
And what's beautiful aboutDirect Primary Care is we.
Don't really need all of them.
I mean, some of it could behelpful.
Absolutely.
But everyone is trying to kindof get in on the movement and so
I think all of us are naturallyskeptical.
Mm-hmm.
But I do also think that we knowthat we have a nice piece of the
puzzle, but the puzzle, there'smore pieces to it that need to
be a part of it.
So after a few years of havingmy own direct primary care, we
(27:23):
have a good amount of otherphysicians that are here.
And we were having aconversation about marketing and
how do we kind of, maybe wecollectively market and things
of that sort.
And I remember seeing anadvertisement about tarot health
and I was like, well, they saidsomething about marketing, so
let me just call them.
And I ended up connecting withthem.
And that was kind of what theywere doing.
And, and to be fair, they weredoing some market research in
the beginning offering websitehealth and, and, and it wasn't
(27:46):
nefarious.
It was just them really tryingto understand.
I never would've gone down thispath if I had any feeling like
they weren't genuine.
Yeah.
And so to this day, I stand by,I I would never do that unless
they truly understood DPC.
Yeah.
But many people say, well, Idon't want somebody else,
selling DPC for me.
And I completely appreciate thatapproach.
And so I was very wary about itin the beginning, but.
(28:06):
But I had wonderfulconversations with them about,
we're trying to figure out howto fix healthcare.
And of course that's, that'sinteresting to me.
And so kind of got my ear, wechatted a little bit and we
talked about how people havealways talked about, well,
direct primary care is wonderfuland handle about 80 to 90% of
what people need, but what abouta wraparound plan?
Right?
And so in Maine, we've.
Sort of vaguely talked about,talking to some insurance
(28:28):
companies, could we help them tocreate something?
And, and, again, s skeptical,but still we need to figure out
how we fit in.
And my old program director usedto always say this, where he'd
say.
If you don't have a seat at thetable, you're on the menu.
Mm-hmm.
And so I remember very muchcalling that back and saying,
well, I have this opportunitywhere these people who genuinely
(28:50):
understand DPC and have spentyears trying to understand it,
want to try to do somethingdifferent.
Mm-hmm.
Is it gonna be perfect?
Probably not.
Is it gonna ruffle feathers?
Absolutely.
But I think that if we are notthere to help guide it, it will
inevitably not represent us.
Mm-hmm.
And it will hurt us.
So I went down this path of.
Talking to our local docs.
(29:10):
We have a pretty good densityof, of primary care physicians
here at DPCs here.
And I said, well, I kind of wastesting the waters.
What does everyone think?
And so we got enough people thatwere interested enough and it
was a long process, we didn'twanna be told what to do.
Yeah.
We didn't want to affect our dayto day.
I said, I'm not doing a priorauthorization.
Mm-hmm.
Right.
All those things.
And really, they heardeverything we said.
Yeah.
And we got, we got somewonderful DPC lawyers involved
(29:34):
and we did it all the right way.
And we said, let's just, this isa, might just be a beautiful
experiment.
It might fail, but we're gonnagive it a go.
Yeah.
And so Tarot Health startedoffering plans in 2022.
Started just in CumberlandCounty and that includes this
greater Portland area that we'rein.
And then from every year on, ithas expanded.
We're now now into fourcounties.
(29:55):
And it's interesting, it's, whatI think people don't recognize
is now with this ability tocollect data.
I remember from the beginningsaying, all right, I want us to
collect data and say I need usto prove mm-hmm.
Sure.
That if we do a better jobright.
That there will be feweradmissions.
Mm-hmm.
And, and fewer higher acuityvisits.
And you don't often get anopportunity to talk to an
(30:15):
insurance company about this.
Because truthfully, in the end,we all know they don't have a
lot of incentives to make thingscheaper.
And so they really were on thesame mission of let's just give
this a go and let's just try tosee.
And so now we're sort of in thisprocess of trying to collect
some of that data and.
And sort of see how we can proveand we, we do have some data to
already show what we alreadyknow.
Yeah.
That our patients are notadmitted as much.
(30:36):
Yeah.
And we take better care of them.
And so it's been a really, it'sbeen a really interesting ride.
And again, there are some peoplethat do not think we should be
working with insurance at all.
But I would say it's been areally good experience.
And could things be better?
Yeah.
But they're also great and ourpatients love it.
Yeah.
I mean, they love us, let's behonest.
Right.
But, but they also are then ableto also get their colonoscopy
(30:58):
and their mammogram and.
And everything else covered.
And if something terriblehappens, a cancer diagnosis or
something, ter, they still have,the ability to be cared for.
So it's been interesting
Dr. Maryal Concepcion (31:07):
and I, I love that, how you're describing
a wraparound plan, because thatis precisely what it is.
you're still Dr.
Lisa Lucas at Fulcrum FamilyHealth.
This is where I think it'simportant for people to hear
what you just said Insurance aswe know it.
Nobody is wanting that again,but insurance so we can actually
help people achieve healthcareand prevention, especially when
(31:29):
it comes to cancer screenings.
Things are, that are tooexpensive ways to.
Work with people to figure outcan we lower the cost of doing
this, surgical procedure,colonoscopy, whatever.
Because I, I think that, likewhat you said is so pertinent,
especially now, now that thisHSA portion has passed the
Primary Care Enhancement Actthis is the time we have to do
the work because this is a timewhere so many people are gonna
(31:52):
lose access to healthcarebecause they think healthcare is
insurance.
And we have an opportunity toshow up and to speak to how we
can do better because we arealready doing better.
But how do we get this to morepeople?
So I, I love, just the thetransparency of you were, on
guard, but you're also likewilling to listen.
It's a big place that a lot ofus can benefit from being in.
(32:14):
When it comes to your husbandtell us about that, that moment
when you guys decided to both bein direct care because I, I know
that journey well,
Dr. Lisa Lucas (32:23):
It was terrifying, honestly.
I mean, I, I am I'm my husband'sbiggest fan.
I think that he has this reallyinteresting history of education
where he, prior to becoming a dowas a chiropractor.
And so he has this amazingunderstanding of anatomy, and I
think at every level he's justbeen able to perfect that.
And so then when he was workingas an ob, GYN.
(32:43):
He liked delivering babies, buthe did sort of prefer surgery.
Mm-hmm.
And then he started recognizingthat he, he had this interesting
model of understandingmusculoskeletal medicine.
And then obviously, so he'lljoke about that.
It's like a.
They say it's a what?
A seven headed beast, pelvicpain.
And it doesn't mean that to bein any way, except to say it
really could be anything.
We are very complicated.
Yeah.
But he understandsmusculoskeletal, the GI
(33:04):
components, urologic all of it.
Putting it together.
Totally.
And so when patients come in tosee him, he is able to consider
all of those options.
It's not that everybody needssurgery, but the patients that
he sees, he saw when he was,working that really got him to
think, I really think I wanna dothis on my own, is.
Is the patients withendometriosis.
Yeah.
That had seen, 10 otherphysicians and, and it's been
(33:25):
eight to 10 years before theywere able to get a diagnosis and
they're in horrible pain and hejust would come home and say, I
just feel awful for them.
And, and unfortunately thehospital did not really support
for him to do the kind ofsurgery he wanted to do.
He does robotic assistedendometrial implant excision as
opposed to just going in.
And burning.
Mm-hmm.
Which, there's a bit of adiscussion in that in the OB GYN
(33:47):
world.
But, but he's a phenomenalsurgeon and he's like, I just
feel like I'm not giving mypatients enough time.
Wow.
I wanna be able to talk themthrough.
He's very sensitive and warm andwants to do a thorough exam and
they would just keep pushingthem through.
And when, when you have apartner that's unhappy anywhere,
you wanna be supportive.
And so I just kept saying, ifthis really means this much to
you mm-hmm then we're gonna doit.
(34:09):
If you think.
It's not that important to you,then this is going to be a
massive hassle and I'mterrified.
But, but otherwise I said, no,I'm, I'm here for you.
Like, You just, you say the wordand I think, between a couple
bad days and, and, and lack ofsupport, I think we had some
really good conversations.
You said, I, I wanna do it.
And so, yeah, it's scary.
At that point I was up andrunning and doing fine, but
(34:29):
crunching the numbers andthinking how are we gonna get
insurance and how are we gonnamake ends meet?
But you know, I just, I dug alittle deeper in my, in my
budget and we, I said, well,there's no way I'm gonna let my
partner just sit there and bemiserable justice for us.
So we just, you figure it out.
Dr. Maryal Concepcion (34:43):
whether it be financially or emotionally
or both, like it's gonna affectyou one way or the other
because.
Like job stress is real.
And so, for anybody who'sdiscussing this right now, in
terms of with their partner,with their family, the, the
implications of DPC yourpersonal health and your
family's health absolutely is,is a card that a lot of people
(35:03):
don't necessarily name whenthey're talking about the
finances of DPC and its impact.
But therapy costs money too.
And
Dr. Lisa Lucas (35:10):
And our decision was just, we made some
sacrifices.
And because it's a value.
Mm-hmm.
It's a value conversation again.
Yeah.
It keeps coming back to the samethings of just, if it's
important enough, then we'll doit.
And, and, we actually started bytrying to take insurance.
I don't know if we've reallytalked about this that much, I
kind of joke, but I felt like wewere gonna go bankrupt.
It was very, it was worrisome.
And so I said, you know what?
Like we, we tried, okay, wetried and we, we just couldn't
(35:32):
make it work.
Also realizing that we didn'thave the right help, so we
decided for him to go justcomplete direct specialty care
mm-hmm.
And to do what he does reallywell and we'll figure it out.
And so he was able to buildthat.
He's got a wonderful reputation.
People know that he's going togive really wonderful care.
And so, so we kind of went downthat road and then we went and
found some help, and now we havea fractional CFO that helps us,
(35:53):
and answers questions and, andhe may or may not take an
insurance here or there.
We're not sure yet.
We're kind of testing thewaters.
I think it's important just tokeep checking back in.
But, but overall, I think he, hetruly wants to be able to, as
long as he can do the surgerythe way he wants to.
Sure.
And take care of people as hewants to.
But he's been doing great.
Yeah.
Literally teaching hospitals howto do it because.
(36:14):
CMOs of hospitals don'tunderstand how they get paid.
It's, it's interesting.
So don't doubt yourself, becauseyou probably know a lot more
than the people that are makingbig decisions for you.
Dr. Maryal Concepcion (36:24):
Amen.
And I just, I, I hope that thatalso, especially for any
listener out there who's feltdevalued because, a
non-physician provider, an AIbot is the same as a, is treated
as the same as a doctor.
I do hope that that just givesyou a little bit of, boost in
your day because ultimately itjust, it goes back to what we
were talking about before.
The relationship is driven bythe human connection and not by
(36:47):
the code connection.
So this is, that's wonderful forpeople especially who are
surgical specialists also tohear.
So when it comes to.
You and your husband now, beingcontacted a lot in terms of
like, how did you guys do this?
Your, your partners and medicinepartners in life.
And you're also, looking toexpand the offerings that
(37:08):
Fulcrum Family Health has aswell as your husband's practice.
Any words you'd, you'd like toshare with the audience when it
comes to how, how to learn howto do DBC?
Because there's lots ofresources out there, lots of
podcasts, but when it comes totalking with someone, what are
good questions that yourecommend that people ask when
it comes to is DPC right for me?
Dr. Lisa Lucas (37:31):
Yeah, I think that there's the obvious
logistical questions and I thinka lot of those you could get
answered with a local group.
Mm-hmm.
Right.
And so getting, just getting intouch with and looking around to
see if there is a local grouparound you and a lot of direct
primary care physicians arehappy to talk to you about the
basics.
What are the laws in your state?
In Maine, one of the reasons wehave a big identity of, of
direct primary care physiciansis because we have legislation
(37:53):
that was.
That was put forth by ourpredecessors that did this
first, these pioneers that said,no, we have to make sure that
insurance companies cannot denyour referrals even if we're out
of network.
Dr. Maryal Concepcion (38:02):
Yeah.
Dr. Lisa Lucas (38:02):
And so there are states that have a bit of
advantage, and so we are luckyto have that.
And we, but we still get thosebasic questions all the time.
So I think first is making sureyou just tap into that network.
I, I would argue, I think thatthe biggest issues are, does
this, does this make sense forme?
Do, is this the way I want topractice?
Do I want to handle business ornot?
And so.
I have now I have a physicianthat works with me.
(38:24):
She's employed and she's a greatfriend of mine Dr.
Joanna Rolf.
She kind of was.
She was here for the wholeprocess.
She watched me with the idea ofit.
She came to my first locationwhen I was first looking at it,
and she, I bounced my ideas offof her.
What am I gonna call it?
Where's it gonna be?
And so, she was watching fromafar and for her, it just wasn't
right in the beginning.
But at a certain point, she hitthe same part of her life
(38:46):
saying, I can't do this anymore,and wanting to be present for
her children.
And so, when we had thatconversation, I said, Hey, I'm
happy to help you to do ityourself, if that feels like
what you need.
I also think we could find a wayif you wanted to join.
And so her decision was to join.
Yeah.
And that's just a personalchoice, I think It just depends
on what you're thinking.
And so we've designed it aroundthat.
Other people have called me justsaying, what, what are you doing
(39:08):
over there?
And, and how do I get involved?
Former residents of mine justfrom out of the woodwork and
it's wonderful.
And so sometimes I have thisconversation with them too.
It really depends on what feelsgood for you.
Yeah.
And this is, it's hard.
It's, I'm not gonna lie, it'shard to run a business.
You have to have that enoughpassion and have that mindset.
I, I'm a bit analytical and Ilike it, that's okay.
I told you I'm a nerd.
(39:28):
It, it's just the way I like it.
But some people just don't wannado.
Payroll and staffing and some ofthose things to, be able to have
a, a practice.
And so, so some of those peopleare interested in maybe like an
incubator model where we havethem come through, they could
build up a panel.
Mm-hmm.
I don't ever wanna have arestrictive covenant with
anyone.
I want them just to feel free topractice medicine and it feels
like a good relationship forboth of us.
(39:50):
And then at some point, whoknows, we either open another
location or they go off on theirown.
But I think it's important thatthere are.
There's availability, there'saccess, there's opportunity all
over.
And you have to think about whatdo you want your data to look
like?
Yeah.
What do you, how do you wantthis to be structured?
And you truly do have thatchoice.
You don't have to do anythingbecause someone else says you
(40:11):
have to do it that way.
I think it's important to theemotional component of DPC.
It's, it can be heavy and, butalso really amazing.
And so I think that you justhave to sit with yourself a
little bit and be like, what doI want?
And then.
And then tap into thoseresources and then think about
the finances.
And truth is, anyone can dothis.
Dr. Maryal Concepcion (40:30):
Amazing.
Well, thank you so much Iappreciate you, talking to the
audience about everything youhave, especially when it comes
to how we can really truly bepresent to craft our future of
healthcare in this country.
Thanks so much for having me.
Thank you for listening toanother episode of my DBC story.
If you enjoyed it, please leavea five star review on your
(40:50):
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
and challenges.
Links are@mydpcstory.com forexclusive content you won't hear
(41:11):
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.
(00:26):
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
(00:49):
care.
Dr. Lisa Lucas (00:53):
Direct primary care is the answer from patients
and physicians alike of there'sgotta be a better way.
DPC is restoring the trustbetween physicians and patients
and teaching the next generationthat primary care is valuable
and necessary for all people.
I'm Dr.
Lisa Lucas of Fulcrum FamilyHealth, and this is my DPC
story.
Dr. Maryal Concepcion (01:18):
Dr.
Lisa Lucas is an osteopathicfamily physician with more than
10 years of experience caringfor patients in community
hospitals.
Certified in both obesitymedicine and menopause
treatment.
She focuses on primary care andmetabolic health, helping
patients manage and even reverseconditions like obesity,
diabetes, and PCOS.
In 2019, she stepped away fromthe insurance-based system to
(01:40):
open her own clinic, fulcrumFamily Health, where she
delivers patient-centered careand.
Specialized programs for weightmanagement, hormone support, and
women's health outside ofmedicine.
Dr.
Lucas lives in Cumberland, Mainewith her husband, Dr.
Romeo Lucas, also a physicianand their three children, Sophie
and Henry and Oliver, who happento be twins.
She loves bringing her ownparenting experience into her
(02:01):
work, offering familiespractical and compassionate
approaches to buildinghealthier, happier lives.
We are recording here at FulcrumFamily Health in Maine.
Oh my goodness.
So thank you so much for comingon
Dr. Lisa Lucas (02:14):
oh, I'm thrilled to be here.
This is, this is a blast.
I feel like I've been thinkingabout this for years and we're
just continually crossing paths.
So this is about time.
Dr. Maryal Concepcion (02:21):
You're originally from New York, your
husband's originally from NewJersey.
We will we will parking lot yourhusband's episode for another
time because he's doing his ownthing in direct specialty care.
But for you, what even broughtyou to Maine?
Dr. Lisa Lucas (02:36):
Oh sure.
I joke all the time that I waslike slowly creeping up the
coast.
Starting in New York.
I was born and raised inRockland County, just like 20
miles north of the city.
So, we still call it the city'cause it's in our mind, still
the only city.
But regardless, I then went tocollege at Holy Cross in
Worcester, mass.
And so then I was in CentralMass, then I lived in Boston,
then I lived in New Hampshire.
And when I was looking atschools I lived at university of
(02:59):
England, which is in, it wasthat time in Biddeford Has since
moved to Portland.
Yeah.
And I.
I don't wanna go to Maine.
That sounds, that sounds toofar.
And then I came up here and Ijust fell in love with it.
And, and then we went to schoolhere, met my husband here and I
ended up going back to NewJersey for a while for training,
but we moved back when we hadkids.
Yeah.
'cause it's a great place toraise
Dr. Maryal Concepcion (03:16):
kids.
When it comes to Maine, I wouldlove also if you could tell us
here, what has healthcare beenlike because the building that
we're sitting in, you're, youguys have been here for over
three years.
You've been in Maine long enoughthat you've seen the transition
and now with the quote unquotebig beautiful bill having
passed.
I'm wondering if you could alsotie in what is on the cusp of
(03:39):
happening for Mainers when itcomes to healthcare in the
future.
Dr. Lisa Lucas (03:43):
Sure.
Probably similar to lots oflocations.
We are we are a state that has acouple of established.
Healthcare entities.
Mm-hmm.
So they have multiple hospitalsand clinics that are run by the
hospitals, and so we kind ofhave to deal with the, the
business and bureaucracy thatgoes along with that.
So I think patients here havebeen looking for an alternative
for a while.
(04:04):
When I first started in 2019 Ididn't really know the landscape
very well because I worked onlyrandomly as a hospitalist and
then I worked in a, in aresidency, but.
Mainly trying to work around myhusband's schedule and take care
of our kids.
Yeah.
And so I didn't really know whatit was like to train here.
I didn't know all thespecialists here.
I feel like over the past, whatnow?
(04:24):
Six years, I have been able tosort of.
Really observe what Mainers arelooking for.
I think we would joke here thatMainers are sort of known for
wanting to do things on theirown.
They want to pull themselves up,but they're bootstraps.
They want to be able to, likethey're farming and running into
their eighties.
I mean, they really want to beindependent.
Yeah.
And I think that they appreciatethe independent nature of direct
primary care.
And so I think that they come tous.
(04:45):
We get some people that come tous just for that.
But I think when it comes tochanges.
We're recognizing thelimitations that comes along
with a hospital owned entity.
And I think that really showedits face at during COVID, which
I think is probably the same formost other locations.
I opened my practice the Junebefore COVID and I got so many
patients that just werefrustrated that couldn't get in,
(05:07):
just again, the bureaucracy ofit all.
And so they just wanted thatrelationship based care and so I
really didn't have to market inthe beginning.
It was hard, but it was stillgreat.
It just worked out beautifully.
But I think people here arereally looking for
relationships.
They very much value that.
And again, I'm sure that's verysimilar to other places around
the country, but they're tiredof being a number.
Even the independent practicesare too big.
(05:27):
Mm-hmm.
That they just feel like mills.
And I think that when patientscome into our space, they just,
common amount, it just feelslighter in here.
Everything feels calmer.
My blood pressure feels better.
I know that if I call you,you're gonna answer.
We get that sort of responseoften, which is really
reaffirming.
Yeah.
So when it comes to, nowobviously with all these changes
(05:48):
and this bill that's going toimprove access when it comes to
payment, when it comes to HSAand such, I do think we are
going to have a lot of Mainersthat, are, have been on and off
what we call main care or, ummm-hmm.
Or Medicaid and, and they're notgonna know where to go.
Yeah.
And I think luckily since.
We have, we have exploded herewith direct primary care.
Mm-hmm.
People know we exist.
(06:09):
And I think that we are gonnatry to find these patients and
just tell them that there isanother way for us to be able to
give them their care.
But I, I do expect us to havemore people knocking on our
door.
Dr. Maryal Concepcion (06:19):
That's fantastic and, and so relatable
to so many places.
But also I just wanna highlightthe relationship of your office.
Like for the audience out therewho weren't present.
When my 4-year-old walked in andneeded to use the potty it was
like, hello with me with my darksunglasses.
Nobody knows who the hell I am.
And then Dr.
Lucas was here and she was like,okay, yeah, like she's cool.
(06:39):
Like she's not just somestranger, but like literally
there's children's toys and youoffered my boys seltzer water.
I mean it literally from the getgo.
The opposite I think about islike the carpet squares that
can't even be glued correctly ina Medi-Cal clinic.
In our world, it's Medi-Cal andnobody cares.
It's like it's decent enough.
Or could we try to make therelationship.
(07:01):
At the forefront of care, andso, no matter what state, you're
exactly right, no matter whatstate you're in, people all over
this country, rural, urban,doesn't matter, are really
asking for, but I want a, I wanta doctor, I actually want
somebody who knows me.
And I'm not just, gettingprocessed by somebody who will
just ultimately send me to theemergency room or make me wait
(07:22):
eight to 12 months, or not evengo in because it's not worth my
time.
So I, I love that, all of thethings that Direct Primary Care
is known and loved for arereally, coming to fruition.
And especially the fact that thecommunity is growing in Maine.
And by sharing your story,you're helping empower people to
know that yeah, sure as heck inMaine, but also sure as heck,
(07:42):
anywhere where, where a patientwants a relationship with
somebody, that's where DBC canthrive.
So amazing.
I'm, I'm so glad that you're,you're sharing more of the main
journey on the podcast.
Dr. Lisa Lucas (07:53):
Thanks.
Yeah, we are very careful abouthow we curate the right type of
environment here.
Yeah.
I think it makes a bigdifference with our patients.
You met some of our front staffthat are phenomenal.
We have Emily, that's aregistered nurse who's worked in
all aspects of healthcare.
Kristin, who has worked indifferent offices and is just
the person you want on the otherend of the phone when you have a
(08:13):
problem.
And, and Camille who just joinedus as a medical assistant who
graduated medical school and istaking a bit of break before she
starts.
And so it just happened to allbe women, but that all worked
out for us.
Yeah.
Which So I just, I think we wantpeople to feel like everyone
that is an extension of usmm-hmm.
Is there for them.
Totally.
And we really do feel we getthat feedback all the time.
Yeah.
And I think it's reallyimportant to find the right
people Yeah.
When you're hiring.
(08:34):
Yeah.
Amazing.
Dr. Maryal Concepcion (08:35):
Tell us about what was going on before
you opened, because as many ofus know fee for service is, the,
the biggest option out there interms of number of jobs, but you
didn't choose to stay in fee forservice.
Mm-hmm.
Dr. Lisa Lucas (08:48):
Yeah, I think like a lot of us, I, I stalked
the idea of DPC for a while.
I, I knew about it ever since,probably around 2012 when I
graduated residency, and I keptsaying, yeah, at some point I'll
do it at some point.
And then it never really madesense.
I had my.
First child in 2012, and then Iended up having twins in 2014.
And, and really I don't think, Imean, having three kids under
(09:09):
two is probably just, justbecame the priority, right?
And so the thought of thatagain, just became an in in the
future.
And then I worked at a residencyin New Jersey, the residency I
went to, which was wonderful,still did inpatient, outpatient.
I kept saying at some pointwe're going to do it, and then
we decided to move to Maine.
And then again, it's like, well,I don't wanna start a new panel.
I don't know where we're gonnaland.
And so there's a lot of thoseconversations.
Totally.
(09:29):
Again, my husband is a he's aphysician as well, and he's a
ob.
GYN trained at that point was,was working in full spectrum ob
and not that his job became apriority, it was just more that
his hours were so difficult tonavigate and I just became the
flexible one.
Yeah.
Hence the hospital work and, andsuch, which worked fine.
And I worked with the medicalschool, but I really loved
teaching.
I think that was a huge part ofjust a big part of, of, I think
(09:51):
the way I expressed myself inmedicine.
And so I went and actuallyworked up at Mean Dartmouth in
Augusta.
Nice.
Which was wonderful.
And staff is wonderful and Ilove teaching.
But we just ended up, my husbandand I were passing each other on
the highway with children and wedon't have support here, so that
just, it got hard.
And we said, you know what,again like, maybe, maybe I'll
start a practice.
And again, just didn't feel likea great time.
(10:12):
And my mother had moved up herewith us.
My mother is a French andSpanish teacher at that point,
retired, but you know, just,just loved, wanted to be near
the babies and she had ms.
It was really hard for her toget around.
And so we would, we were a scenegoing anywhere.
It was like two little babies,another toddler and my mom in
the wheelchair so it was hardfor her to get around and we
would talk all the time aboutthe day I was gonna open my own
practice.
(10:33):
I think she was just a reallybig inspiration for me because
as most people know, when youhave a MS or another chronic
disease, it's just really hardto, to be mobile.
Mm-hmm.
And so she would getintermittent fevers or.
Any sort of ailment and justwanna talk to, I mean, not only
the same person, but a person.
And they would say she had tokeep coming in and, and then we
would just sit there andcomplain about, oh, why do I
(10:54):
have to keep coming in?
Why can't someone talk to me?
And then there was me with mythree kids trying to navigate if
one has strap, the other do too,and so we just talked about how
the system just didn't makesense.
And so it was always a plan.
And unfortunately my mom, uh, mymom just got, she got she
progressed a little bit faster'cause in addition to ms, she
also had breast cancer, which issomething that runs in our
(11:15):
family.
So my grandmother died at 57.
And my mom, unfortunately shegot pretty sick while I was
working at the residency.
And so, obviously we handled,the acute illness and then we
realized we needed to take herhome on hospice.
And so, so she was home onhospice in my house, and there
was no other place I wanted tobe, but I was stuck working.
And I said, well, then I thinkI, I think we're done here.
(11:37):
And so I think that was themoment I, I really decided I
needed to do it.
And, and I had plenty of timewith her, but of course you
always want more.
And so she ended up passing inmy house.
I went and got a prophylacticmastectomy to make sure I was
safe after many scares.
Sure.
Getting mammograms.
I tell the story'cause I thinkit's, I think it's important to,
to realize that the dedicationis, needs to be there.
(11:59):
Like you, there has to besomething that makes you so
angry.
Yeah.
Right.
And I think we've all had thoseexperiences.
Whereas I was healing from mymastectomy and couldn't really
lose my arms.
I was making my website andsaying, I gotta be out, and so
my mom motivated me, mychildren, my husband was very
supportive throughout the wholeprocess, and we were lucky in
that he still could work.
I calculated exactly how muchmoney I had to make to make sure
(12:20):
it wasn't a strain.
And I opened in June of 2019 andI got about, I got about what,
six to eight months in beforeand before everything changed
and I, I sent my opt out noticein after having my wait list for
Medicare, and it was March of2020.
And man, I mean, everyone knowshow it changed after that, but I
will say, I think it actuallysaved us because if I didn't, if
(12:42):
I hadn't have started mypractice I would not have able
to be home for my children.
Sure.
So I had two kindergartners anda second grader, and as many
parents know, you had to bethere while they were on the
screen.
And so I was doing, nighttime.
It's urgent care, taking care ofpatients in Minnesota and
Arkansas through telehealth and,and being there for my kids
(13:02):
during the day.
So homeschooling and all thethings.
That was, that was a lot.
But, but otherwise one of uswould've had to quit and it
probably would've been me.
Yeah.
Which again, I would've doneobviously for my family, but it,
the timing actually, when youlook back, it was perfect.
Yeah.
And so it worked out.
Dr. Maryal Concepcion (13:17):
Well, and that everybody is badass.
Dr.
Lisa Lucas.
My God, as my dad has passedalso, I just, I think about that
both of our parents are justlike giving us high fives.
Even having this conversation,because we are telling more and
more about the direct primarycare experience and also how you
were at this crossroads and you,like you said, you, you, you
(13:39):
figured it out that.
I can't do this anymore.
I'm pissed off enough to notkeep doing this because I don't
wanna be complicit in treatingother people the way that the
fee for service world treatspeople.
It's beautiful.
It's bittersweet for sure.
Mm-hmm.
But when it comes to this timeof you could have quit, but you
opened and yes that time wascrazy for so many people who
(14:02):
opened.
I'm assuming your husbandcontinued on his practice.
I'd love if you could talk to usabout how you guys.
Had any discussions about,growing the practice.
Now he's direct specialty careas well.
Did you guys talk about it thento have him possibly join you?
Because I, I think about,there's listeners out there who
are partners with a physician orpartners with a physician and
(14:25):
they're, they're thinking aboutD pc, but.
One of the things that ismentioned so many times, is,
financially, I don't think thisis gonna work.
Dr. Lisa Lucas (14:33):
Yeah, I think this is probably the biggest
question we get and especiallynow that my husband is open to
some practice, but I think evenmore so, there's just a lot of,
well, it was easy for youbecause your partner had, he was
working and, and Yes.
Did it make it easier?
Absolutely.
He had health insurance, he hadhis.
His salary and it did make iteasier, but, our salaries
mattered also.
You gotta get real deep on yourfinances.
(14:54):
Yeah.
You gotta, you gotta make thespreadsheet, you gotta find out
exactly how much you have tomake.
And if it is worth it to you,you will find a way to do it.
Yeah.
You do have to get a littlecreative.
Right.
I mean, I think I held onto my,I still did hospital work
mm-hmm.
After I left for a while andfound out again exactly how much
I had to make to make sure thatthis was gonna work.
Yeah.
I could have done it longer andhe would've been very supportive
of me if I wanted to do that.
(15:15):
But I think sometimes you haveto pare down a little bit.
Sometimes you don't.
I think it just depends on yoursituation.
Yeah.
And what it's a valueproposition, kind of just like
with direct primary care, we'retrying to say like, is something
worth it to you?
If so, then you'll find a way todo it.
Yeah.
And I think it just, it's, it'sthe fear I think that holds
people back.
Mm-hmm.
But it absolutely is doable.
And of course, remember when youown a business.
(15:36):
Their salary that you're makingis different than what you'd be
making as a W2.
Sure.
And so I think that sometimespeople don't fully understand
that and they just hear a numberand that gets scary.
And so I think finding someoneto kind of walk you through it
is, is nice because then theycan show you, well that's
exactly the way it's supposed tobe, and let's work on the
numbers and let's.
Kind of take a differentperspective.
Mm-hmm.
And when you talk through itwith people, they go, oh, well,
(15:58):
well that makes sense.
Right?
Yeah.
But I think as physicians, we'renot taught these things.
It's not something that's aclass in school.
They, if anything, I rememberspecifically someone saying,
well, you're never gonna dothat.
'cause that's not possible.
Yeah.
Don't even bother.
Even though I, I graduatedresidency in a time where an
independent doctor stillexisted.
And in New Jersey, my programdirector Yeah.
(16:18):
Was on practice for a long time.
Wow.
And so.
That changed very much when wecame out.
And so I think, I think it'sjust, it's fear.
Just like with our patients is,is a driving motivator and our
population in general.
And so it's the same withphysicians and we're used to a
certain level of living andthat's not meant to be a
judgment, but I think sometimeswe just have to say, well,
what's important and
Dr. Maryal Concepcion (16:38):
mm-hmm.
Dr. Lisa Lucas (16:38):
And truth be told is you can make a, a fine
living, working less and doing abetter job for your patients.
Dr. Maryal Concepcion (16:45):
Yeah, totally.
When you talk about better jobfor your patients, I'm wondering
if you give some examples.
I mean, I'm literally sitting ina very inclusive chair.
I commented on that before westarted recording, but it's like
the, the way that you've builtyour practice, you've been
intentional about everythingthat you've put in, how you've
designed everything, when itcomes to actual care plans,
(17:05):
coordination, what are someexamples of how you've done
things in DPC that you couldnever have done in fee for
service?
Dr. Lisa Lucas (17:12):
That's a great question.
'cause I think that that issomething that.
A lot of physicians will respondto where I say I am board
certified in obesity medicine.
And I also am a do so I doosteopathic manipulation.
And I also then went on to geta, a special a separate
menopausal certificate becauseat the end of the day, that
transition all happened becauseI kept talking to patients.
(17:33):
Mm-hmm.
And.
Either I felt like I didn't havethe exact knowledge, or I wanted
some more framework, but Ireally, in the end just wanted
more time.
Yeah, because I, I'm a formerchemistry major, a big, big old
nerd.
And I really like, I like thescience of it all, and I think
that very much rooted inevidence-based medicine, and I
think that if we have enoughtime with patients mm-hmm.
That they've, they appreciatethat approach.
I think unfortunately theInstagram influencer world that
(17:56):
we're in is fast and easy, butreally when you sit and chat
with them for a while, theyappreciate the comprehensive
approach.
And so here, I think I was justalways trying to create and be
the doctor I wanted.
Mm-hmm.
And I, everything down to,again, the chair you're sitting
in and where are the childrengonna go?
Yeah.
And that they can color on thatspecial part on the wall and the
toys that are behind me.
(18:16):
Because again, I always wantedthat.
Mm-hmm.
I couldn't even fit my strolleraround the corner.
It was so difficult.
But when it comes to patientsnow, I mean, I very much focus
on.
Metabolic health.
Mm-hmm.
And again, now hormonal aspectsof that.
'cause you can't, not, it's partof medicine.
Totally.
But when I see patients either,again, that are direct primary
care patients, but I do also dosome separate hormonal consults.
It's, it's a full hour of Yeah.
(18:38):
Of a, a pretty comprehensivehistory and walking them through
how all of it matters.
Mm-hmm.
And I want to hear their wholestory and really showing them
that you're feeling all of thesethings.
And I'm sorry that you've beendismissed.
I feel like some of it is we'redoing a little bit of therapy
when they come in, they've beenYeah, totally.
They have been dismissed andthey're frustrated and you have
to build that trust back up.
Right.
But it's so therapeutic and it'sso worthwhile.
(19:01):
And then they very much are opento listen and understand and
they know they're not beingshamed here.
This is, we just meet peoplewhere they are.
So in our office we'll docomprehensive intakes.
We do nutrition audits.
We educate them on thephysiology of obesity and, and
sometimes, thin people havemetabolic health issues, right?
Sure, absolutely.
(19:22):
So, so we're kind of teachingthem through about all of these
things and we use bodycomposition and talk to'em about
why this matters and why is thisbeing suggested.
And, and and they just, they'relistening.
Their ears are wide open.
And I, when we see them comeback after doing an intensive
three month program with them,which we've started to develop
some and see that they arehappier mm-hmm.
They feel better.
(19:42):
They're sleeping a ton ofnon-scale victories, right.
Where they just, they feel sogood about themselves, they
accomplish something.
And they also lost visceral fat,which is something that is
really, obviously we hear aboutthat all the time with
inflammation, right?
The vapor inflammation, but,which is important, but this is
consistency and support.
Outside of direct primary care.
There's just not enough time.
And I'm lucky enough to haveEmily as our registered nurse
(20:04):
who is basically an extensionand she, and I'll talk about
patients and, and really meetthem where they are and just
really try to support them andshe'll help coach with them and.
It's just been amazing.
Like I would never go back andwhen people experience that,
they, they don't
Dr. Maryal Concepcion (20:18):
want to go back.
Dr. Lisa Lucas (20:19):
Yeah.
Dr. Maryal Concepcion (20:19):
It's, it's so interesting'cause I just
recently, the future of familymedicine conference happened and
I was making a comment to one ofthe presenters about, how, how
are you talking about lifestylemedicine in a fee for service
dominant world?
I mean, it's very interesting'cause I'd love to hear.
How that's actually going to sayit very facetiously and
sarcastically.
I literally am wondering like,how is that going?
(20:40):
I absolutely firmly believe 110%what you're saying.
I think that it is somethingthat especially the.
Medical students and residentsare really waking up to.
So on that note, I'd love if youcould talk to us about what
you're seeing on the ground,what you're hearing, because
teaching is so much of like howyou, how you exist in medicine
what are the, the futuregenerations saying
Dr. Lisa Lucas (21:02):
yeah, I think I, I've stood by this for, for
years and I, I feel like it'sfinally coming true.
I, I've worked with medicalstudents and residents in, in
every level.
And I truly think that mostpeople go into medicine because
they actually do wanna havesomething like what we have
here.
They want to.
Really get to know patients,especially in family medicine.
They can see like we have actualrelationships with patients.
(21:24):
There's definitely some medstudents where this is just not
for them.
I get it.
They want to do surgery orwhatever it might be.
Sure.
But when you really talk tothem, that is what they want.
What they don't want is to beseeing 30 patients a day and
doing chart audits and click inboxes.
Right?
Yeah.
And so when they see thatthey're turned off immediately
and then they hear things like,you're too smart for family
medicine.
And, but when you really sitdown one-on-one and when you
(21:46):
show them what it's like here.
We've had a couple patients,actually we have a couple
medical students and residentsthat have come through,
especially because my partner isan ob, GYN, and so they're kind
of doing the, oh, can I, howabout I get to spend time with
him and I get to spend time withyou?
And they do a lot of, what's thedifference and why would I do
this over, OB, GYN?
And again, I don't ever wannadissuade anyone there are a lot
(22:07):
of people that really want to dofamily medicine with a focus on
women's health.
Mm-hmm.
So we always say, if you wantsurgery, then you go that way.
Right?
But if you want, like there is aworld where you can very much
take care of patients Yeah.
In this intimate way.
And you don't have to go downthat route.
So I've recruited a fewstudents, which has been really
lovely.
And then they follow up with melater on and say, I'm so happy I
(22:28):
made this choice.
And then they start asking meabout my practice and how can
they do that?
And so I think it's modeling.
Yeah, absolutely.
So I don't unfortunately get toteach as much, but I am gonna
start going back to our medicalschool that's now moved closer
by and we're gonna start doingsome case-based learning and
chatting with them and showingthem like we know a lot, we see
a lot, it's not coughs andcolds.
Like we have very complicatedpatients and, and it's really
(22:51):
fulfilling.
Yeah.
And I do think that's actuallywhat they want, but we have to
show them that it also is fun.
And they're gonna like it.
Yeah,
Dr. Maryal Concepcion (22:58):
totally.
I, I love that.
'cause even just when you saythat, I think about the people
who, even though it was fee forservice, the attendings who
loved their jobs were prettymuch the people who have been
generational doctors, liketypical rural family doctors who
are like, oh my God, we get todo this, I delivered their,
there's their generation.
And I'm like, oh my God.
But it's, it totally makes adifference when you have
(23:19):
something modeled.
Also in alignment with yourgoals, what you think you're
gonna actually achieve inmedical school and residency.
And I do, I encourage anybodywho's out there, even if you're
not a medical student orresident, if you're an attending
who's has their own job, you canstill call one of us and just
say like, Hey, I'd love to knowmore.
That's absolutely something thatis happening all over the
country, Tell us about justcomments in general that you're
(23:41):
hearing from people who are inpractice and who are.
Looking to DPC for a way out.
I think about the fallacy thatDPC is gonna cause a physician
shortage.
These are from people whobelieve that the fee for service
system typically is not thething causing the physician
shortage.
Dr. Lisa Lucas (23:57):
Oh yeah.
I think the system is causing aphysician shortage.
I think it's specificallycausing a primary care shortage.
Mm-hmm.
It's, it's not fun.
It's, it's miserable and, we areall too smart and we are all too
accomplished and dedicated to beput in those positions.
And I, I, I like to think thatwe are, that the society is
starting to see that and thatthese alternatives are popping
up and they're recognizing thatthis is the way it should be.
(24:18):
But I've spent way too muchtime.
I've missed way too manybirthdays, way too many
vacations firsts with my kids,right?
Where I think I'm not gonna do,I don't have to do this.
Yeah.
And I think what's interestingis we get phone calls all the
time from.
Non-primary care doctors.
And so some of these arespecialists, right?
Er doctors and, and differentspecialists that just say, how
(24:38):
are you?
What are you doing?
Mm-hmm.
How are you doing this?
And, and truthfully, I hear intheir voice some jealousy,
right?
Yeah.
Where they're thinking, man, Ikind of wish I did that.
And so, sometimes it's possiblefor them and sometimes it's not.
But you kind of hear them almostsay, I kind of wish I had
thought of that.
And, and now they're stuck,maybe where they are or they
feel like they're stuck.
So it depends on the person.
But I think that, there's justthis opportunity to show that
(25:01):
medicine in its bare bones, isjust a beautiful thing.
And, and people really enjoy it.
And I think that if we can provethat, and honestly just by, just
by doing what we're doing, youdon't have to do anything else
but just, telling whoever youcan tell and letting them see
you.
I think that we're gonna showlike, this is really the
direction we need to be goingin.
Totally.
We need more of us.
We don't need as many,especially with right.
(25:23):
AI and software and all theseother things, like we need more
people.
With more experience with abroad breadth of experience to
be able to really like, sitacross the table from a patient
and put hands on a patient.
So we just, I, I think we'regonna win in the end.
We're playing the long game inthe end, right?
Yeah,
Dr. Maryal Concepcion (25:38):
It also goes back to your comment on
modeling.
If you have, the model is that,oh, you don't do anything but
just ai, whatever, or just hirea non-physician provider for
whatever.
It's like where is the knowledgegoing to go at some point?
And so by modeling that, thisis.
A a very sustainable way ofpractice.
And it's the, it's the desirableway of practice.
It's not concierge medicine forpeople with seven figure
(26:00):
salaries.
That I, I am absolutely withyou.
And that this is, this is theway of the future.
You have an interesting view ofthis whole ecosystem also
because you are a medicaldirector of a, of a plan that is
a CA compliant that allows aperson to have the DBC
membership paid for as part ofthe insurance plan, which you,
you and I have definitely seenthe conversations online about
(26:21):
oh.
Which said DPC and insurance inthe same sentence.
So tell us what your, what yourtake on this plan, being very
mindful of no one is wanting togo back to what we have right
now and how when we're at thetable, we can actually craft a
different future
Dr. Lisa Lucas (26:39):
Mm-hmm.
Yeah, I think, I think, yourlisteners are obviously a mix of
people that are thinking aboutit and then some people that are
already doing it.
Mm-hmm.
And I think after doing thesefor this for a while, I think
what we're recognizing is thatwe have something really
special.
And I think the way you knowthat is by it's like directly
related to the amount of phonecalls you get from either
venture capital or somebodywho's got their handout right
(27:00):
now.
Everybody wants a piece.
And what's beautiful aboutDirect Primary Care is we.
Don't really need all of them.
I mean, some of it could behelpful.
Absolutely.
But everyone is trying to kindof get in on the movement and so
I think all of us are naturallyskeptical.
Mm-hmm.
But I do also think that we knowthat we have a nice piece of the
puzzle, but the puzzle, there'smore pieces to it that need to
be a part of it.
So after a few years of havingmy own direct primary care, we
(27:23):
have a good amount of otherphysicians that are here.
And we were having aconversation about marketing and
how do we kind of, maybe wecollectively market and things
of that sort.
And I remember seeing anadvertisement about tarot health
and I was like, well, they saidsomething about marketing, so
let me just call them.
And I ended up connecting withthem.
And that was kind of what theywere doing.
And, and to be fair, they weredoing some market research in
the beginning offering websitehealth and, and, and it wasn't
(27:46):
nefarious.
It was just them really tryingto understand.
I never would've gone down thispath if I had any feeling like
they weren't genuine.
Yeah.
And so to this day, I stand by,I I would never do that unless
they truly understood DPC.
Yeah.
But many people say, well, Idon't want somebody else,
selling DPC for me.
And I completely appreciate thatapproach.
And so I was very wary about itin the beginning, but.
(28:06):
But I had wonderfulconversations with them about,
we're trying to figure out howto fix healthcare.
And of course that's, that'sinteresting to me.
And so kind of got my ear, wechatted a little bit and we
talked about how people havealways talked about, well,
direct primary care is wonderfuland handle about 80 to 90% of
what people need, but what abouta wraparound plan?
Right?
And so in Maine, we've.
Sort of vaguely talked about,talking to some insurance
(28:28):
companies, could we help them tocreate something?
And, and, again, s skeptical,but still we need to figure out
how we fit in.
And my old program director usedto always say this, where he'd
say.
If you don't have a seat at thetable, you're on the menu.
Mm-hmm.
And so I remember very muchcalling that back and saying,
well, I have this opportunitywhere these people who genuinely
(28:50):
understand DPC and have spentyears trying to understand it,
want to try to do somethingdifferent.
Mm-hmm.
Is it gonna be perfect?
Probably not.
Is it gonna ruffle feathers?
Absolutely.
But I think that if we are notthere to help guide it, it will
inevitably not represent us.
Mm-hmm.
And it will hurt us.
So I went down this path of.
Talking to our local docs.
(29:10):
We have a pretty good densityof, of primary care physicians
here at DPCs here.
And I said, well, I kind of wastesting the waters.
What does everyone think?
And so we got enough people thatwere interested enough and it
was a long process, we didn'twanna be told what to do.
Yeah.
We didn't want to affect our dayto day.
I said, I'm not doing a priorauthorization.
Mm-hmm.
Right.
All those things.
And really, they heardeverything we said.
Yeah.
And we got, we got somewonderful DPC lawyers involved
(29:34):
and we did it all the right way.
And we said, let's just, this isa, might just be a beautiful
experiment.
It might fail, but we're gonnagive it a go.
Yeah.
And so Tarot Health startedoffering plans in 2022.
Started just in CumberlandCounty and that includes this
greater Portland area that we'rein.
And then from every year on, ithas expanded.
We're now now into fourcounties.
(29:55):
And it's interesting, it's, whatI think people don't recognize
is now with this ability tocollect data.
I remember from the beginningsaying, all right, I want us to
collect data and say I need usto prove mm-hmm.
Sure.
That if we do a better jobright.
That there will be feweradmissions.
Mm-hmm.
And, and fewer higher acuityvisits.
And you don't often get anopportunity to talk to an
(30:15):
insurance company about this.
Because truthfully, in the end,we all know they don't have a
lot of incentives to make thingscheaper.
And so they really were on thesame mission of let's just give
this a go and let's just try tosee.
And so now we're sort of in thisprocess of trying to collect
some of that data and.
And sort of see how we can proveand we, we do have some data to
already show what we alreadyknow.
Yeah.
That our patients are notadmitted as much.
(30:36):
Yeah.
And we take better care of them.
And so it's been a really, it'sbeen a really interesting ride.
And again, there are some peoplethat do not think we should be
working with insurance at all.
But I would say it's been areally good experience.
And could things be better?
Yeah.
But they're also great and ourpatients love it.
Yeah.
I mean, they love us, let's behonest.
Right.
But, but they also are then ableto also get their colonoscopy
(30:58):
and their mammogram and.
And everything else covered.
And if something terriblehappens, a cancer diagnosis or
something, ter, they still have,the ability to be cared for.
So it's been interesting
Dr. Maryal Concepcion (31:07):
and I, I love that, how you're describing
a wraparound plan, because thatis precisely what it is.
you're still Dr.
Lisa Lucas at Fulcrum FamilyHealth.
This is where I think it'simportant for people to hear
what you just said Insurance aswe know it.
Nobody is wanting that again,but insurance so we can actually
help people achieve healthcareand prevention, especially when
(31:29):
it comes to cancer screenings.
Things are, that are tooexpensive ways to.
Work with people to figure outcan we lower the cost of doing
this, surgical procedure,colonoscopy, whatever.
Because I, I think that, likewhat you said is so pertinent,
especially now, now that thisHSA portion has passed the
Primary Care Enhancement Actthis is the time we have to do
the work because this is a timewhere so many people are gonna
(31:52):
lose access to healthcarebecause they think healthcare is
insurance.
And we have an opportunity toshow up and to speak to how we
can do better because we arealready doing better.
But how do we get this to morepeople?
So I, I love, just the thetransparency of you were, on
guard, but you're also likewilling to listen.
It's a big place that a lot ofus can benefit from being in.
(32:14):
When it comes to your husbandtell us about that, that moment
when you guys decided to both bein direct care because I, I know
that journey well,
Dr. Lisa Lucas (32:23):
It was terrifying, honestly.
I mean, I, I am I'm my husband'sbiggest fan.
I think that he has this reallyinteresting history of education
where he, prior to becoming a dowas a chiropractor.
And so he has this amazingunderstanding of anatomy, and I
think at every level he's justbeen able to perfect that.
And so then when he was workingas an ob, GYN.
(32:43):
He liked delivering babies, buthe did sort of prefer surgery.
Mm-hmm.
And then he started recognizingthat he, he had this interesting
model of understandingmusculoskeletal medicine.
And then obviously, so he'lljoke about that.
It's like a.
They say it's a what?
A seven headed beast, pelvicpain.
And it doesn't mean that to bein any way, except to say it
really could be anything.
We are very complicated.
Yeah.
But he understandsmusculoskeletal, the GI
(33:04):
components, urologic all of it.
Putting it together.
Totally.
And so when patients come in tosee him, he is able to consider
all of those options.
It's not that everybody needssurgery, but the patients that
he sees, he saw when he was,working that really got him to
think, I really think I wanna dothis on my own, is.
Is the patients withendometriosis.
Yeah.
That had seen, 10 otherphysicians and, and it's been
(33:25):
eight to 10 years before theywere able to get a diagnosis and
they're in horrible pain and hejust would come home and say, I
just feel awful for them.
And, and unfortunately thehospital did not really support
for him to do the kind ofsurgery he wanted to do.
He does robotic assistedendometrial implant excision as
opposed to just going in.
And burning.
Mm-hmm.
Which, there's a bit of adiscussion in that in the OB GYN
(33:47):
world.
But, but he's a phenomenalsurgeon and he's like, I just
feel like I'm not giving mypatients enough time.
Wow.
I wanna be able to talk themthrough.
He's very sensitive and warm andwants to do a thorough exam and
they would just keep pushingthem through.
And when, when you have apartner that's unhappy anywhere,
you wanna be supportive.
And so I just kept saying, ifthis really means this much to
you mm-hmm then we're gonna doit.
(34:09):
If you think.
It's not that important to you,then this is going to be a
massive hassle and I'mterrified.
But, but otherwise I said, no,I'm, I'm here for you.
Like, You just, you say the wordand I think, between a couple
bad days and, and, and lack ofsupport, I think we had some
really good conversations.
You said, I, I wanna do it.
And so, yeah, it's scary.
At that point I was up andrunning and doing fine, but
(34:29):
crunching the numbers andthinking how are we gonna get
insurance and how are we gonnamake ends meet?
But you know, I just, I dug alittle deeper in my, in my
budget and we, I said, well,there's no way I'm gonna let my
partner just sit there and bemiserable justice for us.
So we just, you figure it out.
Dr. Maryal Concepcion (34:43):
whether it be financially or emotionally
or both, like it's gonna affectyou one way or the other
because.
Like job stress is real.
And so, for anybody who'sdiscussing this right now, in
terms of with their partner,with their family, the, the
implications of DPC yourpersonal health and your
family's health absolutely is,is a card that a lot of people
(35:03):
don't necessarily name whenthey're talking about the
finances of DPC and its impact.
But therapy costs money too.
And
Dr. Lisa Lucas (35:10):
And our decision was just, we made some
sacrifices.
And because it's a value.
Mm-hmm.
It's a value conversation again.
Yeah.
It keeps coming back to the samethings of just, if it's
important enough, then we'll doit.
And, and, we actually started bytrying to take insurance.
I don't know if we've reallytalked about this that much, I
kind of joke, but I felt like wewere gonna go bankrupt.
It was very, it was worrisome.
And so I said, you know what?
Like we, we tried, okay, wetried and we, we just couldn't
(35:32):
make it work.
Also realizing that we didn'thave the right help, so we
decided for him to go justcomplete direct specialty care
mm-hmm.
And to do what he does reallywell and we'll figure it out.
And so he was able to buildthat.
He's got a wonderful reputation.
People know that he's going togive really wonderful care.
And so, so we kind of went downthat road and then we went and
found some help, and now we havea fractional CFO that helps us,
(35:53):
and answers questions and, andhe may or may not take an
insurance here or there.
We're not sure yet.
We're kind of testing thewaters.
I think it's important just tokeep checking back in.
But, but overall, I think he, hetruly wants to be able to, as
long as he can do the surgerythe way he wants to.
Sure.
And take care of people as hewants to.
But he's been doing great.
Yeah.
Literally teaching hospitals howto do it because.
(36:14):
CMOs of hospitals don'tunderstand how they get paid.
It's, it's interesting.
So don't doubt yourself, becauseyou probably know a lot more
than the people that are makingbig decisions for you.
Dr. Maryal Concepcion (36:24):
Amen.
And I just, I, I hope that thatalso, especially for any
listener out there who's feltdevalued because, a
non-physician provider, an AIbot is the same as a, is treated
as the same as a doctor.
I do hope that that just givesyou a little bit of, boost in
your day because ultimately itjust, it goes back to what we
were talking about before.
The relationship is driven bythe human connection and not by
(36:47):
the code connection.
So this is, that's wonderful forpeople especially who are
surgical specialists also tohear.
So when it comes to.
You and your husband now, beingcontacted a lot in terms of
like, how did you guys do this?
Your, your partners and medicinepartners in life.
And you're also, looking toexpand the offerings that
(37:08):
Fulcrum Family Health has aswell as your husband's practice.
Any words you'd, you'd like toshare with the audience when it
comes to how, how to learn howto do DBC?
Because there's lots ofresources out there, lots of
podcasts, but when it comes totalking with someone, what are
good questions that yourecommend that people ask when
it comes to is DPC right for me?
Dr. Lisa Lucas (37:31):
Yeah, I think that there's the obvious
logistical questions and I thinka lot of those you could get
answered with a local group.
Mm-hmm.
Right.
And so getting, just getting intouch with and looking around to
see if there is a local grouparound you and a lot of direct
primary care physicians arehappy to talk to you about the
basics.
What are the laws in your state?
In Maine, one of the reasons wehave a big identity of, of
direct primary care physiciansis because we have legislation
(37:53):
that was.
That was put forth by ourpredecessors that did this
first, these pioneers that said,no, we have to make sure that
insurance companies cannot denyour referrals even if we're out
of network.
Dr. Maryal Concepcion (38:02):
Yeah.
Dr. Lisa Lucas (38:02):
And so there are states that have a bit of
advantage, and so we are luckyto have that.
And we, but we still get thosebasic questions all the time.
So I think first is making sureyou just tap into that network.
I, I would argue, I think thatthe biggest issues are, does
this, does this make sense forme?
Do, is this the way I want topractice?
Do I want to handle business ornot?
And so.
I have now I have a physicianthat works with me.
(38:24):
She's employed and she's a greatfriend of mine Dr.
Joanna Rolf.
She kind of was.
She was here for the wholeprocess.
She watched me with the idea ofit.
She came to my first locationwhen I was first looking at it,
and she, I bounced my ideas offof her.
What am I gonna call it?
Where's it gonna be?
And so, she was watching fromafar and for her, it just wasn't
right in the beginning.
But at a certain point, she hitthe same part of her life
(38:46):
saying, I can't do this anymore,and wanting to be present for
her children.
And so, when we had thatconversation, I said, Hey, I'm
happy to help you to do ityourself, if that feels like
what you need.
I also think we could find a wayif you wanted to join.
And so her decision was to join.
Yeah.
And that's just a personalchoice, I think It just depends
on what you're thinking.
And so we've designed it aroundthat.
Other people have called me justsaying, what, what are you doing
(39:08):
over there?
And, and how do I get involved?
Former residents of mine justfrom out of the woodwork and
it's wonderful.
And so sometimes I have thisconversation with them too.
It really depends on what feelsgood for you.
Yeah.
And this is, it's hard.
It's, I'm not gonna lie, it'shard to run a business.
You have to have that enoughpassion and have that mindset.
I, I'm a bit analytical and Ilike it, that's okay.
I told you I'm a nerd.
(39:28):
It, it's just the way I like it.
But some people just don't wannado.
Payroll and staffing and some ofthose things to, be able to have
a, a practice.
And so, so some of those peopleare interested in maybe like an
incubator model where we havethem come through, they could
build up a panel.
Mm-hmm.
I don't ever wanna have arestrictive covenant with
anyone.
I want them just to feel free topractice medicine and it feels
like a good relationship forboth of us.
(39:50):
And then at some point, whoknows, we either open another
location or they go off on theirown.
But I think it's important thatthere are.
There's availability, there'saccess, there's opportunity all
over.
And you have to think about whatdo you want your data to look
like?
Yeah.
What do you, how do you wantthis to be structured?
And you truly do have thatchoice.
You don't have to do anythingbecause someone else says you
(40:11):
have to do it that way.
I think it's important to theemotional component of DPC.
It's, it can be heavy and, butalso really amazing.
And so I think that you justhave to sit with yourself a
little bit and be like, what doI want?
And then.
And then tap into thoseresources and then think about
the finances.
And truth is, anyone can dothis.
Dr. Maryal Concepcion (40:30):
Amazing.
Well, thank you so much Iappreciate you, talking to the
audience about everything youhave, especially when it comes
to how we can really truly bepresent to craft our future of
healthcare in this country.
Thanks so much for having me.
Thank you for listening toanother episode of my DBC story.
If you enjoyed it, please leavea five star review on your
(40:50):
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
and challenges.
Links are@mydpcstory.com forexclusive content you won't hear
(41:11):
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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