Opening North Dakota’s First Direct Primary Care Practice: Lessons from a DPC Trailblazer with Dr. Kristine Martens

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Maryal Concepcion MD (00:04):
Direct Primary care is an innovative
alternative path toinsurance-driven healthcare.
Typically, a patient pays theirdoctor a low monthly membership
and in return builds a lastingrelationship with their doctor
and has their doctor availableat their fingertips.
Welcome to the My DPC Storypodcast, where each week you

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

(00:49):
care.

Kristine Martens, DO (00:53):
DPC has helped me get back to.
The reason why I went intomedicine in the first place I
was losing my love for takingcare of people.
And this has really ignited thatfor me again and made everything
really exciting again.
I'm Dr.

(01:13):
Christine Martins of ResurgentHealth, and this is my DPC
story.

Dr.
Christine Martens was raised ina single parent household in
Billings, Montana, where shelearned the value of resilience
and hard work early on.
She earned her undergraduatedegree from Concordia College in
Moorhead, Minnesota, and went onto complete her medical
education at Nova SoutheasternUniversity College of
Osteopathic Medicine in FortLauderdale, Florida.
She then pursued specialtytraining in family medicine at

(01:45):
the Rapid City Regional HospitalResidency Program in South
Dakota, completing her residencyin 2013.
Before returning to Fargo, NorthDakota where she has practiced
full scope family medicine eversince.
Throughout her career, Dr.
Martens has remained deeplycommitted to building
meaningful, trustingrelationships with her patients
time and again.
She has heard patients expressfrustration at feeling rushed or

(02:06):
unheard in traditionalhealthcare settings.
Determined to change thatnarrative, she helped launch the
family medicine residencyprogram in Fargo in 2017.
There she had the uniqueopportunity to shape a new
generation of physicians, notonly by teaching clinical
excellence, but by emphasizingthe heart of medicine, human
connection, empathy, and thepower of truly listening.
After the inaugural classgraduated in 2020, Dr.

(02:29):
Martens returned to full-timepatient care where she feels
most at home by her patient'sside.
Outside the clinic, Dr.
Martens is happiest with herfamily.
She loves supporting her husbandas he plays guitar around town,
whether it's classical, jazz, orelectric with a full band.
And is always his biggest fanwhenever she gets the chance to
cheer him on.
These days, she spends much ofher time with her two children,

(02:50):
juggling soccer and dancepractices, and savoring every
minute of the beautiful chaosthat comes with being a mom.
Welcome to the podcast Dr.
Martins.
Thank you for having me.
So if you did not know alreadyby all of the, excitement in my
voice that we are able to bringDr.

(03:11):
Martin's and her voice fromNorth Dakota coming onto the
podcast today.
I'm so excited because you aredelivering an example of what
you're doing in a state where wedo not have representation
before you coming on.
So I'm super excited to havethis conversation today.

Me too.

Jumping in there, you and your partner
created the very first DPC inNorth Dakota.
And I'm wondering in general,just what, what are the
takeaways in terms of thefeelings that you've had being a
trailblazer in your state?
honestly, there've been, it'slike a, been a rollercoaster I
guess.
There, it started out really,really high, right?

(03:52):
Like we had a bunch of patientsthat were with us previously
that sort of just kind of jumpedover with us.
So we started out doing really,really good with a bunch of
patients and everybody was soexcited.
And then because we started outclinically like kind of full
force, there wasn't a whole lotof learning how to actually run

(04:12):
a business.
That happened in the verybeginning.
So then, there's the lows oflike, wow, like no one has
signed up in three months.
This is no good.
Like, so financially it's a hugechange for me.
But then as soon as you talk toa, a patient or like get a new
family, it's like, I don't know,you raise back up the high, high

(04:33):
of the rollercoaster again.
So, yeah,

it's been up and down

and I appreciate that honesty and that
vulnerability because I thinkthat it, there's so many ways
that a person can ride thatrollercoaster because the
rollercoaster is differentdepending on a person's locale
in terms of a person's state,and you have a state with zero
DPCs opening your guys' clinic.
So, I mean, that's fantastic tohear that there was so, so much

(04:57):
excitement.
Going into the opening timeespecially of, of your clinic.
can you tell the audience whendid you guys officially open
your doors?

we say that our official opening was
June 17th.
It's funny because, so we, like,we left a previous position on
May 15th, and then I had a one,one of my patients sign up on
like May 28th because theyneeded medications or whatever.
We were just like continuingcare.
So technically, I guess that wasthe first member, although we

(05:26):
didn't have, like, they couldn'tcome to the.
The clinic, the clinic wasn'topen that we didn't have an exam
room or anything like that, likeset up.
So, but June 17th is sort of theday that we say that this is
like our hard opening for, foranniversary purposes and
celebration purposes.

Maryal Concepcion M (05:44):
Absolutely.
And I love that there's so muchmomentum already, as, as you
shared it, it may have beenearlier on fine, but at the same
time I know that a lot ofmomentum goes unspoken and
unadvertised on TV interviewsand newspaper interviews,
whatnot.
When you're seeing more patientsin your clinic, you're making a
bigger impact in your community.
So let's go back to yourjourney, before that person

(06:09):
signed up in May and before youopened your doors in June,
because I think that this isreally, important for people to
hear, especially given that youhave the history that you do,
and yet you, you pursued openinga direct primary care clinic and
Fargo, you've trained in, allover the country like many of
our guests, and yet youeventually went to residency in

(06:29):
South Dakota and then went upnorth to open it again in Fargo.
So mm-hmm.
Tell us about your journey ineducation to become a family
physician.
I'm just wondering, what was itthat put your, your sights on
even residency in the Dakotasafter you finished medical
school?

Sure.
So it's funny, I think I just.
As a small child, always justsaid I wanted to be a doctor
when I grew up.
And then, when I went to collegehere in Fargo at Concordia in
Moorhead, Minnesota, and it waslike maybe my sophomore, junior
year or so where I kind ofwondered if that was just me
saying that or if I actuallywanted to do it.

(07:10):
So I took like a, I call it mymidlife crisis when I was what,
20 years old.
And thought, well, what elsewould I wanna do?
And CSI was cool.
So I was like, well, maybe I'llbe a forensic scientist.
And then I realized I wasneeding to go to school for
longer.
I loved school a lot.
And then I was, I don't know, Ijust came to the decision that
no, that is actually what Iwanna do when I talk to people

(07:31):
and help people and know people,I guess.
I learned about do school there,like when I was taking the
Kaplan courses to study for themcat, right?
And so I'd never heard aboutthem either.
They're not huge around thisarea.
And it just seemed more like me.
It was more holistic.
And so I went for it because Icouldn't afford to apply to both

(07:52):
types of schools.
I just picked the one like thedo route and, and did that.
And that's sort of how I endedup in Fort Lauderdale, at Nova
down there.
And then honestly, so in medschool was a different, like the
way that the training was downthere, I.
Super did not like ob.

(08:12):
Like all of the OB doctors justseemed to just do the surgeries
and it was like midwives andstuff that were doing that fun
deliveries.
So I thought, I'm gonna be medpeds, like that's what I'm gonna
do.
So I actually applied to bunchof med peds residencies and
ended up ha scrambling into afamily medicine residency back

(08:34):
when we had, it was an actualanxiety ridden scramble.
So that's how I ended up inRapid City and thank goodness
for that.
Like things happened for areason.
But I like fell in love withobstetrics there as well, which
was what I was trying to avoidthe whole time, which is
hilarious.
But I don't know.
The residency there had a lot ofdos.

(08:56):
So even though it was an MDresidency, there was an
osteopathic preceptor and we hadan OMT clinic and so we've got
to continue like our skills andstuff, during residency.
I met my husband actually onvacation during my fourth year
of med school.
And so then we just decided tohave a long distance
relationship for a year and thenhe like moved to South Dakota

(09:19):
when I went to residency.
So it was a huge leap of faith.
But like he is the reason, oneof the biggest reasons that we
ended up back in Fargo,'cause hewanted to do his like master's
in.
He's a guitar player, so he didhis master's in classical guitar
at NDSU here.
So then I knew I was gonna comehere, so I just applied for the

(09:41):
two main big hospitals that arein town.
Basically told them I'm movinghere, so I hope that one of them
gives me a job.
Yeah.
And so then that's how I, that'show I ended up back in Fargo.
I was doing deliveries in like,the whole scope, like when I
moved here and I feel like justover time, I don't know if it
was like EMR and just all of theafter clinic work that just

(10:06):
started getting to be more andmore, and I don't know if like
my paranoia or like my incessantneed to know everything about
everybody was just like gettingworse and worse or something
that it just felt like over,eight years or whatever.
At that point it was harder.
I'm like, isn't this supposed toget easier?
Like I was just working longer.

(10:28):
So I made a lots of differentchanges thinking, oh, I just
need a fresh start.
So I would, I at one point cutout deliveries.
And, but it was nice here'causethey allowed me to still keep my
newborn nursery privileges andso I did all of the prenatal
care for my patients and thenwould transfer them to a
different family doctor to dothe delivery.

(10:50):
So they'd still get that benefitof like, knowing who's gonna
deliver them.
And then I would just go up whenthe baby was born.
So it kind of kept me in theloop there, kept my practice
young, which I liked.
And then I, one of my colleaguesstarted the residency here in
Fargo.
And she was like, so she sentout an email to the whole staff

(11:11):
and I like deleted it, like,nah.
And then she called me and waslike, I think you'd be really
great.
'cause I was, I was like, reallyonly what, three or four years
maybe out of residency at thatpoint.
And she was like, I need someonewho's close to residency.
'cause she was like super farout from residency.
Yeah.
And so I started that with herand yeah.

(11:33):
And did that for the first, Isaw the first inaugural class
graduate.
And then even during that time Ifelt like I, I had to give up a
lot of clinical time with mypatients and it was extremely
difficult for me.
So it just felt like I was doingtwo full-time jobs and I, so I
ended up going back tofull-time, just clinical

(11:55):
practice then again.
And then after another couple ofyears, two, three years doing
that, it started to feel thesame.
Just like, I don't know, likeburnt out.
Nobody was happy, patients couldnever get in.
I could never see my patientsfor like, if they're actually
sick or if they need to be seen.

(12:15):
I mean, even within a montharound here, if you call as a
new patient, you can get anappointment with a family doctor
in like nine months, maybe evenif it's your own doctor three
months out.
So it was, it just got to be alot.
I had heard, I don't know,everyone's like, oh, it's better

(12:37):
in, private practice, right?
So I was doing the publicservice loan forgiveness, and so
this, the, the system that I wasworking for qualified.
So I was like, well, I'm hereuntil this can get resolved or
whatever.
Forgiven.
So that got forgiven in Januaryof what year?

(12:57):
What, two years ago or whatever.
And then, or maybe it was threenow, either way.
So that was sort of my like,okay, now I can actually go and
do something at that point,ally.
So I had known Ally.
I trained her when she was doingPA school.
Like before I did the residencystuff, she had already left the,

(13:19):
this.
System and went to a, a privatepractice and was trying to get
me to come over there.
So I finally was like, okay,it's gonna be better.
And there were lots of tears'cause I loved my colleagues
and, so then I went over toprivate practice about two, that
was two years ago.
It was probably six months inwhen I really realized how

(13:40):
doctors get paid by insurance.
And like, I felt like I wasdoing a great job with my
patients.
I felt like I was at home withmy family when I needed to be.
I was able to answer messages'cause I wasn't like overwhelmed
with, 20 to 30 patientappointments every day and or
anything like that.
And people could get in whenthey needed to.

(14:00):
But then when you look atreimbursement and like how much
you actually are getting paid, Imean, it wasn't sustainable for
life for me.
Totally.
So luckily I had, a guaranteethat year, but I knew it wasn't,
I wasn't gonna be able to staythere.
So I had heard about DPCA lotactually.

(14:22):
A lot of family doctors will beonline talking about burnout.
And there's always someone who'slike, you gotta start a DPC.
So, and then Allie had been inthe same situation, so she was
the one who was like, I'm out.
I'm doing this with or withoutyou.
And I'm like, oh gosh, I don'tknow.
So we just decided it's this orI didn't know what else I would.

(14:43):
What, what to do.
It's like, go back to a systemand be burnt out.
'cause I couldn't financiallysupport my family at the job I
was at.
And we finally were like, Nope,we're gonna do it.
So then we, we started the firstDPC in North Dakota.
You did it.
That's how I got here.

I love it.
I love it.
So I, I wanna, I wanna dive intothe Dr.
Martins who was being approachedto help this residency program
get off the ground.
Yeah.
'cause I, you've spoken so muchabout even just access to care
already, what it looks like, foryour geographic location.
And Fargo is not the entirestate of North Dakota, so I'm

(15:23):
sure that that definitelychanges, right?
The, the farther you get outfrom the city.
But when it comes to the, theperson who's three to four years
outta residency, who's stillvery much like, because I feel
that in three to four years, andeven when you're in a, in a
system, you're not as jaded asyou could have as you as you are
at six years or 10 years later.
And so I'm wondering, if you canbring us back to that, Dr.

(15:45):
Martins who was like, I am goingto make an impact in the way
that people are practicing asphysicians in the pe in the way
that people are focusing onrelationship driven care as you
did as, the, the person seeingpatients on your own panel.
Because I think that that also,I I, I wanna ask more about how

(16:05):
that, if that.
Dr.
Martins in particular, if thatperson was, was changing as you
were exploring private practiceespecially?

Yeah, no, well, so that Dr.
Martins was definitelypassionate about improving the
physician patient relationship.
I had a great relationship withmy patients.
I've always just been like atalker.
I guess.
Like at one point my patientsknew to bring books.
They knew they were gonna bewaiting there because I've

(16:38):
spending way too much time withthe person before them.
But I'll do the same thingbecause I genuinely just feel
like that gives people bettermedical care when you actually
know socially what's going onwith them and like what's
actually happening in theirlife, and it makes them trust
you.
So then they'll actually tellyou when things are going on

(16:59):
anyways.
So like, even at that pointthere's people complaining
about, such and such provider,doesn't listen this, whatever,
lots of complaints, right?
So I was like, I'm gonna teachdoctors to be great doctors and
like keep their passion there.
Dr.
Walker was the program director.

(17:19):
She was like, I mean the, thepassion that that woman has for
just like.
This community.
She grew up here.
She did the first residency whenit was here.
She, she was a big influencer inmy, like, motivating me to
actually come over and do it.
'cause it's not that I didn'twanna do it, honestly.
It was like I was four yearsoutta residency.

(17:39):
I was like, I don't know enoughto, to be an associate program
director of a, of a residency.
Like, are you sure?
So it was really just my ownimposter syndrome probably.
Or not feeling like I would begood enough for her to do a
really great job.

(18:00):
Like, I knew I wanted, I wanteddoctors to be loved by their
patients.
Again, we just get such a badname around this area.
So, that was a, once she boostedmy confidence, it was an easy
switch and, and the residencywas so much fun, like trying to
figure out how to get them thebest experiences and, and seeing

(18:21):
them become better doctors thanI ever was.
Like, it just, it, it wasamazing.
It just was that my, my to mycore, I missed, I missed my
patients and I missed my family,never home.
So,

yeah.
Two full-time jobs is a lot.
And then you add being a mom ontop of that, and that's, four
jobs right there.
So yeah.
Yeah.
I totally get it.
And I'm wondering when you guyswere creating this residency
from the ground up, I'mwondering, did you, what was the
acceptance like in yourcommunity?
Because I think about, when Iapplied for residency, I wanna

(19:01):
say 2011 or 2012.
I, I, I was a winter grad, so I,it's a little off there, but the
number of residencies has been,it's, it's so different now in
California.
And I'm wondering, as moreresidencies are being created,
especially family practiceresidencies.
Do you have any can you sharewith us your, your guys' journey

(19:22):
in the community support and howmaybe other residencies could
lean into really making a greatexperience just like, as you
you've described, to help theseresidents become amazing
physicians?

Yeah, so it's interesting because like
when I was applying.
Well, and I had a sort of adifferent like route obviously,
but you know, you look forthose, the residencies that are
unopposed, right?
Like, you wanna be like the onlyresidents that you can do all of
the things.
And this system already had likesurgical residency, podiatry,

(19:56):
psychiatry, internal medicineortho, maybe ortho started when
we, when we started, but therewere still, there were already
like tons of residents.
So it wasn't a hard sell for theinstitution itself, obviously.
And our community of patients, Iguess are all very well aware of
the residents in the hospitalsystem.

(20:18):
I think the biggest differencewas trying to, I had to change
my mindset even on like sellinga, an an, an opposed residency
and, and why it's actuallyamazing to like go and do trauma
surgery with the trauma surgeonsbecause then you're not gonna do
it, but you're gonna know how tobetter inform your patient who

(20:42):
might be doing that.
Or like psychiatry.
We got to have like a psychiatryresident or preceptor at our,
the family medicine residency sothat you have like sort of that
specialist education for primarycare.
I think continuity was a newconcept to the system because I

(21:02):
don't, I don't, I shouldn'tspeak to like internal medicine,
like what their requirementswere or anything, but it seemed
like that was a really thehardest thing was to be able to
get the same patient with thesame residents all the time and
like to grow an actual panel andto get the system to realize
that a family doctor isn't justlike, wipe in noses and we don't

(21:22):
need to refer to derm.
We want to keep all theseprocedures here in the clinic.
So there was there was lots ofbattles to get our way so that
we could get them that, thateducation.
But I mean all in all, honestly,I think it wasn't like once I
said it out loud even, I waslike, that's a great sell.
Like we're a, you get to see thehighest of acuity people at the

(21:45):
hospital.
It's not the rural hospital, butyou can see how the rural
hospitals would've handled itand what you should do, because
now you're the one accepting thepatient, right?
What you'd want them to do in a,in a rural setting.
So, when you're out, what to doin the rural setting and how to
get a good, when someone needsto go to a higher acuity.
So it, it was a, it wasdefinitely a different mindset,

(22:08):
but I think it was, it's, theyfilled every year.
So like, I think Fargo in thearea.
Not in the United States maybe,but it's like more of a
desirable place to be than a lotof the other, where the other
residencies in North Dakota weresure.
Or are.

Yeah.
And when you, as you spoke abouthow in Florida OB wasn't a great
experience, but then inresidency it was a totally
different ball game.
You, you also spoke about howyou were able to maintain your
newborn nursery privileges afteryou left the residency.
And so I'm wondering like, justover your span of being an
attending what's been youroutlook on being able to be

(22:49):
there for women who are pregnanteven though you might not be
doing the deliveries, as well ashow you've maintained, that
population of moms and theirbabies, especially that, that
particular branch of yourpopulation as you've gone
between all of these models andinto DPC?

Yeah.
Well, it all comes down to likethe relationship that I have
with, with my patients, right?
Like I, when I was delivering, Iguess I would get some
referrals, I guess from, the PAsor NPS in the practice that
would send them to me for theirOB care.
But like, after I stoppeddelivering, I'd still have all
my patients who would getpregnant.
And even, even then, it's likethey.

(23:26):
They trust my opinion.
They know that I'm gonna choosesomebody who is going to mesh
well with them.
It's not gonna be like thisquestion mark of who's gonna be
there when, when I'm delivering.
And I still get to do themajority of, of the care.
And I, we have a good back andforth between myself and the
delivering physician.
So, and then I think the idea ofme being able to be up there for

(23:49):
the, for the baby, it wascomforting to them.
But it was also a little bitselfish for me, just'cause I
just wanted to be involved.
I felt like I probably would'vecontinued delivering if I felt
there was better support fromthe OB department.
I wasn't used to, I kind ofrealized leaving from residency

(24:11):
to a different hospital systemthat not every hospital systems
play as nicely inter theinterdepartment.
And so it just was a littlelike, I loved doing it, but then
I, I also, like, I loved doingit because I knew I was really
supported if I needed somethingand if I lost any amount of
that, it would just got to betoo anxiety ridden.

(24:33):
So it was really nice that this.
System still allowed me.
And I think there was one or twoother family doctors that were
still doing prenatal care withjust the newborn nursery.
Cares.

Yeah.

And then I got to still do that with the
residents too then.
So, in their clinics, theirprenatal care and everything,
they still got to have a lot ofpreceptors who were very capable
of, of helping them with thosetypes of patients.

I love it.
So now I wanna fast forward intothis time of you're in private
practice and you're like, wow,the compensation that we're
getting from the insurancecompanies is not at all what you
know, it should be, or, what, ina lot of people's cases, what a

(25:23):
lot of people thought it wouldbe once mm-hmm.
A person went from salary to anRVU based model.
And so I'm just wondering if youcan talk to us about that, Dr.
Martins, when it comes to havingthis conversation with Allie,
but also going from being anemployed physician to like, I'm
gonna open up my own DPC becauseI've read about these, I've

(25:45):
read, it, it does exist.
But again, just really like, howdid you guys overcome?
There is no one yet in NorthDakota, and yet we're still
gonna do it.
Yeah,

I,

I guess

the fir, the first part of that is I
really was unaware of the amountof overhead costs for clinic,
right?
Like, I had no clue.
So even when I see like, oh, therevenue brought in was this X
number, but then I am onlygetting whatever, 40% or 30% of

(26:21):
that.
And then I look at all thesespecific visits and I'm like,
well, I, I did, I double codedthis or I double, why didn't
this get charged?
Why didn't these things getcharged?
Or you can charge for all theserandom things that are just
ridiculous now looking back.
But then I learn, oh, well youhave these, each clinic has a
different contract with eachindividual insurance company,

(26:43):
and you may not get as muchmoney for that visit if you
worked for this bigger companywho has much better negotiating
power.
And there's just, you just feellike defeated, I guess.
Like what is the, what's thepoint?
Like I just spent three hoursand a lot of brain power on this
for 20 bucks, and it's just, itsounds terrible because it's not

(27:08):
why we all go into it for likemoney, but like at some point
you still have to be able tosupport your, you gotta be able
to support your family and youhave to.
Value what you, what I do, Ihave to tell myself this all the
time.
What you, what you know isvaluable.
Amen.
So that was a, Allie was muchmore, I think when she grew up,

(27:30):
she wanted to own her ownbusiness.
I went to med school and I waslike, I can't wait to be an
employee for the rest of mylife.
I had no interest in like havingto learn all that.
A hundred percent of me wantedto just like, take care of
people and let somebody elsefigure out the behind the scenes
stuff.
So I think the idea of it was,came a lot easier to her than me

(27:53):
mostly.
'cause I didn't know, I, I don'tknow what I don't know.
And I know I don't know a lotwhen it comes to business stuff.
So yeah, it was, it was areally, really hard reality for
me that I really thought ifyou're just taking really good
care of people, you'll becompensated appropriately for

(28:14):
it.
And it's just not true in the

insurance world.
Yep.
And I know that there's so manypeople out there nodding their
heads, whether they're open orwhether they're not even a
physician and they're just, aperson who works in the DPC
space that everybody knows thatthis is true.
It is ammunition for thosepeople who are like saying
otherwise on social media thatwere like, oh, we're in this for
a gazillion dollars.

(28:38):
It's like, not family medicine.
Thank you so much.
Have a good day.
No one who went into familymedicine went in for a gazillion
dollars.
For sure.
Absolutely.
So as you guys were exploringopening this model, and you guys
are two people coming together,you opened up as a 50 50 owned
business.
Yeah.
So tell us about that, becauseyou guys are almost to your one

(29:00):
year anniversary here and youknow a heck of a lot more now
than you did then.
Every day we are in thesebusinesses.
We know more than we did the daybefore, but how did you guys set
up the clinic on the backend ofthings such that,
responsibilities were laid outas well as compensation.

Allie was the first one to reach out.
There's one lawyer in the statewho will work with.
A pa I think that was the thing,is like that would work with an
a like a PA or a nursepractitioner opening their own
business.
So she had reached out to thatperson.
Initially, nobody in the stateknows anything about direct

(29:36):
primary care.
So then we were talking to theclosest direct primary care to
us is in Alexandria, Minnesota.
So we were reaching out to themto get some ideas and try to
figure out like, what do, wow,what did you do?
How do we do this?
The, and then, comp wassomething we had to like talk
about mostly because in my mind,like her patients are, are

(30:01):
paying the same amount as mypatients.
So it didn't seem fair that, oh,60% goes to me and 40% to Allie.
But like we've, we fully havelike separate panels.
We are not like, I'm the doctorand she's like my pa she is a
great primary provider and herpatients love her.

(30:23):
She takes care of them and I catake care of mine.
So at, at the end of the day,we're like, we're just gonna
have to have it equal.
And then I'm a medical director,PAs have to have a medical
director in North Dakota.
So we just came up with like aseparate medical director salary
that would set us apart.
That much.
But that, that amount stays thesame.

(30:45):
So, but that's, I think that thebiggest thing was just to sort
of both of us needing to like,sort of check our egos at the
door.
Like she knows that she isn't adoctor.
I love her for this becauseshe'll like correct her
patients.
She always asks for help if sheneeds it.

(31:05):
But like, likewise, I, I willask her things that she's more
passionate about than I am andmight have done more research on
than, than I did.
So at the end of the day, wejust decide not to be, I don't
know, upset about, upset aboutit.

When it comes to marketing and financial
decisions, how do you guys cometogether to, decide what the
money is going to be spent onwhen it comes to getting in
patience and then what happensif a patient wants to join the
practice?
Do they get to then choose anddo a meet and greet with both of
you?
How does it work from the wholeflow of deciding to spend the

(31:43):
marketing dollars?
And then what happens when thepatient is like, yep, I'm ready
to sign up.

We very naturally sort of like split the
types of business things thatwe, I don't know, enjoyed the
most.
I very naturally went theclinical route, so like getting
the stuff for supplies for theclinic and like, um, that type
of financial stuff, sort of aslike my realm, setting up the

(32:09):
lab.
She went marketing.
Thank God I, I don't, I don't,I'm, I'm not great at it.
I don't.
Know anything about it and Ihave made little efforts.
She's great at that.
So we're just gonna, we let herdo marketing stuff and decide
which marketing things to do.
If it's a big cost, we alwaystalk about it together.

(32:32):
We have two business meetings aweek together, so we have a lot
of time that we just spend sortof brain dumping is what we call
it.
'cause there's just so much thatwe just have to literally brain
dump.
And then sometimes we'll justpick one to like talk out.
Patients can, when they, like,when prospective patients come
for like a meet and greet orsomething, they can do it

(32:54):
online.
If they do that, they have topick one of us, like just for
the EMR.
So they pick one of us and thenit gets scheduled on that
person's schedule and then theymeet them.
But like I did a meet and greetwith somebody who, when we were
talking, I was like, you are soperfect for ally.
Ally is much more, I'mintegrative and I'm holistic.

(33:17):
Right.
But Ally will go above andbeyond to like appease.
And look into hormonediscrepancies and really do all
those types of things for likeperimenopausal women And this
person just was very much like,oh, I do all my, all my own
research.
I do all my own this.
And just, she, she just remindedme of, of Allie.

(33:41):
So I was like, so it doesn'tnecessarily mean that they're
going to be with me just'causethey're doing the, the meet and
greet with me.
Most of the time it works outthat way.
But if it's someone who I reallyfeel like they're gonna click
better, then I'll send'em herway if they're calling in.
Our nurses actually are reallygood at deciphering like, oh,

(34:01):
this seems like Martin'spatient, or This seems like a,
an Allie patient.
And we've had a couple of peoplewho did.
As long as we're available,we'll both go in and, and talk
to them.

Mm-hmm.

But it gets hard with our schedules to
like, have us both be availablefor all of those.

Maryal Concepci (34:17):
Understandable.
And then at the end of the day,you guys just split that income
50 50, right.
Minus your medical director andthen any staff that you guys
have or expenditures that youguys have at the clinic.
Right.
Yeah.
And then what is your guys'legal structure?
Are you guys an L-L-C-P-L-L-C-SCorp?
What are you in North Dakota?

We're A-P-L-L-C.
So, and I think we filesomething different for taxes,
but again, that's why I have anaccountant tells me what to do.
But we're an LLC, not acorporation.
Got it.

So you guys are about to have your,
your physical doors open.
Tell us about finding the spacethat you guys are in, because
I'm wondering, being where youare, what is the availability of
spaces that could be used frommedical clinic?

So the, the majority of these spaces are
all completely dirt floors,right?
Like, like you build them.
And so at first we're like, hada realtor taking us around and
looking at all these space andthey're like, oh, this is the
great space.
You just, we would give you xamount of money to, to build it
up and then you'd have to spendall the rest of your money to do

(35:27):
the rest.
But it's such a greatinvestment.
And we just, were like, for who?
This is an investment for you.
You're the, I don't, I'm gonnarent the place.
So it was a lot harder to findthe spaces that were already
used.
Like there was one place welooked at that used to be a,
like a chiropractor had leasedit.
And then the space that we're inright now we just like lucked

(35:50):
out.
It's like in the perfect, it'slike a little mini mall.
I don't know if you guys call itmini mall, whatever, like a.
Strip, I dunno what else it'scalled strip mall.
It's called them mall.
Strip mall.
Yeah, strip mall.
So it's like main floor.
It's, it was a insurance companyI think was there before.
So we just, all we had to do wasa couple of different tweaks to
add, like locks on certain doorsand take out the carpet and put

(36:11):
in flooring.
But otherwise it was set upreally, really nice for just a
small clinic.
And it's right next to, sothere's another family doctor
next two doors down from us.
Our, our, our landlord.
I really appreciated this thathe just made sure it was okay
with like all the other peoplein the, in that complex if we

(36:34):
moved in.
And luckily everybody was goodwith that.
So, so yeah, so that's sort ofhow we found our, found our
space.
It was a really lucky.

That's amazing.
And I, I will say that that's agreat call out because landlords
are all gonna be different, justlike we're all different as DPC
doctors, but at the same time,especially around here, the fact
that I was a medical doctor whenI was looking to rent spaces,
people were like can you signtoday?
Can you sign today?
Just because, I'm not a chronicpain, chronic pain clinic.
I'm not, the, the fact that Iwas family medicine people are

(37:08):
like, oh, you're gonna bringamazing families to our, our
strip mall.
We have our own little stripmall here in Arnold, California.
But yes, it's it's, I do thinkthat, I, I say that to, to say
to the audience members who arelooking to rent, don't sell
yourself short when it comes tomedical clinics looking for
space.
Because I do think that you'rebringing a massive value
proposition to the propertyowner, especially when you're

(37:30):
bringing, comprehensive medicalcare to your community.
So That's awesome.

Yeah, they were every, honestly, like
everybody we talked to about it,because like, no one's ever
heard of Direct Primary Care islike, that's awesome.
I want that here.
Like the, the, the landlord waslike, really, really excited.
So he's like, no, we want youhere.
They just, he just really wantedto make sure, probably
specifically with that familydoctor, that he wasn't gonna be
put off by it.
And I was like, we're completelydifferent.

(37:55):
We'll send our insurance peopleover there.

Yeah.
And I mean, that's a, that's apro tip in disguise there.
'cause it's like.
If they have vaccines and you'rea person not necessarily getting
vaccines as easily, you can senda person to a fee for service
clinic.
Yeah, just for their vaccines.
It depends on the, the owner,but especially, having that
culture of like, that, it wasn'tlike, oh surprise, it's another

(38:19):
family practice open next doorto you.
It, it just feeds into the, thisjust the overall culture and
then the future culture becauseof that.
So That's awesome.
That transparency that yourlandlord had.
So you guys are now about toopen and you have your space.
And I'm wondering were there anyunexpected challenges that you
had, going into that first weekof practice?

(38:41):
Because I see the smile and Isee like most people are like
laughing and just like, orshaking their head in pain.
Thinking about that first week,but I'm wondering what was it
like for you guys prepping inthat first week of opening?

The exam tables took a while to come in.
So the first, so luckily I had amassage table that I think they
required me to buy in med schoolfor like do, so I like had this
that I've lugged around.
I'm like, and this guy, I had apatient who just like needed a
pre-op and I'm like, well, Imean, I think we've got this
stuff for it.
So I.
He came in and like, luckily,pretty much everybody was so

(39:17):
excited about us doing this,that they were, they were like
loving being part of like, thegrowth of the clinic, like to
see it changing and everything.
But I feel like not knowing howlong it takes for some of those
bigger items to come in was asurprise.
It was also there was a reallygood one.
I was gonna say it was well, thevisits themselves.

(39:38):
Okay.
So like, I don't know why theyfelt so different, but like, I
remember both Allie and I wouldcome out and be like, I feel
like I should be doing more thanI was.
Do.
Like, there'd be like onepatient that would come in that
day and you just wanna like,hang out with them all day
because I mean,

why not?
Why not?

Because you can.
And so I, we, we would just likebe talking shop and talking
about like how we, how we'redoing at the business.
And I'm like, at one point,probably half an hour in, I was
like, should we talk about likeyour medical things?
Or maybe you wanna make anappointment tomorrow'cause you
can like, it's just like really,we were just like all so excited

(40:22):
about it.
But I think that just like thevibe of the appointments have
still just all been so much, Idon't know, they're different.
Maybe it's the non rush thing,but I never really felt rushed
even though I was always rushed.
I was just.
I was like, well, screw it.
I'm just going to like spend asmuch time as I'm going to spend.
But that surprised me.

(40:44):
And then people were still, ourpatients who signed up for DPC
still did not understand theconcept.
So then they would be like, howmuch do I owe you?
And it's like, no, no, that'swhat works.
Like nothing.
You already paid it'smembership.
Like it's, yeah, they're soready to pay that copay.

(41:04):
They're like, what's my copay?
Yeah.
They're like, well, whatever.
We'll jump off the cliff foryou.
So here, sign me up.
And then, but they didn'treally, most of them, not most
of them, but a lot of them stilljust did not really understand
that you can come in when youneed to, or like, you don't have
to like stop calling.
We, so we use, we have ourdirect contact number and then

(41:26):
like you can call the otherphone number to get basically a
hold of the nurse.
And they were still just like, Igotta talk to the, my nurse.
And like, then she's likerelaying messages to me again
and I'm like, why don't theyjust call me on my number and
like, they still don't get it.
So then I'm calling them.
It's hilarious.
So it's a, it's a learningprocess

as you're saying that, I'm like
envisioning like, you'restanding right there and they're
like, insisting still I have totalk with the nurse.
And you're like, no.
Like literally your physician'sover here.
Like, yeah, but I'm right here.
Do you wanna talk to

me?
No, no.
I don't want, I know you'rebusy.
I know.
They're all like, oh, I knowyou're busy.
I, I'll just talk to Megan.
I'm like, but, okay.

Sounds good.
Such a different world.
And I wonder here, as yourpatients joined, but they didn't
necessarily know what they weregetting.
And they, they've definitelylearned now that you've been in
practice for almost a year.
But I'm wondering what did youhear from people in terms of why
they signed up?
Because again, you're the firstclinic to open up in North
Dakota.

(42:29):
So the, and yes.
As DBCs grown around the nation,people could hear a little bit
from other people outta state,but it's like, why would people
join your clinic when theydidn't even necessarily get what
you guys were doing?

Right.
Well, okay.
So like, my patients who I hadseen who like moved from the
system, then moved to theprivate practice, they were just
moving.
They didn't need a reason.
It was just,'cause I'm goingwhere Dr.
Martins is going.
It doesn't matter where she'sgoing.
The, I had patients who had.
Decided, okay, well that's, thatstinks.

(43:03):
I'm not gonna pay it.
Why would I pay for more when Ialready have insurance,
whatever.
So like, they tried it out.
They tried it out, going back tofind a, a primary back in the
system, and a majority of themcome back later because they
either did meet somebody andwere super un dissatisfied or
didn't feel like a connection,didn't feel like they were
heard, didn't get any of theirneeds met, or they've tried, but

(43:27):
they can't get in anywhere.
So they just come back.
And the people that we've gottenthat were like maybe never
associated with us, like fromthe community that have never
heard of me particularly it isusually I'm not being heard.
I'm nobody cares.

(43:48):
That's usually the reason.
Like,'cause I've, I've had acouple of patients who come in,
they do the, the meet and greetmostly because they, they, they
know that they need to dosomething different.
They're just not getting thecare that they need.
But they've got like, fabulousinsurance, right?
Like their jobs paying a hundredpercent of their insurance, and

(44:10):
their insurance is one of thosethat just pays for everything.
So it's free no matter what.
And so then they're like, whywould I, I need help.
Like, defending, paying$125 amonth.
When I'm already getting it forfree.
And I'm like, well, the value isthe relationship and how you are

(44:31):
actually taken care of, and thatyour needs are actually being
met.
And I am trying to tell peopleto separate primary care from
insurance completely.
Like that's the best way that Ican try to figure out how to
like, navigate the comparisonbetween us and insurance.

(44:51):
And like they, some people thinkwe're insurance.
It's very confusing for people.
And I'm like, no, we're justlike, consider us a different
benefit.
You have your insurance, that'sgreat.
You use it at the hospital, atthe er, anything outside the
clinic, but you also needprimary care and that's
different.
And this is the cost for primarycare and hopefully you won't

(45:14):
have to use that insurance asoften.
So that's worked a little bitthat it, it's usually
dissatisfaction.

Love it.
And as you talked about in thevery beginning, the, the waxing
and waning, the rollercoaster ofentrepreneurship.
What, what, what do you see hasimpacted those, the, the, that
rollercoaster itself?
Because we're, we're speaking ata time when there's been a
change in administration.
People are much more worriedabout their finances in
particular.
So I wonder what have you seenas to things that have impacted

(45:47):
your your journey thus far?
I.

I can't say that we had, I was listening
to a bunch of podcasts.
Yours maybe probably about like,we're seeing it's, it people are
canceling, people are, whatever,like needing to save money and
like, I can't say that I've seenthat, but I don't know that
we've had, we've been aroundlong enough maybe to like, have
people who are like, oh, I'vebeen paying for this for three
years.
Do I really need to do itanymore?

(46:11):
Whatever.
So we'd really see an impactthat way.
If anything, more people havesigned up because of their I
guess nervousness for wherehealthcare is going and what
their insurance is going to costand what it's even going to
cover.
So we've had a benefit in thatsense.

(46:32):
I would have to say itclinically, I feel like I've had
a lot more people withdepression or anxiety, I guess
because of everything going on,but at least they can come in
immediately when they just needto vent, which is sort of what
I've turned into for a lot ofpatients.
Like, I'm not a therapist, butI'm gonna, I'm gonna try my

(46:53):
hardest.

And that is, that is the, the social
worker hat of family medicinefor sure.
Like that is a lot of what wedo.
Absolutely.
And.
Tell us about your staff,because you've mentioned your
nurses, you have both Megan andKayla with you mm-hmm.
With you guys, and I'm wonderingat what point did you guys bring
them on or did you bring themwith you on day one?

Yep.
They came with us day one.
So Kayla actually was a nurse atthe system with Allie when she
started working after PA schoolthere.
And then, so she moved withAllie to the private clinic that
we were at.
And so it was like a naturalprogression for her to continue

(47:35):
on her, patients all loved her,you know, Megan, I met at the
private clinic that I wasworking at for that year, and
she was like, brand new out ofnursing school.
And I love that because there'sso malleable and she's still was

(47:56):
like, desiring so much to like,please me and like, do anything
that she need, like whatever itwas that I needed.
She was, she and she would getit done and taken care of.
So, we just brought them with usfrom that clinic.
The clinic ended up closing,like after we left, so, they
didn't have a job there anyway,but either way we, it's like we

(48:19):
got to do a whole one year.
I guess interview to see howthey work.
And they are both just amazing.
So it just naturally flowedover.

That's incredible.
And then how did you guys adjustfinancially to have two RNs come
on?
Because I think about, they'renot virtual staff.
They're, they're well-trained,they're, they're well-trained in
the sense that, like you guyshave worked with them before
coming into DPC.
How did you guys financiallyplan for that?
Did you cut your salaries backin order to float them until
your practice grew?

Oh

yeah.
So

like, basically, so I'm like the only,
I'm the sole breadwinner for myfamily, so I wasn't able to cut
back the amount that Ally was.
Ally basically took a zerosalary for a while.
But we knew we wanted to pay ournurses well.
So we had to take out a businessloan, we to cover the startup

(49:11):
costs and like salaries andstuff like that.
And then I think that honestly,like the two RN thing definitely
sets us apart for most EPCs,probably even more than the
whole like PA do thing, becauseit is a, it's a much higher cost

(49:32):
than if we were to just have onema, doing some of these things
for us.
Had we not known them, and wewere just starting, like
honestly, like we would not haveout of the bat, hired two RNs
had we not already known themand had a relationship with them
and our patients loved them.
And I just, I honestly don'tknow how I would function

(49:53):
without my, without Megan.
So we've, we've made it work.
And then because they're RNsthey're able to do some other,
like, revenue building things,and that's sort of where their
aesthetic stuff comes in.
So.

And I think that in terms of the
listeners out there who arethinking, what's my five-year
plan?
It, it's definitely something tothink about in terms of if you
know the person eitherpersonally or the ideal person,
it's, it's very much somethingto consider in terms of like,
what is the, the overhead goingto be at day one, because I'm

(50:28):
already thinking about year fiveand what that overhead would be
with the amount of patientsdiffering between those two time
periods.

Yeah, yeah.
It was, it's definitely hard.
But I think that the nice, the,the best thing about them coming
over and is the, the fact thatthey, they knew us.
They, we were like.
I don't know, friends, I guesslike, Megan's probably 20 years
younger than I am, so I don'tknow how friendly, but it, it's

(50:57):
like they, we are starting thisnew business and both Allie and
I are like, we don't know.
Like let's just see how it goes,like processes of the clinic,
how we wanna do anything.
It's all been like an all handson deck.
So all four of us try to figureout, well what works best for
me?
What works best for the nursing?
'cause I don't know what you do.
And I am happy to like, alterwhatever.

(51:19):
It makes it more efficient, butit, it looks really, really
messy, right?
Like they don't it, especiallyin the beginning on a day-to-day
basis, knowing like, what to,how do I do this?
Am I supposed to do this firstor do I have her do it?
If you didn't know us and youdidn't know coming in that it
was gonna be like that, youwould've been so out of there

(51:40):
because of how disorganized itwas.
Like this is, just the mostunorganized company ever.
But like they, they knew thatcoming in and they were like
both excited to try to figureout how to get it to be
efficient and work the best thatit can.
So, not considered, there hasn'tbeen like, struggles with that
because we want there to be likea way to do things.

(52:02):
We just getting to that has beenhard'cause we've got lots four
female, perspectives oneverything.

Oh my God, it makes me think about my,
like, six girls in the same dormat, at college.
Yeah, everybody's cyclingtogether.
Oh my God.
That's, yeah.
That's awesome.
Oh my gosh.
So, so here I, I wanna ask abouthow you guys then are working as
a team, because walk us through,like, if a patient is calling
the clinic or contacting youguys, what is the workflow with

(52:32):
everybody's roles on the table?
Because I'm, I'm guessingthere's like, yes, anybody can
come in if they need to, butalso is there, what, what is
the, what is the standard ofcare in terms of like, somebody
talks with Megan or Kayla firstand then talks to you, or does
it directly to you and Ally?
How does it work

If they're calling our clinic number, like
the office number, then mostpeople know that they're going
to be getting either Kayla orMegan.
So they'll call or even text thenumber just to like, say hi to
them or whatever.
So they know that they'reprobably not gonna be talking to
me or Ally if they're callingthe office number, if they're
calling for an appointment to,the nurses know how to, in our

(53:11):
schedule, like where to putpeople, we always leave room for
like same day acute things.
If there's seemingly nothingthere, then they'll just tell
them, oh, well let me talk toAlly and see, see what she can
do.
Or like, they might say, Hey,have you tried sending her a
message?
She can probably take care ofthis without you having to come
in.
So there's a lot ofcommunication that way.

(53:32):
Most patients wanna talk to oneor the other too, so like,
because they all know them.
It's hilarious.
Like, people are very siloed,people are very, they know their
nurse, they know their doctor,they're not gonna talk to
anybody else.
no matter what.
So they'll talk to Kayla andthey'll be like, well, just,
when's Megan getting back?
It's gonna be rough when Kayla'spregnant and is gonna be on

(53:53):
maternity leave.
So that'll be fun for herpatients.
They're all gonna have to talkto Megan.

Oh my goodness.
And as you guys grow, especiallyknowing how Megan and Kayla are
just part of the fold at yourpractice you guys are already
above, you're almost you're onthe, the, you're past the half
point to almost to 300.
And, and I'm wondering in termsof what is the feel for, do you
have an, a, a number that you'relooking for in terms of this is

(54:22):
the number where I think wecould cap our practices to make
sure that we're, having greatpractices, quality of care, but
also that we're able to justhave time to be ourselves?

Yeah.
I feel like that number has beenchanging a lot for me.
I have asked, I, I feel likethis is like a, almost like an
accounting problem for me.
Like I know where I need to befinancially.
But I haven't quite figured outhow to determine what that
actual number is.

(54:52):
'cause it's not as easy, it'snot like a simple math like, oh,
125 times x number of peopleequals not most must of.
That's not, not coming to me.
So, three 50 to 400 is sort ofwhere we were aiming, like each,
so like where I would have three50 or 400 and Allie would have
350 or 400.
I think that we go throughthese, the rollercoaster of

(55:15):
like,'cause there's weeks thatare like so busy and I'm like,
I, I only have 130 patients.
How am I gonna do this withthree times the amount of
patients?
And so then that gets, defeatinga little bit.
But then there's weeks whereit's like super ideal and
there's like openings in theclinic and I'm able to very

(55:36):
quickly get back to people'smessages and I can talk to them
on the phone and handle problemsvirtually.
And that feels really good.
And I feel like on those weeksI'm like, okay, yeah, I can
definitely handle more clinicalwork.
The other part of it is that wespend a good amount of our week
right now doing like businessrelated things, trying to like

(55:58):
figure out how to recruitpatients.
And it's still been difficult toget the word out about direct
primary care in the, in thecommunity.
So a lot of that is like we justhave to like.
Go out and literally tell peopleabout it.
So then that takes time awayfrom the clinic.
Yeah.
So like I'm hoping that thatamount of business sort of focus

(56:20):
will be able to go, like cutback so that I can have more
clinical time when we have morepatients.
But I'm thinking 3 50, 400.

Yeah.
And, and on top of that, justgrowing with patients who are
signing up as individuals.
You also just signed your firstemployer.
So tell us about that, becausethat is something that a lot of
DPCs are, being asked more aboutbecause more self-funded people
are out there wanting to haveDPC at the core of their, he of

(56:51):
their health plans goingforward.

Yeah, and honestly I think that this is
gonna be like.
Where we are gonna need to go,like in order to like grow the
company where to where we wantto is to do small employers.
We, so yes, we, we just signed asmall employer.
Luckily we, I knew her, theowner from like a networking
group.
She happened to be like myinsurance lady for the last 20

(57:15):
years or something like thattoo.
So like we, we knew and so sheknew me and so she was happy to
be sort of like our Guinea pigon how to like, on roll them
onto the EMR and like, I didn'tknow that the process would be
different for employers than itis for like anybody else signing
up individually.
So we had to work those kinksout.

(57:37):
Luckily with somebody who isvery understanding of that,
because that was my biggestworry is like, I don't wanna
roll something out and not knowthat it's, I don't wanna feel
unorganized to the employer,right?
Like, I just, I don't even wannafeel, I don't wanna feel
unorganized to anybody.
I want everybody to think I'vegot my poop in a group.
Like I don't, I don't, I justwanna put that out there.

(58:01):
So I was happy that she was ableto like, roll with it.
I was like, we gotta change yourenrollment date.
Sorry.
Like, I didn't know this was onthe first, like, like, sorry
about that.
It, it also big learning thingthat we learned from that was
that even if the employer.
They understand what directprimary care is.

(58:24):
They don't either.
They really don't.
And then we, we need to talk tothe employees as well because we
knew how many employees theyhad.
This employer was gonna pay fora hundred percent of the
membership for all the employeesand their families.
And then, you get it and there'slike three people and we're

(58:45):
like, why is, why isn'teverybody enrolled?
Like it's free, free healthcare.
But then they're like, oh, Ihave insurance.
Or like, even one of the, wasn'tthe owner, but like the person
who's gonna probably take overthe company comes in.
And after that appointment itwas like, well, how much do I
owe for today?

(59:06):
Like, they were all just veryconfused.
I don't, I don't know how to getit through their, it is really,
really difficult to change themindset of a mid-westerner.
Like it will not change.

Oh my gosh.
As someone who went to, wholived in Nebraska for five years
I think of so many people whofit that category.
Why I left.
Yes.

Like, oh my.
No, nothing.
Nothing.
You already paid and you didn'tpay.
Well, how much is it gonna costmy employer?
Nothing.
They already paid yourmembership.
It's paid.
Nothing gets paid today.
I know how to be more clear.
Oh

my goodness.
I definitely will say that thatis so echoed in the, the, the,
the practices that we run, butalso when benefits advisors are
trying to build these healthplans and employers don't
necessarily get it.
That it's changing, thatlandscape is very much changing,
but it is very true where it'slike the culture is by default,

(01:00:04):
health insurance is healthcareand we're trying to show them
that health insurance is nothealthcare.

Kristine Martens, DO (01:00:10):
Yeah.
And that you have to pay,somebody has to pay or somebody
has to give something for everyservice.
Yeah.
No matter what, whether it'sfree to me, doesn't mean it's
free to my insurance, but it,you know what I mean?
Like, there always has to besome sort of transactional like
thing that happens with everyencounter in everyone's minds.

(01:00:32):
Yeah.
When it, it just doesn't have tobe like that.
And it's just been, it'll getout there, but I feel like the
only way it is my patience goingout and actually like telling
people how, how it's not toogood to be true.
It is too good to be true.
I think is what everyone'smindset, everybody's waiting for
like the other shoe to drop.
They're all waiting for likethat surprise bill.

(01:00:53):
Like, oh, well now it makessense.
Like, no, it, it is just that,just the month monthly
membership.
But, and they're all aware ofconcierge too, is the other
thing.
There's like a concierge placein town.
So they, they do this membershipfor the concierge, but then they

(01:01:14):
bill insurance or there's alwaysa charge of some sort for like
the visits.
And so that's like, they getthat a little bit better, but

Maryal Concepcion MD (01:01:23):
Nope.
Yeah.
And I think that it is very muchspeaking to how our patients can
help move that needle a littlebit when it comes to people out
there, they're hesitant tochange.
And then if somebody who's verynear and dear to them, has an
experience at A DPC that canhelp change their mind or help
them understand a little bitbetter, it, it absolutely makes

(01:01:45):
a difference.
Yeah.
So, I hope

that's my favorite is when a patient is
like texting and then I'll textback and she'll be like, my
friend is just cannot believeI'm texting you right now.
And she's like, I'm like, well,tell her to sign up.
Ah.
But yeah, seriously.
Yeah.
That is the, my favorite part ofit.
I love that I can just text apatient because it's all already

(01:02:08):
documented.
Love it.

Now, because you are a do and you
have the time, like you, youtalked about bringing your
massage table in from medicalschool, which is awesome when it
comes to OMT and when it comesto treating your patients.
I'm wondering how you're able tobring OMT into the fold.

So I use my current DPC patients as sort
of my like.
Retraining myself or like morelike regaining my confidence, I
guess.
Like,'cause like I had done OMTin residency, right?
Like then I graduated in 2013,so I hadn't done it since then

(01:02:49):
'cause I didn't do it at all.
When I got into practice, we hadan, there was an OMT referral.
There was like a one doctor whowas doing it for this system.
So I'd send people, people knewabout it, but I wasn't doing it.
So for the first like six monthsor so, I just like, if I saw
somebody who I was like, oh,migraines like, do you want,

(01:03:10):
will you come in, come in once aweek so I can do some of this
stuff and see if it actuallyhelped.
And then, then I feel like themore people are like, wow, that
actually helps, then I'm like,okay, this is doing something.
'cause I, I love to do thesubtle OMT.
I don't crack, I don't do likethe high velocity like
techniques.
It's a lot of indirecttechniques that are so subtle

(01:03:31):
that sometimes I'm even like, Idon't know, hopefully that did
something and, but when patientsare like, wow, that I didn't
know, but the next day I waslike, wow, I don't have a
headache.
I was like, okay, good.
It's working.
So then after that I decided,okay, now I have to come up with
some sort of price.
And I know I'm probablyunderpriced, but I also like, I

(01:03:51):
wanted people,'cause OMT againis another sort of thing that
nobody really knows about aroundhere.
People know chiropractors, theyknow massage therapists, they
know physical therapists, butthey have no idea really the
difference about OMT.
So I didn't want, I wantedpeople to utilize it, so I

(01:04:12):
didn't wanna make it tooexpensive.
Plus, I have the impostersyndrome, so I'm like, well, I
can't charge this much.
Is it going to be worth that?
Like, what if it doesn't help?
So I set it at a certain levelfor members and a little bit
higher for like, non-members andhave had a really good response
to like, my current patients,like almost too good of a

(01:04:36):
response because, A, it's superaffordable and b, I don't wanna
fill my whole clinic up withjust OMT.
So that gets, it's a, it's abalancing act.
So I'm not currently liketelling a bunch of people not at
the clinic that I'm doing it.

And that's, that's so important
because again, you're, you'rejust keeping, you're, and you,
you have the time to reevaluate,like what do you want your ideal
practice to look like?
And that absolutely includesthings like, things like OMT in
addition to primary care.
So I'm wondering also, you'vebrought different value
propositions to your patients inaddition to OMT.
You guys have broughtmicroneedling and derma blading

(01:05:19):
and cryo to your population aswell as like on your website.
You guys have your weightmanagement care as well.
So I'm wondering how have youguys envisioned the balance
going forward with your primarycare practice patients as well
as people just coming in forthese services?

I'm hoping that, so the microneedling and
the, and the dermaplaning areprimarily performed by our RNs.
So ideally they would have a, itdoesn't have to be super busy.
I certainly don't want it to be,because like I said, I utilize
my, I'm a nurse for like,anything that I can, so I can't
have her just be doing myneedling.

(01:05:58):
But even if it was like even acouple of them a week or
something like that, it'd benice to have that sort of steady
extra revenue to support theirsalaries and to support the
clinic and everything.
And then cryo, we've alwaysoffered to like our current
patients, but then realized thatat one point Allie and I were
talking about like.

(01:06:18):
Well, should we do any type ofjust onetime visits?
Like sometimes people aretalking about or asking about,
can I just come in for once?
Just pay for once?
And so cryo seemed like a prettyeasy, not too medically complex
reason for like, come and have awork, whatever, like frozen off.

(01:06:40):
So I'm thinking of that as more,more than like the cosmetic, I
guess, way that we would can usecryo.
Again, like I don't know thatthat's actually been marketed in
our area yet because it'sanother thing to do and I, I'm
not a great marketer.
But yeah, cryo is superaffordable.

(01:07:02):
We could probably bump thatprice, so, microneedling is like
the high dollar, like aestheticprocedure, derma planning people
like, because I think just thecost is lower and you can come
in more often.
A lot of people will do it inconjunction with, with the
microneedling, like do dermaplanning first and then come
back later and do amicroneedling.

(01:07:23):
But I think both of those, forme, they like kind of go hand in
hand.
They're just sort of like thenurse aesthetics.
It's their love and happy nursesmake me happy.
They love doing it.
I don't wanna be a spa because Ilove that it still feels like a
clinic.
And I want like our old likefarming men to come in and not

(01:07:44):
feel like they're going into aspa.
So I have to have a balance Iguess between it be getting to
be too, too spa-Like I see thedrive though.
I mean people spend, it's kindof frustrating actually.
Like it is easier to get peopleto spend money on microneedling,
to shove needles in your face tolike regenerate collagen than to

(01:08:09):
spend a quarter of that permonth on good primary care.

Yep.

Or just call'em the kettle block there.
Like it's it's so true.
Okay.
So yeah.
But at least I, but I'm gladthey have it'cause it makes them
happy.
And like I said, if, if they canget some good revenue there,
then I can focus more on my, thepatients that I have and like
maybe the total number of howmany I need to be able to

(01:08:38):
support my household can comedown.

You guys have also started your own
podcast, the direct effect.
And I'm wondering how this playsinto, I know you're saying,
you're not the best atmarketing, but in terms of just
sharing what you're doing andspeaking as a physician who's a
direct primary care physiciannow, I'm wondering how you guys
see the direct effect having adirect effect in your community.

this really came around mostly
because every time that Allieand I would get together, we
would get so excited again, liketalking about it.
And anytime that we like did aninterview with the news or like
went on some agriculturepodcast, everybody would talk
about how you could just see,you can see the passion, when

(01:09:22):
you're talking, you can see itin your face.
And I am really bad at likerecording myself for some sort
of reel on, Facebook orsomething.
And my husband even would belike, you just record.
Like I'll talk to him for liketwo hours about my frustrations
and like why this is going tosave the world.
And he is like, you should justrecord all that and like cut it

(01:09:44):
up.
And so honestly like that's sortof how it came out.
'cause we were like, we shouldjust like talk in front of a
camera and probably some reallygood stuff's gonna come out.
And we also just really wantedto kinda talk about direct
primary care, right?
Like the difference in thebetween.

(01:10:05):
That, and like fee for service,whatever, like what people
around here are aware of.
But then also maybe talk aboutlike ourselves, like what we're
going through as parents, asmoms, some wins and, hard times
just so that people canunderstand us as human beings
and trust us as human beings, Iguess, too.

(01:10:27):
You gotta do all these all thetime so you can be that doctor
that, that they trust and whenthey're finally fed up, they'll
be like, oh, I'm gonna go tothat person I'd seen on Facebook
a million times and I'm gonna,I'm gonna go, I'm gonna go now.
So it was sort of that too,like, just to like keep us out
there.
So people can see us as, aspeople.
I, I feel like it's so hard tomarket this because I'm

(01:10:49):
marketing me and it's, you can'tput your relationship with your
doctor on like a one piece ofpaper.
It's hard to convince anybody inlike a ad why they should sign
up for a doctor, right?
Like, you wanna know that personand feel'em out.
I think that,

It's, it's probably even more, pronounced
when you have a, one of us who'sa, a quality based primary care
physician who's focused on therelationship driving by a
billboard.
And I'm like, yeah.
Human kindness.
I don't think so.
Like, I, I get so, I get sosarcastic when I drive by these
billboards and I'm like, keep itin.
Do not say these things out loudbecause they're not, not always

(01:11:30):
appropriate.
Oh my gosh.
But yeah, I mean, I, I do thinkthat you really make a good
point in that when you're, whenyou're talking to people about
whatever you're talking to themabout people do over time get a
sense that, oh, this isn't justa, a billboard but I just, I
think that when it comes to youalso speaking to the reasons why

(01:11:50):
people join your clinic.
Yeah.
It really does.
It, it combines people who wanta relationship with their
doctor.
They want somebody to know them,and they are willing to invest
in that.
And you guys are delivering thatamazing place for them to go to.
Yeah.

Yeah.
That's what made it really easyfor like a current patients.
'cause they didn't have to likeprove that we could have a
relationship.
They already had therelationship.
And I think that, that overtime, that's really what we've
figured out'cause every time wetalk to anybody, right, like
around here.
They're like, that is so great.
Even the bank, when we went tothe bank to like open up their
loan, they're like, you guys aregonna blow up as soon as like,
everybody hears about this.

(01:12:27):
It's just gonna be so huge.
This is such a great idea.
But like, none of them sign up.
Right?
Like, it's such a great idea,but like, it's like everybody
loves it and they wish thattheir doctor was doing it
because they already have arelationship with that person.
So I get it.
I get like, it's hard to committo for a relationship that you
haven't started yet, like, getmarried and then let's see if it

(01:12:50):
works out after the fact.
So I feel like having a podcastor some sort of like way for
them to see who we arepersonality wise and whatever,
like helps them get, get thatrelationship before they commit
to the, to the membership.

(01:13:10):
I love it because it's beenhard.
Yeah.
Yeah.

And I, I'm excited to see what the next
year has for you guys in store.
As you, celebrate your one yearanniversary and it'll be passed
by the time this podcast comesout, so that's awesome.
Yay.
So when you think about thelisteners out there who are
potentially feeling stuck in thesystem or, you know, they're
afraid or they're feelingdifferent feelings about,

(01:13:36):
there's not necessarily not,there's not a DPC in my area.
It doesn't necessarily have tobe the state, like you guys just
check that one off foryourselves, but, yep.
Even, even when it comes to acounty or a city, what would you
say to those people who are inthis place of, I am feeling
stuck and I'm not sure what thenext route is?
And or the person who's like, Iwant to do this, but I am having

(01:14:02):
all these feelings, includingpotentially being afraid

From a patient perspective, I guess.
I would, I would ask them tojust have faith ha like look
around and see if there is, ifthey, if they've heard about it,
they're dissatisfied with thesystem, they know that they
would thrive or like wanna dosomething like DPC to, to look
around and see what's nearbybecause they don't necessarily
have to live next door.

(01:14:26):
A lot of the care can be virtualand like I do have, I have
somebody who lives three hoursaway, saw on like a news cast or
whatever.
And when he is in town, we get'em in.
So it's not impossible.
It might be harder and you mightnot get.
To come into the clinic all thetime, but it doesn't mean that
you can't access your doctor andget the advice that you need and

(01:14:48):
get the care that you need.
For doctors, I feel like youjust need to like, if, if
they're anywhere where I was andare dissatisfied, not feeling
like they're really helpinganybody just consider it.
It's scary.
It's super scary, but you willsurvive.
There's a lot of people tosupport you.
The whole DPC community hasbeen, I don't know what I would

(01:15:11):
do without everybody.
It's, it's amazing how much justfree advice and like help that
everybody wants to give you.
And when you're opening abusiness, anything with free and
it's like, yes please, I willtake it.

And in terms of those doctors who are
not necessarily sure aboutopening their own business, what
would you say to those people?

If I can do it, you can do it.
Or find a really good businesspartner who, who did want to do
that for her life.
Or really good business coach.
So we also have a really goodbusiness coach and that has been
helpful too to sort of likenavigate two separate opinions
on something.

I'm so grateful that you came onto the
podcast today.
I'm so grateful to hear, what'sgoing on in North Dakota, and I
hope that it also inspires otherpeople, specifically in your
state, to take the leap and openin their community.

Same.
Thank you so much for having me.
This was really fun and way lessintimidating than I thought it
was gonna be.

Thank you for listening to another episode
of my DBC story.
If you enjoyed it, please leavea five star review on your
favorite podcast platform.
It helps others find the show,have a question about direct
primary care.
Leave me a voicemail.
You might hear it answered in afuture episode.
Follow us on socials at thehandle at my D DPC story and
join DPC didactics our monthlydeep dive into your questions

(01:16:36):
and challenges.
Links are@mydpcstory.com forexclusive content you won't hear
anywhere else.
Join our Patreon.
Find the link in the show notesor search for my DPC story on
patreon.com for DPC news on thedaily.
Check out DPC news.com.
Until next week, this isMarielle conception.

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