June 15, 2025 • 59 mins
Dr. Jason Hoke, founder of Hoke Direct Primary Care in Oxford, Ohio, shares his journey from insurance-based, network medicine to launching the town’s first and only Direct Primary Care (DPC) practice. Dr. Hoke details the burnout and inefficiencies he faced under traditional healthcare models, and how the DPC model restored his passion for medicine by prioritizing personalized patient-physician relationships and affordable care. Dr. Hoke discuss practical tips for transitioning to DPC, building a loyal patient base, managing rapid practice growth, and team collaboration. Dr. Hoke also reveals how DPC empowered him to provide innovative, accessible care during the COVID-19 pandemic and improved his work-life balance—impacting his family and inspiring the next generation of healthcare clinicians.
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Transcript
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.
Jason Hoke, DO (00:53):
for years I was practicing in network-based and
insurance-based medicine andfeeling more and more
discouraged.
And so if you as a physician arefinding yourself in that
situation direct primary carecan be the answer that you're
looking for, to give you life,to give you energy, to give you
enthusiasm for medicine again tohave that patient care that you
(01:15):
had always dreamed of as far asbeing personalized and not being
restricted by the structure of anetwork or the restrictions of
an insurance or Medicare.
I'm Dr.
Jason Hoke of Hoke DirectPrimary Care, and this is my DPC
story.
(01:35):
Dr.
Jason Hoke, founder andphysician owner of Hoke Direct
Primary Care feels that theburdens of Medicare and
insurance are detrimental to thedoctor patient relationship, and
the efficient delivery ofhealthcare.
Upon completing residency in2001, he and two partners
started an independent medicalpractice in the small college
town of Oxford, Ohio, asMedicare and insurance
(01:56):
reimbursements failed to keep upwith the rising cost of
providing care, the practicejoined a local hospital health
network, Dr.
Hoax.
Soon discovered that networkmedicine only introduced new
layers of inefficiency andphysician burnout.
He saw that physician chartingwas prioritized over patient
care, which created an extremesense of apathy and burnout.
He contemplated leaving medicinealtogether.
(02:18):
But then read about directprimary care, a model of
medicine that wasrevolutionizing healthcare by
prioritizing the patientphysician relationship.
After attending the DPC summitin 2017, he felt energized by
the stories of practicingmedicine the way he dreamed it
would be when he first beganmedical school.
After the following year'ssummit, he returned home
(02:39):
confident and equipped to makethe leap five months later.
After fervent prayer, countlesshours of planning and the
unwavering support of his wifeand six children, Dr.
Hoke opened Oxford's first andonly DPC practice now six years
into his practice.
He wants to share his DPC story,hoping it will encourage other
physicians who are feelingapathetic and burned out.
(03:00):
There is a better way where youcan rediscover your love of
medicine.
Maryal Concepcion, MD (03:08):
Welcome to the podcast, Dr.
Hoke.
Jason Hoke, DO (03:10):
Hello.
Thank you for having me on yourshow.
Maryal Concepcion, MD (03:13):
I'm so excited to chat with you.
We just saw each other a fewmonths ago at the Ohio DPC uns
Summit.
So make sure that in February of2026, if you're in Ohio or able
to travel to Ohio, make sure youcheck out the state focused on
summit in Ohio.
It's been going on longer thanthe DPC summit.
So I, I just, I really, I, Ihope that your introduction,
(03:36):
your bio really moved peoplealready, and we haven't even
started our conversation, but Ithink that your calling out of.
What happened after youtransitioned your guys' practice
to a hospital in-networkpractice was not necessarily a
way to save the practice and itwas actually pushing you more
towards contemplating leavingmedicine.
(03:56):
So I wanna zoom in at thatmoment in time because the
feeling of leaving medicine orwanting to leave medicine is
quite significant for someonewho's dedicated their entire
career.
Training, education, everything,sleepless nights, delivering
babies, all of the things tothen to then step away.
So bring us to this point of youhad done independent practice,
(04:20):
but it was still insurance basedand you tried to find a better
way, but it still was notworking out the way that you
would envision starting medicalschool.
Jason Hoke, DO (04:27):
Sure.
So, In 2001, I had graduatedfrom residency and myself and
two partners from residency, westarted a practice in Oxford.
And on day one we had onepatient and that quickly grew
over the course of about 10years to four offices with a
total of 11 providers.
So we were quite successful herein, in our small college town
(04:50):
area drawing patients from aquite a large area.
But what we saw is, there wasjust a lot of stress and
frustration with trying to dealwith insurances tightening
burdens from Medicare, making itharder and harder to try and
just see our patients and getreimbursed for our care.
And so what we saw was we neededto be proactive and move forward
(05:11):
with making a change so that waywe could continue to sustain a,
a very successful practice.
And so what happened is we thenmy Oxford location, we joined a
local health network with theidea that, now we can get back
to being doctors and we can letthe health networks, attorneys
and billers argue with theinsurance attorneys and billers.
(05:32):
And what I found is veryquickly, that was rather naive.
We found is that a lot of thehassles that we were dealing
with before now were replacedwith new hassles and new
requirements from the healthnetwork.
And I became very quicklydisillusioned with what was
happening in healthcare.
I worked actually quite, I.
(05:52):
Closely with the CFO of ourhealth network, trying to come
up with a new reimbursementmodel that would allow the
primary care care physicians totake care of patients the way
that we knew they had to betaken care of, and that personal
approach and not doing it basedon an RVU model.
And the CFO and I, we came upwith a great idea that we
thought would go really welluntil it then got presented to
(06:13):
the board.
So my point in telling you thatis that we actually, I tried to
work within the network model tomake it a better place for
patients and for physicians.
And what I was finding is I wasjust banging my head against the
brick wall that was not going torelent.
And then when we had primarycare meetings and every meeting
every month was about billingand coding and charting, and
(06:36):
never talking about diseasemanagement, I saw myself getting
disillusioned, getting veryburned out, feeling like I had
to see more patients to maintaina reasonable salary.
But then at the same time,Marielle, I saw young
physicians, I mean, talkingabout folks who were just outta
residency for two years alreadytalking about wanting to give up
and leave medicine altogether.
(06:56):
And so I knew that I wasn'talone in this idea that this
isn't right.
It's just a matter of, I, Ididn't know where to go, where
to turn.
Maryal Concepcion, MD (07:04):
Totally.
And how relatable is that?
I know that there are audiencemembers out there, some have
even opened their DPC clinicsand have been in practice for as
long as you have, and they'restill nodding their heads
because that is a real thing.
I, I talk all the time to peoplein medical school, even
pre-meds, by the time yougraduate medical school, what is
the training levels that you'llhave in business?
And I get these dumbfoundedlooks, which I think is really
(07:26):
sad, especially in this day andage when the corporate practice
of medicine is so corporatizedand it is so focused on the
exact things that you're callingout.
Dr.
Maggie Abraham called this out.
Dr.
Edta called this out.
So many people have said overand over.
We have tried as physicians todo our due diligence in the
clinic and take that duediligence and that advocacy to
(07:48):
the boardrooms, to the admintables.
And yet we cannot make changes.
And when you say, you know,banging your head against the
wall and you say, you are readyto leave medicine.
These are real things.
And so for those listeners outthere who have experienced that,
this is exactly why we're havingthis conversation today, this is
exactly why we're gettingstories out there of what life
(08:09):
can be as a physician who's ableto just be able to focus on
their patients.
So, yes.
Because you are the first andonly DPC in Oxford now, I'm
wondering about the conversationthat happened between you and
your two partners, because youguys opened together mm-hmm.
And then you opened DPC.
On your own.
(08:29):
And I'm just wondering, did youguys converse as the, the
corporate situation washappening about, hey, like this
is really unsustainable?
Did they stay in the practice?
What happened to your twopartners as you explored your
own DBC journey?
Jason Hoke, DO (08:44):
Sure.
So, we had the four offices andthe US original partners, we
were each in charge of one ofthe three offices.
One of my partners actually wentmore of the functional medicine
route after being a, what Iwould consider a traditional
family practice physician about10 years.
So he continued with doingfunctional medicine and, and
remained independent.
My other partner his office isactually in Brookville, Indiana.
(09:06):
Oxford is a border town onlyabout five minutes from the
Ohio, Indiana border.
So his practice actually joineda health network in Indiana.
I.
And then my office and the otheroffice that was in Ohio, we
joined the same health network.
Having that conversation amongstall the three offices that were
what I would considertraditional family medicine, we
(09:27):
all came to the same decisionsaying, Hey guys, this is not
sustainable with the wayinsurances are just squeezing us
as far as trying to being anindependent practice.
So we were all in agreement thatit was time to join a health
network and we just kind of didit a little bit differently at
shared offices.
Yeah.
Maryal Concepcion, MD (09:43):
I think about as you responded there,
you still went the DPC route.
You did not leave medicine, you.
Talk to people who had openedand had the exact same practice
experience as you in terms ofopening as an independent
continuing fee for servicethrough hospital networks.
But you stayed and I'm justwondering what was it that made
(10:04):
you stay and pursue somethingelse?
Jason Hoke, DO (10:07):
Sure.
So when I was getting veryfrustrated with the situation
one of the things that you getas a bonus when you're a network
physician is you get CME money.
And so one year I was looking atdifferent CME conferences and I
just happened to stumble acrossthe DPC on summit sorry, the DPC
summit on summit is in Ohio, theDPC summits.
(10:28):
And uh, and so I looked at thisand.
Was reading about what DPC wasand like this is what medicine
is supposed to be.
So I was telling my wife about,I said, I, I need to go to this
conference because this isreally how we as physicians
should be taking care ofpatients.
And so I attended that firstconference in 2000 and 17, and I
(10:50):
was in awe.
So for anybody who's been aroundin DPC for long enough, I, I got
to hear a presentation and meetJulie Gunther I mean, pioneers
in DPC as far as just, and theywere so enthusiastic and loving
practice again.
And wow, look, they go to workand they have a smile on their
face and they're loving whatthey do.
And at that point, like that,that's just so awesome.
(11:13):
And I came back and told my wifeall about it.
And uh, so, and then it kind ofjust, Hey, that sounds great,
but now I need to go back towork
Maryal Concepcion, MD (11:21):
and.
In your bio, it was mentionedthat by the next year, the
second time you attended Summit,you were like, I have all the
things that I need to just keepthe ball rolling and I'm gonna
do this.
So I'm wondering if you canbring us back to that moment in
time when you're prepared with alot of stories, a lot of
inspiration, and a lot ofenthusiasm and a a, a glimpse as
(11:45):
to another way to practice, andthen you spent the next year,
what was going on in that yearas you were preparing for the
next summit.
Jason Hoke, DO (11:55):
Sure.
So, that next year was full of alot of things.
So I I continued to work with myhealth network.
I was still in that mo mode of Ican make things better, we can
do this better.
And then it became obvious to methat it was not improving.
And I had a patient encounterthat really solidified for me.
How broken the system is, and,and briefly it was, I was
(12:17):
dealing with a teenage girl whowas in my office.
Horrible, horrible otitis media,which is an ear infection, and
to the point where it lookedlike the eardrum was getting to
Rup ready to rupture.
So I talked to the mom about,the best option here would be to
give her a shot of Efen.
Give her that quick antibody,give her that quick improvement
so that way we can, get her somerelief.
(12:38):
And the, this family was cashpay.
And so I went to my receptionistand said, Hey I want to go ahead
and give them a shot ofreception.
They're asking how much thiswould be.
And she said, that's gonna be$160 for that injection, plus
the injection fee.
And I said, okay, well wait.
Remember they, they're cash pay.
And she said, well,unfortunately, the network only
gives a cash pay discount forthe office visits, but not for
(12:59):
procedures.
Which again, I thought was sobogus.
And I said, well, hang on asecond.
Let me make a quick phone callover to the pharmacy and we'll
just find out how much a vial ofefen is.
You go pick it up, bring itback, and we'll just give you
the shot.
So I called over to thepharmacy.
The efen injection would've been$10 for the vial, but we don't
have it in stock.
We'd have to order it, it won'tbe here till tomorrow.
(13:22):
And so mom is left with thisheartbreaking situation.
Do I let my daughter suffer foranother day?
Or do we just go ahead and paythe 160, 170 bucks and do this
shot here in the office?
And she chose to go ahead andgive the shot for 170 bucks.
And at that point, I realizedthat this is so unethical for
our patients that they're havingto make this decision on a
medication that costs 10 bucks.
(13:43):
So by the way, now we give herseven shots in my office and it
costs$8.
So, I went home that day andtold my wife about that, and I
said, I, I look in the mirrornow.
And I said, I hate my job.
This, this is, it's gotten tothe point where I just truly
hate my job because I just feellike I'm being pulled between
what's right for my patients andwhat's right for the network.
(14:03):
And so, I then, and that wasshortly before I went to the
second DPC conference and gotmore and more information, got
more and more excited.
But again, I'm feeling anxiousand nervous about the situation.
I mean, at the time I.
Was 44, 45 years of age.
Six kids, I've got a couple thatare coming up on high school and
that's college.
(14:23):
In a network you have goodhealth insurance, you've got
retirement.
And all of these things aregoing through my mind as far as
can I make this leap at such abig stage.
And on the last day that I wasat the conference, I'm sitting
there at, at lunch getting readyto leave and I, and I order my
sandwich and get a drink And Igot this bottle of tea and on
(14:45):
the bottle of tea was a saying.
And I still have it on mywebsite'cause it's so
inspirational to me.
And it said to dare is to loseone's footing momentarily.
Not to dare is to lose oneself.
And that was said by KierkegaardAnd I just look at this, say,
this is a sign that it is timeto stop talk, stop talking about
it and actually take that stepforward because I am losing
(15:07):
myself.
In this medicine practice thatI'm in.
And so, at that time then wesaid, this is what we're gonna
do.
We sat the kids down.
I said, as we said, we have sixkids and we had what's become
affectionately known as thebeans and rice talk.
And so this was in August of2018 and said, kids, we gotta
save some money.
So as a family, we said, we'regonna eat beans and rice and eat
(15:29):
peanut butter sandwiches for thenext several months.
We're not going out, not doinganything fun'cause we have to
save up some money so dad canmake this transition.
And then five months later, inJanuary of 19, I opened my
practice.
Maryal Concepcion, MD (15:42):
All I can say is how effing resilient I
am.
So oh my God, I am so moved bythat, that.
Just serendipity if that's whatwas on your tea.
'cause it's like, how manysnapples have I had in my
lifetime?
And not ever have I been asinspired as I was with your tea
label, but, or your tea saying.
But if that is not resilienceand if that is not, showing your
(16:05):
kids vulnerability, if that'snot showing your kids, this is
standing up for what's right.
I mean, that is so powerful.
It is so powerful.
Everything that you did.
But also it sucks.
It sucks to go through thosemoments when you're, you're
still the same doctor.
You're trying to do your bestand the system is not allowing
(16:26):
you to not have those momentsand that just take care of
patients.
So I, so going from there, thismoment of the beans and rice
talk, I feel that need, need,that needs to be put on a
t-shirt I would buy that.
The, the moment of.
You're done with the beans andrice talk, your family's backing
you, you are making the nextstep.
(16:47):
What was that next step for you?
Jason Hoke, DO (16:50):
Sure.
So, that decision was made inAugust of 18.
And I met with the physicianliaison at my network and said,
you need a 90 day notice.
I'll give you a little bitlonger.
But here's what I'm doing now.
Thankfully, when I made thetransition from private practice
to network, and I wouldencourage any physician who's
gonna be having a cut track toput this in there, is they
(17:13):
wanted to have a open peakclause.
And I said, well, I'm fine withthe no clause.
I won't go ever leave and go toone of your competitors, but you
have to let me have theopportunity to go back into
private practice if I feel thisisn't working.
And so that one sentence inallowed me to break my contract
with them and open a practice, aDPC practice just a few blocks
(17:34):
from my old office.
And so, during the next fourmonths, we diligently did
anything and everything to buildup the practice to get
advertising out there.
And we held three communityevents because nobody in Oxford
knew what direct primary carewas.
They were held at a local churchand we had about 50 attendees at
each of those community talks.
(17:56):
And so by the time I started mypractice in January of 19, I
already had two patients alreadyon 200 patients already on the
schedule in January andFebruary.
So that way I could start offwith having a full schedule
ready to go.
Maryal Concepcion, MD (18:11):
I'm wondering if you had the anti
beans and rice talk at thatpoint, because that's a lot of
patients and I mean, it'sincredible to think about August
to January, February and to have200 patients in that amount of
time.
I'm wondering if you could tellus what your patients said to
you when you were doing thesetalks and the patients in
(18:32):
particular who were part of that200.
Jason Hoke, DO (18:36):
Sure.
So I'll start off with the onethat is, is still fresh in my
mind'cause it's kind of funny.
I had one patient of mine at myprevious practice when I told
him what I was doing, he said,Hey, that all sounds fine and
good, but when you're over withthat fad and come on back here,
I'll be happy to rejoin you.
So that patient did not followme to my new practice'cause this
was not a fad.
I knew that I was making adecision that was gonna be for
(18:57):
the best long term.
Yes.
So when I gave these communitytalks just lots of people just I
mean, glued to what I wassaying, like they'd never heard
of such a thing.
Like we're going, I basicallysaid we are going back to old
style, small town familymedicine.
With the 21st centurytechnology, we're gonna have
(19:17):
computers, electronic records,you're gonna be able to reach
your physician by phone, byemail, by text.
We're gonna have the secureportal and all of these things
that you expect from bighospital networks.
We can do this at a smalloffice.
And that return of that personalconnection, a lot of my patients
had been with me for 10, 15years and they saw the
transition.
I had many patients pull measide and said, Dr.
(19:39):
Hook, I saw you were gettingworn down.
I saw the heaviness in youreyes.
You did not have that same flareand energy that you had years
ago when I first started seeingyou.
And they also got tired ofhaving to wait two weeks to get
in to see me, which I would beupset if it took that long to
see my doctor as well.
So they were excited about thisopportunity to kind of regain
(20:00):
the old Dr.
Ho and have that interactionagain.
Maryal Concepcion, MD (20:04):
I think that's so cool though.
I mean, it really speaks to therelationship that people want in
DPC because especially, to, tohang with you through your
different iterations ofpractice.
I think that is awesome.
And I think that that is trulyone of the things that drew me
into family medicine is thatgenerational aspect of taking
(20:24):
care of a person through theirlifestyle, their through their
life transitions.
Mm-hmm.
So that's, that's incredible.
And you also open, as you, asyou mentioned, you're on a
bordering town between Indianaand Ohio.
Tell us more about Oxford inparticular because it is a
small, small college town, butwhat does that mean in terms of
like population and resources?
Jason Hoke, DO (20:44):
Sure.
So Oxford is probably a town of16 to 18,000 if you consider the
greater Oxford area, if there issuch a thing.
And when Miami University's insession, the town essentially
doubles in population very.
Large rural community lots offarmers.
So it's fun because I get thefull gamut of experiences as a
(21:05):
physician.
I am taking care of for lack ofbetter terms, uneducated
farmers.
I'm taking care of collegestudents, I'm taking care of
college professors, taking careof small business owners here in
town.
So it's neat'cause I truly getthe full experience.
I mean, obviously birth to deaththe whole gamut as far as the
age ages go as well.
So, yeah.
Maryal Concepcion, MD (21:24):
And when it comes to this group of 200
fine, amazing individuals whoare like, yep, Dr.
Ho is still my doctor, or Dr.
Ho is gonna be my doctor goingforward, how did you handle 200
people and onboarding thosepeople to your practice?
Jason Hoke, DO (21:40):
Sure.
So we were fortunate enough tofind a really good electronic
record system that allowedpatients to kind of just
register and get theirinformation in online.
I started the practice with justone assistant.
And we were really nervous aboutstarting on day one with just
one person and just out of theblue, a Miami pre-med student
said, Hey I'm interested inlearning more about this DPC
(22:03):
thing.
Do you, could you use some helpat the front desk?
And I could kind of learn fromyou, but I could, you could use
my services for answering thephone.
And we're like, hallelujah.
That's an answer to prayer.
And so he was with us for thefirst five to six weeks until he
had to start back to classes.
And that gave us time to then dosome interviews and hire a, a
second person so we could uh,run the office because we were
(22:26):
very quickly busy.
I mean, I look back at my firstmonth in practice in January and
seeing seven and eight newpatients a day.
When you spend 45 minutes to anhour with every new patient, I
was full.
And and the word got out andpeople were telling their
friends.
And next thing you know, within,I think by October of that first
(22:48):
year, so in 10 months I hadreached my capacity.
My practice was essentially fullat around 700 patients.
So once people heard about itand saw that it wasn't just a
fad and I was here to stay itvery quickly grew.
Maryal Concepcion, MD (23:02):
That's incredible.
And I think it's also amazingthat, you have this tea phrase
and tea bottle phrase, and thenyou're like, yeah, this is this
is a sign.
And then all of a sudden youhave this Florida medical
student who's like, hello.
That's incredible.
Because you're, balancing theentrepreneur hat of hello, I'm
(23:22):
Dr.
Hoke, I'm also Dr.
Hoke, who, is like doingsoftware things on my EHR and
I'm doing all of these thingsas, as the, the sole business
owner.
How did you make it such thatthe student was able to help you
with your daily things, helpwith the practice itself as you
were building it?
Jason Hoke, DO (23:40):
Sure.
So thankfully my assistant was aregistered nurse who I'd known
for years, very, very.
Organized almost to the point ofOCD, but very, very organized.
And so during the time that Iwas seeing a patient, she was
helping him to understand thisis why we do what we do.
This is how you do thingsefficiently.
And to help to, to do that.
(24:02):
Telling him what to say on thephone as far as encouraging
patients and answeringquestions.
And the student was a very.
Very much a go-getter.
Very it savvy.
So he handled a lot of things asfar as with the website and
things like that, that, at myage, in my forties, like I just
don't even know how to do someof this.
So anything you can do to helpme with is, is awesome.
And then he really, really sawthe, the benefit of DPC and he
(24:26):
remained enthusiastic about it.
And kind of just a fun littleaside, Mario, that same student
is coming back this fall as afourth year med student to do a
family practice elective withme.
Specifically learning more abouthow to run a DPC practice.
Maryal Concepcion, MD (24:42):
How awesome.
I absolutely love that.
That is the best ever to hearthe, it's so full scope right
there.
That is amazing.
And, I, I wonder where is heintending to practice?
Is he intending to prac practicein Oxford, Ohio by chance?
Jason Hoke, DO (24:58):
I don't know.
He still has to do his residencyyet.
I guess we'll talk then.
Maryal Concepcion, MD (25:03):
When he hears this, I, yes.
That was a very loaded questionand yes, that was a very loaded
question.
So, awesome.
So you are in this town of, asyou said, and that's I, I know
that feeling like I went to uc,Davis and Davis at the time.
It's crazy all the time now, butat the time it was like, wow.
When school is not in session,it's a totally different, it's a
(25:24):
totally different experience foryou.
How has your practice grown?
Especially because you havecollege students who do need
healthcare and studenthealthcare is not always the
best.
Jason Hoke, DO (25:37):
So, students are, are, are, are probably a
minority in our practice justbecause they are transient.
But we do have, a a handful ofstudents a lot of professors
especially those who reallyunderstand the benefit of DPC.
We actually have a wait list nowof professors that are still
willing to get in to see me.
But as our practice grew wecontinued to have more and more
(25:58):
phone calls to people coming,wanting to be seen.
And like, guys, look, I, I havea cap at 700.
I, I'm not gonna get myself backinto the same situation before
of just feeling overwhelmed andstretched too thin.
And then over time, as we stillhad more and more phone calls, I
said, well, it's probably timeto look at adding on another
clinician just so that way wecan continue to provide good
(26:19):
care to the area.
Maryal Concepcion, MD (26:20):
And so Julie is your nurse practitioner
and I'm wondering how did youguys connect?
Because definitely it soundslike you need clinical help at
your practice given thosenumbers.
Jason Hoke, DO (26:33):
Yeah.
So, kind of a fun backstory.
Julie was one of my first nursesat my initial practice years
ago.
At the time she was an LPN andthen she left the practice to go
get her RN degree and had a verysuccessful nursing career as an
RN in one of the localhospitals.
And then went on to get hernurse practitioner training and
(26:55):
just out of the blue she calledme saying, Hey, I need to do my
family practice.
Clerkship and so can I come toyour office and do that?
So I'm like, sure.
And so we reconnected.
Then when she is in her nursepractitioner training she gets
her diploma, she goes to workfor a network.
Practice is in practice forabout a year, and I'm like, at
(27:16):
that time I'm looking forsomebody.
Trying to recruit a goodphysician, one that Marielle
knows very well from the DPC onsummit and who has been on the
my DPC story?
Dr.
Andy Chun.
So I, Andy Chun and I actuallywent to residency together, and
so I knew he'd be a great fitfor this practice, but, and Andy
also has a very successfulpractice of his own.
(27:37):
So in my attempts to try andrecruit him my way for DPCI
essentially encouraged him tostart his own DPC practice.
So that was, that's kind of afun aside.
But anyway, so as I'm goingthrough this and looking all,
all these different options, mymind keeps going back to this
great connection I've had withJulie over the course of 20
years.
And so I just give her a calland say, Hey, Julie.
(27:59):
Are you ready to leave thenetwork and just come join me
here and do DPC?
And she's I have been waitingfor this call.
Thank you so much.
And so she has come on and she'sdoing great.
She has actually, this is hertwo year anniversary this month
and she is up to 300 patients ofher own right now.
Maryal Concepcion, MD (28:17):
Wow.
And when it comes to and I willmake a note here definitely I
will link Dr.
Chen's blog and his interview toyour blog.
That's awesome.
I love that story.
When it comes to your patientsyour panel has grown, your panel
has closed, to new patientsbecause you're maintaining that
(28:37):
quality of care for the patientsyou do have.
how was it for patients who wereon the waiting list to join, to
join Julie?
Did they, did, was, was thereany question about, well, if I'm
not seeing Dr.
Hoke, is it a different price?
If I'm not seeing Dr.
Hoke for my day-to-day, do Istill have access to Dr.
Hoke if, if needed, because he'sthere?
How did patients come on fromthat wait list to Julie's
(29:00):
practice?
Jason Hoke, DO (29:02):
Sure.
So, when the wait list, weopened it up, we, we called
those patients and said, here'sthe situation.
Dr.
Ho is full, but he has broughton Julie, who we have great
confidence in, and she's got,she's experienced and she's
gonna is open to taking newpatients.
Probably about a third of thepeople that we talked to came on
with Julie.
(29:22):
A third said, go ahead and keepme on the wait list.
I'll wait for Dr.
Hoke.
And then the other third said,well, we have already went on
and found another provider.
Because that wait list wasprobably there for a good two
years.
So as far as the, the care, wenever really received much
pushback as far as keeping thepricing the same for patients,
(29:43):
whether regardless of whetherthey're seeing Julie or seeing
me.
And the reason for, that'sactually pretty simple in that
if they're seeing Julie, they'reessentially getting two for the
price of one, because Julie andI have the same office hours.
Our desks are right next to eachother.
And just like any good medicalsystem where the providers trust
each other, we're talking toeach other throughout the day as
(30:06):
far as, hey, just bouncing anidea off of each other.
So it is not a problem for Julieto come out of a patient exam
room.
I'm sitting working on a chartand she'll come over and just
ask me, Hey, what do you thinkabout this?
And the neat thing about it is Iwant her to do that.
Nurse practitioners the really,really good nurse practitioners
know what their limits are andthey're not afraid to ask
questions, and they are worththeir weight in gold.
(30:26):
And that is definitely JulieGreen.
She, she'll come to me, she'llask me questions, we'll talk
about it, think through what'sthe best option for the patient.
But if there's ever anyquestion, I just get up from my
desk and go in and talk to thepatient myself.
Maryal Concepcion, MD (30:38):
That's awesome, and I appreciate you
sharing that because that hasbeen a question that I've gotten
from many people.
Like If I add a non-physicianprovider, does the price change?
So I'm, I, I appreciate yousharing what's happened at your
practice now when it comes tonow when it comes to the back
office side of things, your,with your patients, a
(31:01):
significant number of patientsthere already, and then you're
adding people from a wait listand you are, building a team.
It's growing.
I mean, it's definitely grown.
It's very even family orientedwith your son as well Now, let's
start by talking about how it'sgrown in terms of personnel, and
then I wanna talk more aboutthe, the, the back office to
help keep everything copaceticfor your patients and you guys.
Jason Hoke, DO (31:24):
Sure.
So, Monday is, is our busiestday as many offices have with
coming off of the weekend.
And so we have, Julie and I arehere.
We each have a assistant workingwith us, and then we have one
receptionist up front.
And then every other day of theweek, Tuesday through Friday,
it's typically just oneassistant in the back and one
receptionist up front.
And that works out fine.
(31:45):
And the reason is because we canbe efficient.
Our patients understand that werun a lean office.
And the other thing is thatJulie and I don't mind stepping
in and filling in wherever'sneeded if.
The phone is ringing and thereceptionist is on the phone,
and a nurse is in with apatient.
Julie and I have no problemspicking up the phone, and of
(32:06):
course patients are shocked whenthey say, wait, is this Dr.
Hope?
Just.
Am I actually talking to Dr.
Ho?
Yeah, I can answer a phone too.
I'm not above doing that.
And so, so we each pitch and dowhat needs to be done.
There's been times when thenurse is on vacation or is out
sick.
I've given injections.
The only thing I can't do, and Idon't think my patients want me
(32:28):
to even try is draw blood.
I I have to draw the linesomewhere.
So, but yes, so it, it's greatbecause even though we have
people kind of assigned a taskor a duty for the day, we just
all fill in wherever it's neededand it works out great.
Maryal Concepcion, MD (32:41):
That's awesome.
And yeah, I, I love thoseconversations when you're the
doctor talking and they're like,yeah, so can you please make
sure that you give Doctorconception the message?
And I'm like, absolutely, thankyou so much.
Have a good day.
So it's like, oh boy.
But that, that is so funny andvery relatable, I'm sure from
many out there.
When, so.
So thank you.
That's, that's great.
In terms of how you guysorganize your week, in terms of
(33:04):
the tech and just things toorganize you guys on the backend
and keep everybody copacetic andon the same page.
Tell us about how you createdyour tech stack.
Because you mentioned yourelectronic health record, you
started off with that.
It allowed you to really quicklyand efficiently onboard those
first 200, but how have youbuilt your tech stack beyond
that?
Jason Hoke, DO (33:24):
Sure.
So we we're still using the sameelectronic record that we
started with.
We took the ability to registerfor, as a new patient off of the
online segment because we wantedto have the ability to answer
questions directly withpatients.
And that's something thatactually is so unique these
days.
Most of that time when patientscall a doctor's office, they get
that endless phone tree.
And so.
(33:44):
People are shocked when theycall this office and somebody
actually answers the phone.
So, so we, we can continue withthat.
It has a nice portal system sopatients can message us through
the portal which is basically aconfidential email that helps to
cut down on the number of phonecalls and also it actually
allows for a more accuratedescription of what's going on.
'cause it's in the patient'swords.
(34:05):
And it's actually a part of themedical record now too.
We have the ability to dotexting which is great for when
we just need a real quick yes nokind of answer.
Just boom, send them the quicktext.
The texting has on the displayit has our office phone number
so that way patients know whereit's coming from.
And also that's good as aprovider to have confidentiality
that they don't know what ourown personal phone number is.
(34:27):
And then we can use that sametexting option in the evening if
we're logged into our computersystem.
We have, we do labs in theoffice.
We, we use a, a national labprovider that that runs our
labs.
We have a direct interface intothe charting system, so that way
we get results the very nextday.
And that's very quick andefficient because it's the
interface.
We do scan in paper documentsand we do mostly anything that
(34:51):
you'd see at a typical familypractice office.
We do EKGs we do your urinetests.
We do strep tests, the flutests.
Pretty much we love doing skinprocedures, lesion, removals,
things like that.
So yeah, full gamut of familypractice.
Maryal Concepcion, MD (35:05):
I love it.
And any best tips for otherpeople as they're developing
their tech stack?
Because they think aboutespecially with so many people
in your practice, patient-wise,automations and ways to maximize
the tech you already have arereally helpful to anybody no
matter how many years they'vebeen open.
Jason Hoke, DO (35:22):
Sure.
So, one thing I would say, and,and this might be unique to our
practice, but we try to findsomething to provide value to
the DPC monthly membership.
So with having the labs, whichof course are deeply discounted
compared to standard lab prices,we also have a small pharmacy.
So we have your commonantibiotics, high blood pressure
meds, diabetic meds,antidepressants, things of that
(35:42):
nature.
So one of the things that wasimportant to me is I did not
want to ever have to be in asituation where I would have to
figure out whose fault is itwhen this interface doesn't
work?
And so I searched.
Really hard to find a electronicrecord system that could do our
EMR, do our scheduling, do ourbilling, do the and do the
(36:03):
pharmacy dispensing.
And so thankfully I found onethat has worked well for us from
the get go and I see no reasonfor us to change because the
program just continues toimprove.
And so, yeah, that was a bigthing to me, Muriel, is I did
not want to get stuck in a phonecall conversation argument
between two tech folks sayingit's the other person's fault.
This way I can just call onecompany, say it's not working,
(36:25):
and they fix it.
Maryal Concepcion, MD (36:26):
And I hope that that is helpful for
people as they're looking atEHRs or looking to switch EHRs
if they're not happy with theircurrent one.
When it comes to ways that youguys have personalized your
messaging, do you, say thatthere's like new guidelines that
come out on treating somethingor there's, somebody has called
out like, oh, this, this savedphrase, phrase, macro could be
(36:49):
improved upon.
How do you guys reevaluate theday-to-day operations to say
like, okay, yeah, here'ssomething we could make an
improvement on, let's change it.
Jason Hoke, DO (37:01):
Well, one of the advantages with being a small
office is that we just talkabout it, and if we want it
change, we change it.
I'll just say, Hey Julie, whatdo you think about this?
And if she likes it, we we canmake the change.
Yeah.
Yeah.
Actually, I mean, that's a greatquestion.
Our EMR is very user friendly asfar as being able to
individualize and customizethings on it.
Maryal Concepcion, MD (37:18):
going back to the patients who wanted
Dr.
Hoke and followed you throughoutyour different iterations of
practice, and then you're openand, it's years later and
they've been your patients,what, what are some of the
things that you've heard fromthese people or just anybody at
your practice in terms of howDPC is valued by them as the
(37:39):
recipients of your care?
Jason Hoke, DO (37:41):
it's actually been quite humbling now that you
mention it.
We, we have like many practicesthat are growing and trying to
get the word out there.
You take reviews.
So we have right at our checkoutdesk, a a little scan thing that
takes you right to our reviewpage so that way patients can
leave a review.
And the, the one, the, the, thereviews that are most humbling
to me are the folks I've knownfor.
(38:02):
20 years that have, like yousaid, followed me through thick
and thin and to to hear them allsay, this is the best thing that
could have ever happened to Dr.
Hoke.
Or this is the best thing thatcould have ever happened to his
practice.
Or This is the best thing that'sever happened to me as a patient
in this practice.
Because they'll talk about thatpersonalized care.
And just how it really is theway it should be.
(38:24):
I mean, our little catchphrasehere at our office is medicine
simplified because it really is,we're getting back to a simpler
form where it's not socomplicated, unnecessarily
complicated.
And our patients see that andthey know that when they talk,
we're listening and we're notjust trying to run them through
the mill.
So
Maryal Concepcion, MD (38:43):
that's so powerful, especially.
Given, how frustrated you werewith that fin example that you
gave and also just the, thedoctor in, even in that same
example, calling the pharmacy toask how much does this cost cash
pay?
Like I never would have askedthat as a fee for service
physician.
I didn't even know that payingcash was an option except for
(39:04):
GoodRx.
So like calling the pharmacy andfiguring out cash price for
anything other than here's aGoodRx card, figure it out
yourself was, was foreign to me.
So I think that's amazing andit's, it's very cool to see your
patients experiencing that thisalso is not a fad for you and
your practice.
Jason Hoke, DO (39:23):
Right.
Maryal Concepcion, MD (39:24):
in terms of challenges, I would love to
go there because as, as we workvery diligently to deliver on
our promise to our patients andour promise to affordable,
accessible, quality, primarycare.
I'm wondering what challengeshave you guys gone through over
the years that you really wantlisteners to hear about?
Jason Hoke, DO (39:45):
Sure.
Great question.
Because, when we go to DPCsummits, we talk about all the
awesome reasons why we should dothis and, and those are all very
valid.
But, it is work.
I mean, we're talking about, I,I am the physician, but I'm also
the office manager.
We run lean and mean, and I knowhow to do basic accounting.
I know how to write a check fora bill.
(40:05):
I mean, those are things I don'tneed to pay an office manager to
do.
So I have to, set aside time to,to do that.
So for example, I work onFridays a half day and then
seeing patients, and thenusually Friday afternoon I'm
doing that administrative sideof things.
But that took some time to, toget used to, to kind of develop
a a routine for and there'stimes when, you know you, you do
(40:28):
get busy in the office, I dohave 700 patients.
I practice very similar to how Idid when I initially opened my
private practice.
Which means that there's dayswhen I'm gonna be very busy even
though I may only have 12patients on the schedule or 10
patients on the schedule.
There's, there's a ton of, I.
Portal messages and phone callsand message to return.
So there's so still sometimesyou have to work out that
(40:49):
balance.
But in the end, even my, myworst day busiest day here is
still a, a fraction of what itwas in my previous practice.
So there's, there is thatchallenge.
The other challenge is sometimesbutting heads with insurances
because patients need an MRI, Istill want to give them
(41:11):
coverage.
I mean, if, if, if theirinsurance will cover it, we
wanna do that prior approval.
And then the insurances will belike, well, we don't see you in
our system.
That's because I'm not in yournetwork.
So that, that can befrustrating.
And the PAs for medications likeevery physician has to deal
with.
But and the other part of itthat we run into, probably the
biggest frustration we have iswe are not on the large, MR that
(41:35):
pretty much every health systemis on.
That epically big one that seemsto be in every hospital.
And so we call an office andsay, can you please send over
your consult letter?
And they'll say, well, it's onthe EMR, just get on and look at
it.
No, just can you please fax itto us?
We are an independent office.
And that's probably the biggestfrustration and challenge we run
to because we know we miss somedata in that respect.
(41:57):
But our patients are also welleducated.
'cause we tell them, when yousee a specialist, follow up with
us, make sure we actually getthat consult note.
If you get labs done by aspecialist, we us know and we'll
track it down because they knowthat we, we mean what we say.
If we say, if we say, we'lltrack it down, we'll get it for
'em.
And so it, that takes a littlebit of time, but that's okay.
(42:19):
I, I would rather have thatstress and frustration than deal
with the stress and frustrationof feeling like I was being
asked to practice unethically.
Maryal Concepcion, MD (42:26):
Love it.
And on the opposite side ofthings, when it comes to only
because of DPC, you could havedone X, Y, or Z.
can you give us some moreexamples from your patients
about how you as an accessible,affordable, quality physician,
were able to give them somethingthat they, it's hard to put a
price on.
Jason Hoke, DO (42:47):
Mm-hmm.
So, I, I can give you two reallygood examples.
The first one might take alittle while to explain, but it,
it really resonated for me thatDPC is the best medicine.
I started my practice in Januaryof 19.
I think we all remember whathappened at the end of 2019,
beginning of 2020, comeFebruary, 2020 when we're
shutting down the country.
(43:08):
And I'm seeing.
People are basically isolatingand not allowed to go into
doctor's offices.
I had a tremendous amount oftime where I was able to do some
research on what was going onwith COVID.
And I started sending outnewsletters to my patients every
month.
They were getting a newsletterand update from me as far as
what to watch for with COVID andto to, to, how to stay safe.
(43:30):
And just really being active andinvolved and telling patients at
the first time your symptomscall me.
I may not be in the officebecause we went down to seeing
patients just two or three daysa week.
We saw patients in the parkinglot actually.
Which I know probably would'vebeen severely frowned upon if we
were in a network.
But we did what we needed to doand I had a conversation with my
(43:51):
staff.
I said, we're gonna do what weneed to do, take care of our
patients.
Are you comfortable with that?
And they all were, as long as wewere outside and in a well
ventilated area.
So we did it.
And I am very proud to say thatof those 700 patients, I, I did
not have a single patient diefrom COVID during that time.
Now, and that's not because I'mtaking care of young, healthy
patients.
(44:12):
I mean, I had 80 year olds.
I had folks who we sent them todo the monoclonal antibody
infusions.
And why, because I knew aboutit.
I had time to research it.
And because I'm not part of thehealth network, I could go to
any hospital system in the areaand say, go get what you need.
I can only imagine if I was in ahealth network and they said,
well, you can only send yourpatients to us and we're all
out, or we're all booked up.
(44:33):
So that very much solidified forme very early in this practice
that DPC was the best waybecause I knew I could take the
best care of my patients.
So that was COVID.
The other, the more fun one thatI've been able to do is I love
procedures.
I love doing stitches.
And in my old practice, becauseyou're double booked and
patients can't see you for twoweeks, if they cut themselves
(44:55):
during the middle of the day, Ilike, I'm sorry, you have to go
to the ER in urgent care.
No, no, come on in here.
We love this.
During COVID, I actually had aguy who, like many other PO
folks during COVID, was doingsome house remodeling and
landscaping, and he pulled outthe chainsaw and it kicked back
and it left a nice big gash inhis leg.
And so, we met at the office andI stitched him up.
(45:16):
I've had guys who were hunting.
I mean, one of my favoritestories is a hunter who
accidentally cut himself withhis hunting knife.
And I met him out at our, at myhouse.
He sat on the back of his pickuptruck and I went ahead and
stitched him.
And I told him, I said, look,I've done mission work where
we're out in the, the boondocksand you don't have an operating
room in a sterile environment.
(45:37):
There's nothing wrong with doingstitches outside.
We had all the clean suppliesand everything.
We did that.
And then there's been countlesstimes where it's in the evening
and a kid needs stitches.
And I just tell'em, come on overthe house.
And we bring'em in, lay'em downthe kitchen table and my kids
gather around.
'cause I think it's so cool towatch Dad stitch.
And so, yeah, so that, that'ssomething fun that I would've
(45:58):
never been able to do before.
Maryal Concepcion, MD (46:01):
I love that.
And it makes you think about Dr.
Lauren Hughes, who's apediatrician in Kansas City.
She'll, she has, has mentionedlike, yeah, I'm taking care of
the kids, but come on, I'llcheck out in the driveway and
then drive away.
Here's your, here's yoursolution.
Bye.
Take care.
Gimme an update later.
I, I just, it's, it's fantasticand I just, it, it makes you
wanna ask because your son is onyour website.
(46:24):
You, you mentioned how your kidsare like fascinated by what you
do and I think again, it isawesome that they saw this,
this, this dad of theirs goingfrom physician to physician,
entrepreneur after the beans andrice talk to bring in the
patients into your guys' home ifneeded.
How, how has it affected yourfamily, especially your son who
(46:45):
is going into healthcarehimself?
Jason Hoke, DO (46:48):
So I have my, my, I have three older boys who
are 16, 18, and 21.
And then my girls are all 11years old.
My boys, when they saw me at myold practice, they had said,
there's no way I will ever be adoctor.
A dad spends too much time everyevening.
I mean, at that time it was twoto three hours every night,
catching up on charts, messages,things like that.
(47:08):
That's it.
There is no way I'll be adoctor.
And now all three of them aregoing into healthcare.
My oldest actually was startingchiropractor school this fall
with the hope to come back hereto Oxford, and he wants to be
here in this office as achiropractor with me.
My second son starts collegethis fall as a pre-med major.
With the goal of, he tellspeople he's gonna take over my
(47:29):
practice.
I said, how about you just joinme first and then we'll see what
happens.
And then just last week, mythird son who just finished his
sophomore year of high schoolsaid, I really think I wanna go
pre-med Dad.
And again, that's a conversationthat would've never, ever
happened six years ago.
(47:50):
And I think about, the I, Ithink about how your kids are
seeing healthcare as generationsdid long ago.
It's so fascinating to hear overand over stories like you
shared, people who are of acommunity and they might, they
usually are older, saying thingslike, wow, this is innovative
(48:11):
healthcare.
And it's I know that I say thatin the intro to my DPC story,
but really it's old schoolmedicine.
This is fantastic and I lovethat your kids get to see this
because, but, but I think also,I think about.
Overextended never ended.
Family medicine is also not howit has to be.
Like you get to choose what youwant to do within your DPC and
you get to determine 700 iswhere I stop, I'm gonna bring on
(48:34):
another person.
You don't have to just keep,keep, keep going.
You don't have to keep going,keep going, keep going.
And I think that it's, it'sreally speaking to the younger
generation, really wanting tohave a work-life balance.
Especially since we saw whatlife could be like during the
pandemic, if you were fired fromyour job and you weren't
(48:55):
necessarily needing to do the,the day-to-day eight to five.
in closing for our maininterview, definitely join us
over on our Patreonconversation, but.
I, I would love if you couldspeak to the physician who is at
the is at or approaching asimilar point to where you were,
where you were thinking about,wow, this might be the time that
(49:18):
I need to leave medicine.
And what would you say to thatphysician to, to give them, to
give them words to think aboutafter hearing your interview?
from my standpoint with talkingwith physicians since I've made
this transition, I think anyphysician that's been in
practice for 10 years, we'lljust say that they have got
(49:39):
enough of a loyal patientfollowing that they will be able
to make the transitionsuccessfully because patients
know good medicine when they seeit.
You don't need to fill outmetrics and have patient surveys
and all the meaningful use stuffthat we did years ago.
Patients know what a good doctoris.
And when you take a stand andsay, I'm not going to continue
(50:02):
to, to play in this false senseof reality that I think network
medicine is, is these days andthey see that you're willing to
take a stand for what's best fortheir patients, they will follow
you.
They will.
Maryal Concepcion, MD (50:14):
Well, thank you so much Dr.
Ho, for joining us today andsharing your story.
I'm so excited for everythingthat's going to happen in the
future.
And again, I wonder if yourmedical student is going to be
coming to Oxford, Ohio when hefinishes.
Jason Hoke, DO (50:30):
Thank you so much.
I wonder too.
Thank you for listening toanother episode of my DBC story.
If you enjoyed it, please leavea five star review on your
favorite podcast platform.
It helps others find the show,have a question about direct
primary care.
Leave me a voicemail.
You might hear it answered in afuture episode.
Follow us on socials at thehandle at my D DPC story and
(50:53):
join DPC didactics our monthlydeep dive into your questions
and challenges.
Links are@mydpcstory.com forexclusive content you won't hear
anywhere else.
Join our Patreon.
Find the link in the show notesor search for my DPC story on
patreon.com for DPC news on thedaily.
Check out DPC news.com.
Until next week, this isMarielle conception.
Direct Primary care is an innovative
alternative path toinsurance-driven healthcare.
Typically, a patient pays theirdoctor a low monthly membership
and in return builds a lastingrelationship with their doctor
and has their doctor availableat their fingertips.
Welcome to the My DPC Storypodcast, where each week 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.
Jason Hoke, DO (00:53):
for years I was practicing in network-based and
insurance-based medicine andfeeling more and more
discouraged.
And so if you as a physician arefinding yourself in that
situation direct primary carecan be the answer that you're
looking for, to give you life,to give you energy, to give you
enthusiasm for medicine again tohave that patient care that you
(01:15):
had always dreamed of as far asbeing personalized and not being
restricted by the structure of anetwork or the restrictions of
an insurance or Medicare.
I'm Dr.
Jason Hoke of Hoke DirectPrimary Care, and this is my DPC
story.
(01:35):
Dr.
Jason Hoke, founder andphysician owner of Hoke Direct
Primary Care feels that theburdens of Medicare and
insurance are detrimental to thedoctor patient relationship, and
the efficient delivery ofhealthcare.
Upon completing residency in2001, he and two partners
started an independent medicalpractice in the small college
town of Oxford, Ohio, asMedicare and insurance
(01:56):
reimbursements failed to keep upwith the rising cost of
providing care, the practicejoined a local hospital health
network, Dr.
Hoax.
Soon discovered that networkmedicine only introduced new
layers of inefficiency andphysician burnout.
He saw that physician chartingwas prioritized over patient
care, which created an extremesense of apathy and burnout.
He contemplated leaving medicinealtogether.
(02:18):
But then read about directprimary care, a model of
medicine that wasrevolutionizing healthcare by
prioritizing the patientphysician relationship.
After attending the DPC summitin 2017, he felt energized by
the stories of practicingmedicine the way he dreamed it
would be when he first beganmedical school.
After the following year'ssummit, he returned home
(02:39):
confident and equipped to makethe leap five months later.
After fervent prayer, countlesshours of planning and the
unwavering support of his wifeand six children, Dr.
Hoke opened Oxford's first andonly DPC practice now six years
into his practice.
He wants to share his DPC story,hoping it will encourage other
physicians who are feelingapathetic and burned out.
(03:00):
There is a better way where youcan rediscover your love of
medicine.
Maryal Concepcion, MD (03:08):
Welcome to the podcast, Dr.
Hoke.
Jason Hoke, DO (03:10):
Hello.
Thank you for having me on yourshow.
Maryal Concepcion, MD (03:13):
I'm so excited to chat with you.
We just saw each other a fewmonths ago at the Ohio DPC uns
Summit.
So make sure that in February of2026, if you're in Ohio or able
to travel to Ohio, make sure youcheck out the state focused on
summit in Ohio.
It's been going on longer thanthe DPC summit.
So I, I just, I really, I, Ihope that your introduction,
(03:36):
your bio really moved peoplealready, and we haven't even
started our conversation, but Ithink that your calling out of.
What happened after youtransitioned your guys' practice
to a hospital in-networkpractice was not necessarily a
way to save the practice and itwas actually pushing you more
towards contemplating leavingmedicine.
(03:56):
So I wanna zoom in at thatmoment in time because the
feeling of leaving medicine orwanting to leave medicine is
quite significant for someonewho's dedicated their entire
career.
Training, education, everything,sleepless nights, delivering
babies, all of the things tothen to then step away.
So bring us to this point of youhad done independent practice,
(04:20):
but it was still insurance basedand you tried to find a better
way, but it still was notworking out the way that you
would envision starting medicalschool.
Jason Hoke, DO (04:27):
Sure.
So, In 2001, I had graduatedfrom residency and myself and
two partners from residency, westarted a practice in Oxford.
And on day one we had onepatient and that quickly grew
over the course of about 10years to four offices with a
total of 11 providers.
So we were quite successful herein, in our small college town
(04:50):
area drawing patients from aquite a large area.
But what we saw is, there wasjust a lot of stress and
frustration with trying to dealwith insurances tightening
burdens from Medicare, making itharder and harder to try and
just see our patients and getreimbursed for our care.
And so what we saw was we neededto be proactive and move forward
(05:11):
with making a change so that waywe could continue to sustain a,
a very successful practice.
And so what happened is we thenmy Oxford location, we joined a
local health network with theidea that, now we can get back
to being doctors and we can letthe health networks, attorneys
and billers argue with theinsurance attorneys and billers.
(05:32):
And what I found is veryquickly, that was rather naive.
We found is that a lot of thehassles that we were dealing
with before now were replacedwith new hassles and new
requirements from the healthnetwork.
And I became very quicklydisillusioned with what was
happening in healthcare.
I worked actually quite, I.
(05:52):
Closely with the CFO of ourhealth network, trying to come
up with a new reimbursementmodel that would allow the
primary care care physicians totake care of patients the way
that we knew they had to betaken care of, and that personal
approach and not doing it basedon an RVU model.
And the CFO and I, we came upwith a great idea that we
thought would go really welluntil it then got presented to
(06:13):
the board.
So my point in telling you thatis that we actually, I tried to
work within the network model tomake it a better place for
patients and for physicians.
And what I was finding is I wasjust banging my head against the
brick wall that was not going torelent.
And then when we had primarycare meetings and every meeting
every month was about billingand coding and charting, and
(06:36):
never talking about diseasemanagement, I saw myself getting
disillusioned, getting veryburned out, feeling like I had
to see more patients to maintaina reasonable salary.
But then at the same time,Marielle, I saw young
physicians, I mean, talkingabout folks who were just outta
residency for two years alreadytalking about wanting to give up
and leave medicine altogether.
(06:56):
And so I knew that I wasn'talone in this idea that this
isn't right.
It's just a matter of, I, Ididn't know where to go, where
to turn.
Maryal Concepcion, MD (07:04):
Totally.
And how relatable is that?
I know that there are audiencemembers out there, some have
even opened their DPC clinicsand have been in practice for as
long as you have, and they'restill nodding their heads
because that is a real thing.
I, I talk all the time to peoplein medical school, even
pre-meds, by the time yougraduate medical school, what is
the training levels that you'llhave in business?
And I get these dumbfoundedlooks, which I think is really
(07:26):
sad, especially in this day andage when the corporate practice
of medicine is so corporatizedand it is so focused on the
exact things that you're callingout.
Dr.
Maggie Abraham called this out.
Dr.
Edta called this out.
So many people have said overand over.
We have tried as physicians todo our due diligence in the
clinic and take that duediligence and that advocacy to
(07:48):
the boardrooms, to the admintables.
And yet we cannot make changes.
And when you say, you know,banging your head against the
wall and you say, you are readyto leave medicine.
These are real things.
And so for those listeners outthere who have experienced that,
this is exactly why we're havingthis conversation today, this is
exactly why we're gettingstories out there of what life
(08:09):
can be as a physician who's ableto just be able to focus on
their patients.
So, yes.
Because you are the first andonly DPC in Oxford now, I'm
wondering about the conversationthat happened between you and
your two partners, because youguys opened together mm-hmm.
And then you opened DPC.
On your own.
(08:29):
And I'm just wondering, did youguys converse as the, the
corporate situation washappening about, hey, like this
is really unsustainable?
Did they stay in the practice?
What happened to your twopartners as you explored your
own DBC journey?
Jason Hoke, DO (08:44):
Sure.
So, we had the four offices andthe US original partners, we
were each in charge of one ofthe three offices.
One of my partners actually wentmore of the functional medicine
route after being a, what Iwould consider a traditional
family practice physician about10 years.
So he continued with doingfunctional medicine and, and
remained independent.
My other partner his office isactually in Brookville, Indiana.
(09:06):
Oxford is a border town onlyabout five minutes from the
Ohio, Indiana border.
So his practice actually joineda health network in Indiana.
I.
And then my office and the otheroffice that was in Ohio, we
joined the same health network.
Having that conversation amongstall the three offices that were
what I would considertraditional family medicine, we
(09:27):
all came to the same decisionsaying, Hey guys, this is not
sustainable with the wayinsurances are just squeezing us
as far as trying to being anindependent practice.
So we were all in agreement thatit was time to join a health
network and we just kind of didit a little bit differently at
shared offices.
Yeah.
Maryal Concepcion, MD (09:43):
I think about as you responded there,
you still went the DPC route.
You did not leave medicine, you.
Talk to people who had openedand had the exact same practice
experience as you in terms ofopening as an independent
continuing fee for servicethrough hospital networks.
But you stayed and I'm justwondering what was it that made
(10:04):
you stay and pursue somethingelse?
Jason Hoke, DO (10:07):
Sure.
So when I was getting veryfrustrated with the situation
one of the things that you getas a bonus when you're a network
physician is you get CME money.
And so one year I was looking atdifferent CME conferences and I
just happened to stumble acrossthe DPC on summit sorry, the DPC
summit on summit is in Ohio, theDPC summits.
(10:28):
And uh, and so I looked at thisand.
Was reading about what DPC wasand like this is what medicine
is supposed to be.
So I was telling my wife about,I said, I, I need to go to this
conference because this isreally how we as physicians
should be taking care ofpatients.
And so I attended that firstconference in 2000 and 17, and I
(10:50):
was in awe.
So for anybody who's been aroundin DPC for long enough, I, I got
to hear a presentation and meetJulie Gunther I mean, pioneers
in DPC as far as just, and theywere so enthusiastic and loving
practice again.
And wow, look, they go to workand they have a smile on their
face and they're loving whatthey do.
And at that point, like that,that's just so awesome.
(11:13):
And I came back and told my wifeall about it.
And uh, so, and then it kind ofjust, Hey, that sounds great,
but now I need to go back towork
Maryal Concepcion, MD (11:21):
and.
In your bio, it was mentionedthat by the next year, the
second time you attended Summit,you were like, I have all the
things that I need to just keepthe ball rolling and I'm gonna
do this.
So I'm wondering if you canbring us back to that moment in
time when you're prepared with alot of stories, a lot of
inspiration, and a lot ofenthusiasm and a a, a glimpse as
(11:45):
to another way to practice, andthen you spent the next year,
what was going on in that yearas you were preparing for the
next summit.
Jason Hoke, DO (11:55):
Sure.
So, that next year was full of alot of things.
So I I continued to work with myhealth network.
I was still in that mo mode of Ican make things better, we can
do this better.
And then it became obvious to methat it was not improving.
And I had a patient encounterthat really solidified for me.
How broken the system is, and,and briefly it was, I was
(12:17):
dealing with a teenage girl whowas in my office.
Horrible, horrible otitis media,which is an ear infection, and
to the point where it lookedlike the eardrum was getting to
Rup ready to rupture.
So I talked to the mom about,the best option here would be to
give her a shot of Efen.
Give her that quick antibody,give her that quick improvement
so that way we can, get her somerelief.
(12:38):
And the, this family was cashpay.
And so I went to my receptionistand said, Hey I want to go ahead
and give them a shot ofreception.
They're asking how much thiswould be.
And she said, that's gonna be$160 for that injection, plus
the injection fee.
And I said, okay, well wait.
Remember they, they're cash pay.
And she said, well,unfortunately, the network only
gives a cash pay discount forthe office visits, but not for
(12:59):
procedures.
Which again, I thought was sobogus.
And I said, well, hang on asecond.
Let me make a quick phone callover to the pharmacy and we'll
just find out how much a vial ofefen is.
You go pick it up, bring itback, and we'll just give you
the shot.
So I called over to thepharmacy.
The efen injection would've been$10 for the vial, but we don't
have it in stock.
We'd have to order it, it won'tbe here till tomorrow.
(13:22):
And so mom is left with thisheartbreaking situation.
Do I let my daughter suffer foranother day?
Or do we just go ahead and paythe 160, 170 bucks and do this
shot here in the office?
And she chose to go ahead andgive the shot for 170 bucks.
And at that point, I realizedthat this is so unethical for
our patients that they're havingto make this decision on a
medication that costs 10 bucks.
(13:43):
So by the way, now we give herseven shots in my office and it
costs$8.
So, I went home that day andtold my wife about that, and I
said, I, I look in the mirrornow.
And I said, I hate my job.
This, this is, it's gotten tothe point where I just truly
hate my job because I just feellike I'm being pulled between
what's right for my patients andwhat's right for the network.
(14:03):
And so, I then, and that wasshortly before I went to the
second DPC conference and gotmore and more information, got
more and more excited.
But again, I'm feeling anxiousand nervous about the situation.
I mean, at the time I.
Was 44, 45 years of age.
Six kids, I've got a couple thatare coming up on high school and
that's college.
(14:23):
In a network you have goodhealth insurance, you've got
retirement.
And all of these things aregoing through my mind as far as
can I make this leap at such abig stage.
And on the last day that I wasat the conference, I'm sitting
there at, at lunch getting readyto leave and I, and I order my
sandwich and get a drink And Igot this bottle of tea and on
(14:45):
the bottle of tea was a saying.
And I still have it on mywebsite'cause it's so
inspirational to me.
And it said to dare is to loseone's footing momentarily.
Not to dare is to lose oneself.
And that was said by KierkegaardAnd I just look at this, say,
this is a sign that it is timeto stop talk, stop talking about
it and actually take that stepforward because I am losing
(15:07):
myself.
In this medicine practice thatI'm in.
And so, at that time then wesaid, this is what we're gonna
do.
We sat the kids down.
I said, as we said, we have sixkids and we had what's become
affectionately known as thebeans and rice talk.
And so this was in August of2018 and said, kids, we gotta
save some money.
So as a family, we said, we'regonna eat beans and rice and eat
(15:29):
peanut butter sandwiches for thenext several months.
We're not going out, not doinganything fun'cause we have to
save up some money so dad canmake this transition.
And then five months later, inJanuary of 19, I opened my
practice.
Maryal Concepcion, MD (15:42):
All I can say is how effing resilient I
am.
So oh my God, I am so moved bythat, that.
Just serendipity if that's whatwas on your tea.
'cause it's like, how manysnapples have I had in my
lifetime?
And not ever have I been asinspired as I was with your tea
label, but, or your tea saying.
But if that is not resilienceand if that is not, showing your
(16:05):
kids vulnerability, if that'snot showing your kids, this is
standing up for what's right.
I mean, that is so powerful.
It is so powerful.
Everything that you did.
But also it sucks.
It sucks to go through thosemoments when you're, you're
still the same doctor.
You're trying to do your bestand the system is not allowing
(16:26):
you to not have those momentsand that just take care of
patients.
So I, so going from there, thismoment of the beans and rice
talk, I feel that need, need,that needs to be put on a
t-shirt I would buy that.
The, the moment of.
You're done with the beans andrice talk, your family's backing
you, you are making the nextstep.
(16:47):
What was that next step for you?
Jason Hoke, DO (16:50):
Sure.
So, that decision was made inAugust of 18.
And I met with the physicianliaison at my network and said,
you need a 90 day notice.
I'll give you a little bitlonger.
But here's what I'm doing now.
Thankfully, when I made thetransition from private practice
to network, and I wouldencourage any physician who's
gonna be having a cut track toput this in there, is they
(17:13):
wanted to have a open peakclause.
And I said, well, I'm fine withthe no clause.
I won't go ever leave and go toone of your competitors, but you
have to let me have theopportunity to go back into
private practice if I feel thisisn't working.
And so that one sentence inallowed me to break my contract
with them and open a practice, aDPC practice just a few blocks
(17:34):
from my old office.
And so, during the next fourmonths, we diligently did
anything and everything to buildup the practice to get
advertising out there.
And we held three communityevents because nobody in Oxford
knew what direct primary carewas.
They were held at a local churchand we had about 50 attendees at
each of those community talks.
(17:56):
And so by the time I started mypractice in January of 19, I
already had two patients alreadyon 200 patients already on the
schedule in January andFebruary.
So that way I could start offwith having a full schedule
ready to go.
Maryal Concepcion, MD (18:11):
I'm wondering if you had the anti
beans and rice talk at thatpoint, because that's a lot of
patients and I mean, it'sincredible to think about August
to January, February and to have200 patients in that amount of
time.
I'm wondering if you could tellus what your patients said to
you when you were doing thesetalks and the patients in
(18:32):
particular who were part of that200.
Jason Hoke, DO (18:36):
Sure.
So I'll start off with the onethat is, is still fresh in my
mind'cause it's kind of funny.
I had one patient of mine at myprevious practice when I told
him what I was doing, he said,Hey, that all sounds fine and
good, but when you're over withthat fad and come on back here,
I'll be happy to rejoin you.
So that patient did not followme to my new practice'cause this
was not a fad.
I knew that I was making adecision that was gonna be for
(18:57):
the best long term.
Yes.
So when I gave these communitytalks just lots of people just I
mean, glued to what I wassaying, like they'd never heard
of such a thing.
Like we're going, I basicallysaid we are going back to old
style, small town familymedicine.
With the 21st centurytechnology, we're gonna have
(19:17):
computers, electronic records,you're gonna be able to reach
your physician by phone, byemail, by text.
We're gonna have the secureportal and all of these things
that you expect from bighospital networks.
We can do this at a smalloffice.
And that return of that personalconnection, a lot of my patients
had been with me for 10, 15years and they saw the
transition.
I had many patients pull measide and said, Dr.
(19:39):
Hook, I saw you were gettingworn down.
I saw the heaviness in youreyes.
You did not have that same flareand energy that you had years
ago when I first started seeingyou.
And they also got tired ofhaving to wait two weeks to get
in to see me, which I would beupset if it took that long to
see my doctor as well.
So they were excited about thisopportunity to kind of regain
(20:00):
the old Dr.
Ho and have that interactionagain.
Maryal Concepcion, MD (20:04):
I think that's so cool though.
I mean, it really speaks to therelationship that people want in
DPC because especially, to, tohang with you through your
different iterations ofpractice.
I think that is awesome.
And I think that that is trulyone of the things that drew me
into family medicine is thatgenerational aspect of taking
(20:24):
care of a person through theirlifestyle, their through their
life transitions.
Mm-hmm.
So that's, that's incredible.
And you also open, as you, asyou mentioned, you're on a
bordering town between Indianaand Ohio.
Tell us more about Oxford inparticular because it is a
small, small college town, butwhat does that mean in terms of
like population and resources?
Jason Hoke, DO (20:44):
Sure.
So Oxford is probably a town of16 to 18,000 if you consider the
greater Oxford area, if there issuch a thing.
And when Miami University's insession, the town essentially
doubles in population very.
Large rural community lots offarmers.
So it's fun because I get thefull gamut of experiences as a
(21:05):
physician.
I am taking care of for lack ofbetter terms, uneducated
farmers.
I'm taking care of collegestudents, I'm taking care of
college professors, taking careof small business owners here in
town.
So it's neat'cause I truly getthe full experience.
I mean, obviously birth to deaththe whole gamut as far as the
age ages go as well.
So, yeah.
Maryal Concepcion, MD (21:24):
And when it comes to this group of 200
fine, amazing individuals whoare like, yep, Dr.
Ho is still my doctor, or Dr.
Ho is gonna be my doctor goingforward, how did you handle 200
people and onboarding thosepeople to your practice?
Jason Hoke, DO (21:40):
Sure.
So we were fortunate enough tofind a really good electronic
record system that allowedpatients to kind of just
register and get theirinformation in online.
I started the practice with justone assistant.
And we were really nervous aboutstarting on day one with just
one person and just out of theblue, a Miami pre-med student
said, Hey I'm interested inlearning more about this DPC
(22:03):
thing.
Do you, could you use some helpat the front desk?
And I could kind of learn fromyou, but I could, you could use
my services for answering thephone.
And we're like, hallelujah.
That's an answer to prayer.
And so he was with us for thefirst five to six weeks until he
had to start back to classes.
And that gave us time to then dosome interviews and hire a, a
second person so we could uh,run the office because we were
(22:26):
very quickly busy.
I mean, I look back at my firstmonth in practice in January and
seeing seven and eight newpatients a day.
When you spend 45 minutes to anhour with every new patient, I
was full.
And and the word got out andpeople were telling their
friends.
And next thing you know, within,I think by October of that first
(22:48):
year, so in 10 months I hadreached my capacity.
My practice was essentially fullat around 700 patients.
So once people heard about itand saw that it wasn't just a
fad and I was here to stay itvery quickly grew.
Maryal Concepcion, MD (23:02):
That's incredible.
And I think it's also amazingthat, you have this tea phrase
and tea bottle phrase, and thenyou're like, yeah, this is this
is a sign.
And then all of a sudden youhave this Florida medical
student who's like, hello.
That's incredible.
Because you're, balancing theentrepreneur hat of hello, I'm
(23:22):
Dr.
Hoke, I'm also Dr.
Hoke, who, is like doingsoftware things on my EHR and
I'm doing all of these thingsas, as the, the sole business
owner.
How did you make it such thatthe student was able to help you
with your daily things, helpwith the practice itself as you
were building it?
Jason Hoke, DO (23:40):
Sure.
So thankfully my assistant was aregistered nurse who I'd known
for years, very, very.
Organized almost to the point ofOCD, but very, very organized.
And so during the time that Iwas seeing a patient, she was
helping him to understand thisis why we do what we do.
This is how you do thingsefficiently.
And to help to, to do that.
(24:02):
Telling him what to say on thephone as far as encouraging
patients and answeringquestions.
And the student was a very.
Very much a go-getter.
Very it savvy.
So he handled a lot of things asfar as with the website and
things like that, that, at myage, in my forties, like I just
don't even know how to do someof this.
So anything you can do to helpme with is, is awesome.
And then he really, really sawthe, the benefit of DPC and he
(24:26):
remained enthusiastic about it.
And kind of just a fun littleaside, Mario, that same student
is coming back this fall as afourth year med student to do a
family practice elective withme.
Specifically learning more abouthow to run a DPC practice.
Maryal Concepcion, MD (24:42):
How awesome.
I absolutely love that.
That is the best ever to hearthe, it's so full scope right
there.
That is amazing.
And, I, I wonder where is heintending to practice?
Is he intending to prac practicein Oxford, Ohio by chance?
Jason Hoke, DO (24:58):
I don't know.
He still has to do his residencyyet.
I guess we'll talk then.
Maryal Concepcion, MD (25:03):
When he hears this, I, yes.
That was a very loaded questionand yes, that was a very loaded
question.
So, awesome.
So you are in this town of, asyou said, and that's I, I know
that feeling like I went to uc,Davis and Davis at the time.
It's crazy all the time now, butat the time it was like, wow.
When school is not in session,it's a totally different, it's a
(25:24):
totally different experience foryou.
How has your practice grown?
Especially because you havecollege students who do need
healthcare and studenthealthcare is not always the
best.
Jason Hoke, DO (25:37):
So, students are, are, are, are probably a
minority in our practice justbecause they are transient.
But we do have, a a handful ofstudents a lot of professors
especially those who reallyunderstand the benefit of DPC.
We actually have a wait list nowof professors that are still
willing to get in to see me.
But as our practice grew wecontinued to have more and more
(25:58):
phone calls to people coming,wanting to be seen.
And like, guys, look, I, I havea cap at 700.
I, I'm not gonna get myself backinto the same situation before
of just feeling overwhelmed andstretched too thin.
And then over time, as we stillhad more and more phone calls, I
said, well, it's probably timeto look at adding on another
clinician just so that way wecan continue to provide good
(26:19):
care to the area.
Maryal Concepcion, MD (26:20):
And so Julie is your nurse practitioner
and I'm wondering how did youguys connect?
Because definitely it soundslike you need clinical help at
your practice given thosenumbers.
Jason Hoke, DO (26:33):
Yeah.
So, kind of a fun backstory.
Julie was one of my first nursesat my initial practice years
ago.
At the time she was an LPN andthen she left the practice to go
get her RN degree and had a verysuccessful nursing career as an
RN in one of the localhospitals.
And then went on to get hernurse practitioner training and
(26:55):
just out of the blue she calledme saying, Hey, I need to do my
family practice.
Clerkship and so can I come toyour office and do that?
So I'm like, sure.
And so we reconnected.
Then when she is in her nursepractitioner training she gets
her diploma, she goes to workfor a network.
Practice is in practice forabout a year, and I'm like, at
(27:16):
that time I'm looking forsomebody.
Trying to recruit a goodphysician, one that Marielle
knows very well from the DPC onsummit and who has been on the
my DPC story?
Dr.
Andy Chun.
So I, Andy Chun and I actuallywent to residency together, and
so I knew he'd be a great fitfor this practice, but, and Andy
also has a very successfulpractice of his own.
(27:37):
So in my attempts to try andrecruit him my way for DPCI
essentially encouraged him tostart his own DPC practice.
So that was, that's kind of afun aside.
But anyway, so as I'm goingthrough this and looking all,
all these different options, mymind keeps going back to this
great connection I've had withJulie over the course of 20
years.
And so I just give her a calland say, Hey, Julie.
(27:59):
Are you ready to leave thenetwork and just come join me
here and do DPC?
And she's I have been waitingfor this call.
Thank you so much.
And so she has come on and she'sdoing great.
She has actually, this is hertwo year anniversary this month
and she is up to 300 patients ofher own right now.
Maryal Concepcion, MD (28:17):
Wow.
And when it comes to and I willmake a note here definitely I
will link Dr.
Chen's blog and his interview toyour blog.
That's awesome.
I love that story.
When it comes to your patientsyour panel has grown, your panel
has closed, to new patientsbecause you're maintaining that
(28:37):
quality of care for the patientsyou do have.
how was it for patients who wereon the waiting list to join, to
join Julie?
Did they, did, was, was thereany question about, well, if I'm
not seeing Dr.
Hoke, is it a different price?
If I'm not seeing Dr.
Hoke for my day-to-day, do Istill have access to Dr.
Hoke if, if needed, because he'sthere?
How did patients come on fromthat wait list to Julie's
(29:00):
practice?
Jason Hoke, DO (29:02):
Sure.
So, when the wait list, weopened it up, we, we called
those patients and said, here'sthe situation.
Dr.
Ho is full, but he has broughton Julie, who we have great
confidence in, and she's got,she's experienced and she's
gonna is open to taking newpatients.
Probably about a third of thepeople that we talked to came on
with Julie.
(29:22):
A third said, go ahead and keepme on the wait list.
I'll wait for Dr.
Hoke.
And then the other third said,well, we have already went on
and found another provider.
Because that wait list wasprobably there for a good two
years.
So as far as the, the care, wenever really received much
pushback as far as keeping thepricing the same for patients,
(29:43):
whether regardless of whetherthey're seeing Julie or seeing
me.
And the reason for, that'sactually pretty simple in that
if they're seeing Julie, they'reessentially getting two for the
price of one, because Julie andI have the same office hours.
Our desks are right next to eachother.
And just like any good medicalsystem where the providers trust
each other, we're talking toeach other throughout the day as
(30:06):
far as, hey, just bouncing anidea off of each other.
So it is not a problem for Julieto come out of a patient exam
room.
I'm sitting working on a chartand she'll come over and just
ask me, Hey, what do you thinkabout this?
And the neat thing about it is Iwant her to do that.
Nurse practitioners the really,really good nurse practitioners
know what their limits are andthey're not afraid to ask
questions, and they are worththeir weight in gold.
(30:26):
And that is definitely JulieGreen.
She, she'll come to me, she'llask me questions, we'll talk
about it, think through what'sthe best option for the patient.
But if there's ever anyquestion, I just get up from my
desk and go in and talk to thepatient myself.
Maryal Concepcion, MD (30:38):
That's awesome, and I appreciate you
sharing that because that hasbeen a question that I've gotten
from many people.
Like If I add a non-physicianprovider, does the price change?
So I'm, I, I appreciate yousharing what's happened at your
practice now when it comes tonow when it comes to the back
office side of things, your,with your patients, a
(31:01):
significant number of patientsthere already, and then you're
adding people from a wait listand you are, building a team.
It's growing.
I mean, it's definitely grown.
It's very even family orientedwith your son as well Now, let's
start by talking about how it'sgrown in terms of personnel, and
then I wanna talk more aboutthe, the, the back office to
help keep everything copaceticfor your patients and you guys.
Jason Hoke, DO (31:24):
Sure.
So, Monday is, is our busiestday as many offices have with
coming off of the weekend.
And so we have, Julie and I arehere.
We each have a assistant workingwith us, and then we have one
receptionist up front.
And then every other day of theweek, Tuesday through Friday,
it's typically just oneassistant in the back and one
receptionist up front.
And that works out fine.
(31:45):
And the reason is because we canbe efficient.
Our patients understand that werun a lean office.
And the other thing is thatJulie and I don't mind stepping
in and filling in wherever'sneeded if.
The phone is ringing and thereceptionist is on the phone,
and a nurse is in with apatient.
Julie and I have no problemspicking up the phone, and of
(32:06):
course patients are shocked whenthey say, wait, is this Dr.
Hope?
Just.
Am I actually talking to Dr.
Ho?
Yeah, I can answer a phone too.
I'm not above doing that.
And so, so we each pitch and dowhat needs to be done.
There's been times when thenurse is on vacation or is out
sick.
I've given injections.
The only thing I can't do, and Idon't think my patients want me
(32:28):
to even try is draw blood.
I I have to draw the linesomewhere.
So, but yes, so it, it's greatbecause even though we have
people kind of assigned a taskor a duty for the day, we just
all fill in wherever it's neededand it works out great.
Maryal Concepcion, MD (32:41):
That's awesome.
And yeah, I, I love thoseconversations when you're the
doctor talking and they're like,yeah, so can you please make
sure that you give Doctorconception the message?
And I'm like, absolutely, thankyou so much.
Have a good day.
So it's like, oh boy.
But that, that is so funny andvery relatable, I'm sure from
many out there.
When, so.
So thank you.
That's, that's great.
In terms of how you guysorganize your week, in terms of
(33:04):
the tech and just things toorganize you guys on the backend
and keep everybody copacetic andon the same page.
Tell us about how you createdyour tech stack.
Because you mentioned yourelectronic health record, you
started off with that.
It allowed you to really quicklyand efficiently onboard those
first 200, but how have youbuilt your tech stack beyond
that?
Jason Hoke, DO (33:24):
Sure.
So we we're still using the sameelectronic record that we
started with.
We took the ability to registerfor, as a new patient off of the
online segment because we wantedto have the ability to answer
questions directly withpatients.
And that's something thatactually is so unique these
days.
Most of that time when patientscall a doctor's office, they get
that endless phone tree.
And so.
(33:44):
People are shocked when theycall this office and somebody
actually answers the phone.
So, so we, we can continue withthat.
It has a nice portal system sopatients can message us through
the portal which is basically aconfidential email that helps to
cut down on the number of phonecalls and also it actually
allows for a more accuratedescription of what's going on.
'cause it's in the patient'swords.
(34:05):
And it's actually a part of themedical record now too.
We have the ability to dotexting which is great for when
we just need a real quick yes nokind of answer.
Just boom, send them the quicktext.
The texting has on the displayit has our office phone number
so that way patients know whereit's coming from.
And also that's good as aprovider to have confidentiality
that they don't know what ourown personal phone number is.
(34:27):
And then we can use that sametexting option in the evening if
we're logged into our computersystem.
We have, we do labs in theoffice.
We, we use a, a national labprovider that that runs our
labs.
We have a direct interface intothe charting system, so that way
we get results the very nextday.
And that's very quick andefficient because it's the
interface.
We do scan in paper documentsand we do mostly anything that
(34:51):
you'd see at a typical familypractice office.
We do EKGs we do your urinetests.
We do strep tests, the flutests.
Pretty much we love doing skinprocedures, lesion, removals,
things like that.
So yeah, full gamut of familypractice.
Maryal Concepcion, MD (35:05):
I love it.
And any best tips for otherpeople as they're developing
their tech stack?
Because they think aboutespecially with so many people
in your practice, patient-wise,automations and ways to maximize
the tech you already have arereally helpful to anybody no
matter how many years they'vebeen open.
Jason Hoke, DO (35:22):
Sure.
So, one thing I would say, and,and this might be unique to our
practice, but we try to findsomething to provide value to
the DPC monthly membership.
So with having the labs, whichof course are deeply discounted
compared to standard lab prices,we also have a small pharmacy.
So we have your commonantibiotics, high blood pressure
meds, diabetic meds,antidepressants, things of that
(35:42):
nature.
So one of the things that wasimportant to me is I did not
want to ever have to be in asituation where I would have to
figure out whose fault is itwhen this interface doesn't
work?
And so I searched.
Really hard to find a electronicrecord system that could do our
EMR, do our scheduling, do ourbilling, do the and do the
(36:03):
pharmacy dispensing.
And so thankfully I found onethat has worked well for us from
the get go and I see no reasonfor us to change because the
program just continues toimprove.
And so, yeah, that was a bigthing to me, Muriel, is I did
not want to get stuck in a phonecall conversation argument
between two tech folks sayingit's the other person's fault.
This way I can just call onecompany, say it's not working,
(36:25):
and they fix it.
Maryal Concepcion, MD (36:26):
And I hope that that is helpful for
people as they're looking atEHRs or looking to switch EHRs
if they're not happy with theircurrent one.
When it comes to ways that youguys have personalized your
messaging, do you, say thatthere's like new guidelines that
come out on treating somethingor there's, somebody has called
out like, oh, this, this savedphrase, phrase, macro could be
(36:49):
improved upon.
How do you guys reevaluate theday-to-day operations to say
like, okay, yeah, here'ssomething we could make an
improvement on, let's change it.
Jason Hoke, DO (37:01):
Well, one of the advantages with being a small
office is that we just talkabout it, and if we want it
change, we change it.
I'll just say, Hey Julie, whatdo you think about this?
And if she likes it, we we canmake the change.
Yeah.
Yeah.
Actually, I mean, that's a greatquestion.
Our EMR is very user friendly asfar as being able to
individualize and customizethings on it.
Maryal Concepcion, MD (37:18):
going back to the patients who wanted
Dr.
Hoke and followed you throughoutyour different iterations of
practice, and then you're openand, it's years later and
they've been your patients,what, what are some of the
things that you've heard fromthese people or just anybody at
your practice in terms of howDPC is valued by them as the
(37:39):
recipients of your care?
Jason Hoke, DO (37:41):
it's actually been quite humbling now that you
mention it.
We, we have like many practicesthat are growing and trying to
get the word out there.
You take reviews.
So we have right at our checkoutdesk, a a little scan thing that
takes you right to our reviewpage so that way patients can
leave a review.
And the, the one, the, the, thereviews that are most humbling
to me are the folks I've knownfor.
(38:02):
20 years that have, like yousaid, followed me through thick
and thin and to to hear them allsay, this is the best thing that
could have ever happened to Dr.
Hoke.
Or this is the best thing thatcould have ever happened to his
practice.
Or This is the best thing that'sever happened to me as a patient
in this practice.
Because they'll talk about thatpersonalized care.
And just how it really is theway it should be.
(38:24):
I mean, our little catchphrasehere at our office is medicine
simplified because it really is,we're getting back to a simpler
form where it's not socomplicated, unnecessarily
complicated.
And our patients see that andthey know that when they talk,
we're listening and we're notjust trying to run them through
the mill.
So
Maryal Concepcion, MD (38:43):
that's so powerful, especially.
Given, how frustrated you werewith that fin example that you
gave and also just the, thedoctor in, even in that same
example, calling the pharmacy toask how much does this cost cash
pay?
Like I never would have askedthat as a fee for service
physician.
I didn't even know that payingcash was an option except for
(39:04):
GoodRx.
So like calling the pharmacy andfiguring out cash price for
anything other than here's aGoodRx card, figure it out
yourself was, was foreign to me.
So I think that's amazing andit's, it's very cool to see your
patients experiencing that thisalso is not a fad for you and
your practice.
Jason Hoke, DO (39:23):
Right.
Maryal Concepcion, MD (39:24):
in terms of challenges, I would love to
go there because as, as we workvery diligently to deliver on
our promise to our patients andour promise to affordable,
accessible, quality, primarycare.
I'm wondering what challengeshave you guys gone through over
the years that you really wantlisteners to hear about?
Jason Hoke, DO (39:45):
Sure.
Great question.
Because, when we go to DPCsummits, we talk about all the
awesome reasons why we should dothis and, and those are all very
valid.
But, it is work.
I mean, we're talking about, I,I am the physician, but I'm also
the office manager.
We run lean and mean, and I knowhow to do basic accounting.
I know how to write a check fora bill.
(40:05):
I mean, those are things I don'tneed to pay an office manager to
do.
So I have to, set aside time to,to do that.
So for example, I work onFridays a half day and then
seeing patients, and thenusually Friday afternoon I'm
doing that administrative sideof things.
But that took some time to, toget used to, to kind of develop
a a routine for and there'stimes when, you know you, you do
(40:28):
get busy in the office, I dohave 700 patients.
I practice very similar to how Idid when I initially opened my
private practice.
Which means that there's dayswhen I'm gonna be very busy even
though I may only have 12patients on the schedule or 10
patients on the schedule.
There's, there's a ton of, I.
Portal messages and phone callsand message to return.
So there's so still sometimesyou have to work out that
(40:49):
balance.
But in the end, even my, myworst day busiest day here is
still a, a fraction of what itwas in my previous practice.
So there's, there is thatchallenge.
The other challenge is sometimesbutting heads with insurances
because patients need an MRI, Istill want to give them
(41:11):
coverage.
I mean, if, if, if theirinsurance will cover it, we
wanna do that prior approval.
And then the insurances will belike, well, we don't see you in
our system.
That's because I'm not in yournetwork.
So that, that can befrustrating.
And the PAs for medications likeevery physician has to deal
with.
But and the other part of itthat we run into, probably the
biggest frustration we have iswe are not on the large, MR that
(41:35):
pretty much every health systemis on.
That epically big one that seemsto be in every hospital.
And so we call an office andsay, can you please send over
your consult letter?
And they'll say, well, it's onthe EMR, just get on and look at
it.
No, just can you please fax itto us?
We are an independent office.
And that's probably the biggestfrustration and challenge we run
to because we know we miss somedata in that respect.
(41:57):
But our patients are also welleducated.
'cause we tell them, when yousee a specialist, follow up with
us, make sure we actually getthat consult note.
If you get labs done by aspecialist, we us know and we'll
track it down because they knowthat we, we mean what we say.
If we say, if we say, we'lltrack it down, we'll get it for
'em.
And so it, that takes a littlebit of time, but that's okay.
(42:19):
I, I would rather have thatstress and frustration than deal
with the stress and frustrationof feeling like I was being
asked to practice unethically.
Maryal Concepcion, MD (42:26):
Love it.
And on the opposite side ofthings, when it comes to only
because of DPC, you could havedone X, Y, or Z.
can you give us some moreexamples from your patients
about how you as an accessible,affordable, quality physician,
were able to give them somethingthat they, it's hard to put a
price on.
Jason Hoke, DO (42:47):
Mm-hmm.
So, I, I can give you two reallygood examples.
The first one might take alittle while to explain, but it,
it really resonated for me thatDPC is the best medicine.
I started my practice in Januaryof 19.
I think we all remember whathappened at the end of 2019,
beginning of 2020, comeFebruary, 2020 when we're
shutting down the country.
(43:08):
And I'm seeing.
People are basically isolatingand not allowed to go into
doctor's offices.
I had a tremendous amount oftime where I was able to do some
research on what was going onwith COVID.
And I started sending outnewsletters to my patients every
month.
They were getting a newsletterand update from me as far as
what to watch for with COVID andto to, to, how to stay safe.
(43:30):
And just really being active andinvolved and telling patients at
the first time your symptomscall me.
I may not be in the officebecause we went down to seeing
patients just two or three daysa week.
We saw patients in the parkinglot actually.
Which I know probably would'vebeen severely frowned upon if we
were in a network.
But we did what we needed to doand I had a conversation with my
(43:51):
staff.
I said, we're gonna do what weneed to do, take care of our
patients.
Are you comfortable with that?
And they all were, as long as wewere outside and in a well
ventilated area.
So we did it.
And I am very proud to say thatof those 700 patients, I, I did
not have a single patient diefrom COVID during that time.
Now, and that's not because I'mtaking care of young, healthy
patients.
(44:12):
I mean, I had 80 year olds.
I had folks who we sent them todo the monoclonal antibody
infusions.
And why, because I knew aboutit.
I had time to research it.
And because I'm not part of thehealth network, I could go to
any hospital system in the areaand say, go get what you need.
I can only imagine if I was in ahealth network and they said,
well, you can only send yourpatients to us and we're all
out, or we're all booked up.
(44:33):
So that very much solidified forme very early in this practice
that DPC was the best waybecause I knew I could take the
best care of my patients.
So that was COVID.
The other, the more fun one thatI've been able to do is I love
procedures.
I love doing stitches.
And in my old practice, becauseyou're double booked and
patients can't see you for twoweeks, if they cut themselves
(44:55):
during the middle of the day, Ilike, I'm sorry, you have to go
to the ER in urgent care.
No, no, come on in here.
We love this.
During COVID, I actually had aguy who, like many other PO
folks during COVID, was doingsome house remodeling and
landscaping, and he pulled outthe chainsaw and it kicked back
and it left a nice big gash inhis leg.
And so, we met at the office andI stitched him up.
(45:16):
I've had guys who were hunting.
I mean, one of my favoritestories is a hunter who
accidentally cut himself withhis hunting knife.
And I met him out at our, at myhouse.
He sat on the back of his pickuptruck and I went ahead and
stitched him.
And I told him, I said, look,I've done mission work where
we're out in the, the boondocksand you don't have an operating
room in a sterile environment.
(45:37):
There's nothing wrong with doingstitches outside.
We had all the clean suppliesand everything.
We did that.
And then there's been countlesstimes where it's in the evening
and a kid needs stitches.
And I just tell'em, come on overthe house.
And we bring'em in, lay'em downthe kitchen table and my kids
gather around.
'cause I think it's so cool towatch Dad stitch.
And so, yeah, so that, that'ssomething fun that I would've
(45:58):
never been able to do before.
Maryal Concepcion, MD (46:01):
I love that.
And it makes you think about Dr.
Lauren Hughes, who's apediatrician in Kansas City.
She'll, she has, has mentionedlike, yeah, I'm taking care of
the kids, but come on, I'llcheck out in the driveway and
then drive away.
Here's your, here's yoursolution.
Bye.
Take care.
Gimme an update later.
I, I just, it's, it's fantasticand I just, it, it makes you
wanna ask because your son is onyour website.
(46:24):
You, you mentioned how your kidsare like fascinated by what you
do and I think again, it isawesome that they saw this,
this, this dad of theirs goingfrom physician to physician,
entrepreneur after the beans andrice talk to bring in the
patients into your guys' home ifneeded.
How, how has it affected yourfamily, especially your son who
(46:45):
is going into healthcarehimself?
Jason Hoke, DO (46:48):
So I have my, my, I have three older boys who
are 16, 18, and 21.
And then my girls are all 11years old.
My boys, when they saw me at myold practice, they had said,
there's no way I will ever be adoctor.
A dad spends too much time everyevening.
I mean, at that time it was twoto three hours every night,
catching up on charts, messages,things like that.
(47:08):
That's it.
There is no way I'll be adoctor.
And now all three of them aregoing into healthcare.
My oldest actually was startingchiropractor school this fall
with the hope to come back hereto Oxford, and he wants to be
here in this office as achiropractor with me.
My second son starts collegethis fall as a pre-med major.
With the goal of, he tellspeople he's gonna take over my
(47:29):
practice.
I said, how about you just joinme first and then we'll see what
happens.
And then just last week, mythird son who just finished his
sophomore year of high schoolsaid, I really think I wanna go
pre-med Dad.
And again, that's a conversationthat would've never, ever
happened six years ago.
(47:50):
And I think about, the I, Ithink about how your kids are
seeing healthcare as generationsdid long ago.
It's so fascinating to hear overand over stories like you
shared, people who are of acommunity and they might, they
usually are older, saying thingslike, wow, this is innovative
(48:11):
healthcare.
And it's I know that I say thatin the intro to my DPC story,
but really it's old schoolmedicine.
This is fantastic and I lovethat your kids get to see this
because, but, but I think also,I think about.
Overextended never ended.
Family medicine is also not howit has to be.
Like you get to choose what youwant to do within your DPC and
you get to determine 700 iswhere I stop, I'm gonna bring on
(48:34):
another person.
You don't have to just keep,keep, keep going.
You don't have to keep going,keep going, keep going.
And I think that it's, it'sreally speaking to the younger
generation, really wanting tohave a work-life balance.
Especially since we saw whatlife could be like during the
pandemic, if you were fired fromyour job and you weren't
(48:55):
necessarily needing to do the,the day-to-day eight to five.
in closing for our maininterview, definitely join us
over on our Patreonconversation, but.
I, I would love if you couldspeak to the physician who is at
the is at or approaching asimilar point to where you were,
where you were thinking about,wow, this might be the time that
(49:18):
I need to leave medicine.
And what would you say to thatphysician to, to give them, to
give them words to think aboutafter hearing your interview?
from my standpoint with talkingwith physicians since I've made
this transition, I think anyphysician that's been in
practice for 10 years, we'lljust say that they have got
(49:39):
enough of a loyal patientfollowing that they will be able
to make the transitionsuccessfully because patients
know good medicine when they seeit.
You don't need to fill outmetrics and have patient surveys
and all the meaningful use stuffthat we did years ago.
Patients know what a good doctoris.
And when you take a stand andsay, I'm not going to continue
(50:02):
to, to play in this false senseof reality that I think network
medicine is, is these days andthey see that you're willing to
take a stand for what's best fortheir patients, they will follow
you.
They will.
Maryal Concepcion, MD (50:14):
Well, thank you so much Dr.
Ho, for joining us today andsharing your story.
I'm so excited for everythingthat's going to happen in the
future.
And again, I wonder if yourmedical student is going to be
coming to Oxford, Ohio when hefinishes.
Jason Hoke, DO (50:30):
Thank you so much.
I wonder too.
Thank you for listening toanother episode of my DBC story.
If you enjoyed it, please leavea five star review on your
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Leave me a voicemail.
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(50:53):
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