Strengthening Access: Lessons from Dr. Stephanie Lucero’s DPC Journey in Rural New Mexico

In today's episode of the My DPC Story Podcast, host Dr. Maryal Concepcion welcomes Dr. Stephanie Lucero, the pioneering founder of Northern New Mexico’s first Direct Primary Care (DPC) clinic, Hometown Doc, LLC. Dr. Lucero shares her journey from growing up in the Pojoaque (Puh-Wah-Kee) Valley to becoming a board-certified family physician deeply committed to her local community. The conversation dives into DPC’s benefits over traditional fee-for-service healthcare within New Mexico, addressing common myths about DPC being “concierge medicine” and highlighting its affordability and accessibility—even for Medicaid patients. Dr. Lucero discusses challenges like physician shortages, healthcare access issues in rural New Mexico, the impact of restrictive non-compete clauses, and the importance of relationship-based care. Listeners will gain valuable insights into how DPC empowers physicians and community by fostering meaningful patient relationships, improving health outcomes, and creating community-focused innovation. Discover how Dr. Lucero is making healthcare personal, accessible, and efficient for New Mexicans/Hispanos/Nuevomexicanos—and why DPC might be the answer for patients and physicians nationwide. 

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Episode Transcript

Maryal Concepcion (00:00):
Dr.
Definitely Lucero is a absolutepioneer in New Mexico.
She opened Northern New Mexico'sfirst direct primary care and
I'm so excited to talk with herbecause like I'm a California
native, born and raised inSacramento, moved to rural
northern California.
Dr.
Lucero is a POA Valley native.

(00:20):
And also she did undergrad withher biology bachelor's degree in
New Mexico med school and NewMexico residency in New Mexico.
So she is bringing New Mexico tothe podcast.
Thank you so much Dr.
Lucero for joining today.

Stephanie Lucero, MD (00:34):
Thank you.
I'm so excited to be here.

Maryal Concepcion (00:37):
So I was so excited when we connected to
have representation from NewMexico on the podcast.
I've been to Albuquerque acouple times since starting this
podcast and every time I'm like.
DPC doctors in New Mexico andI'm like, oh my gosh, that was
so wonderful to connect becauseyou are in a place where, unlike

(00:58):
other cities in the country,there's not like multiple DPCs
to choose from, you know, withina 10 block radius.
So because you've grown up inyour community, you are of your
community that you arepracticing and practicing DPC
in, but I'm guessing that you'veseen a lot of stuff growing up
as well as going to school inthe fee-for-service world in New

(01:22):
Mexico.
Yeah, so I would just saygrowing up around here, I was
lucky enough that we did havesort of a home doc, if you will.
There was a doctor that lived inthe neighborhood who I saw a
couple times as my pediatricianand she also worked with the
schools to make sure that we gotvaccines at school.
And for whatever reason thatreally stuck with me.

(01:44):
And I just always liked thisidea.
Like I knew that she would go topeople's houses and stuff and
again, like a female doctor,this would've been in the mid
eighties.
Yeah, I don't know, it juststuck out to me.
And then just in general growingup in a rural place we were
always like playing in arroyos,which is also known as a small
river for those of you thatdunno or creek.

(02:05):
And I was just always reallyinto nature stuff and I just
really was into medicine, so Ikind of knew from the get go
that was something that I wantedto do.
And then, getting into medicalschool and all that, it was
like, I wanna be, this is, thisis really true.
I have like anxiety aboutthings.
And so I always wanted to beprepared and I was like, oh my

(02:27):
gosh, I don't wanna be like theperson on a plane when, like
someone has a medical episodeand they're like, is there a
doctor on the plane?
And then it's oh yeah, hi here.
But like I am aneuro-ophthalmologist like, or
whatever, like some supersubspecialty that just not like
the person who kind of likeknows how to maybe manage all

(02:47):
the things, and so I kind ofalways had this place in my
heart of being that rural familydoctor because I had had
something similar when I wasgrowing up.
And so family medicine was justsort of the obvious for me.
And then I did a residencyprogram that was very, rural
focused and very sort ofself-motivated.

(03:08):
I'm pretty self-motivatedperson.
I'm not a fan of people tellingme what to do.
I don't know if that's commonacross the doctor world, so
yeah, so that's why I did alocal residency and yeah, I am
literally sitting in my officeright now, which is not even
maybe a half a mile if even fromwhere I grew up.
Yeah, so, and a lot of mypatients are people that I knew

(03:31):
growing up and they know me andthey know my family and oh, and
I, a big part of why too like,you know, I did work for like a,
a fee for service localcorporation that was still in my
hometown.
But I just, I mean the writing'son the wall, I think we all see
it as physicians, how likeyou're just not, you're not
providing what you could andpeople aren't getting out of it

(03:54):
what they could.
And, and I really liked doinghome visits and stuff like that.
And so, when I sort of got burntout, I was looking for options
and that was, this would've beenin 2018 and DPC was sort of big
maybe in Texas, and I knowKansas obviously as we know and
some other places, but it wasnot something anyone had heard

(04:15):
of here.
And they all kind of thought Iwas insane, but.
Do it anyway.
And all of your patients and youknow yourself absolutely.
But are grateful that you didthis.
So I, I wanna delve into thisidea though, that you are like,
I, I love this'cause you're anautonomous family doctor and I
completely get that.
Because when you need to do whatyou need to do to take care of

(04:36):
your patients, it's really adrag when someone's oh no, you
don't have the time to do that,or et cetera BS that actually is
not correct.
Right.
So tell us about, what, whatwas, what was contributing to
your burnout?
Because burnout is experienceddifferently by different people.
The level at, at which burnoutis allowed to continue before we

(04:57):
say peace out man, I'm done isdifferent.
So what was it like for youbecause you were in a fee for
service model in New Mexicoamongst your community that you
remain in today under DPC now?
Yeah.
I mean this is maybe a not sogreat metaphor to use, but I
always tell people working in afee for service corporate sort

(05:20):
of environment, it is like beingin an abusive relationship.
I was getting sick of makingmoney for other people.
I was the one doing the work andeveryone else was getting paid
for it.
The whole burnout thing.
It's well, you're just burntout.
And it's no, but you're makingme burnt out.
I'm burnt out because of thesystem that you built.

(05:41):
And I would say a lot of theburnout it is just like I.
It's not even really how manypatients you see.
It's how, it's how ineffectiveyou're being and seeing that
many patients.
And so at some point you justfeel like you're on a, on an
assembly line.
And now having done DPC, I thinkmost EPC docs can clearly say

(06:04):
that knowing their patients andknowing their family and knowing
their circumstance is thebiggest part of why they have
the health outcomes that theydo.
Hands down, I mean, it, it, itit leeches into the quality of
care, the meaningfulness ofcare, the compliance of care,

(06:26):
the word of mouth of your care.
I mean, it's literally leachinginto everything because it's
foundationally built on arelationship.
Yeah.
So when you talk about that, youare like half a mile or, from
where you grew up, I would loveif you could just also lay the
ground for us in terms of whatdoes healthcare access look like

(06:46):
in New Mexico in general,especially because you're in a
bigger city compared to some ofthe more rural areas of New
Mexico, New Mexico, but ingeneral, New Mexico is what we
would consider a rural state.
Yeah.
So I am about 20 minutes outsideof Santa Fe.
I guess per taxes, we're notconsidered rural anymore, but a
lot of people, I mean like.

(07:08):
Starlink was like a game changerfor us out here.
Like we still had literally acouple years ago, like dial up
at 1.5 megabytes per second.
So it's still pretty rural here.
And in general, people say we'reabout 30 years behind in school,
in technology, in all of thethings, it's very hard to get

(07:29):
doctors to come to New Mexico.
Our malpractice laws are not thegreatest.
Our caps on malpractice payoutsare not the greatest.
There's a lot of fights going onbetween that.
Also I just think, I've seenthem try to recruit younger
doctors out of residency andquite frankly, if they don't
have a tie to New Mexico,there's really not a reason to

(07:51):
come here.
We're lowest in education.
We're lowest.
I mean, we're kind of lowest ineverything.
We're low in all the good thingsand we're high in all the bad
things.
So it's hard to get people tocome here.
And most of the people have somesort of tie and that's why they
come here.
But access is pretty terrible.
'cause just there's a shortage,there's just an absolute

(08:14):
shortage.
Yeah, it's just bad.
And what about for specialtycare?
I'm in rural America.
We're an hour and a half fromthe nearest trauma two center, a
nicu.
45 minutes.
If you choose the wrongdirection, you might go to a
hospital where there's no pedson call or be on call.
Yeah.
I mean it's, it's, so I I, Icompletely empathize with what

(08:35):
you're saying in, I'm infricking California.
This is insane.
Yeah, yeah.
It's 2025.
Yeah.
But I will say it makes me thinkof how when I was at Creighton
there was a widge program thatsome of the dental students were
part of that they got theirdental school basically paid for
if they returned to New Mexico.
And my girlfriend in dentalschool was from Albuquerque, so
she went back there aftergraduating Creighton.

(08:57):
But, I, I think about that, justhearing everything that you're
saying it makes you want to askyou about, what would you say to
those people who say, DPC isconcierge medicine?
DPC is for rich people becausethat is a big thing that policy
makers, ivory tower people whodon't actually see patients

(09:17):
anymore, who are not boots onthe ground claim that DPC is in
fact, oh my gosh.
And it's not, no, I am, that ismy pet peeve.
That is my trigger.
When people will be like, oh,aren't you doing that concierge
thing?
I'm like, no, no, no, no.
I am not doing conciergemedicine where they bill your
insurance and the monthly fee isgenerally on the higher end.

(09:41):
DPC does not involve yourinsurance and it's, trying to
stay as affordable as I canwithin, reality of living in
this economy.
And I have patients from allwalks of life.
I have very well off patientsand I have patients on Medicaid
that are like, it is well worth,they have so many things going
on medically and they just needthat help navigating the system.

(10:03):
And they prioritize their healthin certain ways, and that's
where they send their money.
They'd rather pay me my monthlyfee so that they make sure that
all the ducks are in the rowthen sort of be sort of thrown
to the wolves in the big system.
It, it's so interesting.
I was mentioning right before westarted recording that I have

(10:25):
just come from Washington DC andI was there speaking amongst
different people in ourgovernment.
But I was really excited to hearyour Senator, Senator Luhan talk
about, we have to go forward andthis is not a, a political thing
in terms of one party is rightover the other.
It's literally people in thiscountry need things including

(10:49):
healthcare and we're recordingthis right after there's a claim
that Snap will be.
Funded To what extent?
We don't know when that willhappen.
We don't know, but I thinkabout, even yesterday I had a
conversation with a patient andher daughter, who's also my
patient about how do we have toomuch, too much reliance on the
government and whatnot?
And, I, I would like to alsojust call out New Mexico for its

(11:12):
innovation when it comes to evenbasic things.
I mean, I'm a mom of two littlekids.
If I lived in New Mexico, Iwould have childcare and not
have to worry about childcare.
You guys have been completelyinnovative.
And I think about that you'rereally doing things including,
and especially your DPC, butyou're doing things that are
community based and whether ornot you believe, we have too

(11:32):
much reliance on government ornot.
I'm like, it doesn't freakingmatter if at the end of the day
you're just like, dude, I need adoctor.
I agree.
I think like most doctors canagree that medicine or
healthcare, whatever we wannacall it, should be apolitical.
It really isn't.
I just like I have patientsfinancially from all walks of
life, I have patientspolitically from all walks of

(11:54):
life.
But guess what, they all agreeon this that they like DPC.
I mean, that's why they're here.
They all want access to a doctorthat they can talk to openly.
And I mean, honestly, a lot ofwhat I do is just helping them
navigate the healthcare systembecause it's ever changing and
they just.

(12:14):
I mean, it's totally lost in it.
It's no different than, hiring alawyer to help you navigate the
legal system.
Amen.
And I think that, it's, it'sfunny because when people are
talking about their elevatorpitches and whatnot it
definitely can change over timedepending on where a person is
practicing.
But I think that that'ssomething that is not commonly
mentioned because it's not evensomething that, it's almost like

(12:39):
you need to do that, but youdon't necessarily have a name
for what that is.
And the navigation ofhealthcare, I mean, I, I just
watched one of the best memes,this a comedian was like trying
to explain American healthcareand copayments and all the stuff
deductibles to a Canadian comedyaudience.
And it was just like, this is sofunny, but also super messed up.
Yeah.
It's so complicated and it'sever changing.

(13:02):
I mean, it'd be one thing ifevery insurance did the same
thing, but not only did they notdo the same thing, they change
what they're doing in the middleof the year, or randomly, or now
your employer, doesn't contractwith this pharmacy program
anymore.
So the place where you got allyour medications now, you can't
get it there anymore.
And it's all unnecessary.

(13:24):
And I, I hate to throw a bigchunk of people under the bus,
but you know, as we say indirect primary care, it's just
unfortunately it's getting ridof all the red tape and all the
people who.
Supply that red tape.
It's just, that's why it'scalled Direct'cause it's from me
to you.

(13:44):
And there's, there's so manythings that we could be doing.
All the home testing, all ofthe, there's so many things that
are cheaper, more efficient,direct, whatever words you wanna
use.
Just efficient, not wasteful.
I don't know why anyone in thiscountry, what would it be for
things that are gonna save moneyexcept for, the reality is

(14:06):
people will lose jobs if we moveto a more direct way of doing
healthcare.
'cause there's a lot of jobs inbetween us and insurance.

(14:48):
I was just listening to anepisode of The Daily where they
were talking about how Amazonhas reduced their workforce the
person was interviewing the, itsounds like the plant manager
maybe in mm-hmm.
Louisiana, where they'vereplaced a massive amount of the
workforce with robots.
Yeah.
So I think that, it's changesare coming.
Absolutely.
But I, I also thought duringthat episode when I was

(15:09):
listening that, I was an anthemmajor for my BS in undergrad and
it's like people.
Evolutionarily want connection.
And so absolutely.
It's so interesting that as AI'sgonna do what it's gonna do,
technology's gonna do what it'sgonna do.
I, I do not think we will everbe in the wrong of, of wanting

(15:30):
to connect to connect withhumans, especially over their
healthcare.
For sure.
So let me ask you here, becauseyou, were born and raised in New
Mexico.
You went all the way throughresidency in New Mexico, and
then you worked for fee forservice.
As you talk about malpracticeissues, did you have any
non-compete issues in openingyour practice?
Would love to hear.

(15:50):
Yeah, I did.
So my non-compete wasessentially that I could not
work for a facility that hadradiology services for a year
after I quit within the county.
And our county is, well, it'sSanta Fe County, so it's sort of
all of the hospitals and urgentcares and whatever in Santa or

(16:13):
even a clinic if they have anx-ray machine, I couldn't work
there.
So yeah, I mean that's prettyridiculous in an underserved
state.
I, yeah, I mean I just, it's,it's pretty self-explanatory.
I don't even know why theyexist.
It's really just a deterrent, ifanything.
But it is what it is or it waswhat it was, amen.

(16:34):
And I will say that this isexactly like.
Why like why I was even in DC totalk about what we need as, as
small businesses, because we aresmall businesses at the end of
the day.
And when it comes to restrictiveclauses like this, I mean, and
you, you like called the kettleblack, right there.
You're, you're in fricking NewMexico.

(16:54):
Yes, let's let's addrestrictions for people to
access their doctor.
Like lovely best idea ever.
Yeah.
So, it's, it's ridiculous.
But when you, now it's not 2018any longer, it's 2025.
And I'm wondering if you couldtalk to us about the opening of
your practice and definitelyit's a little bit different from
in your story compared tosomeone who did not practice or

(17:17):
do not, did not grow up nortrain in the prac in the place
where they're practicing now.
But what was it like for you tostart talking to people about
this thing called direct primarycare?
Yeah, so the good thing aboutbeing from here is that I know
that this place is very smalltown and very word of mouth.
And because, my parents grew uphere and I grew up here.

(17:39):
It was a lot easier to spreadthat word of mouth, but it was a
hard sell.
Like people did not.
I mean, I would say still aroundhere, if you ask someone what
direct primary care is, they'llbe like, well, that's concierge,
right?
That's like boutique medicine orwhatever the term they wanna
use.
And I'm like, I'm, I am gettingtired.
I, I kind of want DPC to sort oflike hit the zeitgeist a little

(18:03):
bit more around here so that weall kinda don't have to explain
it anymore.
And then so maybe it wouldexplode.
But essentially I just toldpeople, yeah, there's this thing
where, and they were like, well,why would I pay a monthly fee?
That makes no sense.
Why would I do that?
I only go to the doctor twice ayear and I'm like, I tell people

(18:25):
all the time, you're not payingfor the medicine.
You're paying for theconvenience, the trust and the
relationship.
If those things matter to you,even if you see me once a year
for your annual physical and Inever speak to you again, that
is going to be worth its weightand goals.

(18:45):
That physical is gonna be verythorough.
We're gonna answer all yourquestions, we're gonna take our
time.
And guess what?
If you leave and then you thinkof something, you're not gonna
have to call back and go throughsome phone tree to communicate
back to me or a portal messagethat's gonna go to my, ma or

(19:05):
whatever.
You're just gonna send me amessage and be like, Hey.
I forgot to ask you this andthen guess what I'm gonna
answer?
Not some third party, not someai, and then sort of like all of
those DPC stories in a way.
Once I got a few patients onboard, then they sort of saw
what it was and then theystarted selling it themselves to

(19:27):
other people.
So then it was sort of like,like-minded people we're
telling, like-minded peoplewe're telling like-minded
people.
And now pretty much everyone onmy wait list is someone who was
referred by, a current patientor heard about it.
Somewhere like that.
Yeah.
And again, just like dottingthat I crossing that t like

(19:47):
absolutely what you'redelivering is what people want.
Like it is in any geographicregion in this country, this is
exactly what people want anddeserve.
I right?
I was gonna say right now a lotof people, they don't know what
they don't know.
They don't know that they wantit'cause they don't even know it
exists.
But I guarantee if theyexperienced it, they would never

(20:10):
wanna go back.
I mean, all of my patients areconstantly, like when they have
to go, see a specialist and sortof the regular system if you
will, most of them come back andare like, oh my God, I forgot
what it was like to have to goand wait in a waiting room and
fill out the paperwork and give'em your insurance card and all

(20:30):
the things that come with it.
And I'm like.
I know sometimes I have toaccess it too, and I'm just
sitting there ugh.
Absolutely.
And I hear, I think about the,the value that DPC brings and
Yes.
Convenience.
Absolutely.
But I'm wondering if you cantalk to us about even what is

(20:53):
the word?
Even just soundbites or feedbackthat you've heard about how your
clinic and how you as aphysician who have a, who has a
relationship with your patientshas completely transformed their
access or their quality ofhealth care access.
Because I, in a world wherepeople are about to lose, their
insurance plan, their insurancethrough their employer you, the,

(21:16):
the, the list is endless as tohow healthcare is changing,
especially in this season.
I, I wonder what your patientsare saying about your practice,
that it's only because you'rethere that they're able to get
X, Y, or Z.
Oh, for sure.
I mean, again, it just goes backto navigating.
So I would say it's navigatingthe system and it's the

(21:36):
efficiency and speed at whichthey can get in to see me,
right?
So they have a problem, they letme know, I get them in, we
figure it out, and then it'snavigate, navigate, navigate the
system.
Maybe they need to go see aspecialist the time that it
takes.
Me to sort of complete thatcircle of initial diagnosis to

(22:00):
them getting to the point wherethey need to be is pretty fast
compared to, I mean, well also,I would say you just, a lot of
patients didn't understand inthe, in the fee-based system,
I'd be like, okay, your, your,your blood counts are abnormal.

(22:20):
I need to, we need to get moreblood tests, and then I need to
refer you to a hematologist thatwas sort of lost upon them.
And oftentimes they would leaveand they wouldn't do their blood
work, so then I never got theresults.
And then they're one of,thousands of patients.
So I, I'll like, remember themwhen I'm lying in bed one night
oh, what happened to thatperson?

(22:41):
And did they ever do their labs?
And then I'm trying to chasethem down and maybe they've,
gotten lost in the mix orwhatever.
And so just the delay in that aswe know, can be detrimental.
And I would also say that I, Ido also do hospice work on the
side, and it is so devastatingto me how many of those cases

(23:09):
would have been prevented bysomeone having access to a good

(23:44):
primary care doctor.
Like it is.
I mean, there are things thatpeople are dying from in this
country that no one should bedying from.
Super preventable.
But it's just, a lot of it islike people just not going to
the doctor.
And I don't blame them.
There's so many people out therethat just the fear of the

(24:05):
system, they don't understandit.
They don't wanna hear thediagnosis, the, yeah, I, I mean,
I think about, we've all hadpatients where it's oh my God,
how did it get so bad?
Is like the question we'reasking ourselves.
I remember the person who had askin cancer.
It was a melanoma that had takenover half of her face, and I was

(24:28):
with an ENT surgeon and we weretrying to dissect a portion of
her ear.
And the ear just sloughed off.
I mean, it was so diseased.
The tissue was so diseased andit's I think about patients who
have come over to DPC andthey're like, I didn't get this
addressed before because Ididn't think that I, I could
afford testing to follow up forsomething, or I didn't think

(24:50):
that I could afford themedicine, or I just hate going
and sitting.
Right?
And after waiting nine months tosee a person who's not even a
physician to tell me like,whatever they're typing and not
actually look at me in the face.
And so, I mean, there's so manyreasons that the healthcare
system can be improved, and it'sliterally what we're able to

(25:11):
take in all that feedback andthen change our practices to, be
with our patients and what theyneed and what they're looking
for.
And like you're saying, and notputting them in the, the poor
house by charging concierge feesas well as billing insurance.
So, that, that's awesome to hearthough, how you, patients have
learned to have, have learnedthe value of direct primary care

(25:34):
and what you are doing as adoctor.
I'm wondering here in terms oflike, when I was looking for DPC
physicians in New Mexico I, Iask this just because I do think
that we're gonna see more ofthis in the future.
People on the podcast are veryaware that um mm-hmm.
My husband was let go becausethe model that we were working
at went to a non-physicianmodel.

(25:54):
And I'm just wondering, like inNew Mexico, there's a lot more
that I can find non-physicianproviders compared to
physicians, A KAU in the stateof New Mexico providing direct
primary care.
And I'm wondering if you cantalk to us about trends that
you're seeing when it comes tonon-physician providers as well
as, what, what things are youseeing because of those trends?

(26:15):
Yeah, I mean, I, trust me, I amnot an expert in New Mexico
medical law by any means, but I,I would just say my experience
in living here.
Is that because we are such arural state, I know that there
are a lot of clinics andfacilities that just because of
their reimbursement rates thatthey get they can't afford to

(26:36):
pay what a physician might want.
And New Mexico is a state thatdoes allow nurse practitioners
in particular to do a lot ofstuff that maybe in other states
they can't.
And so, New Mexico definitely isa place where I've seen a lot
of, a lot of nurses go the nursepractitioner route because they
are able to do so much stuffindependently here.

(26:58):
And I don't wanna throw PS andNmps under the bus.
It's just like physicians.
There's really good ones andthere's really terrible ones.
And it's the same for PS andnurse practitioners.
Absolutely.
It's just, the reality is ourtraining is different.
It just is.
And so there's just certainthings that a physician can do
that maybe some PAs and othernurse practitioners can't.

(27:20):
Legally, I mean, and then Iwould just say, I have so many
friends, colleagues, and sort ofremote acquaintances that get
ahold of me on the down low tobe like, Hey, how's it doing in
DPC world?
I'm thinking about doing it.
I'm moving to do it.

(27:40):
And not just primary care docs,we're talking BGY OBGYNs, we're
talking dermatologists, we'retalking other people who are
like, even in the specializedworld, it's just not working for
them.
And they're like, Hey, I'm onlygetting a certain percentage of
whatever company A is billingout for me.

(28:03):
I could be making a hundredpercent of this and not seeing
as many people and giving bettercare.
And I think that the reality ofthat phenomenon is that we're
just gonna need more peoplebecause if we all, and I, I'm
not naive to the fact that whenI left my old clinic, I took a
very, very small fraction ofthose patients to my new right.

(28:27):
And so that leaves.
Thousands of other people inthat pool sort of scrounging to
get in.
And again, there was already adoctor shortage before, and now
it's just I'm not naive to that.
And it does make me feel badsometimes that I don't seem more
people because pretty mucheverywhere I go, someone's

(28:49):
asking if I'm taking newpatients or how long the wait is
or whatever.
But I don't know.
That'll take care of myself too.
And I think about thoughsomething that Dr.
Anas Mohammed said in hisinterview, that the idea that.
You have good, fast or cheap,and you can only have two at the
same time.
Yeah.
And I think about that when itcomes to healthcare.

(29:10):
Like I, I totally hear you and Iempathize with the that feeling
that I think is also put on usthat like we are supposed to see
more.
But it's I, I think about alsothat, I really love that you
said like you have to take careof yourself because hell yes.
If you don't have yourself, youcannot take care of anybody
else.
And so, it is so pertinent andyou are spot on when it comes to

(29:32):
specialists as well.
The conference at my DPC storyand Flex Mid Summit just hosted,
had over a hundred people, mostof whom were specialty doctors
not in primary care focused, andalso surgical specialists who
are looking to do care exactlyas you're talking about.
Yeah.
Directly for the patients.
So, there's so manyopportunities in this world and

(29:54):
I love that.
Again, and this is why I'm soexcited for you to, beyond
sharing your story, is becausehearing like how it's going in
New Mexico, what services areneed in New Mexico, there's so
much space for innovation aswell as building that innovation
with the patients and our, ourown ability to survive under the
model that we're building in thefuture or in building going into

(30:16):
the future.
There's so much innovation thatcan happen and if we're not a
part of it, we're gonna be onthe menu like a hundred percent.
Oh, for sure.
No, I would love to see NewMexico.
My, my little, little New Mexicothat's always so far behind.
I would love to see them be afront runner on figuring out a
potential solution to this sortof healthcare debacle that we're

(30:37):
in.
And I think New Mexico doesthink outside the box in a lot
of ways for a lot of things, andI would love to see them do that
with healthcare.
Yeah.
And when you spoke about accessto doctors and just what it
looks like in, in New Mexico onthe, medicine and in our world
medicine type of type of, or inmedicine side of things, I'm

(31:00):
wondering if you could also talkto us about how you're making
community connections, even likewithin the state, because people
like who are doing physicaltherapy or speech therapy or
whatnot people are even in thoseworlds, are offering
telemedicine care.
So how are you makingconnections with people who are,
like super excited to know thatyou're, you and your services

(31:20):
exist because you do hospicework also and you do home visits
on top of primary care?
Yeah, no, I mean, the home visitthing, honestly, I could
probably just do home visits ahundred percent of the time.
It's huge, especially out herebecause, well, in general, we
all know that baby boomers areaging.

(31:41):
And in a rural area there's nota lot of public transportation.
So, and then even if there is,even if you live in a, in a
place where there's, reallygreat public transportation for
elderly, disabled, whatever, thefamily member often has to, get
up, get that person ready, getthem outta the house.

(32:02):
Often they don't wanna leave thehouse.
The home visit thing is, ishuge.
I really could just do that ahundred percent of the time.
And so there's that.
And then I try to dotelemedicine whenever it's sort
of convenient for people forsure.
We do get snow here.
For those of you listening, NewMexico does get snow, especially
northern New Mexico.

(32:23):
It is not just some flat desert.
Everyone's always do you goskiing in New Mexico?
And I'm like, yeah.
So yeah, no during the winter'cause I personally am not a fan
of driving in bad weather atall.
I will make it super convenientfor them, Hey, this, there's a
storm coming in.

(32:44):
If it snows real bad tomorrowwe'll just move to telemedicine.
Then you can come in later forlike the, just the exam portion.
I still need to listen to yourlungs or to your blood pressure
or whatever.
But we can still chat and thenlike you can drop by whatever
and do this.
And then, I am trying to beinvolved as much as I can, can
being from this community it'salways weighing that thing of I

(33:06):
always, my gut is to be veryinvolved and I am constantly
trying to draw myself back toprotect myself a little bit.
But there's all kinds of thingsthat I'd like to do with like
the schools.
I go talk to my old residencyprogram.
I do go talk to this, all of theschools, the school I graduated
from, I go talk to'em aboutcareer day.

(33:27):
I've had kids shadow.
I've talked to kids just likerandomly when I'm out about
they're interested.
They wanna know about our, NewMexico has A-B-A-M-D program.
So they wanna hear about thattype stuff.
Yeah, I'm still involved insports, my kids play sports here
and I talk to their friends andfamily and I took care of a lot
of them when they were kids.

(33:48):
And so, yeah, I'm like superingrained.
Yeah, always trying to get theword out.
People still, again, it's thatwhole concierge thing.
Oh, aren't you doing that thing?
And I'm like, oh, no.
Well, I hope that especiallyyour the, the people who you are
exposing to DPC will also sharethe story with people and even

(34:10):
just this recording.
Will this interview will, spreadthe word that that is a myth
that, that you do conciergemedicine?
Yeah.
Yes.
What about like with withmembers of a patient's
healthcare team, like thephysical therapist or like how
do you, people who might also docash pay services, chiropractic

(34:30):
work, acupuncture, how are youhow are you building your
network so that you're alsofinding trusted people that your
patients can see?
Yeah.
So good and bad thing aboutliving here is there's not a lot
of options.
Right.
And, I am also a patient, so Idefinitely make it, no,
sometimes I won't, I generallygo into something not telling

(34:52):
them that I'm a physician'causeI kind of wanna see what it's
like.
And then like I will tell youright now, I have an
acupuncturist who's worked on meand my husband and my
mother-in-law, and myfather-in-law.
And I sent so many patients toher because I've experienced her
myself, and she's awesome.

(35:13):
I have some occupationaltherapists that I send people
to.
I have some physical therapistsand I think it's because I have
that relationship with that, ot,pt, whatever they are.
And they know me sort of like alittle bit more on a personal
level.
There is that connection there.
And I, I don't really thinkthat, it's not like we do favors

(35:33):
for each other, but there'ssomething about, I mean, it's
networking.
It's plain and simplenetworking.
It's good old fashionednetworking, it's just so and so
went to this college and so andso's you know, whatever is on
the board and whatever.
It's networking.
And it's the same thing inmedicine.
You just sort of build thatnetwork of sort of those other

(35:54):
providers and, and then, andthen it helps because then my
patients know that I trust thisperson and I go to them too.
And I would say the opposite istrue as well.
When they go and they have a badexperience, and I'll give people
the benefit of the doubt andI'll still send referrals to
them.
But if I get enough bad, Iconstantly ask my patients for

(36:17):
feedback, like, how was it?
And if they're like, oh, Ididn't like this, I didn't like
that.
Their bedside manner, theydidn't answer my questions, I'm
like, okay, not going to thatperson no more.
Totally.
Because it's just medicine orrestaurant recommendations,
whatever.
It's like it it's part of thetrust that they have in you as
the recommender.
Absolutely.
Yeah.
Yeah.

(36:37):
we talk about that too, like in,in the world.
Imagine a world where you knowyour doctor, it's sort of like,
a hair salon, right?
You go to the hair salon, youget a bad haircut, you leave a
bad review, right?
But maybe 5,000 people go tothat hair salon and you, that
was the one bad review out ofthe 5,000.

(36:58):
Well, we don't really have thatfor.
Doctor's offices and there's somany other variables that, how
they were scheduled.
Was it AI scheduling it?
Was it scheduling online?
Was the ma rude?
Was the ma nice?
Was the doctor rude or was thedoctor amazing?
There's so ma there's no way tomeasure and people just don't

(37:18):
really have a choice.
'cause they don't, they don'teven really know what they're
choosing.
People will ask me, do you knowa good so and so?
And I'm like, well, either I didand now they're not here no more
'cause they left New Mexico.
Or they're good.
But the facility in which theypractice I can't really say a
great thing about.
So I don't know what to tellyou.

(37:39):
That's, that's so true.
And again, I can completelyempathize'cause I literally have
one where I'm like, the doctor'samazing.
The front staff not so much.
But that's where I need you tofigure out if you want to go
despite the front office beingnot so nice all the time.
Right.
And and I, I tell them like, I'mmore than happy to help

(38:01):
facilitate the conversation orget information.
But I will tell you that this isthe option locally.
Yeah.
And this is like someone notlocally.
Yeah.
We're talking two hours probablyto drive to see someone if they
have openings.
Yeah, yeah.
No, I definitely I sort of likeplant that seed for them.
I'm like, okay, I'm gonna sendyou to this person.

(38:23):
Because they are the best personfor this problem that you have.
But forewarning, they're notwarm and fuzzy.
Their front desk is not gonna bewarm and fuzzy.
You're probably gonna have todrive over there in person to
make an appointment'cause noone's going to answer the phone.
But despite all that, this isthe person you wanna see.
Just know going into it, they'renot gonna give you a hug at the

(38:45):
end and tell you to have a niceday.
And I really think it helpsbecause, if a patient,
especially, coming from anoffice like mine and then they,
go somewhere that where it'sjust, maybe cut and dry.
But if they're going into it atleast with this expectation of
oh, she said that this is kindof how this person is.
And I'm like, especially likewith surgeons, sorry, I know

(39:08):
there's some great surgeons outthere, but it is totally the
stereotype.
I'm like, they're probably notgonna wanna sit down and chat
with you about your life storythe way I do.
That's just not how surgeonsroll.
If they're in the room with youfor two minutes, like that's
appropriate.
Just is what it is.
I totally hear you.
So let me ask you this, becauseyou have, grown in your

(39:31):
community to the point where youeven have a wait list.
I'm wondering if you can, justthink about.
Changes that you've gone throughas a physician entrepreneur
either that you had to or youdidn't see coming, or you're
like, I know that I'm preparingfor, because I, I think that
there's so many people who arelistening to the podcast and
listening to this interview whoare, in the, in all stages of

(39:55):
DPC and at any time in ourpractices, no matter how long
we've been open, we can alwayslearn and change based on, what
we've experienced or others haveexperienced.
So I'm wondering if you can talkto us about top things that
you've experienced as aphysician, entrepreneur that
other people might, be otherpeople might benefit from
hearing about from your practiceperspective.

(40:15):
Yeah, I mean, I think thebiggest thing is, and it's gonna
be different for everybody, butfeeling out, feeling or figuring
out what you are mostcomfortable with and what you're
not.
There's some DPC docs that aresuper good at the business stuff
and they can really market andthey can really whatever.
And there's other ones like methat, like that is not my forte.

(40:41):
I am freakishly private, sort ofreserved person.
I know it might not seem likethat right now, but that's'cause
in my head this is a one-on-oneconversation.
But you know, I would say thebiggest evolution has been
offering more and more services.
Right.
So I think when I started out, Ibought an EKG machine, which was

(41:04):
like, I mean, I'm embarrassed tosay, but it was like I had to
learn how to do an EKG onsomeone.
Sure, I could read it, but likesomeone else was the one hooking
it up.
So I had to learn how to do amachine, learn how to trial and
error with the little electrodesand like all of the chaos that
came with it.
I don't have a s spirometer,which honestly I don't know why

(41:25):
I really should get one.
But like new and evolving thingslike home overnight, pulse ox,
like that's super easy, right?
Like sort of all of thesethings.
Or like I have an oxygenconcentrator in my office for
emergencies.
Sometimes I've lent it out topeople because they're sick and
they just need a little bit of,a little bit of help, and then

(41:45):
just different injections anddifferent medications.
I think when I started off I wasgung ho and I'm like I basically
wanted to offer them a fullpharmacy when I first started,
and I quickly realized that thatwas gonna be a lot of work for
me.
Well, because I will say thatthere's not a pharmacy within 25
minutes of where I'm sitting.

(42:06):
There's no pharmacy in thistown.
So if a patient comes to see meand you know they need
antibiotics, I felt reallyterrible being like, well, I
know you feel terrible, but nowyou have to get back in your car
and drive 25 minutes in eitherdirection to wait at the
pharmacy for gosh knows how longto get your prescription.
So I do, I continually keep likethe, Z packs, like the sort of

(42:31):
obvious ones in stock.
And then of course I keepfluconazole to go with those
antibiotics.
So yeah, I learned over timelike, okay, these are the most,
these are the things that I'mreally gonna give out the most
and these are the things that Idon't need to be spending my
money on.
But that's just something youlearn.
And then also I would say withprocedures, like I love doing

(42:52):
skin biopsies.
Some people aren't gonna likedoing those, so I have a ton of
supplies to do skin biopsies andsutures and stuff, and maybe
other DP socks just don't wannado that.
So I think it's for figuring outlike.
What I dabbled in Botox for awhile and then I was sort of
like, this isn't for me.
Everyone's gonna have theirthings that they really like and
they don't like, and you're justgonna figure that out over time

(43:14):
and sort of what's the most bangfor your buck and also what's
the most bang for your time,because you quickly learn.
Especially like in my practice,I don't have an assistant or a
nurse or anything like that.
It's just me by myself.
Like I have to learn like thisis worth my time and this is
something that's worth meoutsourcing.

(43:36):
Totally.
And it's I think that it reallyjust goes back to your love of
autonomy even as a, a personcoming up the ranks through
through medical training.
So that's awesome that you'reable to make these decisions.
I am so excited for people whoare in your state, your, the
people who are coming up again,like I mentioned in the ranks in
medicine to hear this, but alsoeverybody in the, whose, whose

(44:01):
ears are leaning in becausethey're thinking about DPC
considering DPC or like, how canI optimize my clinic?
So thank you so much Dr.
Lucero for coming on today andsharing about direct primary
care in New Mexico.
Thank you.
My gosh, I'm so excited.
I really appreciate it.
So We are about to close outseason five and we are about to

(44:22):
go into season six.
has been almost now six yearssince Asher was on the podcast.
So here he is to share anothermessage.
Hey everyone.
Now here's a sneak peek from mymom's Patreon.
You can hear the rest of this qand a commercial free episodes
plus extra update episodes fromprevious guests and behind the

(44:45):
scenes stuff at patreon.com/myDBC story fan.
Thank you Patreon members for supporting
the work the podcast is doing.
I hope you enjoyed the main feedinterview this week.
Now here's some extra contentrecorded, especially for you.
Enjoy.

(45:10):
Mentioning that New Mexico haschildcare provided to its
citizens, I'm just wonderingabout if you can, if you can
talk to us about any grants orsubsidies that people.
Access through this is a littlebit off the entrepreneurship,
but, but just the idea that asyou were talking, I was thinking
about how one of the things Imentioned in DC was like, for

(45:32):
small businesses, tariffs are africking killer because it's
like, are we gonna have tariffson our generic meds and not have
an easy, as easy a time getting,or Zacks and stuff that are like
less than five bucks for a wholepacket that absolutely you can
handle in your clinic.
For those of us who can selfdispense.
And I think about even just thecost of medical tools.
Like I, I've had to ask peoplelike, can I crowdsource a box of

(45:55):
pap just disposable speculums.
And then I ended up buying aautoclavable one.
'cause I was like, I don't knowif I have to buy zombie
apocalypse levels of things orare we gonna be able to afford
things in the future?
And that said, I said tostaffers, I was telling them
about how, like where we are inrural California, I got a grant
during the pandemic for$10,000and it allowed me to get a VFC

(46:19):
compliant fridge freezer andtransport.
Oh yeah.
And but then when I said that,the conversation was from their
side, oh, we don't believe ingrants and subsidies.
And I'm just like, I like what?
I don't understand thatrhetoric.
And so I'm just wondering if youcan, think about your own

(46:40):
patients and think about likehow grants and subsidies,
especially for like how youmentioned the BAMD program.
I mean that the, there's thingsthat like, if, if you're gonna
be so staunchly againstsomething and not even be open
to hearing but actually thisactually helps our community.
But how, how do grants andsubsidies work in your world and
like from your experience, yourpatient's experiences?

(47:01):
Because I, it's just, I, I thinkabout this is the crap that
we're hearing from our policymakers.
Oh my gosh.
Policy makers.
If you're listening I'll tellyou like when the pandemic
started, because my office isoff of a main road, I was so
gung po I was like, okay, I'mgonna get a CD compliant CDC
compliant refrigerator and I'mgonna get, the, the state will

(47:26):
give all these COVID vaccinesand then people can literally
like, just drive off the road,we'll vaccinate them.
I was all about it.
And then they were like, therefrigerator you bought isn't
compliant.
And I was like, but it was onthe CDC list.
No, but it has to have the autothermometer thing.
'cause you have to send us thetemperature readings every when
I was like, well, no one told methat at the beginning.

(47:49):
Okay, fine.
I'll order the, auto thermometerwith the wifi that'll send you
the temperature reading allthis.
And then it was like, well, whathappens if the power goes out?
Because yes, in a rural area,the power goes out all the time.
Oh, well you need a backupgenerator.
And I'm like, well, that's gonnacost$5,000.
And it's like, all I wanna do isget these vaccines and vaccinate

(48:10):
people.
That's all I wanna do.
And I'm offering to do like thatpart I was gonna do for free.
It was just getting all theequipment and stuff that even I
was, willing to pay for.
And in the end, I never did itbecause there were so many
roadblocks.
The, the wifi thermometers wereoutta stock by the way, and they
weren't, like the vaccines cameout.
What was it that, that last,like the first two weeks of

(48:33):
December or whatever it was of2020?
Yep.
Yeah.
And then I was like, they werelike, oh yeah, you, the wifi
thermometers are back ordereduntil like March.
And I was like, oh, well nowwhat's the point?
But I have thought a lot aboutthis also in sense, again,
policymakers is like, what ifthere was a grant that just paid
my salary and then I could seepatients for free, meaning they

(48:58):
wouldn't have to pay me?
That's like a whole other safetynet.
And we're not even, I mean, I'vethought about things like if
there was a grant to pay me formy time, to go do physicals for
the school sports programs, thenthat's a whole bunch of kids
whose parents don't have to tryto get them appointments to do
sports physicals.
Just all, all the, employmentphysicals, all of these things

(49:22):
that we need just for society torun TB testing.
I have patients that work atplaces where they, I mean, I
have to get TB tested routinelybecause of doing hospice, but
anyone who works in healthcarefacilities, whatever, they have
to constantly, be TB tested.
It's really hard to find a placeto do TB testing.

(49:45):
That in itself could be a grant.
Like you just give someone moneyto buy the tuberculin so that
they can do TB testing onpeople.
There's just so many simplethings that we could be doing,
and it's just insane to me thatthey would be like, we don't
believe in grants.
And, and I'm like, and it, it isvery, well, I am not a
nonprofit.

(50:06):
And that was simply because,trying to find people to be on
my board and all the whatever.
And so that just not being a notnonprofit excluded me from tons
of grants right off the board.
And that was very frustrating.
And at some point I was justlike, I even talked to a grant
writer to see about hiring themto find grants for me so that I

(50:26):
could do certain things for mycommunity.
And that just got to be toomuch.
And I will say here for ourconversation, but also for the
listeners do you think aboutthat?
Even if you're not a nonprofit?
'cause Bigtree MD is not anonprofit either.
If you are doing something incollaboration with a nonprofit,
like for example, Dr.
Angela by Master healing Groveis funded in part by a nonprofit

(50:50):
branch of her clinic.
Mm-hmm.
And so, like if a church ornonprofit organization wanted to
fund whatever you can get thegrants through that nonprofit
and still be like a contractoror a collaborator with that,
that company, or excuse me, of,of that with that nonprofit.
So it's definitely a way to getaround some of these ridiculous

(51:11):
things.
But I will say here that this isexactly where it matters.
Like for those of you who arelike, I would love to share my
story.
Absolutely.
If you have not come on thepodcast.
But if you have not also talked,to your representatives, this is
exactly what.
Why it matters to tell them Iget that your belief in da da
da, because your classic exampleis, whatever.

(51:32):
But it's let me actuallyactually provide you with 20
more examples of how, thispolicy affects small businesses,
affects physician access tothings, even, even, even if
we're for profit.
And, one of the things too thatI think about is during the same
conversation in therepresentative's office when I
was talking about PRP offerings,we're talking like hundreds of

(51:53):
dollars for a PRP injection andI can get six six syringes of
PRP from a person's blood draw.
And I'm like, but down the, inthe next county over, you could
pay$10,000 for the same thing.
And so they're like, oh, so butbut what's your overhead?
I mean, what's your what's yourmargin?
I'm like, like 20%.
Like we're not talking 20000%.

(52:16):
We're literally talking likehundreds of dollars versus
thousands.
And they were completelydumbfounded that oh, so you're
like not doing this, for themoney.
I'm like, dude, if we were doingall money, we would not be
family medicine doctors.
We would not be family medicinedoctors.
Yes.
That is a great point.
Like I, I think just like theworld needs to know, trust me,
and I wish it wasn't true.

(52:36):
Family medicine doctors are notout there like bringing it home.
We are not, and we are doingthis because, I mean obviously I
don't wanna speak for Emily,family medicine doc.
There are probably some outthere that are filled
differently.
But in general, I would say alot of doctors go into family
medicine because people theywant, they really are, they like

(52:59):
those relationship, they likegetting to know the whole
person.
I, I don't think I've ever hearda family medicine doctor say,
oh, I chose this specialty forthe money.
Pretty sure that wasn't themotivation.
Yeah, a hundred percent.
I've the, the people who said,I'm choosing this because I
wanna go golfing, or I want toda da.

(53:19):
It's not, not once did they say,and that specialty is family
medicine, right?
Yeah.
It was not that one.
Yeah.
Yeah.
No, like I, I, yeah, there, Imean, that just goes back to
that misconception about thatword concierge and, to, to, to
even take this point further.
Tell us about your pricingbecause it's like your pricing

(53:41):
for your population that'sworking for you is, extremely
reasonable.
And I mean, you have a veryreasonable enrollment fee.
You have a very reasonableoption for home visits if
they're within your servicearea.
And if they're not, it's stillnot gonna put them in the, the
bankruptcy arena.
So tell us about your pricingand how you came up with it.

(54:03):
Yeah.
And how it's working for you.
So this goes back to familymedicine doctors not being in it
for money, because trust me, Iget a lot of people being like.
Are you okay?
Are you making it because youshould be charging more?
And I'm like, yeah,realistically I could and
probably should be making moremoney.

(54:24):
But I just, I mean, so goingback to this area where I'm from
again, the sort of economic bellcurve, it's all over the place.
And I didn't wanna price anybodyout.
I really, really didn't wannaprice anybody out.
And I, I have some people thatare like, you could be charging
five times that much.

(54:44):
And I have other people thatstruggle to pay me every month.
And it just sort of goes back tothat thing.
It's just like medicine ismedicine for everybody.
Like everybody is equal upon it.
I feel like everybody shouldhave equal access.
I'm not really a bougie person.
And I just kind of felt like ifI raised my rates too high, it
would sort of self-select forpeople.

(55:07):
Maybe that expected more of meand sort of got, and I mean,
again, that's probably why I amso adverse to that word
concierge.
I'm not like your, I am yourdoctor, but I'm not your
personal doctor at your beck andcall.
And I think that went into thepricing a lot.
Like I wanted it to be like.

(55:28):
This is affordable.
This is an adjunct, this is not,something that like, you're
gonna be so consumed with payingthat you felt like you were
gonna have to overuse it almostunnecessarily.
Totally.
And can you say for thelisteners what is your price
point?
So right now I'm charging ahundred dollars a month.
I do have some grandfathered inpatients at a different rate for

(55:52):
different reasons.
And then for home visits thatare basically within this sort
of general little area where I'mat, there's no charge.
'Cause often this is, this isso, it's almost embarrassing,
but maybe people will love this.
I mean, I live here, right?
So like I might go see someoneon my way home or i'm going out

(56:13):
to lunch and then I'm like gonnago see them and then I'm gonna
drop by or they're on the way tothe school or whatever.
Like I'm constantly drivingaround in this area anyway.
So I don't charge anything forhome visits that are kind of
within this area.
And then home visits that I haveto drive past a certain point, I
charge for those and I chargemileage, which I'm still told is

(56:34):
like less than what it would befor someone to come look at your
appliance.
Yeah, so again, like trying tokeep it affordable.
I don't know.
I mean, we could get into awhole soap box about like
retirement and if doctors everretired and hopefully I never
get hurt or disabled.
But yeah, because I mean, it issomething that DPC docs and

(56:57):
policymakers should hear about,if they're going back to grants
and subsidies and stuff if youcan subsidize a physician's A
DPC doc's salary, then youwouldn't have to charge as much
and then you could open accessto more people and so on and so
forth.
And that open access to morepeople absolutely rolls into.

(57:18):
Oh, more people would choosefamily medicine and primary
care.
Well look at that.
Oh my god.
Amazing.
Yeah.
Yeah.
I mean, it, it's so, it's socrazy to think about where we
are as a fee for serviceinsurance based system in the
majority of, how people gettheir healthcare access.
And I think about how like othercountries, the, the pyramid of
what is the foundation?

(57:39):
And the foundation here is basedon specially specialty care and
like the high ticket, the thingsthat, like you're already with
cancer, diabetes or whatever.
And in other countries, thefoundation is of the healthcare
system is based on primary careand it, it just, outcomes are so
different.
So it's, it's crazy.
Yeah.
I mean you and I can probablyrelate in that you being in
rural area in California and mebeing in a more rural area in

(58:00):
New Mexico, but really it's NewMexico in general, a lot of it
falls on the primary carephysician.
It just does.
'cause they're, who am I gonnarefer to?
And in general when I refersomeone out like if someone, I
think they tore their ACL orsomething like that.
I do that full workup.
I get the MRI whatever before Isend them because I'm not gonna

(58:23):
send them to the orthopedist.
And then the first appointmentis going to be, yeah, your knee
swollen, let's get an MRI.
And then they just wasted thatwhole copay and time and
appointment and all of that.
So a hundred percent.
A hundred percent.
Yeah.
And.
For you to deliver the care thatyou are because you don't have
staff like you explained.
What are the most useful toolsthat you have or workflow hacks

(58:46):
that you've developed, becausethere's definitely lots of
people who are opening as solodoctors.
Yeah.
So I really rely on my portaland I try my best, like even my,
I mean for non DPC world peopleout there, if this is your first
time listening, I literally have80-year-old patients that I

(59:07):
bring into my office and I helpthem log on and learn to log
onto their portal.
And I download the app on theirphone and I show them how to use
it to really keep theirinformation safe.
Because a lot of them were likeemailing me insane things and I
was like, please do not email mestuff.
And, for, yeah.

(59:28):
So for a lot of my technoltechnologically disadvantaged
patients, they still, I'm like,just call me on the phone.
I'm probably not gonna answer'cause I'm probably here, there,
wherever with a patient, butcall and leave me a message and
I'll call you back.
But for the most part, I tellpeople, use the portal.
I check the portal obsessively.
Because I'm super type A personand I don't like things to pile

(59:51):
up on my plate.
And, and I really do try to getback to people like.
I tell people up to 48 businesshours.
And that's mostly because if Ihave a day where I have patients
all day long, it's really hardfor me to sort of look and, and
give thoughtful responses back.
'cause I really wanna givethoughtful responses back.
But generally I get back to mostpeople same day.

(01:00:13):
Or if I'm just sitting here inthe office, someone will write
something, it'll pop up and I'llwrite back to them right away.
So I generally, yeah, I like tokeep my plate as clean as
possible.
I don't like things to build up,I like to get people their
results back right away.
And sort of, I mean, it goesback to what we were saying
about if efficiency and gettingthings done.
I'll literally see someone on aTuesday like today, and then

(01:00:35):
they'll go get an X-ray in theafternoon.
I'll get the X-ray results backthat afternoon and I'm calling
them by the end of the daysaying this is what it is and
this is what we need to do.
Mind blowing and it's so sadthat this crap is mind blowing.
'cause it's it's literally ifthe system is working well and
we're literally working for ourpatients, I mean, we are
behooved to do these things.
And, and, and you're still notoh, I will get back to you

(01:00:57):
within 24 hours.
I mean, 48 business hours.
Totally reasonable and also notheard of in most clinics to even
get a call back.
Well, I know, and I, I think itjust introduces that, as we say,
all the people in between thepatient and the doctor and
you're playing, we all know thegame of telephone, right?
And so if you're not directlyhaving that conversation and the

(01:01:20):
doc like, I don't need to golook in my patient's chart, like
they can call me and I knowexactly what's going on and
there's not that 20 levels ofthe game of telephone that by
the end the message gets,totally messed up.
And, and quite frankly, in ourwork, that's dangerous.
Absolutely.
And that's, I mean, I thinkabout your comment about how so

(01:01:42):
many people in hospice whoyou've seen have pathologies
that have totally, could havegone a different way if had they
had access.
And it's I, I think that dangeris very, very apparent in the,
the healthcare system wheninsurance codes are involved.
Yeah.
And denial of insur or, anddenial of, access to healthcare
is like the, the top decisionmaker happens.

(01:02:03):
I mean, I would, well, and I wasgonna say, I would say to our
policy makers, I don't even knowwhy we're talking about, it's
like right now we're, we're justscratching the surface of
putting a bandaid on a giantproblem.
We have the technology and theability to do purely
preventative medicine, longevityand preventative medicine.

(01:02:25):
We have that technology, we havegenetic testing, we have full
body MRIs, we have all the toolsat our disposal, and we're still
doing this sort of reactive, notpreventative medicine.
And I don't know whypolicymakers cannot see that
even in their own healthcare.

(01:02:46):
Policymakers that have hadcancer policy makers that have
had this, that, and the other.
Think about your own healthcareand how what happened to you
could have been prevented somany steps prior to that.
As a country, we stoppedthinking about bandaids and
reactive medicine and movedtowards super preventative

(01:03:07):
medicine.
Like we can do that.
And I don't know why we're not.
Amen.
But DPC could be that road.
And it is.
I I, that's what I was gonna sayin response.
Exactly.
That is we are not waiting forthe policy to, allow us to do
what we're doing.
Right.
We're just saying boardcertified, licensed physician

(01:03:27):
surgeon, I can do my things.
'cause that's what I went totraining for.
And you did do so amazing.
What is one of the mostsurprising things that you found
out about being an entrepreneur?
It's really easy.
I mean, everything has pros andcons, right?
If you work for a big hospitalsystem, you're gonna have all

(01:03:49):
kinds of perks and things, butmaybe you won't have control
over your schedule.
And then when you're, a solepractice, company, I don't have
a lot of like those perks, but Ihave total control over my
schedule.
So it's two opposite ends of thespectrum.
And there's all the in-betweensand, everybody's different and
they're gonna choose what's sortof right for them.

(01:04:10):
But I think the mostdiscouraging thing was that when
I was a resident, so thiswould've been back in the, like,
when was I resident?
2011, 12 in that area.
They were like, oh, you can'tsurvive in private practice
doing family medicine.
Are you nuts?
You'd have to see 50 patients aday and the insurance and the

(01:04:32):
overhead and oh, you'll nevermake it.
And and so we were really soldand that was, I would say now
with DPC, there's a lot ofpeople going into private
practice, but in general, a lotof those old solo or small group
practices were being bought upby all the big hospital based
companies because they reallycouldn't survive.

(01:04:52):
And I mean, I kind of would sayit's really hard to survive as a
sole practitioner if you'retaking insurance these days.
But overall, there's people fromall walks of life that start
businesses and that areentrepreneurs and all different
kinds of things, and then is nodifferent.

(01:05:13):
When you take insurance, I hateto say it, but you know, you're
working for the insurancecompany, you're not doing what's
right for the patient.
You're doing the best possibleoption you can do for the
patient that the insurancecompany allows on their
timeframe or that the patientcan afford.
So true.
See, watch, talk.

(01:05:34):
Hello, this is Nolan here.
Yeah.
You got it.
See how it, it moves the, itmoves the line?
Mm-hmm.
Did you see that?
Yes.
See, watch, say Hi, this isNolan here.
Hi, this is Nolan here.
See, it moves the line.
Okay.
Ready?
Now can you say.
Hi, this is Nolan here.

(01:05:55):
Hi, this is Nolan here.
Thank you.
Thank you for listening toanother episode, to another
episode of my DB, C story.
Have a great rest of the day.