August 24, 2026 • 31 mins
Direct primary care costs $80 a month for adults and $60 for children at Prairie Roots Health in Sioux Falls, and it buys unlimited visits, one-hour appointments, and your provider's cell number.
Sam Niewenhuis is a family nurse practitioner and founder of Prairie Roots Health, a direct primary care clinic in Sioux Falls, South Dakota. Host Melissa Goodwin asks him what people type into Google before they switch: what direct primary care is, what the membership actually covers, whether you still need health insurance, what happens when you need imaging or a specialist, what a full lab panel costs, and whether an HSA can pay the fee. Sam caps his panel at 200 to 400 members. Conventional primary care runs 3,000 to 6,000. That ratio explains almost everything else in this conversation.
In this episode
- What direct primary care is, described by a practicing family NP: "an innovative alternative to insurance driven healthcare"
- What $80 a month covers for adults, $60 for children, and why he calls it unlimited
- Why he gives members his cell number, and how rarely it actually rings
- A full hour with a new member instead of fifteen minutes with a nurse first
- Why he still tells people to carry a catastrophic plan, a high deductible plan with an HSA, or a health share
- A comprehensive lab panel at wholesale for roughly $100 to $150
- Who bills your insurance when you need an X-ray, imaging, or a specialist
- Direct primary care versus concierge medicine, cleanly separated
- Why family practice providers refer out biopsies and workups they are trained to do
- The Weston A. Price Foundation, fermented foods, fiber, and freshly milled grain
- A myth round: HSAs, wealth, medical records, alternative medicine, and whether DPC is a fad
- Who direct primary care is honestly not a good fit for
Chapters
- 0:00 Health advice is confusing, and that is the show
- 0:41 Medicine used to come to your door
- 1:31 What is direct primary care?
- 2:04 What $80 a month buys, and $60 for kids
- 2:10 Why members get his cell number
- 4:32 A full hour, not fifteen minutes
- 5:41 Getting seen the same day you call
- 6:34 A flat fee and no surprise bills
- 7:35 Do you still need health insurance?
- 8:14 Why paying cash changes who shows up
- 9:24 Labs for $100 to $150, not insurance pricing
- 10:06 Who actually joins a DPC clinic
- 11:27 Primary care is underused, and dermatology waits
- 13:06 Imaging and specialists: who bills your insurance
- 13:49 Why he left the conventional system
- 16:50 House calls, still a real thing
- 17:17 The cholesterol phone call that sends people looking
- 18:36 The Weston A. Price Foundation and food as medicine
- 19:37 Freshly milled flour, and why store flour is empty
- 20:48 Why so many young people have gut problems
- 23:44 Myth: DPC is concierge medicine, renamed
- 24:19 200 to 400 members versus 3,000 to 6,000
- 24:50 Myth: you cannot use an HSA for direct primary care
- 25:12 Myths: only for wealthy people, and losing your records
- 26:07 Myth: direct primary care is a fad
- 26:28 Who should be calling him tomorrow
- 27:05 Chronic illness and functional medicine
- 27:42 Who direct primary care is not for
- 29:00 The free meet and greet, and how to find him
About the guest
Sam Niewenhuis, Family Nurse Practitioner, is the founder of Prairie Roots Health, a direct primary care clinic at 5010 S Broadband Ln, Suite 110, Sioux Falls, SD 57106. Phone (605) 307-5737. He practices full scope family medicine from newborns through adults over 75, offers house calls in the Sioux Falls area, and is finishing his certification with the Institute for Functional Medicine. He is part of the Weston A. Price Foundation.
prairierootshealth.com/direct-primary-care
Resources mentioned
- Weston A. Price Foundation
- Institute for Functional Medicine
- Samaritan Ministries (named as an example of a health share)
- IRS Notice 2026-05, the HSA and direct primary care rule effective for months beginning after December 31, 2025
About Dialed In Health
There is a new health trend every week and half the time you cannot tell what is legitimate and what is good marketing. Dialed In Health brings in the people who do the work and asks what you would ask if you were sitting across from them. Hosted by Melissa Goodwin. Weekly, across Sioux Falls, the Twin Cities, and Omaha.
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- Watch this episode on YouTube: [YOUTUBE URL]
- Full transcript, chapters, an
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Episode Transcript
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(00:00):
Health and wellness is confusing.
There's a new trend every week.
Everyone's got an
opinion, and half the time,
you can't tell what's legit and what's
just good marketing.
And we get it.
We're in it too.
Welcome to Dialed In Health.
I'm Melissa Goodwin.
Every episode, we bring in the people
who actually do this work,
providers, practitioners,
the experts who see
clients and patients every day.
We ask the questions you'd ask
(00:21):
if you were sitting across from them
so you can find the right
people, make better decisions,
and feel confident
about what's out there,
whether it's peptides, gut
health, water quality, ADHD,
biohacking, or
something you've never heard of,
we're covering it.
So let's get into it.
Let's get dialed in.
(00:41):
Welcome to today's
edition of Dialed In Health.
I'm really excited because this one,
we're gonna hearken back a little bit
to how medicine used to be practiced
when a doctor would show up
at your door with a doctor bag.
Prior to my time, I don't
remember any times like that,
but I've heard of this, right?
When my parents were little.
And we're gonna talk a little bit about
direct primary care.
(01:01):
So this is a newish model in
some places in the country.
You may have heard of
it more than others.
But today I am at Prairie Roots Health
with Sam Niewenhuis,
who is a family nurse
practitioner, family practitioner
who can see just about
anything from what I'm understanding.
And I'm really excited
for our conversation.
Welcome to the show.
(01:21):
Yes, thank you.
So first, before we like
tell us direct primary care,
it's kind of a new
model, different than maybe
what most of us are used
to when we go to the doctor.
So can you explain what
direct primary care is?
Yeah, so I like to
say direct primary care
is an innovative alternative
to insurance driven healthcare.
People pay a low
monthly fee and in return,
(01:42):
they get a lasting
relationship with their provider
who happens to be me.
And they can build that trust that way
and get the care that they need, so.
Okay, so for those that maybe like never,
this is still a little foreign.
You pay a monthly fee.
And then what do I actually get?
So I might pay between 60 and $80 a
month, is that right?
(02:03):
Yeah, yep, yep.
So 60 for children, 80 for adults.
And essentially you get me.
You get your
relationship with your provider.
So I give people my cell phone number out
so they can contact me if they have
urgent needs after hours.
They get unlimited visits
here with me at the clinic.
So everything from,
hey, I just wanna come in
and I saw this thing on the internet
or they send me an
(02:23):
email, unlimited contact.
So it's just opening
that door of access to them.
That makes it easy.
And I love that
because there's so many times
where you're like, is this something
I should be worried about?
Or is this something
that is like totally fine?
But I don't wanna make a
$200 appointment at my doctor,
a $400 appointment to go find out
(02:44):
if like this weird
growth on my arm or mole
or something's tinnitus
or whatever it might be.
So tell me, you know,
I always thought that was more for like
really wealthy people.
They could message my doctor,
but you do that for everybody.
Yeah, that's one, I guess, Hill,
we've had to climb as a
direct primary care community,
(03:05):
DPC community across
the nation is getting it,
people in the mindset
that this is for everybody.
I just, my
mother-in-law told me this weekend
that Netflix
subscription is like $45 now.
And it's like, okay,
well, yeah, for $15 more,
you can pay to have
unlimited healthcare visits
with a primary care person with your kid.
(03:26):
You know, it's like, it's,
the price hurdle is not as
unrealistic as people think.
They keep raising the
price of that Netflix
and I didn't even realize that.
Yeah, it's insane.
So how many visits can
a person have with you
for that monthly fee?
Yeah, it's
technically worded as unlimited.
With the, you know, I
think it's very rare
people bought in, you know,
(03:46):
they generally respect
the barriers of like,
hey, I'm not gonna
literally see you every day.
Right, right.
You have to set that up,
set those boundaries up with patients.
But you know, most people get it.
Most people are
realistic and normal people
and they respect you and how it operates.
So, hasn't been an issue.
So tell me how many text
(04:06):
messages do you really get?
A lot?
So after hours, almost none.
Okay.
I have a few patients
who are very early patients
that knew me that are
very comfortable with me.
But other than, I mean, realistically,
you just kind of set it up of,
hey, use the patient portal mostly,
unless it's something really urgent.
And I would say I have
(04:26):
less than five patients
who are comfortable texting me
and it's rare that I
get texts from them, but.
Okay, so how long, if I
were to come into Prairie Roots
and set up a visit, how
long is a typical visit?
Because I know, I used
to work in healthcare
for a lot of years and there was like,
they, you know,
physicians are paid in RVUs
and you have like 15 to
20 minutes and that's it.
(04:48):
What does your visit look like?
I take an hour with many patients.
So when you come in and
schedule that first visit,
we get a solid hour.
And the nice part is,
even if we don't make
it through everything,
you have a lot to talk about, you know.
I'm very just like,
hey, come back next week
and you know, we'll
finish our conversation,
we'll get labs.
In the meantime, we'll
do all this other stuff.
You try this and we'll
(05:09):
just touch base next week
and have you in again.
So, a solid hour.
And that's an hour I get in front of you
versus when you go to the normal doctor,
there's 15 minutes
with the nurse asking you
all the questions like, this
is face to face, hour time.
Yeah, that's the one thing I've noted.
Like you go to the
doctor, you meet with a nurse
and there's usually
another nurse that comes in
and asks more questions.
And the doctor comes in and asks you
(05:30):
the exact same questions again.
Sometimes the nurse comes back for labs
and then, you know, you just, it's very,
it's kind of like this
machine that you're in.
So, if somebody, one of the things that,
that's always been
frustrating to me when I've tried to,
they asked, do you have
a primary care provider?
(05:51):
And I'm like, no,
because I never see them.
Why would I even bother?
Because every time I'm sick, I call in
and I get whoever is available.
If I'm sick and I call
in here, what happens?
So, either I answer the
phone or the front desk
answer the phone and they're
right across the wall from me
and they just get a message to me
and it's as easy as that.
(06:11):
I purposely keep a couple
slots open a day for my members
if they do need same day appointments.
So, there's always gonna be
availability when you need it.
You know, we make
sure to prioritize that.
But it's very, in
conventional medicine, yeah,
they just have too many
patients, too full of schedules.
They just don't have the
time to be able to flex
and get those patients in same day.
(06:34):
So, let's talk a little
bit around the insurance
or the money side a little bit.
Because I do think that's one thing that
people struggle with,
right, with these new models.
Because we're so used to paying insurance
and getting services, then
you get a bill in the mail,
like sometimes it's six
bills, maybe, afterwards.
Tell me, how does that
(06:54):
work with your system?
We're very transparent with our fees.
We have a small lab
draw fee when we draw labs
just to help cover costs.
And we do have a
full-time phlebotomist, typically.
And it's just that
monthly subscription fee
and that's it.
So you're never gonna get a
surprise bill in the mail.
I'm a firm believer that
insurance is way too influential
(07:16):
in conventional medicine
and dictate way too much
of the patient-provider relationship,
which really should be sacred.
And that's what this is
really trying to bring back.
So, if we can eliminate any of those
financial questions,
barriers, concerns for people,
and they just know up
front what they're gonna pay
when they come see me,
that's really the goal.
That's really what
we're trying to get at.
So, do you not need insurance?
(07:37):
So, we encourage people,
I have patients that
don't have insurance,
but I encourage
people to have some sort of
backstop for insurance,
whether that's an Aflac catastrophic
hospitalization plan,
whether that's a high
deductible plan with an HSA account
or a health share like
Samaritan Ministries,
have something for that, you know,
you get appendicitis end
up with emergency surgery,
(07:57):
you know, you're gonna
be stuck with a huge bill
if you don't.
So, it's wise if you can afford it
to still have some
sort of catastrophic plan.
In case there's a car
accident or a cancer diagnosis
or something that requires quite a bit of
Yep.
extensive medical intervention.
So, how do you help
someone who may be just
(08:18):
an average person who's working
that doesn't have a lot of extra money?
Yeah.
How do you help them
kind of overcome this like,
"Have insurance, why
would I pay out of pocket?"
Like, how do you work
through that with them?
Whatever barrier we can break down
to at least get them
face to face with someone.
Because it sounds like
you're describing the person
who's, you know, lower income, you know,
(08:39):
maybe even qualifies for
like a Medicaid type situation
where they're getting some sort of
government assistance.
We know in conventional medicine,
just getting that person
through the door is huge
because those are the people that'll
flake on appointments,
you know, not show up, not
pick up their prescription,
not be compliant.
So, when you pay cash for something,
(09:01):
you're getting that buy-in too of people.
A lot of times it really
eliminates that patient
almost all together for us on our end
because people are ready if
you're handing over money,
it feels different than
just using a Medicaid benefit.
Sure.
It almost feel like
you're stealing, right?
So, that buy-in there we
experienced great buy-in
from patients and, you
(09:22):
know, they do well there, so.
Yeah.
So, when somebody spends
a year with you, you know,
like if they're spending,
if they need to do some labs,
like what would be, what
would you say a typical
all-in cost for direct primary care?
If the patient's never had
expansive labs drawn before,
you know, 100 to 150 bucks,
(09:42):
I can get what they
would get at a regular doctor
plus everything you
would see on a, you know,
Dr. Axe panel plus
probably some more actually.
So, we can get really
affordable wholesale lab costs
and, you know, any DPC
provider can do that, you know,
there's a little extra hurdle of
shipping, but it's great.
I mean, we can, a lot
of times even cheaper
(10:02):
than using your insurance,
just paying the wholesale costs for labs.
So, you've been doing
this now for almost a year,
is that right?
Yep.
Tell me a little bit about
how would you characterize
the folks who've come to see you so far?
Like, what kinds of
people come to see you?
Oh man, I've had cute old men
all the way down to newborn babies.
We've had a variety.
(10:24):
I mean, I have a really
good mix of age group.
I think a third of my
practice is children,
two thirds is adults and then, you know,
a handful over the age of 75.
But really seeing all types
and most of them share their,
some sort of concern
with conventional medicine,
whether that's because
they're super, super crunchy,
eating organic chicken, you
know, doing all the things
(10:45):
versus someone just had a bad experience.
And now they're here at our door
because they want something different
and they don't even know
what functional medicine is,
or what this clinic does,
but they know that I have primary care.
Right.
So I think one of the
things that many of us,
because we just sort of
like look at a big hospital
and say, oh, that's
where I go if I'm sick,
(11:06):
or if I'm not feeling well,
most people don't even
realize there's alternatives
to traditional care.
Yeah, that's been a big challenge for us
is getting in the
community of Sioux Falls,
as DPC is new, and so
people just don't know
that there's another option out there.
And so getting people
to think outside that box
has been the challenge.
And I think we're making headway.
(11:27):
And I think too, people just underutilize
primary care doctors and family practice.
Providers don't practice at
their fullest extent either.
You know, they're busy
and they don't really
want to do that skin biopsy.
They would rather just refer to
dermatology to do it.
You know, they don't have that extra time
to spend with patients.
They really could do more
than what the system
is allowing them to do.
And we get to do that
(11:48):
here, which is great.
So tell me a little bit more about that.
So you say we're
underutilizing primary care.
Tell me more.
So traditionally primary
care should be a gateway
to the specialist, right?
And now we can, you can
call up an orthopedic doctor
for shoulder pain that
actually might be your gallbladder,
but you think it's shoulder pain.
You really should have help deciding
(12:08):
what specialist you need to see, right?
We should, as family practice providers,
be able to do a simple skin biopsy
without seeing dermatology
and waiting eight months.
You know, we have training
and experience in these areas
where we can do more than time allows.
A lot of times on the
conventional side, you know,
you are just limited
by throughput and time
and insurance burden.
(12:29):
And so they end up getting, you know,
I did plenty of rotations
with people that's like,
they refer everything
out and they don't do,
they don't spend the
time to work up anything.
It's like, oh, you think you
might have a thyroid problem?
Just send them to
endocrinology, you know,
like just very quick,
easy button referral out
when they should be utilized more.
Got it. Okay. That makes sense.
(12:49):
And I guess, you know,
dermatologists are really hard
to get into by the way.
That's insane.
And part of that, this
is part of the reason why.
Yeah. Because like you do
not need to see a dermatologist
for probably 90% of the things
that actually get sent to dermatology.
Yeah. I guess I'd
never thought about that.
You're right.
So that's, that's good to know.
How do you, let's say, you know,
because you're a smaller
clinic or if somebody does,
(13:11):
you feel like they need
an x-ray or a specialist
or they need medications,
how does that work with you?
Super, super common question.
Whatever facility is doing
the image or lab or procedure,
they're the ones that bill insurance.
So if you carry, I can
refer out to Sanford or Avera,
whatever I want done there.
(13:31):
And then they're the
ones doing the billing
with your insurance.
So I get to stay
completely hands-free off of that.
But if you need to see a
specialist, I can get you there.
You know, I can refer
you just like you would
any other doctor.
So it's a great option.
And that's part of the
reason why we like to have people
maintain health
insurance on the back end.
Do you run into any
providers from your old life
(13:54):
when you were in the traditional health,
are they jealous?
I wouldn't say jealous.
They're more confused,
like just, okay, cool.
If it works, it works, you know.
So it's just, it's new to them too.
I mean, most providers haven't,
most medical providers
haven't heard of this either.
And so.
(14:15):
I see, or I've run into a lot of,
so I used to work in the innovation space
and I would work with a lot of docs that,
and all kinds of
providers, not just doctors,
that brilliant ideas, they wanted
something different.
And they all kind of dreamed of like,
what if I went off on my own?
But you're in this system and you've,
I don't want to say golden handcuffs,
but you're used to it,
(14:36):
you know how it works.
Sometimes the W knows easier
than the one that you don't.
It's kind of brave to go off and do
something different.
Like what made you want to do that?
I was in a place, both
professionally and personally,
that I was ready for a change.
So personally I had begun learning about
functional medicine,
had changed how my family was living.
(14:57):
My wife had some
personal gut related issues.
So we did a lot of functional medicine,
gut things with her, trying to fix her.
One of my kids had a tongue tie.
We just had a lot of personal things
that were leading us down the space.
And then just professionally,
I was ready to be able to
spend time with patients
to actually do things
that I think they need
instead of fighting with insurance.
(15:19):
Spending the time, I was
notorious and back at my old job
for being in a room for
two hours with a patient,
just talking and getting to know people.
And that allows me to,
this allows me to do that,
to kind of do medicine
the way my personality
and the way I want to do medicine,
without anyone telling me what to do.
Yeah, I love that.
Yeah, so I think, I
(15:39):
guess it was just to say,
there's a lot of people that do wish
they could sort of move
into a space like this,
but it just seems so
unfathomable to them to do that.
So I think that's great.
So when people come through
your door and they see you,
what is they, do they give you any like,
oh, this is different than I expected.
What do they say?
Most people are like really bought in
(16:04):
and enthralled with the first visit.
I mean, they're like, oh, this was great.
This was so much
different than my regular doctor.
It just, cause I mean,
the space feels different.
The leisure, the
casualness of having a conversation,
the time we get to be
thorough, they're like,
this is what people,
typically what they're wanting
at their regular doctor,
(16:24):
what they're expecting even,
from a regular doctor.
And it just frees us up
to be able to do that.
And so, I mean, I haven't
had anyone walk out of my door
initially unhappy.
They're never coming here again.
Yeah, yeah, most people
are like, yes, I'm up.
Once you get them through this door,
they're sold on the model.
They immediately see the benefit of it
and how it can be powerful
(16:46):
and what kind of
service it brings to them
and how they can use it.
So I sort of made a
little bit of a hat nod
to the old days where
the doctor would show up
with a doctor bag.
You do that too, like
you will do house visits?
I will do house visits.
Okay. Yep, within reason.
I've only done one.
It was a neighbor of mine actually.
We signed up for membership on the spot.
(17:07):
I love it. We did it, but yep.
Yeah, it was great.
Yeah, we do doctor's visit
within the Sioux Falls area.
So tell me, I heard
that there was a patient
that had, they found out
they had high cholesterol.
So told they'd be on medication for life,
never spoke to their doctor.
Tell me about, can
(17:28):
you tell me a little bit
about some of the stories like that?
Yeah, it is super common.
I see it, I mean, I
have, I can think of a number
of patients off the top of my head
where they ended up with me
because a nurse called them
to tell them that, hey,
your blood came back as this
or this doctor wants to start a blood
pressure medication.
And that was kind of the
end of the conversation.
Or even just a portal message of, hey,
(17:48):
we're sending this script
in for you on the computer.
And that's just, I mean, when I was even
in conventional medicine, I
would try to take the time
to call a patient if
you're starting a med
or changing something,
especially in med they might be
on the rest of their life.
Like that's a big deal for people.
I think doctors just, we
just get really calloused
of like how big a deal it
is for people to like go
(18:09):
from no medications to a
prescription medication.
That is, makes people feel old,
it makes people feel different.
It's a big deal and
it's just a small thing
to make people feel comfortable of like,
hey, I'm gonna actually give
you the respect to call you
or have you back in to
talk to you about this
before we start this.
Yeah, and it is a big
deal if you haven't,
(18:29):
a lifetime med is not
something to be taken
just nonchalantly, I
would agree with that.
I've got a few things.
Now you, I saw on your
social media, is it kombucha?
Were you making kombucha or bread or
something from scratch?
We make a lot of things.
Yeah.
Yeah.
So tell me about your
passion projects at home
(18:50):
or your food.
Yeah.
Yeah, what do you do there?
I'm kind of the food guy around here.
Yeah, so I'm part of something called
the Weston A. Price
Foundation, which has been a big
influence on my
family's health and how we eat
and frankly how I counsel patients to eat
and talking about children's nutrition
and even adults and that kind of thing.
But yeah, there's some
(19:11):
principles that that foundation
advocates for which
is animals on pasture,
fermented vegetables, raw milk and
fermented dairy products,
freshly milled grain, bone broth,
you know, a variety of things like that,
that becoming fairly popular in the
(19:32):
crunchy natural world,
but very healing and great things.
So we do cut all of it.
So do you mill your own grain
and do you have one of those things?
Do you make your own bread?
My wife mostly does.
I made freshly milled,
I made freshly milled
buttermilk pancakes this morning.
Okay.
They just take the wheat,
they call them wheat berries,
which I learned this
a couple of years ago.
And then you just have a plug-in mill
and you just pour it in
the top and out comes flour.
(19:55):
That's something, you know, I
had an Uber driver in Austin
and he said he used to
work at like a flour mill
and I was like, okay, whatever.
He's like, they are disgusting.
And he started telling me how the bugs
and the larva would
lay eggs in like the top
where the flour is and
how many insects and bugs
are in flour and he's like,
there's actually a
(20:15):
percentage that's allowed.
That's nice.
In like, so your
cereals and all the things
because there's no way that he's like,
they would scrape them out.
So disgusting.
Yeah.
Now the flour mill makes sense.
Yeah, and it's great.
Cause the second you grind
that, it starts oxidizing.
And the longer it sits,
it becomes less nutritious
(20:36):
and more inflammatory to
you cause it's oxidized.
So like the store bought flour
is just empty calories and nutrition,
whereas a freshly
milled whole grain wheat
is actually quite healing.
Okay.
Interesting.
So sounds like you've done a lot of work
around the gut and food and food health.
So why do you think
that there's so many people
young people that are
having gut problems?
(20:58):
There's, I mean, this
is a giant rabbit hole.
It is a rabbit hole.
There's a lot, but one thing is
we just don't do a lot to
maintain the microbiome.
I mean, two things stick out to me.
One is just lack of fiber consumption.
We have a lot of processed
food with low fiber, right?
We should be getting 30
to 50 grams of fiber a day,
which is frankly difficult
(21:19):
to eat that in whole food.
And so between that and then
fermented foods
provide probiotics, right?
And so 200 years ago, we
didn't have refrigeration.
We didn't even have
modern canning, right?
So the only way to preserve food was
through fermentation,
both beverages,
condiments, eggs, you name it.
They were fermenting it.
(21:40):
It would stay shelf stable
for a really long time that way.
So with every meal they were eating
something fermented,
something with probiotic,
and so they're
constantly nourishing their gut.
And I think the benefits
of fermented food kind of
go ahead of me.
I mean, people know they're good for you.
I mean, short chain
fatty acids, butyrate,
the amount of fiber in it,
it unlocks nutrients
for certain nutrients
(22:01):
that otherwise wouldn't be available.
It pre-digests the food for you.
It usually has a ton of fiber.
I mean, all the probiotics in it.
I think kefir's got 60
to 80 different strains
of bacteria in it when
you do homemade kefir.
It's just incredible, yeah.
Well, and it's just, you
know, I grew up in the 80s
where everything was like low fat,
or it was like they
actually added more sugar
(22:22):
because everything was low fat.
And I don't even remember
hearing the word kefir.
So it's for a lot of
people like me, Gen X,
where you grew up on
Kool-Aid and cereal and whatever,
even that has gotten
different over the last 30 years
in terms of what's in those things.
kefir and milled
bread sounds so foreign.
How do you have people make that leap to?
(22:43):
Yeah, I mean, a lot
of people who I end up
having this conversation with,
they're already ready for a big change.
It's like, you know, I try
to get them in the mindset of,
hey, this is gonna do more for you
than any supplement or
medication I can give you,
if what you're
putting in is so important.
And people kind of know that.
(23:04):
People kind of know that intuitively.
But we do, my wife and I
have taught a couple classes
with this talking about
how we do our food prep
at our house.
I have four kids and
our fifths on the way.
If I can do it at
home, you guys can do it.
It doesn't take that much more time.
It just takes a little forethought.
And we've walked people through that.
We've recorded that and have that
(23:25):
available for patients.
So we try to do what we
can to get people started
in the right direction.
Yeah, baby steps.
A couple of, some small
changes can make huge results.
Oh yeah, and now you can
just do one thing at a time.
Don't do everything.
Start with soaking your beans.
Just get in the habit of
that first or something.
Yeah. Or something easy.
So I have some statements
(23:46):
that you can tell me true or false.
Direct primary care is
just concierge medicine
with a nicer name.
I think there's a partial truth in that.
No, DPC is more strictly cash-based
and completely free of
insurance entanglement.
Concierge, a lot of them
(24:06):
will still bill insurance
for patients.
It's usually quite a bit more expensive
and they have way less patients.
So I mean, some of
those concierge service,
50 patients, you know.
I'll carry a little more on my panel.
Two to 400 is kind of
what I'm planning of.
That's the most I'll ever
be able to take at one time.
So you said you cap
(24:26):
your panel at two to 400.
What is typical primary,
that's like the number of
patients you have, right?
Yeah, yeah. For those that maybe
don't know what those terms mean.
On membership, yep.
So what is typical primary care?
Three to 6,000 depending on the system.
Wow. This is crazy.
Yeah, I mean, that's why when you call,
you can't get in for two or three weeks.
Or you have to go to
urgent care or ER or something
because they're just booked out
(24:47):
and they just have too many.
Too many.
All right, you can't use
HSA for direct primary care.
You can use HSA to pay
the direct primary care fee.
Okay.
So it was a gray area before January.
This January it became officially
announced in tax code
that you can use HSA for paying for
direct primary care.
(25:07):
And that's for your subscription as well?
Yep, yeah, that's what I mean.
Yep, subscription, yep.
All right, it's only for wealthy people.
That is totally false.
Typically, I haven't
actually had a lot of,
I don't think wealthy people, I guess.
I don't know what my patient income is,
but no, it actually makes healthcare
somewhat more affordable a lot of times.
(25:29):
If you switch, you lose
all your medical records.
That is false.
You are an owner of your medical records.
Wherever you've had care before,
they're legally required to maintain
those records for you.
So it's just a matter of requesting them
and getting copies and things like that.
You have to be into alternative medicine
and alternative lifestyles to fit in.
Absolutely not.
(25:49):
Okay.
We get people from all walks of life,
the people who are just
totally hardcore conventional
and they just want a better product
to people that are
outside of conventional space
because they don't like pharmaceuticals.
I mean, we get the whole gambit, so.
What would you say to folks who say
this is just a fad?
(26:11):
I think that, I mean,
the original DPC clinics
were starting in 2010, 11
were kind of the initial ones
out on the East Coast,
from my understanding.
And it's done nothing
but grow over the last,
I mean, we're close to 20
years of DPC being a thing
in the United States.
So I think it's well
past the fad stage, yeah.
All right, so who, if
you think about the people
(26:31):
who should be calling you tomorrow,
somebody who's like an
ideal patient for you,
what is that, who would those people be?
I think it's that person
that just can sense something
is not sufficient with primary care.
I think most people,
they end up getting the care
that they need and
heavy air quotes there,
(26:53):
but they just feel like it's insufficient
or they're missing something
or they're just a little unsatisfied.
Those are the people
that don't even realize
that there's a better
product out there that they want,
that they don't even know they need, yep.
What about like if
you've got a chronic illness?
Yeah, yeah.
Is that something that you help manage?
Yeah, so I am nearly
complete with my Institute
(27:13):
for Functional Medicine
training and certification.
I have one course left.
It's, I mean, really the gold standard
of functional medicine training.
So I pull in functional medicine concepts
to how I do primary care.
So if the person needs
that, I'll pull that in.
I mean, people get functional medicine
from me all the time.
They just don't even
realize they're getting it.
Okay.
Because I mean, most
of functional medicine
(27:34):
is talking about your lifestyle.
What are you eating?
How are you moving?
These things that I just work that into
how I care for the normal patient, so.
So is there anyone that,
in terms of how Prairie
roots and your overall ethos
and what you believe
and your style of work,
is there anyone that this is not for?
(27:54):
I wanna say no.
I think we can,
especially me having my background
in conventional that I can get along
with pretty much anyone.
Okay.
And can find a space
that's right for you.
We don't wanna touch
pharmaceutical or supplements.
We don't have to use supplements.
If you don't wanna touch pharmaceutical,
I'll advise you, but we can
try doing the supplements.
But I'm gonna tell you what
I think and what you need.
(28:14):
But if you're not willing
to invest in your health,
cause there's that barrier there,
I think that's the type of person,
if you're really tight
and you don't wanna pay
that $80 a month to get a better product
and invest that little bit extra time
and effort into your care,
you're not gonna like what I
have to say to you either of,
hey, you gotta do this
(28:35):
or change how you eat
or start moving a little bit more.
It'd be harder.
So it sounds like
maybe if somebody's looking
for a pill to fix everything,
it's probably not the right fit.
I could do it.
I've done it a lot.
I don't know.
It was part of my conscience in
conventional medicine
was I've had to do that a lot
and I inevitably will
get people like that.
But yeah.
(28:55):
Ideally we'll find some other things
that we can help look at first.
If somebody's
interested but a little nervous,
not sure what's the first step.
Yeah, so I offer, we
call the meet and greet,
just a 15 minute in
person or phone call with me.
So you just call the office and say,
I wanna chat with Sam
for a while and kinda see
(29:16):
and I'd be happy to talk to you
or meet you at the office
and just go over what the
questions are and concerns are.
All right.
Well, if somebody wants to find you,
how do people find you?
Where do they look
you up and get in touch?
Yeah, the clinic's all on social media,
Instagram and
Facebook, Prairie Roots Health.
And it's very easy if you
(29:36):
Google Prairie Roots Health,
it'll pop up here in Sioux Falls
and just give the clinic a call.
Absolutely, all right.
Well, we'll make sure to put
those in the show notes too.
So if you're watching on YouTube,
you can click on the description.
We'll put a link to Prairie Roots Health
and Sam Niewenhuis and his
name, Sam Niewenhuis
and you can connect
and call directly there.
But thank you so much for describing
(29:58):
direct primary care to us today
and the new model and
just so that people know
that there's an alternative.
Yeah.
If things aren't working out.
Anything else you
would want people to know
about the work that you do?
I don't think so.
I think we can make things work
for a variety of people and backgrounds.
I would just encourage
you just sit down with me,
have a conversation.
Absolutely, okay.
(30:18):
Well, great.
Thank you so much for being on the show.
We'll look forward.
I know there's lots of
things we could talk about.
So we'll look forward
to maybe having you again
down the road to talk
about some other stuff.
All right, take care.
Yep.
Hey, that's our show.
If someone came to mind
while you were listening to this,
if you thought, "Hey, my
sister needs to hear this,"
or, "I should send this to my mom,"
(30:38):
or, "My buddy would
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please share it with them.
Just hit the share
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You never know what one
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And if you haven't
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you won't miss an episode.
We've got incredible stuff coming up
and I don't want you to miss any of it.
(31:00):
And if you're a
health or wellness provider
and you wanna be on the
show, we'd love to hear from you.
There's a link in the
show notes to get in touch.
We're always looking for
people doing interesting work
who wanna share what they know.
And one last thing, I
get asked all the time
about the products and
brands I actually use.
So I put together a list of
sponsors and favorite products
that have worked for me and my family.
If you're curious, that
link is in the show notes too.
(31:21):
Thank you for being here.
And I really mean that.
I'm Melissa Goodwin.
The line is open.
See you next time.
(upbeat music)
Health and wellness is confusing.
There's a new trend every week.
Everyone's got an
opinion, and half the time,
you can't tell what's legit and what's
just good marketing.
And we get it.
We're in it too.
Welcome to Dialed In Health.
I'm Melissa Goodwin.
Every episode, we bring in the people
who actually do this work,
providers, practitioners,
the experts who see
clients and patients every day.
We ask the questions you'd ask
(00:21):
if you were sitting across from them
so you can find the right
people, make better decisions,
and feel confident
about what's out there,
whether it's peptides, gut
health, water quality, ADHD,
biohacking, or
something you've never heard of,
we're covering it.
So let's get into it.
Let's get dialed in.
(00:41):
Welcome to today's
edition of Dialed In Health.
I'm really excited because this one,
we're gonna hearken back a little bit
to how medicine used to be practiced
when a doctor would show up
at your door with a doctor bag.
Prior to my time, I don't
remember any times like that,
but I've heard of this, right?
When my parents were little.
And we're gonna talk a little bit about
direct primary care.
(01:01):
So this is a newish model in
some places in the country.
You may have heard of
it more than others.
But today I am at Prairie Roots Health
with Sam Niewenhuis,
who is a family nurse
practitioner, family practitioner
who can see just about
anything from what I'm understanding.
And I'm really excited
for our conversation.
Welcome to the show.
(01:21):
Yes, thank you.
So first, before we like
tell us direct primary care,
it's kind of a new
model, different than maybe
what most of us are used
to when we go to the doctor.
So can you explain what
direct primary care is?
Yeah, so I like to
say direct primary care
is an innovative alternative
to insurance driven healthcare.
People pay a low
monthly fee and in return,
(01:42):
they get a lasting
relationship with their provider
who happens to be me.
And they can build that trust that way
and get the care that they need, so.
Okay, so for those that maybe like never,
this is still a little foreign.
You pay a monthly fee.
And then what do I actually get?
So I might pay between 60 and $80 a
month, is that right?
(02:03):
Yeah, yep, yep.
So 60 for children, 80 for adults.
And essentially you get me.
You get your
relationship with your provider.
So I give people my cell phone number out
so they can contact me if they have
urgent needs after hours.
They get unlimited visits
here with me at the clinic.
So everything from,
hey, I just wanna come in
and I saw this thing on the internet
or they send me an
(02:23):
email, unlimited contact.
So it's just opening
that door of access to them.
That makes it easy.
And I love that
because there's so many times
where you're like, is this something
I should be worried about?
Or is this something
that is like totally fine?
But I don't wanna make a
$200 appointment at my doctor,
a $400 appointment to go find out
(02:44):
if like this weird
growth on my arm or mole
or something's tinnitus
or whatever it might be.
So tell me, you know,
I always thought that was more for like
really wealthy people.
They could message my doctor,
but you do that for everybody.
Yeah, that's one, I guess, Hill,
we've had to climb as a
direct primary care community,
(03:05):
DPC community across
the nation is getting it,
people in the mindset
that this is for everybody.
I just, my
mother-in-law told me this weekend
that Netflix
subscription is like $45 now.
And it's like, okay,
well, yeah, for $15 more,
you can pay to have
unlimited healthcare visits
with a primary care person with your kid.
(03:26):
You know, it's like, it's,
the price hurdle is not as
unrealistic as people think.
They keep raising the
price of that Netflix
and I didn't even realize that.
Yeah, it's insane.
So how many visits can
a person have with you
for that monthly fee?
Yeah, it's
technically worded as unlimited.
With the, you know, I
think it's very rare
people bought in, you know,
(03:46):
they generally respect
the barriers of like,
hey, I'm not gonna
literally see you every day.
Right, right.
You have to set that up,
set those boundaries up with patients.
But you know, most people get it.
Most people are
realistic and normal people
and they respect you and how it operates.
So, hasn't been an issue.
So tell me how many text
(04:06):
messages do you really get?
A lot?
So after hours, almost none.
Okay.
I have a few patients
who are very early patients
that knew me that are
very comfortable with me.
But other than, I mean, realistically,
you just kind of set it up of,
hey, use the patient portal mostly,
unless it's something really urgent.
And I would say I have
(04:26):
less than five patients
who are comfortable texting me
and it's rare that I
get texts from them, but.
Okay, so how long, if I
were to come into Prairie Roots
and set up a visit, how
long is a typical visit?
Because I know, I used
to work in healthcare
for a lot of years and there was like,
they, you know,
physicians are paid in RVUs
and you have like 15 to
20 minutes and that's it.
(04:48):
What does your visit look like?
I take an hour with many patients.
So when you come in and
schedule that first visit,
we get a solid hour.
And the nice part is,
even if we don't make
it through everything,
you have a lot to talk about, you know.
I'm very just like,
hey, come back next week
and you know, we'll
finish our conversation,
we'll get labs.
In the meantime, we'll
do all this other stuff.
You try this and we'll
(05:09):
just touch base next week
and have you in again.
So, a solid hour.
And that's an hour I get in front of you
versus when you go to the normal doctor,
there's 15 minutes
with the nurse asking you
all the questions like, this
is face to face, hour time.
Yeah, that's the one thing I've noted.
Like you go to the
doctor, you meet with a nurse
and there's usually
another nurse that comes in
and asks more questions.
And the doctor comes in and asks you
(05:30):
the exact same questions again.
Sometimes the nurse comes back for labs
and then, you know, you just, it's very,
it's kind of like this
machine that you're in.
So, if somebody, one of the things that,
that's always been
frustrating to me when I've tried to,
they asked, do you have
a primary care provider?
(05:51):
And I'm like, no,
because I never see them.
Why would I even bother?
Because every time I'm sick, I call in
and I get whoever is available.
If I'm sick and I call
in here, what happens?
So, either I answer the
phone or the front desk
answer the phone and they're
right across the wall from me
and they just get a message to me
and it's as easy as that.
(06:11):
I purposely keep a couple
slots open a day for my members
if they do need same day appointments.
So, there's always gonna be
availability when you need it.
You know, we make
sure to prioritize that.
But it's very, in
conventional medicine, yeah,
they just have too many
patients, too full of schedules.
They just don't have the
time to be able to flex
and get those patients in same day.
(06:34):
So, let's talk a little
bit around the insurance
or the money side a little bit.
Because I do think that's one thing that
people struggle with,
right, with these new models.
Because we're so used to paying insurance
and getting services, then
you get a bill in the mail,
like sometimes it's six
bills, maybe, afterwards.
Tell me, how does that
(06:54):
work with your system?
We're very transparent with our fees.
We have a small lab
draw fee when we draw labs
just to help cover costs.
And we do have a
full-time phlebotomist, typically.
And it's just that
monthly subscription fee
and that's it.
So you're never gonna get a
surprise bill in the mail.
I'm a firm believer that
insurance is way too influential
(07:16):
in conventional medicine
and dictate way too much
of the patient-provider relationship,
which really should be sacred.
And that's what this is
really trying to bring back.
So, if we can eliminate any of those
financial questions,
barriers, concerns for people,
and they just know up
front what they're gonna pay
when they come see me,
that's really the goal.
That's really what
we're trying to get at.
So, do you not need insurance?
(07:37):
So, we encourage people,
I have patients that
don't have insurance,
but I encourage
people to have some sort of
backstop for insurance,
whether that's an Aflac catastrophic
hospitalization plan,
whether that's a high
deductible plan with an HSA account
or a health share like
Samaritan Ministries,
have something for that, you know,
you get appendicitis end
up with emergency surgery,
(07:57):
you know, you're gonna
be stuck with a huge bill
if you don't.
So, it's wise if you can afford it
to still have some
sort of catastrophic plan.
In case there's a car
accident or a cancer diagnosis
or something that requires quite a bit of
Yep.
extensive medical intervention.
So, how do you help
someone who may be just
(08:18):
an average person who's working
that doesn't have a lot of extra money?
Yeah.
How do you help them
kind of overcome this like,
"Have insurance, why
would I pay out of pocket?"
Like, how do you work
through that with them?
Whatever barrier we can break down
to at least get them
face to face with someone.
Because it sounds like
you're describing the person
who's, you know, lower income, you know,
(08:39):
maybe even qualifies for
like a Medicaid type situation
where they're getting some sort of
government assistance.
We know in conventional medicine,
just getting that person
through the door is huge
because those are the people that'll
flake on appointments,
you know, not show up, not
pick up their prescription,
not be compliant.
So, when you pay cash for something,
(09:01):
you're getting that buy-in too of people.
A lot of times it really
eliminates that patient
almost all together for us on our end
because people are ready if
you're handing over money,
it feels different than
just using a Medicaid benefit.
Sure.
It almost feel like
you're stealing, right?
So, that buy-in there we
experienced great buy-in
from patients and, you
(09:22):
know, they do well there, so.
Yeah.
So, when somebody spends
a year with you, you know,
like if they're spending,
if they need to do some labs,
like what would be, what
would you say a typical
all-in cost for direct primary care?
If the patient's never had
expansive labs drawn before,
you know, 100 to 150 bucks,
(09:42):
I can get what they
would get at a regular doctor
plus everything you
would see on a, you know,
Dr. Axe panel plus
probably some more actually.
So, we can get really
affordable wholesale lab costs
and, you know, any DPC
provider can do that, you know,
there's a little extra hurdle of
shipping, but it's great.
I mean, we can, a lot
of times even cheaper
(10:02):
than using your insurance,
just paying the wholesale costs for labs.
So, you've been doing
this now for almost a year,
is that right?
Yep.
Tell me a little bit about
how would you characterize
the folks who've come to see you so far?
Like, what kinds of
people come to see you?
Oh man, I've had cute old men
all the way down to newborn babies.
We've had a variety.
(10:24):
I mean, I have a really
good mix of age group.
I think a third of my
practice is children,
two thirds is adults and then, you know,
a handful over the age of 75.
But really seeing all types
and most of them share their,
some sort of concern
with conventional medicine,
whether that's because
they're super, super crunchy,
eating organic chicken, you
know, doing all the things
(10:45):
versus someone just had a bad experience.
And now they're here at our door
because they want something different
and they don't even know
what functional medicine is,
or what this clinic does,
but they know that I have primary care.
Right.
So I think one of the
things that many of us,
because we just sort of
like look at a big hospital
and say, oh, that's
where I go if I'm sick,
(11:06):
or if I'm not feeling well,
most people don't even
realize there's alternatives
to traditional care.
Yeah, that's been a big challenge for us
is getting in the
community of Sioux Falls,
as DPC is new, and so
people just don't know
that there's another option out there.
And so getting people
to think outside that box
has been the challenge.
And I think we're making headway.
(11:27):
And I think too, people just underutilize
primary care doctors and family practice.
Providers don't practice at
their fullest extent either.
You know, they're busy
and they don't really
want to do that skin biopsy.
They would rather just refer to
dermatology to do it.
You know, they don't have that extra time
to spend with patients.
They really could do more
than what the system
is allowing them to do.
And we get to do that
(11:48):
here, which is great.
So tell me a little bit more about that.
So you say we're
underutilizing primary care.
Tell me more.
So traditionally primary
care should be a gateway
to the specialist, right?
And now we can, you can
call up an orthopedic doctor
for shoulder pain that
actually might be your gallbladder,
but you think it's shoulder pain.
You really should have help deciding
(12:08):
what specialist you need to see, right?
We should, as family practice providers,
be able to do a simple skin biopsy
without seeing dermatology
and waiting eight months.
You know, we have training
and experience in these areas
where we can do more than time allows.
A lot of times on the
conventional side, you know,
you are just limited
by throughput and time
and insurance burden.
(12:29):
And so they end up getting, you know,
I did plenty of rotations
with people that's like,
they refer everything
out and they don't do,
they don't spend the
time to work up anything.
It's like, oh, you think you
might have a thyroid problem?
Just send them to
endocrinology, you know,
like just very quick,
easy button referral out
when they should be utilized more.
Got it. Okay. That makes sense.
(12:49):
And I guess, you know,
dermatologists are really hard
to get into by the way.
That's insane.
And part of that, this
is part of the reason why.
Yeah. Because like you do
not need to see a dermatologist
for probably 90% of the things
that actually get sent to dermatology.
Yeah. I guess I'd
never thought about that.
You're right.
So that's, that's good to know.
How do you, let's say, you know,
because you're a smaller
clinic or if somebody does,
(13:11):
you feel like they need
an x-ray or a specialist
or they need medications,
how does that work with you?
Super, super common question.
Whatever facility is doing
the image or lab or procedure,
they're the ones that bill insurance.
So if you carry, I can
refer out to Sanford or Avera,
whatever I want done there.
(13:31):
And then they're the
ones doing the billing
with your insurance.
So I get to stay
completely hands-free off of that.
But if you need to see a
specialist, I can get you there.
You know, I can refer
you just like you would
any other doctor.
So it's a great option.
And that's part of the
reason why we like to have people
maintain health
insurance on the back end.
Do you run into any
providers from your old life
(13:54):
when you were in the traditional health,
are they jealous?
I wouldn't say jealous.
They're more confused,
like just, okay, cool.
If it works, it works, you know.
So it's just, it's new to them too.
I mean, most providers haven't,
most medical providers
haven't heard of this either.
And so.
(14:15):
I see, or I've run into a lot of,
so I used to work in the innovation space
and I would work with a lot of docs that,
and all kinds of
providers, not just doctors,
that brilliant ideas, they wanted
something different.
And they all kind of dreamed of like,
what if I went off on my own?
But you're in this system and you've,
I don't want to say golden handcuffs,
but you're used to it,
(14:36):
you know how it works.
Sometimes the W knows easier
than the one that you don't.
It's kind of brave to go off and do
something different.
Like what made you want to do that?
I was in a place, both
professionally and personally,
that I was ready for a change.
So personally I had begun learning about
functional medicine,
had changed how my family was living.
(14:57):
My wife had some
personal gut related issues.
So we did a lot of functional medicine,
gut things with her, trying to fix her.
One of my kids had a tongue tie.
We just had a lot of personal things
that were leading us down the space.
And then just professionally,
I was ready to be able to
spend time with patients
to actually do things
that I think they need
instead of fighting with insurance.
(15:19):
Spending the time, I was
notorious and back at my old job
for being in a room for
two hours with a patient,
just talking and getting to know people.
And that allows me to,
this allows me to do that,
to kind of do medicine
the way my personality
and the way I want to do medicine,
without anyone telling me what to do.
Yeah, I love that.
Yeah, so I think, I
(15:39):
guess it was just to say,
there's a lot of people that do wish
they could sort of move
into a space like this,
but it just seems so
unfathomable to them to do that.
So I think that's great.
So when people come through
your door and they see you,
what is they, do they give you any like,
oh, this is different than I expected.
What do they say?
Most people are like really bought in
(16:04):
and enthralled with the first visit.
I mean, they're like, oh, this was great.
This was so much
different than my regular doctor.
It just, cause I mean,
the space feels different.
The leisure, the
casualness of having a conversation,
the time we get to be
thorough, they're like,
this is what people,
typically what they're wanting
at their regular doctor,
(16:24):
what they're expecting even,
from a regular doctor.
And it just frees us up
to be able to do that.
And so, I mean, I haven't
had anyone walk out of my door
initially unhappy.
They're never coming here again.
Yeah, yeah, most people
are like, yes, I'm up.
Once you get them through this door,
they're sold on the model.
They immediately see the benefit of it
and how it can be powerful
(16:46):
and what kind of
service it brings to them
and how they can use it.
So I sort of made a
little bit of a hat nod
to the old days where
the doctor would show up
with a doctor bag.
You do that too, like
you will do house visits?
I will do house visits.
Okay. Yep, within reason.
I've only done one.
It was a neighbor of mine actually.
We signed up for membership on the spot.
(17:07):
I love it. We did it, but yep.
Yeah, it was great.
Yeah, we do doctor's visit
within the Sioux Falls area.
So tell me, I heard
that there was a patient
that had, they found out
they had high cholesterol.
So told they'd be on medication for life,
never spoke to their doctor.
Tell me about, can
(17:28):
you tell me a little bit
about some of the stories like that?
Yeah, it is super common.
I see it, I mean, I
have, I can think of a number
of patients off the top of my head
where they ended up with me
because a nurse called them
to tell them that, hey,
your blood came back as this
or this doctor wants to start a blood
pressure medication.
And that was kind of the
end of the conversation.
Or even just a portal message of, hey,
(17:48):
we're sending this script
in for you on the computer.
And that's just, I mean, when I was even
in conventional medicine, I
would try to take the time
to call a patient if
you're starting a med
or changing something,
especially in med they might be
on the rest of their life.
Like that's a big deal for people.
I think doctors just, we
just get really calloused
of like how big a deal it
is for people to like go
(18:09):
from no medications to a
prescription medication.
That is, makes people feel old,
it makes people feel different.
It's a big deal and
it's just a small thing
to make people feel comfortable of like,
hey, I'm gonna actually give
you the respect to call you
or have you back in to
talk to you about this
before we start this.
Yeah, and it is a big
deal if you haven't,
(18:29):
a lifetime med is not
something to be taken
just nonchalantly, I
would agree with that.
I've got a few things.
Now you, I saw on your
social media, is it kombucha?
Were you making kombucha or bread or
something from scratch?
We make a lot of things.
Yeah.
Yeah.
So tell me about your
passion projects at home
(18:50):
or your food.
Yeah.
Yeah, what do you do there?
I'm kind of the food guy around here.
Yeah, so I'm part of something called
the Weston A. Price
Foundation, which has been a big
influence on my
family's health and how we eat
and frankly how I counsel patients to eat
and talking about children's nutrition
and even adults and that kind of thing.
But yeah, there's some
(19:11):
principles that that foundation
advocates for which
is animals on pasture,
fermented vegetables, raw milk and
fermented dairy products,
freshly milled grain, bone broth,
you know, a variety of things like that,
that becoming fairly popular in the
(19:32):
crunchy natural world,
but very healing and great things.
So we do cut all of it.
So do you mill your own grain
and do you have one of those things?
Do you make your own bread?
My wife mostly does.
I made freshly milled,
I made freshly milled
buttermilk pancakes this morning.
Okay.
They just take the wheat,
they call them wheat berries,
which I learned this
a couple of years ago.
And then you just have a plug-in mill
and you just pour it in
the top and out comes flour.
(19:55):
That's something, you know, I
had an Uber driver in Austin
and he said he used to
work at like a flour mill
and I was like, okay, whatever.
He's like, they are disgusting.
And he started telling me how the bugs
and the larva would
lay eggs in like the top
where the flour is and
how many insects and bugs
are in flour and he's like,
there's actually a
(20:15):
percentage that's allowed.
That's nice.
In like, so your
cereals and all the things
because there's no way that he's like,
they would scrape them out.
So disgusting.
Yeah.
Now the flour mill makes sense.
Yeah, and it's great.
Cause the second you grind
that, it starts oxidizing.
And the longer it sits,
it becomes less nutritious
(20:36):
and more inflammatory to
you cause it's oxidized.
So like the store bought flour
is just empty calories and nutrition,
whereas a freshly
milled whole grain wheat
is actually quite healing.
Okay.
Interesting.
So sounds like you've done a lot of work
around the gut and food and food health.
So why do you think
that there's so many people
young people that are
having gut problems?
(20:58):
There's, I mean, this
is a giant rabbit hole.
It is a rabbit hole.
There's a lot, but one thing is
we just don't do a lot to
maintain the microbiome.
I mean, two things stick out to me.
One is just lack of fiber consumption.
We have a lot of processed
food with low fiber, right?
We should be getting 30
to 50 grams of fiber a day,
which is frankly difficult
(21:19):
to eat that in whole food.
And so between that and then
fermented foods
provide probiotics, right?
And so 200 years ago, we
didn't have refrigeration.
We didn't even have
modern canning, right?
So the only way to preserve food was
through fermentation,
both beverages,
condiments, eggs, you name it.
They were fermenting it.
(21:40):
It would stay shelf stable
for a really long time that way.
So with every meal they were eating
something fermented,
something with probiotic,
and so they're
constantly nourishing their gut.
And I think the benefits
of fermented food kind of
go ahead of me.
I mean, people know they're good for you.
I mean, short chain
fatty acids, butyrate,
the amount of fiber in it,
it unlocks nutrients
for certain nutrients
(22:01):
that otherwise wouldn't be available.
It pre-digests the food for you.
It usually has a ton of fiber.
I mean, all the probiotics in it.
I think kefir's got 60
to 80 different strains
of bacteria in it when
you do homemade kefir.
It's just incredible, yeah.
Well, and it's just, you
know, I grew up in the 80s
where everything was like low fat,
or it was like they
actually added more sugar
(22:22):
because everything was low fat.
And I don't even remember
hearing the word kefir.
So it's for a lot of
people like me, Gen X,
where you grew up on
Kool-Aid and cereal and whatever,
even that has gotten
different over the last 30 years
in terms of what's in those things.
kefir and milled
bread sounds so foreign.
How do you have people make that leap to?
(22:43):
Yeah, I mean, a lot
of people who I end up
having this conversation with,
they're already ready for a big change.
It's like, you know, I try
to get them in the mindset of,
hey, this is gonna do more for you
than any supplement or
medication I can give you,
if what you're
putting in is so important.
And people kind of know that.
(23:04):
People kind of know that intuitively.
But we do, my wife and I
have taught a couple classes
with this talking about
how we do our food prep
at our house.
I have four kids and
our fifths on the way.
If I can do it at
home, you guys can do it.
It doesn't take that much more time.
It just takes a little forethought.
And we've walked people through that.
We've recorded that and have that
(23:25):
available for patients.
So we try to do what we
can to get people started
in the right direction.
Yeah, baby steps.
A couple of, some small
changes can make huge results.
Oh yeah, and now you can
just do one thing at a time.
Don't do everything.
Start with soaking your beans.
Just get in the habit of
that first or something.
Yeah. Or something easy.
So I have some statements
(23:46):
that you can tell me true or false.
Direct primary care is
just concierge medicine
with a nicer name.
I think there's a partial truth in that.
No, DPC is more strictly cash-based
and completely free of
insurance entanglement.
Concierge, a lot of them
(24:06):
will still bill insurance
for patients.
It's usually quite a bit more expensive
and they have way less patients.
So I mean, some of
those concierge service,
50 patients, you know.
I'll carry a little more on my panel.
Two to 400 is kind of
what I'm planning of.
That's the most I'll ever
be able to take at one time.
So you said you cap
(24:26):
your panel at two to 400.
What is typical primary,
that's like the number of
patients you have, right?
Yeah, yeah. For those that maybe
don't know what those terms mean.
On membership, yep.
So what is typical primary care?
Three to 6,000 depending on the system.
Wow. This is crazy.
Yeah, I mean, that's why when you call,
you can't get in for two or three weeks.
Or you have to go to
urgent care or ER or something
because they're just booked out
(24:47):
and they just have too many.
Too many.
All right, you can't use
HSA for direct primary care.
You can use HSA to pay
the direct primary care fee.
Okay.
So it was a gray area before January.
This January it became officially
announced in tax code
that you can use HSA for paying for
direct primary care.
(25:07):
And that's for your subscription as well?
Yep, yeah, that's what I mean.
Yep, subscription, yep.
All right, it's only for wealthy people.
That is totally false.
Typically, I haven't
actually had a lot of,
I don't think wealthy people, I guess.
I don't know what my patient income is,
but no, it actually makes healthcare
somewhat more affordable a lot of times.
(25:29):
If you switch, you lose
all your medical records.
That is false.
You are an owner of your medical records.
Wherever you've had care before,
they're legally required to maintain
those records for you.
So it's just a matter of requesting them
and getting copies and things like that.
You have to be into alternative medicine
and alternative lifestyles to fit in.
Absolutely not.
(25:49):
Okay.
We get people from all walks of life,
the people who are just
totally hardcore conventional
and they just want a better product
to people that are
outside of conventional space
because they don't like pharmaceuticals.
I mean, we get the whole gambit, so.
What would you say to folks who say
this is just a fad?
(26:11):
I think that, I mean,
the original DPC clinics
were starting in 2010, 11
were kind of the initial ones
out on the East Coast,
from my understanding.
And it's done nothing
but grow over the last,
I mean, we're close to 20
years of DPC being a thing
in the United States.
So I think it's well
past the fad stage, yeah.
All right, so who, if
you think about the people
(26:31):
who should be calling you tomorrow,
somebody who's like an
ideal patient for you,
what is that, who would those people be?
I think it's that person
that just can sense something
is not sufficient with primary care.
I think most people,
they end up getting the care
that they need and
heavy air quotes there,
(26:53):
but they just feel like it's insufficient
or they're missing something
or they're just a little unsatisfied.
Those are the people
that don't even realize
that there's a better
product out there that they want,
that they don't even know they need, yep.
What about like if
you've got a chronic illness?
Yeah, yeah.
Is that something that you help manage?
Yeah, so I am nearly
complete with my Institute
(27:13):
for Functional Medicine
training and certification.
I have one course left.
It's, I mean, really the gold standard
of functional medicine training.
So I pull in functional medicine concepts
to how I do primary care.
So if the person needs
that, I'll pull that in.
I mean, people get functional medicine
from me all the time.
They just don't even
realize they're getting it.
Okay.
Because I mean, most
of functional medicine
(27:34):
is talking about your lifestyle.
What are you eating?
How are you moving?
These things that I just work that into
how I care for the normal patient, so.
So is there anyone that,
in terms of how Prairie
roots and your overall ethos
and what you believe
and your style of work,
is there anyone that this is not for?
(27:54):
I wanna say no.
I think we can,
especially me having my background
in conventional that I can get along
with pretty much anyone.
Okay.
And can find a space
that's right for you.
We don't wanna touch
pharmaceutical or supplements.
We don't have to use supplements.
If you don't wanna touch pharmaceutical,
I'll advise you, but we can
try doing the supplements.
But I'm gonna tell you what
I think and what you need.
(28:14):
But if you're not willing
to invest in your health,
cause there's that barrier there,
I think that's the type of person,
if you're really tight
and you don't wanna pay
that $80 a month to get a better product
and invest that little bit extra time
and effort into your care,
you're not gonna like what I
have to say to you either of,
hey, you gotta do this
(28:35):
or change how you eat
or start moving a little bit more.
It'd be harder.
So it sounds like
maybe if somebody's looking
for a pill to fix everything,
it's probably not the right fit.
I could do it.
I've done it a lot.
I don't know.
It was part of my conscience in
conventional medicine
was I've had to do that a lot
and I inevitably will
get people like that.
But yeah.
(28:55):
Ideally we'll find some other things
that we can help look at first.
If somebody's
interested but a little nervous,
not sure what's the first step.
Yeah, so I offer, we
call the meet and greet,
just a 15 minute in
person or phone call with me.
So you just call the office and say,
I wanna chat with Sam
for a while and kinda see
(29:16):
and I'd be happy to talk to you
or meet you at the office
and just go over what the
questions are and concerns are.
All right.
Well, if somebody wants to find you,
how do people find you?
Where do they look
you up and get in touch?
Yeah, the clinic's all on social media,
Instagram and
Facebook, Prairie Roots Health.
And it's very easy if you
(29:36):
Google Prairie Roots Health,
it'll pop up here in Sioux Falls
and just give the clinic a call.
Absolutely, all right.
Well, we'll make sure to put
those in the show notes too.
So if you're watching on YouTube,
you can click on the description.
We'll put a link to Prairie Roots Health
and Sam Niewenhuis and his
name, Sam Niewenhuis
and you can connect
and call directly there.
But thank you so much for describing
(29:58):
direct primary care to us today
and the new model and
just so that people know
that there's an alternative.
Yeah.
If things aren't working out.
Anything else you
would want people to know
about the work that you do?
I don't think so.
I think we can make things work
for a variety of people and backgrounds.
I would just encourage
you just sit down with me,
have a conversation.
Absolutely, okay.
(30:18):
Well, great.
Thank you so much for being on the show.
We'll look forward.
I know there's lots of
things we could talk about.
So we'll look forward
to maybe having you again
down the road to talk
about some other stuff.
All right, take care.
Yep.
Hey, that's our show.
If someone came to mind
while you were listening to this,
if you thought, "Hey, my
sister needs to hear this,"
or, "I should send this to my mom,"
(30:38):
or, "My buddy would
get a lot out of this,"
please share it with them.
Just hit the share
button and send it their way.
You never know what one
conversation, one episode,
or one piece of information can do
for someone who's
been looking for answers.
And if you haven't
subscribed yet, please do it now.
It takes two seconds.
It's free and it means
you won't miss an episode.
We've got incredible stuff coming up
and I don't want you to miss any of it.
(31:00):
And if you're a
health or wellness provider
and you wanna be on the
show, we'd love to hear from you.
There's a link in the
show notes to get in touch.
We're always looking for
people doing interesting work
who wanna share what they know.
And one last thing, I
get asked all the time
about the products and
brands I actually use.
So I put together a list of
sponsors and favorite products
that have worked for me and my family.
If you're curious, that
link is in the show notes too.
(31:21):
Thank you for being here.
And I really mean that.
I'm Melissa Goodwin.
The line is open.
See you next time.
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