Transcript:

 

Dr. Tea  0:52  

I have Dr. Sejal Desai here, who is practicing obesity medicine from Houston, Texas. And I want to welcome you to the podcast, and thank you so much for the invitation to share your direct care pathway.

 

Dr. Desai  1:06  

Thanks so much for having me Tea.

 

Dr. Tea  1:08  

So we were just briefly talking about Houston, because they just experienced some tragic weather, and I saw some other colleagues out there in direct specialty care space where they had to share offices because one office was down and another provided the support and care. So I'm glad to hear that you're doing okay. Are you up and running now? 

 

Dr. Desai  1:28  

Yeah, yeah, we finally are. It was a lot, I think a lot of people, was mostly, you know, losing power and then, like, things that go along with it, and especially as a, you know, having a practice, I'm lucky. Mine is telemedicine, so, you know, at least in that sense, once I got power back, which we were closed for several days, but then once I got power back, we were good to go. But that was the wonderful thing. You see all of these people coming out, you know, supporting each other and saying, Hey, I have some space, you know, come see your patients. Here that part. I love seeing all of that.

 

Dr. Tea  2:00  

And you can't do that if you're employed in a system, you know (Exactly) yeah. So I love private practice. I love supporting solo practitioners. We literally do everything. So I have sympathy for people, you know, we're just trying to put up the pillars and make this little business of ours work. So you mentioned you have a telemedicine practice, and I think we are all very interested in how that came about. Working from home is the new trend. It's the new time freedom. It's the new well, but tell us how you started your career in medicine, from residency there on. What did your life look like? 

 

Dr. Desai  2:39  

Yeah, so thanks for asking. I'm really, you know, I graduated, like, 24 years ago from residency, so I've been doing family medicine. Was my first board certification. I've been a family medicine physician, primary care employed physician, for like, 20 plus years, you know, and you just kind of get into the groove of things, and you just keep going. And I never even thought about anything else, you know, or if I did think about it, I thought, Oh, it's too hard to go out on my own. Or, you know, all the negative kinds of talk that you make yourself believe, I guess. And, and I was doing, you know, okay, until covid hit. And when covid hit, like so many people, I think so many, you know, in the healthcare field, I felt extremely burnt out after that, and was just starting to lose the joy in medicine, which I never had felt before, you know. And so when all of that had happened, I decided to just take a break from it all, because I really knew I didn't, you know, not, not like medicine. I just wanted to kind of figure out what I wanted to do. And by that point, I had actually gotten board certified in Obesity Medicine as well. And I was practicing both. Within my practice, I was doing Family Medicine and Obesity Medicine. So it really was a lot. And so when I took that break, I just had to kind of step away from it all just for my own mental health. I felt like it took a few months to just kind of, you know, redirect myself and say, what do I really want? What makes me happy? What's my passion? and when I really started thinking about all these things, I realized that, you know, I didn't want to work in an employed position anymore. I wanted to be able to make the decisions for my patients. I wanted to be able to practice the way, you know. I wanted, you know, I wanted to care for my patients the way I thought was the best way to do it, not something I was told by someone. So I really took some time to figure all that out, and decided that I would, you know, open up direct specialty care practice and not take insurance, opt out and and only do obesity medicine, because I really that is where my joy is. I've always loved preventative medicine, and obesity medicine allows me to practice this whole scope of comprehensive, holistic medicine. So I. Know that that's where, you know, I really wanted to focus. So that's what I did after covid and opened up this telemedicine direct care, direct specialty care practice in 2022

 

Dr. Tea  5:12  

Is it commonplace to see those who are practicing obesity medicine to do so without insurance? Or are there covered benefits to that?  

 

Dr. Desai  5:21  

Yes, so part of it was that, right, like, we're still fighting and advocating for coverage for our patients. You know, obesity was just recognized as a disease by the AMA in 2013 which was not that long ago. And so we're, you know, we're in the early stages, and now, with all these new medications and indications, you know, coming out, we're working towards that, but a lot of insurance companies, they don't cover the diagnosis of obesity. They don't cover obesity medications, you know, and they don't, you know, they just don't cover treatment. They definitely don't cover lifestyle treatment for, you know, obesity, which I think should be first and foremost for everybody. So it, you know, it was difficult to treat my patients the right way, taking insurance anyways. So it was, you know, and then, of course, with something like this that we're working on lifestyle, I can't just do a 15 minute visit, you know, every three months, or even every month sometimes, you know. But that just was not, was not enough, and it was not good patient care in my eyes, and I saw that the results weren't good when I tried to do that. So, yeah, so it is, it's, I don't know if I think it's probably 50-50, there are, you know, there are providers who are doing purely, you know, cash based, or concierge or membership based, but then there are some that are taking insurance. So, you know, I think we have the whole gamut, but there's just not a lot of us obesity medicine doctors to begin with. So I think it's a fairly new field that's evolving.

 

Dr. Tea  6:52  

So not only are your visits not covered, they have to be longer to even educate pre educate patients, but also medications are not covered. So how are you helping patients get around that barrier? 

 

Dr. Desai  7:07  

Yeah, and that's what I love about my practice now, is, you know, with a lot of these medications, we have to do extensive prior authorizations and before, when I'm seeing, you know, 25 patients a day, and you know you're like, then you have labs and imaging, and, you know, I felt like I was just busy working. And then I would come home and try to finish all the stuff I had still left over, right? And working till midnight just to try to, you know, get all that stuff done. I didn't have time to really put in the prior ops. And honestly, I was just having my medical assistant do it, and everything was getting turned down, you know, and now that I have more time because I see less patients, I really put in that time to do the prior authorizations for my patients. And I'm not saying that they always get covered, but I definitely have a bigger success rate in getting things covered because I'm really spending the time to to put in things like, you know, putting in the studies that are done that shows, you know, cardiovascular benefits and things like that, you know, showing the insurance company that the patient has done this, this, this, you know, and and, you know, just giving them all of that proof and all of that documentation, and then if we get denied, then, like, trying to go for appeals and peer to peers, Like just taking that time to do it can help, you know, quite a bit. So, you know, I'm lucky now to be able to do that. 

 

Dr. Tea  8:26  

My mind's just blown as to how much time you have to spend as a physician to get what we think is simple, a medication for their medical problems, to resolve other medical issues that arise from obesity, hypertension, diabetes, the works, right? But you have committed time, which means you're pricing your services to reflect that level of care and expertise. Now, do you have a fee for service practice, or is it membership based? What does it look like for somebody who wants to get your care? 

 

Dr. Desai  9:00  

Yeah, good, good question. And I think I've evolved through all the different, you know, phases, because the one thing I've learned in this journey of kind of going out on my own is you can do whatever you want, but that also is, you know, makes it a little bit difficult. And so I've just kind of, I've, you know, tried to evolve as to what I see the need is. And at this point where I am, I really do try to offer both. I have a fee for service, you know, pricing, and I have a membership pricing. And so it really is, you know, every patient, especially in my field of obesity medicine, every patient, has their own pathway and their own journeys. It's, it's, it's not, you know, just cut and dry. It's not just so simple, right? It's not a one size fits all option. And because I do comprehensive lifestyle guidance as well, again, coaching as well as medication prescribing, it's, it's a lot of different things. So I offer all of those options. It really, if I don't want, you know, I don't want somebody to not be able to do it because of. Cost, because there's not enough of us doctors. And so I really, you know, I really want to make sure that we are able to serve all of our patients. Obviously, we can't serve all of our patients, but I do try to make it, you know, you know, make it based on what the need is. So if somebody really is doing a lot on their own. They don't need the coaching aspect, and we're just doing the medical aspect, then, you know, that'll be a lesser fee. But, and if they want to do membership, then, then we'll do a membership fee. And if they want to do kind of the full comprehensive program, which includes everything, then that's just a one time fee for that three month program. And then we have a long term follow up. There's always long term follow up, because with obesity, it is a chronic disease. So we always want to at least, I want my patients to check in at least a couple times a year just to make sure they've kept that weight off. 

 

Dr. Tea  10:53  

I'm coming from the perspective of a surgeon who needs to see the problem like a broken bone and I gotta put it back together, there's a tangible end result. Whereas lifestyle preventive medicine, there is, it's all a lot of it is mental endurance, and a lot of it is coaching, which is, you know, kind of new for me. So how do you prove to your patients that this is worth investing in when the outcome isn't so quick. What is their little like? Quick Wins, or is there a certain demographic that you advertise or market to to make your practice work for you?

 

Dr. Desai  11:29  

Yeah, you know, over the years, and I saw this in in primary care as well, the majority of my patients were very similar to me, in the sense that they were usually about, you know, the same age group, you know, as me, I felt like and so, and majority were female. I kind of started seeing that those were the patients that were attracted, you know, to coming to see me as a primary care doctor. Probably, you know, probably it's just easier to, you know, get along with somebody who is similar to you, I guess, right. And so I started seeing a lot of women and a lot of women in their 30s to 50s, which ended up being kind of this perimenopausal, post menopausal female, which is where I am, you know. So I do feel my practice is quite a bit Peri and postmenopausal females. And this is a time in our lives where so much is changing. There's not enough information about it. And one of the big things that happens is we are gaining weight, and we gain weight around the midsection during this time and and then weight is then directly correlated to a lot of the symptoms that we feel in, you know, during this time, in this transition phase. So I, my, my practice is, is a lot of that helping the Peri and post menopausal female, kind of, with the lifestyle changes, to help with weight and symptoms. And so that is, you know, that's really been a big passion of mine, because I'm going through it myself as well. And so I think that's typically, you know my patients, and that is a time where they are already just frustrated. So I think just talking to somebody who truly understands, because I'm going through it with them, right, who truly understands what they're going through, I think that really does bring on a little bit of a trust factor. And so I think that that helps, um, helps, kind of sell it and, and I'm, really, I'm not a great salesperson, you know, I've never been, I think in most of us in the healthcare field, you know, it's just that's not, you know what we do. But I've realized that when you, when you do something with full passion, it kind of comes through, you know, it comes through as they understand and they get it when we talk about, when I talk about things like, Yes, I'm a weight loss doctor, but weight loss is not really all I do. What I'm really trying to do is help you live healthy and help you, help you live a longer, healthier life, right? Health span, not life span. So we, you know, we want to focus on way more than just the number on the scale. And so when I talk about these things, and I think just kind of hearing, you know, hearing me talk about it, and knowing that I'm also going through it, I think a lot of those things kind of help, help patients understand, you know, that that it's, it's, it's about health and long term and it's important. 

 

Dr. Tea  14:21  

So the reason I bring that up is because, you know, I wasn't trained. I think many of us are not trained to have conversations in that depth, especially, you know, we know it's necessary. I used to take care of a lot of people with diabetes. Their symptom is an open diabetic foot ulcer, but the process that it took for them to get there was because of not very optimum lifestyle factors, habits, lack of education, lack of access. There's so many social determinants as to how they got there, and so I found myself very frustrated talking to a patient about how to keep. Of an ulcer by modifying what they eat. But those conversations were, like, two minutes long. It's like, Oh, you just gotta stop eating sugar. Oh, you need to stop grabbing that bag of fries, you know? And it's like, it's hard to not be judgmental when you're your schedule is stacked 30 to 40, people deep, and you just want them to get to the solution, but the path to get there does require a lot more time, and I think that is something that we can all benefit from in a direct care practice, to just learn how to have that connection first before we start educating because as soon as you say something that feels judgmental to the patient, they're off to the next door, they're off to the next doctor. So how do people find you? Or how do you find your ideal clients?

 

Dr. Desai  15:47  

Yeah, such a good point, right about making sure that you know that they trust you first. I you know, I think for me most, most of my patients come from two ways. One is referral by current patients, or the second is, is referral from the doctors around me, the primary care docs, the OBGYN You know, the orthopedics, the podiatrists, you know, who are see. So it's just, it's like obesity affects, you know, every single specialty, right? And everybody has different things. And so I think a lot of the doctors who don't have time in their practice, like you said, you have two minutes to talk to them about it, right? And I felt the same way in primary care, I felt the same way I don't have time. I have 15 minutes with you, and I need to talk about, you know, all these different things and the medications you're on and, you know, and how am I going to get to lifestyle and what you should be doing, and if I see you once every three months, even talking to you about it, like, how, how much of an effect is that going to have anyways, right? So it really wasn't having a lot of effect. And so that's where I've really also been reaching out to my local, you know, primary care doctors and specialists, and doing things like just free webinars and stuff for patients, just to give them that, you know, knowledge and, you know, one of my big things is to develop a course as well, you know, just for patients To be able to take so if they're, you know, they have diabetes or they're perimenopausal, or they're dealing with infertility or whatever it is that they're dealing with, you know, have something that you know that they can that they can look at and get some information from, from a doctor I, I do some social media as well, and So lots of different speaking and education and being involved in the community. And I do try to do a lot of those things to try to get the message out, you know, as well.

 

Dr. Tea  17:50  

So you left corporate medicine that you were in for 20 years, you took a break, and you went full into a cash practice, and you opened, was it 2022, now, did you ever think this was the trajectory of your medical practice? 

 

Dr. Desai  18:09  

Gosh, oh my God. Never did I think that before? Ever because, you know, I just feel like in medicine, we are, you know, just kind of guided towards one way, like there's no looking anywhere else, right? Like I was in high school, and I just knew I wanted to go into medicine, right? Then I go to college, and then I go to medical school and I go to resident, and you're just kind of like, you know, going the same way, kind of doing what the majority of the people are doing, and not really look thinking outside of the box, or looking outside of the box at all. I don't think I ever did. I just kind of led that path, and I just did what I thought I needed to do. And I thought this is what how all doctors work, you know, either you work for a hospital or you are employed by a larger group or but you can start your own, you know, practice, but, you know, it would be, you know, so much work because then you're contracting with all these insurances. And that was always a big headache to me, the whole insurance thing, because I just never thought that that was good medicine. I was never allowed to just prescribe what I wanted to prescribe, or even with imaging, you know, forget medications, but even things like imaging and things, you know, everything is dictated by insurance, you know. So it was just, I just always thought that that's how you had to be. It wasn't really until, you know, I really started looking more after I got board certified in obesity medicine. That was in 2017 I I really started meeting so many other people who had either direct primary care or direct specialty care practices. Really, it was through that that I started meeting a lot of people and seeing what they were doing, and thinking, wow, you know, maybe I could do that, you know. But then, you know, you have imposter syndrome, or I did, at least, you know, thinking, Well, no, there's no way I can do that right. And and, you know, and also just. Feeling like I didn't have time to even think about how to do that, because with, you know, having a family and having, you know, friends and a life outside of medicine too, and also just my work, I just didn't have time I felt like for anything else. So that's when I took that break away from medicine totally for a few months, and really honed in on my vision, what I really wanted, what I wanted to create, and I just went, went for it. You know, it's like you just have to, you know, kind of just go for it sometimes, and just have faith.

 

Dr. Tea  20:33  

Yes, having faith seems to be the key characteristic, what it takes to do this, because it's not common to have a doctor, particularly if you've been in it for decades, to even consider something totally different. So what was it like for you to start up your telemedicine practice, and how is it going for you right now? What are your biggest challenges and some of your wins within your direct specialty care practice.

 

Dr. Desai  21:01  

Yeah, it's been so fantastic. I mean, you know, I think so many people say this, who does direct specialty care? I know you probably know this, but everybody's like, I wish I would have done it sooner, right? I really, really wish I would have done it sooner. But I'm just, I'm glad I'm here now, and it's just been life changing in so many ways. It's been life changing for me. I feel like, you know, as far as just being able to have better work life balance, being able to, you know, do so many of the other things, my other passions and and, you know, be able to, first of all be there for my kids and my, you know, children way more than I was before, and, and, and be able to, like, be there for myself, and have some self care and and do the things that I need to do for myself as well. Um, I've been able to, like, you know, do all of these things I'm making, you know, making sure that I, you know, all the lifestyle stuff I've always told my patients I've always tried to do but, you know, sometimes you just, I just couldn't before, but now it's, it is priority. You know, exercise is a non negotiable, and, and, you know, my mental health is a non negotiable. And, you know, proper nutrition, all of these things, you know, I just feel like I have more time to take care of myself. So it's, it's really been life changing, but then also on a professional level, it's been life changing because I have all these other interests, which I'm now finding out I didn't even know. But I love speaking, and I love being, you know, on, you know, on different podcasts or talking to you, whether it's you know, patients or providers or whoever it is. I love all of that. I love the education piece, you know. So all of that has been just wonderful that I actually get to time now to be able to do some of these things, which I never even thought of before. So that's been great. Of course, there's always, you know, challenges, but I think it's more learning experiences than anything else, because I knew there'd be challenges, right? It was something I've never done before. I, you know, do a lot of research. I did a lot of research into all of this stuff, and I did a lot of work into it. But, you know, before I even started my practice, and every day is continuous learning, right? Every day, I'm still learning more and more. But, you know, I I really feel that, you know, the learning experiences that I've had have been mostly around things I never got taught in medicine. It's like the financial part of it, the business part of it, right? Nobody teaches us that. And just even some of the other things like nowadays, like social media, you know, that was a challenge or learning experience for me, because I, you know, before, just did not feel comfortable putting my face out there and doing a lot of these things and but the more you know, I started looking into things, the more I realized that I wanted, you know, big part of what I do is see patients, but then also just educate. And social media for me is education. There's so much miseducation out there, so I feel that it's my duty to spread the right, you know, information regarding healthy weight loss, you know, so, so, you know, though those things have been, you know, works in progress, and I feel like I'm still learning, you know, I'm still learning with a lot of those things, 

 

Dr. Tea  24:24  

What were your go to Resources in creating your practice?

 

Dr. Desai  24:28  

Um, gosh, I did, um, so many things. Um, I definitely, you know, now in the, you know, time of social media, like there's, there's so many wonderful, you know, Facebook groups that are out there other, you know, doctors doing things that I'm doing, you know, just reaching out to colleagues that are doing it. I'm just really putting myself out there, and even, you know, learning from webinars. I mean, I did tons and tons of different webinars and courses. There are a lot of courses in, you know, that you can take about. The business aspect of starting a practice, and, you know, all of those types of things I think are crucial, you know, to really help learn. So I did some kind of just investing in myself as I was learning how to do all of these things. So I think all of that was critically important, and I was just, you know, reaching out to all the people that I already had access to. You know, I had wonderful, you know, friends who were entrepreneurs, or, you know, in business, or, you know, doing different types of things. And I just asked as many people as I could about different things and talked to them and got their ideas. And so I just think about talking about it, you know. And, you know, I feel like I get I learn from everyone that I meet and everywhere that I go, I feel like I learn the one thing, you know, and one of the podcasts that I had listened, I love podcasts, by the way, there's a big, big, big way of how I learned a lot of things. And the way, you know, I met you initially was through the Sony docs, you know, talk that you did, which I absolutely love, too, and, and you know now I'm part of that as well. And so it's, it's, it's been this whole community. It's out there, right? We just need to be able to seek it and find, you know, the ways that's going to speak to us so but, but what I really, you know, was looking for, I'd heard in a podcast before, was this woman who was giving the talk. She was saying that she had a community of people in her area, a group of other women, and they met once in a while, and they, you know, once a week or something, and they discussed their businesses, and they helped each other grow. And I thought, Gosh, I want to have a great group of friends. And I have a great group of, you know, business colleagues and stuff. But I never really had that kind of group of women, you know, that, you know, local women where we could meet and talk about business and growing our businesses. And so I thought, huh, let me start that. And so I just one day, decided to start this organization, which now has turned into women physician entrepreneurs of Houston, and it is a group of women that are all physicians, business owners and women, and we're all near or around Houston. So we meet once a month. We have virtual talks, and we all help support and grow and help just, you know, really, just help support each other as women, because we have so many, you know, so many resources just within ourselves and women are wonderful sources of support for other women. So I've been so blessed to be able to, you know, be a part of this, of this group.

 

Dr. Tea  27:38  

I really love how you knew what you wanted and decided just to create it for yourself. The woman physician entrepreneur group of Houston, you're like, it doesn't exist. I'm just going to make it myself. That is so the entrepreneur. You know, I never really adopted the word entrepreneur. I was like, Yeah, I'm a business owner, but they're exactly the same thing. We create stuff that does not happen, and for many of us in direct care, we are creating a direct specialty care space because it never existed, and it won't exist for us if we succumb to being employed forever, then we're never going to really get to realize the magic that's within us that has been suppressed because we were seeing 60 patients a day, and so you have really just shined a light on what could be, not just your direct care practice, but what life can be like when you have control in your time and how you take care of patients. So I know there's somebody listening who's on the fence about direct care. What would you say to that doctor who's hesitating, who's got imposter syndrome, who says, Oh, I can't do it. This doctor's been doing this for 20 plus years. What would you say to that doctor about direct care?

 

Dr. Desai  28:46  

First of all, you know, I think everyone can do it if you got through medical school and residency, and you know, you're, you're practicing, you know, whatever field you're in, if you, you know, gotten to this point to be called the doctor, you definitely can do it. There's no doubt about it. It's just having that faith in ourselves and you know, and at the same token, having the faith and then putting in the work, you know, I think it is a good combination of both, if you are willing to put in the work, and you know, and you believe in yourself, because self talk and the words we say to ourselves is so incredibly important, right? And it goes, it's the same thing that I tell my patients with weight, right? It's the way we talk to ourselves, it's, it's what we're going to believe, right? So you know, first of all, you know, looking at how you're talking to yourself and and if this is what you really want, that if you want work life balance, if you want to be your own boss, you want more time. You want to be able to, you know, make the decisions that are the best for your patients and for yourself, right? Because, because we matter too. Then you know, then definitely consider specialty care and know that you can do it. You. Just have to, you have to just put in some time to figure out how to do it, because, like you said, there's not a lot of us, and everybody's kind of doing it a little bit differently, right? There's concierge medicine, there's direct primary care, there's direct specialty care, there's fee for service, there's all these different ways. The great thing is, you can pick and choose. You can do both, right? Take insurance, not take insurance. You can do it, you know? So there's so many options. It's just, we just, you just have to think outside the box. And believe

 

Dr. Tea  30:31  

We're here to help you think outside the box. So you heard her say that her practice evolved, and I would agree that has happened for all of us, because there wasn't a template for what we wanted, only we know what we want. So being open to evolving and just putting in the work the challenges that we have, they're really just lessons to learn from. And at the end of it all, if you just do it, you can have your own direct care practice that is thriving, and I think on average, what I've seen, I don't know what you're seeing, talking amongst your colleagues and friends, but the first two years are the hardest. It's figuring out what you actually want, what demographics you serve, what you want to charge. Do you want to do a membership? Do you want a hybrid? Do you want to do telemedicine practice? Do you want it in person? There is literally anything that you can think of, you can probably create, and you're the only limiting factor in the entire process of the human brain. We have a tricky way of tricking ourselves on not doing something, when in reality, it's not that hard. I want to thank you so much for being on the podcast and for sharing your journey and your experiences with us. Do you have any last words for the listeners?

 

Dr. Desai  31:49  

I guess my last would just be, you know, I mentioned it earlier, but you know, remember balance in all aspects of everything, right? I named my practice Tula medical because Tula T, U, L, A means balance. And so you know, when we're when we're, you know, working and we're doing things. Sometimes we forget about, you know, so many parts of ourselves. We're just focused on doing our job and making money and serving the patients, you know. But, but don't forget about all the different aspects of your physical health, your mental health, your spiritual health, you know, think about all of that. Make sure you live in your truth and make sure that you know you stay balanced. 

 

Dr. Tea  32:29  

Speaking like a true lifestyle coach, balance is key. Well, thank you again. So much. If people want to connect with you, how can they do so they can

 

Dr. Desai  32:39  

Find me on social media. I'm on Facebook, Tula Medical Weight Loss, Instagram: @tulamedicalweightloss, I have a YouTube channel under Tula Medical Weight Loss & Wellness, and they can go to my website as well, at tulawlw.com

 

Dr. Tea  33:00  

Great! Thank you so much, and I look forward to meeting you in real life sometime. 

 

Dr. Desai  33:04  

Yeah, thank you. Tea, this was wonderful.