Transcript:

 

Dr. Tea  0:51  

I want to welcome Dr Becky Lynn. She is Adjunct Associate Professor OB-GYN in Missouri, and she owned the direct care practice called Evora Women’s Health. So welcome to the podcast.

 

Dr. Lynn  1:07  

Thank you so much for having me. I'm excited to be here.

 

Dr. Tea  1:10  

I really love hearing how doctors like you, OB-GYN, who you know, like traditionally, we would think it's covered by insurance what you do, right? But me, as a podiatrist, I don't know squat about women's health. Surprisingly, being a woman myself, so I never really know, like, if I'm going to get the services I need in my OB-GYN doctor's office. And I actually just made a phone call to try to get an appointment, and I got hung up on like, three times because my insurance is kind of like in a little HMO network, and it's a little bit of a nightmare to get access to. And so I know how important it is to have direct care access. What struggles did you see in the traditional practices? And why did you choose to leave it in favor of direct care?

 

Dr. Lynn  1:58  

Yeah, so I actually worked in a traditional practice for 20 years. I finished my residency in 2003 and ended up being an employed physician. And I just saw medicine change before my eyes. I noticed over that time, I was getting less and less time with my patients. You know, I would be booked like an eight o'clock and 8:15 another 8:15 and 8:30 and I just really felt like I didn't have the time with my patients that I really needed, and I spent a lot of time, like I would see patients all day, and then I'd go home and do my charting all night. And you know, that was a struggle, because I had kids, they might need help with homework. I might be like, sorry, I can't help you. I gotta get all my charting done. It just, I felt like the system wasn't what. It wasn't a great system for patients or physicians. And I can remember the day that it really hit me. I had a patient I was seeing for pelvic pain, and I was behind, and I was in a rush. And after she left, I was like, I just I did not do the kind of job as a physician that I wanted to do. And I called her back at the end of the day, completely. I was more thorough. Completed the visit, and I felt better about that, but I was like, the system that I'm working in is not working for what I'm trying to do. So I left. I had a running friend I used to run with, and I would complain about my job. And she's like, you know, quit complaining. Just leave, go do something else. And I'm like, Oh, maybe I could do that. And that kind of got the ball rolling. And so I credit her with some of my happiness and success now. But yeah, that's kind of how I ended up leaving and starting Evora Women’s Health. 

 

Dr. Tea  3:42  

So you started Evora Women’s Health? Was it in 2020?

 

Dr. Lynn  3:46  

It was, Yes.

 

Dr. Tea  3:47  

Oh my gosh, at the beginning of the pandemic?

 

Dr. Lynn  3:51  

Yeah. So I left my full time job at the end of January, and I opened Evora in February, 2020 so I had about a month of being open before the world shut down, actually, six weeks. So yeah, that was kind of crazy, because I had, you know, forever, just been a working mom, not home, taking call at night, working on the weekends, and then all of a sudden, the world shut down, and I went home and hung out with my teenagers, which was actually really nice. 

 

Dr. Tea  4:19  

So how did you decide to open your own practice? Was, was that already brewing in the back of your mind when you left your job?

 

Dr. Lynn  4:27  

Yeah, so a couple things. So I specialize in sexual problems, in women in menopause and weight loss, and I had some colleagues who are already doing cash pay practices, not in Missouri, but in other places. And so I knew that it could be done. I also had been previously at St Louis University, full time faculty. They go by SLU, and I went and got my MB. While I was at SLU with the idea, initially, I decided to get my MBA, thinking I would go towards academics, like, raise up in the faculty. But in the end, I was really glad I got my MBA, because it gave me the confidence to say, you know, I'm just going to start my own practice. So, so it had been brewing, you know, it I didn't leave my job without knowing that I had another job lined up for sure. I'm not that. I'm not that much of a risk taker, even though it was a big risk to leave my job and start a business from scratch. But the idea had been brewing, and I had been sort of planning. I created a business plan. I was looking for spaces. I was thinking about advertising. I really kind of lined up all the ducks, and then I left.

 

Dr. Tea  5:48  

How did it feel to open your doors on your first day?

 

Dr. Lynn  5:53  

It was exciting. So it was exciting. It was terrifying. I feel like doing this kind of business. It's so different from your traditional medical practice, where, you know, as an employed physician, I would show up at work, and then my patients would just come. And now I opened my doors, and I had a unique kind of practice. I had to explain to people why the direct care is of value to them, because so many people are used to, oh, well, my insurance, you know, like, I just why. And we still get patients who call sometimes they're like, does she take, you know, Blue Cross, Blue Shield, and we say no, and they're like, Wait, well, does she take insurance to and it's so, you know, not it. It's becoming more the norm, but it was definitely especially in 2020 there were fewer practices in the area that were cash pay only. So I really had to learn to talk about the business and explain the value in it. And I think there's huge value in a direct care practice. We take out all the middlemen. There's price transparency. My patients have my phone number. They can call me directly, they can email, they can text me if they have an emergency. We my patient panel is small, so I can get them in quickly, usually, same day, next day, unless I'm out of town for some reason. But there's definitely value in this kind of system, you know, and the traditional system, like, I'm a patient too, I can't, I can't reach my doctor. Like, if I call, I get the wall, gotta talk to the nurse and get a call three days later. So, you know, for a lot of people, that just doesn't work. And so this is a good option for people who really want that more. They want to be able to reach their doctor, get seen right away, and they want to spend time with their doctor. You know, my first visit is about an hour long, and my follow ups are about 30 minutes. So I definitely don't want to be in that rush that I was in when I was at St Louis University. Not good medicine.

 

Dr. Tea  8:00  

Do you have a fee for service practice, or is it membership based?

 

Dr. Lynn  8:04  

It's both. So we have a membership so people pay monthly, and then we also have the option of fee for service. And the reason that we did that is because, as a gynecologist, I have some patients. They only come to me once a year for an annual there's no reason they need to be paying a monthly fee, and for them, just the fee for service pay as you go. Works. Now there are some people I see more frequently, so it makes sense to be a member, and being a member also gives our patients some discounts if they see other providers in our office. So we have an internal medicine physician, we have a psychiatrist, we have a whole bunch of other services, like dietitian, personal trainer, acupuncture, chiropractic, massage therapy, therapy, esthetic. So for people who utilize our services a lot, it makes sense to be a member.

 

Dr. Tea  8:58  

Could you talk a little bit more about your business model, so it's not just you as the physician. You have other services that sound very comprehensive in women's care. Are you hiring them? Are they contracted? How does the system work for you?

 

Dr. Lynn  9:14  

It's both. Some are hired, some are contracted. But our goal really is to have everything that a woman needs in one supportive space. And we really work as a team. And I love this, because I've always worked in an OB-GYN office for just OB-GYN, which is great. That's good. But here, like, I'm not an internal medicine physician, so you know the internal medicine physician with me, we share several patients. So really, we can really come up with a cohesive plan, and a lot of our cohesive, you know, our patients will see like our dietitian or our personal trainer or therapist, and it's all in one electronic medical record in our chart. And. So it's really a team effort to provide everything that a woman needs 

 

Dr. Tea  10:04  

with your internal medicine doctor. Are they a direct care doctor? Do they take insurance?

 

Dr. Lynn  10:11  

Everybody in my office is direct care. 

 

Dr. Tea  10:14  

That's crazy. I'm just so excited to see like, not just the specialist having a direct care practice, but it's starting to branch out to have these Wellness Centers, which is something I desperately want for myself, because there's so much value. You know, once a patient sees a direct care doctor, they're going to want to see more doctors like us. They're going to ask, do you have, you know, one in this specialty or one in that specialty? Because we all have the same problem. We can't get access. And you and I need doctors, and I can't even get access to my doctors, who are my friends that I have on my cell phone, but I don't want to bother them.

 

Dr. Lynn  10:50  

I know, I know, I actually have Facebook, one of my Facebook like messenger, my doctor, because I couldn't get through. And we're friends on Facebook, and I'm like this, this is the only way to reach her.

 

Dr. Tea  11:02  

Yeah, and I, I hate that we have to go to that because I know they're in the system. They're inundated, they've got a laundry list of patients. So I myself want direct care doctors. That's what I'm actively looking for now, now that I know that I can pay, you know, just to get that access, and that when I pay them, they will also reserve that time for me, rather than waiting in line with the whole mess of other people. And they probably, you know, those doctors hate their job, they hate their life. They show up and they're upset. They're disgruntled, you know, and me as a doctor, it's like, I don't want that energy on me either. I want to feel like I'm the special one in the room,

 

Dr. Lynn  11:43  

right, right? Yeah. I mean, a lot of doctors are really burned out from the current system.

 

Dr. Tea  11:48  

So what has been the hardest thing for you in opening your direct care practice?

 

Dr. Lynn  11:53  

Well, I think the hardest thing was the pandemic only because I left my job, so I went from a nice salary to zero, and we didn't know the pandemic was coming, and my husband lost his job during the pandemic, so all of a sudden, like we went from being a really financially stable household to oh my gosh, what are we going to do? So that was the hardest thing we did fine. We had savings. My husband got another job, but at that point in time, it was stressful. It was a kind of stressor that I hadn't had before. So that was difficult. But beyond that, I have really enjoyed being a business owner. I love being able to, you know, say, Well, let's try this, and if it doesn't work, let's try that. And, and I love thinking out the box, outside the box, like, how could we do this? I mean, we're not a classic OB-GYN office. And I love that. And I really love my team. Also, knock on wood, I've assembled the loveliest team, and I feel like there's a good culture here, and it's a fun place to work, and we get to do a lot of neat things that are not like your typical OB-GYN office. So it's been really fulfilling for me, personally, to start a business and have the challenge to try and grow it. I've really enjoyed it.

 

Dr. Tea  13:21  

How are you able to find another direct care, internal medicine doctor? That's what I want to know. Because, as specialists, yes, we are often on our own island trying to navigate, like an HMO system. You know, patients left their HMO system to see me, but then I can't communicate. You know, it's, it's one direction. It's unilateral care, like I can't tell the Kaiser doctors what I did for their patient, you know, I sent out a mail, you know, with my soap note, and it got returned to me like it was like an automatic you cannot send this stuff, so I can't even communicate to the doctors in those closed network. And I find that to be such a problem in healthcare. So it's not just their system, not just taking on Kaiser, but generally speaking, just accessing their doctors is challenging. On the phone, I can't even send them mail to let them know I took care of their patients. So everything goes through the patient. So how did you find an internal medicine doctor who had the buy in to direct care practice, did you incentivize them with a salary? Was it like you eat, what you kill? What did that look like?

 

Dr. Lynn  14:26  

Yeah. So she, yeah. So we were friends, and she was burnt out. And so she, I mean, that was the perfect kind of get tired, like burnout in her current job. And so she has slowly moved over from her other job, where she did a couple hours with us, and as her practice has grown, then she's working less and less in her other job, and that has allowed her to because I, I mean, I was a small I still am a small business like I can't pay. A big fat physician salary, so she started small and has grown. 

 

Dr. Tea  15:04  

So it's just a mutual understanding. This is amazing. It's so hard to find that, and so it's nice to hear that it's possible, and hopefully people just see the value in partnering with specialists like us, because we can do that cohesive care without insurance, that's the best part.

 

Dr. Lynn  15:24  

So will there's a way. You just have to figure it out. 

 

Dr. Tea  15:27  

Yes. And I really, like your friend who said, Stop complaining. I will do something about it.

 

Dr. Lynn  15:33  

You did. She's a physician too, and we used to run together every morning. I'm a runner, and she's so straightforward, I would just complain. And she's like, stop complaining, please. Okay.

 

Dr. Tea  15:46  

And then you finally did right? Yeah. So how does your practice? How do people find you to have patience?

 

Dr. Lynn  15:53  

Yeah. So we do marketing, we do paid advertising, we do Google Ads. We a lot of patients from Google ads, but we also get referrals. I would say, when I started, I practiced in St Louis for like, six years, or maybe five years, five and a half years before I came here. So I was known in the community, and I'm a specialist, so I did a lot of menopause and sexual problems in women, and I'm really the only physician who really specializes in sexual problems in women. So even when I started Evora, I had patients follow me, but also people got referred to me, and then I did paid advertising. So we do Google ads, we've done print, and everybody always says, oh, print isn't any good. But I actually think for us in our market, it's been a good thing. And then we do a lot of social media. So we don't really do any paid social media, but we make posts and have a following and do events and things like that to get the word out. So yeah,

 

Dr. Tea  16:56  

What would you tell the doctor who is on the fence about direct care. They're not quite sure which way to swing it. What would you advise them?

 

Dr. Lynn  17:08  

Um, well, I mean, it certainly depends on their situation. I think, like, if they were kind of on the fence, I don't know, should I do it? Should I not do it? I really do believe that, like, where there's a will, there's a way, if you want to do this. Like, I don't know if you ever watched Project Runway, but the main guy in Project Runway be like, make it work. Like, you can make it work. So you might have to be creative and pivot. And do you know something that you weren't expecting to do? But like, I mean, you can do it. And the thing is, if it doesn't work, you're still an MD, you can still go back and get a job, like it's not and that's kind of what I thought at the time. This was my plan. I was so burnt out, but I was like, you know, if this doesn't work, I'm going to actually. Was like, I'm going to go use my MBA, because I was so burned out with traditional medicine. I'm like, I'm going to go work for American Airlines because I want free plane tickets. So that was my plan. And you know, if it works, great, if it doesn't work, that's okay too, but you don't know unless you try.

 

Dr. Tea  18:08  

What was the biggest surprise for you when you opened your own practice?

 

Dr. Lynn  18:11  

The biggest surprise? Um, well, it didn't turn out to be how I thought it was going to be, because I just, when I opened, it was just going to be me, OB-GYN, that's what I was going to do. And then we realized there was a need for other services, and so we just kept adding services. Um, so it the the thing that I think about starting a business, and like I wrote this whole business plan, I had it all mapped out. My business looks nothing like that. Business Plans like it just change, and you just don't know things change, things come up. So but that's one thing I love about it.

 

Dr. Tea  18:51  

And how have your patients been responding to the direct care type of practices?

 

Dr. Lynn  18:57  

Yeah, I think we get a lot of feedback, a lot of good or positive feedback. People are like, I'm so glad that I answer their text messages. Like, you can text me at nine o'clock now, there are times where I can't answer right away, but like, they can directly answer me. I mean, I can directly answer them, and I think people appreciate that, and the fact that I have time with my patients. We're not in a rush. We usually don't run behind schedule, so no one's going to sit in our waiting room for two hours. I think patients really appreciate that a lot, and so I'm happy I can do it. I'm so grateful. I say that all the time, how grateful I am that I've been able to make this work. I'm very fortunate, like very lucky. I mean, it doesn't come without a lot of hard work. I'm also a super hard worker. Just comes with the territory, but I do feel really fortunate that I've been able to make it work.

 

Dr. Tea  19:56  

Can you share a little bit about the demographics in your area? People think Direct Care is concierge, where we only treat bougie people with lots of money. Is that true for you? 

 

Dr. Lynn  20:08  

So no, I would say our demographic does have disposable income. So, yeah, we're expensive, and I get that and so that does narrow down the market of patients that we see. But what I've done, because I felt bad about that, right? Like, I feel kind of guilty, like, you know, oh, so only rich people can get good care. Like, that's not fair. So what I did when I started is I, I offer a giving back to the community day, which is a day where I'll see anyone. It's regular, scheduled appointments. You can pay for something. You cannot pay for something. You could bring me some eggs from your farm, like it's, you know, it's one of those, whatever. And I've been doing that one day a month since I started. And that way I mean that that just allows me to provide care to people who can't afford it. Now, granted, I don't do that every single day, so we're still a narrow demographic of people who have disposable income, but I just it makes me feel good that I can offer that 

 

Dr. Tea  21:16  

I did that one day. Was it this past year I did a free day, you know, free foot care day, and I posted it on LinkedIn because I was like, that's pretty cool. No one's taught me how to do anything that I do. I just started, like, thinking about it. I did it, and I felt good about it. But of course, there's always somebody out there in the universe saying you probably shouldn't have done that, especially for a Medicare beneficiary, in which if you're providing free care with the I guess, the intention to make them pay later on, or make them believe that they would have to pay for future care. That's problematic. Have you experienced anything like that before? 

 

Dr. Lynn  21:52  

Yeah, so I've opted out of Medicare, so that means I can see Medicare patients and I can charge them, but if you're opted into Medicare, at least in the medical world, I'm not sure. For podiatry, if you're opted into Medicare, and you see a Medicare patient, you have to bill Medicare. And if you do like concierge, you have to have a whole contract which explains you can only charge them for things that are not covered by Medicare. So I opted out in the beginning, so I don't run into those problems with Medicare, because my primary care, primary care, wanted to see Medicare patients, but she's opted in because she also works somewhere else that she needs to stay opted in. And so what she's done is she decided to bill insurance, bill Medicare through our office, but it is such a regulatory nightmare. It took months to get it all set up, but she's all set up. She has, like, a separate little Medicare practice. She bills Medicare. She has a different EMR. It's kind of separate from us, but it was so frustrating because it was so complicated and a regulatory nightmare that, like we almost didn't do it, and many people in the Medicare age really would thrive with concierge because they're complex and they need time. They have multiple medical problems, and a five minute visit isn't going to do it for them. So, yeah, that's how we've handled Medicare, but I'm opted out.

 

Dr. Tea  23:27  

You're opted out, but your internal medicine doctor is opted in. Medicare still,

 

Dr. Lynn  23:33  

yep. So how do you separate Medicare? Panel LLC, it's separate,

 

Dr. Tea  23:39  

okay, so if a patient sees you, then they need to see her. Those are completely divided lines. They pay you your fees, and then whether she builds Medicare or not, that's between her and the patient.

 

Dr. Lynn  23:52  

If the patient has Medicare, she bills Medicare, that's the law. Yeah, 

 

Dr. Tea  23:57  

yeah, right, which is what I thought. So I'm not billing Medicare. I'm opted out 100%. I'm a direct care practice, and so, you know, I made this very apparent on LinkedIn that I don't. I'm not trying to incentivize people who have Medicare. I don't bill Medicare. That's the whole purpose of calling yourself a direct care practice. You don't have insurance contract obligations. But I just wanted to be sure that I wasn't missing something that would put me at liability. I'm still going to give free care like when I want to, because I own my business, it's fine, but for other people who feel the same way, I think a lot of us just really enjoy having a percentage of our practice given away for free, because that's the reason why we went into medicine in the first place, just to have access. And now that we have a direct care practice, we can actually get paid for our services. What a concept, right?

 

Dr. Lynn  24:46  

Yeah, I know it's crazy.

 

Dr. Tea  24:50  

Do you think people need to have an MBA to make their business work for them? 

 

Dr. Lynn  24:54  

Nope, not at all. Not at all. I think you can do this without an MBA. I just think. In my past, like the MBA just gave me that extra bit of confidence that I could do it, that I knew what I was doing. But you don't need one at all. It's a lot of theory, not as much useful stuff. 

 

Dr. Tea  25:12  

Well, it seems like you would also have a lot of network too, outside of medicine,

 

Dr. Lynn  25:18  

yeah. And actually, I think networking is really important to growing your practice. I still do some networking, but when I started, I did so much networking. I think it's so important to get out in the community and meet people and let people know what you do. I think that's one thing that, like I never learned in my younger years, the importance of networking, but I think it's so important.

 

Dr. Tea  25:41  

What's the one advice you have for the doctor who wants to do direct care? 

 

Dr. Lynn  25:45  

Um, believe in yourself and believe in your value. So I think a lot of doctors are like, Oh, no, one's going to pay for me. No, that's not true. You have, you're an MD or a do? You have all this education and knowledge and you know, just your wealth of knowledge and good information that you can help people with. So I would say, believe in yourself and believe in your value. Any last words for the listeners, the only thing I would add is that since I started this, I've had so many people ask me for help in starting up practices that for a while I was doing consulting and helping people start up practices, and now we have started offering helping other direct care gynecologists get started as an Evora practice. So we've just launched this. It's a baby, it's new, but if there are any gynecologists who are listening to this and wanted help getting started. That's what we do. 

 

Dr. Tea  26:44  

Oh my gosh, yes, yes, I do know some people, and so I will be sending them your information. So thank you for sharing that information. 

 

Dr. Lynn  26:51  

Yeah, yeah. 

 

Dr. Tea  26:53  

Well, I appreciate your time so much for telling us how it was like for you leaving an employee job for 20 plus years, and then choosing to do direct care exclusively, and then some hardships in between. But eventually, four years later, do you feel like you've made it, or do you think there's more to come?

 

Dr. Lynn  27:12  

Oh, there's more to come, but I feel like I've made it. There's more to come. We're still growing.

 

Dr. Tea  27:19  

Perfect. Well, thank you so much again for being here and for everyone who's listening, I will catch you next week. Thank you. Bye.