Bloom Pediatrics with Dr. Jennifer Dilts

Transcript:

Dr. Tea Nguyen (00:53.71)

I'd like to welcome Dr. Jennifer Dilts to our podcast today. She is a pediatrician specialized in general peas, but she just shared with me some really cool niche things that I'm going to let her share with us today. So welcome to the podcast.

Dr. Jennifer Dilts (01:09.358)

Thank you. Yes, I started my career in general pediatrics, did general peds, outpatient and urgent care for 10 years and then had always had a love for chronic pain and the co-existing mental health conditions that a lot of times go along with that. So I worked in my local children's hospital, headache clinic for about seven years and got my board certification in both headache medicine and medical acupuncture. And then for the past two years, I've been in private practice. And so I work as a PEEDS subspecialist. I see kids and teens for headaches as well as anxiety, ADHD, and depression. And then I also do some acupuncture for both kids and adults. 

Dr. Tea Nguyen (02:04.578)

This is so new for me. So I do podiatry and it's mostly older people. I'll get like a couple of kids here and there, friends and things, but it never dawned on me that children would suffer from headaches, that that would be a subspecialty. If you can just entertain me for a hot second, what does that look like? Like, how do they find you and why are they choosing to see you versus whatever options are available to them? 

Dr. Jennifer Dilts (02:27.406)

Yeah, yeah, great questions. And it's really interesting because there are so many kids out there with headaches and the majority of kids who have headaches, it's tension type headatension-typeche. And those are the ones that don't generally come to me or even their general pediatricians because they're short-lived and they're not interfering with functioning. But there are a lot of kids that have migraines. It's estimated that 15 % of 15 year olds have migraines and the percentage goes down a little bit as kids get younger, but about 10 % of 10 year olds have migraines.

And the thing with migraine, even with kids and teens is that they can be really debilitating. And so there are lots of kids and teens who are unfortunately missing lots of school and lots of sports and other activities and social activities because of their migraines. And unfortunately, most general pediatricians don't have a lot of training in headache and migraine. And so a lot of times these kids are going untreated. And so people find me in my current practice through a variety of ways. I have some pediatricians and family practice physicians who refer patients to me. I have some mental health therapists who refer patients to me. And then I'm also really active on social media and I've gotten patients.  who have found me that way. 

Dr. Tea Nguyen (03:56.206)

That's amazing. I have a seven year old and it breaks my heart to hear that children can be suffering through this and not get the right treatment. So you will absolutely be my number one person in mind to think about. Should I ever encounter this? So thank you so much for sharing that. The reason I brought you on is because you have a specialty that is quite desirable, but it may not be common for a direct care practice. And you had mentioned that you are an independent contractor for a direct care practice. 

Can you walk us through life before direct care and as how, how did you decide on this pathway for you as a business owner now? 

Dr. Jennifer Dilts (04:36.384)

Yeah, sure. So I have, as I shared, I've worked in different practice situations. I started as an outpatient pediatrician right out of residency. I was employed by a hospital-owned practice, and then I was in a large Children's Hospital, urgent care, and then finally subspecialty care, kind of a headache clinic. And I have always loved my colleagues, the people I work with, I've always loved my patients, but man, it is hard to be an employee of a large hospital system. I kept asking, why can't we do things this way? Why can't we add this information to the discharge? Information we give to patients. Why can't we squeeze patients in at this time if they need to be seen? And as you probably know, and I know our audience knows, things just move really slowly in a big hospital system. And it's very hard to feel like as a physician that you have any control over your schedule or over what's best for patients. And I had gotten to the point after COVID where I was seeing the most debilitated headache patients. I was in a mostly spending my time in a multidisciplinary comprehensive headache clinic. And it was me, pain psychologist, a headache social worker. And so we were seeing patients that were had truly missed many, many days of their life and activities due to headache. And we were only seeing these patients every five months just due to access. And I thought, this doesn't feel good.

My patients aren't happy with their lack of access to me. I don't feel like I'm making them better because I don't. get enough time with them. I don't get to see them frequently.

And so it doesn't feel good to me or the patients. And so I just got to the point a few years ago where I thought I've got to do something different. And I got to know Dr. Lauren Hughes, who is the practice owner of Bloom General Pediatrician, started our practice in 2020. And I was talking with her and I asked her, said, do you think this could work? I do headaches and acupuncture? And she was like, yeah, I think that would work. And so it was fun for me. felt a little, a lot less scary compared to just completely going out on my own. I knew that I would have Lauren and then our other Dr. Jody. And so that was just a nice way for me. She already had the office, the practice space. She already had the EMR. 

I really could just kind of jump in and focus on building my patient population and not have to figure out all of the other logistics. 

Dr. Tea Nguyen (07:27.874)

You just gave us new insight as to how you can create a direct care practice. And it's kind of just partnering with another DPC practice, which I think is wonderful. And I hope that we get more opportunities for that. In your mind, did you feel that this was a good fit or did you just have a leap of faith? Like, I don't even know what I'm trying to ask. Did you know this was going to work out for you? Cause you've been doing this for two years. 

Dr. Tea Nguyen (07:55.815)

So it sounds like it's doing okay, but tell us what your thoughts were when you first decided to make the jump and what actually happened. 

Dr. Jennifer Dilts (08:05.162)

Yeah, I think I had just gotten to the point. I heard on one of your other recent episodes, I think it was a guest that said a lot of physicians stay in a practice for way longer than we should have like past the point where we knew it wasn't working. And I think the same was true with me where

Dr. Jennifer Dilts (08:24.75)

I had definitely gotten to the point where I was like, okay, I need to do something different. I want more autonomy and control and I just want to be able to treat my patients the way that I feel like they deserve to be treated. And headache medicine is a field that it just takes time. It takes a lot of time to understand why someone's having headaches and the whole social context and their sleep and their nutrition and the stressors and those kinds of things. And it takes a long time to be able to educate patients and their families about all of the different treatments for headache. And it's certainly not just medication. It's also a lot of times management of stress and again, sleep and activity and nutrition and all of these good things. And that's just so hard to do in short little clinic visits. And so I... 

I wasn't sure that it would work out in this way. It felt scary to just be depending on myself and my own reputation and my own skillset versus having a hospital name behind me. But I had gotten to the point where I was just really ready to do something else. really liked Lauren and the way that she was running her practice. I knew that our philosophies aligned and so I had a really good feeling about it. 

Dr. Tea Nguyen (09:51.576)

Tell us about your model. Is it strictly membership or do you have pay per visit? What does that look like? 

Dr. Jennifer Dilts (09:58.936)

So I do both. For my headache patients, they can either do a paper visit or membership. And part of the reason that I did that is I did have some patients that moved over with me from my previous practice. And for them, if they're doing really well, if their migraines are really well controlled and they only need to see me every six months or so, I didn't think that a membership necessarily made sense for them. And I still get... 

Dr. Jennifer Dilts (10:27.2)

Sometimes my new headache patients will have really episodic migraines and they need a really good rescue treatment and some education, but not a lot else. And so I still offer pay per visit. I do get a lot of migraine patients who are really struggling with migraine. And for them, the vast majority of them do the membership plan because that just makes sense since it covers all follow ups and it covers close communication with me. 

Dr. Jennifer Dilts (10:55.276)

I talked to the parents about the paper visit or membership model and almost all of them now decide to do membership. When I started offering ADHD and anxiety and depression care, I only offered the membership model because close follow-up is so important in managing those conditions. And so I really like the membership model. I think it makes a lot of sense for the conditions that I treat. 

Dr. Tea Nguyen (11:23.104)

When you were explaining your model to patients, did they understand what you were doing? 

Dr. Jennifer Dilts (11:30.166)

I would say most of the time they do and as I've gotten farther into it, it's gotten a lot easier to explain it. I sometimes will say, you know, it's like a gym membership. Some months you may go a lot, other months you may not need as much, but I'm here when you need me. This is paying for access with me. And most of the time then the parents will not say, yeah, that makes sense. They also of course like the price transparency about it. They like knowing, okay, I'm paying this amount each month and then everything's covered and I don't have to guess about how much it's going to be. And for me, I just really like this model because I think it removes any barrier to me providing the best care and for parents reaching out to me when they have questions and concerns. I also really like it in the pediatric space because 

Dr. Jennifer Dilts (12:24.738)

There are times with all of the conditions I treat where the parent has a question or maybe there's a medication side effect and the parents and I can do a phone call or do a virtual visit, and the child can still be in school. Of course I'm bringing kids into the office and I'm following up with kids, but not every question needs for the child to miss school or the parents to need work and bring them in. And so I love... that ease of access. And that's very different from our traditional model where if you call your pediatrician and say, I'm worried that Johnny's having a problem with his ADHD med, well, that's automatically a visit and you're bringing your child in. And it's just so nice to just be able to talk to Johnny's mom and say, yeah, it sounds like we need to adjust it. Let's do this. And then I'll see him in the clinic in a couple of weeks. And so I just feel like that model works really well for the patients that I treat. 

Dr. Tea Nguyen (13:20.406)

I really love that idea. And I'm still a specialist trying to wrap my head around membership for my practice. And I wanted to know how did you have that discussion with patients about how the membership is like a gym membership, but if they went months without using it and they maybe wanted a credit, did you apply any credits or was it just what it is? 

Dr. Jennifer Dilts (13:45.134)

I have never had anybody ask me for a credit. I think they all know that it is what it is. And so, yeah, I haven't had anybody that's asked that. I think they also know that the monthly rate is low enough that the monthly rate is lower than what they would pay if they went to a mental health therapist or a doctor out of network or anything like that. And so, 

Dr. Jennifer Dilts (14:12.864)

Really, even if you're going a month without asking me or a month without talking with me, if you're seeing me every three months or so, that monthly membership is still going to make sense. I don't know if I explained that. 

Dr. Tea Nguyen (14:28.3)

Yeah, definitely. It's low enough, then they're not really losing anything. It's just cheaper. 

Dr. Jennifer Dilts (14:35.968)

Yeah, and I actually have tried to schedule or to price my follow-up visits so that it's about the same. It's not too much less than three months of membership. And I intentionally did that again because I really want to guide people towards that membership model so that there isn't a barrier. I think if they know that they reach out to me and I'm going to say, it sounds like I need to see you in the office and they're 

Dr. Jennifer Dilts (15:00.344)

paper visit, then they may be like, I don't know, maybe I'll wait a while versus with the membership. Hopefully if they have a question or concern, they're reaching out to me right away. And a lot of times with initial new patients, I am seeing them every month for the first couple months, three months. And so I think they feel like they're really getting a lot of value out of the membership. And then when we stretch out and they're not needing to see me every month, I think 

Dr. Jennifer Dilts (15:29.378)

By then, they're sold on the membership and they like, yeah, she really does email me back when I have a question and she's easy to get a hold of. It's worth it to me to continue that membership. 

Dr. Tea Nguyen (15:41.528)

Have you ever had to deal with high users or higher than normal users in your membership? 

Dr. Jennifer Dilts (15:47.766)

No. And I think that's a common question that direct primary care docs get and probably those of us in the specialty care world that are doing memberships, which I know there's not a ton of us, but you know, people don't want to spend their time at the doctor's office. I think that's what it really comes down to. And I honestly have that here too. thought, gosh, are they gonna really want to get their money's worth and they're gonna be trying to come see me every week. again, people have... have other things they want to do with their time. They're not trying to come in and see me every week or take their kid out of school. And so I really have not had that. So if you are listening and you're worried about that, I would let that worry go. 

Dr. Tea Nguyen (16:32.172)

Yeah, a lot of doctors have this fear of being overutilized because we're already burned out in the system and they fear that they're going to attract a certain type of person who's just really demanding, who's never happy or satisfied. There's this misconception that it's just for the wealthy people. Did you have any of those ideas when you thought about direct care? 

Dr. Jennifer Dilts (16:53.934)

I did, yes. I think I was worried about what kind of patient population I would get because I have always worked in healthcare systems where we took all comers, we took Medicaid, we took private insurance, we took non-insured. And that's always been a high value of mine. And one thing I really like about Bloom where I practice and the practice that 

Dr. Jennifer Dilts (17:22.434)

Lauren built is that we're really centrally located in Kansas City. So there are a lot of different types of neighborhoods around us. And she had found a way to really get her name out in lots of different circles. And I've been pleasantly surprised. I really have patients from all different walks of life and income levels. And I have heard of your podcasts and other podcasts before that. 

Dr. Jennifer Dilts (17:51.17)

We're not always very good at predicting who is going to value our services. There are some people that cost wouldn't be much of an issue and they're not gonna see the value. And then I have other families where I know they are really working hard to make ends meet and they keep their membership faithfully every month because they see value in it. And so that has been a really nice thing to see that there really are lots of different types of patients that come see me. 

Dr. Tea Nguyen (18:20.216)

What kinds of things surprised you when you decided to have your direct care practice? 

Dr. Jennifer Dilts (18:27.246)

So one thing was, and I do think I'm usually an optimist and usually a why not let's try it type of thing, but it was a lot harder to get patients initially than I thought that it would be. I was used to practicing in a hospital system. I knew that those visits take a really long time by the time you navigate the parking garage and checking in and answering the same question multiple times and then waiting for the nurse and then waiting for the physician. 

Dr. Jennifer Dilts (18:55.662)

I also knew navigating the phone system at a large hospital system is hard. And so I knew the value that I provided. I knew that I had worked really hard to make my services really streamlined and make it really easy and convenient to see me. I didn't think about the fact that it still takes 

Dr. Jennifer Dilts (19:22.57)

a long time to get the word out and for people to change their referral patterns. It was harder for me to, and it still is harder for me to get referrals from general pediatricians than I thought that it would be. And I think part of it is they're just used to, their nurses know how to refer to the big hospital system. They're used to that. And so it's changing that referral pattern has been kind of hard and 

Dr. Jennifer Dilts (19:50.822)

So that's, it's taken more time for me to get a good patient base and some good referral sources. And I think the other thing, a lot of times, at least in pediatrics with direct primary care, when you get a new patient, a lot of times you might get two or three or even four new patients because you're getting a whole family that's joining your practice. 

Dr. Jennifer Dilts (20:18.15)

And specialty care isn't usually that way. I've gotten to the point now where I have multiple groups of siblings because I started to see one patient and then now I see the sibling for that same condition, but that took a while. And so I think growth for me has been slower than some of my DPC pediatrician colleagues. Again, just because I'm not getting whole families. 

Dr. Tea Nguyen (20:44.13)

That's a really interesting point that even though it was slower, you can still get the whole family. So that becomes kind of a banger deal. It's a slow, but steady growth. And I want to make it very transparent because I think that's very common for direct care doctors, even specialists where the growth is slow, especially if you're coming from a place of employment where your schedule is just full. You show up and you've got 30 people and you're like, wow, that was effortless. Like literally that's how you're set up for. 

Dr. Tea Nguyen (21:14.36)

But when it comes to building your practice, it's everything is you. You're wearing 15 different hats to get people in. So I'm wondering, do you do any paid ads or marketing or social media to get people in? 

Dr. Jennifer Dilts (21:28.694)

I don't right now about a year and a half ago. I did some Google ads for probably three months and they drove a lot of people to my website, but I don't think I had a single new patient appointment from that. And so that's the only paid advertising I've done. I have spent a lot of time building my Instagram following and just trying to put out good content on the conditions I treat. And so that hasn't been paid advertising, but it's taken a lot of my time. 

Dr. Jennifer Dilts (22:04.528)

And then I have worked on just building my network and my referral sources and a really great one for the conditions I treat have been mental health therapists. And some of that really started organically where 

Dr. Jennifer Dilts (22:20.93)

I would reach out to a therapist on a patient I was seeing and they'd be like, man, the doctor never calls me. This is so great that you're calling to coordinate care on this child with anxiety or this child with migraine. And so then that was just a really nice connection. And so that's a big referral source for me. And I know I've heard you say on the podcast, know, think about where your potential patients are already going. What other services are they utilizing? And 

Dr. Jennifer Dilts (22:48.322)

That's been a really great one for me, my mental health colleagues. Another thing that has been so good for me is we have a couple of big direct primary care family practices here in town and they've been a great referral source for me. And that's been really nice because those are families that already know and value the direct care model. So it's really easy... 

transition for them to come see me as a specialist. 

Dr. Tea Nguyen (23:20.184)

Thank you for sharing that. I wanted to circle back to how you were able to work within a direct primary care practice as an independent contractor. Could you tell us a little bit more of what that looks like? Or maybe the doctor who's listening, they're trying to figure out what's their next step and how do you start that kind of relationship? 

Dr. Jennifer Dilts (23:42.19)

Yeah. So for me, it just has worked really well. And as an independent contractor, I have complete control over my schedule and over how many patients I see and that kind of thing. So with my particular arrangement, Lauren, the practice owner takes a percentage of all of the revenue that I bring in. So what that means for me is that even initially when I was starting out and I was slow, 

Dr. Jennifer Dilts (24:10.956)

She was getting a percentage of the revenue I brought in, but I didn't have fixed overhead costs and still don't. And so it was a really nice, stress-free way for me to start because I didn't have, you know, I wasn't paying rents and paying for my EMR and utilities and that kind of thing. And that's still how our relationship has been. And so it feels really good because I get complete control over 

Dr. Jennifer Dilts (24:41.226)

my practice and how I do things, but then I still get to go to an office every day where three other pediatricians work and have that collaboration. And so that has been a really nice middle ground for me. 

Dr. Tea Nguyen (24:57.23)

When it comes to marketing yourself, does Bloom DPC market for you or are you doing this independently? 

Dr. Jennifer Dilts (25:05.71)

So I would say both. Lauren, the owner of has a huge Instagram following. so she shares, I do reels, she shares them to her followers too. And that certainly has helped me out. She's never done any kind of paid advertising either. so she, yeah, she shares my Instagram and that's been most of our advertising. 

Dr. Tea Nguyen (25:33.088)

I love that because I always go back and forth with paid advertising for certain services and some months it's like, wow, I spent a lot. I did not see a return on investment. In other months, I'm totally consumed with social media and the people who inquire. And it's just for me, spaghetti on the wall. You see what works and you'd keep doing that thing. What are some things that maybe I didn't ask that you want to share with people who are interested in direct care? 

Dr. Jennifer Dilts (26:02.248)

That is a great question. 

Dr. Tea Nguyen (26:06.872)

What would you tell yourself, you know, 10 years, what would you tell your younger self about the models of private practice? Did you think you were going to be in private practice? I mean, I know I wasn't, I just kind of got pushed up against a wall, but for you, did you think you would be a private practice owner someday? 

Dr. Jennifer Dilts (26:25.774)

No, I didn't. I thought I would be in my hospital system until the end. I think I would just say, you know, it is a leap and it feels scary, but it has been so worth it. I'm so proud of the practice that I've built. I'm proud of the new skills that I've learned. I, you know, there are... 

Dr. Jennifer Dilts (26:47.982)

so many different ways to do things. And for me, I decided, okay, I'm not gonna spend a lot of money on building a website or advertising or those kinds of things. I've got some time. And so instead I'm gonna see what I can learn to do on my own. And especially in this day and age with so many online courses and online information, I paid for a... 

Dr. Jennifer Dilts (27:14.414)

a course on building a website. built it myself on Squarespace, which I am not, I had never done anything like that. I'm not really a techie type person. So that was a real confidence builder. I had no online presence. I had never recorded myself doing Instagram reels. And now I've got over 10,000 followers on Instagram and I've done, I don't even know how many hundreds of reels and There's a pediatrician in Lincoln, Nebraska, Dr. Phil Boucher, who has a really good Instagram following. And he does different, really accessible courses on teaching, mostly physicians, doesn't have to be pediatricians, or how to start doing content on social media. So that was super helpful for me. And so I would just say the resources are out there and you don't necessarily have to spend a lot of money on advertising or. 

Dr. Jennifer Dilts (28:10.796)

building a big fancy website or anything like that. If you have the interest, then there are people who are happy to help teach you the skills. 

Dr. Tea Nguyen (28:22.55)

Awesome, thank you so much for sharing all of your insight. If people wanted to connect with you, how can they find you? 

Dr. Jennifer Dilts (28:29.198)

Yeah, so my website is drjenniferdilts.com and that's my Instagram handle too. And so those are the best ways to find me. 

Dr. Tea Nguyen (28:42.222)

I'm going to stalk you. I'm going to borrow some inspiration. 

Dr. Jennifer Dilts (28:46.958)

Do it. I mean, the other thing as you know, is that the world needs more physicians out there putting out good quality medical information. And historically it hasn't been physicians, especially if we're employed physicians, there's not a lot of incentive to do that. And when I was employed, there were a lot of restrictions around, you know, putting medical content out there and that kind of thing. And so those of us that, that are independently practicing and I think we should be having an online presence. Not only is it good for getting new patients, but the world just needs good medical content right now. 

Dr. Tea Nguyen (29:30.166)

I really love that you brought that up because when you're employed, you're just too busy to think about anything outside of work. But when you're in private practice, you get to control your story and who you take care of and the medical education that they can get readily online through a reliable resource. And I think that's a public health service on its own. And I know that that's what a lot of us crave to do. And you're showing us a pathway to do that is by being your own boss. So thank you so much for your time and for sharing your insights today. 

Dr. Jennifer Dilts (30:04.462)

Yeah, you're welcome. And to that note, that just reminded me, I also am now a podcast host. My friend, Dr. Nerissa Bauer and I started our own podcast a couple of months ago. It's called ADHD Mom Docs. And it's just been a really fun way to put high quality ADHD parenting content out into the world. so my first... take home on that is even if you never in your wildest dreams thought you would be on social media or doing a podcast, like you can do it, you can learn how to do it. The second thing too is I had some angst when I was leaving my previous job to how am I going to be able to feel like I'm serving people in my community who maybe can't afford my services. And number one, you can offer discounted memberships at your discretion since you are the boss and 

Dr. Jennifer Dilts (30:59.016)

I have done that and will continue to do that. But number two, you can put free content out into the world on Instagram, on podcasts. And that's just a really nice way to feel like you're serving people who maybe aren't able to come see you in person too, for whatever reason. 

Dr. Tea Nguyen (31:19.202)

Yeah, I'll share your podcast down in the show notes. And I do know Dr. Nerissa Bauer, and this is such a perfect match for you both. Yes. I'm so happy to see you expanding into places of discomfort. 

Dr. Jennifer Dilts (31:33.452)

Well, thanks. to that end, I think we all just need to reach out to each other too. She has been doing this longer than I have, and she's been a really good helper to me as far as figuring out, okay, what are my next business management steps? And what do I want to start incorporating into my practice? And so it's really fun to be able to have colleagues. She's not in the same state I am in. We've never met in person. 

Dr. Jennifer Dilts (32:03.31)

But yeah, we have this close relationship and meet every week to podcast. And so that's another tip is to reach out to other people who are doing this. 

Dr. Tea Nguyen (32:13.4)

That is so cool. I'm so happy for you. Thank you so much for being here. And I look forward to chatting with you in the future to see how life looks like for you in a couple of years, not just in your direct care practice, but in your life, because I strongly believe your direct care practice affords you the freedom to literally do whatever you want with your time. 

Dr. Jennifer Dilts (32:33.454)

Great. 

Dr. Tea Nguyen (32:34.552)

Thank you so much. One last thing, if you took anything from this episode, whether it's a small dose of inspiration or even an aha moment, could you please share it with a friend or post it on LinkedIn? The direct care community depends on doctors like you because no one is coming to save us. So it's up to each and every one of us to keep the conversation going to a point where direct care becomes a normalized path for private practice. 

Dr. Tea Nguyen (33:03.478)

and not some secret that we have to mine for. Thank you if you've already done so or if you've given this podcast a review, really does mean a lot to me. Sending you peace and possibilities. I'll catch you next week. Take care.