Transcript:

Dr. Tea  0:01  

Practicing medicine without insurance is possible. Imagine a private practice where you get to see your best patients every day, providing medical services you truly enjoy, all without the hassle of insurance. My name is Dr. Tea Nguyen, and I'm a recovering specialist who was completely burned out from insurance based medicine. I pivoted into direct care, where patients pay me directly for my medical services, and have never looked back. If you're a private practice owner or planning to become one who's looking to be free of the grind of insurance and you're craving it, simplicity, efficiency and connection with patients, you are in the right place. This podcast will help you map out your exit plan and uncover the mindset needed to thrive in today's economy. Welcome to the Direct Care Podcast For Specialists.

Dr. Tea  0:53  

I don't know if you noticed, but every 10th episode is a really, really special episode, and this one is no different. Welcome to Episode 40. I am going to share with you a conversation I had with my own personal mentor, Dr Grace Torres Hodges, who had recently earned her MBA degree, and she is a practicing podiatrist doing direct care in Florida, and was receptive enough to talk with me about direct care and all of the things really I let her take on the conversation because she had just gotten back from speaking at the nuts and bolts 2.0 Conference, which is all DPC doctors. So DPC is direct primary care doctors, and she spoke as a specialist, and some of the challenges that specialists have that are different from primary care, and so she was able to give us an inside look to that conversation. So I hope you enjoy this one. And, oh yes, there was just so much to get into that there will be a part two. So stay tuned for that one too. All right, here you go. Enjoy. 

Dr. Tea  1:58  

I'm so excited to have my very own private mentor. I call her, although I've not paid her, but she should be charging me for all the questions I've ever asked her about transitioning from the insurance based practice into direct care. And I met Dr Grace Torres, what, two years ago, and I feel like I've known you forever, because I've constantly, you know, at the start of something new, at the start of the transition, I was so afraid of what I didn't know. And Grace was really, literally that saving grace for me, that anchor that said, look, it's fine. I've been doing this a lot longer than you have, and look where I'm at. And so grace is alive. She's well, so I invited her on here,

Dr. Grace  2:39  

I'm so excited every time I see you move further along on the direct care path and spread the spread the good news, you know, I think, yeah, two years is when two years ago we met, but actually you contacted me a little bit right before it's right at the beginning of COVID, right before COVID Even, I think, to a certain extent. So COVID seems to be the one that actually opened the eyes of direct care to everybody else. You know, those of us that were in it before, we're just really more jaded by all the insurance things I recall, my my transition all the time, whenever I have to speak in front of groups. And most recently, I was going through that again, because I just came back from Dallas, from the 2.0 DPC nuts and bolts conference. And it's full circle for me with that one, because 2013 was when I first met that group and also through the American Association of Physicians and Surgeons. And I, you know, was the lone podiatrist at that at that conference, actually take that back, there was one other guy that was there that was interested, but, you know, we were at the beginning of Obamacare had just been regulated and approved, and the exchange was about to start, and the the website just crashed. And that's what we were. We were in the midst of all that, because I remember that, yeah, we were, we were, we were about to get inundated by all these people. And my thing was, I have a very smart office manager, my husband, who actually has an insurance background. He was the one that actually got me out of getting me on the straight and narrow to get away from insurance and saying, you know, these guys are just like taking advantage of y'all, and you don't need to be your skill set, your knowledge, your they can't function without you. So you better start looking at maybe getting out of it. And I didn't believe him at first, because I had all the fears like everybody else, like everybody that always comes and says, Will it work? I mean, will it work even in my area, especially because I live here, you know, I live on the Gulf Coast in Florida. Not only is it geriatric, uh. Uh, heavy, but I'm also in a military town, so we have a lot of federal TRICARE and campus and all that too. So everything really is already the mindset here among patients is that everything should be covered. I put my time in, it should be covered. But, you know, even at the start of my practice a lot of what I learned was from my folks, who were both physicians. They were in general surgery. My dad and my mom was internal medicine. I was free labor in their office. So I grew up in that office. A lot of my business sense in running a practice, I learned from them. So that's my advantage. But, you know, the specialties are completely different and but you know, with that in mind, I watched them practice medicine the old fashioned way. You know, my mom was the type that would take patients after she examined them in the exam room, take them to her room and literally sit down with them, one on one for a good 1520 minutes. She was notoriously known for running behind. The mall was near her office. So patients would say, How long is she behind? The staff would say, she's about two hours. We'll call you when it's your time. You can go shopping, you know. So if she spent the time it was she always worked the way. My father was very good about explaining procedures and drawing everything out. I picked up that skill from him. So I draw procedures out for patients. And if you don't create that common bond with them and that relationship with them, why do you know they are entrusting you? That's a lot when they come to you. And that's the beauty of medicine, is because you know you're You're someone's trusting you to do something for them. And it's that giving back. And I think that's what all of us went into medicine to do. We did not go into medicine to do all the minutia. And so that's, that's what direct care has been a saving grace for me, because I didn't realize that you could do it that way. So whenever I have somebody like yourself reach out to me, I am more than happy to help them through it and guide you through it. But there's no magic pill and there's no magic formula. Everybody has to do it their way, but there's a lot of trial and error that we've gone through already that we try and share back.

Dr. Tea  7:28  

Do you think that there is some kind of relative formula for one doctor to decide if it's going to work in their community? Because, like, I was in the same situation, most of the people in my community were low income or on Medicare, and so that was 60% of my revenue. So having to opt out of the, you know, the financial aspect was a huge blow to me, but I was prepared for that, right? What do you think? How should somebody be prepared to start transitioning from insurance into direct care?

Dr. Grace  7:59  

 I, you know, one of the things that I think, that I see very different is when you get a resident coming in and talking to me and asking about direct care, their mindset and their lifestyle is very different than a transitioning doctor who has already been used to receiving A ex salary or from their practice and everything. So your lifestyles are different to a certain extent. It's easier when they're a resident and transitioning when they have that. It's lower, you know, they lower the numbers a little bit better, and that way it's easier to build. You have to when you're starting out fresh, if you recall, even, even in your insurance based practice. When we started fresh, we still had to build rapport in the community. And you know, there were days early on that I didn't have full, full schedules. I mean, you were only seeing, you know, 10 to 12, and then you built up to 20. And for some reason, we have this mindset that the more the better. That means we're more successful. And that's not necessarily the case. The idea of working smarter, not harder, is something that we need to instill again, back to doctors, but there's, there's always that the numbers game of increasing. So with regards to your question, is there a formula? It's really reading the demographics in your area. You have to do good market research there. But I do see it in mentoring others, I've noticed that the ones that go straight out have a little easier time reaching their goal. If you're transitioning, be realistic, and you almost have to, like, take away all the fancy and get back to really the nuts and bolts, get very lean with your expenditures, you know. And that's, that's, it's, I wish there was a formula, but I'm working on something, so I'll just kind of. Leave that out there. I am working out. 

Dr. Tea  10:01  

I knew you were regarding

Dr. Grace  10:03  

pricing and strategy, but, you know, I'm trying to explain it in a way that everybody can appreciate. 

Dr. Tea  10:10  

So because we know direct primary care doctors exist in rural places, right? And it works for them because they're working off of a membership, so they can still offer a low monthly fee and see a certain number of people. But specialists have a different challenge. We pull from a smaller pool of people to serve in a way. We're not the primary person that people seek medical care from, although we do a lot of primary care and podiatry, and so that isn't part of our practice. And so have you ever considered a membership type of pricing for your practice?

Dr. Grace  10:46  

I actually, I actually did, you know, because I especially look at our seniors and then our diabetic care and everything like that. Personally, the issue that I had with it was because the care tends to be episodic, and because the relationship developed even before I left insurance based I was very preventative care, and so I had them on regular schedule. They weren't coming in as often as, like, a monthly, a monthly, monthly thing. The other thing was, more importantly, they were willing to pay a visit rather than a membership. And having talked to some of the MD VIP doctors, one of the issues that they had was they felt like they were tethered to their patient the entire time when they remember membership, I don't want to be tethered. That's my personal thing with it. If there was a way, I think I would do it, I think for some specialists, I mean, I know you've, you've ventured into membership, and if it works for you, it really depends upon the demographic. I have a I have a lot of diabetics, I have a lot of seniors, but healthy seniors, I have a lot of kids, and parents pay for children episodically. It's not going to be a chronic, chronic thing. So I really, I tried, but it didn't work in my, in my realm. I wish we knew, you're always looking for that revenue stream. Though, the beauty of at least in podiatry, we have so many other revenue streams, not just our visits, because we have procedures, we have surgeries, we have orthotics, we have in office dispensing. You know that that offers lasers, that offers a lot of other venues for us to work with. So I wish there was, I wish there was a way. But I think, like certain ones, like rheumatology, I think endocrinology, because there's that chronicity with their care. 

Dr. Tea  12:53  

So yeah, I like, I like having both, but I can see where it can be confusing, because the reason why I implemented a membership was to serve the lower income people so that it's just an act, because I had so many already in my panel before, I was like, Well, how can I give back without, like, going without bankrupting my practice? And so this was the only way that I saw was it's not working on financial numbers. It's actually a way for me to give back. So if they are buying into my membership for palliative foot care, they can also get X rays, you know, covered, because it's like they sprained something they stepped on. Like, I don't make a big deal about it, right? I know they're going to tell their friends and their family members, and it kind of works out. It's not working out in a profitable way, as a fee for service. I don't think or not yet, there is a tipping point. So I'm I'm free to explore, and that's kind of why I like direct care, because I get to choose exactly,

Dr. Grace  13:48  

exactly, you know. And one of the things that you may want to consider also is the fact that, you know, I'm all about giving back as much as possible, but when we have our practices set up the way that they are now, as direct care. Patients that are coming here value the fact that we're actually taking that time. And so our time here is much more intentional. It's also better managed to the point where, you know, I cut the number of days a week that I work as a result of it, so I can spend a full day doing clinic in a, in a in a free clinic, you know. So you know your patients that are seeing you as in the direct care practice, they're, they're the ones subsidizing your ability to go and and go elsewhere. You know, my thing with charity was always that when, when someone's on insurance still, and if you're still taking third parties, every write off that you do is a charity, you know, when you think about and but I'd rather give the charity to the ones that I want to give, rather than being told how much to take a paycheck, you know. But I. As far as what's interesting is that there's this misconception with direct care, that we only take care of rich folks, and it's not. That's probably the furthest from the truth, because, you know, when we do go and if I have a patient, even if they're doing surgery, you know, one of the things for me is that we can make payment plans with the patient. We can set up bundled services. There is not a rule set that it is that it has to be done or paid on this day, or anything like that. You can make a payment plan because you have that relationship with them. I barter. I had my logo for our consulting firm. It was a barter for a nail kit, for nail surgery. You know, you can do things like that. So old school medicine definitely, do you know? And so it's just, there are a lot of options there. And I think, I think as more and more people find out about direct care, I think they'll be, they'll be happy to see it. The thing about primary care, which you brought up, was interesting, because, like I said, I just came back from this conference, and the topic I was given was redefining direct primary care for the specialist. And I know you and I have been also on my DPC story, and one of the things that they mentioned at the end of that is like, and this is my DPC story, and you're supposed to say my direct primary care practice. The funny thing was that, as I was researching for that and preparing that lecture, every doctor does primary care, if we're really practicing medicine, every doctor does primary care? Primary care is not a specialty. Primary Care is a designation, ironically, started by insurance companies. And the weird thing about it is, and it was always all these things that were started by insurance companies or weren't bad to begin with. They were, they were initially set up so that it could push patients to go and get regular checkups. And as a result of that, they had to, in their contracts, designate specifically primary care, and they designated specific specialists in family practice, internal medicine and and in OB GYN to be that. And then as time went on, they changed the reimbursement rates, the RV use and everything like that. But you know it for every doctor who takes care of patients that have chronic illnesses, takes care of patients in a preventative way. If we're doing our job right, we should be doing all those things also. So when specialists come to me and ask about, can DPC work, I think one of the first things that turns them off is that they're thinking, it's just for primary care. It's not. It's for everyone. If we are practicing medicine the way it should be, it just happens to be that that name came up, the DPC is the, the main one, because they were the first ones to really get this going. But that was just kind of an, I know that's a little bit sidetracked, but I found that interesting over the weekend, when I was going and I had the realization while I was giving the presentation, actually,

Dr. Tea  18:12  

That's a really good point, because now that I can spend more time with patients, I have to look at them as a whole person. So I call it holistic care, but that's kind of what you should be doing anyway. It's not a toe that's broken, it's actually who it is connected to, and what are their obligations outside of the office? Like, can we actually take them to surgery? Are they in their right mind to even have the surgery? 

Dr. Grace  18:33  

Absolutely. Do they have enough support at home? Or even, how is their home set up? You don't get a chance to ask. I know, you know, when we were in residency, how many times do you ask, do you have stairs at your house? How many stairs do you have to go up to your bedroom? How many times do you get up in the middle of the night? You know, those things count for us because we don't want them to step on our surgery side, you know? But, yeah, so. But that was kind of a, that was kind of a realization that I came up with when I was talking, was like, Oh, that makes sense now. And so I think it all like I said, it came full circle for me when I was speaking there, but, you know, but I do whatever we need to do to really push this. It's the way that insurance based practices are going. It's dying and it's going to kill off doctors also. And I hate to be that dramatic, but it's doing that already. We're losing so many good doctors out there in all specialties, you know. And the thing is, doctors are innately resilient, and we're very proactive. We know that if we get to the root cause of things, and the root causes is interference, and I'm not an anti insurance person, as far as people need to have insurance, insurance is a risk management tool to protect you from financial disarray, from health care expenses. The problem is, they are not good stewards of money. There are other health issues. Insurance, insurance type of plans that are out there, other than the typical, what we call the Bucha, which is Blue Cross, united, Cigna, health, Humana and Aetna, you know, just but people need to be aware of it. There are a lot of health sharing ministries out there. But, you know, we were talking about the lower income patients. I don't know. Even when I'm at the clinic, every single one of my patients has a cell phone. How they have a cell phone, or they're smoking, they've got to pay for that someplace, right? You know, it's where you put your money. And one of the things with my patients is the fact that, you know, they will save up. You can budget properly. And if they take, if they take, if they really consider their health to be something that they want to invest in, they need to save it. And you know, and we make it, we make it easy. 

Dr. Tea  21:00  

If you would like to learn more about Dr Grace, I will be putting her social media handbook down in the show notes. Please be sure to subscribe and share this episode with anybody you think who would benefit from a direct care practice. I'll see you next time. 

Dr. Tea  21:15  

If you enjoyed this episode, please give it a review and share it with a friend so more doctors can learn about direct care. Let's keep the conversation going on LinkedIn so we can help more doctors escape insurance and thrive in private practice. Thanks for listening. I'll talk with you next time take care.