Bad things about direct care

Dr. Tea  0:01  
Owners of a direct care practice are more likely to experience higher job satisfaction than the insurance based practice. And it's no wonder why direct care is independent of insurance. Patients pay the doctor directly for their expertise, the doctor gets full autonomy in how they care for patients, and how they get paid. We've chosen this path for the love of medicine. This is the direct care way. 

Dr. Tea  0:26  
By listening to this podcast, you may even start to believe you too can have a successful direct care practice. Come listen with an open mind as I share my personal journey on how I pivoted from an insurance based practice to direct care, right in the middle of a pandemic. And the valuable lessons along the way. This podcast may be the very thing you need to revitalize your medical practice on your host owner of a direct care podiatry practice, Dr. Tea Nguyen.

Dr. Tea  0:55  
Hey, welcome to episode 28. Up to this point, I've shared a lot about my journey, and all of the wonderful things about direct care. But you know, the reality is, as a business owner, there are some downsides to direct care. It's not all rainbows and unicorns. And it's not all freedom all the time. After all, you're still a business owner. So I'm going to share with you maybe the top three things that I have experienced in my direct care practice that you should be aware of.

Dr. Tea  1:31  
But what I'm going to do a little bit different, is every time I say something negative, I'm going to turn it into a positive. And this is an important exercise for you to go through as well. Because you don't want to drown in negativity, every single day of your life, do you I mean, that's what I did when I was in the insurance based practice. And that's really devaluing. And it changes who you are and your personality. So instead, I invite you to change the dialogue you have in your mind about what you perceive as a negative experience, and turn it around so that it becomes a learning experience or even a positive experience. So that's what I want to do for you here. 

Dr. Tea  2:11  
Okay, top three things, bad things about direct care. Number one, it's going to be slow in the beginning. So anytime you create a new business, or new venture or something that's different, you are really starting all over. Even if you started with an insurance based practice and you have a patient base, realize that only a small percentage of them will convert. And that will heavily depend on the relationship you have with them, or the messaging that you have around your offer, and really their own personal experiences. And if they even want to pay out of pocket for something that's already covered under insurance. And again, it really depends on your reputation within the community. So for example, if you so if you are the only person who offers a certain thing within a 20 mile or 50 mile radius, then you are much more desirable, which means people are more likely to convert to you if you're the only person that offers that thing. So it really just depends on your individual circumstances and what percentage of patients will convert over. So there really isn't a rate or customary rate that you can expect when you convert, we just know that the conversion is not 100%. you're marketing to a new demographic. 

Dr. Tea  3:26  
So what's the point about turning a bad thing into a good thing? Right? So let's flip this script to making it a positive thing. Why is it a good thing to be slow in the beginning? Well, because when you're new at something, you are in the discovery phase, and you're trying to figure out what works for you and what doesn't. And what better time to explore is when you're slow, because when you're slow, your mistakes don't seem so magnified. So if you make a change in a protocol changing, it is easy. Plus indirect care when you change a protocol. It's just a matter of typing it up and training yourself or your staff, you don't have to go through seven different people to propose a change, and then realizing that you might have to change it again shortly thereafter. So change is quick. And it's not so painful in the beginning. So this is opportunity to explore. And perhaps you need to put your marketing things in order. You can meet people face to face more frequently. You can do lunch and learns you can go to community centers, and give a talk connect with the community. You're not going to have so much time doing this later on when he starts to get more full. Right. So now's a good time to do that. This is also a really good time to grow your creative side when we are so used to being busy all day long. We don't even make time to think creatively, which is an essential part of entrepreneurship or business ownership. 

Dr. Tea  4:50  
So because there is no one right way to do everything, like no one right way to do marketing, no one right way to do hiring, there are guidelines, but then you really only know what works by testing it out. So this is a really good opportunity to also build your creative side or hone in on it. Number two, number two is hiring staff, maintaining staff and keeping them as your revenue generating powerhouse. This is really a universal problem, it is not unique to direct care at all. If anything in direct care, you need less staff. Because you don't need someone to manage insurance phone calls, you don't need somebody to manage claim denials, or even collect billing or review your AR, a lot of that gets wiped out. But still, you still have to know how to hire staff appropriately for the position that you have for them. So ask any business in existence, whether it is a one person show or a business with 500 employees. So it's not exclusive to direct care. If anything, it's better indirect care, because we have a lower volume, therefore, we don't need as much support staff. So I'll share with you my negative experience in hiring staff. I didn't have any background in HR, I just hired people for a variety of reasons. One person I thought had a great personality, another person fit the drug criteria. 

Dr. Tea  6:20  
And I had problems in both. So the person who I hired in personality, she was really good with patients, very good, personable skills, but could not for the life of her do things without permission, which means I had to double check all of her work all the time. Or she would have to ask questions and clarifications for protocols that were already in existence for many, many years. So you see, it's trial and error. Now the other employee that I hired because she met the skill, brought a lot of drama brought a lot of her baggage, and how do you even screen for that, right? You just don't. So it's experience in hiring, and firing and really learning what you're looking for and communicating that clearly in your job description. And throughout your hiring. Now, what I can say about this negative experience is that it's actually turned me into a better hiring manager, I now see what I've done in the past. And I certainly try not to repeat it. So what I look for in future hires, it's a lot more clear now, like now that I'm looking for an office manager, or a marketing director, or an executive assistant, I have with clarity, what personality traits I need for that role. It must be somebody who is independent, it must be somebody who has strong critical thinking skills, it must be somebody who can do basic math. And if you didn't ask for basic math, you would be surprised at how deficient most people are in basic math. So if you're asking your staff to do a percentage of like a discount off of goods that you sell, and you don't tell them what that is, they're gonna think 10% of $30 is $10. 

Dr. Tea  8:01  
Let me tell you, I had that experience, and it blew me away. Because I didn't screen for that. Isn't that crazy? That was a learning point for me. And I want to share that with you, just so that, you know, hiring staff is an issue for everybody. It's not a unique problem. So how do you get good staff? Again, this turns out to be a numbers game. With more experience, you get more refined in how you select for people. And then you just keep getting better. And eventually, you'll have the funds to hire on an agency if you really wanted to. But indirect care, you don't necessarily need that level of hiring that's usually reserved for types of practices are looking to expand quickly. And direct care. It's not really a model where you can scale up to that level. But the resources are there for you if you decide you wanted to use it. And then number three, the downside of direct care is that it's still foreign to most people. Therefore you have to learn how to create your offer, which means you have to learn how to speak a different language, a marketing language, this is a new skill set. This is actually the skill set that we've been blunted from learning because what happens when you become a good salesperson in medicine as an employed position, you become really dangerous, you get to know yourself worth you get to ask for a bigger raise, you know your own value. And systems. They don't want that. 

Dr. Tea  9:26  
They don't want you to know that about yourself. They just want you to show up, do the job and then clock out meet their metrics. That's it. And if you go beyond that, if you are a creative self thinker, if you know your own value, then yeah, you're gonna see the system for what it is and you're gonna leave. Why would Corporation want to empower you in that way? They just don't. So because direct care is foreign to most people. I mean, the good news is is expanding, it's growing exponentially, but you're also going to have to deal with a lot of pushback object Questions, people may not just get it no matter what, and then there are some people who will get it. And they're gonna say that makes total sense. So now you're doing something that's totally different from mainstream from traditional medicine, which on the good side, that means you are at the forefront of a huge social change, and you're creating an impact, you are considered part of the movement. 

Dr. Tea  10:26  
And think about it, people who create history, they don't know that they're doing it, they're just doing what feels right to them. And often it's against the grain, it's against traditional means the system, corporations, industrialized medicine, so you can be that leader, you are paving the way, for future generations, you are making a difference to the individual who is fed up with a traditional system, and you're going to pull them right back in to your office. And they're going to experience what individualize medical attention really looks like. You're restoring the patient physician relationship. How incredible is that direct care has great implications for medicine as a whole, for patients who are frustrated for doctors who are frustrated, and we are restoring that relationship, taking out the middleman, who's interfering with that care, you're providing patients with options they wouldn't have otherwise known about, there's really a lot to owning a business that unless you took formal classes or have prior experience in a successful business, a lot of the stuff may come to you as a surprise. 

Dr. Tea  11:30  
So just having that level of expectations that, yes, it's going to be slow in the beginning, unless you have secondary income. Yes, hiring staff firing staff is going to be a big challenge. But it's just kind of part of the job. And of course, looking at the fact that you're doing something drastically different, that nobody else is doing possibly in your entire community, that can be very scary, it's daunting, you're gonna feel what if this fails, right. And I have spoken in the past about that feeling of failure, don't go into direct care with one foot in and one foot out the door, you need to go in direct care, with the same audacity you had, when you entered medical school, you are going to figure out a way to make it work. That is an energy you need to go into when you start transitioning your practice into direct care. Now, if you go into direct, cared severely, under prepared, you are going to start making some costly mistakes, because you are going to be reacting when you are properly prepared to start your direct care practice. Whether you're fresh out of training or transitioning, it's better to be prepared. Because if you're not, then you're going to react to your circumstance and reacting is very costly. Trust me, I've been there, I get it. 

Dr. Tea  12:53  
So you have to be proactive, you have to know what you're walking into, and improve the chances of a successful practice by associating yourself with people who are already doing it. And they've been doing it for a long time successfully. That way, you can see the future version of yourself that will motivate you to keep going most business owners have good days, they have bad days, but hopefully, more good days than bad. And when we're in business by ourselves, it's very easy to feel isolated. And it's very easy to just want to quit when you have one bad day versus a lot of good days, right? So you want to make sure you're around good company, so that you keep going and then you realize why you're going on those bad days, you might feel like you've been doing all the things and nothing is transpiring, nothing is, quote, working, but you have to keep going. 

Dr. Tea  13:41  
Because what happens if you don't, then you'll actually prove to yourself that it's not working, because then you just stop trying. But you have to keep going, you're going to be tested, and you're going to have to make a choice on making that means something to you. I mean, does that mean you want to quit? Or does that mean that you continue to persevere, that you're going to be resourceful that you're going to find people who are going to help you professional people who can help you to make it right, these hardships are a character building, which might be a good thing might be a bad thing might be incredibly stressful to and at the end of it, you need to realize what you're gonna gain. Do you want your freedom, this is how you do it. Direct Care, is practicing medicine the way you want to. We can also talk about the negative things in the insurance based practices. And that's exhausting because everyone's feeling it right now. It's a pinch, right? They're squeezing out time that doesn't exist. They're squeezing out energy that is no longer there. But I'll share with you my issues I had with insurance based practices, just in case you missed that episode. 

Dr. Tea  14:43  
The beef I had with insurance best practices. Here it goes. Number one I absolutely hated not having control of my schedule. So I had a daughter 2018 And I can't even imagine being an employee at the time because I would not have had the liberty to leave when I wanted to or when I needed to So let's say daycare closed again, for COVID. And I had to isolate for two weeks, more or less. And with the last two years of the pandemic, and their frequency of exposures, and how much time I've had to take off just because of that, I probably would have already been fired. I mean, what business owner wants that instability from an employee, right, and I don't blame them, you hire people to produce income, and you can't produce income, if you're not physically in the office. That was what drove me crazy is that I couldn't have control on my schedule, it was full the way they wanted it to be full, you know, I did surgery on the day, they wanted me to do surgery, and so on. So being a business owner, that stress just gets taken care of, I can choose when I can leave. 

Dr. Tea  15:45  
And I can choose when I can see patients. Number two, if staff was terrible, I had no control over that, which means I couldn't train them, I couldn't improve the system, and I couldn't avoid them. So really, I can influence any part of that patient interaction that patients have because the patient experience starts where it starts with the staff. And if I couldn't correct something, if I couldn't improve it, or I improved it, but I couldn't assist in the training process. And I'm literally just sitting duck just kind of walking in the patient room and walking out, like that's incomplete care. Whereas in my private practice, because I own the practice, and I owe my time to my patients who pay me, I get to give complete care, and it makes me feel really proud for the work that I do. And number three, the consistent day to day depletion of myself morale, it's just, it's part of being employed, I think, I don't know. That's just how I feel, you know, you want to make your practice yours even as an employee, but you really have no control over most of it, your schedule, your energy, your time, even your skill set. So if they just put a patient on your schedule, you're kind of obligated to deal with it one way or another. So as an employee, being told what to do is part of the job description, speaking out of line, or having a different idea made you difficult, a challenge to work with and so on. 

Dr. Tea  17:12  
So the employed position, it didn't work for me. And it's not working for a lot of people because loss of physician autonomy, and I had to make a trade I had to make a decision, do I want comfort and being employed, and getting those weekly paychecks or bi weekly paychecks in exchange for a loss of autonomy? Or do I open my own practice, gain my autonomy, have a little bit of risk in doing that. But then I'm set up for the rest of my career once I established those systems in place. So I made the decision. And I opened my own business. And I had a lot to learn along the way, because I was severely underprepared to run a business. But you know what, these are learnable skills, I just had to learn a few more skills to make it happen. And to make it happen for me, on my terms, of course. So I hope that this was enlightening. I packed a whole bunch of stuff in this one, I'm hoping that it gives you clarity on what to expect. Direct Care is not for everyone. It's really for the person who is not averse to taking risk. And the risk in doing nothing is burnout. The risk in doing something is a risk that I was willing to take. Because I didn't see any other way around practicing medicine the way I wanted to, with my schedule, flexibility and the income that I wanted to make. Doing it all on my terms was only possible if I work for myself. So I hope that you see some of my mistakes pretty loud and clear that they were learning opportunities. 

Dr. Tea  18:44  
And whatever your negative experiences are in life in general, find some opportunities in there. So that you can grow through it or out of it. So however you want to label your experiences, just know it's really testing your character to it's developing your perseverance, your thick skin, I would say, and it's really necessary as a business owner, because you'll have good days, and you'll have bad days. So it's all hard, whether you're employed in a job that you hate, or you open your own business. And that seems very challenging and all of that they're all hard. You just have to figure out what hard you're willing to tolerate and which hard gives you what you want. In the long run. This is a long run type of deal. Now if you're looking to retire within a year or two, maybe transitioning from insurance to direct care is not a great idea. Because it takes time there's a growth period. But if you're looking to extend your medical practice for another 510 20 years, you know, the first couple of years seems like nothing. It's just like starting another residency program or even a fellowship. So just some food for that. I'd love to hear from you. And I'd love to know what your current challenges are. My information will be below. I'll catch you next week.

Dr. Tea  19:54  
Thank you so much for being here with me today. If you enjoyed this episode and want to hear more Please Like, Share and Subscribe so more people like you can have access to another way of practicing medicine, that direct care way. Let's connect by my info in the show notes and send me your questions. It might be the topic for future episodes. 

Dr. Tea  20:14  
And lastly, if you remember nothing else, remember this. You are in control of your life. See you next time.