Dr. T  0:00  
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. They have chosen this path with a love of medicine. This is the direct care way. 

Dr. T  0:24  
By listening to this podcast, you may even start to believe that you too can have a successful direct care practice. Come listen with an open mind as I share my personal journey and how I pivoted from an insurance based practice to direct care right in the middle of the pandemic. And the valuable lessons along the way. This podcast may be the very thing you need to revitalize your medical practice. I'm your host, owner of a direct care podiatry practice Dr. Tea Nguyen.

Dr. T  0:52  
Hey there, welcome to another episode, this is a fun one, probably for you more than me, because I'm going to share with you some of the mistakes I made in my practice so that you don't have to, I initially recorded this and the list was really long. So I'm going to cut it, I'm going to cut it down to five things. And, you know, I hope that by sharing this with you, it gives you insight to the things that maybe you don't have to go through the expenses that I went through, you don't have to go through. I mean, you made it this far in listening to this podcast, so I want to make sure you get the most out of it. 

Dr. T  1:32  
And what better way to learn than to learn from somebody else's mistake. So five things that I want to share with you today includes number one, getting stuck with a five year commercial lease number two, hiring too much too soon. Number three, buying a bunch of shit. Number four, not screening my consultants well enough. And number five, not valuing the ideal client avatar, I'm going to elaborate on these five things. Now you might be hearing some background noise. I'm recording this pretty late. And there's still traffic right by my house. I don't I don't know why that is. All of the rooms of my house have windows. So I can't even find a room that doesn't either echo or have background noise. So that's what's happening in my woods. 

Dr. T  2:19  
Sometimes you might even hear coyotes singing at nighttime, or my neighbor playing the trombone. Don't worry about them, just pay attention to the five things I have to share with you right now. You ready? Number one, so I talked about signing on a five year commercial lease. Now, I had flipped the property from a previous medical office to what I have now. It was raggedy, there was nasty carpet from the 80s. The walls were a weird Barfi color. So I just had some minor things adjusted the flooring had to be put in new fresh paint, the doorknobs and the doors, some of the doors had to be replaced. And then I asked to have another divider to create kind of a back office. So there was quite a bit of work to be done. It wasn't moving ready. But that was what I really wanted to have. 

Dr. T  3:12  
Because I had this idea that this practice was going to last me a long time. And it takes about three to five years to build your practice to make it sustainable, you know how some stability within the community. So that was my logic in signing a five year lease. And I know I've heard previously to be careful about signing long term leases, because you don't really know how your practice is going to evolve. And that was a lesson that I didn't pick up right away. So here I am on year four of five of my lease and I'm no longer in that building. So that was my mistake number one having to sign on a long term lease, not realizing that it wasn't really a good fit for me. 

Dr. T  3:56  
What happened was I started with the insurance based practice. And then in year two, I was like, I don't like this at all. So I switched to direct care. And with that, the changes that were really important to share was that indirect care, you don't need to double book or triple book. So in the office that I got was a three exam room office. And in six months into my practice, I was pretty booked out. But I was seeing patients back to back and it was like a few minutes here a few minutes there. And so I was whipping through these appointments. And you know, I thought that was just how you practice medicine. 

Dr. T  4:33  
You just saw people really fast. And that was just how it went. But then I started to feel very empty. I wasn't connecting with my patients. I didn't even remember a lot of them because I spent so little time with them. And I had to reflect and say this is not how I envisioned my practice when I first decided to become a podiatrist when I wrote that essay to enter podiatry school I wrote that I wanted that personal connections with patients. That's what I saw. That's who I shadowed. That's how I got interested in medicine. But here I am doing exactly the opposite. I was not connecting, I was not getting quality care. I was just giving average care, you know, what do they call it standard of care, like what everybody else was doing. 

Dr. T  5:19  
But it really wasn't enough. So when I moved into direct care, I didn't need all of these exam rooms, I didn't need all of the things, some of the things I that I needed to downsize was really space for stuff. So in the insurance based practice, and even the beginning of my practice, I was printing a lot of paper, the registration forms, and so on. But now with the direct care practice, I made the effort to digitize my registration process to minimize paperwork. So in combination of not needing another exam room, I also reduced my space. So I didn't need all the space that was just holding stuff, it wasn't making revenue. So a couple of things came into play. But anyway, I didn't need that five year lease, I know other people have different situations. But if I were able to start over again, I would probably just rent out an exam room from an existing practice, like our primary care doctor or another specialist who isn't using their exam room, most of these doctors don't work five days a week, so there would have been an opportunity to rent out a space, and I probably would have done that instead. But here, I am not doing that. And I'm sharing that with you. 

Dr. T  6:25  
So you don't have to suffer as well. And by the way, if you know somebody who needs an office space in Watsonville, California, I've got the space for you. So number two, I mentioned I hired too much too soon, what happened was that I knew I needed two staff members, because one person is kind of dangerous, you know, they're out for the day, if they're sick if something comes up, and you're really kind of by yourself, and that is not in efficient workflow. So I hired two people, but I hired two people full time, full time with benefits, and I wasn't even full in my schedule. But I just heard from another consultant tell me that you want to prepare for the growth in your practice. But what I didn't know was when that time was going to look right to do that. So I hired on staff, and you're gonna find that your overhead, the most expensive thing about your overhead is going to be your staff wages. And that's exactly right. I was spending a lot of money on my staff. 

Dr. T  7:24  
So I actually worked them really hard to ensure that they were also doing other things, like marketing on behalf of my practice to fill the schedule. And although it did work out for periods of my practice, when I started to transition out into the insurance, the direct care practice, I didn't need them full time anymore, it became part time. And that made one person, you know, feel like this wasn't the job for them. And so they moved on, which was a blessing in itself, because I didn't really want to let people go. But if they went on on their own, then I support that, you know, that's just how things are changing, things are evolving, fine. But in the beginning, I did spend a lot of money on overhead on staff, because I had hired too much too soon. I think what would have been better is either hiring staff who didn't need benefits, like they were looking for part time work, or some variation of that. But you know, I was a little bit stubborn. 

Dr. T  8:20  
And I felt the competition was very real. In my area, the corporations here, they pay extremely well, I don't even know how they do it. But they do it. I mean, I have an idea of how they pay them well, but that's a different story. But it's really good competition here. So I thought I had to be just as competitive these days, you know, post, well, I guess mid pandemic, we're still kind of in it. People are actually looking for more flexible jobs, jobs where they can work from home or just have their freedom to pick up their kids drop off their kids, and so have you So flexibility is actually a great benefit. So if you're looking to hire, consider people who want a flexible schedule, and may be starting them part time with the potential to go full time. If you're just in the beginning of your practice, so make room to grow. You don't need to spend all that money so soon like I did, which is number three, I bought a bunch of shit also in the beginning. 

Dr. T  9:16  
So I bought all new equipments. I bought new exam chairs. I started with two exam chairs and then I got busy enough to expand to the third room bought everything brand new because I didn't want any of my equipment because they were so expensive. I didn't want it to no function. And so I got everything brand new. I even bought a bunch of inventory, because sometimes you get a really good deal or what looks like a good deal. And to this day, I still have boxes and boxes of alcohol swabs. I just bought too much stuff when all you really needed was like a month's worth of inventory. So keep that in mind stuff that's sitting in your inventory is money. And if it expires, your money went down the drain. I've had lidocaine that expired steroid injections that got expired. I even had fiberglass that I didn't even touch that got really hard and became unusable. So you don't need a bunch of stuff you do still.

Dr. T  10:08  
Number four, I didn't screen my consultant. Well, you know, so I had a business consultant, because I was really wanting help. In my practice, I wanted to make sure I was doing everything right that I was not making a lot of mistakes, that I had everything taken away to get going. But what works for one person may not work for you, and what works for you may not work for somebody else. And so I a failure on my part was not knowing how to screen the consultant to see if we're even a personality match. And it turns out, we're not. But I also feel kind of bad, because this was a referral from a friend. And they're doing really well. And everything's working out for them in some of the other people that this constant consultant was working for. So that's great, I have no issues with this particular person. But for me, and where I was going, where I wanted to take the practice, it was not a good fit. And it was really expensive, too. So don't make that expensive mistake of not screening your consultants. 

Dr. T  11:06  
Back in the day, there wasn't this podcast where you can just kind of learn about the person through social media or through the things that they were putting out there, the only way to know about consultants was word of mouth, or even at practice management conferences. And so now that you have the resource here in your ears, you have better opportunity to screen your consultants, and decide if they're a good fit for your practice or not. So take the time to learn about them to ensure your personality type matches. And you know, what a what a good giveaway for me at the time was that the person did not show up to my open house, they knew my open date, they knew that transition I was in but not a peep on my opening day, it was incredibly lonely. I've talked about this in a previous episode, it's a super old story. But still, you know, it still makes me feel really sad that I paid that much money. And the consultant couldn't even reach out to send a card or to text me or to call me and say congratulations. So I'm not that kind of person, I certainly don't want to work with that kind of person. And it's just what it is. So don't worry about what I went through, just make sure you don't go through that heartache as well. 

Dr. T  12:18  
So screen your consultants. Number five, I didn't understand the value of an ideal client avatar, the ICA, I've heard this multiple places in all of the books and podcasts and business seminars that you need to know who your ideal client avatar is. This is a visual, the summation of your perfect patient. So this is a thought in your mind of who you best serve, because you love serving this particular person. For this particular thing, what I used to think was that I had to serve everybody that walked through the door that it was my moral obligation to take care of every single person that came to my office, whether they were able to pay or not, right. But the reality is, when you are unclear about who you serve best, you expose yourself to being really vulnerable to depleting your energy, because you'll find that there are people who you simply cannot help because they don't want to be helped, or it's out of your expertise. So if you try to bend a little bit backwards, and accommodate them, and do everything in your power to try to help them and they're not receptive to that because they were not your ideal client avatar, you wasted a lot of energy, you wasted time that you'll never get back. And you might even get a complaint. Because no good deed goes unpunished. 

Dr. T  13:39  
I'm gonna say it again. No good deed goes unpunished. I'll share with you a case I had a patient who came in and was argumentative, somehow managed to get through the doors and into my exam chair, she demanded that I do surgery for her, she was clearly not a surgical candidate. So I had that clarity already, there was some hesitation about giving her a surgery that she didn't really need or wasn't prepared to undergo. So patient selection is really important in surgery. And the ideal client is the same thing. You have to assess this person, can you actually help them? Do they want to be helped? And is it within the realm of things you want to do? Those are questions you need to ask yourself, I told the patient that I couldn't do the surgery that she was demanding. She started to try to invalidate me that I wasn't a good doctor. And she started to question my credentials and all these things, you know, trying to bring me down to her level. 

Dr. T  14:34  
But at the time, I was like, well, there's truly nothing I can do for you. And so she stormed out, made a big mess. And weeks later, she came back and she wanted to be my patient again, because she had gone somewhere else and didn't get the same attention. By that time. It was very clear to me that she was not my ideal client. I could not serve her as much as I wanted to. And as much as I tried it just wasn't in it wasn't it In either of our cards to be with each other, you know, like, it was made very clear to me that I had to be clear about who I serve, so that my staff can understand and know when to say no. So if you encounter a situation, or if your staff encounters a situation where maybe somebody's on the phone, and they're being really rude or demanding, or their self directing their care, this is a really nice thing that you can say, or teach your staff to say, this is what I do. 

Dr. T  15:28  
I tell them, it sounds like we may not be a good fit for your needs, you may have to go elsewhere, find some variation of that, like work it out, say it in a nice kind way, but firm enough to make them understand that we may not be the best fit for them. And you have to be clear about who you serve and who you don't serve. And don't be discriminatory about it. Don't judge them based on ability to pay but rather make the decision on can I actually help them with your skill set with what you want to do? Or are they better suited somewhere else, because there's always going to be somebody else to help them you don't have to be the Savior, be the hero for everybody. Just stick to your ideal client. And you're going to find a lot of peace, a lot of fulfillment in your practice when you stick to this concept. 

Dr. T  16:17  
So I'm looking at my list here of mistakes I made, and it's really long. So I'm going to leave it here to be continued. Because I have a lot, a lot of stuff that is worth sharing. But it's a little bit exhausting to talk about all of my mistakes. So let's just take a break right here. I want you to walk away with this one thought, Is it possible that the life you want is just a single idea away the idea of a direct care practice, where there is no need to learn a billing code a modifier a T code for which till you even worked on not doing prior authorizations not having to do peer to peer calls, not dealing with claim denials, or the risk of audits not having to have a lot of staff because you don't need to do insurance verification, cutting out all of the expenses related to insurance shenanigans, it's totally possible, you don't even have to have anyone monitoring your AR Because everybody pays the day they're seen. And you can cut out some of the overhead. 

Dr. T  17:15  
I already talked about reducing your staff, because you'll have less of a workload, you can even get rid of your billing software. You know, that stuff's expensive. So the idea that direct care practice exists, and there's over 40,000 doctors doing it this way. And I have not heard of one doctor wanting to go back to the insurance based practice. So that should speak volumes about what is on the other side of the insurance based model. So it is possible, you just have to be strategic about it, know what to do, what not to do. And then eventually you're going to find your voice. You're going to find how you want to do things and then you're going to evolve and figure out how to do it. If you find this information helpful. And you want to learn more, please continue to subscribe. 

Dr. T  17:59  
And I also am offering a one on one coaching service. And the information will be down in the show notes for you to connect with me. I hope that this was helpful, insightful, and I hope that you don't make the mistake that I did. All this information is here for you reflect back on it, listen to it again. Make sure you share it with a friend. And I will plan to see you again next week. Take care for now. 

Dr. T  18:23  
Thank you so much for being here with me. 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 find my info in the show notes and send me your questions. That might be the topic for future episodes. 

Dr. T  18:42  
And lastly, if you remember nothing else, remember this be the energy you want to attract. See you next time