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 q&a. Okay, really, it's just one question. Somebody asked is direct care scalable? And I was like, that's an interesting question. And I'll tell you why I thought that I went to direct care to see fewer patients and make more money. I mean, the other side of that is I wanted to deliver quality care, expert care, and so on. Right, it's all the same. I just wanted to see less patients, I didn't want to see 30 patients in a day. And I wanted to give quality care, which meant I had to spend 30, to 60 minutes with each individual patient. And in podiatry, you kind of need that time to evaluate their gait, to look at their shoes to answer all their questions, to talk to people who don't have a medical background and explain it to them exactly what they have and what their options are. And you really can't do that in under 10 minutes. I mean, I used to do that. But it wasn't giving effective cared. It was just like in one ear and out the other. So I thought that this was a very interesting question. And I also thought, like, why would you want to scale. 

Dr. T  1:59  
So here were the benefits of my direct care practice. When I pivoted from the insurance based practice into direct care, I cut a bunch of my overhead out. My clinic space went from having three exam rooms. Now I'm down to two, I had three full time staff members, and now I have one part time staff in house. So I mean, the biggest expense is going to be your rent and your staff. And I was able to lock that more than a third down. I also was able to remove the expenses related to insurance based practices, like I was doing. I had an EMR that did the MIPS and macros and those strange performance measurements that we did on behalf of the insurance, which had nothing to do with the metrics of quality care. Yeah, I had I was able to cut that out the expenses related to that out as well. 

Dr. T  2:52  
I also didn't need staff to manage the prior authorizations or the surgery scheduling. Because I brought surgery in house. I didn't have to deal with prior authorizations or the confusions that surround which foot are you working on? What's the CPT code for what particular bunion procedure? Is it a distal head procedure? Is it a fusion? Is it a Lapidus was it the right side was it the left side and so on, like all these tiny little things, that it's not just irritating, but it's a waste of time. So I was able to cut all that out, I even got to cut out the billing component of my EMR. And a lot of these billing software's, you know, they have all these huge fancy perks in how you can analyze the data, and all of that stuff, that doesn't really matter to me, it might matter to somebody who has multiple clinics, who wants to have certain measurements in their practice. But I really wanted to simplify the way I was delivering medical care. 

Dr. T  3:51  
I really didn't want to be the person who had multiple clinics, who had multiple staff to manage to have all of these associates doing all these different things. And that just seems like kind of a nightmare to me. I don't want to do that in my practice. So I chose direct care intentionally to scale back from the administrative burdens that I wasn't really good at anyway. I wasn't really wanting to get emails about how to code better, and didn't want to go to conferences that talked about coding, and how one procedure is similar but not similar to another layer and then like bundling and unbundling and the risk of auditing because you coded wrong, or you didn't have the appropriate modifier because you started to do home care or nursing home visits, and then you weren't getting paid, or in trying to understand Can you even Bill a service to a hospice patient? Like I've had a breath just talking about this. 

Dr. T  4:46  
So you see, I didn't have the intention of ever scaling my direct care practice. I went in with the intention of simplifying the way I got paid. That's it. I wanted to give the best care I wanted to give personally care. And I wanted to be there for people who had questions that were left unanswered, because their doctor visits were 10 minutes or less. I wanted to be able to provide patients with peace of mind, because that's what they came for. And that's what they deserve. So to answer the question is direct care scalable, probably is my best answer. I'm not the best resource for that. I don't have the desire to have another clinic, maybe down the road, if I get an associate or a business partner, we can reevaluate. But at this current phase, in my practice, I'm pretty happy with what I have is direct care, it's deliverable services, and then you get paid on the same day, there's no ar to fuss with, I do see models that exist in a scalable fashion, there are concierge practices where they bill insurance, and they also have an annual retainer fee. So the doctor does this because they want to see fewer patients, but they still want to give the benefits of the insurance based care, which is great, and that is scalable. 

Dr. T  5:59  
They come in forms like MD VIP, for example, you can look that up, that's more relevant to primary care doctors, I haven't seen that type of thing happened for podiatry. For those in podiatry, they might be scaling it in the way of providing physical therapy types of care as well. Something that requires longevity, which I think is wonderful, I love physical therapy and what they do to help patients move and be mobile and stay active. I think that is scalable. Or if you have some kind of sports medicine practice, and you're able to train your staff or your associate in doing things a certain way where it maximizes profits, and it's effective, and then it's reproducible. Yeah, you can scale that as well. I don't see any issues about that either. 

Dr. T  6:44  
But you are asking people to pay out of pocket for your services. And I think this is a great opportunity to think creatively about how you're going to go about and do that if you truly wanted to scale a cash practice. And it does exist, I'm just not going to be the expert speaking on that. At this moment, maybe if I kept a win of ambition, and I decided to scale my direct care podiatry practice down the road, maybe that's a thing. But I have a lot of other interests outside of my clinical practice. And I've made the conscious decision, as of this year in 2022, that I will not be defined by my work, I am not just a podiatrist, I am a mother, I am a business owner of multiple businesses, I am a wife, I have other interest that is outside of clinical practice. Now I want to take a moment to talk about this because there is a lot of judgment about those of us who have different desires, we came from a place where the judgment was, if you didn't do exclusively medicine, then you didn't really care that much, therefore, you weren't really good. 

Dr. T  7:46  
And I'm gonna bash that right here. If you ever hear anybody talk to you in that way, you need to stand up to that you need to say your way of thinking is old school. And I'm actually excellent at what I do. I'm so good at what I do that I can walk away. Because I'm a quick learner, okay, you hear me there is judgment about having multiple interest. I don't know where that comes from, maybe somebody else's ego, but that shouldn't be your own ego, we're in a generation where you are allowed to have multiple interests and make multiple streams of income in that you can still be excellent in all of those things. Don't let somebody else's limitation become your own. I have to say this over and over again, do not let somebody else's limitation become your reality. Just because one individual defines himself in this way does not mean that you need to define yourself in that way. This is the biggest problem we have in medicine, especially for women, for women who are already forced or expected to do uncompensated work, like house chores, childcare, cooking, these things that we don't get paid for. 

Dr. T  8:50  
But there are people who get paid to do that professionally. On top of that we have to give unlimited care as a medical professional to you kidding me? I'm not about that. I'm totally over that. If anything, women need to get paid more, because we do all of these uncompensated work. Yeah, you heard me women need to be paid more this day and age it needs to happen. And we also don't need to be defined by our singular careers period. I think it's ridiculous. So if you're onboard with me, and you understand that the human nature is dynamic, that you are allowed to change your career or have multiple careers, you can do that. You define your happiness. Nobody else does that. So that is my side tangent on the whole situation about whether or not direct care is scalable. This is so important. I the reason I bring this up is because I just had a coaching client talk to me about this, how they felt so they felt like they were put in a box that they didn't create somebody else put them in there for them. And I think that's completely tragic. We have multiple skill sets that are needed in different areas in the world in different industries.

Dr. T  9:55  
We need to be brothers we need to be wise we need to be physicians, we need to be in a ators whatever right you choose, but that's the thing, you get to choose that. So don't ever feel small because your heart is not completely in clinical medicine 100% There are non clinical careers, that is just as valuable and you need to be there as well. podiatrists are needed in all facets of medicine. I'm gonna say this over and over again. It's not all just clinical career is not all just doing hospital or taking call doing trauma. Yes, those jobs are necessary. They're needed for the community. But there are other things that are needed as well. And the fun part about this day and age you can choose and you can choose to be happy as well. I hope this was a fun and interesting episode for you. If you found it to be ridiculous, please share it with somebody else. I look forward to talking to you next week. Take care. 

Dr. T  10:50  
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  11:09  
And lastly, if you remember nothing else, remember this be the energy you want to attract. See you next time