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  0:53  
Hey there, welcome to another episode. By the time this episode gets published, I will probably be somewhere in Maui. I'm taking a vacation a family vacation, one that is much needed. And actually, this was a trip that I was supposed to take earlier in the year. But you know, stuff happens and it finally got pushed out to November. So I am really looking forward to this trip. But I wanted to make sure I didn't miss a week with you. I really appreciate you being here. And as I said in the last episode, I'm incredibly thankful that you are choosing me to spend time with that you are choosing my podcast episodes to build your business repertoire, I wanted to share with you kind of a two year update over I was two years ago to where I am now. And this is really showing up as to what could be possible. 

Dr. T  1:53  
If you start doing things with intent, I think a lot of us might be in the mindset of we're just deal with things from day to day. I know I was like that for a long time. It's barely seeing what's on the agenda for the day or even the next week or month. But I never actually projected my future into the coming years ahead. So I never really looked one year ahead or two year ahead. The only time I actually did that was when I went into training. So into podiatry school, we know that four years, we'll get us the degree and then we go into residency, right. And then in residency, it's three years of surgical training, and then you get a job. 

Dr. T  2:32  
But then after that, I mean, anything goes whether you become employed, or you stop being a clinician and you went to non clinical careers, like we don't really no. And so this has been a an active exercise for me in the last few years to help push myself further by trying to create that future that I actually want, and doing it with intent. So let me share that with you. I'm gonna time travel with you. Let's go back to January of 2020. When we were just learning about some novel virus hitting the United States, I remember this so distinctly because in January, there was snow on the ground, I was visiting somebody who was going to teach me minimally invasive surgery. And you know, as a California girl, I don't love seeing the presence of snow. But because I remember so distinctly the whole time, I was like, I really don't want to be here. I really love my sunny coastal side of the world. But you know, I came here with optimism, trying to learn a new skill so that I can start implementing a cash practice. 

Dr. T  3:41  
And by 2020, I was already deep into debt. And I realized that my business model, the insurance based model, was a crap shoot, for me, at least. And for a lot of the people I was talking to, especially the small business owners, we had to do so much to gain so little for the work that we provided. And if you made it this far to this episode, then you know, I'm not a huge fan of the insurance based practices for small businesses. It just doesn't work in our favor, because we have to spend so much time, so much money to capture that discounted dollar. Anyway, on behalf of the services we provide. So I had been talking to a lot of people. And one option was to do office space procedures in charge people cash for that. And I thought, well, intellectually, this made sense to get rid of the middleman and just have a patient physician interaction. But Emotionally, I was like, now how does this work? Exactly? Because all of our training is surrounded around how to Bill appropriately right? How to get paid by insurance, how to chart in a way that gets most of our dollars back And at the time, my biggest payers were Medicare and Medicaid, so state and federally funded moneys for insurances. 

Dr. T  5:07  
And then I looked at my financials, and I was like, what is it going to take to make my practice fully cash, because in my office, I can hear all of my staff member call the insurances be put on hold, and then hung up on for 3040 minutes at a time, their frustration when they hung up the phone, or they never got their questions answered, or they've gotten the wrong code. And now they have to call back and edit the code so that we can get prior authorizations for either an MRI or for surgery. And it was a really drawn out process, just to take care of a patient. And all of that time that is spent on the phone doing these administrative work did not improve patient care whatsoever. So I was like, I was determined to figure out a more simple way to deliver medical care, without all that stuff in between. 

Dr. T  6:00  
So here's what I'll share with you. If you're going from an insurance based practice into direct care, like I did, everything I have to say is going to make sense. But if you're going straight out of training, and you want to go directly into a direct care practice, trust me, you're going to be fine, because you will actually have the contrast to compare and run away from the trauma of insurance based practices, which means you would have been skipped the part that gives us most headache, and also kind of fueled our anger. Well, if you had my anger, at least, so you're already far ahead. So what I'm getting at is what I'm sharing has a lot more to do with my frustration in the insurance based practice, which is the fuel for me to find a different way direct care, essentially, you can certainly have a cash practice out of residency, I've met somebody who's done that, and they're doing that really well. 

Dr. T  6:49  
But just hang out for me for a little bit as I share my story. So this should be no shocker. For anybody who knows me, I'm generally speaking, always fueled by disappointment. So this story that I have works for me, and I know you're going to get something valuable from it, too. So anyway, if you really want to know what it takes to have a direct care practice, I'm going to be very happy to share that with you. I mean, that's the whole point of everything that I share with you is that you are prepared emotionally, and technically, right, you want to be prepared before you do something different drastically different from the norm. So this is the stuff that people don't normally openly talk about. In fact, I've been post checked in a private Facebook group for talking about direct care. 

Dr. T  7:37  
So I had posted something about you know, the headings that you're experiencing, is alleviated. Once you get rid of the headaches, the insurance rate, and I started talking about direct care. And then somebody private messaged me and said, what you're posting is not appropriate for this group. So I was post checked, what I have to say is generally speaking not for people who don't have any interest in this model, they're content with the insurance based practice, or they're employed and see themselves employed indefinitely, whether in private practice or hospital based. But if you are here, then I would assume that you're at least curious and maybe even seriously curious. So I want to help you out. Now going back to 20, and 20. I didn't know that two years later, from that point in time, that I would successfully have 100% Cash practice, I did know that I had to do something radically different to get here. Because traditional employment wasn't working for me. The insurance model wasn't working for me. 

Dr. T  8:40  
And so then I was like running out of options. And I was like, well, let's see what this direct care practice is going to be all about. Right? Just see people for cash. Let's see how that works out. And let me just say the last two years was a doozy. And in particular, I had a 3d meltdown, where I asked my husband to take my daughter, she's four years old on a trip, and just leave me alone for three days and things worked out. And he did. But really, that experience in itself is really for adult beverages to be involved. So I'm going to skip all of that. But I'm going to share with you to get to where I am now where I am 100% Cash practice, it requires a significant transformation that I didn't know I was actually undergoing. So it wasn't just a matter of dropping the insurance and then charging cash, although that's what it looks like on the surface layer. But it actually requires you to have a different set of lens. Because this whole time I didn't have the concept of working of direct care working for surgeons, I still wanted to continue with surgery. I just really enjoy that work. It's focused attention and it's transformative. That's what I wanted to do. But what I had to give up to get where I am today are some of these crazy ideas that I know some of you are holding on to but I also want to let you know that The things that you believe they're not reality, they are malleable, which means you can change your beliefs. 

Dr. T  10:07  
So here are the things that I had to deal with that I thought were true. But they're actually just beliefs. So number one, employment will provide security. That's a belief. It's not a fact. And we know this, because throughout the pandemic, a lot of doctors were letting go for various reasons. Maybe they spoke out about the shortage of PPE, maybe they realize that they didn't want that type of job anymore, and had something to say about it on social media, or whatever the reason was, but these doctors got let go from a job that was perceived as secure because it was an employment position at a hospital or even a group practice. And we see that not all employed, situations are secure. And if it was, there are circumstances to make it secure, you had to trade your autonomy, in order to get that paycheck every other week. And some people are really great with that they're happy with their employment situation. 

Dr. T  11:00  
But then there are the rest of us who are like, I don't think I really wanted to trade that autonomy for this paycheck. I'm not completely fulfilled, I feel like I'm just settling, you know, these kinds of thoughts. And so that was a belief I had to let go of, several years ago, when I decided to open my own practice. Now, if you heard me in the past, I never really dreamt about running my own business in this way. It was just not an idea that I really entertained that long for more than five minutes. But then it just happened. Things came into place, there was really no job that would employ me and I was like, I don't have much of a choice than to open my own practice. And here we are, I have my own practice. But that was a thought I really had to let go of the employment will provide job security when the reality is it didn't. It didn't provide me fulfillment. It wasn't very that it wasn't that secure. It was just a paycheck every other week, which was super nice. 

Dr. T  11:55  
But I had to trade a lot for that. And I wasn't willing to go on with that for the rest of my career. Number two, another crazy idea that we believe to be fact when it's not, is that in the traditional insurance based practice is the only way to make money. And here I am showing you how untrue that is. So it is not true that the insurance based practice is the only way to make money, you can still make money. Without insurance, the insurance is just the middlemen paying for your services. And in fact, they're paying it at a discount. When you signed the 30 page, whatever page number contract at the last couple of appendices, it says the rate that you provide, you will only get certain percentage of or it's only going to follow what Medicare allows minus another set of percentages. It's very frustrating when you get through these contracts. But you see the the insurance based practice is not the only way to make money. 

Dr. T  12:50  
And in fact, more and more consultants are helping their clients see that they do need to add cash revenue, current cash flow into their practice, whether it be selling products are offering non covered services, and then having having patients pay cash for that. And another idea that we have that is not factual is just a belief. It's this saying, I'm just a doctor. And clinical work is the only way I know how to use my degree, this I won't dive into but I've met so many doctors who don't have clinical careers, but they are using their medical degrees for other things. Maybe they're doing research and development for a product, they have maybe a coaching business doing other various things. They're consultants, they write professionally. And they get paid to do that, or they're speaking professionally, and they get paid to do that. So these are just examples of ideas that aren't really reality unless you accept them to be factual, and they're not factual and the beliefs that you currently have right now, a lot of them you might have to let go of in order to get to a new, different future. 

Dr. T  13:56  
And so for me, I had to let go of the idea that employment was the only way that insurance based payments were the only way. And two years later, after my first experience of seeing what a cash practice can do for the business owner and for the patient, I have a cash practice. And so I get to share that with you. And isn't that lovely? What can happen in two years, but you have to let go of these beliefs. Some of these beliefs, obviously, the last one is not relevant, but just an example, how tightly we hold these beliefs to be factual when in reality, they're not factual at all. So the harm in sticking into the beliefs that limit us is, is that we don't really get to the other side. And I think that limitation in itself is tragic. We've lost our creative abilities to find creative solutions, right? That's a big part of not being able to see what's beyond the window of your world. It's like saying, I've seen all that I needed to see about the world from my porch window. 

Dr. T  14:54  
And, you know, that's kind of kind of silly, right? You can't know everything simply from sitting your porch when Bill, just like you can't know everything simply by going into residency. I mean, you have the foundation, but there's more, there is definitely more to your world. But you had to put on another pair of lens to see that someone had inquired, What does it take to start a direct care practice? Like it's one of those? Can I pick your brain questions on some random social media forum. And I was like, you know, I've been doing a lot of these free calls. And a lot of people generally speaking are not that serious. They were just curious, they just wanted to see like, the fun part, the part that I get to enjoy, which is the revenue increase, right. But this person had said, specifically, I'm not willing to risk anything to do it. And this is such a problematic statement. If you find yourself in a situation where you want a different life, but you're unwilling to risk anything, whether that be financial loss, or even a change in belief. You won't get that far. 

Dr. T  15:56  
Because the belief that you have right now is what's creating your current reality. To change that reality, you have to think different. There's just no way around it. What I have right now is not really an accident. Everything was intentional. All of the books that I read the podcasts that I listened to the people I interact with the circle that I've created, these are daily activities that I made the intention to have to change my mind. It's not like you just wake up overnight, you sign on a new consultant or business coach, and then you change, no, you actually have to do the work, you actually have to break down a little bit to get a break through. So you know, people who think that they can have a different future are in for a huge disappointment, you actually have to change the way you think and the things that you believe. So I would hate to be exactly where I was one year from now. Like, who I am today, if this exists exactly the same in 2023, I would be completely disappointed because life is meant to change, we are dynamic, we are supposed to change with the time. And unfortunately, a lot of people are choosing to live this way. 

Dr. T  17:02  
They are complacent, they will settle. And that's all there is for it. But I know that you're here because you won't settle just as much as I won't settle. And the thing is, a lot of people just don't really know how to get out of that cycle. And I'm showing you exactly how to get out of this. Like you have to do things with intent, like the news article you're reading? Is it about all of the tragedies in the world? Or is it a self development article? Right? When you're driving? Are you listening to music just to pass the time? Or are you listening to a podcast that can help you actually change the way you see the world? When you go out socially? Are you binge drinking weekend, after a weekend? Are you actually with people who help push you to grow to become a better version of yourself? Are you spending time with people who have minimum wage habits, when really you should be hanging out with people who have million dollar habits, even if you don't want to make millions of dollars, the way people think is related to their income level. 

Dr. T  18:01  
So just think about that every thing that you do think read listen to affects your current reality. And this is what I mean, when I say live with intent, every decision that you make, should put you a little bit closer to your goal. So if you want to have a direct care practice, you want to be grabbing business books, you want to be talking to people who have direct care practices, you have to surround yourself with things that are aligned to that future. And you actually have to plan for that. Yeah, so you have to write it out on a piece of paper. And let me show you this exercise that I did with my clients. I invited everyone to write on a piece of paper that they are willing to throw away what core belief that they have that they're hanging on to but no, it's not serving them in their future. So I invite you to do that as well. So if you're sitting somewhere and you can grab a piece of paper, please do that with me, you're going to be really happy that you did. 

Dr. T  18:58  
And if you're not take a pause and come back to me. And let's do this together. So on your piece of paper, write out the things, the thoughts, the beliefs that you have to let go of in order to get to your dream future, that dream practice that direct care practice. What is it that you are thinking, believing feeling that's holding you back? When I did this with my clients? Here are some of the things that came up. Someone said, I don't feel worthy of success. Somebody else said, I don't feel like I deserve what I have. Because it all comes too easily. Somebody said I'm afraid of not knowing. And that's why they're holding back on doing what they need to do. Someone else said, If I drop insurances, then I'll feel like I'm abandoning these people. And then someone said, I'm not smart enough. 

Dr. T  19:49  
I don't deserve to be here. I don't even know why I'm here. I'll share with you my belief that was holding me back. My belief was that I didn't think I was good at business. I had said to myself, because I wasn't seeing the financial gain in my practice in the last two years, that I was not good at business. So I sat with that belief and believed it to be true. Can I just tell you something, all of these beliefs we have, they're all shitty. They don't serve us, they're not moving us forward. If anything, it makes us sit and wallow in despair. So please do the exercise with me write your thing out, reflect on it. And this is what I want you to do when you're done, I want you to trash it, this exercise is going to be called shove it in the shredder because these beliefs don't help you move forward, right? If you feel like you're not worthy of success, then do you think you'll ever get to where you want to be? I mean, sometimes these voices, they come at us because of a particular experience as we were growing up, and we just held on to that voice. 

Dr. T  20:46  
Maybe it's from a parent or from a life experience, wherever, but we need to let it go. It's not doing anything for you. If anything is holding you down, it's making you feel shame, it's making you feel guilty for wanting what you want, you should never feel guilty about that you should never feel guilty for wanting what you want. So here's the deal, you need to replace these beliefs with new ones that will serve you and I know you know this intellectually, I know that, you know, it sounds really silly, don't hold back. And I believe in these thoughts that you have. But sometimes it takes an external source to get you out of that mindset. That's what a coach does. So you need to replace your beliefs with a new one that will serve you. So anytime you cycle back to these old beliefs, write it on a piece of paper and trash it, shove it in the shredder, it's not doing shit for you. Okay, it took me two years to get here, because I was slowly peeling back the layers that were holding me back. And it was just recently that my coach helped me through these negative thoughts that I finally decided that I actively chose to let them go. And that's when I really got to enjoy my success. And I want you to experience that too. 

Dr. T  21:52  
Don't wait for external validation, or a specific financial goal to be met to feel successful accept you for who you exactly are and then plan for the next move so that you are in a radically different place one year from now. So how's that for free therapy, your exercise after listening to this episode is going to be very simple, you're going to write the date, today's date, plus one year from now. So if today is November 29th 2022, you would then write November 2920 23. Write a letter to your future self, right. Because when you read that you're going to you're going to see that you've made some significant strides towards your goal. And I'll share with you what I wrote, when I did this exercise in 2019, I wrote a letter to myself in 2020, that I would have paid off all of my credit card debts, it seemed totally impossible. Because I was knee deep in all of this stuff surrounding insurance payments, staff hiring whatever. I had no idea what I was supposed to be doing. 

Dr. T  22:57  
And I wrote it down that this would have been paid by the time by next year. And then I look back in my notes, and I have a seed in just a couple of months, I actually was able to pay off all of my credit card debts. And even to know two years later, all of my credit card debts are paid off on time. I don't have old debts laying around on my credit card, not for my business and not for my personal life. And that felt really good for me. So imagine if you were strategic in how you lived your life, and you wrote all the things down, and you made a plan for yourself to get there. That's how you get to become a totally different person one year from now, and a little bit closer to your crazy idea goals. And I know that you're here, and I know that you've got some crazy wild ambition, and I'm here to support it. So I hope this exercise helps you put yourself in the right mindset to start really being active about your future to make decisions that align that gets you closer to that future. And I shared my own story so that you can see how much can change in two years if you made purposeful decisions to get there. And you might even get there faster, you just make room for magic. So remember, this is a daily exercise. You don't just do this one time. You got to do it all the time. Thank you so much for listening. I'll catch you next week.

Dr. T  24:17  
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  24:36  
And lastly, if you remember nothing else, remember this be the energy you want to attract. See you next time