Dr. Melody Stouder is a board certified foot & ankle specialist who has a Direct Specialty Care podiatry practice in Pennsylvania and shares how burnout motivated her to leave insurance and start her own practice instead. Find her at https://onthemovedoc.com/
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 0:51
Hey there, today's episode, another special one, I'm really enjoying having conversations with other direct care doctors to share with you so you can see what the transition into direct care could look like. A lot of us have parallel paths some of us might have been employed, or we are self employed and went from insurance and into direct care. So I hope that by sharing all of these conversations with you, it gives you an idea of what's really possible for you and then you get to decide how you write your story. Today I'm sharing with you a conversation I had with Dr. Melody Stouder. She is a podiatrist who practices in Philadelphia, Her website is on the move doc.com. And initially she had thought about having a mobile podiatry clinic that was quickly halted. And you'll hear how that all played out. And now she has a private practice that she runs by herself. And she is also a mother of two small children. And I think you'll start to see that Direct Care offers you life and job satisfaction with the flexibility of us deciding who we get to see how much we charge and how many patients you want to see in a day, all to benefit patient care. So tune in to this conversation. And I hope you can grab a couple of few gems as you are along your journey in the direct care way. So happy to connect with you Dr. Stouder.
Dr. T 2:13
Dr. Stouder has been on my radar, I'm kind of peeking around and seeing who is next to jump on to the direct care bandwagon. And I'm so excited to be able to connect with you sprayer for you to share really what your journey has been like, from the insurance based practice into your your current practice. And then certainly, I'm here to network with you and offer you any insight I might have that might be relevant to your practice. So can you give us a little background about why you became a direct care practice? And what prompted you to be where you are now?
Dr. Stouder 2:45
Yeah, and I thank you for the intro. I'm happy to be here. Yeah. So I worked for a very large super group for about five years. And I've always been the type of doctor I like to, I don't always like to do the mainstream treatment. I like to do things outside of the box. And it bothered me that I feel like I can only treat people with what insurance would cover. And sometimes that wasn't always the best treatment. And I felt like I was limiting myself. I was preventing myself from expanding and growing. So there were resources I asked, I asked permission to have at the office. And I was told now which I understand because insurance model, if they don't think it's going to bring in profit, then they won't they don't want to expend the money, you know, for you to have that. So I just got to the point where I felt like I was strange analogy, but I felt like I was this fish in a little fishbowl and I couldn't grow anymore, and I wanted a bigger fish tank. So I just thought I need to leave. And I didn't care if it meant less money, more money, I just needed to feel peace and be happy with what I do. And I was getting very burnout with insurance. It was constant every day trying to reason or write an appeal letter or explain why I thought this was necessary for someone you know, someone who's had half their foot amputated, getting denied for custom diabetic inserts, things like that. That just didn't make sense. So I left I was nine months pregnant. And I put in my resignation and went on maternity leave and said, I'm going to do this on my maternity leave. Which looking back on it was I don't regret it. But it wasn't the most simple path. Yeah, it worked out.
Dr. T 4:24
It's a pregnancy can do that to you. Hmm. It changes you a little.
Dr. Stouder 4:28
Yeah, it just makes you realize you just got to you don't want to waste time and you want to live each moment the stability that you can. So I went back and forth on maternity leave at this point. I still didn't know if I want to take insurance or not. And it was just such an internal struggle for me because I cared about my patients from the last practice and I wanted them to be able to feel like they could follow me so and I didn't want to upset them either. So I felt terrible about it. But I talked to some other peers in the direct care realm and And honestly, like listening to your posts, you were a big motivator, because reading things that you've posted and that other women had posted on Facebook, even just Facebook made me realize that's possible. And there's no reason why I can't do it. So someone else said to me, if you're going to start off fresh, you should just completely opt out, just start off no go down a whole nother path. And I, I thought about it, and I just, it just felt right. So I just went with it. And I don't regret it at all. It was bumpy in the beginning, but things are really panning out now. And so I do, I do really think it was a good choice.
Dr. T 5:36
Well, thank you for validating my podcast. Because you know, I'm, these are monologues, most of the time, I'm talking about my personal journey, I don't know who's listening. People don't always reach out, I know, they're reading, you know, because they'll send me a message here and there. But they'll never comment on my stuff I'll never pose a lot of people are kind of just lurking. But to be able to hear it from a real person who's actually doing direct care, it's, it's really meaningful to, to know that, that this is a viable path for other people. So I wanted to know, well, I don't know if you know, but I started my private practice when I was pregnant, too, because I was employed. And same thing I said, I wanted to do a very specific thing. And they said, tough luck, we own you, basically. So whatever is on your schedule, you are obligated to do if you want to get paycheck, and that felt very restrictive. I really hated that. And it was a fight between getting a comfortable check every two weeks, versus truly having desire to create something and make my life a little bit more meaningful and doing work that matters to me. And there was a cost to that there was a cost of peace, you know, we took risk to doing something that we have a calling for. It was not a written path, there is no book, but I'm on the same page that I'm happy that I'm doing what I'm doing every day is a different day. And I'm glad to be able to meet people like you because this is not easy. It's I've never said that. A direct care practice is easy. It's simple. It's way more simple than being insurance bound and having to sign all those contracts. But that's not necessarily easily we have to get through some of the mind drama, of really believing in ourselves, the fear of failure, the fear of success to actually get to where we are. So can you tell me how far in your practice Are you now
Dr. Stouder 7:26
I opened up in April of last year. So coming up on a year soon. So yeah, it's flying by
Dr. T 7:32
And how's it going? You are saying you are getting busier.
Dr. Stouder 7:35
And it's been rewarding every step of the way. It just in the beginning, it was a little bit felt more risky. Because we're in the type of career where we built this path for so long. We invested all this time and money in turn our education, and then we're taking this huge leap and doing something completely against the way that we're taught. So it's it was scary in the beginning. But it was always rewarding. There was never a day where I came home and thought I shouldn't have done this because I just felt more fulfilled. So I think you go into it just expecting you know, the first year, don't expect to bring in a lot of profit. If anything. Just keep an eye on your numbers each month and see if you if you can steadily see the amount of new patients coming in and increasing and your revenue slowly increasing, at least you know you're getting somewhere, but it might just take a while. So this month, I would say this past January, I did notice all of a sudden things just kicked off. I don't know how to explain it. We were slow January, and then just sorry, we were slow in December. And then all of a sudden in January, our phones started ringing more. And I started to hear a lot of people saying word of mouth things like oh, my family member, my friend, my aunt. And that's how I knew. It just took time for Word to spread. Even though I'd been doing advertising. I truly do think word of mouth is one of the best ways. So
Dr. T 8:56
I was gonna ask you, how are you marketing your practice?
Dr. Stouder 8:58
So I am in an area where there's a lot of people who don't have insurance. So because of that, that we have a great relationship. I love natural medicine. They love natural medicine. I don't take insurance, they don't have insurance. So we've established a great relationship from the beginning. And I did that just by advertising in our newspapers. I've done local regular newspapers, but I've also done a couple local magazines. Like we have some elderly magazine magazines that go out. So like a couple things like like neighborhood magazines. I had one company does a Facebook ad for me once a month. I mean, and social media wise, I'm definitely lacking. That's the part I'm trying to work on. But it's definitely not anywhere near where it should be.
Dr. T 9:43
So do you think your biggest return has been word of mouth?
Dr. Stouder 9:46
Yeah, definitely. And where are you at? I'm in Shippensburg, Pennsylvania. It's an hour south of Harrisburg. So I'm kind of right near the Maryland border. So actually I did actually have my Maryland and Pennsylvania license for a while because I practiced in both states.
Dr. T 9:59
You had been In that you started off with the idea of doing a mobile practice, but it didn't pan out. Is that right? What were some of the limitations with that
Dr. Stouder 10:08
we bought shuttle bus. Because once when they retire shuttle buses, they still function. They just have more mileage on them. And so we got a good deal on it. And my husband's great at building things and renovating stuff. So we started renovating it. And then one day, the engine just wouldn't start. And we looked for mechanics in the area. In our area, there aren't shuttle buses. So there was no one that wanted to work on it. So then we realize, oh, wow, in the future, if this just randomly happens, you know, is are we digging the hole right now. So at that point, it I think it was within the same week, we had a friend text us and say, Hey, I found this property in your area, it's been on the market for a while now. It's an it's a cute office, you should go look at it. And it was like meant to be we loved it. So then we just drove the the shuttle bus to the scrapyard that day and just moved on. It was a great idea. And I was really excited about it. But it wasn't meant to be I think it would have gotten very complicated. And you if you think about it, we deal with a lot of products and, you know, durable medical equipment, all kinds of stuff. And I don't know where I would have put it all.
Dr. T 11:14
Well, that's good feedback. A, I love the idea. I don't do more like I don't have a mobile van, I do home visit and I'm offering visits to other medical offices. But yeah, there is a little bit of, I guess, maybe savviness when it comes to having a shuttle bus that I have no idea and how to do but I see it all the time. And I reminded him when we were in grade school the bookmobile like it was so exciting to have them come to our school. So it's very nostalgic for me to see mobile clinics on on the go.
Dr. Stouder 11:46
Yeah, I love that idea. And I was so serious. I had even started getting my CDL. Like I had already had my CDL permit and everything and I was determined I was going to drive this bus. And but it wasn't an just wasn't meant to be.
Dr. T 11:59
Well, that's great. So what has surprised you about direct care now that you're in it?
Dr. Stouder 12:04
One thing that stood out to me the most is I came out of residency. So surgically hungry, you know, I wanted to get my numbers, I wanted to get board certified. And they just instill this hunger in you to want to do surgery, which is great in a way, but sometimes it's not. And I feel like I did so many surgeries. And some people were chronically ill, to the point where they already they just struggled with healing. And some people that are in those situations, surgery isn't always the best answer right away. So now that I don't take insurance, I have natural, more natural healing types of modalities like my laser, my shockwave and from using different types of treatments. I've seen people heal more than I ever have without surgery. So now before I used to do a lot more tendon repairs, ligament repairs, things like that. Now only surgeries I really do are bunions, because obviously bunions aren't going to get better with a laser or Shockwave. But the other surgeries I do besides that kind of stuff is trauma. So like bad fractures or things like coalition's that just kids need to be removed. So I'm really avoiding a lot of that other stuff that I used to see. So it's the shift has been amazing. Like I enjoy that makes me happy. Because it just seems like people heal and recover better. Now, I don't know if you've ever if you've experienced that.
Dr. T 13:29
Yeah, I everything you're saying is exactly where I was in the in the shift. Because yeah, I was also I really like you said surgically hungry, like you go out thinking you're just gonna meet everybody and everyone's gonna be on the books. And then you know, it's, that's how life was going to be there was a reality, check that most people don't want surgery, regardless of it being a good outcome or not. They're just not in the mindset to say that's what I want. Unless you're doing trauma, right? Unless you got a bone sticking out of your skin. Of course you want it to fix it. But the majority of people in my community as well wanted to avoid surgery. And if anything, they were going to Google to find natural treatments. So I thought what what better, better way to serve my community than to provide them with evidence based practices that can get them better without surgery. And so I have both elements available. I still do surgery, I offer everything that I was trained to do. But I am predominantly doing more of the education, pain management modality minimally invasive surgery and Fulfiller in my practice, because I just had to learn to listen to my community to see what they needed. Because I have limited resources and I'll, I've said this. In the past, we were trained to see everybody that comes in. But when you're in private practice, that is not a really good business model. Because if you bring everything in, and perhaps you don't do some of those things, well, just because you made some revenue doesn't mean that was the right decision. And so I think I'm just learning to sort out what is appropriate for an academic institution versus private practice. And so being able to freely choose what we want to do, and what we want to pay is really empowering. And so that's kind of where I started to develop my practice.
Dr. Stouder 15:12
And when you said, listen to the people, it is so true, if you could list listen to the people, and they could list the things that they do want, I think it would be they want more time with a physician, because they want the physician to hear them out, which we're able to do in direct care. They want options to avoid surgery, which now we can offer when we do more direct care. And then if they do need surgery, which if like bunions and hammertoes, you can do minimally invasive in the office. So that's a lot of people do want to avoid going in a hospital setting and get going under anesthesia. So it seems like we can just address the things that people want, we're able to do them in a better fashion. Now. I think
Dr. T 15:50
I agree. Has there been? Have you been confronted with any misconceptions about your practice?
Dr. Stouder 15:55
When we first opened the first it seemed like the first couple months, we did get a lot of phone calls, where people seem to be frustrated when we explained we didn't take insurance. One woman even said, how do you expect me to pay for my groceries if you don't take my insurance, and she hung up the phone. And I had empathy for her because it sounds like it's hard for her to make her bills. And, you know, I growing up, like my family didn't have much money. So I can sympathize. But at the end of the day, there are podiatrist 15 minutes from me 30 minutes north, there are other people that take insurance within a day she can go somewhere else. But what I was offering was an appointment the next day, and I was offering treatment options that she wouldn't get in other places. So I just said, you know, when you can if you're able to I would just call another office and then that way, you know, hopefully you don't have any medical bills and they cover your treatment, but she was very unhappy. So I'll never forget that conversation because it did upset me. And it didn't make me regret it. But it did kind of you have that moment where you're like, oh, no, is this a bad idea too, is it this is I don't want to upset people. I'm a people pleaser. And that's I want to make people happy. So that was a tough, those conversations were a little tough for me. But they get easier and easier. The more times you have them, it seemed like my my schpeel in the beginning was one thing. And then by the end of the year, it was completely transformed into this amazing, elegant conversation whereby the end, people completely understood and they said, Oh, I get it. I appreciate that. So you just get better at it. But as time goes on, it really does change. Have you stopped getting?
Dr. T 17:25
Oh, let me tell you to do okay, so I don't have staff today, today's a Monday. And I took the day off. But I had a bunch of voicemails and saying call everybody back and 100% of them didn't want to book because they were they were not pre screened. So they were either referred by somebody who didn't pre educate them that I was a cash practice or whatever the circumstances were. And so I'm still having those conversations. And it's it doesn't bother me as much as it takes up a lot of my time because I have people who do want to pay. And so I'm having to spend less time being upset and annoyed. Rather, I'm trying to spend time on people who really need my service. And so, yeah, you're right there there in the beginning, when you don't have experience with rejection, you're just dealing with it and you're like, is this the right thing to do, but you really have to stand firm in your beliefs that you know that you're doing the right thing, and some people are just not fit for your practice this like you shouldn't be seeing emergency cases in your office when they're better served at the emergency room, for example, right? There's just some things that we can't do, and that we have to learn to accept. It's just part of our practice.
Dr. T 18:24
Because at the end of the day, we want a business that works for us, not for us to be in our business all the time drowning in CPT codes, ICD 10 codes, trying to figure out billing stuff taking charting home and those things. So I still get patients who call upset. Many of them will say things like, Well, I'm on a limited budget, or I can't believe you don't take insurance, or I'm sorry, you don't take insurance. And I said, and then this one lady today said she asked me so why don't you take insurance, that's unfortunate. And I said, I can't survive on insurance financially. So there's no way they would never pay me enough to survive. And so she could she only only like really understood her anchor that I didn't take insurance. But I sat firm and that I could couldn't survive on my first year and a half in private practice. I was drowning in debt, and I had no idea how to pay it off. Because I had to pay for my overhead. So I wanted to ask you going through the hardships that you did in your first year, what would you have said to the younger version of yourself about this practice, this direct care practice that you have,
Dr. Stouder 19:27
the first thing that popped in my head was trust your instincts, because I have learned that if you follow that voice that just pops up in your head, it usually does take you to a good place. You just have to actually listen to it and drown out the chaos that can overwhelm that. So I think yeah, just trust your instincts, instincts and stay firm with your beliefs and you'll just continue to progress and move forward with the practice. So and I've only I mean, I haven't even been a year in so it's hard for me to say that but you've been further along. So I think it'd be better question for you.
Dr. T 19:58
Yeah, No, actually, I started my practice in 2018 and 2020. So I'm about two years, I was a hybrid, and then I was fully cash last year. So it was a transition. And that's something that I highly recommend whoever has an insurance base to consider just dropping out one insurance at a time just to experience it to know how to have this conversation and then eventually be comfortable with your decision. Yeah, so that was my, my story. But I think I had to go back and speak to the younger version of myself, I would say that there was there will be a lot of hard time. Yeah. And sometimes the right thing to do is the hard thing to do. Because if I sat and was complacent and just said, I want that easy cush job and the check every two weeks, I don't think I would alas it in medicine as long as I want to, because that was not just burned out. But I felt very exploited, you know, our goodwill, wanting to help people get better at any cost. You know, oftentimes, we're doing things for free, we never ask for money. And that is just not sustainable for me or my family. So I think realizing what's up ahead, it's not easy, but we can figure stuff out, we made it this far through medical school and training, that this is just the next phase in our career. And, and I also learned that no matter what an individual's income level is, there will always be these types of struggles, it just looks a little bit different each income level as you go. So you know, we went from residency, which was, we were getting paid with 50 grand or something, and then you move into private practice, and you get a cush salary, and then you're moving up in a different income level, you're gonna have similar problems, it just looks a little differently. So I don't think we ever get away from the fear of self doubt, or the even the fear of success. Many of us are afraid of having success to the point where it takes us away from the things that we want to have in our lives, like family and personal time. But certainly, if you're a failure, I think that is always present. So we have to learn how to manage that now. And then with time, we will get better at it. So that's what I would say to my younger self, you're gonna be afraid, but do it anyway.
Dr. Stouder 22:04
And I think I developed this weird technique to make myself feel better is if I feared of a failure, I would tell myself, Okay, well, what's the worst case scenario if I fail, and I thought, because I knew if I moved forward with the insurance model where the company I worked for, I would never attain that peace and happiness. So that was just wasn't an option. So I told myself, Okay, well, if I fail, and I lose everything, because I had sunk a lot of my savings into opening this, so I thought, if I lose everything, and this doesn't work, worst case scenario is we move into a camper and my family and I, we just like, live a more outdoorsy life and have minimal living and live in an RV and travel. And I'm like, You know what, that's not that bad. And then I thought, yeah, that's okay.
Dr. T 22:49
That sounds really good. Actually.
Dr. T 22:51
Yeah, I just tried to think of the worst case scenario. And then when it doesn't seem as bad as you, it just you make it seem worse in your head until you verbalize it out loud.
Dr. T 22:59
Yeah. So what motivates you to keep going
Dr. Stouder 23:02
to things I've always had a burning desire to want to help people, like heal people, like even when I was three years old, I was playing with the stuff that's stethoscope and I was obsessed with my doctor toys. So I've always had that. The other thing is, my, my two boys, I just want to show them that you can you don't need anyone, no one should ever make you feel like you have limitations. You can always exceed those, and you should never place them on yourself either. So I think with them seeing my growth is just setting a good example for them.
Dr. T 23:30
What would you say to the doctor who's on the fence about direct care? What would you say to them?
Dr. Stouder 23:35
Whether you're meditating or whatever you're doing, just assess your current life. And if you feel like your current situation does make you feel happy and not burnout, and you come home feeling satisfied, and you then maybe you can go the rest of your career and feel okay with that, like, maybe that's all you need, as long as you come home feeling satisfied. And maybe that's all you need. But if deep down, you just know there's something missing and you feel like, you know, you could grow more and just change change the rest of your career. Yeah, I think you just need to go and have a deep reflection. And if you feel like something's missing, then it probably is.
Dr. T 24:11
But go get it. Yeah, go go. Well, I really appreciate your insight because it's hard. I don't I'm not gonna lie, and I don't care. Doing something that is the opposite of what everyone else is doing. Even even opposing our training. This has been incredibly challenging, but it's been rewarding for me and it sounds like it's very rewarding for you too. So I'm really happy to hear that
Dr. Stouder 24:33
Yeah. And if it helps, I don't know if sometimes people see someone like you or someone who's already done it and they think oh, well they probably have someone they probably have so much help or this and that for me. I have no one no one in my family owns a business no one in my family is in the medical field. I have a ton of student debt. I no one I didn't have no one gave me money to do this. You know, I did just put it on the line and eventually if it pays off, as long as you know, in your heart, you're good doctor. I mean, if you get terrible feedback from your patients all the time, I'd probably say don't go this route because but if you know, in your heart, you're good at what you do, then yeah, it's gonna cut, it's going to it's going to pay off in the future.
Dr. T 25:18
I like that I didn't have any resources, I did have the support of my husband. So that's something that is unique. Because both of our parents are immigrants, we all came here in poverty eventually became a middle class and kind of stayed there. But you know, when you're a middle class coming from immigrant background, your mentality is still very much in poverty, it just looks a little bit differently. And so I didn't have these resources, which is why I tried to put this kind of stuff together, I stay engaged on Facebook groups, because all other professions have business coaches, athletes have coaches, CEOs of huge corporations have business coaches, and I think it's about time physicians really understand the value of getting the help when you don't have it from your own family resources. And that's no fault of our own. It's just what we it's just the cards we were dealt. And so being able to reach out to these higher resources is incredibly helpful. And it can really push you to the next level. And that's something that I highly recommend for everyone to look at to seek out our professional coaches who can mentor you and get you to move into that next level of your professional career.
Dr. Stouder 26:25
Yeah, no, I definitely agree. And I just started meeting with two other female podiatrists, we just meet every other week for about a half an hour and just come brainstorm. And we're all direct care so that we've we've actually only had two sessions so far. So I'm really eager to see where it goes.
Dr. T 26:40
But those masterminds are incredible. It really pushes you when you feel down.
Dr. Stouder 26:44
Yeah, yeah, that's great.
Dr. T 26:46
Do you have any last advice last words, he would like the history the listeners to hear
Dr. Stouder 26:51
always keep direct here in the back of your mind is an option. And then if you're a patient, or someone who's seeking treatment to stay open minded, that you might end up getting better care going to an office where they offer like, like yours, where they offer multiple treatments that aren't covered by insurance plans anyways. So I think no matter who's listening, I think everyone can have something to gain by learning more about direct care.
Dr. T 27:13
I agree. Of course, I agree here. Yeah. Well, I appreciate you talking to me about your journey, and certainly sharing all of your wisdom. How can people find you if you want to learn more?
Dr. Stouder 27:25
My website www.onthemovedoc.com not the one in Arizona, the one in Pennsylvania? I found out after I created the business name. There's one in Arizona.
Dr. T 27:36
Well, thank you so much.
Dr. Stouder 27:37
Yeah, thanks for everything. I really do appreciate it. It's nice to just chat and talk to other fellow direct care podiatrist. I think you have to stay hungry to learn because the second you decide that I remember when I was younger. When I was a student in medical school, I thought, Okay, I can't wait to graduate because once I'm done learning, I never want to read a book again, like I just want to be done. And then I learned well, no, you, you have to always want to learn more. And you pretty much even reinvent the wheel like every five years because times keep changing and you need to be able to keep up with things. So if you don't have that hunger, then sometimes that is an issue. Because you can be stuck in your ways. But
Dr. T 28:14
yeah, that's really good advice. Actually. I'm going to keep that.
Dr. T 28:18
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 28:37
And lastly, if you remember nothing else, remember this be the energy you want to attract. See you next time.