Direct Podiatry Arizona with Dr. Sondema Tarr

Dr. Tea  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. Tea  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 Ngyuen.

Dr. Tea  0:52  

 I'm so excited to have Dr. Sondema Tarr here today. She is a direct care podiatrist in Arizona. And I'm going to have you introduce yourself to the world to how you want to be represented and we're going to have a conversation about how she started her direct care practice less than one year ago. Did I say that right? Less than a year ago, whatever my English is still a second language. So moving on. Welcome Dr. Tarr.

Dr. Tarr  1:18  

Thank you for having me, Dr. T. I appreciate it.

Dr. Tea  1:21  

If you don't mind, please tell the world who you are, what you do, and why direct care.

Dr. Tarr  1:28  

So Hi, everyone. My name is Dr. Sondema Tarr, I'm a podiatrist based in Phoenix, Arizona, like Dr. Tea said, I opened my practice, March of this year will be one year ago today. So at my practice, my focus really is serving the underserved community, I see a lot of patients that don't have any type of health coverage, patients that just have concerns about getting the treatment or fair treatment within like kind of the current healthcare climate. So I see patients that do have insurance as well, and kind of patients and I think we all do this as direct care doctors as well that have fallen through the cracks with certain diagnoses, especially when it comes to pain. So I do all of those things. And that's just a little bit about me.

Dr. Tea  2:23  

How did you decide that location?

Dr. Tarr  2:26  

Well, I live in Tempe. So when I moved to Arizona, I moved here during the pandemic, and 2020 has bounced around a little bit to the different areas in the county. Phoenix has a lot of sprawl, kind of like LA Atlanta, it covers a large area, Tempe I like because it's, for the most part centrally located. There's a lot of freeways here. So a lot of people if they're coming from, let's say, Mesa, out east, it's easier for them to get here. People that live in Phoenix and Scottsdale, they have direct links here as well. So it's kind of more centrally located within the county. And that was important to me. I know sometimes with doctors in general. I know for me in the past, if I truly liked someone, I would travel regardless of how far away they are. I've done it before I've driven an hour, but also at the same time. I know the majority of people like to kind of stay in their area. So Tempe is centrally located. And that's why I chose it.

Dr. Tea  3:40  

What was life before your direct care practice? Were you employed as an independent contractor and training to draw, draw the picture for us.

Dr. Tarr  3:48  

Um, so I was an independent contractor. When I first moved to Arizona, my first job was an independent contractor job doing mobile podiatry, going to group homes, nursing homes, and then freestanding homes as well. It wasn't fulfilling it just you know, if I'm perfectly honest, I think all of us when we're in residency, and in school, we kind of have this, you know, super idealized view of how medicine is going to be when we get out. And I remember going to work the first day and I'm thinking, this was it. This is what I've spent the last 11 plus years of my life if not more, like dedicating myself to and it wasn't super fulfilling. But you know, at the same time, it was at the peak of COVID. So I kept going, and then also too, I think for me, and it happens to a lot of people too. I got comfortable, I got comfortable with the pay because the pay was really good. So despite the fact that I wasn't feeling fulfilled. My mental health was kind of tanking as well just because of the amount of trial. Well, I was doing that job, because it wasn't an independent contractor job, you know, you have to log your mileage. And I was driving about 130 miles a day, every day. So going through all of that, it just really started to weigh on me. And I always wanted to open a practice. But graduating when I did in 2020, I was apprehensive to open it during that time with the pandemic going on. So I kind of told myself, Okay, well, even though you don't like this job, maybe the safer quote unquote, and I use that term loosely, the safer option would be just to stay here and continue on. And I had that job for maybe a year and a half. And everything just kind of built up within me personally. They were happy to keep me on but I just wasn't fulfilled, it's hard to ignore your true feelings and your true calling. For all you can only do it for so long without it really starting to eat at you. So I had that job for about a year and a half, and I quit, I walked away. At that time, again, burnout was real. I actually left the United States after I left that job, and went to Kenya to see my aunt. She had moved there during the pandemic as well and gotten a job. I hadn't seen her in years. So I went with my mom to Kenya for a couple of weeks. Then I went to Liberia and my family's originally from Liberia. So I hadn't been to Liberia in 10-11 years at that point. So I just went to Africa for about two months with my family decompressed and kind of sat with myself and thought, Okay, well, what do you want to do with yourself, with your life, with your profession, and that time period kind of gave me time to rest. I think that was the first time in a long time that I felt like I had the space to breathe just because I was so exhausted with that last job. So once I got back to the States, I left, I think it was February, early February, I got back probably late March. So a little bit under two months, and I got a second job thinking that this job was going to be better. It was a bigger company, they had bigger, better infrastructure. So I thought, so I thought that that would be better for my mental health. And then also it was a part time position as well. And that Job was honestly worse. The first job was worse than the first job. So all those feelings that I had 2020 to 2022 came back when I got that second job, if not tenfold, because I wasn't addressing now I see it now the root cause where it wasn't so much the job itself or wasn't me, but we weren't, I wasn't living in my truth. I guess I shouldn't say that I wasn't being honest with what I truly wanted. I was just kind of doing the quote unquote, safe thing. But that safety was really compromising my happiness, and my mental health and even my physical health because I believe that your physical health definitely will eventually stress all of that will impact your physical health to a certain extent. So that job I ended up quitting as well. During that time, when I kind of saw the writing on the wall with the second job, and even when I had the first job, I told myself, okay, you need to start your practice because you're not feeling fulfilled. I started to realize that I wasn't feeling fulfilled because I wasn't living in my truth. I wasn't honest with myself, I wasn't practicing medicine, the way I wanted to practice medicine, things that I was seeing between both jobs, I think just the the lack of concern with actual patient care and more so that the coding is right, the charting is right, so that you can get paid, that never sat well with me, ever, ever, ever sat well with me. And, you know, as doctors, I feel like when you're in that insurance realm, whether you want to believe it or not, you're working on behalf of the insurance company. It's like, yes, we've spent, you know, our entire lives in school to do all this training, but the insurance company will dictate your care plan at the end of the day, even though we are the knowledgeable ones. We are the experts, obviously. But if insurance refuses to pay for a treatment, and that treatment is in the best interest of the patient, then they're just not going to pay for it. So I learned a lot and kind of got like a proverbial slap in the face from the universe during like my first probably two years out as a resident, and I didn't really like what I saw. So actually, I was considering doing the insurance thing before I left for Kenya. But once I came back, and I got that second job, even though that period was like a very trying to say the least time in my life, I feel like it showed me a lot. And truly let me land on direct care. Once I went through the whole situation with a second job, I told myself, I can't do the insurance thing anymore, I can't do it. I was talking with some friends and I had a good friend in school, who she had been going through a lot of just job issues as well as drama with a previous employer. And she said something to the effect of oh, I want to be like Dr. T, I want to have a practice like she has. And I remember, like your name on Instagram, and I knew we follow each other. But I wasn't really like actively paying attention to your content, I just would see it and just kind of like how everyone does on Instagram, you scroll by. So I went through your page and actively looked at your stuff and what you were saying, and I'm like, Oh, she has a direct care practice. So basically, to come back to that I started learning about direct care when I was in podiatry school, I want to say maybe 2015. At the time, people were saying that, Oh, we don't know how this will work for specialists, this that. And the rest of it. At the time, it was a lot of primary care doctors who were leaving the insurance realm and labeling this style of practice as direct care. And I knew back then, when I was in school, oh my gosh, that sounds amazing. But because there was no one in podiatry doing it, I just kind of put it in the back of my mind, kind of like a pipe dream. Like, wow, that sounds really beautiful. But I don't know how this is going to work. So I'm just going to kind of continue on the path that I see everyone else doing until I really pay attention to your content. So yeah, a really rough two year period post residency led me to direct care. So that's when I started researching and looking into you and looking into other podiatrists that are direct care as well. And once I saw that it is possible other people are doing it was like, Okay, well, I have to make this work for myself. Because the way that I've been living for the past two years, isn't it? I'm miserable. So it's like there's gotta be something better than this. And that's how my practice was born.

Dr. Tea  12:20  

What an awesome story. And listen, I did not pay her to say that. But I really appreciate that. The universe really gave you what you asked for, you wanted a job, you got the job, and it gave you some lessons along the way. Like maybe this isn't what you wanted. And I truly believe that whatever we put out there what we seek, we will get. And unfortunately, we learned that sometimes what we're asking for isn't really what we wanted. It's just what people told us what it's supposed to be like, and I'm so happy to see more doctors like you who are just going to do it. Because what's worse, you know, being told what to do as a doctor, right? And I'm really happy to see where you are. So bring us back to where you are today. So you opened almost a year ago last year. How did that feel to finally clean what you've always wanted.

Dr. Tarr  13:19  

It felt amazing, you know, if you've ever had a dream come to fruition, especially something that was in your mind for the longest time. Because I think most doctors know they want to be doctors from a pretty early point in their life. And so for me, that was no different. I think from the time I was eight years old, I told myself I'm going to become a doctor and I didn't deviate from that and didn't really look into any other options. I was just very focused, almost like a type person in certain regards. And when it came to education I was so I always wanted to be a doctor. And I was just working, working, working towards that goal. Whether it was reading my mom's medical textbooks at like nine years old, just learn more about the human body or doing, you know, random courses and middle school, high school, volunteering, all that type of stuff. So but I think a business is different because I think it truly is an act in manifestation. You have this dream, this idea, this goal in your head and to see it physically in front of you. It's wild. It's the wildest thing in the most beautiful way. I still almost get emotional like walking into my office now I'm like, wow, this is mine like this. This is truly mine. And each time I kind of look around and I'm like, Oh my gosh, you did it. You actually did it. I was there. I think it was two days ago. And every time I walk in that room, I'm just like, oh my gosh, I'm still in disbelief. So once I made the decision to actually go forward and do it. Yeah, it was scary but um was scary because it was unknown. I didn't have any close friends at the time that have gone down the entrepreneur route when it came to opening a medical practice. So it was kind of like I was alone in certain regards, but at the same time, I just kind of had to trust that whatever information I needed, I would find, but you have to put yourself in that position to find that information, you have to be open to receive that information. So it was definitely an act of faith, like a big leap of faith in myself. Not because opening a practice is so insurmountable. And I tell people all the time, like friends and colleagues, people I, you know, cohorts that I went to school with, we're in the same residency program, I've had a lot of people emailing me and texting me over the year, how did you do it? I want to do it, how did you do it? And I always tell them, the steps are easy, like the stuff you can find in any book or any online blog posts in a YouTube channel and execute those steps. That part is fine. But it's the psychological point to be like, Okay, I'm scared, but I'm still going to do this thing. Anyway, That's the harder part. And I think that's what stops people because especially if you don't have any people that you're friends with, for example, or family members that have walked down this road, it's very much unknown. But again, you just have to trust that. Just like with medical school, whatever information you needed, when all of us started this journey, none of us knew that it would work out 100%. Because we're not fortune tellers, we just had to trust that whatever happened, we would get to where our final goal was, becoming doctors. So no matter how hard the road was, you just don't stray. And I think business ownership is like that, too.

Dr. Tea  16:52  

What was the biggest hurdle you had when you finally opened? Like, what what's the biggest challenge you've had,

Dr. Tarr  16:59  

I would say for me is finding ways to put myself out there, like different ways. Because I am an introverted person, even though you wouldn't see that looking at my social media. But there are studies done that actually say that. Probably some of the most successful people on social media are introverts, because they think that we have so much in our head, that we don't say that if you put a camera in front of us, that's kind of like our moment to like, say everything and to be super animated, and this, that and the rest of it. So I know a lot of the people that I follow on social media, they've said all the time, I'm super introverted, like you would never see that based on my feed, but I'm actually extremely introverted, but they're super popular and successful on social media. So I feel like I'm finding ways to get my message out there. I think that has been the most challenging part. Once patients come to you, then you know, you do what you have been trained to do. You do what's in the best interest of the patient. But I think for someone that's introverted, you kind of have to get out of your own way. And I listened to a lot of Dr. Lunas podcast and I'm in her Facebook group. And her big thing is that she stresses that if you're in your own head, and you're not finding ways to actively share your message or market your practice, it's you're denying yourself growth in your business. And then you're really denying yourself because we're all doctors, at the end of the day, the ability to help somebody, somebody is looking for what you do. But you have to be willing to show up enough and say, Hey, this is me, this is what I do. So that has been a practice this year. And I'm proud of myself that I've actively been making steps to just say, hey, that maybe this thing is very uncomfortable. Maybe I haven't done it before, but I'm going to do it so that I get my name out there. And just so that people can find me, you know, because once they sit in your chair, are very grateful to be there, even though they might be scared, even though they might have some anxiety, especially if there's a procedure going on. But at the same time, they're grateful that they found you. So it's like you don't want to limit that. Or has there been a block there between people finding you that truly do need your help.

Dr. Tea  19:35  

So as an introvert to another introvert, what do you think gave you the best return on investment as far as putting yourself out there?

Dr. Tarr  19:46  

I think honestly, my website and the blog that gave me the best turn on investment this year. That was one thing I was thinking about, like 2024 What do I want to change up? What do I want to kind of tweak when it comes to marketing? And I think by far, the blog gave me the best return on investment just because that that's kind of like my one property on the internet, so to speak, when it comes to like different social media sites or social media platforms, rather, versus the website and the blog, the blog, definitely, because I'll get calls from people that don't follow me on social media, don't watch any of my stuff. But they, you know, read a couple of blog posts about a procedure or treatment that I offer, or just educational things about, like maybe ingrown toenails or something like that. And they find out, you know, I'm here in Tempe, and they make an appointment. So social media, I would say, maybe number two, but definitely the blog slash website. And I'm so good,

Dr. Tea  20:47  

because I am in the camp of the opposite. Flush people find me on social media, and I think it's just tailored to our personality. And I've learned a lot from you with blogging. So I am trying to do that myself. And it's a challenge to write content in a way that keeps people engaged. Because you know, people's attention spans are like three seconds, so you don't capture them. In the first three seconds, you've already lost them to something else. What are you using to help with your blog? Are there tools and tips and tricks to help other doctors who are listening to improve their SEO without having to spend 1000s of dollars on it? 

Dr. Tarr  21:27  

Yeah, so that was my big thing, because I really didn't want to hire a marketing company to do all of that, for me, just one for me, it wasn't feasible to put out, you know, 1000s of dollars a month solely on marketing. When you know, practice is first just getting started. And it's a very low overhead practice. So I wanted to find a way to do it myself. Things that I did, I watched a lot of YouTube videos in the beginning when it came to Google SEO and understanding how that works, how to struggle, our structure, sorry, a blog post. Private Practice skills was one YouTube channel that I watched, and she also bootstrapped her practice as well. She used direct care, technically, she's a therapist, but she's not accepting any insurance. And she had, you know, just kind of like a micro practice one room situation. In Northern California, she moved back to San Diego, I think during the pandemic, and she restarted her practice again with her family. And her practice has just taken off within a couple of months, really, thanks to her blog, and her SEO knowledge, because she's not really on social media other than YouTube. But between YouTube and the blog, she was able to fill her practice. So I have been watching her since residency. So that was really inspiring to kind of see her whole journey from when she first opened, decided she was going to drop insurance, and then moving to a completely different region of California, and still being successful and not really losing too much momentum. So she has a really good playlist on how she built her website, how she designs her blog posts on Google SEO, how she structured them so that they'll rank or ideally rank in the Google search engine. The income school is another good YouTube channel. So they do kind of blogging for everyone, not just you know, businesses or not just medical practices, if you have a blog about I don't know, cats, and you want to talk about everything cat related, they, you know, they reach out to everyone. So that was very insightful. And they also, a lot of their information is free on YouTube free online. But they do have a paid course, if you want to join that as well. I haven't done their paid course yet. Maybe one day, I will. But for right now, I've gotten so much from their YouTube information. And so those are really the two I think big teachers or big accounts that I followed for, like my SEO knowledge for actual software to track keywords and ranking and all that type of stuff. Uber suggests.com is what I use right now. It's affordable, it's probably the most affordable out of all of the big seo software programs that you have, but you can put your website there. It gives you keyword suggestions, you can research keywords, you can follow the rankings of your keywords over time, see if they are ranking where they're ranking if they drop in ranking. So that has been super, super helpful. And then they also give you two tips to change specific pages on your website to help them rank higher to which is extremely, extremely helpful. So that's what I've used for the past year for my website and that's that's worked out. Well. I'm happy with it.

Dr. Tea  25:00  

I'm gonna put all that information down in the show notes. So everyone has access to it, it's really, it's really wonderful to see how resourceful you are. Back when I owned my insurance based practice, I thought that we just needed to hire people and call it good. And then when people started to create content that was not my voice, it just never really resonated, I just, I wasted so much money. And so what you're doing, I feel is the best way, it's the right way. It just requires a little bit of elbow grease, and a lot of patience. And as we're building or, as we're building our practice, that's we have a lot of time, we have a lot of time to think about what it is, we truly want in our practice how we want to show up the tone that we create. And I just really admire everything that you're doing. And I, I wish I could go back in time and say, you know, that's how I would have done it. But without that, I wouldn't have learned the lessons that I did learn. So regardless of where we are in our journey, there's always something to learn. And I wanted to know, what is your favorite part about your direct care practice?

Dr. Tarr  26:06  

My favorite part, there's so many favorite parts. Um, it's hard to pick just one. I love that my patients truly respect me. They truly, truly respect me. And I think that comes from a couple different reasons. One, I think when you're paying out of pocket, because there is that physical exchange of money going on, you have kind of like what you say all the time, you have some skin in the game. So I haven't had any patients that have been unruly or disrespectful, or rude or anything, they are so so so respectful and kind. And that's a blessing. Dr. T and I were both in, you know, different groups for podiatry, and, you know, just doctors in general and to hear some of the stories from our colleagues with patients being verbally abusive. It's really heartbreaking. It's honestly very heartbreaking. I think I read one yesterday, you know, being sexist being all these different things, it's really, really heartbreaking. That hasn't been my experience yet in direct care. But in the insurance realm, it happens every day, unfortunately. And I think a big reason is because they're choosing whether they have insurance coverage or not to see you and they're paying out of pocket. And I think because of that there is kind of like a different level of respect there. So I think that my favorite thing is that my patients truly, truly respect me. And I feel valuable, I feel truly valuable. Whereas when I was you know, in the insurance realm, it kind of came and went, sometimes patients were really nice, or for the most part they were, but you would have a couple that just really tried to beat you down for a lot of different reasons, to the fact that I can spend time with them, I'm not rushed, I can truly get to know them, I can ask them about their families, you know, they can ask them about mine. And it's just that relationship because I don't have 20 people waiting in a waiting room to see me and I'm not running two hours behind. I can truly, truly, truly sit with them and get to know them. I'm accessible to them. They have my number, they can text, they can email, and I can get back in a timely matter. No one's waiting, you know, 1224 hours to get a hold of me a lot of times when patients call to ask for really any questions or, you know, maybe they want a free consultation, they're always surprised that it's me talking to them and not like an office manager. But at the same time, they also say, wow, I wish more doctors would do this. I wish more doctors would just sit down for 10 to 15 minutes. And you could just talk to them about what you're considering. The procedure was really helpful. Thank you. So even if they don't make an appointment right then and there at that moment, that's okay. At least I've helped to educate them about their issue in some way, shape or form, giving them some sort of clarity and like that 1015 minute time. Yeah, so there's a lot of things I like about direct care. But overall, my happiness level has increased tenfold if not more.

Dr. Tea  29:20  

I have to agree. Every time I hear someone complain about an unruly patient, it's like why can't we select for people who respect us? Why do we have to tolerate that type of abuse? And it only takes that one unruly person to really push us over the edge? And I think a lot of us physicians are really vulnerable to that because in the insurance practice, we're seeing lots of people, which means we multiply those stressors in indirect care. How many patients do you see a day? What's a good number for you in a day, would you say?

Dr. Tarr  29:53  

Oh, maybe in a day if it's a full day, probably right now. Got a five to six? Yeah, and the full day So it's not a time. Yeah, the rec has like a low volume practice, but it's perfect for me again, because I love spending time with my patients truly being able to get to the root cause of their issue. So really in a full day, that's kind of like the sweet spot for right now. I don't really see it increasing to much more than that.

Dr. Tea  30:21  

I agree. I know, I thought 1520 people was normal. And then I hear colleagues saying they see 70 Because they're working in a large practice with mid levels. And it's, it's like they're proud of being able to see that many people, but are other patients happy? Probably not. So we do create a different culture in direct care. And I wanted, I had two questions I wanted, I had two questions that I wanted to ask, and you can pick which one you want to answer, because they're kind of fun. I like fun questions. The first question is, what would you say to your younger self, about how life has transpired? Maybe it's your younger version of you as you were struggling in medical school or undergrad? And the second question is, what would you say to the doctor who might be on the fence about direct care? You can answer both? Or you can answer one, your choice.

Dr. Tarr  31:18  

Let's see, I'll answer both to my younger self, I will say, you will be okay. You will be okay. I'm someone that just has a lot of anxiety. A lot of times, I'm always worried about what the future will hold. And I think I would tell my younger self, you will be fine. What you want to do in this life, people are doing it, you just need to find those people, once you find those people, you'll be able to see that because it's possible for them, it's possible for you to so I think that would be my biggest lesson. And to the doctor that's on the fence about direct care, tell them that they're not wrong for feeling what they're feeling. I think all doctors get it. I won't even say the majority of all doctors in your insurance realm get you, you just get it. I think we're all unfortunate, or majority of us. I don't want to speak for everybody. Maybe there's some doctors that are completely content with the way that the healthcare system is in this country. But I think the majority of us are just traumatized in a way when, you know, I told my friends that I was opening a practice. At first I didn't tell them it was gonna be direct care. They just knew I was opening at practice, they found out by looking at my website, it was direct care. 9.9 out of 10 of them got it. They said, Oh yeah, I get it. I get it girl, I understand. Maybe there was one that was kind of judgmental about it, but we just ignored them and keep going. But 9.9 out of 10 they got it because they're in it every day. You know, they're in it every day. So to the doctor that's on the fence, I would say again, find your tribe, find people that are doing what you want to be doing. Study them, learn from them, talk with them, and know that if it's possible for them, it's possible for you to

Dr. Tea  33:09  

Where were you all my life, honestly. So grateful. I'm so grateful to have run into you and meet you and hear your story. It's a beautiful story.

Dr. Tarr  33:21  

Thank you. Thank you. And I'm so grateful for you, too. I honestly and I tell everybody this, I've told you this several times, but I would not be here. I wouldn't have I think I wouldn't have had the courage to do this the way I've done it if I hadn't come across you. So thank you for just being so open and an open book because you're paving the way I think especially for specialists for podiatrists that have been told that direct care isn't possible if you're not primary care if you're not family medicine, and if you're not internal medicine, you usual me and you show everybody that it is indeed possible. Yeah, you just have to kind of rework it a little bit here and there, but it is possible. It's doable. So think. 

Dr. Tea  34:05  

Well, thanks again, so much. I'm gonna leave all of Dr. Sondema Tarr has information in the section below. Click to support her and send people her way. She's an amazing doctor, as you can already tell she's very kind, and very thoughtful and highly intelligent. So thank you so much for being on the show today. I look forward to seeing where your growth takes you in the next year. And we might touch base again at your next anniversary. Congratulations on your direct care practice. I look forward to seeing what you've got for us.

Dr. Tea  34:38  

 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. Tea  34:57  

And lastly, if you remember nothing else Remember this be the energy you want to attract See you next time