Dr. Paul Thomas on the Soul of Enterprise Podcast

Dr. Paul Thomas on the Soul of Enterprise

In February 2022, Dr. Paul Thomas was featured in an episode of The Soul of Enterprise with Ron Baker and Ed Kless. In the episode we discuss all things Direct Primary Care! and they plug my book, Startup DPC:

Dr. Paul WROTE THE BOOK on Direct Primary Care. It’s called Startup DPC. Ron recommends this book because you can learn a lot from Dr. Paul’s experience. Here’s the Amazon link.

Here’s the full interview.

Dr. Paul Thomas is a family medicine physician who started Plum Health DPC in 2016, right out of residency. He is a board-certified Family Medicine Physician.

Direct Primary Care (DPC) is a model of primary care that is growing in popularity as an alternative to the traditional fee-for-service model. In a DPC practice, patients pay a monthly or annual membership fee for access to comprehensive primary care services. This fee typically covers all office visits and DPC practices offer at-cost medications, lab work, and imaging services to lower the cost of care for patients.

One of the benefits of DPC is that it allows for more time for the physician to spend with each patient. This is because DPC practices typically have fewer patients than traditional practices, which allows for more personalized care. Additionally, DPC patients often have direct access to their physician through phone or email, which can lead to quicker resolution of health concerns.

Another benefit of DPC is that it can help to lower healthcare costs for patients. By eliminating the need for insurance and reducing the number of unnecessary tests and procedures, DPC can save patients money in the long run.

Dr. Paul Thomas has been offering DPC services for the last 6 years and has seen positive results in the health of his patients. He believes that the DPC model allows for better continuity of care and a stronger physician-patient relationship, which leads to better health outcomes.

A big thanks to Ed Kless and Ron Baker for highlighting the work of Dr. Thomas and Plum Health DPC on The Soul of Enterprise!

-Paul Thomas MD with Startup DPC

Dr. Paul Thomas MD Featured on The Changed Physician

How I started Plum Health DPC - a recap with The Changed Physician

This is Episode 68 of The Changed Physician Podcast when hosts, Drs. Melissa Cady and Kevin Cuccaro, speak with direct primary care physician, Dr. Paul Thomas about how any new physician can successfully start and build a direct primary care practice.

Timeline:

• 01:00​ Why and how he started a DPC practice in 2016

• 03:40​ How he dealt with the fears of risk & recruited interest from patients

• 05:00​ The house call that changed everything

• 06:30​ Where he started his physical practice

• 10:00​ His first “doctor bag” (medications from Andameds)

• 10:50​ Setting up a business entity

• 13:45​ Medical malpractice

• 17:00​ How he acquired new equipment/resources

• 20:00​ How he adds value to his patient members

• 22:30​ Electronic Medical Records from beginning (e.g. Atlas, Hint & Elation, etc.)

• 24:30​ Typical overhead for direct primary care

• 25:40​ Leveraging moonlighting while building own practice

• 28:00​ Reasons not to go into your own direct primary care practice

• 29:30​ The “safer” route?

• 32:00​ How he marketed himself and grew his practice

• 35:30​ Pain now or pain later?

• 39:00​ Paul Thomas’ take on his own practice and work

You can learn more about Dr. Paul Thomas and his practice at: https://www.plumhealthdpc.com/

HOW CAN I LEARN MORE ABOUT STARTING A DIRECT PRIMARY CARE PRACTICE?

If you enjoyed reading this blog post and if you want to learn more about starting and growing your direct primary care practice, look no further than our book and our courses on how to start and grow your direct primary care practice. We at Startup DPC have begun compiling some of the best content available on this blog, in our book, and in our courses.

The best place to start is to take our Direct Primary Care Business Plan course, available here. From there, you can learn how to attract new patients to your direct primary care practice and how to find the perfect location or build out the practice of your dreams.

STARTUP DPC - DIRECT PRIMARY CARE MASTER CLASS

Because there are no in-person conferences this year, we decided to host an intimate gathering of Direct Primary Care doctors who are looking to start and grow their DPC practices. We did this last year, and it was a rousing success! Join our Direct Primary Care Master Class on May 14th through May 15th, 2021 at our Plum Health DPC office in Detroit, Michigan and kickstart your DPC journey!

Thanks for reading and watching, and best of luck in your direct primary care journey!

-Dr. Paul Thomas with Startup DPC

The First Direct Primary Care Doctor in Puerto Rico

Dr. Lorimar Ortiz is the First Direct Primary Care Doctor in Puerto Rico

Dr. Lorimar Ortiz is the First Direct Primary Care Doctor in Puerto Rico - yes you read that correctly! Her clinic is called The Way Family Clinic. She has launched recently, has gained a few members, and looks forward to growing into this model.

About Dr. Lorimar Ortiz (Spanish):

En respuesta al deterioro en la calidad del servicio de medicina primaria en Puerto Rico, fundé la primera clínica de Cuidado Primario Directo (DPC) en nuestra isla. En mi clínica recibirás un cuidado personalizado donde trabajaré en conjunto contigo para lograr tus metas de bienestar físico, emocional y familiar. Estaré accesible para ti a tu mayor conveniencia. Disfrutarás de citas sin espera, evaluaciones agendadas para el mismo día o al próximo, visitas extensas y relajadas, acceso vía llamada telefónica, texto, correo electrónico o vía mensajería a través de tu portal de paciente. Todo esto a un costo mensual asequible, similar a tener una membresía de Netflix o de un gimnasio.

About Dr. Lorimar Ortiz (English):

In response to the deterioration in the quality of the primary medicine service in Puerto Rico, I founded the first Direct Primary Care (DPC) clinic on our island. In my clinic you will receive personalized care where I will work together with you to achieve your goals of physical, emotional and family well-being. I will be accessible to you at your greatest convenience. You will enjoy appointments without waiting, evaluations scheduled for the same day or the next, extensive and relaxed visits, access via phone call, text, email or via messaging through your patient portal. All this at an affordable monthly cost, similar to having a Netflix or gym membership.

Dr. Lorimar Ortiz is the first Direct Primary Care doctor to start a practice in Puerto Rico. She started The Way Family Clinic.

HOW CAN I LEARN MORE ABOUT STARTING A DIRECT PRIMARY CARE PRACTICE?

If you enjoyed reading this blog post and if you want to learn more about starting and growing your direct primary care practice, look no further than our book and our courses on how to start and grow your direct primary care practice. We at Startup DPC have begun compiling some of the best content available on this blog, in our book, and in our courses.

The best place to start is to take our Direct Primary Care Business Plan course, available here. From there, you can learn how to attract new patients to your direct primary care practice and how to find the perfect location or build out the practice of your dreams.

Thanks for reading and watching, and best of luck in your direct primary care journey!

-Dr. Paul Thomas with Startup DPC

How this Family Physician Started a Direct Primary Care Practice Straight Out of Residency

How to Start a Direct Primary Care Practice Straight Out of Residency

Many doctors want to start a direct primary care practice straight out of residency. This is a difficult task, so many doctors become intimidated by the amount of work involved and subsequently settle for a job as an employed physician with a large hospital system.

But, it doesn’t have to be this way. There is a step-by-step approach available to doctors who want to start their own direct primary care practices. First, you need to write a business plan for your direct primary care practice. This is crucial so that you understand the numbers involved, like how much it’ll cost to get set up, how much it will cost each month to run your business, how many patients you’ll need, and the average amount of money each patient needs to spend for your business to be sustainable.

Once you have your business plan in hand, you can create a timeline for that business. You will start by laying out a 12-month or 9-month or 6-month road map where you execute all of the tasks that you’ll need to complete to have a successful and thriving direct primary care practice. The great news is that you can complete many of these steps while in residency.

As a resident you can:

• write a business plan

• start building relationships with specialists

• learn as many new skills as you can that will help you deliver excellent medical care for your future patients

• design a website or work with a web designer

• design a logo or work with a logo designer

• come up with your mission, vision, and values for your new clinic

• start developing relationships with vendors like lab vendors, whole-sale medication vendors, and imaging services vendors

• start looking for locations for your new clinic

Simply put, residency is a great time to plan and dream big for your future direct primary care practice because you can start working on it now. I write about this process extensively in my book, Startup DPC: How to Start and Grow Your Direct Primary Care Practice. In the book, I dedicate an entire chapter to what to do in Residency and how to do it, so you’re primed for success in the direct primary care model after graduation.

One of the biggest things you can do during residency is to set up your own elective rotation in direct primary care. I created a Direct Primary Care Elective Rotation Curriculum and I am happy to share it with you here - just drop me an email and I will send you my direct primary care elective rotation curriculum. Please include “Send me the Direct Primary Care Curriculum” in the message for the fastest response possible.

I also dedicate an entire chapter of the book to a detailed timeline of what to do over a 6 month to 12 month period, and how to leverage that time to build up to a successful and thriving direct primary care practice.

I’m writing about this today because I was recently featured on the Health Solutions podcast with Shawn Needham. It was a great conversation and we touch on these subjects in the interview!

HOW CAN I LEARN MORE ABOUT STARTING A DIRECT PRIMARY CARE PRACTICE?

If you enjoyed reading this blog post and if you want to learn more about starting and growing your direct primary care practice, look no further than our book and our courses on how to start and grow your direct primary care practice. We at Startup DPC have begun compiling some of the best content available on this blog, in our book, and in our courses.

The best place to start is to take our Direct Primary Care Business Plan course, available here. From there, you can learn how to attract new patients to your direct primary care practice and how to find the perfect location or build out the practice of your dreams.

Thanks for reading and watching, and best of luck in your direct primary care journey!

-Dr. Paul Thomas with Startup DPC

Can You Have a Successful Practice and See Five Patients Each Day?

Every day, primary care doctors are running from room to room, having less and less time to spend with their patients. That’s because our current system incentivizes doctors to see more and more patients in less and less time. Doctors lose out because they don’t have enough time to invest in the relationship with patients, and patients lose out because they don’t have enough time to get the excellent medical care that they deserve.

But what if there was a better way?

In this podcast episode hosted by Brent Lacey MD and the Scope of Practice, we explore what it looks like to start and grow a direct primary care practice. In this model, the relationship between doctor and patient is paramount. Therefore, there is a huge emphasis on creating enough time for doctor and patient to spend together, creating enough time and space for the delivery of excellent medical care.

Here’s what the Scope of Practice had to say about it:

Episode 20 – The Direct Primary Care (DPC) model is disrupting the marketplace of the modern healthcare industry.  It’s a good thing too, since the U.S. is projecting a massive shortage of physicians over the next 20 years.  Dr. Paul Thomas has become a national expert in the DPC model, having successfully built his own direct primary care practice over the last few years.

In this model, he sees 5-6 patients a day, makes a middle six-figure salary, and has tremendous patient satisfaction scores.  If that sounds too good to be true, it almost is.  Work less and make good money?  And it’s better for your patients?  And it saves them money too?  No, this is not a scam, this is a phenomenal business model!

Whether you’re interested in direct primary care or not, this episode has got some great information for you!  Dr. Thomas shares his incredible business savvy to help us learn how we can modify our own practice to make more money, have a better lifestyle, and yet still help our patients more!

“Direct primary care is ‘concierge medicine for everyone else.’  It’s a membership model for primary care that makes health care affordable for the average person.”

 – Dr. Paul Thomas

Contact Dr. Thomas:

• Instagram: @PlumHealthDPC https://www.instagram.com/plumhealthdpc/

• YouTube: https://www.youtube.com/plumhealthdpc

• Facebook: https://www.facebook.com/PlumHealthDPC/

• LinkedIn: https://www.linkedin.com/in/paulthomasmd

HOW CAN I LEARN MORE ABOUT STARTING A DIRECT PRIMARY CARE PRACTICE?

If you enjoyed reading this blog post and if you want to learn more about starting and growing your direct primary care practice, look no further than our book and our courses on how to start and grow your direct primary care practice. We at Startup DPC have begun compiling some of the best content available on this blog, in our book, and in our courses.

The best place to start is to take our Direct Primary Care Business Plan course, available here. From there, you can learn how to attract new patients to your direct primary care practice and how to find the perfect location or build out the practice of your dreams.

Thanks for reading and watching, and best of luck in your direct primary care journey!

-Dr. Paul Thomas with Startup DPC

Paul Thomas MD and Startup DPC Featured on Physician Estate

This week, Paul Thomas MD and Startup DPC was featured on Physician Estate. Here’s the full interview:

Direct Primary Care vs Traditional Fee-for-Service Medicine

Direct Primary Care Practice vs. Traditional Fee-for-Service. We wanted to know more about DPC practice and how it is different from fee-for-service from the perspective of an experienced DPC doctor. We were lucky enough to have a Q&A interview with Dr. Paul Thomas of Plum Health DPC. Dr. Paul Thomas is a board-certified family medicine physician practicing in Corktown Detroit. His practice is Plum Health DPC, a Direct Primary Care service that is the first of its kind in Detroit and Wayne County.

In this Q&A blog post interview, he will share about his practice, challenges and milestones in his journey, and tips for physicians who are planning to start their own DPC practice. Are you a physician interested in starting your own DPC practice? This blog post might be helpful for you!

On Background

1. Please tell us a bit about your personal story, growing up, and medical training.

• I started volunteering in Detroit for homeless and uninsured folks in 2017. I really love taking care of people, but the further and further I got into my training, the less and less time I spend with my patients. Until I get to the end of my residency, I’m spending 10 or 15 minute per patient, and spending a lot more time charting, writing things in the medical record. I thought this was really unsustainable, I felt burned out–I didn’t want to do that anymore. 

• So I wrote a business plan in the last year of my residency, and I launched my practice, Plum Health DPC. And 4 years later, I’ve been doing really well with the practice–we’ve grown, we’ve hired 2 more doctors and we had a second location. 

2. What made you develop interest in Direct Primary Care? Motivating factors? Did you pursue any formal education/training that focuses on Direct Primary Care? If so, what was it?

• I developed an interest in Direct Primary Care because I felt like it was the only way out of a dysfunctional, industrial complex. I didn’t have any formal training in this, I wrote a business plan, I worked with a friend who started a suit company, of all things to write a business plan.

• I went on a road trip, visited a few mentors across the country who helped me formulate my plans and refine my business plan and make it so that I could develop a thriving practice here in Detroit, Michigan.

About Plum Health – A Direct Primary Care Platform

3. What is Plum Health? As a platform that specializes in Direct Primary Care practice, what is its unique value proposition? Tell us the story behind its creation. 

• In Plum Health, we believe that healthcare should be affordable and accessible for everyone, so we really do our best to lower the cost in Detroit and beyond. We contract with a local imaging vendor, a medication wholesale supplier, etc. to lower the costs of all those things. 

• So if you come in for a lab draw, you might get a TSH for $6, that’s what it costs here. But if you go to a hospital, it might cost you $125. So we really try to reduce the cost of healthcare for people. 

• Our unique value proposition is that we have time for our patients. Because our patients pay a monthly membership to be a part of our practice, we have this nice recurring revenue from our patients. We then get to spend more time with them as an individual–we have 1-hour appointments, and we can really listen to them and take care of them and all their concerns.  

4. Generally, how do you help educate physicians in the US who are interested in starting their own Direct Primary Care practice? Do you provide any services, courses, coaching, etc?

• I’m so glad you asked this. I’ve written 2 books about this. The first is called Direct Primary Care–it focuses on how Direct Primary Care serves people in the greater healthcare ecosystem, how you can lower the cost of healthcare for everyone (medications, labs, imaging, etc.) We also discuss how we’ve done this in an equitable and sustainable way in our hometown of Detroit, Michigan. 

• For the book How to Start Your Direct Primary Care Practice, we’ve had so much success here in Detroit. Because I’ve been a speaker at the American Academy of Family Physicians Direct Primary Care Conference and the Nuts and Bolts Conference in Florida, I’ve had a lot of people reach out to me and asked how we were successful, how we did this. To answer that, I wrote a book–it’s called Start Up DPC, how to start and grow your Direct Primary Care practice. I wrote in step-by-step how to start your Direct Primary Care practice. I’ve got a ton of great feedback on this book! We’ve had a lot of people reach out and say how impactful the book has been for them, and we’ve helped other doctors launch their own practices.

• I’ve been doing consulting throughout this, so people pay me some money each hour that I consult with them, and I’ve also taken everything I’ve learned and put it into some courses on my website https://startupdpc.com. I really walk doctors step-by-step through how to start and grow their practices, and I go beyond just the words, I show you how to do it physically. I show you how to do it online and how to leverage your Facebook page and other social media channels to grow your business etc.

Challenges and Milestones in Starting A Direct Primary Care Practice

5. What are some of the mistakes you made when you were still starting out with your Direct Primary Care practice? If you had to redo the whole journey, what would you do differently?

• The biggest mistake was I was thinking too small, I should have hired a medical assistant sooner. I thought I could do everything by myself, and I could–I could draw blood, count all the lab samples and the meds, I can answer all the phone calls, and I did that for about 450 patients, and I hired a medical assistant. And as soon as I did that, it freed up so much of my time to market the practice and help me grow my business.

• So if I had to redo the whole journey, I would have hired someone sooner. As a business owner you want to control everything, but sometimes you have to delegate and relinquish that control so you can focus on your strengths to help you grow your business. 

6. Share a few very milestones you achieved in your Direct Primary Care journey.

• One of those big milestones was hiring a medical assistant, another doctor to help me lower the cost of healthcare in Detroit. I’m very happy to share it with my partner who is Dr. Raquel Orlich.

• Another milestone for me is getting to 500 patients, and 200 patients for Dr. Raquel, and now she’s over 250 patients. These are the milestones that we celebrate because we’re actively learning the cost for healthcare in our community, we’re helping patients, we’re liberating doctors from the dysfunctional fee-for-service medical industrial complex system. 

7. How do you see Direct Primary Care evolving over the next 5-10 years? How does the political climate and ever so polar political opinions affect the evolution of DPC? 

• I only see Direct Primary Care growing over time because people hate having to deal with their insurance for their basic healthcare needs. It puts up so many barriers between people and our doctors. Direct Primary Care doctors are problem solvers. We go above and beyond to solve problems for our patients and make our healthcare journey easier. So when you have doctors actively working on behalf of patients, it’s only going to grow because patients see value in that kind of work that doctors provide. 

• As for the political climate, or let’s say medicare for all passes, which does not apply for Donald Trump, or presidential candidate Joe Biden at this time, neither of these political parties want to see medicare for all at this point. But let’s say even if it does pass 20 years from now, the United States government will not be able to outlaw elective procedures. Americans will always be able to opt for paying above and beyond for health insurance, etc. 

• In a nutshell, I don’t foresee paying above and beyond your health insurance for better healthcare experiences through Direct Primary Care or concierge medicine. I don’t ever see that being outlawed in the US.

Direct Primary Care vs. Traditional Fee-for-Service

*This section is for patients and doctors that are not yet aware of DPC

8. In a nutshell, what do you think is the major difference of Direct Primary Care practice vs. Traditional fee-for service? 

• The number of patients. Fee-for-service doctors have 2,500 patients a year, and they have to see 1% of their panel each day. So they have to see at least 25 patient visits a day. In our model, we only need 500 patients to have a robust, thriving practice. We make about the same amount of money as a fee-for-service doctor. 

• That being said, I have 5 times fewer patients and 5 times more time for each of those patients. It makes a huge difference.  

9. Why should a patient consider enrolling in a Direct Primary Care practice over the traditional fee-for-service?

• You are going to have 5 times more time with your doctor, you’re going to have your doctor’s mobile number and email address, you’re going to be able to reach out to them whenever you need them and not the other way around. 

• We’re not fitting you into our schedule, we’re making time for you anytime you need us. 

10. If you are explaining about Direct Primary Care to a layman who doesn’t have a medical background, what would be your 2-minute explanation to make him/her understand Direct Primary Care practice?

• We really believe that healthcare should be affordable and accessible for everyone. You should sign up for Direct Primary Care practice if you want to have your doctor’s mobile number and text them anytime you need them. Basically if you want to have a better healthcare experience. 

• My patients have my undivided attention for 20-30 minutes to an hour if they need it. I help them with their medications, etc. We take care of everything. If you want that kind of service for yourself and for your family, we’re happy to help you. We do that to all our patients, we deliver high quality, high value services. 

Favorites

11. Favorite book that talks about Direct Primary Care; and favorite book in general about any topic

• My favorites are the 2 books that I’ve written. Startup DPC and Direct Primary Care: The Cure for Our Broken Healthcare System are available on Amazon. Pick those up, you’ll really understand my ethos, and the ethos of the Direct Primary Care movement. People have a lot of great things to say about them. 

• My favorite book in general about business is Crush It by Gary Vander Truck. If you want to know how to market your business, your Direct Primary Care practice, you can learn a lot from reading Gary V. 

12. As someone who is an advocate of Direct Primary Care practice, what are your favorite resources for Direct Primary Care?

• I would say my website https://startupdpc.com. I really took the time to compile all the resources in the ecosystem and give it to you in a palpable, easy-to-understand, easy-to-digest format. 

13. Favorite bloggers that have the same passion as you when it comes to Direct Primary Care

• I blog a lot about this subject, I haven’t seen anyone “out blog” me, so check out our blog at https://startupdpc.com/blog. See for yourself.  

14. Favorite quote

• “It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better.” –Theodore Roosevelt

Tips for Physicians Who Are Planning to Start Their Own Direct Primary Care Practice

15. Many physicians find it challenging to start their own Direct Primary Care practice. As someone who’s been in the Direct Primary Care business for quite some time now, what do you think physicians should first do when they are starting out? Any tips and/or strategies you highly recommend?

• I really recommend you read my books because I put them all in there. 

• My biggest tip is that doctors think that when they start their Direct Primary Care practice, it’s for everyone. You ask them who’s your ideal customer and they say “everybody”. But it’s not true. You really have to hammer down and hone in on who your ideal customer is. If you don’t, you’re going to try to serve everyone, and your business is going to fail.

Paul Thomas MD has written two books on Direct Primary Care - both can be found on Amazon, here: Startup DPC and Direct Primary Care.

When Starting a DPC Practice, You must be decisive

It’s not the decisions, it’s the decisiveness

When starting your direct primary care practice, it’s not the decisions, it’s the decisiveness. Make a decision and move on! Listen to my most recent podcast interview, here:

• Apple Podcast: https://podcasts.apple.com/us/podcast/tsoe-excerpt-dr-paul-thomas-on-decisiveness-in-business/id668653849?i=1000480912133

• Google Play: https://play.google.com/music/m/D3duco2lboja2abqjihb6kgmnce

• YouTube: https://www.youtube.com/watch?v=gmuh6XnX_b0

• Stitcher: https://app.stitcher.com/splayer/f/87139/74080652

• iHeartRadio: https://www.iheart.com/podcast/263-sage-advice-podcast-27588757/episode/tsoe-excerpt-dr-paul-thomas-65958260/

• Spotify: https://open.spotify.com/episode/4c2maI8p2wk0A5HXsai68L

• SoundCloud: https://soundcloud.com/sagena-47293133/tsoe-excerpt-dr-paul-thomas-1

• PlayerFM: https://player.fm/series/sage-advice-podcast/tsoe-excerpt-dr-paul-thomas-on-decisiveness-in-business

• Castbox: https://castbox.fm/episode/TSOE-Excerpt---Dr.-Paul-Thomas-on-decisiveness-in-business-id107073-id281653209

• Direct download: https://traffic.libsyn.com/secure/sagena/TSOE_-_Paul_Thomas_on_Decisiveness_in_business.mp3

• Permalink: http://sageadvicepodcast.com/tsoe-thomas

Dr. Paul Thomas on Primary Care Cures with Ron Barshop

Recently I was interviewed by Ron Barshop on his podcast, Primary Care Cures. Here’s what he wrote about the show:

In this episode Ron gets the chance to chat again with Direct Primary Care expert, Dr. Paul Thomas of Plum Health DPC. In this episode he talks about how we went directly into primary care out of college and what his work week looks like, including blogging and youtubing the DPC message. He stressed the importance of relationships with small businesses and reaching the public via social media. Paul touches on how he has been successful in growing his business without brokers so far. He discusses what it takes start a DPC practice, the importance of a good name, creating a SEO course for DPC docs. He addresses Fears physicians have about going into DPC. Here Paul also shares his thoughts around end of life care and end of life care planning.

Paul is a board-certified family medicine physician practicing in Southwest Detroit. His practice is Plum Health DPC, a Direct Primary Care service that is the first of its kind in Detroit and Wayne County. His mission is to deliver affordable, accessible health care services in Detroit and beyond. He has been featured on WDIV-TV Channel 4, WXYZ Channel 7, Crain’s Detroit Business and CBS Radio. He has been a speaker at TEDxDetroit. He is a graduate of Wayne State University School of Medicine and now a Clinical Assistant Professor. Finally, he is an author of the book Direct Primary Care: The Cure for Our Broken Healthcare System.

Listen to the full interview here.

Here’s an excerpt from the interview (below) and the full transcript is here.

How I decided to start my direct primary care practice

Yeah. Well, in my last year of medical school, I actually heard Josh [inaudible 00:04:50] on a podcast and I kind of filed that idea in the back of my brain because I thought I was going to be a professor at a teaching hospital and seeing patients and working with the residents and students, but the deeper and deeper I got into my residency, the less and less time I had with my patients. And I found myself really unsatisfied in the level of care I was able to deliver to my patients simply because I didn't have enough time. Page 3 of 13 And then I got to see Clint Flanagan, Dr. Clint Flanagan of NextEra in Michigan. He was speaking in a conference in Michigan. And so, I talked to both of these physicians and I asked if I could visit their practices. And so in my last year of residency, I wrote a curriculum, a direct primary care curriculum, and I drove out to these two practices and I took the best of their ideas and I brought it back to my hometown in Detroit. And that's where I started Plum Health. And that's three years later from that moment, I'm full with 500 patients and I've brought on a second doctor to help me meet the additional demand.

What’s a Typical Day Like for a Direct Primary Care Doctor

Well, typically most busy on Mondays and Fridays and I'll typically see about five to eight patients each day. Typically, one hour for new patients and 30 minutes for followups. I'll do a lot of texting and phone calls with my patients. I typically field about 20 to 30 text messages each day and just answering some simple questions or coordinating appointments or texting my patients and asking them, "Hey, I saw you on Wednesday with a runny nose and cough. How are you feeling today now that it's four or five days later?" So, that's a workflow that I have and I'm typically in my office 9:00 AM to 5:00 PM.

The other part of it is like on a weekly basis, I'm working on blog posts. I write a blog post and shoot a short YouTube video and post that onto my blog. And then on a weekly basis, I reach out to a small business in my community and ask them, "Would you like to enroll your people into our membership model?" And so, there's different hats that I wear. I'm of course always checking the finances of the business and making sure that our profit and loss statement is lining up each month. So, there's other things beyond patient care and I just fit those between my patient visits so that my business remains healthy as well.

Paul Thomas interviewed by Ron Barshop on Primary Care Cures. See the original post, here.

How do you attract new patients to your Direct Primary Care Practice?

Yeah, I think it's important to develop relationships with small businesses because I really believe that if you're a small business and you're not offering some sort of health care benefit, you would be doing your employees a great service by offering something like this, even if you can't afford health insurance. This is something where offering like direct primary care can help employees maintain a good level of health and have something where they can actually access a physician and have guidance through their illnesses and injuries. And then, I'm also really focusing on social media and reaching the general public. That's where 90% of my members are coming from. So, I try to strike a balance of landing some larger groups, some larger customers, and also maintaining an outreach to individuals.

As for employer groups, I mostly am focusing on those employer groups that are fewer than 50 full time equivalent because those are the folks that aren't mandated to provide health insurance for their employees and they often end up in this messy middle where they're not doing anything because they don't know what's out there.

How Do I Start a Direct Primary Care Practice?

Well, I actually get this question so much that I decided to put all of my knowledge into a website that I recently created and it's in a soft launch right now. It's called startupdpc.com. And folks can go through and read how to, how to start a direct primary care practice. There's a long form blog post that I put there where you can read through, okay, do I have the right mentality to start this? Am I willing to give up the paycheck? Do how to come up with a great name for my practice? How to develop a website? How to build out social media channels? And that kind of gives you a broad overview of if this is something that you want to tackle on your own or with a partner or with some help. And then, I take it one step further and I take a really deep dive into individual topics. And I put together some courses that people can take to really cement their knowledge and become proficient in the skills that you need to become a great direct primary care physician with a thriving successful practice.

A lot of people in medicine have no business experience. And one of the things I often tell people is business is relationships. So as a primary care doctor, we are the most friendly, outgoing doctors that there are. And so how do you cultivate good relationships with people in your community, with small business owners, to create a practice that works for you and works well for your patients?

HOW CAN I LEARN MORE ABOUT STARTING A DIRECT PRIMARY CARE Practice?

If you enjoyed reading this blog post and if you want to learn more about starting and growing your direct primary care practice, look no further than our courses on how to start and grow your direct primary care practice. We at Startup DPC have begun compiling some of the best content available on this blog and in our courses.

The best place to start is to take our Direct Primary Care Business Plan course, available here. From there, you can learn how to attract new patients to your direct primary care practice and how to find the perfect location or build out the practice of your dreams.

Thanks for reading and watching, and best of luck in your direct primary care journey!

- Dr. Paul Thomas with Startup DPC

Startup DPC Show Episode 9: This Primary Care Doctor Charges $35 Per Visit

This week, I get to talk with Dr. Timothy Wong of iHealth in Pittsburgh, Pennsylvania. Dr. Wong is obviously a smart physician and he’s also a smart business person. To be successful in the Direct Primary Care model, it helps to be great at what you’re trained in, medicine, and it’s essential to learn new skills that will help you succeed in creating a thriving business as well.

I really enjoyed my conversation with Dr. Wong because this Episode of the Startup DPC show is full of excellent advice and great tips to help you start and grow your Direct Primary Care practice.

What is the Direct Access Primary Care model?

The Direct Access Primary Care (DAPC) model is something that Dr. Wong has built upon. He states that it’s similar to direct primary care, but the DAPC model is not membership based. Instead, patients pay $35 per visit, plus additional costs depending on which types of services they require. In Dr. Wong’s DAPC model, he doesn’t bill or use insurance for the visits and he keeps a very low overhead. He leverages technology like his EMR as well as Google Forms to collect vital information on his patients quickly and efficiently.

How Did You Market Your Direct Primary Care Practice?

Personal Branding, Business Branding, Marketing, and Public Relations can be foreign topics for a lot of physicians. This was also the case for Dr. Wong as he didn’t have any formal training in these areas. However, that did not stop him from taking a tremendous step towards making his name known in the community and beyond his community.

I reached out to Dr. Wong for this episode because I saw his profile on LinkedIn and I recognized him from the recent NPR article about his practice. He had this to say about his experience in engaging with the local media, also known as public relations:

“Media kind of snowballs. Once you get one thing, a lot of reporters are actually looking for stories - we don’t realize that, but they’re actually looking for stories. And, if you have an interesting story, they’re going to reach out to you. But, you have to get that initial momentum going”

So how do you get that momentum going? Dr. Wong recommends cold emailing journalists and talking up his practice. He was first interviewed by a local newspaper, and then it snowballed into the local NPR affiliate, and then NPR and other national media outlets.

As long as you have an interesting story that could touch a lot of people and help a lot of people, the story starts to speak for itself.

In journalist parlance, that “interesting story”is also known as a peg, or the reason for writing the story in the first place. As Direct Primary Care doctors starting new clinics and hiring new doctors, we have a very clear peg.

The Importance of Sending the Email

Dr. Timothy Wong talks about sending dozens of emails to journalists, but only getting one story. But the difference between no stories and that one store (that may start a snowball of additional stories) is tremendous. If you have no stories, you have a limited stream of new customers. If you have just one story, that then snowballs into additional stories, you may open a floodgate of new patients, new enrollments, and new customers for your business.

That’s why it’s important to send the email, to reach out to the journalist, to tell your story so that your clinic is featured. You’re doing great work that’s changing lives and changing the community, and the world needs to know about it! So, send the damn email.

Business Logistics at iHealth in Pittsburgh

Timothy Wong MD of iHealth in Pittsburgh Pennsylvania talks with Dr. Paul Thomas of Startup DPC about how he’s starting and growing his direct primary care practice.

Dr. Wong uses Athena Health for his electronic medical record. He pays a percentage of his revenue to AthenaHealth, about 6.4% of revenue, but that includes all merchant fees on credit cards. He uses Google Forms to collect patient information up front for his new patients. This helps him prep charts quickly and efficiently.

As for growth, Dr. Wong would like to get up to 20 to 30 patients each day, or a higher volume for his practice. He’s enjoying the practice and feels less burned out. His patients enjoy the service, especially those uninsured patients in his community and those with high out-of-pocket costs. He’s also looking at how he could grow his practice, either by franchising or consulting or by creating an open source platform that other people can replicate.

Dr. Wong is also looking at creating an application that can be a plug and play option for doctors looking to start this Direct Access Primary Care model.

HOW CAN I LEARN MORE ABOUT STARTING A DIRECT PRIMARY CARE Practice?

If you want to learn more about starting and growing your direct primary care practice, look no further than our courses on how to start and grow your direct primary care practice. We at Startup DPC have begun compiling some of the best content available on this blog and in our courses.

The best place to start is to take our Direct Primary Care Business Plan course, available here. From there, you can learn how to attract new patients to your direct primary care practice and how to find the perfect location or build out the practice of your dreams.

Thanks for reading and watching, and best of luck in your direct primary care journey!

- Dr. Paul Thomas with Startup DPC

Startup DPC Show Episode 6: Interview with Harvard-Trained DPC Pediatrician

Harvard-Trained Pediatrician Starts Her Direct Primary Care Practice in Dallas Texas

Welcome to Episode 6 of the Startup DPC Show, and in this episode we have the pleasure of speaking with Tonya McDonald, MD. Dr. McDonald is a Pediatrician and the founder of Radiance Pediatrics in Dallas, Texas. Dr. McDonald trained at Harvard Medical School, graduating in 1998 and she completed her Pediatrics Residency at Baylor College of Medicine.

Dr. McDonald is a Pediatrician and the founder of Radiance Pediatrics in Dallas, Texas. Dr. McDonald trained at Harvard Medical School, graduating in 1998 and she completed her Pediatrics Residency at Baylor College of Medicine. She is the featured Direct Primary Care doctor for our Startup DPC Show, Episode 6.

Dr. McDonald was recently interviewed by Harvard Medical School’s Magazine in a section called The New Black Bag. Here’s a segment of the interview:

This past spring, she opened Radiance Pediatrics, a direct primary care practice that provides in-home and virtual pediatric care to families who pay a flat monthly fee. For this fee, families get extended visits, same- or next-day appointments, telemedicine visits, and direct access to McDonald through phone, text, and email.

“In some ways, this is a throwback, an old-school approach to medicine,” she admits. “But it gives me the opportunity to help rebuild the doctor-patient relationship. It’s a gift to be able to truly bond with families.”

Not long ago, McDonald was part of the 78 percent of U.S. physicians struggling to cope with burnout, a problem some have labeled a public health crisis.

“In the past five years, I was seeing up to thirty children a day, feeling sad that I couldn’t practice medicine the way I wanted,” McDonald says. “Insurance dictated what I could do.”

McDonald knew it was time for a change. And she’s far from alone.

As shown in the interview from HMS above, Dr. McDonald is a quintessential physician on the front lines of the healthcare system, dealing with a packed schedule and not having enough time to fully take care of patients. I also love that she says that she now has the opportunity to rebuild the doctor-patient relationship - I put that in bold for emphasis. Now that we have some context, let’s jump into the interview!

Dr. McDonald’s Startup DPC Story

Dr. McDonald had heard about direct primary care ten years ago, but put it in the back of her mind. Three years ago, while working for Children’s Hospital of Dallas, she got tired of seeing 24, 25, or 30 high-risk pediatric patients each day. This was especially difficult when she was taking care of high-risk, high-needs children with complicated medical problems and adverse social determinants of health. Having only 10 minutes for these patients didn’t work for Dr. McDonald.

The final straw was when her pediatric group was “restructured” to an even higher volume practice with multiple physician extenders in the group. She was laid off, took a severance package, and started planning her transition into direct primary care.

Caring for an underserved community with Direct primary care

Dr. Tonya McDonald is serving pediatric patients and families on the south side of Dallas. Dr. McDonald states that there’s a lot of money in Dallas, but most of that wealth is concentrated in Downtown or on the North Side of the city. She goes on to say that the south side of Dallas has a majority minority population - about 40% African American and 30% Hispanic. The median income in the community is roughly $55,000 each year. She alludes to the historical context of living in the south with restrictive housing covenants, which accounts for income inequality and segregation in this area. Dr. McDonald wants to serve in this type of community because she’s a black, female Pediatrician and she enjoys taking care of people in this population. She also alludes to making an impact by being a role model for kids who may not be able to see a black pediatrician, and she also discusses how it’s empowering to serve in a medically underserved community.

Photo of Dr. Tonya McDonald making a house call, courtesy of Harvard Medical School’s a New Black Bag series.

How Direct Primary Care can Address Health Disparities

Dr. Tonya McDonald discusses how some people hear about a “members only” clinic and think that it’s exclusively for the rich. On the contrary, she takes care of folks who are truly in the middle - these are the folks that make too much to qualify for Medicaid or Children’s Health Insurance Program (CHIP) but they don’t make enough to afford private insurance. These patients are willing to save up and cash pay for their healthcare services, but they didn’t have access to affordable options. Now that Dr. McDonald is in the market, these families now have that option to save up and cash pay for an affordable, accessible pediatrician. These families understand the value of direct primary care and the cost savings therein.

How much does a pediatrics direct primary care membership cost?

For Dr. Tonya McDonald and her Radiance Pediatrics practice in Dallas, she charges a monthly membership that costs $125 per month for children from birth to 2 years of age, $100 per month for children 2 years of age to 15 years of age, and $75 per month for adolescents and young adults from 16 to 26 years of age. She also has some discounts available.

Membership Fees:

One Time Enrollment Fee: $100 Per Child

Introductory Monthly Fee For First 25 Families:

0-2 Years - $125

2-15 Years - $100

16-26 Years - $75

Discounts Available: 3 Or More Enrolled Children; Foster Care Children; Full Annual Payment; In-State College Student

Knowing the market when setting your prices

Dr. Tonya McDonald took a look around at the different healthcare costs in the marketplace, namely the costs for home births, doulas, midwives, and similar services. She notes that families in her community were often paying $5,000 to $12,000 for 9 months of care from a midwife and $2,000 to $3,000 for perinatal care from a doula. In that context, paying $100 each month for high-quality, evidence-based pediatric care is not that much money.

“People who value you will pay you what you’re worth.” - Dr. Tonya McDonald

Dr. McDonald also talks about folks in her community who pay $125 for lash extensions plus $75 every 2 to 3 weeks for maintenance of her lashes. In that context, paying $100 each month for high-quality, evidence-based pediatric care is not that much money. She goes on to say that “People who value you will pay you what you’re worth. And those who don’t want to pay you what you’re worth probably wouldn’t pay you consistently for the long term, even if you were half the price because they just don’t value you.”

What are the monthly expenses like for a house call only Pediatric Practice?

Dr. Tonya McDonald works out of a co-working space and she’s surrounded by other entrepreneurs. These folks are smart risk-takers, they’re all about new ideas, and they help her to become a better business person. By renting space at a co-working space, she doesn’t have to use her home address as her business address. She also has storage space for her supplies as a part of her rent, which is $300 per month.

She bought a separate car via her business because it’s easier and cheaper to maintain with commercial insurance. Buying this relatively inexpensive car helps to build credit for her business as well. She buys a lot of her supplies via Henry Schein and Amazon, and she even splits supplies with other local pediatricians. This helps to keep her overhead low.

They are not able to dispense medications in Texas, because it’s not legal for physicians to dispense medications in Texas. This is one of the rare exceptions in the DPC landscape, as virtually every other state in the US allows for physicians to dispense medications from their offices, but not Texas.

Malpractice Insurance is $71 monthly for claims-made coverage. She shopped around and looked at 4 different carriers and also negotiated. She states that as a DPC practice, you have a lower volume, you don’t have 2,000 or more patients, so you should be paying a lower malpractice insurance rate. She expects her malpractice insurance to max out at $300 per month.

What do you do for Pediatric Vaccines in your direct primary care practice?

Dr. McDonald has partnered with some pediatricians in town to purchase single vaccines from their bulk stock. She has a PedsPal account, so she knows how many vaccines she’ll need for the year, and she keeps a log of what she uses and pays the pediatrician for these vaccines. She then bills her patients directly for the vaccine cost, at cost. If her patients are uninsured, she directs them to the county health department for their pediatric vaccines, which are $5 per shot. Finally, children over 7 can get their shots directly from the pharmacy, covered by the insurance with no copays, so she directs families to this option as well. For a few of her patients, she can give the vaccine and bill through VaxCare, which bills the patient’s insurance for the vaccine.

Thank you for reading! To watch the full conversation, see our YouTube video below.

Resources for starting and growing a direct primary care practice

If you’re interested in learning more about starting and growing your direct primary care practice, head over to our courses where you can learn how to attract more patients to your practice, write the perfect business plan, or find the perfect space for your growing DPC practice.

Sincerely, Dr. Paul Thomas