 So, Kelly, can you please give a quick elevator pitch about what it is that you do? Sure. We are privately owned dark primary care practice called Smarted Pants Medicine, and we provide concierge style medical care through telehealth and health services for adults who want quick and convenient healthcare so they can get their medical needs taken care of and get back to enjoying their life. These are people who are thinking outside the box, they're willing to get healthcare in a different way. They're willing to think a little bit creatively. They want private, you know, private healthcare. And so it kind of attracts a really certain type of person that's great to work with. That's not really the goal. The goal is to practice medicine at a high quality on my terms and to be present with my family. But this is the problem with the system that we're all a part of is that access to care, we're not hitting the mark. And so, and who's getting negatively impacted? The patients are getting negatively impacted. Their outcomes are negatively impacted. Because when you think concierge medicine, you think rich people, you don't afford to pay however much for better access, you know, same-day appointments, whatever they need. But you're kind of like allowing that same access to folks who are not necessarily like rich people. They're working for whatever reason. They're kind of falling through the cracks of the system. Because I'm not burned out anymore and I love what I'm doing and the segment of the population I'm interacting with, you know, goes from multi-millionaires down to people who are, you know, barely putting food on the table. Do you pull up to like a trailer park and then it's like an episode of Hoarders and there's like nine cats that run out. There's rats everywhere. Yep. Like, do you ever feel scared going to people's houses? Actually, I went and saw a patient this morning just reducing, I mean, reducing the ER visits when we did a toroidal injection kept somebody out of the ER, you know, so it's pretty, it's been pretty fun. Good morning, guys. My name is Boris. I'm a board certified physician assistant. Welcome to my channel. If you're new here today, I am very, very honored and privileged to have with me Kelly Vada or Bota? Vada, yeah. Kelly Vada, she's a physician assistant certified. She's actually doing something called direct patient care, which is kind of like a concierge medicine sort of a deal. And she's going to tell you all about it. Kelly, welcome to the channel. Thank you so much for doing the interview. Thanks so much for having me. I'm really excited to talk to you about direct primary care. It's going to be great. Absolutely. I can't wait to teach people about this because like me, before I found your Instagram, I had no idea that this was a thing. So I'm definitely excited about telling all the followers and all the people out there about this question. Oh, I'm sorry. Go ahead. I'm just going to say thanks for having me. I'm excited. Absolutely. Can't wait. So the first thing actually that I just brought to mind, as I said, you know, Kelly Vada, PAC, you've been practicing for over 10 years. I've only been practicing for about one year. And every time I see, you know, PAC behind my name or people say that, it still has not gotten old. Can I just ask you after a decade of practice, does it ever get old, you know, having that seed? The seed, no, I think this is important. You know, you can teach without it, but you can't practice without it. So we work really hard to get certified, you know, getting through PA school is very difficult. It's very, very competitive. As you know, it's been on the top list of in the top three jobs for quite many years and it is continuing to rise. It's a very competitive industry. I think as PAs, we have a huge opportunity to impact our health care system in a positive way. There's a big gap, especially in primary care, as you and I both know, since we're in there, there's a huge need. And so, yeah, it's a good time to be a PA. Definitely is a good time to be a PA. And I mean, with no understatement and not being hyperbolic at all, I think out of all the PAs that I've met and it's been a few hundred by now of all those people, I think the person making the biggest impact overall as a PA would be Kelly. Oh, no hyperbole whatsoever. She is definitely doing something so unique, making such a big difference, being such a trailblazer as you're going to find out from the rest of the interview. So I really hope that you set aside a couple hours and watch this whole thing because this is going to be a big one, guys. This is going to be so eyeopening for the guys. All right, let's do it. And what is your hard cut off time? When should I start like moving this towards a conclusion? It doesn't really matter. My parents are here for my kiddos. So probably an hour. People will be bored of me by then. So they will absolutely not. Our of us talking is probably like 20 minutes of us actually like on video on 2X. So like it'll maybe be like 30 minutes, you know? Yeah, because people are definitely going to listen to this on 2X. I talk so fast. There's no way I listen to your last one on 2X. Which one? I'm the one with the she did like pathology. Yeah, Shauna. Yeah. You listen to the whole thing. I didn't even know that was like a whole industry, right? Yeah, that was really interesting. Yeah, besides her, there's just like random little like niche like mid level careers that I never even knew about. The perfusionist, have you heard about that? No, I'm interested in like our PAs. I just met a local rad PA and I was like, oh, what's that? That sounds fun. Yeah, he does like all the procedures with the radiology team. Like he's just like a piece of radiology. PAs, all he does like fluoro and that kind of stuff. So yeah, I'm out of a soccer game. So I want to I want to talk to him more about what he does. But I didn't know that we were even in that in that space. On the channel. Crazy. But I have a question. What are you doing? What do you do? What's your background? So I'm a primary care PA. OK, that's what I thought. OK, do you do a lot with like, do you do more with like weight stuff or pain, or is that just some of your patient stories that I was looking through? So definitely not pain. We like specifically try to steer clear of pain management. OK, an abundant amount of reasons. But we do weight loss also like medically supervised weight loss. So that is one of your things. OK. Yeah, we try to be a little bit more holistic. So we try to like get weight off of people and then end up seeing them less and putting them on less meds than, you know, just like treating blood pressure, sugar and what we try to be holistic. Yeah, I might be interested in a conversation outside of that, because obviously there's a huge need for that. We have one clinic here in town that does it. They have like all these crazy biometric stuff that I'm not going to do. But just wondering like what your approach is. I was talking to the. I tried to get in contact with the American Board of obesity medicine, I think, and see if I could get a certification through them and they were like, no, PAs can't have that as positions only. So there's like a one credit course we can do through the APA. And I'm like, that's not really the same street cred, you know. Yeah, that's the point. Yeah, so I'd be interested to hear what you guys are doing just for real life. But we'll do that later. Oh, I mean, like, what are your questions? Like, what meds do you guys heavily lean on? Are you doing a lot of the GLP one, GLP ones? And do you have like a dietician that you refer to? Or do you guys just do like basic dietary coaching? Are you doing like macros and how far down do you guys drill in? Yeah, so we have Marie is a weight loss coach. And she used to be a diabetic educator and we lean hard on the data, which says basically low carb, high protein, meal replacement. Basically the same diet coaching that you'd give a diabetic patient is almost the same that these weight loss. Yeah. Right. And so she's very experienced doing that. So we do some of the basic nutrition. We don't have an actual nutritionist on staff, but she's you know, close enough, retired RN, a diabetic educator. And then, of course, me, like in the bodybuilding community, I lose path for fun, right? So I know what I'm doing. Yeah. So just basic diet coaching. We do GLP ones if they are diabetic. OK, covered. And then like sex and does covered would go via is nowhere to be found. So we try, but found for me and will be trend kind of stuff. We do a lot of naltrexone, that kind of thing. You know, Jackson, too. That's interesting. Yeah, bupropion, naltrexone is contrary. OK, I didn't know that was a combo. I've never written it. Yeah. Do you think it works good? Sometimes. Interesting. What about do you guys do any this one clinic bias used to do, which I didn't necessarily agree with, but they used to do like B12 injections. And I don't think there was evidence for that unless you have deficiency. And sometimes they even added like low grade thyroid, like we have a thyroxine for people. Do you guys do that? I don't have any practice with that. I think that's so off label that I wouldn't personally touch it. But I did have one patient that somebody put him on that. So he was actually on two different thyroid pills, which made no sense. He was on was it iron thyroid or something like that and leave with thyroxine. Oh, weird. And I inherited him because I mean, I started less than a year ago, so I inherited a lot of patients. And I was like, what is going on? Who did this to you? Yeah. He finally admitted that it was for weight loss initially, and they just left it on. It's interesting. Yeah, so I mean, some of that stuff is super great. So I just wondering what you guys do. I wouldn't I wouldn't do that either, but I don't have any experience with Contra. So that's interesting that you think that's been worth using at least or trying. Yeah, we're I mean, we're not really experimental. Like we're a small practice. So we just lean on data. If something has not really been proven over and over again, we don't touch it. Yeah, yeah. And you just don't do the biometrics with like measuring out their body fat with like any of the machines or anything. We do. You do. Yeah, we do body composition just to like give them hard numbers here, so much fat you need to lose in order to get into the lower risk category, you know, under 32%. I want to say for women under 30% for men, body fat. And then of course we do BMR testing. So like basal metabolic rate testing. Okay, I don't know anything about that. Really? How do you do that? No. It's just a machine. They basically blow into a tube for like breathe into a tube for like 10 minutes and it measures the oxidation in their stomach. And that gives us an actual number for what their resting metabolic is. Really? Yeah. I wonder how expensive that is. That's interesting. It can be terribly expensive because we afforded it on like a one to two provider, you know, clinic. If you think about when you're in clinic where you snap a picture of it and send it to me. I'm here right now. Oh, yeah. So I can see what the brand is and then I can ask one of my suppliers. That's interesting. That stuff might be really helpful for my practice. Yeah, let me write down a note. Especially if it's not like a thousand pounds and I can like cart it around with me when I'm coming. It's not big. Like it has to be supine and like just chilling. Yeah. The tubing is kind of bulky, but it's not a big machine. Okay. I can take around my table and my EKG machine and that's no problem. You drive around with your EKG machine? Yeah. That's awesome. It's wireless. Yeah. It fits in like a Ziploc bag. It's tiny. Seriously? Mm-hmm. Yeah. Can it be accurate? Yeah. It's a totally EKG. That's amazing. Yeah. It wasn't cheap, but it works really good. So I got that last year. It was hard to send in people to the hospital and having to just get pre-op stuff that's just easier to just take care of it when I'm there. That's so cool. So you're like an old school physician would just come to your door with their bag of goodies and just treat somebody right there. There's my bag. Oh yeah, let's see the bag of goodies. I have a cute bag. You'll have to pause it. It's downstairs. I just got back from my call. Oh, really? Yeah. You don't have to pause anything. We just edit things out. There's a picture on, I have a picture of it on Instagram. I think you can click it in there. Instagram at smartypantsmedicine in case anybody wants to know. Yes. Yeah, this is gonna be posted like the entire time that we're talking. Your Instagram and anything else you wanna share. Okay, yeah. I'm on Instagram, Facebook and my website. Absolutely. Yeah. Smartypantsmedicine. Smartypantsmedicine.com, yep. The patients are smart. Smart patients for healthcare. That's the idea. The provider is smart. Maybe. Someday. Yeah. We do our best. We do our best, right? Absolutely. Yeah. The best we can. Yes. Oh, the best that the insurance companies will allow us to. Right. Well, that's the nice thing. I don't have to really practice that way anymore because we're completely functioning outside the healthcare system, outside of the insurance payment model. So I shouldn't say completely because if my patients have insurance and I do orders, they can choose to use their insurance or not. But largely, we don't have to, to butt heads too much. So it really is truly kind of old school medicine, patient and provider, you know, lead decision making. So it's really, it's been cool. It's been good for, good for me and good for the patients. Okay. I definitely. So we're going to do the official intro in the question list, but like just to go back to that for a second, because I'm going to put this in somewhere. Okay. You're functioning outside of the insurance companies. You're working outside of the insurance companies. So they're, your patients pay a flat fee, right? Yeah. To see you. And then, so you don't have to bill insurance for your visits. They just pay cash. Yeah. What about laboratory testing, medicine, things that insurance would have to cover? Yeah. So it's really interesting. One of the things that I learned when I started practicing in direct primary care model, it is a membership model, which funny enough, I never like like memberships. And, but once I learned more about it, it makes so much more sense. I didn't realize how affordable primary care actually is whenever you cut out a lot of the high cost ticket items, which is like administration, coding, billing, trying to get reimbursement essentially. And so by eliminating that piece, the cost is actually pretty affordable. And so that makes a membership make more sense for people. So it is a monthly membership for my services. I like to say it's like Netflix, but for healthcare. And so it's all included. Just how many times we need to talk, text, phone call, telehealth, whatever. That's all included in a flat rate. And so that allows people to budget for their healthcare. They have known transparent costs. They know what's coming their way. And people really appreciate that. And so as far as the labs and imaging go, actually labs are pretty cheap too. They get marked up like three to 10 X, two to 10 X their actual cost. And so as a practice now, I don't need to make money on labs because I'm making money from my monthly membership fee rates. So I don't need to upcharge all of that stuff. Of course we mark it up a little bit. It takes time to put in orders and do, you know, do callbacks and such, but not 10 X. That's for sure. And so that way I contract with the lab and I'm able to pass through some of those savings to my patients. So if you're my patient and we have to order lab work, you get to decide, I'll say, do you want to do self pay for this with my practices pricing? Or do you want to submit this to your insurance? And then based on where the patient is and they're deductible, whether it's a preventative exam or it's a different exam, preventative is covered 100%. If it's not, they're going to pay out of pocket. If they have a high deductible, they're going to pay completely out of pocket, right? Until they hit the deductible. So depending on what fits their scenario, they can choose. Just like in every other industry, they can choose what works for you and what fits your situation. So it's really personalized that way. It's usually cheaper. Most people don't run their lab costs through insurance. They pay the cash pay prices. It's affordable couple of dollars for each of the lab tests, which I had no idea because as providers in the normal system, we're shielded from all of that. We're not in the conversations with these vendors. We don't know what any of the stuff we order costs. My personal opinions that were intentionally shielded from that information because they don't want us to make decisions based on costs. But reality is patients make decisions based on cost. And 40% of our country is in healthcare debt. And also 40% is what the latest studies show. And so I didn't know that I was really disappointed about that as a provider because we don't intend to do that to our patients, you know, and oftentimes we don't even think of that as part of the decision-making process when we're in the exam room with our patients. And so in this model, we're able to have that conversation. I have contracts with the local imaging companies. And I know if you need an MRI for this body part, it costs this much. If you need a CT, if you need an X-ray, if you need, and I have all the cash pay pricing and then the patient can make an informed decision. Do they want to self-pay for this at this reduced cash price or do they want to submit to their insurance? So any orders that I do, they can choose to use for their insurance company or they can choose to self-pay. It's pretty nice. So who submits things to their insurance company? Who submits things? The company that they're using. So if they go to the lab, the lab bills the insurance company and that's how the lab gets paid. And so the lab bills the insurance company. If the insurance company says there's a portion left for the patient, then they send the patient a bill. So that keeps my practice out of that whole loop. And we can avoid the administrative cost from that same thing with imaging. That's kind of how the healthcare system works all the time. But in this model, you just gain a little bit more knowledge of how the, how it works. And then you can work it to your advantage. If you're not dealing with Pryor, it's not billing and calling labs back. It needs to be this code. It needs to be that code. You're not doing any of that. No, I do, I have had to do a few more Pryor. Then I would like for high cost tests. Some, you know, patients do choose to run those through their insurance. Then I have the same, you know, barriers to care that we have in traditional practice where you're having to submit extra billing and do Pryor. And that kind of a thing, but. Honestly, it's maybe like a 3% of my orders. You know, it's incredibly different. From the traditional model of healthcare. Yeah. You know, we pay for services, what the traditional model is called. Every time you speak with somebody, you get a bill. So I explain it to people like. The way the U.S. healthcare stem functions is much like the way. We pay for our attorneys and our accountants. And so, you know, we pay them every email, every minute we're on the phone, we're getting a bill for that time. And so because of that, people try not to call their lawyer all the time. We try not to talk to our accountant, right? So that doesn't really work if we're trying to go after preventative care and improved health, because that's a financial deterrent to people seeking care. That shouldn't be why they're not seeking care. You know, and so by removing that, and we say, Hey, here's a flat rate. Talk to me anytime you need. Talk to me early. People come in earlier. They present things earlier. They don't wait until they're really sick because they're worried about getting. Not just a bill, but they don't know how big of a bill. Right. And so the system, I believe in the US right now is, is built to discourage people from accessing healthcare. And so as a result, you know, that's, it's a complicated question, but as a result of that, our country is not very healthy. Our care is very expensive. And we're not very healthy when you look at us against the rest of the world, you know, as a country. So this drug primary care model, I think has the potential to change that, to change the face of how people engage with their health and remove some of those big system barriers, you know, the, the big huge phone trees and things. People just don't want to deal with it. And then the unknown cost. It is a big factor for a lot of people. So, and this model's really neat because whether you're insured or you're not, you get the same level of care. I need to ask you more about that. Yeah. You said about 10 seconds ago, I definitely want to come back to at some point and let's just help on healthy the US is here to other countries. Yeah. I definitely have a lot of opinions about as someone who does primary care kind of more in the system, you know, than you are, I'm not outside the system as much. Yeah. But I definitely do take a more holistic approach, I think, than most primary cares. And yeah, just our country compared to a lot of other countries, just the lifestyle, the food, the things we allow into our food is just so different than a lot of the world. 100%. Yeah. It's more than, I think just healthcare. Yeah. What I really, really wanted to come back to what you said a minute ago is that instead of the regular system where it's fee for service, you have a copay every time you see your doctor or your physician assistant. Yes. You know. So you have that. And then every time you go to the lab, it's a copay. Every time you go to a specialist, it's a copay. Right. And like I've actually heard people say like, I'm not going to a cardiologist, even though I have possibly a heart condition because I don't want to pay 70 bucks for a copay. Yes. And then that's terrifying to me, but you can't force them. I can't tie them up and drop them off at cardiology and be like, here, you know, see this guy. I don't care if he pays or not. You can't do that. Exactly. And so like that, that definitely is an issue. Yeah. But what I, what I was a little bit concerned about what you said is your patients can see you. They have unlimited access to you for a monthly fee. Yes. Do people take advantage of that? And how do you deal with that? Yeah. That was probably my biggest concern when I decided to go for direct primary care because one of the reasons I decided to do this was to try and prioritize my family and my kids. Yeah. And so, you know, I was worried about the 24 hour call. In fact, previously I had never taken jobs that required call on purpose. You say 24 hour call. Yeah. I'm on all the time. Seven days a week. Yeah. Just you. Yeah. Okay. Tell me more. Okay. Sounds terrifying. So, you know, that sounded terrifying to me too. Anybody who's in medicine knows like, oh my gosh, I don't know if it's true, but I think it's not. I think the number of people who have been in the hospital for like that going self is really high. And so, you know, for sure, that was one of my barriers before I pulled the trigger to start the practice. And so I actually just spoke to a bunch of different owners across the country. Physicians, nurse practitioners. There's only a couple of handful of PAs across the country. I could get in contact with, but that even owned. But I spoke with a lot of different owners and that was one of the things that I found to be true is that this model of healthcare is so different. People know they have access to you because one of the things that we provide is same day and next day service. That's like guaranteed in their membership. So if they have an acute need, we're going to see them same day next day, period of the end. And once they. Spine that to be true and they've experienced that. They've experienced that. They've experienced that. But there's not this big need to like page somebody after hours, unless it really is necessary. You know, for like, do I need to go to the ER type of a thing? They're not calling us after hours saying, I got this lab result. What does this mean? They're not asking for med refills. Why not? They can send me a text. They can send me an email. And they know I'm going to call them tomorrow. Because there's this different relationship in this kind of model. And to understand how that works, it's a volume. The volume of patients that we care for as a practice is really different. Again, I learned a lot of this when I was starting, starting the practice. So I didn't understand that before. And the only type of care that I ever knew existed, which was fee for service model, which is with insurance companies paying paying for the reimbursement being the third party payer between the practice or between the provider and the patient. Totally lost my train of thought. Hold on. All right. We were talking about how you're going to edit this out. What? The volume of patients is different. Okay. Yeah. So. What I learned was that in traditional practice, each provider full-time provider cares for about. Two to 3000 patients on average. Okay. If you have a full-time, a full-time panel. Okay. And in direct primary care, you contrast that a full-time provider in a direct primary care practice takes care of about 500. So you can see the volume just isn't there. And so one for call that just reduces how many urgent things you have just by sheer numbers. And then the fact that you have this more relational healthcare where access is not a problem when they call, they're not getting a big phone tree. When they call, they're not waiting three days to hear back from the nurse who had to call a doctor who was on vacation, blah, blah, blah, blah. So there's not this kind of fear and this pressure that, that they're, I'm just going to pay to whoever's on call. Like that just isn't a thing. And I think because it's a more relational type of medicine, kind of like old school medicine was when the doctor would come to people's houses, I come to my patients' houses. So they know me as a person. They know I have a family. And so we're able to kind of set up these boundaries of like, I'm available to you during normal business hours for whatever you need. My after hours care is for urgent emergent. So if it's not urgent emergent, you're going to get a text or email from me that says, I'll adjust this with you tomorrow. Right. The end. I don't have to call them back. I can text them or email them. And if it is urgent emergent, then I want to field that for them because part of the value that I'm providing is to keep them out of the high cost centers, the urgent cares, the ERs. And I understand that if I don't do a good job, they're canceling their membership next month. Right. So I'm properly incentivized to do a good job for them. Yeah. And they don't want, you know, they don't want me to burn out and quit because this is a really cool model of care. So there's this really neat, like mutual respect that kind of develops where people understand how it works. And it's been really few after hour and weekend problems. Very few. And just one thing in other perspective, I'd like to put in here is like in primary care, I was of course afraid of, you know, the midnight phone call, whatever it may be, even though personally my job doesn't have any call. Yeah. You know, my supervising physician takes call and has to do very much even with the amount of patients that we have usually. But one little perspective I'd like to put on, on that whole situation for people is that when you do get that call that you really, really do have to answer. And you answer it and it makes the difference. That is like, you're just set for like the month. You just feel amazing because you literally made a difference. Yes. And how people feel confident in this decision they're making, you know, in the moment, if they're not sure if they should go to the hospital or not. And one that's really scary for people medically, it's really a high cost thing to do. It takes a lot of time. It's often in the middle of the night, they got to find childcare. It's a big disruption. So they want to know that if they're going, they're making the right decision. And someone who's educated agreed with them. They need to go. And so I'm happy to feel that. And how long does it take us to triage that? Right. Maybe three minutes. Yeah. Maybe you ask about three or four follow-up questions. So I'm happy to provide that, you know, for my chance. And also I want them to go if they need to go. Yeah. Like you can literally save their life, which very quick story. I mean, I had a lady with ITP, videopathic thrombocytic corpora, which means her platelets were like, you know, I don't know. I don't know. Yeah. For whatever reason, her body's attacking her platelets for the people that don't know. Platelets are, you know, the blood cells that clump, the clot. So they basically prevent you from bleeding out. And this lady's were 20. It should be 150 to 450,000. They were 20,000. So this lady was like in acute risk of like an. Intercranial hemorrhage. Like she could have totally had a hemorrhagic stroke like that. I'm just like tapping your head. You know, really put your heart and soul during business hours. And then she gets there. They didn't get any of her paperwork of course, which always happens. They didn't get the pass down that I gave the nurse, which also always happens. So she's like, yeah, I'm about to just go home. They said they don't know anything about me. And I'm like, no, no, no, no, don't go home. She called me at like eight PM. Like I said, I'm not on call. So she just had my cell phone number for some reason. And I almost didn't answer. This lady with platelets of 20,000 was about to go home. Yeah. And when I talked to the head nurse or whoever the heck I talked to, I was like, no, you do not understand this is what's going on. Yeah, you got to run our labs. She got admitted like please do a stat CBC and they're like, oh, okay, we get it. But like that little phone call could have literally been life or death. Absolutely. And so I mean I feel like as providers that's why we went into our profession right we want to be there we have knowledge to help people that critical decision points. And when I was in my other job in primary care. I was on what's called a population health team and so one of the things that we were stressing and trying to teach and that we still try and all teach our patients is getting the right care at the right time at the right place. You know, and so we can as primary care that's one of the really cool things about what we do no matter what model you're in is we help people understand they don't know the system they don't know where they need to be they just you know they just don't know that stuff and and it's not their industry they don't need to know it. But if they have somebody like us that they can ask these questions to we can efficiently get them to the right place for the right care the right time and it saves them in outcomes and it saves them in finances. So, it's a huge value that we can provide people for the one time that it inconveniences me for three minutes. You know, so I've been loving it and I know whenever people contact me they really need it. Have my fun Apple watch I'm on call all the time. Oh my god. We just talked about how, like gratifying and important it feels that you can just save a life for the 10 second phone call. 365 seven days a week 24 hours a day still feels like a terrifying. Yeah, it sounds terrifying. It's a different weight. You know, it's a different way but I think you just kind of trade responsibilities. And so the stress that out by seeing having to be at work during certain hours and seeing a high volume of patients. And then what that did to me physically and emotionally and how fatigued I was and what I had left to give when I got home that that stress is gone. And now it's a different stress of being present for my patients knowing I'm not, you know, the last stop for them being on call all the time, carrying all the business, you know, the business weight that I never had before as an employee. So I think you just kind of like trade different stressors right now in each different season of our life. There was nothing wrong with what I did before I absolutely loved it. And it served me really well and that season of my life but then as this new season of my life came, it didn't really fit anymore. And then this season of my life direct primary care is serving me really well, the stresses and the weights are different. But it's a better fit for my family and the main thing that's cool about that is one, I'm a better person and I'm a better mom, when I'm not into so many people end up leaving our profession, because they can't find the way to blend all of that in a way that's that works long term for them. And so, you know, I'm 12, I'm like 12 or 13 years in now. And so at this like what I've seen at least in my region is a lot of people are either switching jobs at best, or leaving the field at worst, you know, and totally going to different careers, which is so disappointing because in direct primary care, we have a massive shortage of primary care providers that PAs are luckily filling because the physician shortage has been ongoing for over 10 years. But, you know, instead of leaving the whole field, why don't they look at direct primary care, why don't you look at some creative ways to just do something that in that season of your life fits you a little bit better. Like the third time you mentioned season, and at least the second time you mentioned family. So I got to interject with this very big question. So this is how it was when I was applying to PA school, I'm sure it was similar when you were, you know, 10 years ago or so. The P profession is about 70% female in our at least current culture, you know, a lot of times, women in their 30s 40s end up you know going to part time or even leaving the workforce entirely for a number of years to raise children and whatnot. But whether you agree with that or not, you know, that's a topic for a different day. But it's just it's the fact that that's what happens. So to all the people out there going into PA thinking like I'm going to be a mom I'm going to have to give this up at some point. You just told me that when you switched to this direct primary care model, you were able to be more present at home you're able to be a better mom, but you still have the advantage of a full time, you know, employment income and all that stuff. Yeah, just talk a little bit more about your philosophy of like family and just, you know, work my synergy as Jeff Bezos says. Yeah, sure. I would love to because that's what made me that's what made me take the jump, you know, really. Yeah, so I did exactly. Yeah, so I had, well first of all we come out of school with a lot of loans right male or female like we have a lot of loans and we're not physicians but we still have a lot of loans. So you can't just like, you know, tap out whenever you feel like it you have this responsibility. And plus usually we love what we're doing. So kind of went through that had I have a two daughters so I had my first daughter kept working full time, like backing off the throttle was not really an option so we made it work. And then we actually went through infertility treatments for quite some time. And so and I talk about that on social media so you know if you're going through that follow me on social media I'm talking about all the time. It's super common in anybody who's in health care, unfortunately, they don't know. The studies are mostly on physicians but female physician infertility rate is, I forget the stat now but I believe it's over two times higher than the regular, you know, population non physician females and when they age matched age matched and demographic match, all of that. Really, so 32 year old physician female physician is more likely to be infertile than a 32 year old non female physician or non physician. 100% Yes, really. Yes. And they don't, there's not been a lot of studies trying to figure out why. But that we don't have it for PAs, but among my me and my female colleagues which are not few. I have seen that as well, percentage wise. So anyways, I walked through that that's been part of my story. And so when we finally had a successful pregnancy after that. I had an infant and I was going back to work and my work was really great they accommodated me to drop down to part time and so I was down at three days I think I was doing maybe three 10s or something so you know a little more than them traditional part time. And even still it was more than I wanted to do with what quality of life I wanted, knowing that this was something I really wanted that we really worked for to have to have children and family is everything. I'm a person of faith and I think it's really important to raise your kids that way to teach you know to be present with them. I only have these little years for like five years and then they're in school, you know, it's it's this very critical period of time, where if you want to be around, it's not coming back. And I also on the other hand, love my job was really good at my job didn't want to leave my job, but there it became kind of this storm where I was really fatigued from raising an infant, and then really fatigued after working a 10 hour shift and then commuting on both ends of it. And I thought, like, there's, there's got to be a better way to do this. And so I ended up getting to a point where I didn't recognize it at that time because we never in our workplace talked about provider burnout. But I was burnout I just didn't have that term for it. And I was trying to figure out how to be good at all the pieces because we're real high achievers as as people in medicine, and I couldn't be good at all the pieces. And so at some point I was like, okay, I'm not healthy right now and I have to pick and I'm going to pick my family even if that means a backseat for my career, you know, is what I thought so I actually resigned my job I didn't really have a plan. Thankfully, I had the luxury of a really supportive husband who could carry us for a little bit while I was trying to figure out what the next steps looked like, and was going to do per diem work at the urgent care and ER within the health system I was working for. And then coven happened. So I resigned in December of 2019 and coven hit in March. So essentially then there was no patient seeking, you know, seeking care and there was no need for per diem employees. And I just went from working close to full time, and a job that I loved to working. Nothing, which hindsight was a huge blessing because I needed to be doing nothing to recover from what I didn't know was burnt out. And so in that season I was able to, you know, like most people sink in with their family and kind of re prioritize some things. And then I was missing practicing medicine I wanted to see patients. I like the mental stimulation I love what I do. And so I started researching there's got to be other providers who don't want to run this pace in the United States that are doing something. And so I was just researching that or researching that and I actually found direct primary care. It was as a spin off of concierge medicine. And so I heard all about it I heard about membership medicine I heard about the volume was lower the quality of life was better. And I thought like, is this real, how come I've never heard of this practicing primary care for 12 years like how have I not heard of this before. Well we're in a pretty rural area in Virginia and there's not one here. So the first thing I did was look for one I thought I want to go be employed by somebody who has a practice like this right. At that point I didn't even know PAs could own practice. And so there wasn't one within an hour of me. And so I thought I'm going to be signing up again for a commute on both ends in an eight hour day this isn't the solution. And so the more I thought about it I was like, you know my husband encouraged me you should just start one. So we looked into that with the lawyer found out that it was legal got everything in place I have a collaborating physician that works with me to satisfy our state law. And we went for it. So here we are two years later, almost two years later in October. It sounds like your husband is just super supportive and amazing with this whole thing. Yeah. What's his name. His name is Jeff. And he's yeah and he's a physical therapist so he kind of understands the world of medicine and how intense it can be on some days, and we're nerd so we met in anatomy class and at church. Oh my gosh that's awesome. We're like the classic story. Yeah, it's crazy. The classic story while like meeting in college meeting in anatomy class and grad school and then we end up married you know we had the same like cadaver that we were working on and everything. Super nerd is so romantic. Super nerds. Yeah, I'm like from L to high just like. Maybe never go back in there. I'm sure a lot of people. Yeah, he's been essential. And I think if anyone, you know is thinking about doing this or starting with, you know, you're thinking about just being employed in a different model direct primary care is amazing. And honestly, I probably would have done that because it frankly would have been easier to just show up and do my job but I really believed in this model and I wanted to bring it to our area and I wanted to have an option for myself and my family so a little bit bigger risk opening at yourself. But if you want to do it yourself and you don't have a spell so you don't have someone who's supportive, you know that way I do think it can still be done it's a little bit trickier. Because you need to moonlight a lot more to be able to make income while you're growing your practice, you know, so it's harder you'll have to, you'll have to put in a bit more hours on the front end, but it can definitely be done there are people doing it. So there's physicians that have taken a leap from the traditional practice, you know, to this model and you can do it but there's a really great network there's an online network if anyone's interested in dark primary care you can reach out to me I'm sure Boris will have my email linked in somewhere. And you can reach out to me and I can help you get into the network like Facebook's been powerful for direct primary care for me which is funny. Never would have guessed that but it's you know you're independent and so you it's nice to have some colleagues that are doing what you're doing. And social media is really provided a great networking platform for for that so people have been incredibly helpful people who've taken this jump it's a big risk. And so everybody's really supportive, they offer their services and I'll talk with you I mean, I was shocked how collegial the whole community was not to say there's not some pushback because I'm a PA. And it is kind of a visit you know it's definitely a physician dominated space where physicians are typically owners. But generally speaking, really supportive. I mean for somebody who might be looking to get into that kind of model especially as a PA. Yeah, I think that they probably like to hear what you just said about that there is a community, you know getting your business off the ground. Just like struggles that come up. So that's one thing. The other thing that that brings to mind is you do have a collaborating physician of course because your physician assistant. You know me as a PA like I'm in my first year of practice year and you're like 12 years of practice or obviously on totally different levels, but like, at least, maybe one to three times a day I still call him and ask him questions. Yeah, you find that that's still the same for you or is it very rare that you need to lean on them. Yeah, pretty rare. And I would say if I was at the front end of my career and I would never have even wanted to take this jump because it would have been way too much risk both for myself and for my patients. Right. But after you're practicing for a while you'll end up finding. You don't really ask. You know it might be rare it might be once a week, it might be less. So once you do, especially if you're not jumping special days right like I've been in internal medicine essentially the entire time I did go work in the ER for two years was the first female PA in our role er so yeah. And yeah, that's awesome. Now they have a thriving, a thriving, I guess they call them APPs advanced practice providers at our hospital nurse practitioners and PAs but and then I went back to primary care because I love it. And so I've been doing internal medicine for you know 10 years so at that point the medicine part almost becomes easy. And it's pretty easy to do that there's only like these really interesting kind of one off cases that you want to make sure you're not missing anything you know and so you run this by your collaborating. And so that's how I was practicing before I ever would have thought of taking this jump if I was still if I was still regularly needing to talk with my physician I really don't think this would work well. Unless that physician became a business partner with you and you started it with them. And if you had a physical location and they were with you, it would totally be fine. But what I'm doing is I'm doing a house call practice so I don't have a brick and mortar location. I don't have health email calls and house calls. And so I can't just like walk down the hall and talk to my physician right like that's not a thing. We're on the phone, or we're doing stuff through e communication. So, it's different, and definitely a lot more autonomous practice. Now that's not to say I never speak to my collaborating physician I do, but not at the frequency with which I did the first five years of my career. Right. I'm glad you actually said first five years because I did want to get some numbers in here so it's probably different, you know it's probably different for everybody. Well so how long were you practicing before you went out on your own like this. Yeah, 10 years. 10 years in internal medicine. You know full time grinding it out before you were even remotely comfortable enough to go out on your own like this. And I would still say, you know, when I first did it and it was just new, I thought, you know, is this going to be sustainable for my collaborating physician because I'm not trying to weigh them down either. You know, is this going to be sustainable for me I really didn't know the answer to that but I did have, you know, the last couple of years to say okay how much have I needed consult. Okay if we keep up at that pace it's fine. So the, you know, if it stays the same as much as I needed to and then here's the other thing that comes into that is the volumes lower. Right. So I was seeing how are many patients a week I don't even remember those numbers now thank God. I don't know how many it was a day but whatever your weekly number is. And then how many times that I have to talk to somebody and make sure things were okay, and then look at that volume translated to what I'm doing. It's not often. The other nice thing is this. This model of care I think maybe one of the downsides is, I don't know if I'm still in year two, we'll see how it goes as as the practice ages but I just started accepting Medicare patients 65 and older last year. And so those are a lot of your heavily complicated patients that you know in internal medicine we're seeing that age group 90% of the time. Up until this year I've been seeing basically under age 65, not saying there's not disease but the ratio is different. And so that's made my need for questions go down to because my acuity has gone down a little bit. And so now that over this last year I've been taking over 65 patient some of that complexity is medical complexities coming back which I missed and I enjoy. But I'm sure that will bring a little bit more need for, you know, speaking with the collaborating physician. We'll have to do, we'll have to do a follow up in a year or two and we could talk about it again. We're definitely going to do a follow up but I mean I'm not sure how many views this is going to get but this is an incredibly interesting topic I feel like physician assistants. Yeah, I bet you there's going to be demand for that. And you can own right like did you even know that I didn't know that. You can own a practice as a physician assistant. Yeah. So what I knew it. What's that in theory I knew that but I never knew anybody who did so this is my first time talking to a PA that owns a practice. Yeah, it's pretty neat because, like I said there's not that many PA on practices so I didn't have a heavy pool, you know to lean on, but if you stay in that fee for service model. You can still own but you have to have a physician I believe it's probably different state to state but I believe it's like a 1% ownership the physician has to have. And it's a Medicare requirement. And so, but here's the deal right like I'm not being paid. I'm not contracted with insurance companies I'm not being paid by the insurance companies so we don't have to follow those rules. And so, because of that I can 100% on I still have to meet all the state law requirements I still have to have a collaborating position, all of that kind of stuff. And that's varies by state, you know if you have anyone who's not not sure about that it's a state law level thing. The ownership piece is different. And so, for some, for some position that's great because quite frankly they don't want to do all the business side of stuff and be an owner and deal with the administrative stuff. They want to practice medicine and so this is neat because they don't have to take on, you know that to be a collaborating with us which is kind of cool. But it seems like the answer to a lot of these like main concerns we have about meeting your collaborative position, you know to make decisions that you just don't feel comfortable with as a PA. You know, patients just like calling you all the time or midnight phone calls and whatnot. It seems like the answer to all of these is volume. Your volume is just straight up less like for me, working full time, I take care of like you said three to 4000 people total, my whole patient pool. And so out of them, you know, I still don't get a whole lot of, you know, there's not a whole lot of phone calls late at night to whoever's on call. There's not a whole lot of issues usually everything's pretty smooth. It's just like once in a while. And with that number reduced, you know to a quarter of that or if not less, all those issues just kind of go away essentially there might be one a week a month, but it's just not that much. Exactly. And so that was another, again that's a piece I just didn't know it was just an awareness, an awareness issue because we're not educated about this stuff because we don't think about this is we don't know there's other choices. And so it's kind of neat to learn the business side and the statistical side of the industry that we're in because quite frankly we're always just focused on the medicine and the patient in front of us because we have to be because at such a high pace, you can't, you don't have time to like sit down and research this stuff, which I think is what what the blessing was in me not working. You know, for that six to eight months was I had time to learn the business side of healthcare and understand the industry and how all the pieces work together and interview all these owners and kind of learn about people who were thinking a little bit and although 10 years is a decently long time in medicine that's nothing compared to these positions who've been practicing 30 to 40 years. And, you know, being able to interview these guys who own practices and fee for service and switch to direct primary care and hear their perspective on contrasting quality of life cost, you know, all of these things was incredibly valuable and helpful and eye opening. So, you know, we're kind of lifelong learners when we're in medicine we have to stay current on everything. And so what has been neat about this is I've been able to learn more about being an entrepreneur and business and the system and the industry that we're in in our in our country and how to kind of shift change for our community. It's a little bit higher level learning than nitty gritty. What's the newest blood pressure drug and what are the side effects right and so just like shifted. What I was learning about which was really fun for me is somebody who's like into entrepreneurship and adventure and I liked it and I still like it I'm learning every day. So if that's the type of personality you have I would definitely say like practice owning an entrepreneurship is not for everybody. But if you know your personality is kind of set towards that I wish I would have known like when I was my first year out that this was a choice because I would have paid attention to different things. You know, I like what things. Well, first of all, like, you have to have good relationships with collaborating physicians because if you don't you don't have a prayer doing what I'm doing, because you have to have a relationship well enough with somebody who's willing to be your collaborating physician with me practicing fairly autonomously. Right. They have to know you're good. They have to know you know what you're doing they have to know you know your limits. You have to have this pretty intense like level of trust, politically and professionally and that doesn't come with anything but time. And so I think there's value in staying in the traditional model you see high volume you learn the medicine. You learn how the system works, you know, you learn a lot. So there's value in the traditional model. What do you think like as seasons of life shift, who knows what's going to happen with your health with your family's health with, you know, like all the things. When your mental health might be challenged, you know, it's just nice to know that there's another option. So I would, but I would have thought about things like how like what's this referral process and who are they faxing these things to and how did they get poorly approved and because I'm doing it all myself now. Right now I don't have a staff, because I'm intentionally practicing part time. So I don't, I don't even have 500 patients, you know, intentionally, because I want to have more time with my family. But so I'm doing that all right now eventually I'll probably bring on an MA and a secretary but this is working for me but that means I'm doing all these pieces so I'm back and forth at the lab doing add on orders for myself, you know, and I would I think I would appreciate other things like what a great value that I had FMLA whenever I had my child right that's not available in private practice, not in drug primary care and not in private practice it's not, you know, that's not a paid a paid benefit. So some of these things that like we kind of take for granted like our DEA fees are paid for and our licensing fees are paid for and we can go to conference for $2,000, you know, I'm paying for all that now. So, that's fine as part of the cost of doing business, but I think my appreciation level would have been different which may have helped my burnout a little bit, because I just said a post yesterday but what you appreciate appreciates. And so if you don't understand, you know what it's like to not have that you don't really appreciate it that much you just think like of course I have that, you know, we just have like a vacation time, you know, what is unemployment insurance not unemployment insurance but disability insurance, you know, practice insurance like my practice is incredibly expensive and say, yeah, incredibly expensive. And so carrying all those, you know, carrying all those fees is fine, but it just gives you a better appreciation awareness of like what it actually takes from a business perspective to run things. And I think a lot of us providers would have a better appreciation for our jobs in the system that we are a part of if we were clued into those conversations. And I know that's hard to do in a big healthcare system in a private practice. It's a lot easier. And so, you know, the practice I originally was with was a private practice we were a multi physician practice multi PMP practice, we ended up being purchased by a local large health system. And so I've seen both sides of that. But there's perks, you know, there's pros and cons to each, each thing that you're in. But yeah for this season life man it's been great. I also love that you keep using the word season for your life. Yeah, it's a really different season. Absolutely. Like you're taking care of small kids right now so you're intentionally keeping the practice small. Yes. The cost of that is you have to do all the, you know, like nitty gritty stuff yourself benefits as you're working part time. Yeah. Yeah. And my hours aren't you have to show up between eight to 430. My hours are, I'm on call for my people. I schedule them on the days that I want to as long as that fits with them. I pick the hours so I can get my child on and off the bus. That's value to me. I can show up at the soccer, I can show up at the soccer game and it's not incredibly stressful and I don't have to skip dinner. That's valuable to me. That's actually amazing because you're not like letting people down someone has to work for you. Yeah, boss is on your back or whatever like none of that is even a factor doing what you're doing and you can go spend time with your kids anytime. Yes. Yes. So, yeah, you have to have a good support system you know I have I have help with my kids so that I can be on call. And so you know, if you don't have that you need to get that if you want to do this model of care. No, actually, we have we have an older lady who's become like our family here she's our nanny. Oh, okay, that's awesome. Yeah, she looks like a couple minutes away and so you know I couldn't do my life without her either because childcare is huge and personally I didn't I wanted to be able to not have my kids in something five days a week for all the hours that I needed to work. I didn't feel great about it. And so this became a solution for us, but I also didn't want them with her full time either. You know, yeah I mean you want to raise your kid. I want to be I want to be present as much as I can with still you know doing what I love and finding, finding some professional enjoyment myself. So yeah it's been a really neat blend but it's been a different dance this deck this you know decade that I mean now compared to the front end of my career. I love both of them, but they're totally they're totally different. I feel like that's what a lot of people don't think about they like they think about getting into a career and think that everything is just going to be the same. Yeah, you know from 25 to 65 they're just going to be doing the same hours same everything. But like your life changes so much, like maybe your career should kind of follow suit. Yeah, and what you want changes. Right. The hardest question to answer is what do you want. Like, it's very kind of want like a cheeseburger maybe. Hey, I could, I want a cheeseburger but I could go for like a grilled chicken salad yum. You're not vegetarian you just don't like red meat. That's not my favorite. Yeah. Yeah. I picked chicken over at any day. I probably shouldn't have all these poultry plants around here I probably should go tour one and then I never want to eat chicken but right now yeah I'd rather I'd rather chicken over meat for sure, but I think that's a hard question like professionally sometimes personally to is like what do you want and you do have to kind of lean into that because there's always when you choose something you want to use something else and also true like you have it and then you want something else just because you don't have it. Yes. It's always a trade you know what it means like you said I'm on call all the time. Yeah I am but I'm not at my door at 615 every morning and home at 630 every night. That's my trade. Yeah. Yeah. So, yeah, it's been it's been a ride man. It's been crazy. What was I going to say there was something we were just talking about the whole chicken thing and then we were talking about the whole burger thing. I was talking about having a good support. Yeah, having a good support. Talking about having a support system and a team, you know to help you do this. That's what I was talking about before we talked about eating. What do you want? No, it was something about. Oh, yeah, you talked about like touring a chicken plant or something and then you were like I'm not going to want chicken after that. So I'm, I'm going to put your Instagram and your Facebook and your website and your email like right below this whole interview so people can get in contact with you is that okay. Yeah, totally. I was just thinking because like we talked about getting into this probably a little bit later in your career not a new grad, not something brand new like you need experience. Absolutely do something like this because it's all on you. You know there is almost no support and that's just designed that way, which is totally fair. Yeah, I was just thinking if somebody would be remotely interested in this maybe finding a direct primary care or direct patient care. What do you call this again? DPC direct primary care. Direct primary care or like concierge medicine provider and shadow them. Yes 100% yes for a whole day see like what the job is like what their life is like. That's that's a perfect idea. I didn't have the luxury of doing that. Before I wanted to launch, but you know most direct primary care practices actually are brick and mortar location like they're a normal practice. Okay, normal exam rooms they don't have all the staff because the volume is lower. More boutique feel because they can. It's a private practice, but most people are not helps. They're not health practices there's some. But most people are brick and mortar location and so there is some familiarity to kind of that model that's not so out of the box. Yeah, I'm totally mobile but the cool thing is with that one it keeps my overhead low right because my overhead goes higher than my cost has to go up. And so for this to be affordable for people, I either have to have higher volume or their cost has to go up and I didn't want to do that at this at the season my life that was. That's not really the goal the goal is to practice medicine at a high quality on my terms, and to be present with my family. And so, but again, whenever my little people aren't so little, that'll shift. You know that'll shift to I'll be in a different season they'll be school they'll be gone at certain hours. Maybe that's something that you know I'll pivot to. But in this area and nobody makes house calls where I am and it's fairly rural. And so that does bring up something that I think is really cool. There's a difference between concierge medicine and drug primary care. So concierge medicine. Well, insurance just like a normal practice right so it's still like a fee for service model, but then there's also either a monthly quarterly or annual fee whatever they set their contract up as. So it's like still a copay every visit it's still they're billing, you know and dealing with all the billing and coding and overhead and admin cost from that. But then also, there's this pretty expensive like two times when I'm charging, you know, fee to have this higher level care. Yeah, so it, they have better access so that the practice has that extra money so they don't have to see such high volume so they take. So they can provide this text service. It's it's boutique style, you know, access matters in health care. And so it provides them access but it provides us really high price tag, which is one of the knocks on concierge medicine is that it only services the affluent members in society. And so with what I think is really cool about direct primary care and that's different is we don't have that insurance piece at all it's just the membership piece. And so whether you have insurance or you don't, you get the same quality of care you get the same access to care. And there's studies that show access access which is a big buzzword in healthcare world, but that just means you can get care when you need it. Right. So if you call in and you say you have urinary tract infection symptoms, you're not told wait two weeks for the next appointment or go to the urgent care, like your actual practice can actually see you. And so that's what we're having a disconnect within the US healthcare system because we have such high volume and not enough providers that it's messing up the access to healthcare. And the studies show when your access goes down, it worsens your medical outcomes, it worsens mortality rates, and it increases cost, because people end up getting care when they're sicker. Right, now they have PILO, it's not just like a little UTI. So it's like it's a huge problem. Exactly. It's a huge, huge, huge problem. And that's just one tiny example of a, you know, somewhat minor condition. But, but this is the problem with the system that we're all a part of is that access to care. We're not hitting the mark. And so, and who's getting negatively impact the patients are getting negatively impacted their outcomes are negatively impacted. And so with this model, we're able to kind of fix that at the primary care level and hopefully that trickles into like they don't have such high acuity stuff that ends up hitting the ER in the hospital. So that's pretty neat to be providing that to the community. So I've had this kind of really interesting demographics in the practice that I didn't expect, which was about 25 of my practices completely uninsured patients. And yes. Yeah. So these are entrepreneurs. These are self employed. These people have no employer sponsored insurance access. Okay. Employer sponsored is the key piece. You have to be a pretty big employer to where legally you have to provide insurance. I want to say it's over 50. I'm not sure that's probably not my very by state. I don't know that side of it as well. But, but when you're a small business, which most of America is like a lot of small businesses. They don't have to they're not mandated by anybody to provide health insurance and quite frankly, what I've learned is that, you know, it's number two on the budget sheet is sheet is healthcare costs for companies of any size basically. And so it's a very expensive and small businesses can't afford, even if they want to, they can't afford to provide it for their employees. So then these people are left to either purchase their, you know, purchase on the marketplace if they can afford that. And a lot of people who are in these jobs cannot afford that. So then what we end up having is this uninsured working force that it makes too much money to qualify for federal assistance. You know, through Medicaid or Medicare, and they don't make enough to be able to access healthcare on the marketplace. And so they just get no, no care. They have no care. And what they use is they use the ER and the urgent cares as their care, which there's no continuity. What's that. And then they, they pile up that healthcare debt that we were talking about that 40% of Americans. Exactly, because because why because a simple UTI, the urgent care cost you three times, right? Your poison IV at the ER cost you six times what it should at your presence. It's just the premise on, you know, like, but But they can't get in right there. They're not patient practice. They cannot get into a private to a private practice when they need it. So it's just kind of this weird disconnected. So that's been super cool to be able to service this part of the community. That are self employed. They need a solution. It's not perfect. They still need catastrophic coverage. Like if they're in a car accident, I can't fix their, you know, neuro trauma. But primary care, I can take care of your, I can take care of their ear infection. I can take care of the poison IV. I can fill their blood pressure medications. I can, you know, all this primary care stuff that we do is 90% of what people need. And so at least they're able to access that. So that's been really, really rewarding. And then the other 75% are people who have insurance and like the access and want the private, you know, the private practice concierge style. And some of them have high deductible plans. So basically when you think about it, high deductible plans say you have $5,000 deductible for your family, two adults, two kids, average American family, right? If you're fairly healthy, you're never going to hit $5,000. In a year. So you're going to pay out of pocket for every lab test for every doctor's visit. So you're paying cash pay yourself paying insurance. Right. And so what does that mean? That means they don't go to the doctor either till they have to. So this model kind of takes that away. It lets them budget for under $1,000 a year. They can have concierge style care, full access. They don't have to come in whenever they need to. They don't have to treat their own stuff at home with homeopathic things that may or may not work and delay care. So that's kind of been the dichotomy or the practice that I didn't really anticipate, but like learning about this working uninsured part of our community has felt really rewarding to be able to help that niche. That's an interesting demographic because when you think concierge medicine, you think rich people forward to pay however much for better access, you know, same day appointments, whatever they need. But you're kind of like allowing that same access to folks who are not necessarily like rich people, they're working for whatever reason they're kind of falling through the cracks of the system because they don't have employer provided care. And employer provided healthcare. And then like healthcare in general is just so expensive nowadays and insurance is so expensive for a number of reasons we're not going to get into. So all these people, they just like, they go to urgent care for 300 bucks for something that I could do in like one minute, you know, prescription. Yes, UTI. Yes, an IV, a little cut, a little, you know, antibiotic blood pressure, whatever, just simple stuff. And it's a month, you know, and it's a month to month service. So, you know, people who are in between jobs and they need mad refills. They don't have a lot of choice, you know, around here to get into a new practice. It's a three month wait for a new patient visit. Yeah. So what do you do if you didn't think ahead? Most people don't think ahead because they don't know the weights that long. If you're not in the industry, you don't know. And so you don't think ahead and then you're like, shoot, I need refills. Okay, where do you go? You end up in the urgent care, which is great that we have the urgent cares because we need some type of a catch. But is that the most affordable? Is that the most consistent? No, you need to be in a primary care practice. And so, you know, I've helped a lot of patients who will come on for the gap between their jobs. And, you know, I've, they couldn't afford Cobra. So they, when they left their job, they couldn't afford their Cobra insurance. So they, they just thought, okay, I'll just carry nothing. And I'll just go off all my meds. And then when I get my new job, I'll just have to start everything. That's terrible. You're going to have a stroke. Your diabetes is going to go out of control. Your mental health is going to go off the rails, you know, and so are these great decisions? No, but they're real decisions people are forced to make. So just being another option on the table for people to choose feels really good. And you're okay with that. You're okay if someone just like subscribes to you and it literally is like a subscription like Netflix. Yeah, it is like a month or two, you know, give you 100 bucks, 200 bucks, whatever that may be pretty affordable costs. And they get amazing care just for those couple months and then they say goodbye because they have their, you know, their primary back or whatever. So I mean, obviously, ideally for me, if they stay on, that's better. Yeah, of course. But no, they probably would. Yeah, I mean, the care is really different. The fact that they can text me a question, should I get this vitamin or not? Should I buy this over counter cold medicine with my blood pressure or this one? And they send me a picture and I answer them back. Most people are willing to pay that it's less than their cell phone bill. How many times do you get? How many times do people go like, oh, should I get this be vitamin or that be vitamin? You know, I almost looked that up the other day. It's a lot. I do feel a lot of texts. But I don't mind doing that because again, it's on my time and I could be in my house with my kids. Yeah, pausing for a second, going to the room answering what I need to answer and then coming back. So it's a lot though, you know, that back and forth is it's different. So obviously, ideally for my business, it would be better for them to stay on. And so a lot of people do, they get their insurance and they're like, this is great for my catastrophic coverage. If I need surgery, this is nice. I can have it covered now. I'm going to keep this on because I like this better than what the alternative is. But if I end up being a gap for them, which I have been, that's fine. They tell their friends about me. I do a good job for them. That's free advertising for me. If they hit a bump again, they're going to come back. So I see that as only a win-win. When you do a good job for people, it's always a good thing. And it's just also great that you're there because like, who else is going to prescribe their meds? Who else is going to see them for a little stuff or, you know, little stuff that might be fixed? You don't pay them for the patients. Yeah, so everything we do, you know, isn't for the money. Some of it is like, I feel really good about doing service. Yeah, I feel really good about doing this. I love that I do this. I love that I can offer this. I find satisfaction in helping people, right? And that was like the one thing you're not supposed to say at your PA interviews. It's like so general. I like to help people, you know, but at the core of it, it's true, right? We're passionate. We like, we want to give back. That's part of the reason we got Madison. And so it's nice that we get paid for it. We all go to work to get paid and to make money for our families. But when you take that satisfaction piece out and you feel like getting used by the system, you feel like you're no longer able, you know, to provide this, this care that you feel really proud of because the pace is too high or whatever the reason is. That's the reason people leave their jobs, you know, and that's the reason people leave the field. So to me, that is incredibly valuable. You have to get to practice the way that you want. That's like orally, ethically, medically congruent with the way I feel like we should practice medicine. It's all there. It's all there. It's so awesome. I love it. I'm so glad I got struck from my carry. Yeah, I never even knew about it. Yeah. It's also like super random, but did you ever watch that show Breaking Bad? I think I made it through half an episode. Really? Okay, you didn't like it. That's a little intense for me, Boris, right? It was a little intense. It was on math and, you know, games. No, when you have small kids, you try and pretend like the whole world is Mayberry because otherwise you have these like panic attacks happening all the time. So I intentionally like insulate myself from some of that because I want to pretend like it's not there. Obviously I worked in the ER. I know it's there, but you know what happens? Yeah, I want to focus on it. All right. Well, I'm not going to say anything triggering, but basically it was about this guy who's a chemist. He's like a very brilliant chemist. He ended up not being successful and, you know, ended up, you know, making drugs. Yes. There was this one scene where he and this other chemist were talking and he, they said something along the lines of like chemistry is magic. And he's like, it's always magic. Don't let, don't like, let it ever not be magic to you. And to me, I feel that way about medicine. Yeah. Because I've literally seen like little, little pills that I can prescribe and suddenly somebody's whole mood and the relationship with their mom, the relationship with their kid, everything is just overnight is better. You know, or this one guy I had, he walked to the cane. He was 300 some pounds. His A1C was 11. He couldn't ride his motorcycle. He had already lost like some of his toes. Literally three months later on a medicine. I'm not going to mention because, you know, I love it, but it's they're not sponsoring me or whatever. But like, literally three months of that plus my weight loss coaching, the guy lost 60 pounds. He's back to riding his motorcycle. Awesome. He got his life back in three months. Yeah. It's literally magic, you know, and so for those of us that practice medicine, we know that. Yeah. And I think in primary care too, because it's not the highest paying specialty, like we, we have to have those wins to, you know, to stay engaged and to stay motivated. It's really important that we have good patient outcomes that we feel that we're making a difference. We have to have that. That's what keeps us going. 100% because it's hard. It's a hard field. It's heavy. The stuff we're dealing with every single day in and out of the room. We're diagnosing people with cancer. We're giving terminal diagnosis. Oftentimes we're telling people they can come up the medicine for the rest of their life. These are big things. These change people's lives. When I have to start insulin, when I have to start insulin, not stop it, but start it. It is like the worst day of my life. It's hard. Like people don't think about that. Like, oh yeah, insulin's expensive. Yeah, you don't understand that you're literally chaining somebody to a needle for the rest of their life. Like it's, we do, it takes an emotional toll. Absolutely. And so I think, you know, the cool thing is too that with this being a practice that's kind of serving some people that hit the gaps. Yeah. I'm seeing that a little bit more frequently. The appreciation value from people who choose this model. These aren't your necessarily like run-of-the-mill average people. These are people who are thinking outside the box. They're willing to get healthcare in a different way. They're willing to think a little bit creatively. They want private, you know, private healthcare. And so it kind of attracts a really certain type of person that's great to work with because they're so happy that I'm doing what I'm doing because it's giving them what they want to. And so it's like this really cool, positive exchange. You're talking about the patience. Yeah. So you're talking about like not only is the model designed in a way that kind of fits your personality, but the patience that it attracts because it's different. Yes. That kind of is good too, because you're working with like-minded people as patients. Yes. It's like kind of self-recruits for out-of-the-box thinkers, right? Yeah. Because like, I thought this was fake when I heard about it. Right. And so you have to be a little bit skeptical to look into, you know, look into things, but you also have to be open-minded enough to say like, could this be a solution? Could this work for me? And then, you know, have a conversation and try it. And then the people that you help and they realize like this is so different from what's being offered in the large corporate-owned practices. I'm such a different positivity than some of the providers that they've seen because I'm not burned out anymore and I love what I'm doing. It's a different exchange for them. And the healthcare system, like people are burnt out of even like finding a provider. And so, you know, it changes their perspective of taking care of themselves because now they have somebody that's, it's not annoying to get an appointment for, you know, in a positive mood most of the time. I'm coming to their house. That's cool. So they feel, you know, there's a level of like, that's a really incredible service, I think. And so I think, you know, patients have really liked that. And so it's just kind of this really neat, like we're happy with the setup. And for the couple, you know, the couple of people that they need to, for financial reasons, you know, change models or drop out, whatever. It's kind of like, not a big deal. Like, that's great. I'm great. I'm glad I was able to help you, like best wishes, you know, tell somebody about the practice. Oh yeah, thank you for all the care, you know, this, this changed my life. I have to drop off. It's like, okay, you know, bless them as they go. It was, it was good for a while it worked, you know, so it's, it's been, I don't know, it's been really good. And actually, I'm glad that you brought up going to people's houses because that brings up a question that just like, I just have this image of because you're you're going to people's houses that's your primary model right. Yeah, yeah. Yeah, like you're like an old school doc who like comes with their little bag of goodies and everything to somebody's house which is awesome. So I have like one very positive image. You pull up to like a nice house with a nice lot and it's clean and then like someone opens the door they offer you coffee. And they're like, Oh, thank you so much for seeing me. I just have like a pimple. I want you. I don't know, like whatever. And then so that's one image. The other image is you pull up to like a trailer park and then it's like an episode of hoarders and there's like nine cats that run out and there's rats everywhere. Yeah. Like, do you ever feel scared, going to people's houses. Yeah, I would. I think that's valid. And especially at the beginning I had a lot more anxiety and nerves about that, especially being female, and yes, and yes to both of those situations. Yes, so true it's happened. Yeah, yeah, pretty much yeah. Maybe like minus the cats but you know some not as nice places. Okay, but listen like those people need care to so yeah, but it does I mean it takes it takes a certain person right like some people aren't going to want to do that or be happy doing that. But those people need care to and they're often the ones that are slipping through the cracks. So yeah it's been, it's been interesting I think at the beginning I was more nervous than I am now. I think about it like there's home health nursing, there's some health PT. You know there's a lot of IV therapies that come to people's houses now. And so once I kind of relaxed and realized like okay there's some best practices you need to follow for safety. And so, you know we have those in place I don't want to go through all of them for my own safety, but there are you know some measures that you can take, you know kind of for personal protection stuff. There's some things that we have in place. And then the other thing that I personally did was I don't just go like do one off random health calls. You have to be a member at the practice for me to make health calls for you. So I will do one time telehealth visits for people, you know if they just need something random. I don't do very many of those because the point of this is membership primary care, which is ongoing chronic care. But I have done that for say somebody's family member who's in town and is sick and they can't get in anywhere and they don't want to go to urgent care. I can hop on here and do a telehealth visit with them you know like it's not that difficult. Like what would you call it almost like an urgent care they could just schedule a one time appointment with you like, please can you just give me antibiotics I have a sinus infection. Something like that yeah or like I have this obvious rash that shingles or you know whatever. So, I don't do that I don't, I don't do that frequently but I can provide that service. You know that's kind of like a hard line boundary like I'm not going to make a one time health call just because of safety issues. So I see everybody for telehealth first. And based on how that goes, then I go to their health subsequently for new patient visit. So there's some measures like that you know that are kind of in place that make that easier. You know of course there's lots of personal protective things we can carry. So, whether you choose to do those are not if you're in this model that's up to you but yeah so I do that kind of thing but there's all different sectors of the population that this serves which is kind of nice that's not the same thing you know that's kind of nice is what primary care what we see is different. We see some chronic disease I see some acute stuff. And the segment of the population I'm interacting with, you know goes from multimillionaires down to people who are, you know barely putting food on the table. And quite frankly I like it that way. I think that that's necessary. Everybody needs that care and that keeps that keeps me honest in the practice that I'm doing. And I think it's, I think it's helpful for the community to have kind of that full. Making out one segment to serve. It's a private practice and that's what I chose to do so but not everybody has to do that. I think you can design that kind of however you want some of that's you know by your pricing if you keep it affordable. You don't push out the segment of the population that needs care. So, yeah it's been not it's not been an issue. I think a lot of people especially like you said like young females might be considering something like this. I think the main thing that you said that would just make me more comfortable with it, like me as a practitioner and also like I don't know my if I had a sister or a daughter whoever going into this would make me feel better is you see them on video. Probably multiple times you talk to them on the phone, you like understand the person before you go to their house. And, you know, in the new patient visit you have all their diagnosis you know all their meds you have all their background you can catch a you can catch a vibe right. We're taught it kind of reading people we go through a lot of years that training and part of that is kind of reading the room if you will and looking at body language and all of that and this is a private practice so I would never exclude you know exclude for anything inappropriate but if there was, you know a concern. So that's my choice whether I want to have this patient in the practice or not this is a membership program right and so that's enough to see someone at their house. Yeah, that's a mutual contract that we have together. And we can either one of us break that at any point. And so you know they do shine a membership contract and so there are things in there that outline you know what those terms are so that legally we're not getting into, you know sticky water, but it hasn't it hasn't been an issue I think that when you think through how to set it up so that you won't fail, you got a better chance at not failing. It's not that something you're not going to get a curveball I'm sure if I do this long enough I'll get a curveball but on the large vast majority, it's been totally fun. The other thing is, you know, it just to throw that out there like if you're a practitioner thinking of doing this. One of the things I haven't been able to provide just because of my concerns for medical legal and safety is, I don't provide women's health primary care anymore so I don't do like pap smears of people's houses, that kind of thing. Can you yeah you probably can is that best practice, I don't think so. You know so I have partnerships with some of the local gyn practices and things like that where we refer out for that. So there's stuff like that to that just like from a patient comfort standpoint, you know, doing doing public exams male or female. If I have to do that for any reason I bring somebody with me there's a nurse that comes along with me right. Yeah, so we don't spontaneously just like oh I have this thing, like, that's a, you know that's a protection line for patient and for for me then I will schedule a visit and come back and I will bring, you know, a third party with me. So there's things like that you can do. If anyone's thinking about going into this they want to talk about it you know I'm happy to talk about more details off off the screen but people emailing you about this kind of stuff. Yeah. Okay her emails below. Absolutely. Email our phone calls a phone call sometimes it's easier. He's on our phone all the time for work that's part of our model so don't feel bad. I would know that actually that brings up an interesting point because if somebody, you know I spent 20 minutes with them in primary care, as you're walking out there's always an oh by the way this happened, you know about that. And so they say like by the way I have a rash on my penis I have you know, I think there's a war blah blah blah I have absolutely no problem pulling in a nurse having a chaperone and just doing it. Exactly. I think that needs to be kind of more premeditated because you can't do intimate exam with just you. And so you know that's why, again, if you think through some of these scenarios that once you do this long enough there's a lot of scenarios you think through, like how am I going to handle that how am I going to handle that and how am I going to handle that. And if you know you can't pre plan for all of it but if you talk to providers who are doing what you want to do they are where you want to be. There's a lot of insight, and then after you know you kind of do as best as you can without lining that model then you do along the way even simple stuff like when I started I didn't have anything in my new patient paperwork about pets. Okay, I did house calls, I never took it, you know, equipment to the house before this just wasn't something I did. I had a cat jump on my leather exam table portable exam table that I bring and scratch the heck out of the exam table. And so then it was like wait do I pay for that or does the patient pay for that or like that's uncomfortable how do we do with it. So I ended up covering it my patient offered to pay for but I ended up covering that because I didn't have anything in my preparing for your house call outline that said could you please have your pets because either my equipment can get ruined or quite frankly your pets can get injured if they're in my bag with some of the stuff that's in my bag. It's not safe for them to consume those things or chew on those things so you know I had to put like add that in. And so you kind of learn on the fly with some of these things. Again that wasn't critical but it was just it's just a good example of like you prepare as much as you can. But like I didn't think a cat was going to jump on my exam table you know, so. You give me like one more example of growing pains where you just learn something that you just never would have thought of going into this field. Um, I don't know. Let's see that was a great example. The cat is probably my perfect example. I would, I would say. I guess the only other thing I hadn't thought of this isn't like as fun of an example but I'm glad that I have a portable exam table because you know for most people for doing a preventative exam and just checking their belly mainly for like aortic aneurysm or like masses, you know and noises. You don't necessarily need like a proper exam table like you're not doing an acute abdomen or you know something I thought like okay we could probably use a couch, but interestingly enough not everybody has a full size couch. They don't have the space for it or for whatever reason. And so, you know just making sure that you have equipment so that you can accommodate people no matter what setting they're in. You know, making sure I have the right things that's been important having to bring like a sharps container with me, you know, just trying to think through some of these things that we just kind of have set up in the office. Yeah, maybe take for granted. Yeah, so, but that's also been, you know, that's also been good. Again, I think it just changes the way you think when you're an owner and you're, you know, you're on the go but yeah. I'm not sure if that answered your question. Oh, it did. I mean, it's just like stuff that you don't think about like I could just see you trying to do a full abdominal exam but someone like cramped into like a love seat like bent over like this and you're like elicit and trying to push. So it's just it's little stuff that just makes a big difference. It's just. Yeah, yeah, it's really interesting or not having my, not having my otoscope charged. You know that happened one time I went to turn it and you can just like go down the hall and grab a different time. Yeah, and you can't just like go across the hall and grab the one across. So you have to think a little bit better you got to have systems in place like make sure you're trying to think thing. So then I'm like, okay, I got to go plug this into the wall when we talk for the next five minutes that's kind of unprofessional, you know, so some of these kind of growing pains I've learned along the way or remembering what to bring so I like one time at the beginning I didn't have like the ear lavage kit to get out like serum and impaction stuff like a blocked ear with ear wax. So on a preventative exam well that means then I got to come back and schedule another visit take another hour this person's time to like come back to their house. So some of these things like okay I just need to keep that with me at all times you know some things like procedures I'm not just going to like carry around with me. But something simple like that as far as office equipment. You know, instead of leaving that at the office I bring it with me every time now you know, so. If you ever use an alligator force up. Okay, so you know about those. Mm hmm. Yeah, it's like the best kept secret people just like spray the crap out of this hard wax that just won't come out where you could literally just reach in and just thinking about it. Yeah, they're a little, they make you a little bit they make me a little bit more nervous as a provider just like now wanting to get close to the to panic memory. But once you do them enough. Once you do enough Europe, you're okay. Yeah, I like it or force ups are great I think I got good use out of this in the ER. Oh my bad taking stuff out of people's ears and noses and stuff. No it is oh yeah. I just push it came with like a little endoscope because trying to like at the same time is just really difficult. Yes, if people have big ears it's nice and easy. Yes, exactly, exactly. All right, so I think we actually, I think we actually covered most of my question list organically. Okay, amazing you're just you're such a good like presenter and you're so passionate and knowledgeable about everything it just kind of flowed out of you which is just it's fantastic. Thank you. You know it's it wasn't like pulling teeth like you just know your stuff and you just like already with examples. You're such an easy interview it's not even funny I didn't do anything. Thank you. I love what I'm doing I love that I found this it's right. It's been such a gift I think for my family because I was out of crux where it was like, do I have to give up my career. Right. I had to totally on shoes. One thing that I love to choose something else that I love and I just didn't want to do that. And I think, I think a lot of people end up in that situation for one or another. It's a fair choice for us as providers so we've given our lives to spend a lot of money to get where we are. And I, and I, that's one of the disdains I have with the current system is that it's really hard for private practices to survive. And they provided different option. Again, not that there's anything bad with, you know, the corporate run practices, they serve me really well for a lot of years. It's a private practice. And that became not an option in my area. And so then now I have direct primary care. You know there's a lot of other stuff you can do you can be a telehealth provider now you can moonlight at you know a lot of these practices, but it's different than primary care. You don't see people just it's a different continuity of care, you know, and not having that longitudinal relationship with people. And I think for those of us that end up in primary care like you value that and we like that. And it's one of the things that makes us stick. It was one of the things that made me come back to it after, you know, leaving working in the era for a while, which is very transactional. You know, primary care is not so transactional. And I think that's why personally why one of the main reasons why I like direct primary care is it's not transactional medicine. This is more of like a long term personal. This is personalized healthcare. I know about their life a lot more because every time we talk I have 30 minutes to an hour should we need it, we don't always need it or two. Yeah, but I actually know my people. Yeah. And so one of the stats that I learned that also I didn't know again you can hear this recurrent theme of like I learned a lot about the system I was a part of once I got out of it. Because you're just like in such a dogfight when you're like trying to survive every day. But the average time and I think this is based on physicians but exchangeable in this sense, the average face to face time with your patients like seven to eight minutes. That's alarming. That's alarming. Yeah. And so what are we doing as a system, thinking that we're going to help people's chronic disease when we have seven minutes, like you can barely say like hey, how's your left toe feeling and describe how that pain feels in seven minutes. You know what I mean, and get through their med list. Maybe if your nurse, you know, luckily in that system the nurse usually helps you but oftentimes as providers we're verifying a bunch of information. And so, you know, yeah, when you get these people with complex disease and they've got multiple, you know, multiple different conditions it's like, I'm sorry you're gonna have to come back up you're gonna have to come back guess what that's more PTO for them that's another day of, you know, it's not a realistic ask of us as a healthcare, like not us as providers but as a system that's not a realistic ask that these people are actually going to be healthy and improve in their diseases when we don't have time to educate them. We don't have we just don't have time period the end we don't have time. And that's, that's not the provider's fault it's the system's fault, because the payers are cutting reimbursement. And that means in order to make the budget we have to see high volume. And so it's this like the term in the world that I'm in now is there's misaligned financial incentives. Right. And so, now we're incentivized to see high volume. And they're trying to change the paradigm back to quality. Right they're trying to like shift that. As long as the insurance companies are dictating how much we get paid for our quality, or our volume, the providers and the patients are never going to be the ones deciding what that model looks like. And so that's disappointing because a lot of people in medicine, we don't get that until we've been practicing a while. We understand the game very well. And so this has been refreshing to not just feel upset about that or jaded about that, but to be able to do something to fix it. And to actually provide another solution right now in real time, like thinking that we can provide a solution for like the entire US healthcare system is like paralyzing. But thinking like I can fix this in my community and how I engage with my patients. That's incredibly empowering. And the fact that all of us in primary care could do that if we wanted to is really empowering. You know, like could we change the face of healthcare in our country if primary care shifted to a different payment model that put our patients as the primary payers. And not an insurance company, right. And so that that is essentially what direct primary care does if they don't feel like they're getting a good service, they leave. Right. And so we can't really do that as providers, you know, getting paid by an insurance company for our patient care, we can't just be like by anthem we don't like the way you do prior us like your company will go under you know what I mean and so you're kind of handcuffed a little bit on as a practice because your payment model is fixed and you don't have a choice in that really. So, I'm all about patient choice and provider choice and I think competition in a market is good. And I think there's a lot of different people with a lot of different needs and the more options we can provide for people to access healthcare it's better for everybody. It's better for providers because we have choice it's better for patients because they have choice. Quite frankly insurance companies save money on the patients I see because I take care of them outside of their payment model. Right. And so they don't even get any claims for these people, essentially for the entire year unless it's a medication. So it's actually somewhat beneficial for the insurance companies. And for those that can afford to be insured so I don't know pretty just like interesting high level thinking with style analysis. Yeah, it's, it's, it's important because the impact we're making an individual lives is undeniable as healthcare providers, you know doesn't matter what model we're in we're making one on one impact every single day. And I feel like the difference with what I'm doing now is like, I'm able to make a community difference. I'm able to make a difference in this sector of the population or this underserved group or, you know, so it's different and then if we're able to do that. As a bunch of direct primary care providers in our state or in our, you know, in our country, could we change the way that people engage with their own health, and actually become healthier. You know, amazing. And while also being able to spend time with your family and have like a much better connection with your patients and just all that stuff that we still make money right at the end of the day like we have to make money. And so this model gives you a predictable income as long as you're doing a good job right and people stay. You gotta do a good job. People gotta like you kind of constantly got to be growing because there is some churn, you know with patients that are leaving for whatever reason they move out of state, a new job, whatever. So that is a little bit, no matter what practice you're in that's part of it. That's part of the business but, you know, still being able to make money but not having to become jaded in the process is invaluable. So, yeah, highly recommends if anyone wants to talk to me about it. Clearly, I don't have a problem talking about it. I think it's really exciting for everybody involved with patients and providers, especially. And it's called primary care. There's, there's a resource that maybe we should link to if any patients are listening to this or people want their, you know, families or their parents to become members that are direct primary care practice. DPC mapper is what it's called and it's kind of, it's a physician who owns a practice who kind of keeps like a Google Maps of all the DPC practices across the country. Yeah, and so you can find my practice on there and it's you can search any state so when I see people on social media contact me be like you're in Virginia where can I find one of these. DPC mapper.com or what is that? I think it's.com. That's a double check for you. But we can probably link to it. So that's a great resource and like I said, there's a lot of startup. Other other physicians, mainly physicians is mainly a physician led movement have written books about how to do this. They have checklist on things you have to do to start your practice. They break down the business side of things and so I'm happy to help if anybody's curious about this or wants to put it in their five or 10 year plan. You know some books that you can start reading some podcasts you can start listening to to kind of get familiar with the field because I definitely think we're going to continue to see growth shifting back towards private practice. And I'm definitely going to link that it's a mapper.dpcfront.com so just put the link across the screen so people can go there but yeah that's that's definitely a great thing. I hope we do get more people patients and providers kind of linked up with this model because it just is such an improvement for what we have. I just want to see if there's any question I possibly miss I know this has been going way longer so thank you so much for all your time. And hopefully this gives you some value as well some way down the line maybe a partnership with somebody. I don't know what it could open up to you customers you know patients. By the way, what's that what area of Virginia are you in. Yeah I'm in Winchester, Virginia. So it's about an hour and a half west of DC. Okay, you said Winchester, Northern Virginia. So Virginia, okay. Yeah, actually so a little bit away from the DMV area. It's outside the, the Russian the madness but close enough that we have lots of commuters. I'll hear you about orchards and vineyards and farms and yeah. I remember living there because I was there for a couple of years on JBab joint base and Acosta bowling. Okay. And we did actually have a lot of people who lived as far away as you and commuted into the city. 100%. Yeah. So questions that we may have missed. What exactly is concierge medicine we definitely talked about that. Did you give a quick elevator pitch I think I can definitely tease that out of everything that we talked about. I can give you one if you want to have done a lot. Anyway just so it's in the beginning. So can you please give a quick elevator pitch about what it is that you do. Here we are privately owned dark primary care practice called smarty pants medicine, and we provide concierge style medical care through telehealth and health call services for adults who want quick and convenient health care. So they can get their medical needs taken care of and get back to enjoying their life. Back of a pitch. Sounds good I would definitely sign up for that if I was in the Winchester Virginia area. Absolutely. Okay, and I think. Do you have an MD talked about this. What made you want to do this in the first place you definitely covered that one. Yeah, my little smarty pants kiddos. That's adorable so Jeff is the husband what's the kiddos names. Brooke and Bria Brooks my baby, she was the real she was the real catalyst I did a post on that and then Bria is my first daughter. Brooke was a miracle child. Yeah, absolutely and Bria is a miracle herself of course she's watching that. Yeah, yeah, we had secondary infertility which I didn't even know much about. So, you said secondary infertility. Yes we had Bria on our own without any assist medical assistance and then multiple years and developed unexplained infertility which is called secondary infertility. So, yeah, never knew that was the thing but it is. So, if anybody wants to follow us Kelly story about that definitely follow her on Instagram she talks about it at length. Okay, so Kelly. And then we go into the rest of the interview. It's so weird doing that at the end. Good for you man that's this is awesome that you're doing this this is on one of my, this is on my five year list is to do. Yeah, I want to I want to write a book. I want to write a book about this experience. I want to, I don't know if I want to host a I think I want to host a podcast eventually like way down the line maybe I don't know what on yet my husband and I talked about doing one together. I'm not sure. And I really want to be a mentor for other PAs who want to do this. Because I think there are a lot of us, you know who chose PA intentionally like I did. And you probably could have chose to go to med school, you know or went that route but we chose this route and understanding that we have this as an option is super exciting. And I think if more people knew about it, more people be doing it. You know, I think it's just like a knowledge gap. And so there's that knowledge gap in the community they've never heard of direct primary care, I had never heard of direct primary care. But, especially as, you know as as a PA understanding that this is another option is something that I really want to, that's why I'm on your podcast. I want people to know, and now they have a choice another choice. You know, you keep trying to let you go but you keep bringing stuff up that I want to ask you about. Why did you decide to be a PA instead of going to medical school. Yeah, that's a good question and I knew in high school I wanted to go into medicine. I was I was a gymnast, and I thought I wanted to be an orthopedic surgeon. And then I actually didn't hear about the PA profession until I was a junior in college. And one of my, one of my colleagues in class had mentioned she was going to apply to PA school and I was like, what's that never heard of that. And I had never seen a PA, you know, I'm practice. And I think maybe I had any orthopedic offenses just not realized it hindsight but so she told me about it and I was like wow this sounds incredible there's like you can you can shift among fields which is one of the things I like about our profession mobility. Yeah, that's so cool about our profession. And so I learned about it I went and did a bunch of shadowing. And I think that's what actually secured it for me was I shadowed a bunch of physicians and I and orthopedic surgeons and I shadowed several PAs. I don't think I even knew like nurse practitioners existed that sounds so ridiculous, but I didn't know PAs existed at that point so I was just like this was so long ago. And all the physicians that I talked to said that they wouldn't that they wouldn't do it again. Not everyone but a, but a decent percentage. And when I talked to the PAs I didn't hear that same sentiment. And so like, you know we've talked about, you talked to the people who are where you want to be, and then you figure out how you're going to get there. So, you know, I wanted to be in a place where I loved what I was doing and I didn't have regrets about the field I went into and I heard that louder from the PAs. So that was a huge piece for me and then I think just being the person that I am and knowing that I value the family, and I didn't want to be working a 40 hour work week forever. I realized quickly that if I became an orthopedic surgeon that was not going to be a compatible lifestyle with what I wanted my family life to be. Being a PA gave me a better option of maybe being an ortho PA or maybe being, you know, having these different options to be able to pivot easier. And so, you know, then you have all those other added benefits like it's not so many years in school and it's not so expensive and my debt level wouldn't be high and I was hoping to have a family so it seems like a logical fit to me. But a big driver for me was the fact that PAs liked what they were doing. Yeah, and so that's pretty cool because I would say that that I still see that. I don't know. It'd be interesting if somebody did a job satisfaction comparing, you know, physician satisfaction PA and MP would be really interesting to see if that varies more by specialty or more by the role that we have. I don't know what the answer would be but it'd be really interesting. And I put the same thing, like a lot of doctors just told me like I kind of wish I was just like PA. Yeah, or maybe maybe I'm saying like I would tell my kids not to do this. Yeah, you know, that's really, that's disappointing. And that's telling and I don't know, you know, if it's always been like that and we were just young and so we never would have thought to ask those questions, or if it's because the healthcare model is shifted. And so it's become that way to where it's not as physician friendly. I don't know what the answer to that is either but yeah, that's what's so fun about what you're doing you could probably have on like a senior physician, who's been practicing since like before statins were available, and then like all the way to present day and like wow the change that they've seen. I mean my supervising physician would be on that list but he's a very unique guy so I'm not sure what he would say. But no, so like a lot of those are kind of up in the air like job satisfaction, you know what you could do X, Y and Z. But I think the biggest thing that we have in common why we both became PAs is family. You know you want to have a family you want to have some flexibility some time, which I feel like you could do more as a PA than as a physician. Yeah, I think, I think physicians have a lot more pressure from a lot of different angles. And it's not that they can't have a good quality of life to, but it is different. And I think it's easier for us to get out of our financial debt faster. And when you don't have financial pressure you have, we have more options. Exactly. You know, and so you have a bigger time investment before you even get started as a physician. And so we need both we definitely need both and I do wish. I wish the system was set up differently to encourage more physicians to go into primary care, because you know as much as I love our possession profession and we can't exist without the physicians we need them. They have knowledge we don't have no matter you know how independent how experienced we are they are changed differently than we are and we do need to collaborate I think, and we need we need them. And so I kind of wish that in like magic perfect world, there would be a way where like their loans would be repaid if they went into primary care for five years or you know some type of like a higher level system benefit to them maybe their med schools paid for based on where they practice or you know something that would encourage physicians because I wouldn't know anything without the physicians I worked with, you know, like you learn so much. So yeah, they're, they're huge. We all have our roles on the patient care team but I do wish that we were incentivizing more providers across all the fields to go into primary care I think if we did a better job at that we'd be preventing a lot of disease for our patients. You and I. Yeah. You know. All right, Kelly, man. Thank you so much for doing this this was awesome. All right I'm nervous to watch it. Why are you nervous to watch it. I don't know I hate watching video myself like my worst fear. Oh, sorry to subject you to two hours of it. But no I'm going to take it home I'm going to edit it I'm going to you know put it in this like just like the Shawna thing it's going to go into that really pretty background, if I can. So all that stuff is going to take me a while. Okay. It's going to be like a month or like one will come out. It's possible that I'm going to get it done this weekend. Oh, okay. It's also possible that I don't and then I have like weeks before I have time to get to it. So I'm going to try to just get it done like tonight or tomorrow. Cool. But if I can't then it might be a few weeks. Okay. You have kids. I do not I don't know I'm free as a bird which is fantastic. But like I said I still want a family and whatnot so I'm like hustling towards that. Yeah. My plan for that is to also spend lots of time with my kids if I ever have them. Yeah. So I'm like part-time by then but still making it off to have a good life and be part-time. Yep. Exactly. That's that's the best. I think. Yeah, I think you'll do it. You're already obviously an outside the box thinker and entrepreneurial and already running one Airbnb. I want three or four. These pictures behind me are a PA owned codex. Really? Yeah, I bought these from a PA online. She's on social media. They're awesome. Oh, that is cool. Yeah. You know there's a lot of PAs who are starting to my dad always says many streams make a river. Your dad's a smart man for income. Yep. And so that's always been our model too. So like real estate and you know just financial freedom is huge and it allows you the ability to design the life you want. So good for you having a podcast man. I hope it becomes an income stream for you. Hopefully even if it doesn't I enjoy it and then I get to meet cool people like you. I had like one follower. You'd be like, yeah, let's maybe do this in two years. But like I have enough to where you, you know, it makes it worthwhile for you because there's enough eyeballs. So it's open up. It's good for me too because it gives me content for social media, which is like the bane of my existence. That's probably that's probably like my thing. I hate the most about being in private practice is it's free advertising. It works. You know, so like you have to do it. So this kind of stuff is really helpful for me too. Because I'll be able to post some of the sound bites and then it gives me credibility. Like, oh, she's been on a few podcasts. That's cool. You know, a thousand subscriber, a little tiny podcast, but it might have like the other two. Some of the other ones I've been on have been way smaller than yours. So yeah, they're just people in my town that have started podcasts. And so I'm like, yeah, be on, you know, like I'll help them out. How does that hurt me to help them out? Like exactly. Yeah, so yeah, I'll send you a link to like the raw file so you can actually download it and clip it up as much as you need to. I don't even know how to do that man. But I'm excited. Maybe I can figure that out for you. Either way, send me some sound bites too. Can you like, are you going to use some sound bites on your social media? Oh yeah, I'm going to make out of this. I'm probably going to make like a hundred of them because there's so many. I'll be tired of hearing my own voice. Don't send me a hundred. Send me like, I'll send you a few. Absolutely. All right, Kelly. In your corner. Yeah. Let me know what you need. What's that? I said I'm in your corner. Let me know what you need for links or whatever. Hey, likewise. Absolutely. All right. Hi, thank you. I have your email, right? Yeah, I emailed you the link. Okay. If you sent send me any stuff. If you guys have any like protocols or like pamphlet stuff on your weight loss stuff. I like going to make all this stuff myself. So if you have any like page and handouts or that kind of stuff that you use for the weight loss that you're willing to share. I would really appreciate collaborating with those. Oh, sure. I won't like steal them word for word, but they just give me some content to run off of. Yeah. Look around and I can just share like I typed up my own, you know, just diet counseling that I made up myself. Yeah. So I can share that with you. I'll look at a. All of our other stuff. We have a lot of materials. Okay. Yeah. I'd appreciate that. That'd be awesome. Oh, and let me send you a picture of that thing. Yeah. Kelly at smart advanced medicine. That's, that's the one. Got it. Yeah, I'll go through that right now. All right, dude. Thanks so much. Thank you. Have a great day. See you.