The DPC NP
Redefining Patient Care: Alesha Logan's Journey to a Compassionate Direct Primary Care Practice
Have you ever wondered what it takes to break free from traditional healthcare and pioneer a clinic centered around true patient care? Join us as Alesha Logan, DNP takes us through her transformation from a critical care nurse to a trailblazer in the Direct Primary Care (DPC) world. With a heart for service and an entrepreneurial spirit, Alesha unveils the ups and downs of launching her own DPC clinic, emphasizing the human touch in medicine and how faith helped her navigate the tumultuous seas of a global pandemic.
This episode is a treasure trove of insights on innovation in healthcare, as Alesha and I swap stories about the unconventional yet effective practice of bartering medical services. From website development to team incentives, we share the creative strategies that have fueled the growth of our clinics. The dialogue shifts to the nuts and bolts of managing a DPC practice, balancing patient care with business acumen, and the importance of establishing boundaries for a sustainable work-life harmony.
As we wrap up, the conversation takes a deep dive into the realm of integrative medicine within DPC clinics. Alesha and I dissect the delicate balance between traditional services and the rising demand for holistic treatment options, from vitamin D to alternative approaches for chronic conditions like migraines. We underscore the critical need for healthcare practitioners to expand their knowledge beyond the scope of pharmaceuticals, and how embracing natural remedies can be both a professional and personal revelation. This episode isn't just a peek behind the curtain; it's a call to action for a healthcare revolution—one where patients and natural treatments are at the forefront.
Thank you for joining us today!
Be sure to follow and share, and leave a review!
If you have questions, comments or want to be part of our community, follow us on Facebook at The DPC NP!
Have you ever wondered what it takes to break free from traditional healthcare and pioneer a clinic centered around true patient care? Join us as Alesha Logan, DNP takes us through her transformation from a critical care nurse to a trailblazer in the Direct Primary Care (DPC) world. With a heart for service and an entrepreneurial spirit, Alesha unveils the ups and downs of launching her own DPC clinic, emphasizing the human touch in medicine and how faith helped her navigate the tumultuous seas of a global pandemic.
This episode is a treasure trove of insights on innovation in healthcare, as Alesha and I swap stories about the unconventional yet effective practice of bartering medical services. From website development to team incentives, we share the creative strategies that have fueled the growth of our clinics. The dialogue shifts to the nuts and bolts of managing a DPC practice, balancing patient care with business acumen, and the importance of establishing boundaries for a sustainable work-life harmony.
As we wrap up, the conversation takes a deep dive into the realm of integrative medicine within DPC clinics. Alesha and I dissect the delicate balance between traditional services and the rising demand for holistic treatment options, from vitamin D to alternative approaches for chronic conditions like migraines. We underscore the critical need for healthcare practitioners to expand their knowledge beyond the scope of pharmaceuticals, and how embracing natural remedies can be both a professional and personal revelation. This episode isn't just a peek behind the curtain; it's a call to action for a healthcare revolution—one where patients and natural treatments are at the forefront.
Thank you for joining us today!
Be sure to follow and share, and leave a review!
If you have questions, comments or want to be part of our community, follow us on Facebook at The DPC NP!
Welcome to the DPCNP. I'm your host, amanda Price, family nurse practitioner with two decades of experience, including 16 years as a business owner. Hey everybody, and welcome to the DPCNP. Today I have the pleasure of interviewing Alicia Logan DNP, from North Carolina. Welcome to the show, alicia. Thank you so much for having me. Well, you are welcome. I'm so excited to talk to you today. Why don't you just start off by letting us know how did you get into nursing?
Speaker 2:Wow, so let's see, many moons ago I actually started out as a critical care nurse. That was always something that I knew I wanted to do. I think if you were to ask my family, they probably saw the writing on the wall from an early age. I think that's probably true for most of us. But I started out as a CNA in high school and realized that that was not going to be a long, lasting career. Cnas do so much hard work they really do and I knew that I wanted to provide a more broader sense of care to patients, and so I decided I was going to go back to nursing school, and so my journey started. I stair-stepped my way through nursing, like so many people do. I did an associate degree and practiced for a little while, and then went back and did a bachelor's degree and then, ultimately, my master's degree while I was working in critical care along the way Awesome.
Speaker 1:So you worked in critical care and then when did you decide to go back to nurse practitioner school?
Speaker 2:So I would say probably three years in to my nursing career I was working in the ICU, I had been promoted to rapid response and then charge nurse and then I ended up doing some work in administration and kind of you know, had my feels for the hospital side of things and realized that I could probably be of better service to patients if I could keep them out of the hospital altogether.
Speaker 2:And so that's when I started looking and toying around with the idea of going back to school to become a nurse practitioner. Fortunately, I worked alongside another critical care nurse who was like minded and she had ambitions of becoming a physician, and so the two of us worked night shift together. We both were studying in preparation for our advanced careers. He's now a maternal fetal medicine physician and I'm a nurse practitioner. So we look back on those days, finally thinking oh man, we would have never thought in a million years we'd be doing what we're doing now. But three years in is kind of when I got the itch that there was more out there for me.
Speaker 1:And then so how long did you work as a nurse practitioner before you opened up your own clinic? Oh, I got to do the math.
Speaker 2:Let's see six and a half seven years before I opened my own clinic. Yeah, so 2021 is when we opened our doors, so at that time I've been practicing about six and a half years.
Speaker 1:Oh wow. So you went straight to opening up a DPC clinic. You didn't open up an insurance-based clinic first.
Speaker 2:I did not. No, I actually I know at some point we'll probably talk about this, but when I thought about the reasonings for opening up my clinic and what I wanted to do and what I wanted this to be and the thing that I liked and disliked about the role that I had inside of the hospital organization, insurance was the number one reason why I wanted to leave in the first place. So I never, not for one second thought I was going to take insurance. In fact, I opted out of the insurances early on and I remember calling the credentialer at the hospital like you make sure you're taking me off all those panels, she's like are you sure you might want to come back, you might want to moonlight.
Speaker 2:I'm like no, I am positive, I want no parts of this. So anyway, no, that was never thought in my mind that I was going to take insurance.
Speaker 1:How did you know about DPC? I didn't.
Speaker 2:I did not. I knew what I wanted to do. I didn't know that it had a name attached to it. I knew I, through research, understood what DPC is and that there was a name for this model that I envisioned. But I knew I did not want to deal with insurance and there had to be a way to deliver care in a way outside of the insurance system. And I was watching old conferences, old DPC conferences, and came on YouTube actually and came across a conference from a few years ago and thought, oh, there's a name for this, this is a thing and it's called direct primary care.
Speaker 2:A little bit just about my testimony I say this actually upfront, and so it'll provide context to the other things I'm about to say is I'm a believer, and so what that means is I'm not just a Christian, I actually read and believe the Bible and I actually apply it to my everyday life. I do believe that we have a God that still speaks to us. I believe if we quiet ourselves and we can listen, he'll give us direction and guidance. And so I don't make many decisions. I try not to make many decisions, I should say, without his guidance first, and so he actually threw a fast that our church was doing, the Lord actually spoke to me and told me that he wanted me to open up a clinic.
Speaker 2:This was in the middle of a pandemic, early 2021. At that time, I was working in a hospital organization-based primary care clinic and I had the title of medical director for advanced practice providers. Now, you know, they throw titles at you. That meant I probably had a panel and went to more meetings than everybody else. Right, for what it was worth. At that time, I thought that I was really being instrumental in shaping the way that hospital organizations and primary care namely was taking care of the pandemic. I was at the fore to telemedicine within our organization and looking at all the community statistics and figuring out how we were going to triage patients and bring people in all the things. And so I thought, man, we've got a chance here to really rise to the occasion and do something amazing. And what I realized is I was sadly mistaken.
Speaker 2:That was not the way that our organization, or many organizations for that matter, were handling the pandemic response, and so open my eyes to a lot of things and I'll spare all the details. But I knew that there needed to be a place for people to go outside of the hospital system because, by and large, hospitals are organizations that are government and payer affiliated and they're largely shaped by the policies of those particular organizations. And so when I made a suggestion for an example, you know, hey, can we do this for patients? You know I've got patients that are chronic asthmatics and you know they're at home and they need to be seen, and everybody was being turned away. I think everybody was kind of in a bit of a panic frenzy during the pandemic.
Speaker 2:So, like many others it really was, the start to my entrepreneurial journey is just living and walking through that entire pandemic response and feeling disheartened at the way that my colleagues and I mean I'm not being specific, I think this is broadly true of most healthcare professionals how we really succumbed to the anxiety and the fear that was plaguing our nation at that time.
Speaker 2:And so I had an opportunity to open up my own clinic at the leading and following of the Lord, and we did so. We opened and within three months I treated a hundred and some people for COVID. Within a few months, I mean, the people were coming out the woodworks, yes. So I was so grateful. I didn't know that's not what I thought that I would be doing up front. I just I didn't even know that was a need. But I realized there was lots of evidence-based treatment that was being overlooked and that people were very anxious to find, and so we had an amazing first quarter, really primarily due to the fact that so many people were being affected by COVID. So that's how we got our initial start.
Speaker 1:And so you were able to build your patient panel pretty quickly, since you opened right in the heat of the pandemic.
Speaker 2:I did so I had an existing panel. I had a non-compete clause, and so those have since now been dissolved. But I had a non-compete clause at that time and so I was forbidden from directly marketing or promoting myself to my existing panel. But some of them did find me and so they followed me over. So I started out with not many, I would say a couple dozen patients. I only worked part-time in that clinic. I actually teach full-time. So I had a couple dozen that pre-registered before my clinic opened and then during the first parts of the pandemic, many of those patients that I saw treated for one-time visits, acute visits. They were converting over into memberships because they just appreciated the care that they received, and so we had very steady growth during that first part of the pandemic?
Speaker 1:Yeah, so your clinic is only open part-time? Is that what I'm understanding?
Speaker 2:Well, no, not entirely no. So I mean we, we want a full-time practice. I have support staff that helps have clinic days, so I have days where I'm actually, you know, scheduled to see patients in the clinic and then in between then I have a nurse that helps with triage and, you know, messages and refills and that kind of thing. So we're doing business five days a week. I'm not always in the clinic going to see patients five days a week.
Speaker 1:Okay, well, we'll get to your teaching job in a minute, and one of my questions was going to be about staff in the office and everything.
Speaker 2:So let's now that you've opened that, listened to you, know and many others describe you know very lean models for direct primary care where someone essentially is a solo provider or a micro practice and they are the end all be all, they do all things.
Speaker 2:But for me, just touching a little bit on like the work home life balance, that was not feasible.
Speaker 2:And I had worked very successfully in models that used a team-based approach and so I was also uncomfortable in being kind of the everything. So I didn't want to take care of the patient and then turn around and have a question with them about their bill and that just felt very awkward to me. I just thought I just don't, I don't, I shouldn't be the one, and you know, I felt like, respectfully and professionally, there needed to be that line of delineation. So, in saying that I knew minimally, I needed somebody to have those conversations and probably to answer the phones too, so that I could focus on the things that only I could do. So I'm really big on height of licensure and scope of practice and using everybody to the fullest potential possible, and that's been drilled in me from some of my administrative background. So I believe that I should do the things that only I can do and that the things that somebody else can do, they should do them, and so I started out with a front office assistant, probably from day one.
Speaker 2:Fortunately and this is something that I would say is a clinical pearl or practice pearl for folks is leverage, the fact that you can barter services. So if I had a I guess, a gift to the DPC community, it would be my ability to barter services. I have bartered so many different things and I think that I think people need to figure out how to leverage that to their advantage. But I bartered my website, and the gentleman that developed my website actually developed our church's website, so it was a professional, high quality. I encourage you to go out there and look at it, call the listeners and see. And so I didn't have to pay for that. I bartered for that Same thing with administrative help.
Speaker 2:People need healthcare. You provide a service. You come up with an arrangement that works, and so I started out with having just a front office receptionist or assistant, and then, about I would say, 50 to 100 patients in. I realized I don't want to room the patient, do the vital signs, bring them in, go, do all those things, because it's making my visits take a little longer than anticipated, and I also felt like there were other things that I could be doing, like helping to grow the business, and so I brought in a medical assistant and I found one.
Speaker 2:Actually, she's amazing she's not with me anymore, but during that time she was an asset to us. She actually agreed to take a graduated pay raise, so she started out on one salary and then, as our patients grew, I incentivized her to help and I increased her salary along with that, and so she was phenomenal. And I would say another kind of practice, pearl is to get your team involved in the growth of your practice, so incentivize them. We often think patients bring referrals in and they do, but so does your team, and so she was instrumental in doing that. And then later on down the road, I ended up actually bringing in an RN just for the scope and being able to do more things.
Speaker 1:So are you the only nurse practitioner in your clinic? I was until Monday. Oh, you hired a new provider.
Speaker 2:I did and I kind of so two. Actually I taught another practice pearl is to precept. It's a wonderful way to kind of vet and train and mentor new providers and get them acclimated to your practice. So last year I've had two that floated through our practice and then they came on board just this Monday.
Speaker 1:What is their goal for the number of patients that you would ideally like them to have?
Speaker 2:Yeah. So we've kind of established goals somewhere between four to 600 is probably where they'll be, and then I will be backing down and taking on more of that administrative role and kind of helping to expand the practice. And I have more nurse practitioners that I'm training and so that'll be kind of their sweet spot. I told them we can see what it feels like at 400, to see if it feels like they can. I say that you know it's an arbitrary number, but they may get there and decide that I want to hold here at 450.
Speaker 1:So what is their pay structure look like? Do you pay them a percentage of every membership, or are you paying them a base salary? What does that look like?
Speaker 2:Yeah, so that's interesting Cause I just kind of took a long time to come up with this.
Speaker 1:I listened to your podcast and I did I do the Monica McKitterick model Right? I was going to say that.
Speaker 2:Thank you, Monica Shout out to Monica. Monica's got a fascinating model, and then I listened to some other folks.
Speaker 2:So I kind of did a and another gentleman we know, brian, has an interesting model, so kind of men in the middle, and so we basically have a tiered approach, so based off of the number of patients. So from zero to 200 patients, this is your base. From two to 400, you move up to the next tier here's your base. And then from four to 600, you get this base and then after 600 patients, then we reevaluate. I mean they essentially can make over $115,000 plus commission. So I say that because as a business owner I realize there's going to be some sort of loss that you absorb until they build their panels up. On the other side of things, it incentivizes them to grow their panels because now they realize they've got another tier or marker to reach, they're not stagnated, because they realize if I want to move up in salary I need to actually move up in patients, and so they're very involved in that.
Speaker 1:Do you plan on sharing the weekend call with them? What does that look like?
Speaker 2:Yes, we absolutely do. So I don't get very much weekend call. Let me just say that, Say, in a month we probably get two, maybe three weekend calls. We have Spruce set up and Spruce has an autoresponder built into it and so we've got all that in place. So as far as, like you know, after hours things, our system is pretty robust in that it triages and handles a lot of that automatically, and if it bypasses and reaches to me then I'll address it. But those are few and far between maybe two to three a month.
Speaker 1:Is that because when you originally started telling people about your DPC clinic that you drew boundaries really well? Or is it just naturally that they are respecting your privacy? Or did you have to go mama bear on them and say don't reach out to me on the weekends unless it's an emergency? How did you do that? Because that is not the case for me, oh my gosh.
Speaker 2:So well, you know what I would say. I have a fabulous patient panel that is probably more health and wellness minded. They're not a very or high acuity patient panel. So I don't have very many after hours emergencies that I mean. I say emergencies in the sense of triage, you know, like they're not. You know, blood pressure is just 300. I need you to tell me to go to the ER, kind of thing. I think it has a lot to do with our patient population, quite honestly. And then we, you know our messaging is very clear, like if this is an emergency, of course here's, here are your resources. If it's not just reply urgent, I think it's also. People know that I have six kids and they probably feel bad to bother me. They know that I'm at home, so I'll tell them. If I'm messaging someone I'm like hey, I'm going to call you as soon as I get done putting this baby to sleep.
Speaker 1:So a little guilt tripping probably doesn't hurt either Good for you, maybe I need to just start letting my people know I got five kids.
Speaker 2:I know we were talking about that too. I'm like, I think, having you know I have six children and telling them that I think people are like I so hate to bother you, but so anyway, that's probably it more than anything.
Speaker 1:What kind of marketing tools are you going to use in order to help your other nurse practitioners build up their clientele?
Speaker 2:Oh yeah, I actually just went through a marketing workshop, still finishing it up. So we rely heavily on community events. So we do those almost monthly, some sort of workshop, seminar fair. So we do those almost monthly, some sort of workshop, seminar, fair, expo kind of thing. We set up a table and tell people who we are and so we're very much, you know, trying to get out in the community for social media, and so there's some ways to do that.
Speaker 2:Social media is not a huge referral source for us. A lot of, most I would say, of our referrals come through word of mouth and you know those inner circles. So I have a heavy presence in our church and so our nurse practitioners one of them does as well in her respective church. So we were kind of brainstorming to come up with creative ways to kind of appeal to that audience, because people are looking for and respect the fact that they have, like minded caregivers and so I think having that commonality helps as well. So you know, so word of mouth, of course, referrals. You know churches and you know I do health events and wellness events at churches and then, of course, all the usual things like, you know, the chamber of commerce and networking in that way as well.
Speaker 1:Are you the only DPC clinic in your area? I?
Speaker 2:am not. So there is another DPC clinic about 15 minutes away from me. He is full. He's been at this a lot longer than I have. He's a physician, so he's been doing this a while and his panel is at capacity and he has attrition. So you know, but he actually he's very. Let me just say this too he's amazing. He actually allowed me to come and shadow him multiple times. He is a supporter and a believer and he has an excellent office manager. Shout out, melissa, she's amazing. I could text them. If I have a question. He'll send me his lab resources. I mean, it's just, I've been very blessed in that way where I just have a great support team around me and he's not exclusive. There's other resources I have, but he's the closest one probably there, and I say that. And then last year another DPC opened, but I was, I was first, so they're they're like five minutes up the road. Well, that.
Speaker 1:That just tells me, though, that your community knows what DPC is Like. You're not starting off this brand new idea amongst fee-for-service clinics, and you're trying to get people to buy into your idea and what's going on. So you have to train patients from the get-go that, no, you're not wasting your money by paying a membership on top of your insurance, that this is going to be a value and an asset. The people in your community already recognize that, because they have options. Absolutely, absolutely. Does your state require a collaborating physician? It? Does North Carolina state require a collaborating physician?
Speaker 2:It does, I mean North Carolina does require a collaborating physician, so I have one of those. Another practice, pearl, is, if you anticipate that you may at some point develop or establish an entrepreneurial endeavor, I encourage you to kind of put little feelers out there to the physicians that you work with. I mean, they know you the best, and so that's what I did. Actually, she's a friend, so it doesn't really count. I mean, she became my friend, but she started as my coworker. She does it for me pro bono, I don't have to pay her anything, wow. So it's amazing.
Speaker 2:And you know, what's interesting is, though, as an aside, the actual physician that the hospital system assigned as my collaborator was more apprehensive about doing it, and we worked so closely together. So sometimes it doesn't work out that way. I say that to say, but I always encourage folks like looking like you know your networks, the collaborative physician I had prior when I was in Indiana I'm from Indiana Originally we went to church together. We wanted to, you know so. So, yeah, you, yeah, you've got circles and that you can tap into resources there. But yeah, I have one. Yes, I don't have to pay her anything.
Speaker 1:That's amazing and that is such a blessing, because collaborating physicians can be extremely expensive. You have to really find a good one that's willing to understand that your clientele is a whole lot less than it would be if you were seeing 20 to 25 patients every day, and that that should reflect how much it should cost you each month.
Speaker 2:Absolutely yeah, and I know that there are many companies that help with that, that help providers to find collaborators. You know, and I'm not knocking anyone, you got to do what you got to do. But certainly as a startup business, that's a huge overhead, a huge expense right away if you have to pay somebody before you even build your panel up.
Speaker 1:Yes, Speaking of huge expenses, malpractice insurance is a huge expense and I meant to go back and ask you for the two nurse practitioners that are starting in your clinic. Are you covering their malpractice or are you requiring that they have their own policy?
Speaker 2:I am. I am hiring them as W-2 employees and I am covering their malpractice. My collaborator covers me, but I have found collaborators for them cover that fee as well. Awesome, oh well, how much does that be?
Speaker 1:You're not going to believe this, and if you say pro bono, I'm going to die.
Speaker 2:No, almost, it's like both of them. I'm going to end up paying $400 a month for both of them. What I'm going to tell you? Something I told y'all I'm a believer. The Lord led me to this person that is agreeing to do this. I'm a believer. I walk by faith.
Speaker 2:One thing I didn't share is when I left the hospital-based primary care clinic to open my practice, I knew I wanted a brick and mortar space. I know some people will start out with mobile or telemedicine or what have you, but I knew I did not want to go into people's homes and there's certainly nothing wrong with those that do. I have had experience doing that. That just was not something that my husband and I felt safe with, so we did not go that route. So I knew I needed a physical location and I started out looking, and if you're looking for a space, sometimes chiropractors are a great fit. They usually have an extra room they can lease out to you. That didn't work out so well for me only because we couldn't come to an agreement with price, and so it was like my last day and I did not have a place to go and I was like Lord.
Speaker 1:Where am I?
Speaker 2:Where am I going? And so I get on the internet, start searching, found a realtor. He chose me a space.
Speaker 2:He had a little office plaza and he goes yeah, you want to look at this one, and I was like I'm not really that interested. He's like I've got a great space for you. There's a physician in there. He's internal medicine. He's about to retire. He just signed this lease. He's only been in here two years. He's got three more years left. He's about to break this lease because he's got to go take care of his health and so you might want to go talk to him.
Speaker 2:So the realtor property manager introduces me to this internal medicine physician and he's like hey and his wife's his office manager and they're so nice. And he's like what are you doing? I worked for MDVIP, which is a concierge service, so he had a concierge style practice. So he understood DPC and that model. We were talking and they were amazing. He goes. You know what he said I think this would work out for you and I said great. And so I say how much is it? And they tell me how much it is. I go no way, I can't afford that. There's no way I can afford that. And so, fast forward.
Speaker 2:I ended up taking, assuming his lease and taking over that practice. Of course I didn't keep any of the patients. They all were a part of that MDVIP. They left but he sold all of the equipment. So exam tables, computers, 2,300 square feet worth of equipment, you know, office furniture, desks, ekg machines, audiometers, otoscopes, I mean all the things. He sold me everything for a dollar.
Speaker 2:I stepped into a fully furnished 2,300 square foot space. I actually got my first three months of rent or lease for free and then, because I still couldn't afford it, I negotiated a graduated lease thereafter until I could kind of get some wind up under me and get going. So there are very creative ways and that's the favor of God. I will say that that's the absolute favor of God. But I have relatives and friends that are very skilled at the art of negotiation and real estate and so they were able to help me kind of come up with something that worked for me, because that's such an overwhelming expense In addition to the collaborative position is like the brick and mortar space, but for me it helped really to provide me some footing while we got it going. Wow.
Speaker 1:That's amazing. And is that the clinic you're sitting in right now? No, this is my home office, what With that pretty brick wall in the back.
Speaker 2:It's so pretty, thank you, my husband did that. Thank you so much, good job husband he did, he's amazing.
Speaker 1:And the flowers, it's a good touch, it's a nice touch. Okay, you mentioned that you use spruce. What EMR do you use?
Speaker 2:Elation. So I use the trifecta elation for my EHR spruce, for my messenger communication, and then I use Hint for membership and billing and invoices and all the payments.
Speaker 1:Okay, I'm curious to know, because you're not the first person that I've talked to that uses multiple programs to meet their needs. Why does someone do that? The only reason I ask is because I don't know. I am still using an EMR that I had a contract with when I was a fee-for-service clinic and I still have another year to go before I can entertain the idea of changing to an EMR that would be more conducive to DPC. But I was kind of hoping that there was this EMR that does all the things, but everybody seems to be using different things, so why do you have to do that? Is that because there isn't really an EMR out there that will do communications, memberships and charting?
Speaker 2:So I think the closest you'll get to it is probably the newly developed all in one. I do not know if it has anything as robust and as effective as spruce. Spruce really is a whole thing all in and of itself and it's hard to replicate, particularly with the enterprise plan that I'm on, where you can actually schedule messages, and that changes the game. So there is the ability to have a phone tree, but they also have the ability to do a message tree. So patients can, of course, call and press one, press two, press three, press four. But they can also text one, two, three or four and get auto responses that you pre-develop or pre-establish. In addition to that, we have the ability to simultaneously have multiple people looking at the same messages at the same time and assigning them or routing them. So it's almost its own little routing system, so to speak. So when a message comes in, we put it in a folder Think about it like an email, if you will, email system and then people are assigned to those folders. We have a refill folder, somebody, an appointment request folder, and you can, and then those staff members, those people that are responsible for those things, can easily, you know, address those things. So workflow, yes, then we have found it to be extremely helpful in communicating with patients and follow up.
Speaker 2:So if a patient comes into the office sick and I want to check on them in a few days, I will schedule a message that says hey, mrs Jones, how are you doing? And they think I'm amazing, like I just remembered everything. And I am, I am amazing, but I scheduled that message the day of the visit, nice, okay. So I did not know you could do that. That is, oh, yes, you can schedule reminders to yourself, called Mrs Jones, but you can also just post date a message to be released. So oftentimes if I'm working at night two, three in the morning I don't want patients to know I'm on there two, three in the morning, so I'll just schedule the message to go out the next morning. In that way I don't want them to think that you know, hey, she might be up, I probably am, but anyway, just during business hours. There's also, I guess, the professional appearance of messaging someone at two in the morning, right, so I will often schedule messages to go out that following day, nice.
Speaker 1:And for the record, people, she is up at two in the morning, probably feeding a baby, not mindlessly deciding to work.
Speaker 2:No, no, no, no, they keep me up. They're six months old, so I have twins.
Speaker 1:By the way, oh, I didn't realize it was twins.
Speaker 2:Yes, I have six month old twins.
Speaker 1:Yes, I knew there was the one baby, but there was actually two six month old twins. Yes, I knew there was the one baby, but there was actually two. Yes, you go girl, you are, you are the champion. Okay, elation, are you satisfied with it? Does it have?
Speaker 2:pros and cons.
Speaker 1:What's? What's the story with elation?
Speaker 2:So you know I will say I like it. I don't know if it's the best thing out there, cause I've never tried anything else. So let me just say that I'm used to Epic and it is no Epic in good ways and bad. You know I miss my dot phrases and you know it's got templates and the such and I've heard it's pretty. It is pretty intuitive in the sense of it doesn't take very long to figure out how to use it. But I would say I don't know that I've been very pleased. It's one of the more pricier ones. Certainly as you add more providers that cost goes up. So definitely cost is a factor.
Speaker 2:But I saw the feedback, I demoed it, I liked it. It integrated well with my billing system, hit and spruce. It also had the ability that was another thing. A lot of the other EHRs kind of a la carte, a lot of the other services, but everything was included with relations, so systems, internal, all those things that has a messenger. Many of the other EHRs don't have the ability to have a patient portal to message so you can message patients inside of Elation through the portal. So we use that feature as well. So I think there was all the things together and just kind of checked all the boxes.
Speaker 1:Okay, how did you come up with the fees that you were charging the patient for your memberships?
Speaker 2:So I had an actual worksheet, spreadsheet that I use in combination with market analysis and the DPC up the road for me. So he had prices set. I thought, okay, well he's been. Yeah, I kind of had a benchmark, so to speak, where to set things.
Speaker 1:I think that's a common way that we're all figuring out how to charge our patients is we're just calling or stalking the websites of the DPC clinics up the street.
Speaker 2:I mean, it's what I did.
Speaker 1:I did that to Brian, brian Fretwell. He's in Tennessee. I just stalked his website and I was like, oh okay, that looks like a great price and it's worked well. It really has. Have you gone up in your price since you originally I?
Speaker 2:have, and I'm also gone up in services and knowledge as well, so I have acquired some additional skill sets that my patients get to take advantage of. Yeah, so we got up a little bit about $6, not a lot, so.
Speaker 1:I noticed on your website that you have some different fees for different services, such as integrative medicine, and you're about to do a medical weight loss program. So did you get certified in functional medicine or integrative medicine?
Speaker 2:So I took a number of modules and courses and trainings in integrative medicine. Same thing with hormone treatment, bioidentical hormone replacement. I've been to several conferences and workshops and seminars. I can't even keep up, and I was in a training program for that.
Speaker 2:So, yes, and so, as I was acquiring this additional knowledge base, I thought it was helpful to know that there was a way to treat people outside of conventional medicine, that you could kind of offer them a deeper dive into their health. But I recognize that that wasn't mainstream, not everyone necessarily wanted it, but some people really wanted to invest in their health in that way, and so I offer those so that and I tell patients okay, you kind of reached the point where the conventional medicine can't take you any further. And I'll use for, I guess, practical sake and context sake, I'll use GERD heartburn as an example. We can try weight loss and we can try diet changes and avoiding spicy food and eliminating caffeine, and you're on a PPI. And then that's about the extent of what modern medicine can do for your GERD other than telling you to stay on a PPI for the rest of your life.
Speaker 2:I mean, that's what it boils down to. There's nothing structurally going on, and then functional medicine would take another step further and say, okay, let's do a gut health assessment, let's figure out what's going on. So some people wanted to kind of get to the root of it. They weren't satisfied with just take this protonics or take this PPI. Some people really wanted to figure out the root of their issues, and so those people were able to offer extended service to help them with that, and that's the reason why we have those multiple packages. Not everyone has the desire to do that, but it is a resource and some people come to us just for that.
Speaker 1:What does the conversation look like of the patients that have paid for DPC and then start asking you about more integrative style of medicine, but they are not paying for that? How do you handle that conversation?
Speaker 2:Great question comes up all the time. Well, all of our patients will benefit from our integrative approach, just because, because they're talking to me, that's who I am. So I'll give you an example migraines. All patients are going to get a holistic approach to migraines, including magnesium. Like I mean, like that's, that's just going to get a holistic approach to migraines, including magnesium. Like I mean, like that's, that's just going to be a part of what we offer them.
Speaker 2:However, if you kind of take a deeper dive, if a patient thinks that they might be exposed to mold, you know, when we're talking about their treatment plan, I'll say you know, I think there's a possibility these migraines could be caused by mold exposure. This isn't a test that most of your specialists or doctors are going to offer or ask you about. I'm confident, based off of our history, that there'd be some value in doing this and we have a plan that'll help you address it, treat it, work it up and deal with that. Here are the pros and cons and I'll give them, including the option of just seeing a neurologist. I mean, they have the option to just go the conventional route, but I think that in many cases, modern medicine has a limit. It can take you, but so far. And so that particular patient, when I presented them the options, oftentimes they're like well, I've seen neurology before, I don't want Botox, they don't have anything new up their sleeves, I've already been down that route. I'm very interested in going a different route.
Speaker 2:So I often find that patients that have kind of gone all the paths and done all the things that are kind of at the end of their ropes.
Speaker 2:It's a little bit easier to convince them to come on over to the integrative medicine package than patients that you know maybe have been pretty healthy and don't really see the value in that. But I will say, in terms of growth that particular package grows just as fast and steady as our DPC package because there's a trend I can see kind of the shift. People are abandoning more conventional mainstream appeal for every ill and kind of leaning more into holistic health. A nice little plug the university that I teach at full-time actually is in the process of starting a program to help train healthcare providers and professionals on how to integrate and provide this type of care in their day-to-day practice. And so I think that we're going to see that shift kind of across the nation that the people are kind of sick of just give me a pill for this. They really want to understand why they want the help with getting those resources.
Speaker 1:That's excellent that your university is getting ready to offer those classes, because, I agree with you, the shift is getting ready to offer those classes, because, I agree with you, the shift not just across the professional panel, but across America, like, just like you said, people are just wanting to get back to the basics, and 2020, I think, is where that shift happened, where it all changed. We recognized for the first time just how corrupt westernized medicine is, how controlled it is by big pharma, and we are not just minions walking around for you to play Russian roulette with. That's not what we're supposed to be doing here. We are supposed to keep the Hippocratic Oath and we're not doing that because there's too many providers and too many hospitals with their hands out, getting so many kickbacks from worthless treatment plans.
Speaker 2:Absolutely and along those lines, just speaking about this, I guess holistically and biblically, as a believer, I have to believe that God put cures in the earth. He created an earth and he created people here. He gave us everything we need plants, and he gave us fruits and all these things here, and so there is healing and treatments that exist in the earth. But in most of our training as nurse practitioners and the medical model as well, we're not even really trained on diet. There's so much attention given to medications and little attention. I think if you ask any physician, they probably had maybe a few weeks of nutrition, Certainly not the amount of time they spent learning how to give medication.
Speaker 2:It shouldn't be surprising that big pharma has risen to the occasion, so to speak, because they've been baited and encouraged to do so. And I think we've got to get back to the basics of helping people discover that, yeah, there's cures here in the earth for these things. Likewise, there is little profit on those things, right? So when you have the whole argument about evidence-based thing and it's like, yeah, there probably won't be any high-powered, randomized, controlled trials on the benefit of taking vitamin D Because I mean, who's profiting off of vitamin D, right? But when I tell you that that was probably one of the best treatments out there, available during the whole COVID era and still to this day vitamin D has been. There was lots of evidence out there, but people aren't making tons of money off of it. So that is probably the aha moment is you follow the dollar, as they say, and you start to realize why healthcare, our outcomes are so poor and why our system is so corrupt.
Speaker 1:Absolutely, and I'm so thankful for people out there like you that are recognizing that and are truly trying to be a benefit to their patients instead of just continuing to be part of the problem. Thank you, I appreciate that, yes, okay, tell me what is the biggest challenge that you have had in direct primary care? Have you had any challenges?
Speaker 2:Well, I would say lots of challenges. I don't have a business degree, so I'm used to taking care of patients. The business side of things can be overwhelming. I did absolutely hire a phenomenal accountant. We have a CFO, so she's amazing and she does far more than just numbers. She helps us to really run the business in the sense of making sure that we are an upstanding organization that has strong beliefs and foundations and we're practicing ethically and all of our dealings.
Speaker 2:And she's helped me through some difficult situations, including theft, and I don't know that I would have been able to navigate that, you know, without her assistance. So we had an internal audit who knew that that was a thing right. But she's got an accounting background so she knows and I'm just like thinking, oh, we're just discounting stuff and she goes oh no, that's called theft, the way that that is being handled, and you got to deal with that. And so, having support and knowing where your knowledge deficits are and how to lead, I think that, although obviously we practice as independent clinicians, we don't have to do everything. There's people out there that can help us and navigate through that journey. So that's been difficult.
Speaker 2:Also, it's made me more aware of my flaws and the sense of I'm like I'm too much of a people pleaser Like no, sometimes your personality can get in the way and there's a very specific mindset you have to have as a business owner, and oftentimes my experience is that, particularly as nurses, we're caregivers, we're compassionate, and so that doesn't always marry well. As an entrepreneur Like you, need to be compassionate, you need to be caring, but you also need to recognize that you're running a business, and one of the most profound things that my CFO said to me was this is a business, this is not a charity. That my CFO said to me was this is a business, this is not a charity, and so that really resonated with me, and I've had to keep that in mind. There's a place for people that can't afford a membership.
Speaker 2:I actually live or practice, I should say right around the corner from a health department, and I've had to direct people to the health department, not because I feel like it's bad or less than, but because my fee is very reasonable. I mean, it's a little more than a gym membership for many people, and that's just. I don't hassle as much about prices. I feel like my first year I was always running specials, discounting stuff. I don't do that so much anymore.
Speaker 2:My membership fees are what they are. We've actually we charge a little bit more for our registration fee finding that people would sign up and get a lot of value upfront and then cancel, and so when you market and bud prices, you kind of bank on people hanging on for a few months until you can break even, and so we've adjusted it the way we do things. So I think figuring out those things along the way it's been very informative, but at the same time I think that the challenge has been one that I've been willing to take and overcome, just because I do not I have no desire to go back to working for any other organization. I don't even know that I could. I know too much now.
Speaker 2:Yes, I know Once you are an entrepreneur, it's really hard to get back into being an employee again.
Speaker 1:Not that I would know, but I thought about it when I wasn't sure if I was going to open up DPC. I thought am I going to go work for somebody? What's going to happen to this clinic? So I'm so thankful that God got me on this journey, because I don't know if I would be a good employee.
Speaker 1:I might have been a really bad one. You know what. This has been a great interview. I'm so thankful for all the things that you've told us about, and I wish you all the best with your new employees and going forward and I'll talk to you soon.
Speaker 1:Appreciate you Bye-bye. Thank you so much for joining us today on the DPCNP. We hope you found our conversation insightful and informational. If you enjoyed today's episode, please consider subscribing to our podcast so that you do not miss an update, and don't forget to leave us a review. Your feedback means the world to us and it helps others discover our show. We love hearing from our listeners. Feel free to connect on our social media, share your thoughts, your suggestions and even topic ideas for future episodes. As we wrap up today, we are so grateful that you chose to spend a part of your life with us. Until next time, take care. This is Amanda Price signing off. See you on the next episode, thank you.