The DPC NP
Transforming Patient Care: Brian Fretwell’s Journey from Emergency Medicine to Direct Primary Care Innovation
Imagine stepping into the world of medicine not just to heal, but to transform the very fabric of healthcare. That's the story Brian Fretwell, Physician Assistant and founder of Direct Primary Care Associates, shares with us - a tale of shifting from the high-stakes arena of emergency medicine to pioneering a practice that puts patients and their needs first. Our conversation is a riveting journey through the challenges and triumphs of creating a care model that’s more personal, accessible, and liberated from the constraints of traditional insurance-based systems.
Crossing state lines isn't just for road trips—it's a professional hurdle for medical practitioners like Brian, who recounts the bureaucratic maze of obtaining licensure in Georgia. But the frustration is only half the story; the other half is rich with strategies for budding healthcare entrepreneurs. Brian imparts wisdom on growing a sustainable clinic, focusing on the delicate art of balancing patient numbers with quality care, and shares his secrets on achieving that all-important work-life harmony.
Wrapping up this episode, we bridge the gap between healthcare and entrepreneurship, diving into the unique aspects of running a Direct Primary Care clinic. From political action to smart hiring practices, we cover the gambit of what it takes to not just survive but thrive in this evolving landscape. Brian's dedication to his craft and his patients shines through as he talks about integrating pharmacies and offering additional services—always with an eye toward serving the community. Join us for an episode that’s as enlightening as it is heartening, with a guest whose passion for patient care knows no bounds.
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!
Imagine stepping into the world of medicine not just to heal, but to transform the very fabric of healthcare. That's the story Brian Fretwell, Physician Assistant and founder of Direct Primary Care Associates, shares with us - a tale of shifting from the high-stakes arena of emergency medicine to pioneering a practice that puts patients and their needs first. Our conversation is a riveting journey through the challenges and triumphs of creating a care model that’s more personal, accessible, and liberated from the constraints of traditional insurance-based systems.
Crossing state lines isn't just for road trips—it's a professional hurdle for medical practitioners like Brian, who recounts the bureaucratic maze of obtaining licensure in Georgia. But the frustration is only half the story; the other half is rich with strategies for budding healthcare entrepreneurs. Brian imparts wisdom on growing a sustainable clinic, focusing on the delicate art of balancing patient numbers with quality care, and shares his secrets on achieving that all-important work-life harmony.
Wrapping up this episode, we bridge the gap between healthcare and entrepreneurship, diving into the unique aspects of running a Direct Primary Care clinic. From political action to smart hiring practices, we cover the gambit of what it takes to not just survive but thrive in this evolving landscape. Brian's dedication to his craft and his patients shines through as he talks about integrating pharmacies and offering additional services—always with an eye toward serving the community. Join us for an episode that’s as enlightening as it is heartening, with a guest whose passion for patient care knows no bounds.
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 a wonderful guest talking to me today, brian Fretwell, a physician assistant in Tennessee. Brian, welcome to the show.
Speaker 2:Thank you so much, Amanda, for having me. I know it was a serendipitous route and surreptitious route to get here, but I appreciate the opportunity to talk with you and all your followers.
Speaker 1:Well, I'm so glad that we have finally been able to get together and meet. Let's talk about how did you get started in medicine?
Speaker 2:How I got started in medicine was probably really, really young. My mother was a nurse, an LPN, and was a nurse in the independent nursing home when I was a kid and she got to where she was cooking, cleaning, pretty much doing everything, and we didn't grow up with much. I went to work with mom a lot, so I kind of grew up a little bit in a nursing home. That makes sense. I got my mother's heart when it comes to that Thought. I wanted to be a physical therapist in high school but the army got ahold of me so I joined the army and became a medic and loved absolutely loved paramedicine and pre-hospital medicine, emergency medicine. It's a little bit addictive. So I continued that.
Speaker 2:When I got out of the army I was a paramedic field and flight paramedic and my first son was born and kind of looked at him in the hospital and thought, oh my gosh, every third day I want to miss something of his. Whether it's football, ballet, whatever he wanted to do, I was going to miss it. So I went back to school in earnest, was pre-med in Chattanooga at University of Tennessee. At Chattanooga, at the local level, one trauma center had a good friend who was a resident at the time, dr Lisa Smith surgical resident, and that's what I thought I wanted to be had the first PA students from Emory that rotated through the ER and I was like, yeah, well, what's that? And she said to me, brian, if I had it to do all over again, that's exactly what I would do, and so that's really where I first learned about PA.
Speaker 2:As I was in my junior year, I had a lot of the requirements to apply. This was 21 years ago now, actually, no, it was 24 years ago. I graduated 21 years ago. So I applied to UAB. I'm from Florida. Nova Southeastern in Fort Lauderdale, florida, was a place that I thought I wanted to go to physical therapy school actually. So I saw they had a program and a dual degree master's in public health as well, and I really love public health, and so I applied to both those programs, got in very unexpectedly. The rest is history. Here I am.
Speaker 1:So did you work for someone and then start your own clinic later?
Speaker 2:Yeah, actually, again, I've been practicing for 21 years but I just started my practice about five and a half years ago. So I was in emergency medicine for long enough to know that it's tough. It's really really tough physically, emotionally, family life, the whole nine yards. So I really wanted to do rural and underserved medicine, especially here in Tennessee Southeast Tennessee is where I'm at, cleveland, tennessee, and I had the opportunity to take over a retiring doctor's practice in Dayton, tennessee. It's a rural manufacturing town just north of Chattanooga and north of Cleveland where I live and loved it, worked there for four years, did not make a whole lot of money. It worked with the underserved population there and some migrant farm workers. But then I started moonlighting in the ER. They sucked me back in A lot of the ER docs and stuff that I knew. They had some ER nurses who actually went to North Dakota PA program again back some 20 years ago and they hired them and me all at the same time, part-time just testing us out in the emergency room, ended up going to work full-time in the local emergency system here on fast track programs.
Speaker 2:I became really good at engineering problems, things that popped up. Process engineering is a bit of a forte of mine. So I helped develop a fast track program for the emergency room. They had a contract with an onsite clinic actually, and that's really where I first got into kind of a direct care model. We weren't billing insurance, we were just billing for our time.
Speaker 2:And they got a contract with a large manufacturing company in Athens which is just north of us. But they didn't know how to put it together. So they asked me to engineer it for them and then wanted me to work it on top of that. So I did, and that's where I found Josh Umber with Atlas MD. And this is when he was not long out of residency he was about a year and a half into starting his practice and just connected with him and he motivated me for direct primary care and I grew that program actually for the hospital, for the onsite clinics, and they just decided they didn't want to do it anymore and so I was like, well, I wanted to go do this myself because this is a good thing. What I'm doing for this large company, I can actually do for smaller companies and make it work, and that's really how I got my start. So, again, a long route to get to where I am today, but I thank the Lord for it every day.
Speaker 1:So you opened up Direct Primary Care Associates five years ago and just looking at your website, I see it has grown exponentially. So talk to all the listeners about how that grew over the five years, and to multiple locations as well.
Speaker 2:Sure, again, always having a knack for engineering problems and we all know the problems with healthcare but, specifically, companies and companies of all sizes, my heart really led me, in a way, for small companies. When I say small companies, for those folks out there talking about the companies that are 200 full-time employees or less, you may not think of 200 full-time employees as small, but it is in the realm of business, just seeing what we can do and how we could affect their insurance. Again, I just saw it, and so I put together a team of people who were experts in their field and asked them to join me in solving this problem, and they did enthusiastically. So we grew, we started. I actually opened my doors August 2018. So I think that's a little bit more than five years, but in earnest.
Speaker 2:April of 2019 is when we really took off, and you know what we did was we didn't just talk about it, we put the pen to paper. We proved to companies what they could save, what they should save, just based on their claims data alone, and then we started adding things into our services. You know just the value add, and it just took off. You know just the value add, and it just took off. You know we had great word of mouth. We work with a lot of terminal sources of decision makers that implement us into their medical insurance offerings. That often direct primary care in the workplace is lumped in with insurance all over our website. You know we're healthcare, not insurance, but when you plug us in it just makes sense and we have a really good recipe for getting people the decision makers who make those decisions to understand the value add and the benefit and the implementation.
Speaker 2:That's how we've grown. We grew from again a small clinic and a strip mall to four offices, one onsite clinic. What I say four offices were in Knoxville, tennessee, athens Tennessee, cleveland, tennessee and Dalton, georgia, all along that I-75 corridor in East Tennessee. We represent now she's well over 3,000 patients. I think we're at 106 employer groups now. Those employer groups range from everywhere, from one to 500. So we're at that sweet spot of really affecting change for a lot of people. You're able to put the statistics to it as well and show what the benefit is. It turns around and starts to sell itself just based on the good that we do.
Speaker 1:Are you the only physician assistant in your clinic?
Speaker 2:Actually no, I have two other PAs, two nurse practitioners and two physicians.
Speaker 1:Do they all see their own panel of patients?
Speaker 2:Everyone but Dr Mazza. Dr Mazza is my individual medical director and I did that purposefully. Just how PA practice is where I am and in those areas it's just easier being an entrepreneur and owning business and employing physicians to have my own individual medical director.
Speaker 1:And when you say medical director you're talking about he has to co-sign a certain percentage of your charts.
Speaker 2:Yes, so again, I practice and I have locations in Tennessee and Georgia. Most of what I do anymore is CEO of the company. It gets very difficult running multiple offices but I do still see some patients, select patients between Georgia and Tennessee and the laws are very different in both of those states. So in Tennessee it's considered collaborative practice and he does, and the laws just changed here in Tennessee. That should go into effect here in about another year or so, but right now he has to co-sign any controlled substances that I write and a certain amount of charge and the same thing in Georgia, co-signing a co-signature requirement there as well.
Speaker 1:Now a question that I thought of since you have a clinic in Georgia but your medical director evidently has a Tennessee license, is he still able to co-sign your charts of your patients that are down in Georgia?
Speaker 2:Yes, because he's licensed in both states. So here in Cleveland, tennessee, we're right on the Georgia border, so Dalton is 30 minutes south of us and Athens is 30 minutes north of us, so we're right on that southeast corner, an hour from the North Carolina border to the east. So a lot of healthcare providers are dual licensed in multiple states, some even in North Carolina, georgia and Tennessee, because of where we're at and the geolocation and where the patients and clinics are. So yes, we're licensed in both Georgia and Tennessee.
Speaker 1:How did you get multi-licensed in two states? You originally got your license in Tennessee, but what was the process for you to also get your license in Georgia?
Speaker 2:Oh boy, that's a pain, Georgia, in so many ways. And again, for all you Georgia listeners out there, maybe you'll empathize with me a little bit and relish in the pain, but it is not easy, especially during the COVID years and absolutely asynchronous communications and when I say asynchronous, you might get an email back two weeks later letting you know that something that you put in a month ago wasn't received. It was the most painful process, but it's not a difficult one. It's just paperwork process like anything else. I know that the AAPA, our national organization, is working on multiple state collaborations and that would be a big plus, but right now getting one from a different state is difficult.
Speaker 2:I actually let it go, but I was licensed in Florida for a while too, because that's actually where I went to. Pa school is down in Fort Lauderdale, but yeah, having multiple states that you practice in is somewhat of a commonplace where I'm at, but it's still a pain in the butt. Tennessee is much easier, for sure. Georgia has not been very easy to deal with, to practice and also to get your license and the requirements that Georgia has Pretty difficult.
Speaker 1:Man, that's too bad. I was thinking about opening up a clinic in Arkansas, so I hope it's not as difficult in Arkansas as it was in Georgia for you.
Speaker 2:The biggest thing is the people who process your paperwork. The people who process the paperwork are the gatekeepers for everything. It took eight months to get my license in Georgia. It was painful. Just to let everybody know out there, don't look at my website and all the companies that we work with. That's a huge amount of success. It took a whole lot of work too. We actually got a contract with a large company in North Georgia that wanted us to come down and take care of them, and I didn't think that it would take eight months to get our license down there, and so I had to hire a temporary MD, a locums, to come in to cover that contract for us, because they wanted to get up and going.
Speaker 2:It was just a mess. Georgia's a mess. I love Georgia, but they're processed. To get your medical license in the state of Georgia, at least for PA, is very difficult. Dr Mazza and Dr Coker, who work with me they got their medical license within a month. They were good to go, but they've not been very friendly, I feel like. As far as other states Florida, tennessee, you know we're not very difficult really at all. Meet the requirements and you're good, and Georgia was tough.
Speaker 1:Were you acquiring a clinic down there or were you going to start from scratch, open up a brand new clinic?
Speaker 2:We learned our lesson from starting from scratch. Starting from scratch is pretty difficult. So actually what we did was had a good relationship Again, talking to terminal ends of decision makers and them wanting what we do in their area. We just waited until we had enough. For us we don't open doors anymore unless we have 250 patients who are ready to go, Because for us, as far as completely on a financial basis, that's a break-even point really for us. So we needed 250 people just to open the doors and we were able to do that there, and so we had patients who were built in and ready to go.
Speaker 2:So we've started a couple of clinics what we call out of our back pockets, where we all put different types of sweat equity into what it is that we do. And you'll hear me say we a lot, because I don't believe in a just me concept. I have 18 people that work with me, from account managers to accountants, bookkeepers, attorney. There's 18 people who work within my company and they are instrumental in the success of direct primary care associates. So when you hear me say we, I'm talking about all those people.
Speaker 2:So all of us put a whole lot of sweat equity into the first couple of places and figuring out the hard way, really figuring out the sweet spot of hey, where does this turn and where can I start getting a paycheck? How much do I put into growth? How much do I put into groceries? And then moving out from there is valuable experience that looks easy on paper. I know a lot of us get on paper and say, oh, if I just had this many patients I would be just fine. Well, getting to that many patients is a lot harder than it seems. Having the right recipe matters.
Speaker 1:Yeah, and that's a good segue. I was going to ask you you mentioned a little bit earlier that now you're kind of like an overseer and you see a few patients, but you don't have a full panel anymore. What was your full panel before you did that and what are all your other providers panels look like.
Speaker 2:The integrity of what we do and I'll answer your question, Amanda. The integrity of what we do is predicated on our culture, our internal culture of what it is that we believe as a company and what we believe as a company, and this is one I'll say me. This is something that I believe in and something that I set the pace of very quickly, and I did it for myself. I don't believe personally and I'm sure we'll have some people disagree with me, but I don't believe personally that we can separate ourselves from our job, from who we are. When we go out locally to a restaurant or the drive through to pick up our coffee, we're seeing our patients and they're like, hey, will you look at the skin thing for me real quick? Or you're sitting there eating with your family, and so I don't believe in the work-life balance. What I believe in is work-life integration. How does work work with home and how does home work with work? Especially when it comes to family medicine, direct primary care, urgent care, the things that we're going to see in the settings that we practice in. What I believe is 600 patients should be your panel max, and I know there's people out there that are seeing a whole lot more than that, but 600 patients gives you the ability to see people when they want to be seen and how they want to be seen, give you some autonomy with your schedule and also allow you to have plenty of free time at home and the autonomy within the schedule.
Speaker 2:Like I wish I could have Stacy flowers. She was actually my first hire. She's a nurse practitioner that I worked with in the emergency room and every day at 2.30, she goes to pick up her daughter from school. And that's the way I want it. You know there's no clocking in, clocking out. We're all professionals. Show up, see your patients. If there's nobody to see, go pick up your daughter from work. You don't have to ask permission for that, Just do it. And 600 patients allows us to do all of those things. Pick your daughter up from school at 2.30 every day.
Speaker 1:I completely agree with that. Integrating your life into your home life, into your work life, makes perfect sense because you're right, when you live in the community that you serve especially, you are going to see your patients out and about. It would be terrible to put that wall up between them when they're out in the community. So I like that concept.
Speaker 2:I believe in that, and that wall that you're talking about is that wall that I personally had before working in emergency medicine just going so hard and having so many critical patients and so many, even when you're doing the right thing, things still going wrong and not having time to process that. Moving away from that, I really wanted to build a utopian idea of what medicine should be. And again, when I heard Josh Umber talk and that's kind of how I happened across him when he first got out of residency he was talking at some conference and talking about well, if you didn't have patients, you go play golf. But I wasn't looking to play golf because I really stink at it. But what I was looking for is that, that in which he's talking about, and that's that utopian idea of what medicine should be. Again, having enough time with our patients to talk to the patients, to truly talk to them, to listen to them and letting them have more time with you, to interact with you, to build rapport. And that particular skill alone is the one that I believe is what's changing medicine to what it is today.
Speaker 2:Now, what I mean by that specifically is you go back 20, 30 years to medicine, and it was mostly just MDs practicing medicine mostly just MDs. I know there were some PAs, nurse practitioners and DOs sprinkled around in there, but it was mostly MDs. And I heard and I want to give her the credit that she's due but it was Alicia. I'm sorry, alicia, you're going to kill me right now because I forgot your last name. Over in Charlotte, north Carolina. She's the one who said Logan, yeah.
Speaker 2:Alicia said to me and it has had a profound impact on me. Alicia said you know, doctors no longer get to hide behind their names, meaning they don't get to hide behind the MD, meaning patients no longer have to just go because they're the only person in town. Now I don't want to dumb that down to just the only person in town. It is about quality care it is. It is about the quality of outcome of the care that we deliver, and one of the things that we strive for is exceptional outcomes. And we're way you know, as far as direct primary care goes, we're way above what the industry acceptable standard is, what the Medicare acceptable CMS acceptable standards are, and we could talk about that, but that gets really boring.
Speaker 2:But what is, again, I believe, the game changer when it comes to, you know, family medicine, direct primary care, entrepreneurship? It really comes down to creativity being one, you have to be a creative person, but number two, you have to be likable. You can't you know there's no longer, you can't hide behind your degree anymore. The care that you have to deliver has to be exceptional. You have to deliver the level of care that the patient deserves, expects, gets, that they don't even know what it is that they're getting, and they have to get it from somebody that they actually know, like and trust and those three words they get used a lot and I'm sure you've heard them in a lot of different places.
Speaker 2:But how do they get to know you? How they get to know you, is you sit and talking to them because they want to know? Are you interested in them? So how do they get to know you? How do they like you and how do you earn trust? You make the right diagnosis, you prescribe the right treatment plans and you follow up with them, not like you care, but because you care, and that's how you build that. It's the magic recipe, and I thank Alicia very, very much for really setting that light bulb off in my head. That's the secret sauce.
Speaker 1:That's good. That's true, because I know plenty of DPC clinics that have closed up and I can't imagine why they would close up except for the fact that if you don't have that bedside manner, if you do not have that person ability to relate to the patient, to empathize with them and have the compassion you're just not going to keep your clientele.
Speaker 2:That's right and DPC is different. Dpc is different from an insurance model and I'm going to the big blaring difference that everybody needs to understand who is listening and considering DPCs? The DPC is different from an insurance model and the big blaring difference that everybody needs to understand who is listening and considering DPCs the DPCs who are in business. I'm going to tell you something that you may already know, but it's not in your conscious mind. It's in your subconscious, but the difference between direct primary care and insurance-based medicine is this Insurance-based medicine tells people where to go when they call an office. They don't say, hey, is Amanda Price there? She took care of my next door neighbor and I heard she was really awesome. No, they say, hey, does Amanda Price take my insurance? They're going because they're told that's where they're going.
Speaker 2:Now, with direct primary care, they get to choose who their health care provider is. And when you get in that mindset, now that you get to choose me, I'm something that you get to plug in to what it is that you want for yourself, your family, your employees, your company, whatever that you're now choosing that care that you get, and boy, that's a completely different mindset. When those patients show up to, they're a whole lot easier to take care of. They're easier to take care of because they're choosing to be there instead of having to be there. So I love it. But your mindset has to be in that you know you're there to build rapport with the patient as much as you're there to diagnose and treat as well.
Speaker 1:So I've noticed in your clinic. Not so I've noticed in your clinic. Not only do you have providers, but don't you have a physical therapist, an occupational therapist and a counselor.
Speaker 2:Those are my business partners and they were a part of the group that I had over at the hospital that we did the on-site clinics. So, really, what it is, Beth Prine is a physical therapist but she actually is a practice manager. She's my operations officer, she's got her MBA, so she has extensive experience in running clinics in the insurance-based model and we just parlayed that because, again, the success that I had at the large onsite company, again it was not predicated on just me, it was the people that made magic. When you're thinking about your offices and you're thinking about your clinics, the biggest problem that we have is trying to do it all ourselves. You can't, you know, and you can't run a practice as large as mine by myself. And then, on the other side, tim Tatum, who has a background in counseling. He is actually the VP of sales and marketing, he has an MBA as well and he ran multiple inpatient treatment centers for different hospitals and he and I developed a relationship when I worked in the emergency room. He did crisis counseling for the emergency room for and so we just became friends and he was looking for something different. He's the personable, likable guy with lots of rapport within the community.
Speaker 2:Again, I'm going to go back to what I said. It takes a creative person to make it work. I'm a creative person. Again, I see the issues that are out there and I see the human capital that it takes to fix it. I can tell you right now I'm not a great manager of people, but I'm a great motivator of people. I can set culture and all that, but if you're doing something stupid, I have a hard time writing somebody up. I'm not the guy you want to fire anybody, because I believe in the power of the human spirit. I believe everybody can get better. That's also a tragic flaw that could hurt you. So Beth is my bulldog. I say that all the time. She's the person that puts the rubber to the road and holds the pedal to the metal and make sure everything's put together.
Speaker 1:Tim is our community relations guy and, again, she's a physical therapist and he's a licensed counselor and it works and it works beautifully, although neither one of them practice in that respective field Right, which was confusing to me a little bit because I was about to ask you what does it look like to have a direct primary care clinic with all these specialists in your office? But they are doing more leadership and administrative roles for you and not necessarily.
Speaker 2:I'm glad you said that because, especially on you know we're working on that on our new website right now of trying to make that more linear of who's the admin team, who's in what offices, because we do have, you know, individual signups where individuals can sign up. We get a lot of business by word of mouth and they want to know who their healthcare providers are, and so I appreciate you pointing that out.
Speaker 1:I wanted to touch a little bit on you being a physician assistant and being an entrepreneur, and this just could be that I just haven't run into as many independent PAs as I have nurse practitioners when I've been interviewing people for this podcast. But is it safe to assume that the amount of entrepreneurs that are physician assistants is much less than nurse practitioners, and why do you think that that is I?
Speaker 2:absolutely do. Again, I graduated 21 years ago, so I was trained a long time ago and there were not that many PA programs even out there, matter of fact, just a handful, and mostly along the East Coast. So PAs as a history, they really were born out of Duke University, of returning Navy corpsmen from Vietnam that had a certain skill set but they didn't fit anywhere. And so that's where the PA profession was born out of, and it was born out of a group of physicians who needed help doing stuff, doing doctor stuff, but more of the routine, if you will. It's definitely evolved and amalgamated into what it is today, where there's PA programs popping up in a lot of places and the profession now is a linear, terminal profession where, when I started, even to get in the program that I went to, you had to have two years of paid experience. So it was full of nurses, chiropractors, pharmacists, medical lab techs, paramedics. I even had a vet tech, I think. I think she was a vet tech, but most you had to have at least two years of paid experience. And now you know it's a, it's a straight through degree in a career path that people are choosing. So I think it's born out of the lack of representation of entrepreneurship through the PA profession is born out of the dependency model.
Speaker 2:Now that we're moving away from that especially, there are some states that have independent practice for PAs. Now Tennessee is moving in that direction and we just had some great laws changed this year. There's still some states that are way far behind, like Georgia. Georgia is, in my opinion, backing up a little bit. They're taking steps backwards to remove some of those and I think it goes back to what Alicia says.
Speaker 2:I think there's a scaredness of you know what does this degree hold for me and who do I have to compete for to get the patients that I want to have? And when you look across the gambit of primary care, medicine, direct primary care is the place that a lot of people want to go because it just makes sense. It makes sense to everybody except for insurance companies. But when PAs themselves look across, and how do I get into that? How do I do that?
Speaker 2:I think it's probably discouraged all along the way from the inception to training, really to where we are today with our laws and some of the more restrictive laws that don't allow us. I know in some states PAs are the only ones who can't be an owner in a practice, like a wife or husband of a doctor can own a practice but a PA can't. There are states out there that specifically say that and there were some real pioneers here in the state of Tennessee long before me that challenged it in court. Because there's some court precedents, some court rulings that allow PAs and here in Tennessee a husband or wife cannot. It specifically has to be a licensed healthcare professional. It's the way the law reads here.
Speaker 2:But I think there's a lot of limitations and there's a lot of things that keep PAs out of being entrepreneurs, which is sad because there has to be a natural evolution to medicine. We cannot stay where we are and continue to get the results that we've gotten and it's not good enough just to complain about it, and it's take some pioneers. I'll point to Greg Kane, a PA here in Tennessee who has been the Tennessee Association of PAs president for the past couple of years and he's been instrumental in getting the movement and the reason he's been so instrumental in it. I don't know any better way to say it than he's just a bulldog. He's relentless and those of us who sit on the sidelines and haven't put our heads up out of the holes to be a target. Oh, him and Catherine over at that office and the whole Tennessee Association of PAs and American Association of PAs has done a lot for Tennessee, but also individual states, to move that along. And that's really what it's going to take. And if you're out there listening right now and you're in one of those states that restricts that, I'll tell you from personal experience the best way, the number one best way to get that changed, is to start spending your money to change those laws. And, yes, money really does change laws.
Speaker 2:We can gripe and complain about the big fat corporations and everybody else, the man, if you will, and you're not wrong, you're not wrong. It takes the man to move things in a direction that is advantageous for the patients. And if we keep that idea alive not just what's good for me, but what's good for patients keep certain professionals who can go in and really affect a very positive change in their communities and in their counties and cities and states. And you have this big behemoth of these organizations that are dead set against it. They claim a lot of things that we know are inaccurate, but it takes you being proactive and how you do that.
Speaker 2:The question of how do I become proactive? Well, the first thing that you do is you meet with your local leaders when your local leaders are your state senators and your state representatives and just ask them how do they feel about it. And if they're dead set against it, I'm going to give you a little hint. I'm going to give you a little inside information. Invite them to come to your office to see you for free. I will see you for free, just so you can see what it is that I do, and that's the best way I can tell you from firsthand experience. That's the best way, and it changes their mind.
Speaker 2:And then you have to start spending your money too. When I say spend your money, and boy, this is going to put me. I'm going to get a lot of heat for this one and I'm okay with it, but you've got to start helping with the campaigns of the people who have your community's best interest at heart. Again, it's not about you. It really shouldn't be about your ego. It should be about patient access to affordable healthcare.
Speaker 2:I'll tell you the argument that I made in Tennessee, some meetings that I got to be a part of. The one question that I asked any detractor is this does what you propose increase access and affordability or decrease access and affordability? You can talk about outcomes and you can point to some very cagey statistics, but outcomes for PA care, outcomes for nurse practitioner care, outcomes for MD care and DO care is all out there. It's all analogous and the only thing that really changes, the only thing that changes, is access and affordability. That's what's keeping most PAs out of that entrepreneurial space and that's what's keeping a lot of people from advancing I don't even want to call it our cause, but just from advancing healthcare in America and where it should be.
Speaker 1:Yeah, that's a lot. I'm trying to sit here processing, like what do I even say about all that? Because I'm just getting upset like I should be in Nashville right now doing something. But I'm not confrontational.
Speaker 2:So, amanda, you're right, and neither am I. You know, you and I had a conversation before we came on here where I even felt a little guilty by not being more proactive than I am. I've been reaping the benefits of the Greg Cain's and, you know, the TAPA office and those guys who. There are people within your professions, especially the PA professions guys. They're out there fighting the fight for you. That's their talent, you know. So you have to ask yourself what is your talent, and that's why I say the easiest talent that all of us have is money to give. Okay.
Speaker 1:How much money are you talking about?
Speaker 2:I'm going to tell you it's a whole lot less than what you think. It's a whole lot less. I'll tell you this. Well, I won't say there's a lot of things that happen behind the scenes with political action committees and that sort of stuff. But I would tell you this within your professional organization, all right, and PAs have it here in Tennessee, we have it in Georgia, we have it in Georgia, we have it in Florida. So I know everybody has a political action committee that represents your profession and I would tell you that you should at minimum be giving them $500 a year at minimum.
Speaker 1:How do you find out who these people are?
Speaker 2:Well, your professional organizations like again, tapa is for Tennessee, japa and for the PAs across the country, for nurse practitioners, it's your nurse practitioner boards, your professional organizations within your nurse practitioner boards, and they have political action committees. They will not tell you who they pay, they will not tell you who they who represents, but they meet in your state capitals and they hold dinners and fundraisers and they know the things that are important and they've got their finger on the pulse of the things that are important to you and your practice and your community and the care that you give to your people. So if you're, if you're not, that bold, everybody can do that. Let me come back to that. Everybody can give money. You can give 10. Again, I would suggest $1,200 a year, that's $100 a month, that you should be given to your political action committee and that should be like a tithe, an offering, because they are doing things for you that you don't even know about right now, even if you're not a member, still doing it for you, because it affects everybody and they're the only ones who are out there doing it, the only ones. And, boy, if I can get on a pulpit and jump up and down, because if it wasn't for all those pioneers before us, do you think you would be sitting where you're at right now listening to the sound of our voices? You wouldn't, because somebody had the gumption to get up and say, hey, there's a better way. And if you're out there right now and you're listening and you believe and you know that there's a better way and we have it, we have the keys right here, it's in your purse or it's in your wallet right now, that's what you can do Now.
Speaker 2:If you really want to stand up and fight, if you really want to do something, get involved with that professional organization, volunteer for your regional councils. Like in Tennessee, we have regional committees that put together once a month dinners, that have CME events, but that keep you involved, that keep you plugged in to the things that are happening. We have PA Day on the Hill for the state and nationally, where we get access to those lawmakers. And I want to go back to what I said before they get to know us, they get to like us and they get to trust us, because those are the things that it takes.
Speaker 2:And if you're that real pit bull, that Penny Vachon out there, which I love, penny man, get involved. Be the president, be the vice president, get in that political action committee. Be the person who goes up and says no, this isn't right, this is the way that this should be and this is the way that my patients and my community is best represented through the legislations that it is that you pass. So there's multiple different ways to get involved, but I'm going to go back to the easiest, but it's also the most important, and that's money. Whether we like it or not, money makes things happen.
Speaker 1:You are so encouraging about helping to change policies and everything on behalf of our industry, because there's so much room to grow from even where we are now. I've been a nurse practitioner for 20 years. You've been a PA for 21 years, so we remember where we even were when we graduated from school and how far our profession has come to this point, but it's still not at a point where we are entirely accessible to all the patients that need us. And I think there's some old school reasoning behind that.
Speaker 2:Listen, amanda, the old school reasoning is talk to most physicians most and they're a part of the AMA and they're a part of their local state medical association too, and that's built into their contracts. That's built into a lot of things that's paid for that they don't even think about it. Is that built in? And I'm not asking you personally, but is that built into your contract, listener out there, that your professional organization dues are paid and that you're giving a specific amount of money, or maybe your employer, on your behalf, gives a specific amount of money to your political action committee? You can negotiate those things, guys. You absolutely can. Don't let anybody tell you any different. You absolutely can, and you should be, because I promise you, the man that we're fighting against are really not fighting against us. For the most part, it's just that small. It's that same small community of people that are fighting for our professions are also fighting for their profession too, and the only way a fight is ever resolved is compromise, and compromise. For those folks out there, compromise typically means is it uncomfortable for you, yep, is it uncomfortable for me, yep, then it's probably the right thing. We've got to have the professionals, we've got to have the people that that's their job. That's what it is. That they do every day is fight for our rights, find the compromise somewhere in between.
Speaker 2:Ultimately it comes back down to the patients in the communities that we serve. The health of our communities, especially in Tennessee, are rising because they are progressing and moving forward into increasing that access and decreasing the cost of healthcare. And if you look at the states that have collaborative laws, that have independent practice, you're seeing access to care rise and costs fall. And it's, you know, it's. It's basically economics. And again, I know an argument can be made for the quality of care and we can all tell anecdotal stories of that patient we got from XYZ, whatever initials are behind their name. That the standalone stories. But what is overall? What are the true? Statistics say, I know what they say and everybody out there listening should know what they say, because that's the argument that holds us back. But what about outcomes? Well, outcomes are there. It really comes down to finances, a financial reward and messing with other people's paychecks is ultimately what's holding us back.
Speaker 1:So what kind of words of encouragement could you give to a physician assistant that just feels overwhelmed, bogged down, insecure about the process of opening up their own clinic?
Speaker 2:Get help. I'll tell you that, the number one as hard as we work to learn medicine, to know medicine to our CMEs, to get better PAs, we have to retake our national boards every 10 years. We study hard for that. But how much study have you put into being an entrepreneur, what it takes to truly open a business? Or, if you have, how much work have you put into becoming the best entrepreneur that you can be? Do you know your strengths? Do you know your weaknesses? And if those weaknesses, if they're catastrophic to your business, hire somebody, put somebody in the place that can do that for you. And how do you hire them? That's a whole other thing.
Speaker 2:The secret to direct primary care associates is how we hire. I'll tell you, I've had a business coach from the very beginning. It's the best money that I've spent and I promise you guys, to make money you have to spend money. To have growth, you have to invest in growth, and so really, it's not the financial seed, it's really the true commitment to growth and what it takes to grow and be inside that space that you think that you maybe bogged down in or don't know. Invest in it. And business growth a lot of times, especially being the business leader is not about how to do a spreadsheet, it's not about the laws, and when you first start out you're going to try to immerse yourself into those things. What I would tell you is hire somebody to do that for you. Hire the attorney that knows the laws inside and out. Pay them their two, three, $4,000.
Speaker 2:Accounting get a bookkeeper if you're not a good accountant. And what's funny is that you know I mentor and I talk to a lot of DPC practices, and this is physician, pa, nurse practitioner across the country. You know I have a pharmacy company as well that's built for DPCs, and so I talked to a lot of DPCs across the country and we'll talk about the pharmacy program, but they all they always come down to what do you do about this and what do you do about that? How do I fix this and how do I fix that? And it's interesting because I meet a lot of people who are great at accounting or horrible at accounting. They're great at people management or horrible at people management. You know, they're great at time management or they're horrible.
Speaker 2:We all have our strengths and we all have our weaknesses, and that's checking that ego at the door, knowing what it is that you're really, really good at, and focus on that. It's called the Pareto principle. You got 80, 20, 80,. You know 20% of what you do produces 80% of your results and 80% of your day gets sucked up by 20% of the people too. We all, we all know that to be true. So focus on that one, that 20% that nets you 80% of your results.
Speaker 2:And, guys, the best advice that I can give you is try your best to hire out the rest. And I know you say, well, how do I hire them if I don't have any money? How do I do this? How do I do that? I have a saying, and I've said this all along and I say it to myself every day. I got to integrate my wife in here. Somehow my wife will say she doesn't even ask me anymore, and I don't say yes, I say I must. My life depends on it.
Speaker 2:So if you're thinking about opening a business, or you have opened a business and you're out there and you're struggling, you're bogged down. Getting back to your question and you're thinking, oh my gosh, what am I going to do? Ask yourself this question what if my life depended on it? You'll find a way.
Speaker 2:I've got an account manager, jamie Rogers, that works for me. He's 24 years old and just, he's just an awesome go-getter. And so I said to him in one of our markets you know, hey, I want this marketing program out there and this is the vision that I have for it and this is what I want it to do, and your budget is zero, make it happen. And you know what he did? He made it happen. You can do a lot. You can absolutely do a lot when you believe that your life depends on it. It can't just be a saying, it can't just be a mantra. I forget who it was, but one of the explorers lands on the islands and he burned his ships. I know there's an old saying out there there's no turning back. Burn your ships. If you're going to do it, do it.
Speaker 1:I don do. This is what I'll do until the day I retire, and my life depends on it. That's good. What if somebody wanted to reach out to you, had questions? Something you said today resonated with them and they would like to talk further with you. Would you be open to letting people contact you, and how can they do that?
Speaker 2:Absolutely. I'll preface this up front. I do consulting and I do coaching a couple of businesses. I'm an entrepreneur at heart but I have a whole training program for how to be successful in that space. And that's just for you out there listening, and all your office staff, and even if your office staff is you or your spouse or your kids or you've hired people, I'll tell you what I've done. And yes, you can reach me at Brian, super simple, brian B-R-I-A-N at direct pcacom, brian at direct pcacom.
Speaker 2:But I'll tell you what I've done is I've taken the direct primary care model of monthly membership and I've put that into a pharmacy program which I do believe that every dpc should have. It should be a value add. That's just a part of what it is that you do, because it's really, really hard to sell dpc, and what it is that you do, even though you know what it is that you do and you know what it is the value that you add for that monthly membership. A lot of people don't understand that, but they understand pharmacy very quickly. They understand the savings and I have people who sign up for us just for the pharmacy benefit. They never see us, they never grace our door, but they, just because they save money on their pharmacy, spend. So, going back to my point, I have a pharmacy program that I've integrated. If you get our pharmacy program, which is a monthly, per member, per month fee, I include in there for free coaching, coaching from me, coaching from my professional coach, gary White, with High Definition Coaching. And then I also use my chief marketing officer, which is the Alderman Group. They just happen to be located right here in Cleveland, tennessee, but they're a national firm. They actually saved Space Camp. That's their claim to fame. They were going to close down Space Camp in Alabama and they came in as a marketing team and saved Space Camp, but they're a national marketing firm. That the kicker on both of these guys is. Both of them know direct primary care because both of them were instrumental and I give that to you for free with my pharmacy program because I truly want to give back to the DPC community and I want them to grow, I want you to grow, I want everybody out there listening to be successful. Ultimately, you know, when my days are done and the day that I retire, I don't want to say, man, you know, direct Primary Care Associates was a great company.
Speaker 2:What I really hope is said about me is that I helped affect change in a way that was meaningful for society as a whole. I know we all strive for that. It's not enough for me to talk about it. I've got to do it. Now I'll tell you that I don't do it myself. These are just my ideas. I have great, hardworking people around me that do all the heavy lifting, that believe in the vision. That's another thing I would tell everybody out there listening. You've got to figure out are you a visionary or are you an implementer. There's a book out there called Rocket Fuel. I would suggest that you read and you'll learn really, really quickly which one you are.
Speaker 2:I'm a visionary and I attach myself to implementers and I look for those implementers Again through the coaching process. I hire based on personality testing now, because I'm a servant and I want everybody around me to be servants, and so not self-serving, because that's very different, but servants, and so everybody that works with me is our servants. There's a method to the madness, and I would love to be able to teach everybody else how we've been so successful. And how do you count success? You can count in a lot of different ways. Success for me is getting to be here talking to you about what it is that I do and hopefully that inspires or leads to other people reaching out that I can mentor or coach them. That's success to me. But success to a person sitting out there might be getting that 250 patients, that self-sustaining number, and you might have 250 patients out there and I've talked to these folks. They have 250 patients and they're still drowning and they don't know why. And it happens.
Speaker 2:And again, this is not just for PAs, nurse practitioners, but I mentor doctors too. I have one of the coolest doctors in the world that's become a great friend of mine. That's on my program in St Louis Missouri and he has a radio show every morning. So he gets on a radio show every morning. So he gets on a radio show and talks. He talks a lot about direct primary care and that sort of stuff. But it just absolutely helped him turn his business around because he's a visionary, a lot like me. But he was not around implementers, he was around other visionaries. There is a key and I would love to be able to help everybody out that wants help to reach out to me. I would love to talk to you.
Speaker 1:Is there anything else that you can think of that? You just really want to make sure that people hear before I close out the interview.
Speaker 2:You know I got one thing, and I hope that this makes it. I love what you said. Is there one thing that you want to? I love that question. What I want everybody to know is that God loves you. That's it. I'll tell you something. You know a lot of us out there, including me, and I kind of get choked up a little bit about this, because when you're doing what you're supposed to be doing, when you find your calling and I'm living my calling right now by being on your show and doing the things that I love to do it's a reminder that God loves me. And so find your calling and God loves you and he wants the best for you. He does, and so do I. I'll tell you this one short story that brings us all home.
Speaker 2:I cover local jail because they can't afford to pay anything. They can't afford to pay somebody to be in there, so I do it as a part of my mission. I give back 10% of what it is that I do, not just in my personal ties, but in my work as well. We support. Each of my clinics have their own thing that they support. No-transcript told you. Hey, man, god loves you and so do I. I love you too, and I and he just stopped, started crying, broke down and that wasn exactly what God wants me to do.
Speaker 2:We all need to feel and want to feel and know that we are loved and that somebody wants to see us succeed. I want to see everybody out there succeed. I want you to succeed, amanda. I want everybody to succeed. But that person who's out there listening right now, that feels like, oh, and they're questioning themselves. Trust me, I've been there, as successful as my company is, has been and will be. I've had thoughts this week, you know, am I doing the right thing? Am I doing this? Am I doing that? No, you are doing exactly what you're supposed to be doing, and God loves you and I love you too, and I want to see you succeed. And, man, when you have, when you truly have somebody who's on your side, who has no vested interest in anything other than your success, it's uplifting. It makes you feel good. Not just makes you feel good, it knows that somebody is your champion. Just know that I'm your champion, but I'm nobody. God is everything.
Speaker 1:That is so encouraging and to know that you put God first in what you did. I know that you were honoring him and it is a direct reflection of, obviously, your personality and your character and your integrity and it says a lot about you as a person. So I am so thankful to hear you say that.
Speaker 2:Thank you for giving me the opportunity I wouldn't have the opportunity if you weren't doing this.
Speaker 1:I can just see all of the little dominoes that are lining up and falling into place and what I have noticed strategically interviewing all these nurse practitioners and almost all of them have mentioned their faith at some point in the interview, which I absolutely love. But I recognize that we are just one big family and we just didn't know each other and we're getting to know each other and I love having an opportunity to get to know nurse practitioners and physician assistants from all over the country that are doing what we're doing and some have done it longer than I have but just to be able to be inspiring towards other nurse practitioners and physician assistants out there that have not started a clinic yet, that they can just glean from everything that we've learned how to do already. And it's just a journey and we are here to be encouraging and to uplift you and to say you've got this and we're not here to sabotage or to try to hoard the market by any means. There's plenty of people out there to take advantage of.
Speaker 2:I love that process, I love that whole thought process. To hoard patients, that is a finite way of thinking. That's saying I've got this much of a pie right and if I give you any of it, that's that much less that I have, when the truth is that the care of people being the physician and not in the sense of terminal degrees but as fail and the only way, the only way that your business is ever going to grow, is that you have the ability for existential change. And that's why I say we're going to succeed I know we are. When I say we, I'm thinking of anybody less than an MD. The history is, you know, MDs have fought against DOs. They gave up and then they turned on nurse practitioners and nurse practitioners have been bearing the brunt of that independent practice. But now PAs are moving into that. But all of this is an evolution of finite thinking. And that piece of the pie like you can't have that piece of the pie and that's why I know they're going to fail, because that's their thought process. And the care of people is absolutely biblical. Taking care of people, and that's why it's a calling, that's why you're hearing it from everybody, because it is a calling.
Speaker 2:What gives us the most joy? The most joy should be our family, our kids, that sort of stuff. But you know what gives me the most joy? It's when I help somebody. I mean, we get paid to help somebody every single day, and that's again. The key here is existential change. We've got to change, we've got to adapt, we've got to move forward, and this is the way that we do it. And the way that we do it is keeping God first, doing things that help our fellow man, especially with direct primary care. I just don't think that there's another payment model out there that gives the access that DPC does None for the amount of money that you spend.
Speaker 1:No, I agree, brian. Thank you so much for meeting with me today and just talking to all those listeners out there. You were a joy to interview and so knowledgeable. All those listeners out there you were a joy to interview and so knowledgeable. I have so much respect for you. So thank you so much.
Speaker 2:I appreciate you, amanda, and thank you for your listeners, for listening to you, blessing you with all the podcast listens.
Speaker 1:Again, it's an honor to be here. 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.