Matthew Simone’s Mission: Building Trust and Community in Direct Primary Care

Ever wondered what it takes to pivot from psychology to becoming a leading nurse practitioner? Join us as we chat with Matthew Simone from Homesteady Health, who shares his compelling journey from working in a psychiatric ICU in San Diego to pioneering a Direct Primary Care practice in Trumansburg, New York. Listen to Matthew's stories of serving in a native village in rural Alaska, tackling trauma cases in Philadelphia, and eventually settling in upstate New York to create a balanced family life. His narrative is a treasure trove of diverse experiences that have shaped his professional life.

Curious about the transition from the hurried pace of corporate urgent care to the patient-centric world of Direct Primary Care (DPC)? Matthew dives into the motivations behind this significant shift, highlighting the challenges of balancing patient care with a profit-driven system. He eloquently explains how his leadership roles and entrepreneurial spirit guided him to establish a DPC clinic that prioritizes quality time with patients. Matthew also offers insights on choosing the right electronic medical record (EMR) system and integrating essential tools for seamless operations, ensuring that patient care remains at the forefront.

How can a healthcare professional successfully market a new DPC practice in a community that’s unfamiliar with the concept? Matthew shares his grassroots approaches, from in-person interactions and community engagement to leveraging social media and SEO. Notably, he emphasizes the importance of trust-building and offering specialized services like men's health to engage patients more effectively. The episode wraps up with Matthew's vision of expanding his clinic’s services, focusing on a supportive environment that balances quality care with professional fulfillment. Tune in for a rich discussion that’s as educational as it is inspiring.

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Transcript

Speaker 1: 0:06

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, welcome to the DPCNP, and today I have special guest with us, matthew Simone from Home Study Health, and he is in the community of Trumansburg, outside of Ithaca, new York. Welcome to the show, matthew. Thanks for having me.

Speaker 2: 0:34

I'm really excited to be here. I'm really excited to support your podcast that's getting so much good information out to nurse practitioners everywhere, and it's nice to hear that we've kind of got our own thing in DPC, having listened to a lot of other things where we're, you know, somewhat excluded. So I really appreciate you doing this and having me on.

Speaker 1: 0:51

Yes, absolutely. Thank you for meeting with me on the podcast. Why don't you tell everybody what has your journey been to become a nurse practitioner? Let's go all the way back to the early times.

Speaker 2: 1:05

My journey. Coming out of undergrad, I was in psychology and I was working at a psychiatric hospital and I thought I was going to be in a world of individualized therapy and taking care of folks in that way. While I was working at a psychiatric ICU out in San Diego I kind of heard about this whole nurse practitioner thing, which I'd never even thought of before, and it was sort of presented like I could do a lot of that individualized therapy but still prescribe medicine which a clinical psychologist couldn't do, which I was looking at when I started digging a little bit deeper, it really just seemed like why not go into primary care where I could do all those same things plus a lot of other things? And medicine was really interesting to me and I can think back to reading through big biology books that were just floating around my house and it just kind of got me excited to do more. So I ended up pursuing that and ended up in a you know MEPIN program, that sort of you know.

Speaker 2: 1:53

Once I sort of started thinking about it, really everything just lined up in front of me, it all fell into place and it all happened pretty quickly and ended up going into the family practice route and ended up getting a, you know, national Health Service Corps scholarship to kind of really push things forward, as I was in a position where I'm like, well, am I selling myself short by not going to you know medical school or something like that just sort of finding my way. And again things just sort of fell into place. National Health Service Corps came around, paid for my master's work and that kind of took me off my first gig out in the bush in Alaska and just kind of rolled from there.

Speaker 1: 2:24

So, straight out of nurse practitioner school, you were working in Alaska.

Speaker 2: 2:28

Yeah, it was part of my scholarship so I could choose anywhere I wanted to go, but I had to go to a place that had a low enough HPSA score, which is, you know, a high enough need and poor access to care. So I don't know, I just chose up there. I thought it was going to allow me to really practice at the biggest, the broadest scope, you know, and be putting myself in a position to really learn a lot more, rather than be, you know, in a city or something where it's going to be very defined what my role was and not a lot of opportunities for growth. To me it just seemed like, you know, from the nurse practitioner perspective, that it was going to expose me to a lot of different things and I really was just up for the adventure of it. I went out there.

Speaker 2: 3:05

I was doing search programs in my downtime in the summers between nurse practitioners. So I was going out to rural places like Montana and I was out on the Aleutian chain in Alaska and somebody connected the dots. I talked to a medical director up in Kotzebue, which is pretty far north, and got a quick visit and I've heard some people get off the plane and get right back on and leave when they come there for jobs, but to me it was. It was really exciting. Working in a native village, inupiaq Eskimo lifestyle just was really attractive to me and I ate it up. I really loved being up there.

Speaker 1: 3:33

How long were you there for before you moved back to the mainland?

Speaker 2: 3:37

Like a little over two years and I went back up there for some locums kind of stints while I was waiting for credentialing. I'm sure we've all been there waiting months for things to get tied up back on the main side. Probably would have stayed there longer, but it just didn't work out that way. So ended up back in Philly for a while.

Speaker 1: 3:53

So you worked as a family nurse practitioner in Philadelphia.

Speaker 2: 3:56

No, actually. So again, with so much exposure in Bush, alaska, I was really attracted to trauma. So when I came back I was looking to, I wanted to move to a city, I wanted to buy a house and I wanted to work in trauma and I was kind of had a short list of places that I would go. It turned out, you know, philly worked out for me and that happened to be close to where I grew up in South Jersey and the Pine Barrens and family around and friends and all that kind of stuff. So again it just sort of fell into place and ended up there for about a decade.

Speaker 1: 4:25

Well, what led you then to New York?

Speaker 2: 4:27

Family life. We again. You know I grew up in the woods. I really enjoyed the outdoor lifestyle up in Alaska and honestly thought I'd be coming back to the city to drag a wife back up to Alaska with me and she was into it for a minute. But it didn't really work out that way.

Speaker 2: 4:43

Once we started having kids it started to seem more and more like we could get a lot of that lifestyle but still be close to grandparents and family support and away from natural disasters and all that kind of stuff. So you know I was interested in going back out west or up to Alaska. But we ended up fairly close to where our families are in upstate New York and our money goes a lot further here. So we were able to get like a little plot of land with some woods and build a little homestead here and really check off a lot of the boxes for the way of life that we wanted to provide our children. And so far we've been here almost well four years, maybe four and a half or so, and it's really delivering on all the things that we could have hoped for in living here.

Speaker 2: 5:22

It's a great place to raise a family. We're out in nature all the time and my kids are growing up with woods in their backyard and lots of nature around, lots of wildlife. You know we really enjoy that. Waterfalls everywhere. It's just a beautiful place.

Speaker 1: 5:35

I'm sure I haven't been up there to where you're at, but there's something to be said to be around family and to be around nature and to not be intermingled into the inner city. Some people like that lifestyle, but I tend to prefer nature and all of its resources.

Speaker 2: 5:53

Yeah, I mean I like both worlds and I really enjoyed being in the city and I got to do some fast paced like crazy trauma stuff Check that box for my curiosity and felt like I was doing a lot of high level medicine and really enjoying just sort of crazy procedures and, you know, inpatient acute care stuff. That was well beyond my training. So I was like I felt like I got a lot of those good experiences. I enjoyed the city life, the food and music and all the culture. But we feel like we landed in a place where we still have that and at this time of my life, like this is a better fit for who I am and we don't deal with traffic anymore, we don't deal with stress, we don't deal with like trash and lots of other things that the city was bringing that kind of were getting us down after a while. So we're pretty grateful to slow down a little bit and not do the rat race thing.

Speaker 1: 6:40

Yes, well, I was reading on your website, which is beautiful, by the way, for those of you that need to know, it is homestudyhealthcom. But I was reading your bio and it mentioned that you were growing frustrated with just how medicine is, how it is to have to deal with insurance companies and all that. So is that what got you into direct primary care?

Speaker 2: 7:05

Yeah, I think that's fair and it goes off of what we were just talking about, lifestyle wise, you know, wanting to kind of slow down the pace a little bit, have a little bit more flexibility in my lifestyle. I have two young children, so being able to spend time with them, that's that's sort of where the appeal came in. I had been in leadership roles so I helped start a few urgent care groups in Philly. I was with one and then shifted to another one and at the time there was really not any urgent care in the city. So it was a great opportunity to sort of grow that and learn like sort of the inner workings of things. And I feel like we were doing things right for a long time.

Speaker 2: 7:38

And then it just sort of got. We got a board, it got more and more corporate and we started chipping away at the culture that we had built there and that was a really frustrating thing to see. And then moving up to New York sniffing around urgent care again and just got to a place that was even more focused on dollars than patients. And the more of a window you get into that, the more you realize how much of a reality that is. How much of a reality that is, and when you're grinding patients and seeing maybe 60, 70 patients in an urgent care shift really not being able to provide the focus and the attention that they need all just so like a few people at the top can make a lot of money, it just it just doesn't add up.

Speaker 2: 8:15

So, you know, I wanted to get back and, to be honest, I've been burnt out from medicine a couple of times over, doing ER work in the inner city and then on sort of the leadership side. It just seemed like maybe I wasn't even going to continue doing this, but the direct primary care thing felt like, oh, maybe I could get excited about doing family practice again if I was, you know, taking care of my own community and doing it on my terms and doing it with some flexibility and the way life is up here, people seem to be a little bit more focused on the other things rather than just trying to make ends meet. It just was a really good cultural fit for where I was at in life and the community that I take care of, and it seemed like a great way to get back into providing care and doing things that I was once passionate about, while still being able to take care of myself and my family in a comfortable way that we'd be able to grow together.

Speaker 1: 9:06

So is that what inspired you, then, to become an entrepreneur, as opposed to go working at an already established DPC clinic?

Speaker 2: 9:15

Well, I mean, I think it was a part of it. I really had a lot of great opportunities in Philly working in the urgent care space and being moving through these leadership roles and seeing startups grow from nothing to. You know, the second group I was with were kind of the dominant force in the market for urgent care, so we were up to about 11 or 12 clinics when I left there and I really felt like like you're just going through it and you're like I can, I can really do this. I think I got the skill set for this and, you know, probably up until then it's not something you ever really think about doing. But once I was experiencing that and, you know, had the opportunity to learn from a lot of great people, start to piece it all together and you're like, well, why wouldn't I do this on my own? You know, why am I making money for somebody else? I'm doing all the jobs, I'm not getting the paychecks, I'm not getting the credit, so why not just do it for myself and my family? You know, that really excited me. I also just think that the model is great and it's a great way to really to be able to spend time with patients again to really take a deep dive and really spend time on life and to sort of sort out problems that you tend to get dismissed by the system.

Speaker 2: 10:14

I'm not blaming any other people that are out there practicing. It's just really hard to take that deep dive. People are you're cramming, you know. If you're in primary care you're expected to see maybe four patients or five patients in an hour. If you're in urgent care, maybe even more than that and that's just not feasible for good patient care, you know. But it's sort of necessary to keep the lights on in the insurance system.

Speaker 2: 10:36

So kind of rambling about it, but it just just seemed like a great way to do it, to be able to enjoy patient care again and, having developed and helped grow things at a larger scale, like I can really see an opportunity here to try to free up other providers from the system and I hope I can grow to that level to be able to offer other nurse practitioners that I know are dealing with the same level of frustration with the system a chance to practice and take care of people in a much better way for them and for their patients. So I'm excited about the future of that. We'll see if we can get there but that's the vision anyway.

Speaker 1: 11:11

What kind of resources did you use? I'm assuming you had never opened up a business before.

Speaker 2: 11:14

Is that safe to say? Yeah, safe to say, not on my own. Like I said, I'd been involved in the startup world for a little bit with a couple of urgent cares, so I kind of knew how to get it going.

Speaker 1: 11:21

Oh, that's true.

Speaker 2: 11:22

So it was like I feel like, compared to most people that are coming out of healthcare without that training, I had a bit of an advantage there because I did you know sort of learn from the growth of these other companies, and both mistakes that were made and demonstration of how to do it properly. So good.

Speaker 1: 11:37

So how did you come up with Homesteady Health?

Speaker 2: 11:40

Yeah. So I mean, like I said, we moved out to the country a little bit. We do live in a rural community. It's filled with a lot of sort of industrious, like DIY, type of people that take pride in doing things themselves. They take pride in growing their own food and fixing their own things and building their own tables and houses and whatever.

Speaker 2: 11:59

And we moved out to this area to kind of try to build our own homestead and our own little life. And we've got chickens, we have a huge garden where we came in and planted probably 80 trees or something like that, shrubs and everything like that. So it's the kind of life we wanted to live. It's the kind of life we wanted to live. It's the kind of life that people live here, that sort of homestead sort of perspective on how humans can interact with nature and live and take care of themselves. And I like the steady part because it to me demonstrates what we do in DPC, which is we're always there for our patients in a way that the current system doesn't really let you to be. So just that little tiny twist thrown the Y in there makes to me demonstrates, you know, the level of care and dependability that a patient can have in the service that I'm providing.

Speaker 1: 12:43

That's a good answer to that. Do you have to have a collaborating physician in New York?

Speaker 2: 12:48

No, not at the moment it's. You know it's a battle we're facing. We currently have full practice authority in the state of New York but it's not a permanent law. So we're still fighting that battle to make sure that we do get that to be a permanent law. And it just has been going through and it goes through the budget. So it's going to end up sunsetting again in a couple of years and hopefully that everybody realizes the value that we're offering. I know there's a lot of nurse practitioners popping up business across the state and the level of access that we're providing to folks that don't have it otherwise should be enough to demonstrate to folks that we're really a valuable asset to the community and to patient care. We hope for the best. I know there's a lot of good people working on it from throughout, through our trade organization and nurse practitioner association and other folks that are really working hard to keep that the norm.

Speaker 1: 13:36

Yes, and you know that's a good segue. I wanted to mention that you are the current president, for your region, of the Nurse Practitioner Association of New York, so how does that position help the other nurse practitioners in the state of New York? What is it that you're doing to improve legislation on behalf of nurse practitioners, and what can other nurse practitioners that are not involved in the politics of it, how can they help to be a part of that and to keep those temporary laws more constant?

Speaker 2: 14:09

Yeah, I think you're really throwing me up softballs here. I'm sure the folks in our organization love the fact that you're giving me a chance to recruit no.

Speaker 1: 14:15

I'm sure the folks in our organization.

Speaker 2: 14:15

I'm sorry give me a chance to recruit. No, I mean, I mean the number one thing we do is advocacy, right. So we're fighting. We have our own lobbyists. We have our own people that are skilled in the sort of legislative affairs. We have representatives on our board and at the state level board, as well as outside lobbyists that you know know how to how to this work, the whole thing. So that's like the biggest thing we do for nurse practitioners and people may not realize it, but we're really the only advocates we got right. So we're out there fighting for that.

Speaker 2: 14:45

We do our lobby day every year where we get a chance to put on a show for the legislative leaders and let them know who we are and the value that we provide. But we're constantly working on that year round to try to push things forward for nurse practitioners. So we're, as a group, our biggest advocates and anybody who wants to join can join at any level to sort of support that, just by joining and contributing the fees that come with being a member. All that money goes to advocacy. It goes to promoting us as nurse practitioners. Money goes to advocacy. It goes to promoting us as nurse practitioners. It goes to opportunities to put us out in the media to demonstrate our value. So just at a very basic level, by being a member you're contributing a lot, but you can get involved at whatever level you want. We provide a lot of education. So you know, you can sort of get involved at a regional level on a board and really bring your skill set to help advance those causes, whether it's advocacy or educating nurse practitioners or you know, regional conferences.

Speaker 2: 15:41

We just had one not too long ago and in my role I decided to kind of use it to have a platform of other leaders to try to help answer practice questions for folks that are, you know, dealing with the challenges of being a nurse practitioner and working in toxic environments and how to advance their career and those kinds of things. So just really being able to have the platform and the forum to be able to put that level of information out there for folks I think is extremely valuable. I know when I was a new nurse practitioner I would have loved to have that sort of level of mentorship and the kind of people that care in the way that the other folks in our region and at the state do, I mean to be honest, I'm in the president role, but there are people doing a lot more work than I am to keep things running and to continue to move the nurse practitioners forward.

Speaker 1: 16:28

Has that position helped you to create clinical leadership roles for yourself within the community?

Speaker 2: 16:35

Yeah, I would say so. I mean just in the sense that I mean it's, if you want to take it from that perspective, it's been a phenomenal networking thing for me. I mean I came to the state not knowing anybody and just kind of wrote to the nurse practitioner association and say hey, I'm interested.

Speaker 2: 16:50

How can I get involved, you know? And they just took me in with open arms and let me kind of just sort of audit board meetings and then chip in here and there with things, and I guess they thought I could add some value. And so you know, instantly getting in with a bunch of folks that have really worked super hard to move us forward and to advocate for us, and not only that, just to be who they are, working as a nurse practitioner for decades, you know, the combined knowledge and wisdom is just, it's just amazing just to be around these folks just you know, by osmosis or anything else, just sharing the same room, seeing the compassion and the care that people provide for each other, I can't even imagine what it's like being one of their patients.

Speaker 2: 17:29

you know it must be, it must be amazing.

Speaker 1: 17:31

Yeah, I was talking to another physician assistant. Actually the last podcast that I just aired, brian Fretwell, out of Cleveland and he's really involved in his organization and he says he feels like he lives on the curt tales of the bulldogs that are out there. But everybody has their gifts and everybody has their personalities and characteristics that put them in the perfect places that can move our profession forward. So it sounds like you definitely are one of those guys that is moving nurse practitioners forward in New York because you don't mind going to bat for all the non-confrontational ones that sit back and wait for you to make it happen.

Speaker 2: 18:14

Well, yeah, I think it takes all kinds. You'd be surprised some of the kindest, most empathetic folks that are in our group. You'd be surprised how they could be behind the scenes. You know, they know how to get it done in a lot of different ways. So I think that's kind of an interesting thing about it in general, like everybody has a different skill set and a different approach and you know, working together we can. We can get there. Yeah, I tend to. I'm from jersey. I tend to be a little more aggressive, a little bit more blunt. That's gotten me into trouble as much as it is a reason for why I am where I am in life.

Speaker 2: 18:44

But uh, I was about to say, consider it an asset you learn when you get older how to sort of to hone that blade, so to speak, and make it. Make it work for you more than against you. And you know, I think that's partially just as much from observing my other peers and leaders and really learning from just that way they do things. So, yeah, I mean just that exposure and just that camaraderie of being able to meet and work alongside, you know, folks that are that are just putting in the extra work to help us out.

Speaker 1: 19:11

Well, let's go back to Home Study Health. What electronic medical record system did you pick and why did you pick that one?

Speaker 2: 19:19

Yeah, I went with Alation. It was a hard decision. I had been responsible for implementing EMRs and being the sort of quote unquote super user for both of the other companies that I work with, so understanding kind of how they work inside and out made this probably a harder decision than it was for most people. And I chose elation mostly for the integration and and its ability to integrate with hint and spruce and to kind of seamlessly pull all those things in. I like that. It was more or less all-in-one that you know.

Speaker 2: 19:49

There were many of these uh emrs that are highly touted in the dpc world that if you want to do e-prescribed you got to open another tab and click on another thing and then spend. I just can't work with five windows open to do basic tasks, so that's ultimately why I decided on it. The price tag is a little higher than it needed to be. There were other ones that I'd like, but I felt like I was going to get nickel and dimed with faxes and things like that, so I was comfortable with this one. I don't know that it's going to be the one I use moving forward. I don't know if it's the perfect solution. There are things that it doesn't do. I like dot phrases and things like that and there are things like TextExpander and other apps you can use to do that. But I like, as I said, things all in one pretty cohesive, pretty integrative. I don't like having a data entry thing for four or five. Perhaps it's nice that I just somebody signs up through Hint and all that information goes into Alation and Spruce and I don't have to data entry that into anywhere else and that works pretty well for most of the functions that I use.

Speaker 2: 20:47

I have complaints, but you're going to have them with any EMR and I just think, as a word of wisdom for folks out there, like the process I went through might be a little bit much, but you learn so much by just you know. Sign up for the EMR, go through the vetting process, let them tell you what they're all about, let them tell you what they do. I had a whole form of questions that I would ask repeatedly the same battery of questions for everyone and just filled out an Excel spreadsheet and kind of chipped away at what was important to me. And that's going to be different to everybody how they like to work, how they want their practice to work but you really just learn a lot by going through the process and I'd recommend that for basically any vendor that you're using. Talk to them all. You'll be a different person by the end of that experience and want something different out of what you're looking for by the end of vetting them all out.

Speaker 2: 21:35

So long winded answer to say. I ended up on elation, but there are some other good ones out there. I think that might even be cheaper, but pros and cons to each one.

Speaker 1: 21:43

Yeah, I was thinking about the fact that all of the people that I've talked to that use elation are also using Hint for their membership control and they're using Spruce for the communications. So does that not get overwhelming, having these three programs and you've got contracts with all these multiple programs and you're hoping that they'll coordinate together, or does it feel like it's pretty seamless?

Speaker 2: 22:08

No, it's pretty seamless as far as that cohesion goes, and I don't know how other folks function with their membership model, but Hint does a pretty fantastic job and that, like the basic membership with Hint, comes with the relation cost, so I'm not even paying anything extra for that. Now, eventually I will upgrade if I get some small businesses and use some of their higher end employer functionality, which I'd like to get to. But you know, I made these choices thinking for the long run what I was going to be comfortable with. So far it's been very cohesive and I you know I don't think I'd be comfortable with it if it wasn't really helps things go so smooth. Like I said, when somebody signs up, I send them a link to Hint, they put all their information in and it just trickles through all the other apps. I don't even have to think about it. So I think that works really well.

Speaker 1: 22:53

So the majority of your clientele, then, is just individual memberships.

Speaker 2: 22:59

Yeah, so far that's the way it's worked out. I've been marketing pretty hard to small businesses but really haven't had anybody take me up on that yet. As far as being able to, you know, I think it's a great thing If I was a small business and I truly cared about taking care of my employees, I think it'd be a no brainer, you know, but offer volume based discounts for that. But it just hasn't hit yet. I haven't gotten the hooks in the right company yet. I keep working on that. So yeah, so far it's individualized. I do family discounts and age based as far as prices go. But I do have some clients that are a little bit of more of like a higher end concierge type of thing, that that are a little bit of more of like a higher end concierge type of thing. That I mean mostly what we do is kind of concierge at a budget price, except we're not billing insurance companies.

Speaker 2: 23:41

I do a lot of home visits as a part of my service and some folks just have a membership that is exclusively home visits. They can't leave the house for whatever reason, whether it's a medical reason or for whatever. So I just come to them for everything and that's a little bit of a higher price point package. Yeah, that's kind of where things are at. I'm working on trying to do a men's health service line which will also be a membership individualized membership package. So I've got a lot of different service lines that are out there. I'm just trying to be reflexive of whatever the community needs and we'll see which one takes off. I'm still relatively early in it.

Speaker 1: 24:20

I would like to see more growth by now.

Speaker 2: 24:21

Well, I was going to ask you how many clients do you have and how did you come up with the pricing for your memberships? Yeah, right now I am sitting at about 15 members, so maybe five months in compared to what I've heard out there, and I try not to compare myself to other companies out there, but I think it's a little bit slow going, which is I feel like I'm doing all the right things, doing all the marketing things that are necessary, but it's not really quite taken off in the way that I had hoped at this point. But it's going well. I mean I'm enjoying the whole process. I'm enjoying the patient care. You asked about pricing.

Speaker 2: 24:49

I basically went the spreadsheet route again, just did the market research, looked up every DPC in the state of New York and put them into a grid of what the prices were.

Speaker 2: 24:59

New York State's a little bit interesting because we've got New York City and obviously they're going to be able to get away with a much higher price point than I'm doing out in the rural parts. So I just kind of tried to split the difference of what I was seeing throughout the state versus New York State or New York City, excuse me. So basically just doing that research. That way I compared to some other places too, but it's really hard to compare to I don't know different parts of the country. It's just not apples to apples and when I was coming up to it I kind of went a little higher than probably the nationwide average, which I think is a little bit low for what we do personally. But I also was just anticipating inflation and the rise of prices on everything and I didn't want to be in a position where I had to raise prices in a year or two. So I just found what I thought was the sweet spot for that.

Speaker 1: 25:45

Are you working a secondary job somewhere to supplement income, since you just have 15 clients?

Speaker 2: 25:53

Yeah, I do veterans evaluations to help them get their claims through. I've been doing that for about a year and a half. When I was in between jobs I was working about three or four different jobs, mostly just trying to see what angles might work for direct primary care. So I was doing home visit stuff for like the evaluations for the insurance companies for them doing their annual assessments, doing that and that just gave me an opportunity to see if I was comfortable doing home visits. Again. I was still working in the urgent care. I did some telemedicine through that Really just tried to grab a bunch of positions that were 1099, that were flexible, that I could make my own schedule and that way if I could ramp up or ramp down depending on how starting the business went.

Speaker 2: 26:33

So it was all really part of the plan to get to here and I've trickled some of those things away and I still maintain the veterans work. Again, it pays pretty well, it's flexible, I can work when I feel like I want to work and some point in time hopefully the business will take off and I can taper off on that, although I really enjoy taking care of the veterans. I'll probably keep some element of that. It. I'll probably keep some element of that. It's sort of dovetailed together now where I see them in my own office and it's pretty convenient, so that's working out well. It's just sort of all part of what I do, so it's a separate job, but it sort of feels like it's all part of the same mission, so to speak.

Speaker 1: 27:05

You brought up flexibility, and that was one of the things that I wanted to talk to you about. I noticed on your website that you have drop-in rates for people that just want to come. Is that for non-DPC members to be able to walk into your clinic? And if that's the case, do you feel like that is hindering people from joining up as a membership, because they can just pay as they come, as they get sick or as they need to?

Speaker 2: 27:30

Yeah, no it's an interesting point. I'm aware of that perspective. I think for now, while I'm very much in the startup phase, this is an opportunity for someone to come in to meet me, to learn about me, to see the brand, to learn about the business, and then we could talk about membership at that time. So they come in, I offer, like if you were to be seen on a one-off and you decide to become a member, that cost of that one-off visit will roll into your membership.

Speaker 2: 27:54

I think that's probably going to be more of like a one or two time thing, case by case basis, right? If somebody is trying to use it just for that, then it's obviously not the spirit of the business and that's not sustainable. So I just until things kind of take off. I think it's a really good opportunity to take care of the community. I have the time. Somebody needs something, I can manage it for them and then you know, it just gives me an opportunity to share the vision with them and you know, hopefully they'll join or, if not, they'll tell some other people how awesome I am and we can go from there, you know.

Speaker 1: 28:25

How many drop-ins would you say that you get on a daily basis?

Speaker 2: 28:29

Hardly any. Yeah, I don't get many of that traffic. Mostly I'm not even in the office full time. I work from home and do things. I try to be there as much as I can for that reason. But everybody has the phone number. Myspace is shared with several other providers so everybody kind of knows my deal, so they can just pass on my information and if somebody needed something I could just shoot down to the office if I wasn't there.

Speaker 2: 28:49

But I'm not like in a busy strip mall like an urgent care would be, where there's foot traffic walking past nonstop. It's just not really an option for this stage in my business, so I'm not getting a whole lot of drop in, but there's some interest there and being there with my door open gives me the chance to sort of bump into other folks that are there for other services and try to get to know them and let them know what I'm doing as well. So it works both ways. I mean, I don't think it's anything that's hurting me right now.

Speaker 1: 29:14

That's good. Yeah, it takes a process, especially if you're in a new area and people just don't know who you are and you're just you're trying to sell yourself and they've never even heard of you, and so marketing that does take a lot more time than a situation where you've been in the community for many years, they already have heard of you and things like that.

Speaker 2: 29:36

For you. You were just basically transitioning a large group of patients that already knew you. I didn't. No one's seen me here, so that's, that's a challenge. No one's seen DPC here. Direct primary care is not a thing anywhere close to us, so it's like I'm introducing a brand new concept and it's a hard sell, I think, sometimes to folks that have only seen one way of doing things here for a long time.

Speaker 2: 29:59

And even though it's a very open-minded population that's very interested in being outside of the system and doing things their own way, it's taking me surprisingly longer to take off than I would have imagined.

Speaker 1: 30:12

What kind of marketing strategy do you have?

Speaker 2: 30:15

Well, I do a lot of the social media stuff, so I push that. I think probably number one thing I do is just boots on the ground. I'm out there meeting people, talking to people, and that's connected the dots to the next person and the next person and really opened up opportunities for me to get the word out. So whenever I have time, I'm out literally introducing myself, walking in the doors, talking to people. You know, giving my card, trying to set up meetings, so I just basically go to all any place. You know that, I think, is going to be a good fit for the kind of services I offer and sort of almost, you know, door to door. Just get my flyers into people's hands. I do a lot of, you know, just marketing materials everywhere. So my flyers are up every place in town that people go. I have rack cards I share. I try to table as many events as I can. I go to the local farmer's market. I'm going to Ithaca Festival tomorrow, which is going to be a great chance to talk to a lot of folks in Ithaca, which is the bigger town next to us and you know, I think that that's like the biggest thing around here is you really got to work your way into the community and let people know who you are and build that trust, and I think that's the best approach here.

Speaker 2: 31:19

But I do all the other things too. I don't spend a lot of money, although I'm starting to spend a little bit more to launch the men's health side, and a lot of it's also been. As I gain members. I have a little bit more working capital to work with. I'm just kind of bootstrapping this myself, so it's not like I got a bunch of money to throw at marketing right out of the chute. So as I grow I'm able to do a little bit more. I've gotten into the social media side of it, so Instagram, facebook, started that sort of evolving to where I can do more video content. So, like those, they seem to do better than anything else for getting myself out. There is, you know, educational content through Instagram videos and reels, as they're called, as everybody knows you know, that seems to be working fairly well.

Speaker 2: 32:01

But really just trying to hit it from any angle that I have time for that doesn't cost me a fortune. I haven't spent by design, didn't spend a lot on Facebook ads or Google ads or any of that stuff. I more recently started putting a small amount of money into SEO and helping that side of things out Search engine optimization for those that haven't encountered that yet. But that really helps people find my website and find me when they're searching for things. So I think that's an important spend, considering I didn't have a lot of energy into that. I built my website myself, so I wasn't focused on that initially, so I think that's helpful.

Speaker 1: 32:33

Have you talked to your chamber of commerce?

Speaker 2: 32:35

Oh, yeah, very much involved there. Good call, yeah, that's a big part of that boots on the ground stuff, I think, and that's been just a great opportunity for me too. You talk to one person. They're like, oh, you really got to meet so-and-so, and then you know they connect you, you get a meeting with them and it really just puts you in front of a lot more people that wouldn't otherwise know about you. And it seems like our Chamber of Commerce, tompkins County Chamber of Commerce we have a small one in Trumansburg as well. Really, generally, I'm sure this is everywhere, but it's looking out for each other and really trying to help each other grow as businesses. So, yeah, I think that's been an extremely valuable resource.

Speaker 1: 33:10

Yeah, bni groups are helpful for that too. If you're involved in a BNI group, I did sign up for one.

Speaker 2: 33:16

I hadn't been able to make it to any of the meetings yet. I was supposed to go to one last week but it just didn't work out. I mean, even though I've only got 15 members now, it's just I feel like the list of things to do is still as long as my arm and ever growing. So you got to kind of pick and choose on any given day where the priorities are and sometimes that means I can't get to that meeting.

Speaker 1: 33:37

Well, you're still in growth mode. You're still trying to figure it all out. You're trying to get to a sustainable amount of patients so that you can cut back on the passive income you're having to bring in outside of what you're doing. I'm interested to hear about the men's health. What inspired you to take that unique track outside of the family practice medicine that you're offering as well? It's kind of interesting.

Speaker 2: 34:02

In some ways it goes back to what we were talking about earlier. With some of my peers in the Nurse Practitioner Association, I've really had the opportunity to work next to some awesome people that are really doing some amazing things in the women's health space and I just realized that, you know, our area didn't really have any resources for men and it seemed like, well, you know, I think from't really have any resources for men and it seemed like, well, you know, I think from the business side, I think it's really helpful to have a niche and really helpful for marketing purposes to be able to hone in on your target audience. That's been, I think, a problem for me from the get go is not really being able to do that. So I think from the business side of it, it's going to. It allows me to really have a more focused perspective on how I market things. But from the clinical side, it just feels like such a need and men in general, they don't take their healthcare as seriously, they don't get involved as much in their healthcare. So I thought this would be a good chance to sort of tackle some of those issues.

Speaker 2: 34:54

I think the things that really do bring men in are some of these services that are offered in these kinds of clinics and that could be a great chance to talk to them about other health issues and to address some of the other needs and hopefully get them taking their health a little bit more seriously.

Speaker 2: 35:08

There's a lot of mistrust out there, particularly in guys who feel like they really need to go to the doctor. They don't have trust in it. I think it can be a good chance from the business side, but also a really great chance to get the word out on some of these things and I would like to eventually have sort of a men's group that meets monthly or bimonthly or I don't quite know how it's going to play out, but a chance to that kind of dovetail, the medical side and with just the kind of things that interest fellas and really just as a social group to. You know, I think it'll be a good thing for the community to have that outlet. Hopefully people will take to something like that and it can lead to more opportunities to help people out.

Speaker 1: 35:44

Did you take extra clinical module or something?

Speaker 2: 35:48

The testosterone replacement therapy. That was something I felt like I might've been struggling with myself in terms of my own health, and so I pursued it with providers in the past and really been quite dismissed. I was like, well, I want to learn a bit more about this and learn about it. From a business side. It seemed like it could be something that could be, to be honest, a lucrative niche, and it just sort of dovetailed my own interests and my own challenges in healthcare. So I did take a course, kind of learning the basics of that and other erectile dysfunction, those kinds of things that men are dealing with. That really just kind of laid the foundation.

Speaker 2: 36:23

Honestly, I came out of that wanting to learn so much more and there are easy ways to do it, and I think there are better ways to do it, and so I've been kind of just taking the deep dive and learning everything I can about this sort of world that is. It's a buzzword, it's like all the social media influencers are pushing it. So it's really been kind of challenging and interesting to sift through what's real, what's ethical, what's the best way to approach taking care of folks that have interest in this, and so it's kind of been fun. I'm learning so much more and learning more about myself in the process to be able to really provide a higher level of care. So it's been it's been kind of a fun journey. Wish you rolled it out yet, because I just feel like I want to be really at that level before I sit somebody down and take them through the process.

Speaker 1: 37:09

Yeah, I was reflecting on what you said about how you really were inspired to do men's health based on your own personal journey, and I'm like okay that explains why I do all my side hustle things, because everything has affected me at some point, why I'm passionate about functional medicine, why I even give Botox and why I do weight loss management and women's health. I do all these things because I've done all these things to myself.

Speaker 2: 37:34

So that totally makes sense, yeah, and I mean you know, again, I think we might have been off before we started this. But talking about you know, I just had such a desire to get something going on my own, but not really knowing what direction to go. Like I just had to open the doors and let the community tell me what they need. And this has just been one of those things that the people that I've been working with other providers it seems like there's really a lot of folks out there that could benefit from it. So, providers it seems like there's really a lot of folks out there that could benefit from it. So that sort of drives the journey too.

Speaker 2: 38:02

But it's I don't. You know, I'm at the point in my career like I don't want to be doing this just to make money. You know I need to make money. Of course we've got to support our families. All that. I got to be excited to get up and go to work every day and to be passionate about it. It certainly helps when you are making the decisions that directly sort of benefit you from a business perspective, but being able to pursue the things that you find interesting, that you see a need for, without having to like take it to a committee that's just going to reject you outright, for whatever reason, if it's not part of the bigger plan, you know I could just kind of do what I think is best for our community, which this right now seems to be a good angle to pursue.

Speaker 1: 38:39

What does the future of your clinic look like in order for you to say you've reached your goal, you're successful? How many patients is that? Or is that a number of providers that you're hoping that will work for you someday, like, just walk us through what your vision was and where you're hoping to be?

Speaker 2: 38:58

Yeah.

Speaker 2: 38:59

So I kind of, just by the numbers looking, I think a nice size practice that can comfortably balance my other interests and family life would be about 400 patients for me personally.

Speaker 2: 39:10

But I would love to see the interest rise to as I mentioned earlier, excuse me being able to provide the opportunity for other providers to get out of the system and to provide this level of care. So, ideally, having a few other providers working with me, I think, would be great. I would love to have that sort of camaraderie, that sort of hive mind to be able to tackle problems and bounce clinical scenarios off each other. That kind of thing would be really exciting to me. To have a big clinic with several different service lines and you know, honestly, I would probably like my patient panel to be small and really focus on the business in the long run and really be able to build and grow it and scale it. I'm not trying to get too crazy with scale, but I do think that there's just a lot of opportunities for this care out there and I really do think so many people can benefit from it, not just on the patient side but on the provider side.

Speaker 2: 40:00

You know my wife's a psychiatrist so we fantasize about kind of putting our heads together to add different service lines and bring both of our skill sets together to provide different things. We've talked about ketamine therapy and things like that. You know that may be down the road. So just you know, maybe we're in some large office together really offering a lot to the community and being able to bring on other people that can help. I would love to see her bring on a bunch of nurse practitioners and give them a chance to work for people that get it.

Speaker 2: 40:27

That's the very broad vision, but for now I just want to be able to provide good care to the right number of folks and hopefully the need will be there where I need to bring on some help and can give other people the opportunity to do this.

Speaker 1: 40:46

I think once word gets out there when you get however many patients that is, if that's 20, if that's 30, however many it is to where people are finally talking about how awesome direct primary care is and how they can very easily access you for their needs and how you offer telemedicine and even home visits, not just forcing everybody to come to your brick and mortar place all the time whenever they need something. I think that once people in your area figure that out, then the subscriptions are going to just start trickling in really quickly.

Speaker 2: 41:15

I hope so. I mean it seems like the word started to get there. I did have three new people sign up last week. That was exciting, so maybe it's getting there. But I think you're right. I mean to me it just seems like such a no brainer. I mean, obviously there's financial restraints for folks and other challenges. Everybody's got a tough decision to make with how they choose their health care but it's I mean to me to be able to just text somebody and sometimes get an answer or prescription sent in like five minutes.

Speaker 2: 41:39

Have your situation resolved because we built that relationship together. Like how special is that? I mean you don't have to take a day off work. You don't got to worry about kids. How are they going to manage in that situation? If they needed to be seen, you don't have to take them out of school. It just seems like so many different ways to skin the cat that your traditional system doesn't allow for, and it's patient to patient. Some people don't want me to come to their house. They want to come in. That's great. Whatever, we'll manage it however you want. Some people are more into sort of alternative approaches. Some people are more traditional about how they want to get their medicine and I just think you can just have that personalized approach, patient to patient and really meet them on their terms and take care of their needs on an individual basis, and it's pretty exciting to be able to practice that way.

Speaker 1: 42:20

Do you do all your own lab draws and gear analysis and prior authorizations and all that jazz?

Speaker 2: 42:27

Yeah, so it's just me. I'm doing everything. I like to offer that to patients. A lot of people don't like going to the hospital. Nothing against the hospital, but there's risk to going to any hospital. Who wants to be around other sick people? You know I draw when I can or when that works for patients, so that's kind of been fun.

Speaker 2: 42:43

I got my lab set up. I basically, you know, having had the experience of setting up entire urgent carers in the past, I basically have set that up and squeezed that into one little tiny box and I but I can do a lot of the traditional stuff that you'd go to urgent care for and I offer that in the membership so we don't have x-ray but other than that got all the rapid testing. I'm clear wave test set, so you know you just need a prep test or urinalysis. Got you covered in your membership. So you need to get stitched up Gotcha.

Speaker 2: 43:15

Well, all that kind of stuff that honestly I look forward to when I have enough members where they're utilizing those things, cause right now a lot of it's just kind of sitting on the shelf, but I like to do those kind of procedures and really you know the reward of somebody walking in not in great shape and walking out feeling good, that is nice. So I hope that you know one day that'll be a flourishing side of the business where people can really save themselves from waiting three hours in the urgent care down the road you know.

Speaker 1: 43:37

Yes, Once the people of Ithaca figure out the benefit, they're just going to flock to you. I hope so. I do too. I hope that. And honestly, by you offering men's health and that's not a common thing in your area, there's just not people offering that that is going to also start a domino effect of people that are probably going to be interested in everything else that you have to offer outside of that, and then they can bring their family in. Before you know it. It's going to be awesome. I wish you all the best with all that Well, thank you very much.

Speaker 2: 44:09

Thanks for the opportunity to come in here and talk about it. I would just encourage any nurse practitioners out there to know that there are a lot of people that are giving this a go, and I can pretty much guarantee that most of them are ready to share their journey and teach you a few things to help you along the way. Reach out to your peers, reach out to your mentors. Don't be shy about it. Not everybody's going to be willing to help you or have the time, but you'll find somebody that is. Don't feel like you're alone out there.

Speaker 1: 44:34

There's a whole Facebook page of all of us. I think that's where I think I found you Specific to DPC correct, specific to DPC and then this podcast. I'm trying to reach our profession and just let people know that we all started somewhere. We all have gone through a journey. Some of us have been on it for years, some of us just got started last year and some of us just started a few months ago. But wherever we are, we're always willing.

Speaker 1: 45:02

I would like to think that people in our profession would help other people because, if you think about it, we're just trying to have around 500 patients each, which means there's plenty of opportunity for other people to come stand beside us and not take up any of our space. You know what I'm saying stand beside us and not take up any of our space. You know what I'm saying. So we should all be willing to help each other out and better our lives, because really it comes down to not only making it better for the patient and have a better healthcare experience, but also for us to have better quality of life. If we don't have a good quality of life, then we burn out. If we burn out, then we become terrible practitioners, because everything just feels so enormous and just unrealistic to solve I don't know how else to say it yeah.

Speaker 2: 45:49

And you're just not ready for it. When somebody brings something to you, if it doesn't, you might dismiss it as being like an annoying thing because you're just had that was just that one last thing you could deal with for that day, right. But in this environment it's like every little thing. You can really just kind of step back and be like let's take a, let's take a deeper look at that and not feel like you're stressed and have to get onto the next patient or paperwork or the 25 charts you still have to do. So you can really just whatever the concern is, the complaint is you're you're ready to sort of greet that, and to me that's exciting to be back practicing that way again.

Speaker 1: 46:21

Exactly, all right. Well, matthew, good luck to you, and I will maybe be able to follow up with you in a year and see how well you're doing.

Speaker 2: 46:30

Sure, I'd appreciate that, and congrats to you and thank you for putting yourself out there. You're a perfect example of the success that can be had for us nurse practitioners going out and doing their own thing. So continued success, best of luck to you and thanks for putting this forum out there for us to share.

Speaker 1: 46:48

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.