The DPC NP
The DPC NP
Revolutionizing Healthcare: Michael Menchaca's Shift to Direct Primary Care and the Path to Patient-Provider Harmony
Embarking on a healthcare revolution, Michael Menchaca joined me to unravel his inspiring transformation from the conventional grind of fee-for-service to the liberating world of direct primary care with the establishment of Amenity DPC. Imagine a practice where the watchwords are presence and connection, not just in the clinic but also at the dinner table with your family. In today's conversation, we delve into Michael's innovative journey, exploring the deep-rooted changes that occur when doctors take the bold step of aligning their work with their fundamental values, allowing for an intimate patient-doctor relationship that defies traditional healthcare models.
There's a refreshing sense of possibility that permeates our discussion as we look at the evolution of Michael's practice, highlighting how it has grown to encompass a suite of services that prioritize patient wellness over quick fixes. From offering urgent care to pioneering lifestyle programs, we share the personal triumphs of helping patients lead healthier lives, often reducing their reliance on medications. Michael's narrative is a testament to the profound impact such a model can have, not only on the patients but also on the healthcare providers who seek a fulfilling balance between their professional aspirations and their personal lives.
As we wrap up, the conversation takes a forward-looking turn, examining the ongoing shifts in healthcare costs and the inventive strategies to manage them. Whether it’s adjusting insulin regimens or connecting patients with affordable surgery options, we discuss the real-world implications of direct primary care practices. And for the nurse practitioners out there, Michael and I muse over the exciting prospect of a conference dedicated to those in direct care, promoting a collaborative community intent on learning, growing, and refining the art of healthcare. Join us in this episode for a glimpse into a future where healthcare is more than a series of transactions—it’s a journey towards wellness, shared by patients and providers alike.
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. Okay, everybody, thanks for joining us today. We have Michael Menchaca on the DPCNP. Michael, thank you so much for joining me today.
Speaker 2:Happy to be here. Thanks for having me, you're welcome.
Speaker 1:Tell me about Amenity DPC.
Speaker 2:It is my baby of sorts.
Speaker 2:It's kind of what has provided the kind of lifestyle that my wife and I like to have, and what I mean mostly by that is the flexibility to be the parents we want to be, be the husbands and wives that we want to be to each other. And yeah, it started out six years ago. Well, technically, it started in 2017. I started out as a fee-for-service practice and I was doing that for about six months, thinking that I could change the system, and it was six months in, after losing about $15,000, that I realized this isn't going to work. I don't want to be building insurance. That eventually led me to find the model that is direct primary care and eventually made that transition, and we've been doing direct care since 2018 now.
Speaker 1:How did you know about DPC? Like you started off taking insurance and then how did you know that there was something better just six months later?
Speaker 2:Yeah, so it was a little bit of luck, a little bit of determination and curiosity. I was working with a when I first came out of practice. I was working with a very busy internal medicine practice, you know, 40, 50 patients a day. Then I went to work with a clinic that only sees Medicare Advantage plans and you know, it started out with very like only 68 patients a day. You know, based on metrics and it like it seems like the way healthcare should be. And you get in there and get into the weeds and you find out it's really not all that different. And a lot of times you are gaming the metric system in a way and doing so in a way that doesn't give patients the healthcare that they actually want, right, so it doesn't meet them where they need to be met.
Speaker 2:And I grew increasingly frustrated one of those days and I opened my clinic by doing it part time, working part time, maintaining an eight to five working night shifts. So I was driving home one day I had about an hour drive that day and I just thought to myself why can't healthcare be as simple as going to the gym where you just you pay one fee, you go and use what you need to use. You pay a little bit extra if you want a bottle of water or if you need a towel or a locker or whatever. And that day I got home and I Googled gym style primary care practice and that's when I, after a few clicks, came across the term direct primary care. I spent the next month reading everything I could about direct primary care. At this point I was not married. I didn't have any kids, so I literally every waking minute was just direct care, direct care, direct care, direct care. I spent a month reading about it and then said you know what I'm doing it? And we made that switch.
Speaker 1:So were you working for someone when you made the switch, or had you already opened up a clinic where you were taking insurance?
Speaker 2:I had already opened a clinic where I was taking insurance and at the time I was still working part-time for another practice, I think by this point I was actually still doing eight to five at my regular job and then five to nine at my practice, and then when we started, we were charging $50 a month for our membership and just slowly but surely made that transition. I went to part-time or eight to 12 at the primary job and then 12 to five at this job, and then eventually dropped in and just went full-time.
Speaker 1:So how long did it take you before you could be independent with your own practice and you no longer had to work the second job? 18 months, okay. And how many patients was that?
Speaker 2:That is a good question.
Speaker 1:It was so long ago.
Speaker 2:Yeah, that's not one of those data points stuck in my head. I want to say I was probably around 70 or 80, you know, but I was doing some other side jobs and telehealth jobs to support income and I kept doing that, even that for a little while, probably up until the pandemic started. So, yeah, I would say 18 months and then probably around 70 to 80 members.
Speaker 1:Okay, and how many members have you grown to today?
Speaker 2:Just me myself, I have about 550.
Speaker 1:Okay, yeah, and then that feels manageable to you.
Speaker 2:Sometimes sometimes, you know, I guess there's always the busy moments you know where you're busy seasons blue COVID where it can feel a little bit overwhelming, and then there's other days where it feels like man, this is just. This is just new sailing, right. I think you know one thing that I've learned from the, from my time doing this, is that it's probably too much for me being in the owner role and wanting to do a lot of the operations. It's probably too much in that from that viewpoint. But if I was just seeing patients and not worrying about the operational side of the business, then I think it would be perfectly fine.
Speaker 1:So you told me before we started recording the podcast that your wife works for you and she is a physician assistant. So when did that start and how many patients does she have?
Speaker 2:Yeah, so we actually. She got pregnant 2019, going into 2020. It's the middle of 2020. And in our area in June, july, we hit our surge here in South Texas and she was working with cardiology and doing rounds at the hospital and so she took an early maternity leave. She was unsure if she wanted to go back and at this point we were still unsure how it was affecting newborns. And I said, hey, like why don't you come? You know, work with me. And I had already opened up the second location because I wanted a location in my hometown because my first one was not, and I was splitting time between the two. And I told her, like hey, you know, we have the clinic, it's right down the road, you get to be from home, you don't have to worry about hospitals and you can, you know, be a mom but still work. And after a lot of back and forth and weighing the pros and the cons, she decided to go through with it and I offloaded about 70 members to her and right now she's currently sitting at about 400.
Speaker 1:Okay, that's, that is manageable, 400. Yeah, and unless you don't have any ancillary staff, do you have nurses or medical assistants that help you?
Speaker 2:Yeah, we do so we house. We have one RN at her practice, we have an LVN and an MA here at my practice.
Speaker 1:Okay, so you do. You just have the two locations For now. Yes, so she does the one location and you're doing the other one, correct? Do you have plans to open a third practice?
Speaker 2:Hopefully, so Hopefully later this year we can go ahead and accomplish that. We did hire a third NP late last year and the idea is to open up a third location for her.
Speaker 1:So walk us through. What does it look like? How do you hire? It was easy to hire your wife, I'm sure, because you could convince her.
Speaker 1:You already know her personality. You know that she would be a good fit for this type of healthcare Because, as you know, with DPC you have to have a lot of compassion. And you have to have a lot of compassion and you have to give a lot of grace, because people are going to message you at whatever hours. There's no real defining eight to five and you won't hear from me again until the next morning. Those are kind of gray areas. So you already knew that your wife would be a good fit for that. But how do you know, when you're hiring someone, that you're going to hire someone that is will fall in that characteristic that you really need to have if you're a DPC provider?
Speaker 2:It's really difficult and I actually struggled finding that third NP that we, that we hired last year. I think I tried for a full two years before I finally found some success and there was a lot that went into that struggle. It was one, the right person, two qualified people and then three pay right, because not every direct care practice is set up to pay market salaries right from the get-go. And after talking with a bunch of direct care owners, I've seen, I've heard it all you know from the yeah, we raise our prices to pay market salary or we start out with a low monthly rate and then build based on memberships and percentage of memberships and so on and so forth. In South Texas there's really only two direct care practices, so the whole idea is still very new and trying to sell somebody on it was rather difficult.
Speaker 2:And what I ended up doing was I ended up thinking about like, okay, what would be the characteristics of an individual who would thrive in a direct care practice? And the thought that came to mind was somebody who's overly kind, somebody who's extremely talkative, almost to a fault, somebody who is a good team player, not just amongst providers but amongst ancillary staff as well. And when I started thinking about it from that perspective. There was only a few candidates that really came to mind, and this was already after failing for 18, 19 months. One of those candidates was my best friend who's an MP. He wasn't available because he owns his own urgent care. And then this MP that we ended up hiring. I reached out to her and it just so happened that she was in a time of her life where she needed a little bit more work-life balance and everything just happened to work out Timing, pay structure, type of person she was or is and it worked out. But honestly, if I had reached out to her maybe a year prior, I don't think it would have.
Speaker 1:What kind of pay structure did you come up with?
Speaker 2:I ended up going market salary.
Speaker 1:So she just gets a salary and you started paying right from the get-go, even though she didn't have enough patience to cover it.
Speaker 2:That's correct. It go, even though she didn't have enough patience to cover it. That's correct, and I was from a business perspective. It's not the best way to go. My situation was my wife was going on maternity leave with our second child and I was kind of forced into that hand. But I will say, as as fearful as I was to to pay the salary, it has been well worth it, extremely well worth it. That's good, and if I could go back I would have hired another nurse practitioner a lot sooner than what I did.
Speaker 1:I'm kind of in that area right now. I have 540 some odd patients and there's about 50 on a waiting list and I'm just thinking in my head like what does it look like to bring another person? And it's kind of scary because I have hired. I ran a fee-for-service clinic for 16 years before I changed it over to DPC, so I've hired a lot of nurse practitioners over those years and I can't think of more than just a couple of them that would have been good for DPC.
Speaker 1:So I'm just afraid, because I know that I don't have a good discernment, I just like everybody and so when I interview somebody, I naturally am like oh, I love you, you're so awesome until you get in there, and then I see the nuances and so I'm not sure what to do about going that route. Oh, man.
Speaker 2:It's quite the mental, you know, battle to like, as you start thinking about like, okay, do I hire another nurse practitioner, do I not hire a nurse practitioner? And then who? And then what do I hire them for and how long is it going to take for them to? You know? Basically, pay for themselves, right? And you just got to be super selective, I think, and it also depends on what your, what your goals are.
Speaker 2:You know, if you're trying to get a little bit more time away from the practice to pursue other ventures, like a podcast, or maybe a second business, or maybe any product lines and service lines, then having another person in your practice that can do all the things that you do is crucial, and it was one person that told me.
Speaker 2:He broke it down to me by saying stop thinking you're a unicorn. You're not, and every person can do what you do and they can probably do it better. Because you're getting to a point where your focus is stretched between your patients and your business and you're going to have to pick one. You can hire somebody to focus on the business or you can hire somebody to focus on the patient, but you can't do both, otherwise your service will fall and I said that's actually a really great point and it's difficult for me because I like doing both. You know, as much as I would love to say like, oh, I'm going to give up patient care, like I'm only seven years into my career, which is still still pretty, pretty new, I would say, but I've been around business since I was 10 years old, like I love it and I love conversing with people. So I'm trying to find that happy medium right now.
Speaker 1:What did it look like to buy your second business? Did you just open it up from scratch, or was it a business that was already established and you took it over? Talk to me about that.
Speaker 2:Yeah, no, I just I leased an office space, ordered the things that I need to have in there and started I mean I've never really advertised but just started posting about it, you know, and telling people about it and just word of mouth fully. But surely just grew and grew and grew. So I think the initial upfront investment on the second location might've been like 7,500 all in with, like you know, repainting the walls, you know, getting a look, a few pieces of furniture, the otoscope, those types of things. And I try to keep it as bare bones as I can when starting out, like keeping costs low and whatnot. I don't go for the huge fancy design makeover sort of thing, but we do make it look presentable and we get a lot of compliments on our offices, from cozy to clean.
Speaker 1:Talk about your family work-life balance there. How has it improved since fee-for-service?
Speaker 2:and kind of tell us about how good your life is with the work life but you know, I really, I really couldn't I mean I, my wife and I are the type of people that will make it happen and we'll get it done. But you know, thinking about the schedule she used to work, in the schedule I used to work, I'm just like man. I mean we would have seen her kid maybe an hour a day, you know. And now we get, you know, like a full two and a half hours in the morning because we wake up early, we're picking up our three-year-old from school and so that's, you know. We get her about 4.30 and then she doesn't go to bed till like 9, 9.30. So that's a full five hours. But in the past I mean, I wouldn't have been getting home till 7, 8. My wife wouldn't have been getting home till like 6 or 7. So it would have been a lot of time away from then.
Speaker 2:And if you're just thinking about, like how, how much kids need to be around their parents and how much parents need to be around their kid, I just I foresee that if we had stayed in our current or our previous situation, that we would have been pulling a lot of hairs out more than we are now. Right, but at least right now it feels like, oh, we're just learning how to be parents, Right, and we're doing it the best that we can with the amount of time that we have. We keep my wife's membership around 400 or under for that specific reason, so she can be, you know, the mom that she wants to be. We don't want to be overstressed, overworked. The members that we have, they're super respectful of our time and they understand that. You know we're trying to be parents as well and they know what it's like. And whenever we're having them in the practice, when we're visiting with them, you know we let them know what's going on with their family. We show them photos, we talk about the parenting struggles and for some they remember when they were there and so they're very respectful of that time. And thankfully we don't have too many people like over utilizing us on weekends and nights and things like that.
Speaker 2:Flu season will be flu season, right, or COVID season will be COVID season, but other than that I mean it's been really good. I really could never see myself going back to a traditional fee-for-service work environment in any capacity, because I think like in doing so, just kind of it would put barriers in my life to my family and then barriers in my life to the patients. And removing those barriers was kind of one of the key reasons of opening a direct care practice. And yeah, I mean I really have no complaints. You know, we all have our daily struggles, but nothing that I can truly sit here and complain about.
Speaker 1:Yes, you brought up such good points about how nice it is to not go home and worry about charting. You didn't mention that. But that is part of being a fee-for-service provider is you don't have time to chart. If you're seeing 30 patients a day, you have to go home. And now you've got to get caught up so you can get reimbursed that money. And you got to make sure you cross every T and dot every I so that you do get the money. And in direct primary care, all of that time that you're taking to chart it can now be spent really getting to know the patient. You can spend an extra amount of time with them. So when you start to learn how they live and who they live with and what their family and life dynamics are like, it's actually easier to figure out sometimes what their problems are, isn't it For sure?
Speaker 2:For sure. My favorite thing is when we get a family involved together and I'm always preaching like you can't. You can't make the most sound healthcare decisions unless you're incorporating the family as a whole unit and knowing how each decision will affect the other people in that family. Unfortunately, in fee-for-service, everybody just gets treated like their own individual person, without the thought of like okay, what's the home environment like? Do you have the time to do this? Do you not have the time to do that? So, yeah, getting to know them is a great part of it. Getting a family together is a great part of it. It helps me be a better nurse practitioner. I'm sure you feel the same way. Yeah, I mean, whenever I walk into a patient room, it's like it's gonna be good to see them. I don't see them in a while. Bruce is like all right, I got five more and I gotta get them 10 minutes. It's like, hey, mr, we got five minutes today.
Speaker 1:I'm gonna help you yeah, you know, and it's not helpful. It's not helpful because you only have five, seven minutes with that patient, so so it's like you can't short talk. You just got to get you know small talk. I mean, you just got to get straight to the point and then, whatever they tell you, you have to take that at face value so you can figure out a plan. And sometimes what they tell you is not entirely accurate, right, and you don't have time to dissect all that. You just have to assume that that's the true information and then you prescribe a pill and send them out.
Speaker 2:Yeah, that's, unfortunately, that is the healthcare system that we live in traditionally here in America, and you know, I find myself prescribing less now and that's probably a combination of going from that world to the direct care world and also just being a little bit more seasoned in my career. You know I'm not sure about others, but for me I was like man, writing prescriptions is so cool, right. You know I'm not sure about others, but for me I was like man, writing prescriptions is so cool, right. And so I was. I was ready, I was ready to hit the prescription page, but nowadays, you know, I like to focus on lifestyle interventions. I really think a lot of people just need to adjust their lifestyle and you take care of a lot of the common conditions that we see, at least in my area. We have the highest obesity rate in the country, but we do see a lot of diabetes, metabolic syndrome, high blood pressure and things like that.
Speaker 1:What type of software programs do you use to manage memberships and what do you chart with and all that?
Speaker 2:Yeah, so I use AtlerMD as my primary EMR system and I'm probably a loyal customer. Like their customer service is just top notch. They've integrated a lot of the AI features, so like you don't have to pay for free. It's already kind of built in. We do have Spruce, and Spruce has been great. Spruce has been great. I really like Spruce, and so does our team. I'm toying with the idea of putting my direct number back into Atlas just so I can stay in Atlas, because going back and forth between the two can get a little bit annoying. It just feels less efficient at this point. Even. It just feels less efficient at this point, even though I thought it would bring more efficiency. Now I'm having I'm reversing my thoughts on that, but so we use Atlas, we use Spruce, I use ChatGPT a lot. Chatgpt helps me write out a lot of emails, helps me write out a lot of social posts and, aside from other tech platforms, that's really about it. You know just your basic calendar and to-do lists or app.
Speaker 1:So Atlas MD will manage the memberships and it's a EMR and you can also text and email through that, the patients, yeah so the only thing Atlas doesn't do is have like a dedicated like VoIP phone setup.
Speaker 2:But you can text directly from the patient chart, you can email from the patient chart, you can run membership process reports, follow up on failed charges, you can send out text or email links to update your payment settings and adjust their memberships. As of late, the most recent updates gives you a lot more flexibility on pro rating months and group plans like family plans or hormone plans and weight loss plans and whatnot. So a lot of flexibility. I think the only reason they don't market themselves as an all-in-one is because they don't have like the VoIP system set up. But they generally have been updating over the past six years so many different features and they've never raised their price. So I do have a lot of respect for them over there.
Speaker 1:So you still pay $300 a month.
Speaker 2:Per user. I'm sorry, not per user, per provider user.
Speaker 1:Because they don't charge for the nurses or your receptionist or anything. Right Correct, that's great. Well, I've heard good things about Atlas. You're about the third or fourth person that says that they use it and they like it and the customer service is good.
Speaker 2:So it's, you know it's when I when I find myself getting a little bit frustrated with members whenever they're, maybe they're they're going through a rough patch and they're reaching out frequently and it's kind of like, oh man, it kind of wears on you Like I actually just think back about Atlas and it's like if I already emailed them at seven o'clock tonight, like they would respond to me within an hour, you know, and even like during business hours, if I email them in like two minutes I have a response. It's crazy.
Speaker 1:So what you're saying is Atlas also humbles us when we get frustrated.
Speaker 2:They, they do they. Maybe I need some accountability with that every once in a while, yeah, yeah, I kind of remind myself of that when I find myself getting a little bit frustrated. It's like, you know, and I'm sure they're managing a whole lot more than than I do their practice is bigger than ours. They, they're doing the emr stuff right. So, and you know, I can send an email to dr josh and he'll respond pretty quickly, you know, and he's probably the person you would least expect to get such a quick response from.
Speaker 2:But I actually emailed him just last week trying to get some info on a marketing audio book that he had posted about in the support page on their Facebook page and yeah, he gave me a whole list of like hey, this is what comes up for marketing, let me know if this is what you needed. If not, let me know. Super helpful, super friendly. You know I'm not sure where they stand on the whole NP and D thing, but at least in working with them I've never felt any kind of negative you know attitude or characteristic towards me being an NP on practice, and who is this?
Speaker 1:you're talking about Atlas.
Speaker 2:Oh, atlas. I find them kind of like in an interesting situation because, like, if you think about Spruce or Elation or any of the other EMRs and platforms out there, like I mean, they're just you know companies, but Atlas is like was started by a doctor, run by doctors, but yet they have the system that they provide to PAs and MPs across the country as well.
Speaker 1:So that kind of found a question in me. Have you been to any of the DPC conferences that are out there and if you have, what was your experience with that? I have not.
Speaker 2:I have not. I was. I was invited to speak at the Hint conference earlier or late last year to do the whole NP versus MD thing and I couldn't make it last minute due to a family issue, but other than that I haven't been around it. I did get to go through like a a a mock debate with the MDs that we were going to be debating and the only thing I can really say to that and in my experience with in talking to them and having that mock debate, I really, I really think, if you were to remove all the noise, I really think that the direct care MDs and direct care NPs and PAs, we really just have the same goal in mind.
Speaker 2:But you know, direct care isn't just charging a membership for service. Direct care goes way beyond that. Direct care is about being the type of NP, md or PA that's going to really, you know, push yourself to get to the top of your license and practice and really focus on saving people money and really focusing on getting the things that they're going to need without having to rely on like oh, you know what I got to send you to dermatology. Oh, you know what I got to send you to ENT. You know it's not a referral hub. It's where patients can come in and know that they're going to get their care taken care of. It's about being their quarterback through the system so that you can navigate them in an efficient and cost-saving manner.
Speaker 2:So you know, and when you start talking about those aspects of direct care, I really don't think MDs, nps and PAs really differ much in terms of providing that care. But I'm sure that there are some you know MDs and MPs and PA that you know they charge a membership for their service. They call it direct care and wash their hands and they're done. And that's what some of those MDs were a little bit fearful of, but they admitted, you know, they know that their own peers do the same thing and so, like you know, as direct care grows as a movement, I think we need to continue shining light on like it's more than just charging a membership fee. It's about really advocating for your, for your members. It's really about building that relationship. It's really about being able to navigate them through the system. It's really about being able to push yourself as a clinician to help them as much as possible.
Speaker 1:That's good. What other services, other than just family practice, do you offer in your clinic?
Speaker 2:We do urgent care stuff right, so lacerations and all that, all the minor procedures. We do hormone replacement. We do weight loss. We have a really good weight loss program going, where we focused on re-educating members on how to approach nutrition and we do so from the perspective of treating nutrition like a sport and that's probably like our top tier service and I only take about anywhere from three to six people a month on those weight loss programs, but we're having calls with every two weeks and everything kind of gets wrapped in Like they have a UTI. I'll treat them too for that. Those programs are available for members and non-members.
Speaker 2:But yeah, we just really go through the art of nutrition and like really learning how you can still eat your burgers and eat your tacos and eat your pizza and still lose weight, how to incorporate those types of foods into your life so that you can enjoy food right and have a healthy relationship with and not have a relationship that really stresses you out because it's like, oh, I can't eat that because then I'm going to gain five pounds, and it's like you can eat that and then you just got to either prep for it or recover from it, and that's been, lately, what's been the most intriguing for me and I find like it's the most fulfilling, because we're not just helping them lose weight, but people are coming off their medications, lab values are improving, energy is improving, their wife or their husband picks up on it and they're losing weight, the children pick up on it and the children are building healthier habits. It's like oh, like. The ripple effect is just very rewarding.
Speaker 1:I love it when I can get patients off of their medicines or even onto more natural type supplements instead of their medicine and they do just fine on that. That feels like an accomplishment there.
Speaker 2:Yeah, it does. It does, and I think members and people resonate with that too, because I think a lot of practices are starting to feel like pill mills, you know, and it's just like here's the prescription for your symptom, not here's the plan for your cause, exactly.
Speaker 1:So what does the future look like for Amenity DPC?
Speaker 2:Oh, you know that is a question that I ponder almost every day. What does the future look like for Amenity DPC? I know colleague Monica up in Austin. She just announced that she was going to be hanging her hat with patient care and become just the CEO and I think I would like to get to that point. You know she has twice the experience that I do.
Speaker 2:But right now at least, I really struggle with letting the patient care side go, even though from a business perspective it's exactly what I should do. I feel like I have a hard time making that decision. But I think the future would probably be maybe one, maybe two more locations and stepping into that CEO role. But I think I would probably host maybe once weekly or twice weekly webinars so that I can still interact with the members. They know my face, I know their faces, interact with them, talk about nutrition, talk about diabetes, high blood pressure, give them a chance to do Q&A and that way I can still feel connected to them, they feel connected to me. But I can really focus on the delivery of direct care versus delivering the direct care, if that makes sense.
Speaker 1:Yes, well, that's a good future goal that you have. Do you see that five years down the road, or do you see that more like 10 years down the road?
Speaker 2:I would say, just because I like to be a little bit in confidence, I'm going to say that maybe in the next one to three years that I step into that CEO role. But as far as the third and fourth clinics, yeah, within five years, I think is a fair target.
Speaker 1:So you see four clinics possibly. That's good.
Speaker 2:I think so. I think so. There's the area that we're in. Even though it's filled with a bunch of small cities, there's a lot of area to spend, there's a lot of coverage that you can work with, and, where I live, 15 to 20 minute drive seems like too far, but in bigger cities like Austin, that's just the norm. Right, it's like some people can do 40 minutes, 35 minutes.
Speaker 1:Yes, my patients do not like to leave our little suburb, even though we're not too far from Memphis. But we're in a suburb and people like to stay there, so it would be nice to have all these little satellite offices and other surrounding suburbs so people don't have to necessarily drive to my suburb, they can stay in their own, and that's probably the same situation that you're in then, yeah, we're growing area, so the highway construction it's.
Speaker 1:If people don't want to deal with it yes, do you have an example of a really cool personal story since you've opened up DPC that you could share that has really impacted your life and really impacted the life of that patient?
Speaker 2:Yeah, you know there's a few, but I think the one that resonates the most right now. She's a current member. She's about 74 years of age and she's part of the family where she's a member. Her daughter is a member, her niece is a member, the daughter's husband and family member, so there's a lot of connection there. And her husband was a member. He passed away, just kind of helping her through the grief process and working through that.
Speaker 2:I was seeing her pretty frequently and we had a lot of conversations about like what it meant to lose your spouse.
Speaker 2:And just being able to be there and having her like open up the way she did gave me a different appreciation for my life and it's definitely something that I would never have had the time for in a fee-for-service world. And, yeah, kind of build a connection with her. For sure, there's another three-year-old type 1 diabetic and we're just her and I are like this and because they can't get into their endo all the time, you know, I ended up having to make mine like the most minor adjustments possible for her insulin regimen or maybe suggesting a slight increase in carb or decrease of carb intake. So that's that's, you know, a good example of like where you have to maybe exercise a little bit more skilled and what a lot of people would be comfortable with. You know I have a lot of colleagues in the area who are scared to start people on adults on insulin, let alone titrating a pediatric patient. And you know it just comes like using your resources, using your network, you know, making sure that you're doing things appropriately and in a way that's safe.
Speaker 2:There was another gentleman who needed a shoulder surgery and he was looking at about a $35,000 door locally and we connected him with the surgery centers and he ended up getting everything for $7,900. So that was a big savings. A year later he drove up in a UC8 Corvette Stingray. So the savings weren't the good news, I'd say, but that was nice to see. I was very happy for him. I'm a big Corvette guy myself.
Speaker 1:Me too. That's my dream car. Someday I'm having one of those.
Speaker 2:Yeah, definitely Don't let go of that dream. You, you know we've put folks on you know IV antibiotics in the clinic. There was one gentleman who got sick in Florida and he was in the hospital there for two days. They started a PICC line and they were looking for home health to do his IV antibiotic and ended up talking to the team there at the hospital and I said, hey, like where is PCP over here? We can get it taken care of. And that bill went from like $30,000 for home health with plus the antibiotics, so like we got it from a local pharmacy for like $600 and we completed his six weeks of treatment.
Speaker 1:Oh, that's awesome.
Speaker 2:You know so it's, it's things like that, but like you, you you have to like, have the courage to be able to step into those situations and be like, okay, how are we going to do this? And, of course, you know we're talking to a pharmacist, that you know we're talking to the farm instead. You know we're talking to you in Texas, we have our supervising thing. You know talking about supervising, you know, making sure that we're keeping things as safe as possible, but also making sure that we're really doing as much as we possibly can for these people. Awesome.
Speaker 2:I was going to say one just interesting thing that I think is going to be coming about soon that many people may not know of is Atlas is getting ready to launch their own version of an insurance, obviously direct care in mind and whatnot, so it'll be interesting to see what comes of that. It's not that I'm anti-insurance. It would be more like just being anti-bad insurance. Right, and by bad insurance, what I really mean is very little value being provided, or low value insurance, which I struggle to understand what good insurance means these days if it's not some sort of employer funded health plan that has direct primary care at its core.
Speaker 1:So that's, that's something interesting, and I think what would be helpful along these lines of Atlas launching their own insurance and a lot of the same concerns come up with my patients is they recognize that they're paying so much for their insurance, their premiums are high, their deductibles are high, and then, even if they met their deductible, it might be 70-30 or it might be 80-20. So they're still never getting to a point where the insurance will 100% cover them. Once they've met this out-of-pocket expense, or whoever could come up with a policy that would be very inexpensive, that people could utilize only when they need a surgery or they need to go into the hospital for some reason, and that is when they use it. And then they have enough money, you know, tucked away to be able to afford the DPC membership plan.
Speaker 1:Then I think there would be more people that would choose to pick that type of insurance. And there are those plans out there, but you know the catastrophic plans but they're still not great. Premiums are still a bit much.
Speaker 2:Yeah, and where, where my family has found a happy medium is with the health shares. We use Sedera and that's what we provide for the staff here as well, and I think you know with any program like that it does require a responsible utilizer of healthcare services as well. Sometimes I wonder whether the population in mass is ready for that. Obviously so, like you are, but it's definitely. I still see the wave growing, the wave of direct care growing. Change takes a long time. The human condition does not like change and we stay. We stick so much with the this is the way we've always done it mentality before we really venture out into any change.
Speaker 2:Even when we know it's costing us in more ways than one, whether it be time, money or our health, right?
Speaker 2:Because if you just look, at the numbers like the United States is not great at preventative health and chronic conditions. You're paying for it more ways than one, and that's the question I get asked a lot is why would I pay for insurance and your service? Why would I pay twice and like well, with your insurance you're paying like four times, you know. You're paying your premium, you're paying your copay, you're paying your deductible, then you're paying your 70-30, 80-20 split and then you're paying your time and then you're paying for your health. Usually that kind of gets people to be like oh man, you're right, you know, but then not all of them convert into direct care members.
Speaker 1:No, and it's such a new thing, Like you said, I think direct primary care has literally only been out maybe six, seven years. The model, and people think it's just like concierge medicine. So I have to explain to them the slight differences in concierge versus DPC. But I think when more providers start turning towards membership based, it's going to be so recognizable to everybody that there won't be much convincing.
Speaker 2:That has to go on like there does right now, definitely, I hope, hopefully that's the future that comes about, not just for practice growth, but I think the country would be healthier because of it, absolutely.
Speaker 1:So if something that you said today resonated with a nurse practitioner that's listening to this podcast and they want to reach out to you for a question or want to talk to you about something, could they do that and if so, how could they reach you?
Speaker 2:Definitely you can reach me by email at mrmanchaca at amenitydpc. Definitely you can reach me by email at Mr Menchaca at amenitydpccom. You can text me at 956-446-0955. You can follow me on social Instagram at mmenchacanp. Facebook is Amenity Direct Care. Personal page is Michael Menchaca. Anyway, you can get ahold of me, feel free, and if you have questions about direct care whether it be starting, growing, marketing, memberships, anything feel free to reach out. I'm always happy to lend a helping hand.
Speaker 1:Thank you for that Cause. Yeah, we're here to help anybody do this. This is why I wanted to do the podcast. I love the Facebook pages. I love to be able to see what people are asking and then associate that with things that I didn't even know that I needed to know, and it's been so helpful. But I think when I get to interview people such as yourself and really learn the dynamics of how you got started and what worked for you and maybe some things that didn't work for you, that is so encouraging and so helpful. So if we can be encouraging to a nurse practitioner out there or a PA that's considering this, then we've done our job.
Speaker 2:Definitely, definitely, and you know. Kudos to you for starting this podcast too. I'm sure it was in the minds of a lot of different MPs, but this is the first one that I see actually put it out and start doing it. So kudos to you. I hope it continues for many, many years. Thank you.
Speaker 1:And trust me when I say I did not know what I was doing. I don't know why it was put in my head to do this. I had to YouTube everything to learn how to even start it, but it was just such a drive like I had to do it. So here I am, and now I've got this thought in my head I want us to have a DPC nurse practitioner conference.
Speaker 2:So who's doing that?
Speaker 1:So I was talking to Penny yesterday. Penny Vachon and I interviewed her last night and she said somebody just reached out to her last week about doing it and I'm like please give them my contact. I don't know why I have this such a strong desire, but I want our own conference. Why don't?
Speaker 2:we have that? I don't know. I don't know. I actually reached out to Monica and another MP I don't know if you know John Rothwell. I haven't met John. No, he'd be good to interview too, but he has his practice out in Florida. I've come to know Van from a mastermind that we were all part of a few years back, and I reached out to Monica to see if she would have any interest in it and of course she mentioned Penny and she mentioned a few others. So I actually need to reach out to Penny too. But I think we really need to do it. You know, and I think the elite np conference, yeah, something they kind of yeah, but justin is like we can do this, like we can put our own conference together. Uh, we just need to just do it right.
Speaker 1:we can't just be mulling about it yeah, we need to have a handful of business-minded nurse practitioners that are like, okay, we can do this. My office manager puts on a conference for us. It's like a southeast, southeast faith-based denominational conference and she single-handedly organizes that whole thing. And I'm like she already said to me, if y'all want to put together a conference, I will help you do that, and I'm like sweet. So I say we just get a group of people together and start figuring it out. I talked to Shane Grendel.
Speaker 2:I've spoken to him, but I've never met him in person.
Speaker 1:Okay, well, I interviewed him a couple of weeks ago and you know he went to Harvard business school as well as he's a DNP and he's got so much in his brain business sense that it was over my head. So I thought he would be a great one because, in addition to talking to people about DPC, he's like if anybody needs any kind of business, you know information and I thought, Hmm, I'm going to register you in the back of my mind for if this conference really gets going, yeah, there's a.
Speaker 2:There's so many great NPs out there we really should put together. I mean, it's getting to a point where it almost feels like a disservice to the profession to not have more NP-specific conferences and like A&P and the state nurse practitioner conferences are great, but we really need to put something together for, like, the business aspect of the career. The other one, andy Austin. Do you know who, andy Austin?
Speaker 1:is. Haven't met Andy, but I'm writing him down.
Speaker 2:Yeah, the other one, Andy Austin. Do you know who Andy Austin is? Haven't met Andy, but I'm writing him down.
Speaker 1:Yeah, he, he goes by the bald NP, the bald, bald NP. Okay.
Speaker 2:And he, he has a bunch of workshops that he goes around and does each year related to different in-office procedures and injections. Very knowledgeable guy. There's just so many. There's so many great NPs out there. We just We'll find these people right, I'm on it. I'm on it. Yeah, yeah, keep me in the loop. I would love to be, I would love to be part of it.
Speaker 1:Being a new I guess a newborn and a three-year-old, my time is somewhat limited to a certain extent, but yeah, I would love to see that come to fruition in your situation, even if you're able to like get together with a zoom meeting and give insight, like give suggestions, stuff, cause I think that's part of what's going to get it planning done is, you know, cause you'll have, you'll have the nurse practitioners. That'll be the go-getters that don't have a brand new baby and they can go find the hotel where we host it or find the city or whatever. Like they can make that happen. But then there's other people like you that you can be like this would be a good thing I've talked to so-and-so and this would be a good thing to bring into a conference for a breakout session. Like I would even have the slightest clue what kind of breakout sessions people would like.
Speaker 1:The only conferences I've ever been to are orphan. I've been to an orphan conference and I've been to a bunch of church conferences. That's about it.
Speaker 2:Yeah, we need to get it together and I even have this, you know, even if it starts out virtually and then we build into an actual conference, you know, just to kind of keep it easy for everybody. But I'm sure with the right minds we could put together a conference in person, which I think people always resonate more with. Anyway, they like to go and interact and mingle and meet other other people that they can learn from.
Speaker 1:basically, it builds encouragement and builds community For sure.
Speaker 2:So nursing professional needs in its entirety right, so maybe we can be the springboard for that.
Speaker 1:Yes, absolutely Okay, michael. Well, it has been a pleasure interviewing you today. Thank you so much for your time. I really appreciate it, and best of luck to you in your endeavors and with your new baby.
Speaker 2:Thank you, and thank you again for having me and all the well wishes and blessings for you, your practice and your future, and I'm sure we'll talk again sometime soon.
Speaker 1:Yes, we sure will. All right, have a great day, michael, you too. Bye bye, all right, bye bye. Thank you so much for joining us today on the DPCNP. We hope you found our conversation insightful and informational. If you enjoyed today's episode, please consider subscribing to our podcast so that you do not miss an update, and don't forget to leave us a review. Your feedback means the world to us and it helps others discover our show. We love hearing from our listeners. Feel free to connect on our social media, share your thoughts, your suggestions and even topic ideas for future episodes. As we wrap up today, we are so grateful that you chose to spend a part of your life with us. Until next time, take care. This is Amanda Price signing off. See you on the next episode. Thank you.