The DPC NP
The DPC NP
From Hospital Floors to Direct Primary Care Success: Tori Prendergast’s Inspiring Journey
Ever wondered how a nurse transitions from hospital work to running a thriving direct primary care practice? Join us as we chat with Tori Prendergast, a family nurse practitioner from Northern Indiana, who shares her remarkable journey from being a float nurse to owning her own practice. Tori opens up about her father's mentorship, her determination to succeed, and how she managed to navigate the healthcare world without ever entangling with insurance companies. Discover the behind-the-scenes of Tori's life as she balances the demands of a 24/7 on-call schedule with the flexibility and family-friendliness of owning a DPC practice.
We explore the nuts and bolts of running a direct primary care practice, highlighting Tori’s decision to stick with Advanced MD for electronic medical records while contemplating a switch to Spruce for improved patient communication. Tori offers valuable tips on maintaining a healthy work-life balance, especially important as she raises a young family. Learn about the tools and strategies she employs to manage memberships and recurring billing, and get a glimpse into the financial rewards and hard work that come with a successful DPC practice.
In the final part of our episode, Tori emphasizes the power of taking risks and the importance of networking for personal and professional growth. She shares her passion for serving the Hispanic community and the impact of word-of-mouth referrals in building trust. Tori also discusses expanding her service offerings to include weight loss programs and hormone replacement therapy, which help attract and retain patients. Lastly, she touches on the significance of mentorship, promoting wellness, and the future goals for her practice, Mid City Health. Don't miss this episode full of actionable insights and inspiring stories from a trailblazing nurse practitioner.
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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, today we have a great guest speaking with us today Tori Prendergast from Indiana. Tori, welcome to the show. Hi, hey, tori. So you are in Indiana. Where in Indiana?
Speaker 2:are you. So I'm smack dab in the middle of Northern Indiana. I always tell people I always reference most people know the University of Notre Dame. So I'm about 20 minutes from the University of Notre Dame, so we're all Irish.
Speaker 1:Okay. What school did you go to to get your nurse practitioner degree?
Speaker 2:So I went to Ball State University, also in Indiana, and it was one of the few hybrid kind of online and on campus programs. I graduated in 2020. So I was a pandemic NP. So things have felt a little different to me Because I've never practiced outside of you know the post pandemic dynamic. I did all my education here in Indiana.
Speaker 1:Were you an RN working somewhere before you went back to school?
Speaker 2:Yep, I was an RN for six years and I worked in kind of a smaller hospital so I got to float around. I was actually a float nurse so I worked quite often in labor and delivery, med, surge every once in a while kind of on the acute care unit it's called the CCU, not necessarily ICU because we didn't deal with vented patients, but kind of got to float around, find out what I liked, what I didn't like, get some good experience and really kind of hone in on my clinical skills there.
Speaker 1:What made you go back to school to be a nurse practitioner?
Speaker 2:I kind of always knew that would be the end game for me. My dad's a nurse practitioner who owned his own business. So I was kind of able to see how he had the flexibility to practice at the top of his education and I learned kind of some. I got interested, I guess, in being an entrepreneur through him. So I always knew I would want to be an NP. I wasn't sure what track I would focus on. So I'm an FNP and I'm really glad I went that route. But I knew early on, you know, when I became an RN, that was kind of my end goal from the very beginning.
Speaker 1:That's really cool that you have family support, because your dad knows what it's like to be a nurse practitioner. So walk us through like after you graduated, where did you originally start working or did you immediately open up your own practice?
Speaker 2:So I'm one of the rare few who has never worked in the insurance world. I worked for another NP owned direct primary care practice before I went on my own with my own practice. So I have never had to work kind of under the insurance guidelines and deal with all that runaround. But I knew, you know, as soon as I knew that I wanted to work in direct primary care from the time I graduated I had already heard of it, I'd seen my dad do it. I knew I really think it's the model of the future and I'm very passionate about the care we provide. So I knew that's the route I wanted to go.
Speaker 2:I didn't settle, you know I had. Obviously I probably could have gotten a job more easily in the corporate world and traditional medicine, but I kind of waited for that perfect, you know, dpc job that I really wanted. So I learned a lot from that job before I kind of transitioned into my own practice. I'm really thankful and blessed that I had that opportunity because it taught me so much about the business side of things which we don't learn in nursing school, you know we're not we're not educated like chiropractors and dentists when it comes to the business aspect. So I think that I learned a lot from that experience working as as an employee in APC. What?
Speaker 1:did it look like to transition from working in that clinic to moving to having your own?
Speaker 2:So I think the difference is I knew what I was in for kind of, because I the owner of the practice I was working in. He's my friend now, of course, but I kind of knew the struggles he went through and the stresses he went through to open his own practice. And he'd been in practice six years before he hired me. So he was kind of a mentor for me. But I sort of knew because I saw behind the scenes kind of what he was doing on a day to day basis. So I knew what I was getting into. You know, the benefits of working in DPC is the flexibility, the family friendliness, the unlimited income potential, you know, depending on how large you want your panel size to be. But the downside is you think maybe you're going from working in nine to five to working a flexible job. But I really work. I feel like some days I work 24 hours a day.
Speaker 1:That's what it feels like which you know, and it's like I call it feast or famine. There'll be some days where I hardly get anyone texting me, calling me wanting to come in, and I may only see two patients in the office the whole day. And then there'll be another day. It's like they all waited and they all want to be seen that day, and then I'll see 12 people that day.
Speaker 2:Yes, I actually. I have a large corporate contract doing it. Their employee health, all their primary care, so I am truly on call 24 hours a day because they work three shifts in this industry. So I really am on call if there's something that they need, you know, my guidance or need a triage on. So some days I truly do feel like I work 24 hours a day, but it's, like you said, feast or famine. That does not happen all the time, but it does happen occasionally for me.
Speaker 1:So what does it look like to be on call 24 seven and have this big account and you're trying to sleep and somebody's texting you at three in the morning?
Speaker 2:You know, I thought it was going to be potentially more because the practice I was working in we had a similar kind of setup but there were three providers so we weren't on on call all the time. But now it's just me. So I thought, you know, I was kind of nervous about that when I went out on my own like it's just me and it truly is like I have to pick up the phone if they call. But really that has only happened. I've tracked it. So I've been open with that. I've been with that company since February 1st and it's only happened one time that they've called during the night. The rest have been text messages that I kind of was able to wait till morning to address.
Speaker 1:Oh, so you're employed at the company that has the big contract.
Speaker 2:No, I own my own practice, but I work on site at their facility, so I lease a space from them and I'm able to also have my own DPC patients there, outside of the employee health.
Speaker 1:Okay, because I was looking at your Facebook page and it looked like you work at two places. Is that what you're talking about?
Speaker 2:So I started before I went into DPC. I started kind of on the side while I was working direct primary care for the previous employer, a weight loss and metabolic dysfunction clinic. So I was on the side doing weight loss, thyroid care, hormones, hrt, the wellness type things, and I still do a lot of that. But much of that is virtual. I still do see some of those patients in clinic so I have a lot of flexibility with the facility that I have now, even though I'm across the street from the company that I'm working for.
Speaker 2:I have a lot of flexibility because they've given me the go ahead to see all my own patients as often as I want from that that building. So it's really a nice setup for me and it's a large contract, so the income is excellent too.
Speaker 1:So how many employees do you have? And then, how many patients do you have in your private DPC practice?
Speaker 2:So I have 250 give or take because it falls. You know their employment numbers change month to month, but I have 250 employees for the employee health side and then I have about 150 of my own patients.
Speaker 1:Okay, and then what kind of services do you provide for the employees? Are you able to do? You just do acute and chronic care? Are you able to do wound care or suturing and all those?
Speaker 2:things. Yes, all of the above. So I do suturing. That happens pretty frequently. They're a factory so there's a lot of kind of on the job injuries not a lot. They have a great safety program but I have done sutures. It's a really hot work environment so we're often doing like IV fluids and then I do just primary, traditional primary care. So if those employees want to see me for primary care, that's covered for them 100% outside of their insurance. So it's a great employee benefit that that company offers. And then they pay me monthly per employee, just a flat rate, and I bill them monthly for those services. So that's kind of how it works.
Speaker 1:Do you charge extra to the employer for any extra services that you provide, like lab work or injections or anything?
Speaker 2:So each employee that's on the plan they get one wellness panel annually included with that. Now if they need more routine labs for monitoring purposes, for diabetes or you know, testosterone replacement or something like that, I don't cover those at my cost, but every employee gets one good wellness panel annually. So the hope is that they take advantage of that, you know, and at least get their annual wellness labs done.
Speaker 1:if nothing else, I'm just thinking of like you say like what if you diagnosed a new diabetic and you're doing the A1C every three months? To get to their point where they're under six and a half percent or 7%. Yeah, is the employee paying that extra cost.
Speaker 2:Yes, yes, they do, but I have a contract with a local lab and then a contract with Access Medical Labs, so I just give them my pricing on that. So I think an A1C is like $9 or something. It's very affordable.
Speaker 1:Yeah, yeah, that's what.
Speaker 2:I do at my clinic too.
Speaker 1:I basically I use LabCorp and I give them the price that LabCorp gives me and then I just charge a venipuncture charge of $10. So no matter how much lab you want, you pay $10 on top of whatever that is. So I think my A1C is like $2 and 75 cents, yeah, but by the time they pay the $10, you know a little more, yeah, but it's still affordable, like you know, so much more affordable.
Speaker 2:I had a patient who I did a really good like kind of functional workup on her through access medical labs and I charged her my package price for that, which included the labs plus the console with me to review everything and make a treatment plan. And they actually misbilled that and they build her for those labs through LabCorp rather than through access prices and the bill that she received from them was over $2,000. Yeah, and I think she, I think with me it was like 200 and something. It was crazy.
Speaker 1:Well, well then, that was great advertisement for you, because she could see what it would have cost her if she was not part of your program. Yep, exactly Did your dad own his own DPC clinic, and is he still going, or is he?
Speaker 2:retired? Nope, he's retired. He owned his practice in Tennessee oh, we're in Tennessee, I think. So he moved there after I was grown near Murfreesboro Okay, I can't remember the tiny town name. He's retired to Florida now.
Speaker 1:Oh wow, good for him. Yeah, someday we'll retire, but it'll probably be well into our 60s, if not 70s. Yeah, I don't know what retirement looks like when you own your own practice. I really don't.
Speaker 2:Yeah, I think it's. Only if you sell it Do you really retire.
Speaker 1:Yes, so you had your dad to be able to lean on and give you advice on how to get your clinic started. I'm assuming that you utilized his knowledge on that, correct?
Speaker 2:Some. Yeah, I'm modeled a little differently. I don't do anything at all with insurance, so I don't bill insurance for office visits at all. Purely, I will send meds to retail pharmacy and allow them to use their insurance for labs. But he was actually doing some more insurance billing than what I do and I saw the headache with that and I knew I never wanted to do that. So he was set up a little differently and Tennessee is a very restrictive state so they actually have a lot more restriction than we do here in Indiana. We need a collaborative physician still, unfortunately, here but there's a lot of freedoms as far as owning a business in Indiana. So I'm glad I'm set up here.
Speaker 1:Yes, what EMR system did you choose?
Speaker 2:Yeah, I listened to your podcast all the time and I know it's like everyone loves elation and Atlas, md and hint, I use none of those. And it's not because I don't like them, it's because when I switched from the other practice when I was employed in DPC, we used advanced MD. So I just continued with advanced MD because I already know how to navigate the system so well. I just wanted I wanted minimal change.
Speaker 1:So I understand that, but I'll be happy to get rid of eClinicalWorks as soon as my contract is out. The only reason I know how to use it, just like you know how to use yours. I know how to use it. But after talking to all these other independent nurse practitioners and hearing them say that their system keeps up with the membership plans and also has communication aspects to it, I just I felt like that that was going to be a better fit for me going forward. So what do you use for your communications with your patients?
Speaker 2:Advanced MD has a portal, so that's what I really encourage my patients to use. I'm considering transitioning to Spruce because I've hired some staff at this point. So I am thinking about switching to Spruce because the more I hear about it, I just feel like everybody really likes it. Right now we use the portal from Advanced and then I have a HIPAA compliant, like a purchased email that I pay for monthly. That's all encrypted and I really like email as well. And then I use a separate app for texting that's also encrypted.
Speaker 2:So some patients I will allow to have that number. It's just an app on my phone. It's not my personal number, so I can turn that app off if I want to, but in some cases it is really nice to allow patients to text. There's been a few who I want to revoke those privileges from, but most people are pretty respectful. You know of my time and don't bother me out of office hours. I feel like that's one of the barriers to entry that a lot of MPs think like if I start working in direct primary care, my patients are going to be calling me all the time, they're going to be texting me all the time and people are pretty respectful, especially if you quietly lay down the boundary. So, like every once in a while, if someone texts me something after hours that's not truly urgent, I'll say um, you know, I'm with my family right now, so I'll get back with you on this tomorrow. And they get the point. Usually.
Speaker 1:Yes, yes, let me just remind you.
Speaker 2:This is my personal time and my personal phone number.
Speaker 1:Yeah, I'm still a human. Yes, that's good, Because in many interviews I've talked about this very thing is how to discreetly and respectfully tell your patients who you love. You know they're like an extension of your family, but then you have this immediate family around you that hasn't seen you all day, so my kids are little, I mean, they're still young.
Speaker 1:Yeah, yeah, exactly. Well, even as they get older I mean, my kids are teenagers and I still want to make sure that I don't want them to grow up thinking that they were second place in my book.
Speaker 2:You want to be present for them.
Speaker 1:Which they probably already feel that way, because I had a clinic that took insurance up until last year, so they'll probably they're probably already going to feel dysfunctional. I didn't mean to make it that way.
Speaker 1:I didn't know it was gonna be that way good for you that you were able to get your degree at a time where direct primary care was a thing and it was common enough that you had already heard about it, and that you could move forward and have this great work life balance and have this and be it, be an entrepreneur and still make good money and still be there for your family. So that's awesome.
Speaker 2:And I'm a very type A person. So I it's hard for me to turn off sometimes, but I have to remember like there's only one of me and there's 500 patients and sometimes not everything's going to get done every day, but I'm learning and I'm seeing kind of the fruits of my labor. Now I'm seeing like, wow, I really am gonna make more money than I ever would have as an employed NP. But I'm definitely also putting I'm putting in the time. You know I'm in the office 28 hours a week but I'm working from home probably another 20. So right now it's still definitely a full time job.
Speaker 1:What program keeps up with your memberships.
Speaker 2:So I use authorizenet for all of my recurring billing and within authorize you can print different reports and see different reports that report on. You know which payments have gone through, which have declined, how much each person has paid for the year. I use that feature for now and it's kind of it's worked for me so far. The problem is it doesn't notify patients if their card declines or you know, if there's a payment that doesn't go through, it doesn't notify them. So that falls on me. But usually I've found like if I just send them an email it's usually an expiration patient date or they put in a new card and it's not really been a big problem. It's in my clinical or in my policy document that everyone signs that if they fall behind more than 30 days and they don't reach out to me to make some kind of plan, then I can cancel their membership.
Speaker 1:What percentage of patients. Do you feel like cancel each month?
Speaker 2:So I've only been going truly since February and my retention is really good. I've only had three patients cancel since February, so that's great. There's one person who their card declines every single month, so I've just worked out with them that they just come in and pay me cash. That's just how it needs to be for their finances. You know they pay me when they have the money, do you?
Speaker 1:plan on trying to have more patients, or do you feel like you're at your max amount of patients?
Speaker 2:Right now I feel like I'm pretty maxed, unless I want to open up my office another day. Right now we're closed on Wednesdays. I work from home, I do some virtual visits, I do all my admin stuff on Wednesdays from home. But I was just thinking the other day, I don't think I can take anymore unless I'm willing to open on Wednesdays and kind of be in the office another day. And I'm really don't want to do that yet because I'm at a point where I'm paying my staff, I'm paying myself. I'm situated as an S Corp, so I pay myself. You know a paycheck bi weekly and then I'm taking distributions and I'm doing fine. So I don't think that right now I'm gonna really stress so much about numbers and getting more patients, because I just I don't really need the income right now. Sure, that's good.
Speaker 1:So you mentioned earlier that you just hired some staff. So who did you hire and what is their job role?
Speaker 2:So I have a medical assistant and she just completed all of her phlebotomy training so she has started doing blood draws, which has been great, because I was doing all the blood draws myself and some days we were doing eight or 10, which takes time. I mean, it's it's. If it's easy, it's easy, but if it's not that can really be a time suck. If you miss a vein and have to poke two or three times. That can really take a lot of time. So that was kind of my motivation for hiring a medical assistant to sort of take some of those things you know that are not necessarily nurse practitioner only job roles kind of off my plate. So I have her and so she's rooming patients for me, she's doing vital signs and then blood draws, and then I have a front desk receptionist who's doing phones mostly and emails the non clinical stuff.
Speaker 1:But you're still paying your bills and having to keep up with memberships, and all that yourself.
Speaker 2:I do all that myself, I do all the financial stuff myself and I would love to have like my next hire probably I would love to hire like a business manager, someone to do kind of all of that stuff. I don't know that I'm ready to hire another NP. I probably could, but I'm not ready to give up that income yet. I don't think the payroll taxes would eat me alive and I don't know. I have a hard time justifying hiring an NP as a 1099 contractor. I don't know. It kind of just makes me nervous with all the IRS rules around that and me kind of, you know, providing all of the tools they're going to use to do their job and kind of telling them what hours they have to work. It's just a gray area for me. So I've kicked that idea around in my mind of hiring someone as a 1099, you know, like another provider. Mentally I just can't quite make sense of it yet. So I'm waiting and praying and thinking.
Speaker 1:Yes, well, if everything is working out well for you being a solo practice, then definitely don't rush it.
Speaker 2:Yeah, I would love to have someone do all the financial business things right now, because I'm still running my payroll, I'm using QuickBooks and I'm very type A, so I'm very, very like I'm doing my watching my books every single Saturday. That's what I do. I'm pretty organized with it, but I would love to not have to do that anymore because it's tedious.
Speaker 1:So, when you opened up your clinic, what made you choose to be an S-Corp as opposed to an LLC or a PLLC?
Speaker 2:So I am an LLC. That's kind of the business structure. The tax structure, though, is the S-Corp. So I think that's one of the things people get really confused about, and I am not a CPA or a financial person, so, like, don't quote me word for word on this, but they're two separate things.
Speaker 2:So the way I was advised is that once you see that you're going to make over about $60,000 in profit in a year, it's best to organize as an S-corp, because you have significant tax savings there. So, to be an S-corp, you have to pay yourself a paycheck, and then you can take distributions monthly or quarterly, however you want to do it. Your pay has to be reasonable, you know. It has to kind of meet the market value for your profession.
Speaker 2:But for me it made a lot of sense because I knew how much I would save versus initially I was just paying, I was just doing like a regular paycheck and I was paying myself way too much money. I was trying to kind of meet the salary of my previous job, and I saw the taxes on that, and it's incredible how much you pay in payroll tax. So I resituated as an S-corp and adjusted my salary accordingly, based on how many hours. I'm working a week and kind of the median hourly salary in my area and I learned more about S-corporations and the tax savings. You know the potential there and that's why I did it, because I think that's the best structure for most people in this industry.
Speaker 1:So, despite the fact that you own your own business, you're still just paying yourself what the median salary is for any nurse practitioner that would just be working, be employed at another clinic.
Speaker 2:Yeah, so you have to pay yourself a reasonable salary. So I have seen a lot of people who do this as corp and they pay themselves a pretty low salary hourly. I kind of just went online and research like what's the average nurse practitioner salary in Indiana? And that's what I pay myself per hour that I work each week.
Speaker 1:Okay, do you give yourself any bonuses?
Speaker 2:or anything. I do a distribution quarterly based on my profit.
Speaker 1:How did you come up with what that percentage would be.
Speaker 2:Well, I'm still kind of playing with it a little bit. I usually do a little bit about 15% of what I make, what I truly make as a distribution, and then the rest I've sort of been accruing for tax purposes just to save that back so that I'm not, you know, giving myself too much money. And then the tax bill comes and I'm short.
Speaker 1:Yes, I've just recently started putting back quarterly tax, paying quarterly tax payments to the IRS, just hoping that it'll put just a little bitty dent in what I'm going to.
Speaker 2:I know, I know that's the scariest part about being a business owner is all the taxes. It really is overwhelming.
Speaker 1:Yes absolutely so you had mentioned that you're part of some Facebook pages of nurse practitioner entrepreneurs and I know that you're part of the Facebook page where I found you, which is the NPs and PAs in DPC practice. So how have these group pages really helped you, benefited you in moving forward and just encouraging you throughout your process?
Speaker 2:So I'm a huge fan. If you, if whoever's listening out there, has not found the elite nurse practitioner, I'm a huge fan of his business model, his education, his CMEs. They have a wonderful Facebook page. It's huge. There's so many people on that Facebook page and it really opened my eyes to I can do this.
Speaker 2:You know, there's no reason that someone who has been able to obtain a bachelor's in nursing, a master's in nursing, worked successfully in practice. There's no reason you can't own your own business. The limitation is just in your mind. It's the fear of the unknown. And I think networking is so important for that, because it shows us that other people are out there doing it scared too. And that's just. That's been kind of one of my mottos for this year. I live my life doing it scared. I have done a lot of scary things and taken a lot of chances. My risk tolerance has gone up so much because I've seen that you know you always think you're going to fail, but usually you don't. Usually you figure it out. Maybe it's not the huge success you thought it was going to be, but most of us figure it out and it makes you feel like such a strong person. But networking is a huge part of that.
Speaker 1:Yeah, that is such great words because you're right, somebody is sitting here listening to this podcast and they're just trying to build that encouragement, they're trying to get that last step before they jump into it. And for you to just acknowledge the fact that we're all sitting here scared to death, we don't know what's going to happen, you can't predict the future, you don't know if this is going to make or break you, but you just go all in because you have a dream and I think nurse practitioners in general are really good at supporting each other. I'd like to think that anyway. Maybe I'm in a bubble, but I would like to know that. I would like to think that we're here for you. We want to come alongside and so you're right the elite nurse practitioner Facebook page, as well as the website.
Speaker 1:I've done so many CMEs through that website and I've gotten certified in functional medicine. Through that. I learned how to do BHRT, just all kinds of things to grow my knowledge base so I could be more beneficial for the patients that sign up under my care. And it's affordable and it's easy to follow. You can do it at your own pace. So, yeah, that is so great.
Speaker 2:And it adds so much value to your clinic. You know, if you don't have to refer your patients for all of the things, if you can manage their hormones, if you can help them with weight loss, if you can do cosmetic skincare for them, I mean if you can do all of that which is well within the scope of an FNP or an adult NP, I mean that's well within our scope. If you can do that, that adds so much value to your practice. And that's where I really think you're going to retain your patients. You're going to bring in more patients because they see the cost savings there and everyone wants one person taking care of their, of their health.
Speaker 2:You know a lot of my patients who see all these specialists. It feels so disjointed and it feels so inconsistent. They're hearing different things from different people. So it's always easier and Justin, the elite NP, he always says this it's easier to keep a patient and get something else from that patient, meaning make a little more money from that patient and then find a new patient. So the broader we can make our offerings in DPC, in my opinion, the better. I don't do Botox and I don't do aesthetics just because it's really not something I enjoy at all and I'm all about doing things that bring me more joy in my life, not doing things that just add another task to my list. But I really think you know that would be my advice, I guess and I don't know at all and I'm new and I'm I'm messing up every day still but I think add more value to your practice, add more services, get good at a lot of things, and then obviously your patient population increases, the more you can do. Hey, I'm 20 years in and I'm still messing up.
Speaker 1:So there's always this it's always going to be a learning curve, always always. That's why it's called medical practice. It's not medical. I figured it all out.
Speaker 2:Medical expert.
Speaker 1:So what are all the different things that you offer to your patients outside of just the family practice?
Speaker 2:Yeah, so I do a lot of weight loss, a lot of nutrition. I have a nutrition certification. I was a certified personal trainer previously, so I taught women's fitness. My medical assistant is also a certified personal trainer. So we do a lot of weight loss and a lot of metabolic dysfunction is what I like to call it. So thyroid optimization, hormones, nutrition, coaching, accountability I do a lot of that I do. Let's see what else do I do? I do hormone replacement, male and female primary care, and then the occupational health is also what it feels like I do with the corporate contract that I have. So I do a lot of things.
Speaker 2:I don't do procedures. I didn't work in surgery or really ever learn much in that area. I didn't. I just don't have a lot of experience. So I don't want to play around with high risk procedures. So I do PAPs and I'll do like a knee injection because I did learn that I'm comfortable with that IV fluids, but nothing more than that. I don't do a lot of in-office procedures. I don't do pellets, just sticking with the old fashioned BHRT for now, Do you?
Speaker 1:do any specialized testing like mold testing or food sensitivity testing or saliva hormone saliva testing. So I don't do.
Speaker 2:Dutch. That's kind of next on my list. I want to learn Dutch testing Right now. I've just been doing all serum testing. So I use Access Medical Labs. They have a lot more of the integrative type testing options so I use them for all my serum testing. I do food allergy sensitivity testing through them as well, but I really I do want to branch out to like Dutch testing and saliva hormone testing. I just haven't done that yet. And the mold toxicity and all of that is so fascinating but I just don't have the brain space for it right now. I feel like I'm I'm pretty maxed with brain space. That's what it looks like, I think, for me.
Speaker 2:I'm also bilingual, so like I had kind of an interesting road to becoming a nurse, like a lot of people do, wasn't my first degree. I actually studied Spanish language and psychology when I first went to college when I was 18. So I worked as a social worker with Hispanic children actually for a couple of years before I decided I wanted to go back to nursing school. So I have a large Hispanic patient population also and I really enjoy working with that population because a lot of them are either uninsured or underinsured. So that is. It can be a lot of work because I'm doing a lot of more of the social aspect of care helping them find resources in the community, helping them find their medications at an affordable price.
Speaker 2:I have contracts with a couple different radiology facilities so if someone needs imaging they can get it, you know, at a much lower price. There's just a lot of barriers to care with that population. You know a lot of them are undocumented, so that throws a whole big wrench in the game when they literally cannot get insurance and they're afraid to go to any healthcare providers that might ask for their social security number. So I've kind of made it my mission to help that population. I'm really passionate about that. So a lot of my visits are in Spanish, which is interesting because I try to have someone scribe for me sometimes and they can't scribe, so those visits take longer. But my vision is to provide more care for the Hispanic population in my area because it's really an unmet need and I think DPC works so great for those kind of patients.
Speaker 1:Yeah, that's very interesting. I'm glad that you brought that up because I wanted to know what exactly is your percentage of Hispanics to English speaking patients on your DPC role.
Speaker 2:So I think I have. I've never actually looked up the numbers. I would say I have 20 Spanish speaking. About 10% of my patients outside of the corporate contract Is the corporate contract mostly Hispanic? No, it's it's all English speaking.
Speaker 1:Okay, yeah, well, the.
Speaker 2:Spanish speaking patients are just community patients who found me, and word of mouth is huge in the Hispanic culture. They all, you know it's a very, it's a very social culture, I think, even more so than the American culture.
Speaker 1:So if you get a few patients in that community, they will talk and you will get many, many more.
Speaker 2:So that leads me to my next question then do you have a waiting list? I don't. I've accepted everyone so far, except a few patients who I thought were too medically complex for me. I am not interested in the CKD, severe diabetic, type one diabetic. I really I'm not equipped for that kind of patient. I really want more of the wellness type patient, healthy patients that I can help maintain their health. I do have diabetics, I have patients with hyperlipidemia, but I really try to stay away from the really complex patients because I think they need a provider. They need like an internal med provider. They need someone who's got some corporate backing, who can really do good referrals and keep their care real consistent. And it's just. That's not for me. And that's the beauty of DPC, right, we can kind of decide which patients we take and which ones we don't, but I don't have a waitlist.
Speaker 2:I have not paid any money at all for marketing $0 on marketing so everything has been word of mouth. The way that worked for me is I work in my hometown that I grew up in, so everyone. It's a very small town. We have like 5000 people, so everyone knows everyone. I take care of a lot of the kids of people I went to school with, so it's it's been a lot of word of mouth. I haven't spent. I think maybe I might have spent $500 on marketing, because I did run an ad in a magazine that brought me some patients but very minimal money on marketing so far and I think I see that as a trend. A lot.
Speaker 2:I think with DPC, if you give good care, the patients are going to come. You know it takes time maybe, but I don't think it's a business where we have to spend tons of money on marketing unless it's saturated. I know in Florida they have a lot of market saturation, but in Indiana we are still few and far between. So I haven't had to spend a lot of money on marketing. That's good. Who did you get to do your website? So actually, for DPC I truly don't even have a website. I have done everything through social media. I have a website for my wellness clinic that I started initially the weight loss hormones and that in that regard I have a website and it was just a web developer where I live. So I spent about $500 on my website.
Speaker 2:And I think it looks pretty good. I don't know, maybe I'm biased, but for DPC I don't even have a website. My success has come from Facebook. Those are my people. I don't know if it's my age. I think that there's a lot of people my age on Facebook and that's just where I've struggled is on Facebook. I use TikTok a little bit, but I don't like it. I feel like it's not. It's definitely not my thing. I don't like Instagram really either, but Facebook has brought me a lot of patients, I think. On my max metabolic wellness Facebook page, which is my wellness arm, I have over 600 people, 600 followers there, and I just do videos. I do like silly videos where I'm just talking about something that I'm excited about, and I'll have a lot of people reach out to me from those videos. Oh, that's good.
Speaker 1:Social media.
Speaker 2:It's great the great platform for free marketing, yeah that's all I've really used.
Speaker 1:I do have a website because I wanted it to be easy for my patients to be able to sign up for DPC through the website.
Speaker 2:Yeah, to do your intake, your initial touchpoint, yes, and that's where my waiting list is set up and everything through that.
Speaker 1:But I just had a friend that put it together and she did a really good job and so I just kind of leave it. It's not. It's not a website that's constantly changing. I don't really even engage on my Facebook page that much, because I just really don't like social media in general. So, I'll get on Facebook and I really try to interact with people, but really I just want to see what's going on and then move on.
Speaker 2:Well, there's you and there's me. See, I love social media. I'll talk a little bit about you know, like some kind of women's health topic and HRT or misconceptions about HRT, or I'll talk about direct primary care and how we can, you know, provide so the care we provide can be so much more efficient than the care from a corporate medical office. And I think people like to. They like to see a provider's face because it helps them get to know you. So that's why I'm really, really adamant that on my social media I do a lot of talking, because I think when people see your face they start to trust you. And when they hear you talk about something you're passionate about, then they know like she's going to take good care of me, because she really cares about this and that's very important to me. I want my patients to know like I care a lot about you feeling better. You're not just a number. My appointments are 45 minutes for a reason because I talk a lot, we talk a lot. It's a very different vibe than traditional primary care.
Speaker 1:It just is, and that's why I love it Well and I appreciate that you brought that up, because anybody that is considering hiring a new provider and you're trying to figure out how can you build up their clientele, that was very good. Advice is like put their face out there on social media. Let them do short videos so that people can begin to see them and get to know them and then the people will come just because, like you said, they'll learn to trust because they like what they said. I'm hiring a nurse practitioner. That's starting August, the 1st.
Speaker 2:And I think I'm going to yeah. So I think.
Speaker 1:I'm going to take your advice on that. I have about 80 people on a waiting list, but I'm sure she doesn't want just 80 patients and I'm pretty sure, since the waiting list has been going on for so long, probably 50% of those will actually join and the other 50% have moved on. She'll get about 40 patients from that. So. I like your idea of putting her out there and just letting people get to know her, so that you know we can build that up.
Speaker 2:Yeah, and people like to see their provider in regular clothes, you know, not a white coat just at their house. A lot of my videos are me walking my dog and I'll like talk and then I'll show my dog because I love my dog. It makes you relatable. You know I'm a mom. Sometimes you can hear my kids in the background, but that's life so, and I want my patients to feel like I'm a friend, my friend with some medical knowledge that they don't have.
Speaker 1:Yes, that's good. That's good. So do you like going to medical conferences? Do you find that those are helpful?
Speaker 2:I haven't gone to any yet. I would love to more this year. I'm hoping that I can get away more for that Now that I have a little bit more staff in place. You know to kind of man the ship when I'm not there, because I love I'm a nerd. I'm a huge nerd. I love learning about new evidence based practice and I love hearing experts talk, people that know more than me. So, yes, I really am looking forward to doing more of that this year. I really want to go to the Elite NP conference. I'm hoping I can do that.
Speaker 2:So when you go on vacation or you want some time off, what do you do with your patients? So I haven't yet. I haven't done that, like I'm in Ohio this weekend, but I'm obviously I'm working. It's a working trip. I'm reachable by phone, I have my computer. My husband and I were testing it out. We're going away for our anniversary in December. We're actually going to Mexico for five days and I'm hoping to God I'm praying to Lord Jesus that I can actually take a vacation because I have a NP, a local NP, who's kind of starting her own DPC, so she's very slow right now.
Speaker 2:She's agreed to take call for me. So if there's something really urgent, someone really needs seen, she'll be able to come to my office and see them. The rest have my medical assistant there answering phones and triaging, but the rest, if it can wait till I get back, they will wait. But I'll have that other provider there if something urgent. You know, if one of my corporate employee patients need sutures, she can come in and take care of that for me. So I'm figuring out how to compensate her for that, because I don't expect her to do that for free. I would not want to be on call for free. So that's. I have to work that out a little bit, but that's my plan.
Speaker 1:That's good, because everybody does need to have some downtime and some time away, because you certainly do not want to develop any kind of burnout.
Speaker 2:I entered this world because I don't want to feel burnt out. You know and I'm starting to get there I am starting to feel a little burnout, so I need a vacation.
Speaker 1:Yes.
Speaker 2:So what is the future?
Speaker 1:of mid city health look like.
Speaker 2:So I really just want to continue to grow a practice that promotes wellness. I don't like the sick model of care and unfortunately that has. That's where we are in America With the way that our healthcare system is set up. We are not a proactive, we're not proactive against illness and I really just want to continue to let people know that there is a different way to do things.
Speaker 2:You know your insurance is not the be all end all. Your insurance is not as great as you think it is. Your insurance is not set up to keep you healthy in any way. But there are those of us out there who are interested in helping you maintain your health and learn more about the naturopathic ways you know, outside of traditional pharmaceuticals. I just really I want to spread more knowledge that there are other ways to do things, and I think DPC you know it's not new, like those of us that are in it, we know it's been around a while, but people still don't understand the model. They don't understand that you can have insurance and be in a DPC membership and actually those two marry together so well like.
Speaker 2:I encourage all of my patients to keep their insurance if they can afford it, because it has its place. You know, god forbid you get the cancer diagnosis. You need your insurance. But I love the analogy that you don't use your car insurance to put gas in your car, change the oil. There's a time and a place for insurance and there's a time and a place to use primary care as it should be used, and that has gotten twisted over the last decade or two. So I just want to continue to spread knowledge. I would love to grow my practice and my numbers and make more money, but really what I want is just to help people feel better and get some hope back in regard to their health.
Speaker 1:I love that. Well, it has been such a pleasure talking to you and I wish you all the best. I think you have a great model going on. I think you will be maintain your success all through the tenure of this clinic and even going forward. So I think you've been very helpful. So, if anybody wants to reach out to you or do you welcome them to reach out to you on Facebook or something to ask questions.
Speaker 2:I've done some mentorship calls lately and I love doing that because I have learned some things, tips and tricks to grow your practice, things that have worked great for me and my community, to kind of get known a little bit. And I love doing mentorship calls. I know like I've had a lot of people who ask me how much I charge, and I do charge just a little bit like for my time, but nothing crazy and because I'm not, I don't consider myself an expert at all, I just know what's worked for me and I think it might be worth a try at my work for you. So I love to do mentorship. You can follow my Facebook page, mint city health and wellness or max metabolic wellness and weight loss, and kind of see how I do my social media, because I think that's that's the key. It's the age we live in. Social media is is really important, for good or for bad. It's important.
Speaker 1:Perfect, all right. Well, thank you so much, tori, and I really appreciate you being willing to do this interview with me.
Speaker 2:Yeah, thanks, amanda.
Speaker 1:Okay, bye-bye.
Speaker 2:Bye.
Speaker 1: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.