The DPC NP
The DPC NP
Overcoming Adversity: Lisa Magary’s Rise in Direct Primary Care
What happens when a seasoned respiratory therapist transitions into a successful nurse practitioner and then takes the leap into entrepreneurship? Join us as Lisa Magary, DNP, ARNP, CPNP, FNP-BC shares her compelling journey, detailing how she navigated various roles in healthcare to create a Direct Primary Care (DPC) practice that is now thriving. Lisa's story is nothing short of inspiring, especially when she recounts overcoming a severe spinal cord injury to regain her ability to perform medical procedures. Discover her unique marketing strategies via Business Network International (BNI) groups and how her patient-focused approach sets her practice apart.
Dive deep into the technicalities of running a successful medical practice with our exploration of the comprehensive EMR system, Atlas MD. Learn about the seamless integration of billing, inventory management, and patient communication that makes Atlas MD a game-changer for Lisa's clinic. We also highlight the diverse treatments available, from dermatological procedures to innovative therapies like Softwave, which Lisa herself used during her recovery. Through personal anecdotes, Lisa emphasizes the importance of continuous learning and adaptation to provide top-notch patient care.
Balancing compassionate care with professional boundaries is crucial in the DPC model, and Lisa offers valuable advice on managing frequent patient contact and setting limits for non-emergent issues. Hear about her responsible prescribing practices for controlled substances and resourceful ways to equip a medical office without breaking the bank. Reflecting on her practice's evolution, Lisa underscores the benefits of the DPC model for both patients and providers, improving quality of life and family dynamics. Don't forget to connect with us through subscriptions, reviews, and social media to share your thoughts and suggestions for future episodes.
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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, welcome to the DPCNP, and I have a wonderful guest today, lisa McGarry. Lisa, welcome to the show. Awesome, thank you. Thanks for having me. I appreciate it. You're welcome. I am so excited to talk to you today, since you have so much business knowledge and you have overcome so many challenges in recent years to get to the point where you are. So why don't you just take us all the way back to when you became a nurse and the transition to become a nurse practitioner?
Speaker 2:So I have a. I have a different kind of story. I actually started as a respiratory therapist in 1995, worked in a hospital and then I ran medical equipment companies. I was like the head person for pediatric ventilators. I just had that role and then I was like you know what I can be doing more? And so after that I went to school to be a nurse. But I went straight through from a nurse practitioner because I was a respiratory therapist. I worked in a pulmonary clinic as a clinic nurse but I never worked on the floor or anything. So I don't have the. I don't have the story of my sister's a nurse too, like in the grind and the ICU, like I don't have any of those stories. I had it as a respiratory therapist when I was my own. So I became a nurse in 2005, a nurse practitioner December of 2006. And that was in pediatrics. I went back and finished my doctorate, graduated in 2010. But while I was doing my doctorate I did a post masters in family, and that was in 2009. So I'm certified in family and in peds.
Speaker 2:I worked a lot of different places. It took me a long time to realize I was not made for systems, so I worked like I worked he mock. I worked primary care, I worked piece primary care, I did child protection. I did all kinds of things because I love learning, but I can't I'm not one to sit in an office for nine hours and see patients and then go home and do charts for the rest of the night, like I. Just I love to be out. And so DPC was. I basically had to create my own perfect job and that's what I did. And so I worked at a federally qualified health center as a primary care provider in a rural clinic by myself the only person there for three years for loan repayment, which was awesome. I was actually working that job when I started my first DPC.
Speaker 2:I was telling you this earlier. I read an article by Josh Umber and I don't know if you know about him. He's out in Kansas. We actually flew out there and met him. You know he's kind of like the father of DPC. I use Atlas MD. Anyway, great guy, super sweet, super helpful getting the first one going. But we started I read about it in November of 2014. We opened May of 2015. We grew from zero patients and zero revenue to over 2 million a year and 2,700 patients, with over 200 businesses enrolled, yeah, so that was when I was bought out in 2021.
Speaker 2:And then I also in 2021, had a spinal cord injury, so I was paralyzed from the neck down. I only had use of my left arm and I had intensive PT and stem cells and anything you could possibly imagine software therapy, all kinds of stuff and I got function back. I can use my hands, I can do procedures, I can do pellets, I can suture, I can do all the same things, which is so exciting because I was really afraid I would lose that, but I didn't. It's all back, yeah. And so I started another DPC in a different town where I didn't know anyone last September called True Access Primary Care, and we're a DPC, but I do a lot of other things. I do IV therapy, hormone replacement, terepthate, and I have a softwave machine.
Speaker 2:So I'm kind of trying to be like a one-stop shop so people can come in and don't have to go 45 places to get things done. We have a dispensing pharmacy and we draw labs here for Quest, so, yeah, so I love it. It's crazy we were talking about how do you grow the business. I'm in BNI. I was in BNI in Gainesville. We had three chapters, and it's the best way, in my opinion, to do anything. The return on investment is amazing. You can sign up businesses that way. Individuals takes a little time, but, oh my gosh, it's so freaking worth it.
Speaker 1:I mean, I've made, I mean 50, I can look it up probably 50 or $60,000 already since September, just from BNI. So you would say most of your clients come from small business, small businesses in the area, yeah, and the other practice.
Speaker 2:A lot of them did. I haven't really broke into that market here yet. So us a lot of them did. I haven't really broke into that market here yet, so it's mostly individuals. A lot of word of mouth. You know all those Facebook pages like I need a primary, I need a primary, and we have a lot of doctors here. But it's taking people four months to get in with a primary with their insurance, and then they're treated like crap. So you know, we we market about a different experience, right? We have a waiting room where you don't wait. We have I don't know, it's just a different. Like your appointments are an hour and we're always going to call you back and you can call us after hours on the weekend. So it's just about educating them about a different experience. I love it.
Speaker 1:And you said that you use a BNI group to market your business and to really collaborate with other businesses. What does it look like to go to one of those meetings and are you just telling them what you do and then, because they're all in the BNI group, they're going to jump on board and support you as well. So it's like a guaranteed book of business.
Speaker 2:Well, it's not guaranteed. If you're a jerk and you don't refer to other people, you don't go to the one once you don't do the recipe. It's not but time, but over time, like I'm all in, I was on leadership as soon as I got signed up. Because of my history of BNI, I'm going to be chapter president next time around. That's a lot of exposure, not that you have to do those things, but you have to do it. I mean, it's a recipe, it's. Well, am I going to get the best chocolate chip cookies if I don't put chocolate chips and I don't put sugar? Well, no, of course not. You have to do the things and you right. So you go in there and you're like, oh yeah, my AC's out. I know the guy that does ACs in my chapter. He's great. I'm going to have him come and do it. I'm going to write a review for him, so that next, and anybody I know that needs AC work, I'm going to refer him. You know, it's like that kind of thing.
Speaker 2:And then once I saw a relative, so I do once, because I'm not full, I do one time visits for $100. So I'll see you for an ear infection or whatever, as not a patient and everybody knows, once my panel's up like we're not doing this anymore. But it's just a way to get people in the door, get the experience and then hopefully they end up signing up. But oh, the accountant's mother-in-law I saw yesterday, you know she didn't sign up yet but she was like, wow, this place is great, like this is super cool. So yeah, so it's not guaranteed, but I'm telling you, if you're going to put a thousand dollars into ads in a magazine or a thousand dollars into BNI, I would do a thousand dollars into BNI a million times over.
Speaker 1:That's great advice. Now you had mentioned that before you opened up this newest clinic in September, that you were in a different area. So did you move, or did you just decide that you were going to be away from the other clinic?
Speaker 2:So I had a non-compete for two years and so that's in Gainesville. I'm in Palm Coast, flagler Beach, florida, which is on the coast, so in 2021,.
Speaker 2:I also got divorced because why not? So we had a house in Flagler Beach our beach house, and so I got that in the divorce, and so I just spend as much time as I can over here. I have to go back to Gainesville my daughter's in school there, so I'm back and forth. I have an apartment there, but we already had a house here. I love this community. I love the people here. I mean, it's of 2025. Oh, that's great, and how will you?
Speaker 1:find the nurse practitioner that will run that clinic.
Speaker 2:Right now it'll be me at both, because I'm a week there and a week here, and so I'll have a nurse there. So when I'm not there, they can do urines and strep tests and I can do televisits, send them in for labs, yada, yada, because.
Speaker 1:I've been doing that from here.
Speaker 2:So I have a great nurse and a medical assistant here.
Speaker 2:I actually have both, which you would think I wouldn't need both, but I kind of do because I'm not always here. But over there I think I already have my nurse lined up so she'll answer the phones, go prescriptions, you know, take care of the patient stuff when I'm not there. My dream is to have this big enough by the end of the year to hire somebody here and then start growing their panel and then I can focus more on Gainesville and getting that built up. And the long-term goal is for me to get that built up, hire a practitioner and have them buy me out over time so they'll own that location and cause I'm 51, like I don't want to practice till I'm 80. Right, and so the same thing would be here. I would get a practitioner in who's really all in and wants to go the distance, and over time they could buy me out or I would stay. You know, 51%, then 49%, and I would just collect revenue. So I always you know I'm always with the end in mind like where, where do I want to be?
Speaker 1:She would make 49 or 50%, so you would keep the other 50% of the memberships.
Speaker 2:So we I've been through all this. We had six providers, we tried all kinds of ways. Percentages has got so complicated. We just pay them a base salary and and that's what I would do I would be like part-time, because that's how I would start somebody out, somebody who would work part-time. You know, we always tell them there's a trade-off right. Like you're not gonna see 30 patients a day but you're also gonna have to have your phone on at night and on the weekends. Like you're gonna have to be available, but whenever your kids have an activity you can always go. You know what I mean out that way. But as I'm selling to get out of the clinic, they could buy me out for percentages of the practice.
Speaker 1:So what does it look like for you to continue to make an income if they buy you out? Or do you just kind of fizzle yourself out?
Speaker 2:Well, I would still own 51% of the practice, they would own 40, I just get 51% of the profits.
Speaker 1:Oh, that makes sense.
Speaker 2:Okay, and then they have the opportunity to buy me out over time if they wanted to, or I could sell to whoever.
Speaker 1:And if you go to focus your all of your efforts to your new clinic, does that mean that she would absorb all the patients that are under your care currently?
Speaker 2:So I always keep some. Even when we were really busy at the other practice, I kept like 300 because I knew them and it was super easy. So the goal would be and some people don't care like, especially if the other person's awesome too, it's like I'll see anybody Right and so just depends on the person. But yeah, I would. I would eventually phase out. Like you know, I would be like right now I want to have around 600 patients for me, but over time I'd be like all right, I'm down to, I'm down to 500. And all the new patients are going to the other clinicians and like, oh, now I'm down to whatever. Or this person liked them better and moved to them, which is fine by me.
Speaker 2:I never get my feelings hurt Like people have to go with who they like, and then I would just slowly just wean it down and just kind of phase out. That's like over 10 years. I wouldn't mind having it be where I'm just in clinic, you know, tuesday, wednesday, thursday, half days you know what I mean or something like that where I'm in the clinic, a couple of love it and I love the business side and the coaching and the mentoring. So I can't see myself being completely out of it, but having more flexibility to travel and go on vacations and stuff like that and empowering the people need to do well so they can grow.
Speaker 1:And you know, without me, since you have run a clinic that had six providers in addition to yourself and now it's just you, is there any advice that you can give about growing a clinic to that magnitude versus keeping it a micro clinic? Okay?
Speaker 2:So my original goal was to have a bunch of clinics in town, two providers, two medical assistants and just like, when it gets to 1200, we open another one, when it gets to 1200, we open another one. It didn't work out that way. My business partner and I didn't really see eye to eye on all that stuff. So we, just as it's like, every time the new provider would get to 300, 350 patients, we'd start the process of hiring somebody. So we wanted them to all have their panels between six and 700. But we knew that we were covering overhead and their costs when we get to about 350. And then the rest of that money we could start reinvesting back in the clinic.
Speaker 1:So you mentioned that you use Atlas MD. I do. I just started Atlas MD two days ago, so I'm excited you need anything.
Speaker 2:I just started Atlas MD two days ago, so I'm excited. You need anything, I'm. I've been doing it a long time. I mean I've since 2015. So it's yeah.
Speaker 1:I'm gonna need a lot because I don't understand it. Like I'm coming from an EMR that lays out all of the soap note for you and you just have to like you can download all the macros and put them in.
Speaker 2:You can they have macros available.
Speaker 1:You just, there are macros available. But I guess I don't understand how that works. Like, there's all these hashtags and I'm like hashtag what? Like I I'm sitting here trying to type in a hashtag and nothing's popping up and I'm like okay, that's not a hashtag, okay, I don't know, it's going to be trawling there.
Speaker 2:I was going to say there's videos on it, just watch them. Yeah, I had a macro in and the macros that are already available it's. I mean, alice did a good job with the education stuff and I just wrote all my own macros. Like I went in, like for all my pediatrics I have the, the ones that are from the state, from you know the. Yeah, it's like pound, well, child 16 months or whatever, and it is it a community macro?
Speaker 2:That's not that's not, but I'm sure you can find them. I just I've because I'm old school, like they've done. They've done upgrades that I don't do yet, because I just always don't the other way. I'd probably make my life easier if I did, but I created all my own macros and so I just put them all in. Listening has no idea what we're talking about with macros then you must not be using Atlas MD so macros with Epic two that I made, so I've made macros for years.
Speaker 1:Well, macros is a new phenomenon for me, so I'm in a major learning curve here, but I'm excited about it. My office manager says she already likes it better, and so that's a step in the right direction.
Speaker 2:Everything's integrated all your billing, your inventory, everything's in one place. I mean it's fantastic, yes.
Speaker 1:So is Atlas MD, who is keeping up with all your memberships and all that as well. Do you use Atlas MD for your communications with your patients, or do you use Spruce or something else?
Speaker 2:Everything's through Atlas. I can do telemedicine, I can text through it. You set up your text number. They give you a number that goes to your phone, but the patient doesn't have your personal cell phone.
Speaker 1:So so you just access the patient communication through the app on your phone, and then you only carry one phone you carry one phone and it's not right now.
Speaker 2:I got two phones. Oh yeah, it's through Safari. So it's yeah, there's not an app, it's through Safari. You just go in and log in and do all your stuff.
Speaker 1:Oh, okay, well, they do have an app?
Speaker 2:Yeah, but that's for patients to schedule, that's not for you to.
Speaker 1:Well, my guy that was the one telling me all about it a couple of days ago said there is a provider app now and he told me to download that and then the patients have a separate app.
Speaker 2:Oh well, see, I learned you knew something I didn't. Good, I'm gonna get on and figure it out.
Speaker 1:Oh, you're so welcome.
Speaker 2:I mean I use it just through the login and I mean that's what I've always done and it's fine, so, okay, well, good, good.
Speaker 1:So so it's another plug for Josh and his amazing DPC EMR.
Speaker 2:Yeah, yeah, we flew out there in 2016 and went to his clinic.
Speaker 1:It was super cool. I was like, oh, this all works. Yeah, it was neat. I'd like to do that someday myself. Why don't you talk to us about how did you come up with all of the different avenues of care that you offer in your clinic?
Speaker 2:Okay, so not only do I do primary care and I do pap smears, a lot of cloning stone, I do pap smears, I do derm procedures, like I do all kinds of procedures here, suturing stuff like that, and that's all part of membership. I don't charge any extra for that, except for if I have to send a pathology. But I do IV therapy and that's just because we don't have a good place for people to get IV therapy here. There's one in Ormond but there's not really a good one in Palm Coast and I don't do a whole lot of it, but I like having it and stuff like that. And in my old clinic I used to do NAD for Parkinson's patients and I'm somebody just one of the physicians I work with she was telling me about NAD for addiction. So I'm I've gone down that rabbit hole to like it's supposed to really help them if they're in recovery, get over the hump of you know, withdrawals and stuff.
Speaker 2:I'm always like I want to learn what else can I do? How else can I help? And then I do bio T pellets. I do I'll prescribe hormone creams and testosterone and stuff like that. And then I do tyroseptide. I don't do semaglutide because I don't want to deal with side effects. So that's been successful. I don't make a ton of money on it, but I'm getting primary care patients because of it, because they have to join the practice in order to do it, and so I mean, once they're here, they're hooked. So it's perfect. After my spinal cord injury, I didn't have. I had drop wrist on the right and drop foot on the left, and my right arm didn't really work, which I'm right-handed which was super scary. So I did this non-invasive treatment called Softwave. It's a shockwave therapy. I did it at PT and I did it like twice a week for like eight months, but I got full function back.
Speaker 1:And so-. Oh, tell us more about softwave. Wow, because I was so impressed with the fact that you told me you were a quadriplegic, and now you're walking and you're, and you're yeah, you can move both of your hands, guys. I'm sitting here watching her on video. She's like moving all of her fingers and all that like. What an amazing story Super like.
Speaker 2:My hands feel like they've been in ice water, like they're froze. They feel frozen but they work, so I don't care. Okay, yeah, so, anyway. So so the reason I ended up buying the machine and it's not cheap was because I couldn't get treatment here in Palm coast. I was getting treatment in Gainesville and then I last summer I was here all summer and I couldn't get it because nobody would call me back from Daytona. So I was like that's it I can't be with, like frozen shoulders and sciatica and back pain and knee pain and ankle pain and hand. We just treat all kinds of pain non-invasive, so it brings blood supply stem cells. I can use it for erectile dysfunction, diabetic, foot ulcers. I mean it's got some crazy cool indications. I can help a lot of different people with it. I love having it. So that's how I got into having the Softwave machine here.
Speaker 1:Wow, that's awesome. Now do you only offer these extra treatment plans to your DPC patients?
Speaker 2:No, you can get softwave and not be a patient and you can get IV therapy, but everything else you have to be a member.
Speaker 1:Okay, Are you functional medicine certified as well?
Speaker 2:I'm not certified, but that's how I practice, so I'm very holistic. I mean, if you want me to write you seven meds, I will, but I would rather figure out how to get you off of them, if we can. Right, and I have a lot of patients come to me because of that. I'm not going to you have a complaint. I'm not going to give you a pill every time you complain about something like we're going to talk about lifestyle and exercise and sleep and sun and grounding and you know vitamins and all the things probably be monitoring that you're not.
Speaker 1:What is your fee schedule like for your patients? Do you do an age-based fee schedule or something different?
Speaker 2:Yeah, so up to age 51 is 60 a month, 51 to Medicare age is 85 a month and Medicare and kids are 30 with a paying adult. If there's no paying adult, the kids 60.
Speaker 1:And then for businesses.
Speaker 2:oh, and I have $100 enrollment fee to have to pay at the first visit everybody, because we learned our lesson on that a long time ago. And then for businesses it's $60 a month, regardless of age, and if they sign up more than five people I waive the enrollment fee.
Speaker 1:How come the businesses get a discount? What if their employees are over 50? I don't care, oh businesses.
Speaker 2:They don't, they are underutilized. I mean, they have access, they don't. They just don't overutilize, so I don't care, okay.
Speaker 1:So how many messages would you say you get right now? You have, you said, 200 patients. Is that correct? Okay, so if we take that into perspective, how many messages do you get on a daily basis and how many office visits do you have to do every day based on that number?
Speaker 2:Oh, right now. I mean it's all new patients, so it's all heavy loading in the front, right Like that's. It's the heavy lifting in the front. So I mean some days I see six patients. Today I saw two.
Speaker 2:So and then messages I don't know. Some days I don't get any, and some days it starts at six in the morning and doesn't end until 10 at night. But there's several days where I get nothing. And holidays, you would think, would be the worst. I never hear from people, hardly ever on holidays. It's not bad, because usually I can deal with something in two text messages and people don't have to come in for everything. I'm not one of those people like, yes, you had't have to come in. It saves people time and they're. They love it. They get to stay at work, they, you know they're not driving all over town. And then we have a pharmacy with wholesale meds here, which is great for the patients. So the Z-Pak, I think, is $2.80. And they get it when they're here In Florida. We can get dispensing licenses, so it's like $100 every time you renew and then you can dispense medications in your clinic.
Speaker 1:Oh, I can do that in Tennessee, but I don't have to pay a fee to do it.
Speaker 2:Well, Florida.
Speaker 1:Or if I do have to pay a fee. I don't know I'm supposed to pay a fee. Oh well, I'll ask for forgiveness later if that's the case.
Speaker 2:Yeah, I mean it's not that big of a deal. Literally it's like one page instead of money, but anyway, yeah.
Speaker 1:So you have a dispensary in your office. What do you have in there?
Speaker 2:Just the stuff I normally order right, like antibiotics, prednisone, migraine medicine, allergy meds, I don't know. I I right now I only have about 3000 in inventory. At my other practice, when we were really big, we had like we ran about 16,000 inventory all the time which is saying get it down, but we just never could figure out the best way to do that it's. I mean it was, it's fine, I mean there was so much, so many meds going out of that place. But yeah, so just basic stuff, antidepressants, just stuff you would when you meet a new patient that they might need, I do you know hormone replacement for men?
Speaker 1:So anastrozole birth control, I have. I have kind of a little bit of everything. What kind of advice could you offer to people in regards to patients that over utilize the services?
Speaker 2:So here's what you have to accept 20% of your patients are going to take 80% of your time and it just is. I mean, I we rarely had to discharge people, but we would we'd have. You know. It'd have to be like and I would say like I can't help you, there's nothing else I can do. Like this is not within my scope. You need to see an internal medicine, doctor, physician. Like this is because at some point nobody's winning right. They're mad, you're upset, but I didn't, I don't know. I just accept it Like I don't, it doesn't upset me.
Speaker 2:I have a patient that's been with me since 2015. This woman has followed me everywhere. She I'll talk to her 100 times for three days and then not talk to her for three months, and then you know, and it's just like I just know her and this is her anxiety and we talked through it and I love her through it, and then she's fine for a while and it just is. And you know what. I just accept it. So I don't get my panties in a wad. I'm not. I don't make a bunch of rules around how many times you can contact me. That's not what DPC is. I'm sorry. You can go if you want to have it, have your life be challenging and going to have a handful of patients.
Speaker 1:And so just listening to the different opinions on how to handle that, but I think that yours is definitely the compassionate way to handle it is. You're going to have those patients and for the most part, it probably is anxiety that is driving the frequency of the calls and the text messages.
Speaker 2:And I have boundaries too I'll say this isn't. This isn't a medical emergency. I'll just send me an email and I'll handle this tomorrow. Okay, so you have to train them right. You're not being ugly. This is not a medical emergency right now. Send me an email and I'll deal with it tomorrow.
Speaker 1:Is that how you handle patients that are trying to reach out to you on Saturday or Sunday? That the messages clearly look like something they should have waited until the weekday?
Speaker 2:Well. So if somebody will text me like I need a refill on my list, center pearl, I'm like are you out? Well, no, Then send me an email. And you know, in your defense, I'm the same way, Like I'm a squirrel, right, and if it's Saturday, I'll do this to my poor hairdresser. I'll send her a message on Saturday. I know she's not at the office and I know she's not electronic or digital. She works out of a little book. She's not going to know anything, but it's on my mind on Saturday. So I send her a text. I'm like, hey, can you get Naomi, my daughter, in on this date? And she's just like I don't have my book. I'm like I know, but I need to, I need to dump this on you because I don't have the bandwidth to deal with it. Right, Like on Monday. Like you know what I mean, try to teach them in a loving way. I mean, that's just kind of how I've always operated. Yes.
Speaker 1:I like that. Do you have patients that are on controlled substances, or is that a policy where you don't accept patients like that, or is it just open to any patient that wants DPC care?
Speaker 2:So in Florida we can't write schedule two, which is great, so sorry, I tell people I don't deliver babies, I don't write pain meds and I don't write ADHD, but it's pretty much anything else I'll do Now. I'm not going to have you on Xanax four times a day for the rest of your life, though. That's not going to happen. That's not what I do. So I will write people for short term like Ativan, I write Phentermine, like I write controlled substances. So I'm that's not a strict policy, like that's not going to happen right, because I'm not helping you really get better, I'm just medicating you and people will find the people that will give them what they want, and if I don't give them what they want, they'll find somebody else and that's okay. Yeah, that's good advice.
Speaker 1:Okay. So, Lisa, how do you get equipment for your office and supplies for your office?
Speaker 2:So our the first exam table we had at my other practice I got off of, I think, ebay and it was $50 and it was in Jacksonville. So we sent our husbands at the time to Jacksonville to pick up the table and my now ex-husband called and said you realize, this table is pink. And I was like no, no, no, it's like a beige color. He's like, no, this is salmon pink, cause it was the picture it was in like a darkened room. So I, maybe they still have that table, I don't know. But our first table was $50 in salmon pink and we did not care, we just decorate around it, girl, it was like a beach scene, but there was colors in it and it was like perfect, that's for that room.
Speaker 2:And then Amazon and Marketplace we bought nothing new and my exam table here came out of another nurse practitioner's garage. She was giving it away. And then somebody was giving away two brand new exam tables because they were going to open something with one of the schools and never opened it. So I got two brand new exam tables in my garage from my Gainesville office and another doctor's office closed here and they gave me all their stuff too. So just know people and be nice and boom. So don't have to buy expensive stuff.
Speaker 2:I bought my. I bought my EKG machines off of eBay because I knew the ones that were good there. I mean, this thing is probably from I don't know mid 2000,. You know, like 2005, 2006. It works, it's great. I'm not I mean, I'm not a cardiologist here, right Like I just need an EKG to make sure that we don't have something where I need to send you to the hospital. So so, yeah, I bought, and then any like furniture, amazon, you know. So you don't have to do this expensive, you don't have to take a giant loan. I, I opened this practice with $40,000 and it's kept, it's kept running. And I, my accountant, made me start paying myself up. You said you were making 50,000 or whatever. I'm making 40,000.
Speaker 2:Like it's like I'm paying myself with my own money. It makes me want to scream.
Speaker 1:Yeah, so for the record, I was only paying myself 50,000 when I had an insurance based practice.
Speaker 2:So, yeah, so now I can pay myself a little bit more because, oh yeah, when I get up to 300 patients, I'll bump my salary up. I just, I just want to reinvest everything right now and I'm reinvesting in like marketing and my website. And you know, because I made my website, it sucks. You know, I took a like an old one I had and revamped it, but it's getting redone and it's going to be so beautiful. I'm excited.
Speaker 2:I just met with him today and I'm we're shooting video. So I'm reinvesting money. You know we're going to be on LinkedIn and we're going to be doing reels and, you know, just pumping up all the social media stuff, cause I want to grow faster, right, bigger, better, faster, and I and I've never had a wait list I'll have them enroll and I'll schedule them out because I don't want to lose them. Like, once you lose them, they're gone. Like I get them, I'm like, nope, all right, we'll see you and I'll see you my first new patients in three weeks. I'll see you in three weeks, or I'll just work late a couple like days a week or something to get them in.
Speaker 1:Have you feel like are ones that cancel.
Speaker 2:I probably have two a month if that, oh, it's not bad and you have to. I mean it's going to be attrition, people are going to move, people are going to get upset. People's needs change, you know, and I don't take it personally, you know, but I'm okay with putting the time in now for the rewards later. I mean it's crazy, we were making 250,000 a year, my business partner and I at the other practice.
Speaker 1:Oh wow, I would love to get to that number.
Speaker 2:I miss those days. Yeah, we had. It was me and my business partner. We had four of the providers, so there were six total of us and by the end when I left, it was bringing in right around 2 million a year 2 million. Okay, so every provider had 600 patients right, except for my business partner and I. She had 300, I had 300 and the providers had 600.
Speaker 1:Okay, and the providers were making a salary. They were not making a percentage of their memberships.
Speaker 2:They were. They were making 150,000 by the time they had been there three years. Like we bumped them, like we wanted them to stay right. We want to incentivize them as we made more money. We were always very generous bonuses and you know, anytime we could help them grow programs they wanted to take education, they wanted that stuff, like that we were always on board helping them grow.
Speaker 2:My medical assistant I have now is not registered, so she's going to take the class so she can get her certification. I'm paying for that for her and then I'll bump her salary up after she passed.
Speaker 1:What other things do you pay for? Well, you don't have another nurse practitioner yet, but did you say, as soon as you got to 300, you were going to hire a new one? Yeah, so are you going to offer vacation?
Speaker 2:Oh, yeah, I already do simple IRAs and pay holidays for my employees. I'm not paying vacation days yet because I'm not big, but yeah, I already set them up for simple IRAs through the business and yeah, as I grow, I'll continue to add benefits for them.
Speaker 1:Good. So did you rent a space that was already built out for a medical clinic, or did you have to start from scratch?
Speaker 2:So my very first clinic was just a shared space. I had a massage therapist and a therapist. We had five offices and I had one, and then I got to two, and then I got too big and now I have my own space. When I owned the other practice, I also owned buildings. So we had two buildings, two locations. We own the buildings, rented out space, so it was pretty cool.
Speaker 2:One of the buildings that we own had been an imaging center, so it was a distressed, distressed, distressed property. Oh, remembering that. But we remodeled it and then rented out the old MRI suite to an MRI company, which was fantastic because it was already set up for that. And then our other office that we had bought had been a doctor's office that we an old doco. So, yes, and so the space I have now had been a massage therapist. It's got three rooms there's. No, I'm not that OCD about having a sink in my room. I just wash my hands between patients in the kitchen and I carry my paper towel and then I have hand sanitizer. So most of the rooms didn't have seen what I like it. Would it be dreamy? Yes, but is it a necessity?
Speaker 2:No that is my best advice for anybody who wants to do this. It doesn't have to be freaking perfect, okay, it can be a little clunky, it can be a little messy, it doesn't have to be perfect. You just have to keep putting one foot in front of the other and doing the right thing over and over again.
Speaker 1:Yes, it just needs to be clean. Yeah, yep.
Speaker 2:Yeah, patients don't really care about really the aesthetics at all, they just are coming to see you as the provider, not make it aesthetically pleasing, like of course. But you know it doesn't cost a million dollars to do that. Exactly, I know people like they get analysis, paralysis, it's like it's not that deep. Go, just do it.
Speaker 1:I think that our job description anyway is to pay attention to the details, and we can overwhelm ourselves with the details thinking that everybody else is also paying attention to the details. And we can overwhelm ourselves with the details thinking that everybody else is also paying attention to the details, when that's not the case. There's other details that need to be focused on, and those are not the ones.
Speaker 2:Yeah, you have to stay out of the weeds because you'll just know you got to get above and look at the whole.
Speaker 1:Yes, Okay, so we already pretty much know what the future looks like for true access, direct primary care. So you're wanting to extend to Gainesville? What does it look like past that?
Speaker 2:That's a great question. Let's let me get those two going. Yeah, I mean, if the if keep adding providers, you know, bigger office, more providers or another micro office or whatever it just we ended up I wanted two providers and two medical assistants, but then we realized the overhead of like the pharmacy and all this other stuff having all these locations. There was just so much more stuff you had to get, as opposed to having everybody in one building.
Speaker 1:So what would be the benefit of taking on the expense of opening up another practice in another location, versus just bringing a nurse practitioner into your current situation?
Speaker 2:Just depends on what your goals are. I mean, I had first thought it was going to be super boutique-y, intimate, small like two. You know, everybody knows everybody kind of thing, and it just didn't end up making sense financially to have all that overhead over and over. So then we decided just to expand in the, you know, take up more space in the clinic and add providers to the office.
Speaker 1:Yeah, I think that's what my plan would be too, because originally I had thought about well, do I want to open up a DPC clinic in Arkansas, which is, you know, not too far from us? Do I want to go down to Mississippi, which isn't too far from us? And then I'm like wait a minute, no, I'm trying to de-stress my life.
Speaker 2:Yeah, I mean, my motivation is like for wanting more offices that I can take care of more people, Right? So? And I already have a client base in Gainesville that's just waiting for me to come back, which is nice, you know, because I was with them for so long. So so it just makes sense. My daughter's going into high school, so I still have four years that I'm going to have to be going back and forth. I might as well grow that while I'm there and then be able to hand it off to somebody.
Speaker 1:Yes, does she want to be a nurse practitioner?
Speaker 2:No, my older. I have a son that's 30. He's a software developer. And then my 21 year old is in her senior year at UF and she's in healthcare program. And I thought she'd do the healthcare program. Nope, entrepreneurship, which is fine, I mean, that's another path. So I think because we even because she's the one that would be most likely to do medical stuff we've always encouraged her and she's. If it's not her idea, it's a bad idea. She's a teenager, right? So I just stopped talking about it.
Speaker 1:I'm like, hey, do you want to be a nurse practitioner? And she's like, maybe, but I'm not going to do what you're doing. I'm like, okay, we'll see about that.
Speaker 2:Yeah, no, I don't have any. My youngest was the like. She used to be the one who'd want to come to work with me and watch me suture and stuff. She's like does this patient, do you think this patient would care if I came and watch? Now she doesn't, but when she was little she did, you know, and they've grown up around me running a practice, you know, so they've kind of seen it.
Speaker 1:So yeah, that's the way my kids are too. In fact, my kids don't even know what it's like to go to the doctor because they just come to my clinic, so they have no idea the etiquette of going and making an appointment and sitting, oh no.
Speaker 2:So my daughter's on Accutane, so she has to see dermatology and she has gotten a lesson in life. She's like, oh my God, mom, why does anybody deal with this system? I'm like I don't know.
Speaker 1:I have no idea.
Speaker 2:I don't know why they're not knocking my door down. I don't know why I don't have 60 enrollments a day. I don't know Cause they don't know any different monthly membership. Now, what are you doing?
Speaker 1:That's the one thing that I feel like is what needs to be instilled in Americans, because we are so brainwashed into believing that insurance is the only way that we're going to get decent health care, and so this idea of paying a membership in most people's minds sound like they are going above and beyond financially.
Speaker 2:Well, but the thing that's so crazy. I use this example in BNI. I'm like okay, well, you pay for car insurance. Do you run your car into a light pole so you could use your insurance? Do you want to set your house on fire so you can use your homeowners? What Like? Why do we think that way? And health insurance is the only one that's like that, everything else you don't want to use, but I got to use my health insurance. It's like no, you don't, it sucks. They don't treat you well. You can't get in, you're just a number. The provider's miserable, the staff is miserable, everybody there's miserable. Why would you do that here?
Speaker 1:we love you and we're happy Right, and we have plenty of time to talk about all the things, because if you go to a doctor that's taking your insurance, you have about seven minutes to explain to him all of your problems and they are never going to link them together because they don't have time to analyze the big picture, they're like this complaint, there's a pill.
Speaker 2:this complaint, there's a pill. This complaint, there's a pill, it's like no.
Speaker 1:They're band-aids. They're just band-aids. Yep, exactly. I love DPC.
Speaker 2:I love what it's doing, not only for the patients, but what it's doing for our lives, the quality of our lives, 100% Well, and I tell people, I'm like the providers that are in the insurance world aren't happy. They don't want to practice medicine that way. That's not why they went, you know, study medicine they didn't for seven minutes and a administration that gives no craps about them and it's just like. That is not what they're not. They're not greedy, you know. They're like oh, they have to see 20 patients an hour and it's yeah, because the reimbursement is so bad that and all the overhead is so freaking high. They don't have choice and they're miserable too. I like this. It's like yes.
Speaker 1:Yes, well, I'm thankful that we have this program. I'm thankful that more nurse practitioners are becoming entrepreneurs and going with this model, and the more that we're out there, the more that patients are going to hear about it.
Speaker 2:Yeah, we have two other DPCs in town here, so it's cool. They're great nurse practitioners. They're friends of mine. One of them I went to grad school with, so oh, awesome. And there's plenty for everybody. I never have that weird like oh you're my competition thing.
Speaker 1:So Well, Lisa, thank you so much for being willing to talk to me today, and I know that what you have to say is going to be so helpful for a lot of other nurse practitioners that maybe have a desire to be an entrepreneur. So if anyone wanted to contact you to ask you questions or to get your advice on something, are you willing to share your contact information?
Speaker 2:Yeah, it's just Lisa at SureAccessPrimaryCarecom. I'm always happy to help.
Speaker 1:Great. Thank you so much. And she is definitely a wealth of knowledge and she has come from a huge obstacle to to become what she has become, so you're an inspiration, lisa. It's an honor to meet you.
Speaker 2:Yeah, it's nice to meet you too.
Speaker 1:This is awesome. If you need anything, let anything, let me know. All right, talk to you later, lisa. Bye-bye. Thank you so much for joining us today on the dpc np. 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.