The DPC NP
The DPC NP
Breaking Free from Corporate Medicine: Krystle Dillon’s Journey to Direct Primary Care and Holistic Wellness
What if you could transform your professional life and find a deeper sense of fulfillment? In this episode, Krystle Dillon, a nurse practitioner from Olivia, Minnesota, shares her awe-inspiring journey from a young certified nursing assistant to an established family nurse practitioner. Krystle dives into her evolving career, detailing the constraints she faced in hospital nursing and her discovery that building meaningful patient relationships was her true calling. She candidly discusses the challenges of corporate medicine and her courageous decision to embrace the Direct Primary Care (DPC) model, even incorporating an aesthetics business along the way.
Krystle's path to DPC wasn't without its trials. With overwhelming patient loads and the weight of student loan debt, she found herself shackled by the "golden handcuffs" of a high-volume corporate practice. Discover how a serendipitous article and a transformative DPC summit helped her and her initially skeptical spouse see the light. Krystle also credits influential figures in the DPC community for their guidance and support, painting a vivid picture of the tight-knit and innovative world of Direct Primary Care.
Our discussion doesn't stop at Krystle's personal story. We explore broader issues, like the inefficiencies of the traditional healthcare system and the emotional toll on medical professionals. Krystle's experience with Rural Authentic Wellness highlights the benefits of a holistic healthcare approach, where removing insurance complexities can lead to more meaningful patient interactions. Learn about the diverse services her clinic offers and the importance of patient education in DPC. This episode is a treasure trove for anyone keen on understanding the transformative potential of Direct Primary Care and the empowering journey of nurse practitioners stepping beyond conventional roles.
Thank you for joining us today!
Be sure to follow and share, and leave a review!
If you have questions, comments or want to be part of our community, follow us on Facebook at The DPC NP!
Welcome to the DPCNP. I'm your host, amanda Price, family nurse practitioner with two decades of experience, including 16 years as a business owner. Hey everybody, welcome to the DPCNP podcast. Today we're talking with K Dillon, nurse practitioner from Olivia, minnesota. Crystal, welcome to the show. Hi, thanks for having me. Thank you for being willing to be interviewed. I'm excited to hear your story Tell us about how you got into nursing.
Krystle:Yes, so I actually started off as a CNA certified nursing assistant when I was about 15. And that's when I really realized that I love being a nurse or like in the medical field. And then I slowly just worked my way up from there. I became a TMA so I could pass meds, and then I went to school for my LPN and then I went for my RN and I got out of school and I think everybody when you get into nursing, you think about hospital nursing and being in the ER and doing all of that. So I went right to the hospital and I hated it. I enjoyed it, you know, I enjoyed the patients, but it just didn't feel like that was where I was meant to be. And I talked to my husband and decided to go back to school and I ended up getting my family nurse practitioner. I got my master's degree and it was really great, because I remember when I was going to clinical I remember talking to my dad and I called him and I was like what if I hate it? You know what if I? What if I go there? And I've just been in school for the last two and a half years and I get there and I hate it. He's like, but what if you don't? And then I was on my way home after my first day and I was like this is it? This is where I was meant to be. So I graduated with my FNP when nine years ago, so 2015. And I absolutely loved it.
Krystle:I had a place where I really wanted to work and I ended up getting hired by them and I was there for about seven years. The company that I originally worked for was wonderful. We got to kind of manage our own schedules and you know, say how long we wanted to see people. And then we got bought out by corporate medicine about four years ago. And about two years in, I told my husband. I said I can't do this anymore. I can't. I can't continue to see patients in the way that they want me to see patients. And he didn't really understand DPC. He was kind of taken back by it. We had really good insurance through his, his business that he worked at, and so he didn't understand the concept and I just said I was like I can't do this for 35 more years. I have to figure out something. So I told him. I said I'm either going to open up a clinic or I'm going to start working at Burger King. You know like I got to get out of this. And so we went to our first DPC summit actually it was a Hint Summit in Denver and by the third speaker he looked over at me and he said I think we have to come up with a plan for you.
Krystle:At that point I had already started my own business doing aesthetics. Two years prior to that, after corporate took over, they said hey, you know, find ways where we can bring revenue. And I said you know, I'd really love to do some aesthetic services and they were not on board with that. I was given a resounding no, and so I thought you know what? I think I can start my own. So I did, and that was kind of my bridge, which was really nice.
Krystle:I do aesthetics here too as part of our clinic, but my passion is really family medicine, and so about two years after I'd started my business, I was, I was busy enough where I could make that transition, and so I transitioned two years ago out, and so I'll be gone in December. I'll be gone two years from my, my old place. So we've been primarily doing aesthetics for the past year and a half and then a year ago I bought the local bank in town. There was a bank that was sitting empty for several years, so I bought that and we renovated it and we just moved in in June, and so now we're pushing more of our DPC side. That's been going really well.
Amanda:Good, that's great. What was that pivotal moment going back to, when you had that fear that you weren't sure that you were going to love being a nurse practitioner? What was that moment where realized in clinical, yes, this is what I want to do? It was is it just the patient care, just communicating with all different kinds of people throughout the day? Is that what got you?
Krystle:Honestly, it's building relationships. I love to have relationships with my patients and I think that's where sometimes in aesthetics I don't get that as much because I don't see them as frequently, I'm not talking about their health, I'm not talking about their kids as often. We still do a little bit of that. But that was really my turning point of how I get to have these amazing connections with people and I get to walk with them through all different phases of life. You know, like even just having a baby, or maybe they're going through a cancer treatment, or you know, maybe their family member has cancer and so they're struggling mentally or emotionally.
Krystle:It's really that relationship and I think that's why a lot of people get into the medical world. I mean, I think, a lot of people who are physicians or nurse practitioners or PAs. I think that they really have that draw and that pull to the patient, because we're here to help people, we really want to help people. And I think that's where I felt like, yeah, this is where I'm meant to be. I'm not, you know. I think in the nursing world to like in hospitals, where that we're kind of that liaison between the doctors and the patient. So you know, they come in and they see the, they see the patient and they say all these big words and then they leave and the patient looks up at the nurse and says what does it all mean?
Amanda:You know?
Krystle:what did he just say, yeah, and so we get to build those relationships, but then they leave, you know, and so we don't get to see them afterwards in clinic, and and so that's.
Krystle:What's really fun is that you get to kind of walk through people or through their life and through all different aspects, because I think a lot of people think about medicine as being just physical health, and it's emotional health, it's financial health, it's physical health, it's sexual health. I mean there's there's so much more that comes along with it, and I think that's where I really struggled in the corporate world is that I didn't get enough time with my patients to talk to them about all the aspects that are impacting. You know, sleep, like sleep is a great one, right? Like, how are you sleeping? I'm not sleeping very well. Well, that can be a number of things you know. So, really, being able to sit down with them as a DPC provider now and being able to spend 15 minutes just talking about one subject and not feeling like I'm going to have a nurse knock on my door or I'm going to be late for my next appointment, it's just, it's so free really free.
Amanda:How many patients did you used to have to see when you were working for the first clinic before you opened up your deal?
Krystle:Yeah, so that that would range anywhere between 12, sometimes 20. When I was working urgent care, we would do 10 hour shifts and we'd see upwards of 60 to 70 people in a day. That was a lot. When I left corporate, my practice size was over 2200 patients, so I had a very large panel and one of the things that I had requested for two years during my review was to close my panel. And that was the only thing I asked for. And they continuously said you know, well, if you're booked out a couple months, then maybe we can talk about it, and then I would be booked out a couple of months, and then they don't pull back from that. And I remember at my last review I was like you know, if I, if I worked every single day for 10 hours a day, I still wouldn't be able to see all of my patients for a wellness exam once a year, there would be no way, even if I didn't take a vacation and I worked every single day. And I just felt like it was such a disservice to the patient but also to the way that I wanted to practice. You know, and I think that I feel like a lot of people have golden handcuffs. But when we're talking about our work and it's, you know, we have student loans and there's debt and I mean even just coming out into the DPC world, it's it's a huge transition and it's a lot of work. I'm tired. I'll say that I'm tired right now. You know it's it's been a it's been a long process. All worth it, definitely worth it, but it's it's difficult.
Krystle:So how did you hear about DPC? Yeah, so funny about that. My uncle, actually, he worked for a bank up in Fargo, north Dakota, and he saw an article about a company that is close to them. So he sent me the article and he's like hey, I just just wanted to show you this, because at that time I'd already had an aesthetics practice, and so it was another clinic that did aesthetics and DPC. And he goes what do you think about this, you know? And he just he just kind of threw it out there, and so I read about it and then I Googled DPC and I thought this is it, this is my out, this is this is what I'm going to do. And then I brought it to my husband and he thought I was crazy and I just kept bringing it up. I felt like I'm very much a manifester and I'm very much a person that kind of think. Like you know, if God puts something in your heart it'll just keep nagging at you until you, until you follow the path that he chooses for you. And so just kept nagging at me. So I just kept bringing it up to my husband, like everywhere we in the car and at supper and finally he's like well then I get to listen to your next big idea, you know. And and that's when I realized that he had to come to summit with me I'm like he has to understand the other side of it too. And then once he realized, I think there was a, I think it was Dr Vance Lass, who's really big in the DPC world on the physician side.
Krystle:He spoke about the number of administrators versus the number of physicians and how much that overweighs. And I think the number of administrators has gone up like 3,200% in the last, like 20 years, and the cost of healthcare since 1993 has gone up by 3200% as well. So I think it's hard to bypass that very evident reason of why is healthcare getting expensive. And I don't think it's because of the physicians, I think it's, it's very much the upper echelons and the administration and how much we are regulated, so I totally agree. And once we found out that, or once I found out and started looking into it, how much we are regulated, so I totally agree. And once we found out that, or once I found out and started looking into it, how much more affordable healthcare can be when insurance is taken out of the mix.
Krystle:You know when I, when I tell my patients that I'll actually just did this. The other day, I had a member where I had to put a cast on a couple of months ago and it cost $6 and 17 cents for that member to get their cast on and people were just blown away by it. I'm like, yeah, like your membership covers me, right, I take care of all of that. You're not having to pay for a doctor's visit. This is what it covers. And I just took the cast off actually two days ago, and that was part of their membership and took it off and there we go. So I didn't know all of that and being in the medical field and not knowing that and not knowing that, now how are we supposed to explain that to our patients? How are people supposed to know, you know, and navigate the medical world.
Krystle:I think that that's really scary and I think that because patients are given such limited time that they do feel like they have to go on Dr Google, they do have to do their own research because they only got about seven minutes with their PCP and that's not enough.
Krystle:I remember very vividly being in a meeting one time and they said well, you know, you should really have your nurse queue up your patients and say that you can bring up one or two issues. And I said but what if they have seven? And they said well, you only have time for one or two. And I remember saying well, what if the other five things that they're worried about helps me with my differential diagnose for the first two issues? And there really wasn't a response to that, you know, and I remember thinking like that's not okay, right, and we also shouldn't have to be charging people for multiple visits so that they can get their concerns in because they are given such limited time. So I don't know. I think it's just that realization and then also coming to the fact that it's time to take that like we have a service to give to our patients and we have an opportunity to do right by them, and I think that a lot of people want to do that. It's just how do we get there and how do we teach.
Amanda:Yeah, you're absolutely right when you're talking about not giving patients an opportunity to tell us all of their complaints in a visit. That was one of the biggest things that I had an issue with. Also, and I would very frequently spend way too much time with my patients because you know I would very frequently spend way too much time with my patients because you know I want to get it right. I want you to trust me with the care that I'm giving you, but I need all the answers in order to come up with a valid reason behind your complaint. And, just like you said, I can't, because there were times where I had to tell my nurse to tell my patients. You know you can complain of two things, but the patient doesn't know that maybe fatigue and headache might go together, so they pick fatigue and refill my medicine prescription yeah yeah, fill my prescription when you know I'm trying to navigate what fatigue looks like, which could go in any kind of direction, just like chest pain and abdominal pain.
Amanda:You know those are. Those are generic symptoms that can be minimal or they can be extremely bad. So you know, you have to spend the time to be able to really navigate the right answer, and so you don't have time, like you said. That's what I love about DPC is you can spend an hour, two hours, however long you want to with the patient until you actually can come to a decision on what might be wrong with them, right?
Krystle:I feel like when I was in medicine before that, it was almost like I was trying to figure out the thing that was most detrimental to them and trying to treat that. What is this patient going to die from? Like, what's the highest risk? Right, but it wasn't always managing the cause, it was always managing the symptom. And I remember very vividly I had a man who was in his late thirties come in for a DOT physical and he was over 450 pounds and his blood pressure was horrible, you know. And I just said I was like, hey, I can't qualify you, but you need to have a physical within the next three months so you can get on medication and whatever. And he looked at me and he goes well, can't you just do it. And I remember thinking like, oh, I got 20 minutes for this appointment, right. And I said, yeah, you know, I can Don't think I'm rude, but I'm going to like run through your family history really quick. And I remember placing him on a blood pressure medication that day. And then he came back, you know, he did labs that day. And third appointment, we had had his blood pressure under control, he had had a thousand dollars worth of medical bills and I still hadn't addressed the problem, which was his weight, you know.
Krystle:And so I feel like, because we are so limited on time, that we don't get to focus on problem-based care, it's so symptom-based care and I feel our patients feel that too. They say you know, every time I see you I feel like I get another pill and it's like that's the issue is because we don't have enough time to go over the causative factors and we're just symptomatically treating a lot of people. I mean, I do believe that there's a lot of medicine that is necessary right, there's a lot of medications that are necessary, but it's getting to the root of the problem. Why are we doing this that are necessary, but it's getting to the root of the problem. Why are we doing this? Why are we, you know, why are we giving you this med? And also, like, I'd love for you to get off of that. This is how we can do it. Let's talk about it and let's come up with a plan. And I feel like a lot of people in medicine are feeling that we just just these pill pushers and we didn't do that, we didn't do that before.
Krystle:Or, you know, even just talking about a viral illness, you know, like giving them an extra seven to eight minutes, these are some of the over-the-counter medications that you can use. I go to a local school and I teach them suturing and we talk about over-the-counter meds and I'm like did you know that you can help your sore throat with this, this and this? And you know, and, and the kids are 16, 17, 18 years old and they're like, oh, I didn't even know that you could take that. Or you know, I think about all the adults that don't know simple ways to treat viral illnesses.
Krystle:Or do I have to go to the doctor? But, having DPC, our patients have access to us so they can say, oh, what about this? And we can say, yep, you can take this medication or this medication, or maybe you try some hot water and honey or so. So I think that the relationship aspect and once people realize the relationship and the closeness that you get to have with your PCP and DPC, it's a game changer for them and then word of mouth just takes over.
Amanda:You made me think about when you were talking about how we just push pills all the time and I've said this in multiple interviews but I can't reiterate it enough and that is you know, when we're going to school even when MDs, any medical professional is going to school we take multiple pharmacology classes. We are literally being driven to just give a pill for everything, just like you said. So we only have time to listen to your symptoms and then if your symptoms are blood pressure, we're just going to give you a pill to force it down. And once you're at goal, like yeah, just stay on that, because you're at goal, so just leave it there. And we never take any classes in nutraceuticals. We don't take any classes in truly how to tell people what is an appropriate diet for this or appropriate diet for that, like we have to do all the research ourself.
Amanda:When I got into getting certified in functional medicine that really I was already interested in helping patients from that parameter, but when you get into actually the classes to earn the certification, you really recognize all the things that you didn't know how to treat patients with and it just felt like such a like I was robbed of an education, like I was. I've been doing a disservice. I've been a nurse practitioner for almost 21 years and it's like I just saw my life as a nurse practitioner flash before me and I realized all the people in all the years that I thought I was doing something for and I wasn't. I was just giving them a bunch of pills. So now I want to try to right my wrong, but it just really makes me sad. So my nurse practitioner that I just hired was a student that came to my DPC clinic to do one of her rotations, her clinical rotations and she has been my patient since she was 12 years old, so she already knew me very well. And when she graduated I'm like I want to hire you. You're the one.
Amanda:And because I knew all the times that she was coming in learning from me, I was like now don't rush to give this, a patient like this, this pill or this pill. Do you know that there's this naturopathic thing that you can do? You can do this, you can do that, all the things. So I'm just filling her head with all the things that are not on her certification exam. But I'm like, don't just assume that you're going to get out and treat patients and just start pushing all these pills. Because, really, what I have found, the patients that are paying for DPC. They are not interested in taking 1015 pills and they want to resolve the issue. So if you have time to explain to them a good cardiac workout plan or a diet that would be specific to their issues, then that's going to go so much further than oh well, let me give you this pill for your IBS, so let me give you this pill for your chronic yeast infections, and all that, and we'll just keep on like just yeah, I feel like that.
Krystle:So we just started doing menopause hormone therapy. Here, too, we don't use any pellets or anything like that, but we do prescriptions, and I feel like I had that moment with you, that aha moment of like I've just been robbed, and I want to just call all of my patients who I gave an antidepressant to in their 40s and 50s and be like can you come back and see me? I'm so sorry, I've had a new revelation.
Krystle:Yes, like I didn't. I didn't see it. And it wasn't that I didn't see it, I literally just didn't know. I think I was even fearful about hormone replacement therapy for individuals in menopause because I was uneducated. You know we all learned about the WHI and how they gave out that. You know everybody who's on hormones is going to get breast cancer. And also, when you don't understand it, you know. So when your patient comes in and says, hey, can I have my hormones checked, and you go, well, you know there's really, really shouldn't do hormones, you know. And at the end of the day it's like, well, I just didn't know enough about it. No same thing with depression.
Krystle:I had a postpartum psychosis that I experienced after a surrogacy and I remember thinking like this is the worst I've ever felt in my life. And now I, you know, I started an antidepressant because that's what I was told to do. And now, looking back, I just started progesterone a couple of months ago. And, looking back, I go gosh, I could have treated myself with progesterone. I would have felt so much better. But we didn't know about that. I didn't. I certainly didn't know about that.
Krystle:And I remember thinking even back then, before I knew about hormones. I remember thinking I've been treating depression for the last four or five years and this is my first time ever experiencing it and I felt such a different type of empathy towards my patients as well, to think, you know how long was I talking about something that I didn't really know about. And then, once I felt it, once I experienced it, it was, it was a revelation and it was okay. Now I have something I can connect with with my patients, but I don't. But at that same, you know, on that same token, I don't say that you have to see a cardiologist that's had a heart attack in order to understand what a heart attack feels like.
Krystle:But we're not taught about that in school. Mental health, I think I was taught about it for maybe a week at the very most, and, like you said, it was more on the pharmacological level, not emotional level. Or how do I support this patient, or how do we give adjunct treatments? You know when, when somebody is coming in and they're really tired, I mean you can give somebody a B complex supplement or a B 12.
Krystle:And they might feel better, that they might not be experiencing depression. They might not be, you know, wanting to sleep all the time, and those are different things that that we're not taught about and it's. It's really sad not not to say that. You know, everybody needs to know everything. I think in family medicine, I think that's one of the hardest things about family medicine is that we have to know a little bit about a lot of everything. I say that all the time, yeah, and and we just have to know where can we get you or how do we get you to a better place?
Krystle:Where I practice and where I, where I am, I was very fortunate to have a physician who kind of took me under his wing. I call him the wizard, he knows who he is, but he took me under his wing and he said like you know, you got to work at the top of your scope and we have to understand all these things. We have to know how to manage chronic kidney disease and congestive heart failure and do injections and biopsies, because we can't wait out here. You know, in the city you can get into a dermatologist in two to three weeks. Out here you're looking at about six month wait and heaven forbid if you have a melanoma or something like that and you didn't get a biopsy, where if they get a biopsy and it comes back, yeah, this is positive, they're getting seen relatively quickly. But it's very difficult to know how to manage those things. But somebody can die of kidney failure or chronic kidney disease or they can die of congestive heart failure in that six month wait while they're waiting to get into a specialist. So we're really expected to know a lot. And then when you start to go through things like thyroid or hormone management, that's a lot. That's a lot of information to take on in addition to everything else and it almost should be a specialty in and of itself. Same thing with diabetes. You know we have diabetes specialists for a reason because there's new medications all the time, there's new research coming out all the time, and it's hard to stay on top of that when you're working 12 to 14 hours a day and you're 12 to 18 patients a day and you're doing nine physicals in a day, and then you also have to do your my chart messages and you have to do all of your labs and you have to get your callbacks and you have to do your prior authorizations. And it's a lot.
Krystle:It's a lot to take on and then to lay down at night and go. Did I do this? Did I do this? Did I do this? Did I contact that patient? I can't remember if I told my nurse to follow up, you know.
Krystle:And then I remember, very frankly, saying to my husband I said I shouldn't have to be medicated to do my job, I shouldn't have to be this anxious to do my job and I shouldn't be scared when I lay down Like I really want to spend another half hour with this person, but knowing that my next patient was already waiting, and then to be able to walk out of that room, have that emotional connection with that patient, feel that empathy, and then have to pretend like I'm walking into the next room being completely happy like nothing ever happened.
Krystle:Yeah, you know, and I've learned to take five minutes and to work through that. But it's an emotional strain too on medical professionals and I don't think that people understand the amount of emotional strain that we have. That comes with what we do. And I will say, even though in this transition of opening the DPC and becoming a business owner and doing something completely different, it's tiring, but it's a different type of tired, it's a different type of worry and it's almost freeing. Actually, I feel very free now and I feel a better connection with my patients, which I think is part of that freeing aspect where I don't have to worry about checking my phone constantly for my chart message, because I know my patient has my number and they can contact me anytime Right now.
Krystle:So and I feel like they almost don't contact sometimes because they're like oh, they're more respectful, they're more respectful of my time and they want me to have vacations and they want me to have time with my family. And it's really great because they see me as a another person, to not just their, their nurse practitioner.
Amanda:So that's what I like about DPC as well, is you build such a personal relationship that they become your friends and so they know when you're going on vacation and they ask how would that go? How'd your vacation go? You know, I went on a mission trip this summer to Ireland and my patients that knew about that were like how was Ireland Tell me all about it? I was just so excited to tell them how Ireland was.
Amanda:And so so yeah, that's one of the many benefits to DPC. But let's talk about your clinic. It's called Rural Authentic Wellness, and when did you open it? And then what kind of services do you provide there?
Krystle:Yeah so. So I actually started off with rural aesthetics that was my business name four years ago and I started doing aesthetics because I could do that without fringing on my job. So I did that for a couple of years. So we continue to have an aesthetics practice where we do all things aesthetics like neurotoxin and fillers and laser hair removal all that fun stuff but then the clinic. So I wanted to start my clinic last year in June and I realized that our location just wasn't big enough. I only had a three room place and my aesthetics practice was picking up. So we made the transition over and I changed my name to real authentic wellness about two months ago, so just got all that taken care of. So now we're part aesthetics and then we have heart clinic.
Krystle:We do a number of things. We actually have a lab in the back so not it's a Cleo wave lab, which is great for DPC because I don't have to go through all the rigs that you have with a big lab. So we actually do direct lab access to for people who aren't members. So that's a really nice benefit that we can give to our community. For people who have high deductible insurance plans, they can come in and do direct lab access. So we do that. We also offer a weight loss program and we also offer menopause hormone therapy and I feel like our menopause hormone therapy is really starting to pick up. I think women are going gosh. I don't have to be miserable and I don't have to feel this way all the time. That's, that's wonderful. You know, help me through this. So, yeah, I have two nurses that work with me, I have an esthetician who works on the aesthetic side and then I have an accounts manager who also works as my front desk right now, and then she'll help me with employers. So we're trying to just make sure all of our processes are in place.
Krystle:But we're seeing members. I think we have. I think we have like 12 members now because we just started in in June. So for that aspect, but it's been really great and it's really just about teaching people, because I think people don't know a lot about DPC. So so it's really wonderful. We have our own kids room, where I have this beautiful farm mural on the side and we have a rocking chair and it's super comfortable.
Krystle:We do DOT services as well. So I see drivers, they'll come in and we'll certify them. So really we do everything. That's a big question that we get in our community as well. You know, I'd love to see you, but there's no doctor there and I'm like, well, I'm a nurse practitioner and I've been in practice and so we can practice independently in the state of Minnesota, so we don't need a physician here and so teaching people that, or they say, well, well, what if I have to have an ingrown toenail removed? And I'm like that's me, I can do that too. What about a biopsy? I can do that, you know. So anything that you would have in a clinic we have here, with the exception of imaging.
Krystle:We don't have imaging, we don't have mammograms, so those are the big downfalls, which I think a lot of DPCs don't have them, but it's. It's really wonderful to be able to offer all of those services because it really hits people on both sides, on both aesthetics, but also and that's been really nice with the lab. When people come in for lab, we say, oh, do you know that we, we also see patients and we also, like, we can evaluate these labs if you're a member and we can see you in urgent care and we can do strep tests, because I don't think that people understand that. So that's, in a nutshell, that's what we do. So I like to say we do a little bit of everything, but we do a whole lot of everything too.
Amanda:So what is your goal for your patient load on the DPC side?
Krystle:Yeah, so. So on the DPC side for me, I think my patient load is going to be 250 patients is probably where I'm going to cap out. Initially I was going to have 500. But my aesthetics practice is so busy that it's hard for me to take on more than that. I do have another nurse practitioner that I'm kind of working with and she's doing some classes right now and so I'm hoping that she can help me out a little bit there. I'm transitioning some of my aesthetics patients over to my nurses because they can inject too. So it's just that transition.
Krystle:I just I love family medicine. If I could see all of them, I would. If I could just have the largest panel ever, you know, within reason, I think, when you get over, I mean, even if I do hire another nurse practitioner on full time, I think I would cap them out at 500. I think you're really, you know, to be able to give them the services that we are saying that we can give and seeing them in a timely manner. I definitely don't want it to be about money, and I think that that's where some DPCs thrive and I think that's where some DPCs falter is that they get so hung up on the idea of money and I've always told my husband I said, if we treat people well and if I do a good job, the money will come later and it's always, it's always ended up working out. And I think that that's where I say that we need to have a cap.
Krystle:You know, like, on our aspect, I think every DPC is different. I think the support staff looks different in a lot of DPCs and then also the scope of practice for a lot of people looks different. But I was at a, I was at the orchestra one time and I met a man who was the head of a hospital in Wisconsin and he asked me you know why I was there and whatever. And somehow he said oh, you know, I was the CEO of this company and he gave me the best advice. He said when you go to hire your next medical provider, don't hire somebody like you.
Krystle:And I kind of thought, but I'm awesome.
Amanda:Yeah, I know Right Like why not?
Krystle:Oh Gosh, if I could just find people that are just like me, I'd have the greatest clinic, yeah, yeah, and I kind of said that. I was like, really, I said, why not? And he said, because you provide something to your, but one out of six people won't like you, and so you have to have another person who's going to bring a different perspective and a different personality and a different connection with your patients. And it was like a light bulb went off in my head and I was like brilliant, that's brilliant. You know, I think you can teach a lot of people, a lot of things. But personality is really big for me, especially when I'm hiring all of my staff. I've known them prior and they're my people and they, they give me that positive energy and that positive vibe and then we can create a positive culture here.
Krystle:And I actually had one of my nurses who said she, when she first started, she started a couple of months ago she know, because you treat everybody just like they're your best friend, and I was like, well, that's, that's great. You know, because I want that, I want that connect my patients, I want them all like I care, because I do care, and I want to know what's going on with their life, and I think that's where we, as nurses, to like you know, nursing is is holistic not not to say that, you know, family physicians aren't holistic, right Right but I feel like we focus so much more on everything other than medicine, because that's where our niche was, you know, it was building that relationship with the patient when the physician left the room. And so I'm not saying you know it's a generalization, but I feel like that's where we're kind of different is bringing that aspect and really looking at things from a different aspect than what you normally would. It's not such scientific based, but more emotional based and mental health based.
Amanda:And yeah, body, mind and spirit.
Krystle:You nailed it. You nailed it. Yes, body, mind spirit, absolutely yeah. What EMR did you choose? So we chose to go with Atlas.
Krystle:I initially tried Hint and that was it was okay, but I ended up switching back over to Atlas within a month. So I feel really supported by them. I've met members prior to starting my DPC at different DPC summits and I really feel like they have that. The customer service is amazing, you know.
Krystle:So that was a big one for me and I actually got to talk to Keen Umber, who is the father of Josh, dr Josh Umber, and I love talking with him. He actually helped me through how to navigate getting out of the corporate world and how do I do this and legally, can I do this and what do I got to be worried about, or what I don't have to be worried about, and he was awesome, he was great. He was great to work with. So I chose to go with with Atlas and it's a learning curve. I think with anything it's a learning curve, no matter what EMR you choose. It's, it's not. It's not epic, you know where. I think a lot of people were so used to that in the corporate world. But but it's still it's, it's very good.
Amanda:Yeah, that's I just switched to Atlas MD, like two weeks ago, from clinical works, which, a clinical work was great for my insurance base. So when I switched from insurance base to DPC it, you know, eclinicalworks doesn't have anything within their system to manage memberships. I have a small dispensary in my office and I couldn't manage. You know the medications that I was giving out to the patients. So we did a test drive with Hint. We did a test drive with Atlas MD and I will tell you that I completely agree with you on the customer service.
Amanda:That is probably what was the number one key factor that made me switch, because I felt like I was talking to best friends that I didn't know I had over there in Kansas or wherever they are. But I mean I, every time I talk to anybody from Atlas, it's like they're just like my good old buddies, you know. Yeah, and I love the fact that, no matter what I'm trying to learn how to do, I can go to that chat button and they're always so happy to help. I never feel like, oh, it's you again.
Krystle:Yeah.
Amanda:No like, why don't you get this? You got to be the dumbest person. They never make me feel that way, but I feel that way when I'm like hi me again.
Krystle:Yeah, I actually think that too. Like there's times that I forget that I'm talking to a person and it's not a bot, and so I'll be like do you know how to do this? And they'll be like good morning.
Amanda:I know I that's happened to me too. Oh, so sorry.
Krystle:Yeah, so it's really good. It's really good, and even just inventory and managing all of it, I mean it is. It is definitely something that we have to work through, but it's it's really great.
Amanda:I have some aesthetics patients in my clinic as well. I did not enjoy doing fillers so I stopped doing that very early. So I literally just do Botox. I used to have an esthetician, but when she left I sold my Morpheus 8 machine and I decided I'm just going to give Botox to my existing patients. I'm not going to market it because I have 500 DPC patients and really they take my priority. So now I'll have a Botox patient every once in a while, but I don't. I don't know how to set them up in Atlas MD as a chart that doesn't look like my DPC. So that's the only thing that I that maybe. I just don't know.
Krystle:We use aesthetic record for the aesthetic side, so we them separate, because that also allows us to have before and afters. And then we actually do all of our appointments through a third party, because then my schedule doesn't get crazy because we're literally just walking across hallways.
Amanda:So we do have a separate.
Krystle:one Atlas is excuse me, aesthetic records actually pretty affordable less than $60. So it's not terrible on that aspect. Aesthetics is tough though I mean that I think a lot of people I've had gosh, I think I've had four FNs contact me and say you know, how did you do your, how did aesthetics work, or where did you go and what did you get into? And I've been doing it for four years now. So it's a learning curve, but I never bought into the reps, never bought into this. These are all the things that I can do. I remember when I started I started off with a little box and about to go back and I would do.
Krystle:I would do parties at people's houses and at the salons and and then slowly the practice just grew. But it's a lot to learn and everything is so expensive in aesthetics. Even just going to a conference, I spend anywhere between eight and $10,000 a year just on education, because it's a lot to learn and it's a lot of possible complications. And I don't know what it's like where you are, but in the state of Minnesota there's no governing board for aesthetics and it's terrifying. I really hope that. I really actually do hope that something comes down the line and we have some type of governing board. Because they're coming in and I'm I'm like what, what, what did? What did you have done what? Oh, okay, and so, and it's lack of training and I get it right.
Krystle:But I think a lot of people think that it's just easy money and it just comes in and it's like, oh no, there's a lot of overhead, there's a lot of training, there's, you know, there's a lot that goes into it.
Krystle:And when people see my place now, they're like, oh well, so this thriving business and everything is great, and I'm like I started off with a, with a box and a little folder case, so, and it's a lot of work. I was thankful because that was my bridge to get out of corporate. So I like to say it helped me bring my boat to my dock, but it was a lot of work. I feel very much that I was working two full time jobs for several years and now I it's another full-time job and like a job and a half, I think, with managing the clinic. But but I'm also fortunate that my husband helps with my accounting and you know I have a really good team and they're actually now saying Crystal, I can do that. Hey, you know, you know that I can do that Right. So it's delegating, because when you start off by yourself and then you slowly add on forget that you don't have to do everything all the time.
Amanda:Yeah, I think that's the hardest thing for a business owner is giving up all of the responsibilities and learning how to delegate and trusting that this new person will do it just as well as you were doing it, right.
Krystle:Right, but it also goes on that caveat of you know this other person can do it, but they might actually do it better, you know, because they're different, there's that and they do things differently. Yeah, and I feel like the more I've been able to hand over. We actually built our own website, so we had a website that was built with my coach I'll put a plug in here for her Susan Bavasato. I probably didn't say her last name right, but she was absolutely amazing with clear DPC. She was my code, helped me open up the DPC practice, and she was absolutely wonderful and we were able to build a website and it was. It was great. It just didn't fit the aesthetic that I really wanted, and so I was playing around with it one day and I was like I think I can build my own website, and then I thought, when am I going to do that though? So my nurse actually did it and she killed it. She did such a wonderful job and it's better than what I could have done.
Amanda:It is better than what I could have done. So this website your nurse did this yeah.
Krystle:Yeah, so if you go to our website, wwwraw R-A-W-D-P-Ccom, my nurse built it and I really dislike stock photos, but she picked really good ones. We just had a company come in, Lunar Media, and he came in and he did headshots for us and he did pictures of the building. So we're going to switch out all of our pictures with non-stock photos so, but she did such an amazing job and she did a really great job of teaching and you know, teach as best as you can, I think, through a website about what DPC is. I think I really think, in regards to teaching about DPC, there's nothing better than word of mouth and speaking about it, because it's hard to read and understand concepts. So she built that and, oh, I cannot say enough how good it is.
Krystle:Yeah, so that was my nurse Casey, and then my nurse Rachel.
Krystle:I mean, she's just like she's just my right hand person and she handled.
Krystle:She's like you know, we get prior auths coming in which we don't do insurance, but we still have to deal with prior auths, so I put prescriptions in for people who do have it, you know, and I'm like, do you know how to do this? And she's like, yeah, do them all the time and when I was looking into autoclave, she's like oh, I used to work at a surgery center, like a, we can do that. This is the autoclave you should get and these are the you know. And so they're really teaching me too, which is just so fun, because there's a lot that we don't know, and we don't know a lot of the stuff that the nurses do on the clinic side. I mean, I didn't realize how much and I used to joke when I was at corporate. I used to say do you want to talk to me? Or the person who knows refer to my nurse, Penny or Janessa, and say, hey, let's talk with them. So it's really important to have a good support staff.
Amanda:And when you're starting, how did you come up with the pricing for your DPC memberships?
Krystle:So that I actually, so Susan and I both kind of talked about that and came up with a good price. We wanted it to be affordable for the majority of patients. But also, I need to keep my lights on. I don't like to think that, you know, some people think of DPC as just concierge medicine, where you have really expensive costs and you're paying hundreds of dollars a month for the specialty care.
Krystle:I really wanted this to be something that was affordable to everybody, and I think that with aesthetics I learned that if you make something that's more affordable, you can reach more people, and that's really what we want to try and do.
Krystle:So that's kind of how we decided our membership, our membership pricing, and so it's $80 a month for an individual, $150 for a couple, $30 for a child, $40 for 19 to 25. And actually I've been talking to my esthetician because she's still on her parents insurance and she's the only child that's still on it and I said have you talked to your parents about the possibility of you going into health share and how much money that would save them? And she's like, oh, I should probably do that. But I think there's a lot of people who were in that age group, who have children who are college and they have no idea about DPC, or we have a college about 25 minutes away from us, and so I'd like to be able to offer that option to some of our college students who are coming from out of state. Maybe, you know, nothing around here is in their network, but for $40, they can. They can have unlimited visits and they can be seen.
Amanda:How are you marketing Because you said have about 12 patients. You've been advertising since June, so what are we actually started?
Krystle:Yeah, we just started advertising in July, so we opened in June. We told everybody that we were opening. Honestly, I talk to everyone, every single person. But also I try to recognize who's in that range of functionally uninsured Like, for example, our county workers they have and our teachers. Their insurance is not the greatest, especially if you have a family. So trying to find those people who are in that, in that realm, reaching out to small businesses, talking with small businesses, because a lot of them can't afford to give insurance to their patients and they can't afford to provide any type of health care. We're a very rural population. We actually are labeled as the corn capital of the world, self selfed. So we have a lot of farmers who have really high deductible insurances and they can't get the care that they need. Or I'm in a lot of cases out here here men just don't go to the doctor, which I think in general a lot of men don't go to the doctor unless their wives or girlfriends or something make appointments for them. So we're doing it that way. We have a booth at the fair.
Krystle:I did an open house, probably going to get on the radio at some point, but I wanted to make sure all my processes and everything was in place. First, a lot of people are talking about us, which is really great, like that's. I say, hey, whether they said something good or something bad, it's just talking. And so I just, I literally just talk, and talk, and talk, and talk, and everybody that I speak to is like, wow, and they think I came up with it right. They're like this is amazing that you came up with this. And I was like oh no, no, no, dpc has been around for a while, but even I didn't know about it. You know, it's not something that we're taught about in school. Oh hey, after you graduate, did you know? You can open up your own clinic after you know, got your hours in or whatever. So we're doing a lot of that. A lot of it is word of mouth. We try to do open houses.
Krystle:I have an event coming up. I have an exclusive event for my aesthetics practice on the 28th of this month, and then I have another event I'm doing we call it the menopause summit that I'm going to be doing in September. So I'll make a plug about DPC there as well. And then, when people come in for their menopause hormone therapy appointments, we discuss the benefits of membership and how we can help with that, and so that's been something that's really helpful.
Krystle:I just had a patient of mine who was from my old facility who she came in and she actually wrote a review on our Google review, which is it was wonderful. And she says I meet my deductible every year and I have great insurance, but nothing beats coming here and having time with her, and so it's not just about the finances, and I think that that's a hard thing to get across to people is like this is about our relationship and how we can guide you through all the phases of your life. So that's where we're at right now. My accounts manager. She does all of our marketing and so constantly doing posts on Instagram and Facebook, but just with my aesthetics practice, too, the biggest thing has been word of mouth, and I think a lot of DPCs are that way when people start to see the benefit of it it just spreads like wildfire.
Krystle:That's what we're doing at this time. That's awesome.
Amanda:Well, I wish you all the best. I hope that you get to that 250 clientele quickly.
Krystle:Yeah, I don't think it's gonna take very long. To be honest, I really think that it'll. It'll go by pretty quick and I think a lot of places have big populations. We're from a town, I'm from a town of 1200 people and so there's not a huge population. But you know, my dad had said he's like Do you think this is, you think this is gonna work, you're gonna be able to see enough people? And I said, dad, I just need one person and 249 of their friends. You know, like that's all, it is Right. And and I think that when you, when you break it down like that and you just trust the process, you know I just keep going back to. There's always something that I can fall back on, there's always something, but I never want to go back, never want to go back to that life of yeah me neither.
Amanda:I will never not have a DPC clinic. In fact, I am so impressed with how well the structure of DPC work, I was inspired to start a podcast to tell other nurse practitioners and as I'm sitting here talking to you, I'm in my mind thinking I need to go around to the universities that are teaching new nurse practitioner students and let them know that this is a thing, because I'm in an area where I'm the only DPC clinic. I live outside of Memphis and there are no DPC clinics in all the Memphis metropolitan area.
Amanda:There is a DPC clinic in Mississippi which is only about 30, 45 minutes but it's in a different state. So but other than her, there is nobody in West Tennessee until you get closer to Nashville that is doing DPC. So I was so thankful that my clinic had been open for 16 years and so when I switched over to DPC, it was a thriving clinic. I had two other nurse practitioners and we were all seeing, you know, 20, 25 patients every day, and so there was more than 5,000 patients active in our clientele, and so it took me two months to get 500 patients, because I had all those patients that had been. I had history with them.
Amanda:But because word is getting out about DPC, I think that there's so much more availability for other people to open up a clinic like this, and I want other nurse practitioners and students to know you are not stuck on the gerbil wheel where you got to graduate and then you got to go work for a doctor. Now I think it's a good idea certainly to go work for somebody first and to gain your confidence, because you have to have that hardship. So you do that. But then once you decide you want to be independent and you want to be an entrepreneur and open up your own place. I want these students and nurse practitioners to know there's an option. You're not stuck having to negotiate contracts with all these insurance companies because they're going to lowball you, especially if you are not joining a big huge group, right?
Krystle:I think that I completely agree with you on that. In Minnesota, we have to have 2080 hours working in a alongside a physician before they can sign off. Like I said, I was under, I was, I was working alongside the wizard for seven years, you know, and that time that I had at the clinic was invaluable. It was absolutely invaluable. Was it hard? Yes, but I can't build those relationships any other way, you know.
Krystle:And the fact that I could call some of my old colleagues and say, hey, you know, this is what's going on, can I just run this by you? Can I send you a picture of this rash? And and for some of them to still be able to say, yeah, like I can help you, or this is what I would do. Next, you need those sounding boards, because medicine is not just if this is this, then this is that it's. It's a big area of gray. And so building relationships with your colleagues and also just having that time and also learning all the nuances, right, you can't talk about what happens in a physical if you've never worked in a place that does physicals and bills a certain way, or if you don't understand coding and if you kind of have to know some of that stuff because it's still relevant, even in the DPC world. Even if you want to have HSA reimbursement for something, you need a code.
Amanda:And what does?
Krystle:that look like and we aren't taught that a lot in school, but I think a lot of people see that almost as like a sign of weakness and I think it's exactly the opposite. It almost kind of gives you that tough skin, but it also gives you that foundation of this is how you can practice medicine. But then it also allows you to see how each individual person practices. When with my, with my old physician that I worked with, he would often say you know, I hate how they call it family medicine. He goes it's family practice. He goes this is all practice. And he was very diligent about that and he said because you know, you could have one diagnosis and you have four different medical professionals who go about a different way of treating it, of diagnosing it and ongoing management of it. And so when you're working around multiple people, you're exposed to a lot of things. You're exposed to a lot of cases that maybe you wouldn't normally see. But if you, if you just get right out of school and you jump right in, there's nothing wrong with that, but just make sure that you have the support system that's around.
Krystle:I think when I was in school I remember the wizard was my last rotation and I remember doing two rotations prior to that, the same facility, and thinking man, I know my stuff, I'm doing good, I know my stuff. I remember coming into his rotation last and the last three months of my rotation. I remember thinking I know nothing, this man is brilliant. And here I thought you know, I thought I knew it or I thought I understood it. And I think in school they say your first year or your first three years, you're a novice, and then five years you're intermediate and then you become like an expert, around that like seven to 10 years. You know, and sometimes I still feel like I'm in that intermediate stage, like I'd like to say that I'm closer to that expert aspect. But but it's a lot of knowledge and it's a lot of information and learning those different perspectives. It's hard, it's hard to be in that environment, but I do believe that it's necessary and I do that. I'm happy that I'm independent, I'm happy that the state of Minnesota says that we can practice independent, but I very much do agree that we need to have those 2,080 hours in addition to our schooling.
Krystle:The only thing that I feel NPs don't get credit for is that we don't get credit for all the work that we did before we became an N. We don't get to talk about the five years of nursing or the nine months of clinical and all the different settings that we were in. So I feel like that's where we kind of get a disservice. I challenge a lot of NPs. I'm really looking forward to the NP summit but I feel like a lot of NPs don't work at the top of their scope or they've been limited from the, from the place where they work.
Krystle:I remember when we got bought out by corporate, we basically had our own independent practices and then when we got bought out by corporate, it was like well, you're an NP and so you can do referrals and you can do med refills, and I'm like whoa, the RNs can do that.
Krystle:I didn't go to school for three years, in addition to my four years of getting my bachelor's degree, in order to do med refills and to see patients that, excuse me, that you don't want to see. And so I think that we have to dive in. We have to know how to do biopsies. We have to know how to do casting. We have, you know. We have to know how to do joint injections. They're not hard, it's just understanding it and knowing how to do it, because otherwise I think they're going to keep putting us in this box of you can only do this much, where our scope is quite big, and same thing for RNs. Rns have quite a big scope. It's just that a lot of people don't allow them to work at the top of their scope, and that's really a disservice to our profession.
Amanda:What kind of conferences are your favorite ones to go to in regards to DPC and learning all the ins and outs?
Krystle:Yeah, so I've gone to the Hint Summit. That was probably my first one. I went to the DPC Summit here in Minneapolis this past year. That was really nice. I actually took a couple of extra courses for like Botox for migraines and ongoing migraine management and then joint injections and I felt like I was actually kind of teaching everybody else how to do it.
Krystle:I didn't get as much out of that, as much as I wanted. I really want to go to the Ishwish summit or their conference that they do. I think the AANP has a couple of really good ones. I'm really excited about the NP conference that we have coming up for our DPCs because I think that it's just going to give us so much more networking and being able to meet other people who are kind of in the realm and who are in the thick of it with us so we can all kind of join together. If we could get a summit together that's similar to Hint Summit or the DPC Summit, just to really to build that network, I'm looking forward to seeing you at the DPC Launchpad.
Amanda:That will be awesome, it'll be great.
Krystle:Anytime you want to talk again, I'm happy to do it. Maybe we can check in in a couple years when my practice is about as big as yours to do it.
Amanda:Maybe we can check in in a couple years when my practice is about as big as yours. Yeah, I'd love that.
Krystle:I would love that. Okay, well, you have a great day and I will hopefully see you in February.
Amanda:Yes, you will have a wonderful day. We'll see you, you too. Bye, bye. Thank you so much for joining us today on the DPCNP. We hope you found our conversation insightful and informational. If you enjoyed today's episode, please consider subscribing to our podcast so that you do not miss an update, and don't forget to leave us a review. Your feedback means the world to us and it helps others discover our show. We love hearing from our listeners. Feel free to connect on our social media, share your thoughts, your suggestions and even topic ideas for future episodes. As we wrap up today, we are so grateful that you chose to spend a part of your life with us. Until next time, take care. This is Amanda Price signing off. See you on the next episode. Thank you.