Dr. Tea  0:00  

Owners of a direct care practice are more likely to experience higher job satisfaction than the insurance based practice. And it's no wonder why direct care is independent of insurance. Patients pay the doctor directly for their expertise, the doctor gets full autonomy in how they care for patients and how they get paid. They have chosen this path with a love of medicine. This is The Direct Care Way. 

Dr. Tea  0:24  

By listening to this podcast, you may even start to believe that you too can have a successful direct care practice. Come listen with an open mind as I share my personal journey and how I pivoted from an insurance based practice to direct care right in the middle of the pandemic, and the valuable lessons along the way. This podcast may be the very thing you need to revitalize your medical practice. I'm your host, owner of a direct care podiatry practice Dr. Tea Nguyen.

Dr. Tea  0:52  

This episode, I'm talking with an OB-GYN who has a unique situation that might be relevant to you. She works as a hospitalist and also has her direct care practice. And we're going to talk about how she's making that direct care practice work. At the end of the recording, we had some small talk and she clarified how she was able to have the hospitalist position without a conflict in her private practice. And this is what she said. She said she specifically chose to work as a hospitalist doing inpatient care only. At that time, she was able to discuss with her contractor employers her ideas of opening the director of practice, and what that we're going to look like. So her direct care practice was very specific in serving people who are not pregnant. So there would not be any conflict between her employment situation. And as she says it wasn't like it was siphoning patients into her direct care practice. These were two very different populations that would not have a conflict for one or the other. 

Dr. Tea  1:52  

And what she did in her situation was talk with her employer, was very transparent about her plan and got the okay that it would not compromise her job. So she had that open conversation with her employer, transparent about her plan and made clear delineation about what that direct care practice was doing. In this situation, it seems like it was more educational and serving people who she was not taking care of in the hospital. And something to note, some situations of employment. Even if you're not actively working during work hours, in your employee situations, the work that you produce outside of your working hours, may still be considered part of that hospital contract property. So you have to be very mindful before you sign on any contract about what it means to generate money outside of your work hours, because there are clauses that say, whatever money you generate outside of your working hours, is the property of your employer. I know that sounds wild, I don't even know how that's legal, but it's going on. So just pay attention to that, make sure you comb through your contract and make room for an exit plan. Because what we do know is there's never a guarantee in your employment situation. So make sure you protect yourself from that. And without further ado, let's dive into our conversation today. 

Dr. Tea  3:11  

I have Dr. Basma Faris here with me today, she is an OB-GYN specialist. And we're gonna talk about how she started her direct care practice just like you said a year ago.

Dr. Faris  3:23  

And that's about it. Yeah,

Dr. Tea  3:25  

I love love. I love this honeymoon phase, because this is the pivoting moment in our careers where we realize we can do more. And I find that to be the most blissful phase in changing the trajectory for the next decade or two of our careers. So welcome, Dr. Faris.

Dr. Faris  3:44  

Thank you, thank you so much. Um, thank you for having me. Excited to be here and just talk a little bit about my background and experience coming to this place where I am in my in my career,

Dr. Tea  3:56  

Please do so tell me how you decided to jump into direct care where you were before you started? What was life like? And then why did you decide to pivot? 

Dr. Faris  4:07  

So I was working as a generalist OB-GYN for, you know, almost 10 years. And I think, as is the case for many people, a lot of things changed with the 2019 COVID pandemic, right. So I guess that's sort of maybe the start of the change in me and my trajectory. I have been doing my practice now my, my practice is a very niche practice in that it's geared solely for people with polycystic ovarian syndrome. And that's a very specific patient population. And but I sort of just had a realization in the pandemic when we had to switch to doing a lot of telemedicine which I absolutely hated for the purposes of general obstetrics and general gynecology, it really just, as you might imagine, doesn't make a whole lot of sense. But where it did really make sense was that I was able to connect even more so with my patients I was caring for with polycystic ovarian syndrome. So even when we went back to being mostly in person, again, I kept a small part of my schedule reserved for telemed, specifically for these patients. And just as I started to be dis, you know, just just satisfied, you know, for a couple of different reasons with where I was, in my practice, I felt, you know, this is something really that I would love to continue doing, and how can I continue doing this? And how can I hone in on it, and make it a better experience for my patients? How can I have more time, right, because I was limited before to these 15 minute time slots, which really weren't sufficient. So it was when I just started, like, you know, just paying attention and opening my ears and talking to different people and talking to, you know, just being open to the different possibilities I learned about the direct care model. I saw that there were so many innovations in electronic health records making, you know, there's so many affordable solutions now, that where I think maybe before it was a little bit more difficult, people were piecing things together, it was a lot more costly. And so you know, as I, as I just started exploring, I thought, well, this is really doable. This is something I could do and really hone in and use my special skill set to focus on this particular segment of the population that really isn't being served well. 

Dr. Tea  6:50  

So where did you learn about direct care? Was that through DPC? Were there other specialists doing what you wanted to do? What did that look like? 

Dr. Faris  6:58  

No, there weren't. And so yeah, I learned about it really through the direct primary care model, which I think that's why many of us that are in direct specialty care, right, took our cues from the direct primary care, people, those pioneers. And so that's where I first learned about it.

Dr. Tea  7:16  

Is there anyone else doing what you do now specializing in PCOS?

Dr. Faris  7:21  

There are a few startups. But, you know, as far as a solo practice, dedicated solely to PCOS? I don't think so.

Dr. Tea  7:34  

Do you think that hyper niching was difficult? Scary? Possible? What were your thoughts when you thought about, okay, that's the clientele I can serve? But will the numbers support me financially if those concerns come up? 

Dr. Faris  7:50  

Sure. And they still do, you know, they still do come up, I'm growing. I don't, you know, I do have another job that, you know, pays my bills. And so as I'm growing, I'm going to continue to do that. It is a large segment of the population, and how many of them I'm going to capture? I'm not entirely sure. But I'm trying, I'm trying my best to really just get, you know, you know, be known, get my name out there, get the word out there, that this type of practice is available? And, you know, yes, yes, that like niching down is scary, especially for an OB-GYN where we are really trained to do such a broad range of things. So, you know, deciding that that was something that I was really going to focus on certainly is a risk, but at the same time, it makes it easier, because then it just makes me be really clear in terms of what my goals are. And you know, what I'm passionate about. And so in some regards, it's more challenging, but in other regards, it's easier because it's genuine, because I'm really behind it.

Dr. Tea  9:02  

It sounds like it's easier because you love it. And it doesn't matter what it takes. You're gonna love it. Right? (Yeah) So that's, I think that's key and niching down, you have to do what you love. And then what did they say then it doesn't feel like work anymore. You're just doing what you love. Yeah. I want to know, how do people find you?

Dr. Faris  9:19  

Sure. People can find me through my website, if they want to see me as a patient. And that's the name of the company is PolyPrep, and the net that name comes from, I really sort of want this to be an educational experience. So it's the prep school for PCOS. So they can find me at Yes, it's pollyprepmd.com. And people can find me on social media. I'm on Instagram mostly. They can find me at either @drbasmafaris , @pollyprep. I use both accounts. And, you know, and and, you know, I have a blog on my website so people can read all about PCOS and my approach and perspectives that I, you know, that I take to, to help my patients.

Dr. Tea  9:19  

How do patients find you?

Dr. Faris  10:17  

Either through social media or from other physicians, colleagues, I just trying to reach out to people, as much as possible with podcasts. I've had a few patients reach out to me directly, because they've heard me on some of these podcasts. So I'm hoping you know, today that people are going to be able to find me because they listen to your podcast. 

Dr. Tea  10:36  

What is your marketing strategy? Do you have one? Or is it like spaghetti to the wall? To everything?

Dr. Faris  10:45  

Yeah, no, at this point, it kind of is spaghetti to the wall. And it's interesting, sometimes I think something's really not going to be that. Effective. And it turns out to be more effective. And, you know, I've done paid advertising that hasn't been as effective as I thought, I've done speaking engagements that have ended up being more effective than I thought. And so it's, yeah, it's a little bit of trial and error. Because I think we're different, we're kind of like, in a little bit of a different time right now, right? You know, we have this different model. And, you know, you have to sort of social media is changing all the time, and how you use social media and the best strategies for social media one month, it's this and the next month, it's that, so you're having to adapt and adjust. So, yeah, I'm doing a little bit of everything. I guess this is this. Yeah, the spaghetti to the wall analogy. 

Dr. Tea  11:39  

What do you think gives you the best return on your time, as far as marketing goes?

Dr. Faris  11:43  

I think it's a combination of just talking to people really. So those direct one on one interactions with other health care professionals. Referrals still really are important, because I think there is some of that, you know, that trust if a physician recommends me to their patient, there's that level of trust. So I think that's still really important. Which is old fashioned as it sounds? 

Dr. Tea  12:10  

Well, yeah. Because everyone's trying to do things on their couch on their phone, like, why are we getting out of our house out of our comfort zone to meet people? That's so strange. What I agree that's really important. Do you have a membership model fee for service, or combination? What does that look like?

Dr. Faris  12:27  

I have a fee for service model at the moment, but I am planning on launching a program this year, which is going to be a hybrid of individual and Shared medical appointments. And it will be sort of a larger package that includes a membership. So that's super intensive for people who really want to have community and have really high level instruction, in addition to medical care all all in one. And so I just opened up a waiting list for that. And when I have really basically enough of a, you know, a large enough number in the waiting list that will launch the first cohort, so that I'm really excited about 

Dr. Tea  13:17  

What do you mean by Shared medical treatment? And how do we talk about that in regards to HIPAA compliance and legal issues.

Dr. Faris  13:24  

So the Shared medical appointment model is something that is starting to be used more widely. Cleveland Clinic really is a pioneer, they use it in person and virtually in many of their clinics. It's a really great way to be able to provide people who have a common chronic medical condition with more health information, more health education, and also to have peer support at the same time. Yes, there are all those issues that you bring up about, you know, privacy and HIPAA. If you use a HIPAA compliant video conferencing platform, which now you know, I use an electronic health record called Healthie and that has a group visit capability built in that is HIPAA compliant. And as long as you have the correct, you know, privacy and all your disclaimers and all your paperwork in order, everybody has to sign their, you know, their HIPAA waivers and there, there's some agreements that they have to agree to by part, you know, by being a participant, then it can work really well. 

Dr. Faris  14:49  

So this is, you know, documented in the literature. This can be done, it can be billed for as a regular medical visit. So if you're a physician and that's something that you want to do, and you're concerned about, as long as you meet, you know, certain documentation requirements, you can fill it as a visit. But instead of spending, you know, a half an hour, for a follow up visit, you can spend an hour and a half, right, so you can do a ton of education. If you know the group is sort of well selected, and people feel comfortable, then they can lean on each other and get support, because they're building community in that way. And then you can also because we have so many different ways to communicate, now, you can do some same day asynchronous, private communication with each patient. So if there's something that they want to address, that they don't feel comfortable sharing in the group, they can contact you offline, and you could have a conversation that way, and then you can still document that as part of your care. So I think, you know, with all the innovations that we have now and communication, it really still facilitates this sort of group health model. And because I, you know, part of my training is in culinary medicine, you know, I'm hoping as part of these groups that will actually get into the kitchen, so I'll do some cooking demos. And that is a, you know, just a really great way of being able to share health and nutrition information. In a way that's just a little bit more fun than you coming to your you know, your brief follow up appointment.

Dr. Tea  16:35  

You know, what do you want to be at a doctor's office, but lots of people will want to be part of a community to socialize, to cook to break bread with when you envision this program? Did you think it was going to work?

Dr. Faris  16:52  

Um, yes. And I have to say I've been, I've had this vision for a really, really long time, I started my career as a registered dietician. So before I went to medical school, I worked for several years as a dietitian, and I worked in a Family Health Center, where we were doing this. This is going back, you know, 20 years, we were doing some group health care. So I was part of Centering Pregnancy, which is a group prenatal care model. And I would go to the sessions with the midwives and do some nutrition workshops. We had groups for diabetes, we had a big program for childhood obesity. So this is something that has been around and I think there was popularity around it, maybe it fell off and now there's a resurgence in the interest. And so I know it can work. And I think people just need to get comfortable with it. And once they're comfortable with it, they find that they like it even more than sort of their regular care model. So yes, I do believe that it's going to be successful. Because I know it can be

Dr. Tea  18:07  

What do you think is working for your direct care practice and what's not working? 

Dr. Faris  18:12  

You know, I tried some different tools. There's some digital products that I signed up to use, which I think may not fit my practice so well. So I was just, I just met with my accountant and, um, you know, just looking over my projected expenditures, and there certainly are, some are some things I'm going to, I think, cut out that just haven't panned out to be as helpful as I thought. So just as I go forward, I think just being a bit more thoughtful, you know, every time I want to add something, every time I want to add, like just another bell or a whistle, I want to really be thoughtful about how much it's going to cost me and what I'm going to get out of it. So I would say that's kind of the biggest, I think I maybe just overspent on some of those add ons that weren't necessary. But you know, you try things out and you see what works.

Dr. Tea  19:10  

So what is working?

Dr. Faris  19:13  

What is working? I mean, I think just the, you know, the practice that I've set up the timeframes, you know, every new patient I spend an hour with, they have access to me, they have direct messaging, and so they, you know, we can communicate after the fact. And it's nice that they have that they can and it doesn't feel burdensome to me because the number of patients is manageable. I used to hate it. You know, I was on Epic. I hated my epic in basket. I hated just the bombardment of it's like I felt like I was never done. But because of this model, and you know, the size of my patient panel is manageable, and because they have enough time with me face to face as it doesn't feel burdensome, even though I offer unlimited messaging with my patients, it really, it doesn't. It's not a hassle, I enjoy it, I enjoy being able to communicate with them, I feel like I really get to know them better. So I think that's really working.

Dr. Tea  20:20  

When you say patient panel, do you have a target? What does that look like in your practice compared to what it used to be in the insurance based practice?

Dr. Faris  20:29  

Sure. My goal really is for this to be a busy part time practice. So if I have, you know, like two full days of patients per day, and that includes the group visits, because the group visits take up, you know, take up a couple of hours, but that may be 10 patients at a time. That, you know, that would be perfect. 

Dr. Tea  20:57  

You know, when you said busy part time practice it just like glitter and rainbows and unicorns, you know, like, I think women entering medicine are going to find more reasons to stay in medicine, because now we're creating a lifestyle that works for us. Not designed by some crazy drug person who thought 80 hour work weeks were normal for a physician or surgeon. But I think women in general, and including men who want that flexibility, work-life balance are gonna find a lot of joy in direct care. Would you agree with that?

Dr. Faris  21:31  

I agree. I agree, I think it's it, the amount of control that I feel, I think is so really makes me happy. Because I think the lack of control is what made me so unhappy. I can scale up, I can scale back, I can, you know, really have flexibility in my schedule, in a way that I just know that many people in, especially in like, large corporate groups, large faculty practices really don't have. And I think that is what it's really like an intangible thing that I think maybe people don't even put their finger on until they get it back. They don't recognize what they don't have or how burdensome that is, until they actually gain some control back. I know, I didn't, I knew there were many reasons why I was unhappy. But I didn't, I couldn't pinpoint it exactly. Until I stepped out of it, and then created something where I have the control and the autonomy. And I think that is it. Like, I think that's something that we don't talk about enough? And how like the psychological impact of that. Yes, I agree. And I feel like people are gonna gain so much joy out of being able to have that control over their own life.

Dr. Tea  23:04  

Is there anything else you want to share with the listeners who are interested, maybe sitting on the border of maybe I should, maybe I shouldn't, what would you say to them?

Dr. Faris  23:13  

To just do it, I didn't know what I was, honestly, I really, I never wanted to be an entrepreneur. I never wanted to be a private practice owner. Never. Never, ever, ever. I had my father was an entrepreneur, it was kind of a dirty word for me, like I just, I, when I grew up, I wanted to be an employee. And I'm saying in all seriousness, seriousness, and if you have an inkling that this is something that you would like to try, just talk to people about how it doesn't have to be, some people go all in, right, some people go, they'll go all in, and that's incredible. That's their full time, they have dreams to grow a very large practice. And that's amazing. Also, I think maybe if I were doing things all over again, if I was starting from the beginning, you know, maybe I would have taken a different approach. But there's so many ways that you can be flexible. There's so many ways that you can design your life. You can make it as niche or as big as you want it to be. So just start talking to people and talk to people who are doing it. Talk to people who have a brick and mortar business, talk to people who have a telehealth business, and see what appeals to you and see what can fit your life. You can start your practice with a very large budget, you could start your practice with a smaller budget, and you can scale it to suit your needs. 

Dr. Faris  24:40  

There are so many people that are willing to help. I found so many just free resources. And I literally just made a checklist of all the things I needed to do to get from A to Z. And sometimes there were things that I hadn't thought of right or things that came up were little regulatory things that I didn't know about at the time, but I just checked under way, until one day, I realized, wow, I've checked off everything on my list. And now I can actually do it and I could open a business. So you don't need to, you don't need to spend the money on learning about it, you just need to get in touch with the right people. And, you know, make your and make your path forward and just like to be organized. So if I could do it while working full time as a OB-GYN, you know, then and on a on a small budget with very little, you know, I didn't go out and spend a lot of money on a different programs to teach me how to do it, because there's really so many people that are out there willing to help, and there's so many free resources out there, that you can do it too.

Dr. Tea  25:48  

What has been your biggest challenge in starting your practice, and sustaining it?

Dr. Faris  25:52  

Hmm. I mean, I think, with everything, marketing is always right, like finding the language that really resonates with people and how to communicate with that. I think that's been my biggest challenge. I think I'm finally hitting my stride and feeling more comfortable. That was very uncomfortable for me, that, that, that self promotion, and that selling part of it, getting and talking to people right now, I love doing podcasts, interviews, or any kind of interviews or lives or whatever, I used to hate that I used to hate the sound of my recorded voice. I used to hate seeing myself on video, I don't know, and I just, I just had to get over it.

Dr. Tea  26:39  

You hear you hear that? Just get over it. 

Dr. Faris  26:42  

Just gotta go. Do it. Right, like, just got to do it. Totally.

Dr. Tea  26:46  

And what has been your biggest joy with your direct care practice? 

Dr. Faris 26:51  

You know, seeing my old patients come back to me, the patients that I used to see in my practice, that are coming to me specifically for their PCOS care really has been a joy because I you know, to have that continuity and to, to know that they you know, they had such a good experience that they want to continue to work with me, that's really the greatest joy is to have people come back and I can see their wins. That means I'm doing something right.

Dr. Tea  27:19  

I love that. So we know how to contact you. You said through your IG, PollyPrep, which is a very cool business name, I want to make sure I squeeze that in there that that is a very, that's a brilliant name, of course. And you're doing blogs, and you're open to doing podcast interviews and the like. 

Dr. Faris 27:37  

I just hope you know, thank you so much for having this platform for all of us. If there is anybody out there that wants to connect us to talk about how to start or how to, you know, nice or who's interested in doing something niche, especially in women's health or related to nutrition. I just would love to pass along all the great knowledge that I've gotten from, you know, other people that have provided that.

Dr. Tea  28:07  

Awesome, thank you so much for your time. And thank you for listening, and we'll catch you next week. Take care everybody.

Dr. Tea  28:15  

Thank you so much for being here with me. If you enjoyed this episode and want to hear more, please like, share and subscribe so more people like you can have access to another way of practicing medicine, that direct care way. Let's connect find my info in the show notes and send me your questions. That might be the topic for future episodes. 

Dr. Tea  28:34  

And lastly, if you remember nothing else, remember this be the energy you want to attract. See you next time.