Dr. Tea  0:01  

Tea. Practicing medicine without insurance is possible. Imagine a private practice where you get to see your best patients every day, providing medical services you truly enjoy, all without the hassle of insurance. My name is Dr. Tea Nguyen, and I'm a recovering specialist who was completely burned out from insurance based medicine. I pivoted into direct care, where patients pay me directly for my medical services, and have never looked back. If you're a private practice owner or planning to become one who's looking to be free of the grind of insurance and you're craving it, simplicity, efficiency and connection with patients, you are in the right place. This podcast will help you map out your exit plan and uncover the mindset needed to thrive in today's economy. Welcome to The Direct Care Podcast for Specialists. 

Dr. Tea  0:53  

Today, I have Dr. Romeo Lucas, owner of New England Center for Pelvic Health, joining us today to talk about a historic care journey and some really cool topics that I don't think I've talked about before. Welcome, all right. 

Dr. Romeo Lucas  1:06  

Well, thank you so much. I feel welcome, thanks for having me. 

Dr. Tea  1:08  

Could you tell us a little bit about your background and how you got here?

Dr. Romeo Lucas  1:13  

Sure, so I am an OBGYN, I'm practicing in Maine. I'm kind of on a torturous sort of path as to how I got here. But in the end, I like to think that everything, kind of every little bit, contributed to where I am now to contribute to get me to where I am now. So I was initially a chiropractor. I did manual therapy practice in New Jersey for about a year and a half, but over time, I really just realized that wasn't as fulfilling for me, as I hoped it would be. So. After that, I went to medical school, went to Osteopathic medical school here in New England, in Maine, University of New England, college osteopathic medicine. After that, I did a year internship, and then I did an OBGYN residency. While doing my OBGYN residency, I just had a lot of encounters with patients that had pain. And it kind of became apparent to me that, you know, we're pretty good with, you know, addressing issues with pregnancy. You know, seeing through normal pregnancies and complicated pregnancies, problem pregnancies, so to speak. And then, you know, patients who are having bleeding or were added masses or lesions that needed to be removed. But I really felt like there was something lacking as far as patients who had pelvic pain. I started employing some of the osteopathic and chiropractic therapies that I had used previously to help patients who had pelvic and sacroiliac lower lumbar pain, and started finding out that a lot of these patients that had pelvic pain really had musculoskeletal issues, or neuromusculoskeletal issues. So I kind of started down that road. Spent several years as a generalist at OBGYN, but always with the focus and emphasis on pelvic pain and addressing pelvic pain syndromes, and eventually just kind of follow that in the multiple rabbit holes that that would lead me into, including endometriosis care and surgical care endometriosis. And, yeah, it eventually just got to the point where I said, Hey, listen, like this is what I'm really interested in doing, and I enjoy doing it, and I think that we really need it. So I in 2023 I opened up New England Center for Pelvic pain, which is my current clinic. And what I do is I evaluate and treat complicated pelvic pain syndromes and see what I could do to develop care plans and regimens for patients that address the multiple systems that live within the pelvis, to really come up with a personalized pain and dysfunction treatment regimen for patients, and meet them where they are and see if we can get them to a better place than where they've been.

Dr. Tea  3:48  

It's always exciting for me to talk to people who are fresh in opening their business. Is this the first time you've ran a business? 

Dr. Romeo Lucas  3:57  

Yes, it is.

Dr. Tea  3:59  

Tell me what that's like,

Dr. Romeo Lucas  4:00  

the gambit of emotions, it's trying, it's difficult, and like a lot of things that are trying and difficult, it's exceptionally rewarding when you get, I don't want to say, get it right, but when you get it right today than you were yesterday. Oh yeah. So every little win is worth it. But you know, I mean, there's a significant learning curve, and you know, I did a lot of leg work beforehand, trying to figure out, you know, what were the systems that I had to put in place, what were the things that I didn't know about? And, you know, for all of that, you know, maybe this is part of the hindsight. It's always 2020 but you know, there were so many things that I thought I knew that I didn't know, or that I thought I understood I didn't understand, and I really did not appreciate some of the the processes and some of the structures in place that I needed to navigate until I kind of came up against them, right? So I think, you know, sometimes it's the only. Way to do things is to actually do them. The way things to do, the way to do things better is, again, to just start doing it. And, you know, again, I did a lot of work beforehand to set myself up. But, you know, I think ultimately, you know, jumping in the water and swimming made me a better swimmer, right? So that's, that's the best thing that I think I've learned with, with being opening my own business, you know, having never been in that and and as we know, you know, I don't really think that we get, by and large, a good education in, you know, how to open a business, run a business, assess a business, we learn medicine. So learning how to have your own practices is, really is a trial by fire sort of type thing. And I'm still not perfect at it, but I'm certainly better today than I was yesterday. 

Dr. Tea  5:53  

So you didn't have to go and get an MBA to start your direct care practice?

Dr. Romeo Lucas  5:58  

No, no, I didn't. And I think that's one of the things that I tell people who are considering it, or if they're not considering what they're like, how do you do it? Is like, Hey, listen, you know, by virtue of the fact that we are physicians, you know, we're scientists, we have analytical processes, you know, we possess the, the capacity and the know how to get to a better place, with regard to, you know, running a business or acquiring the on the job training. Of course, it's, you know, it's more difficult. It's easier if you have a little bit of a safety net or a backdrop with which you could do that, that you're going to have some financial stability. But it's not beyond us. It is not something that's, you know, this intangible, that's only for people who have a degree in that. No, I don't have a degree in this, but I have a degree in medicine. And my analytical, you know, critical thinking skills that allow me to be a good doctor are exactly the same things that give me the the capacity to be able to do what I'm doing. It's not some secret magic that you only get if you went and got a degree in it. It's, it's not, you know, I tell people a lot of times, hey, listen, if I can do it, you can do it. 

Dr. Tea  7:05  

What's the one thing you learned that might need to be taught in residency in schools to help you have a private practice? What's the one thing would you say to focus on,

Dr. Romeo Lucas  7:15  

sure, navigating, and this is a highly specific depending on the circumstance, but navigating the health care third party payer field, how does actual health care get paid for from third party payers? How do hospitals get paid? What is, you know, and by and large, because, of course, regionally, state to state, area to area, this is different, but the overall overreaching practices and law and or laws in place regarding healthcare reimbursement or just healthcare cost, You know, I think that's really, really, really important, because, yeah, that does that. That almost feels like it's a whole other separate degree. And it's you can pick it up, right? I mean, there's if you have trusted sources that you can get that information. There are places where you can get that information. But I think that we need to do a little bit better job of teaching our physicians that this is how things actually get paid for, instead of, like, you know, the way that it feels, and it certainly felt to me, which was like, Oh, this is underneath this box, and this is, this is information that's privy only to the people who are, you know, the people who are going into the business side of medicine. They handle the business side of medicine. You are clinical and that's it. I think those two need to meet each other, you know, at least to some degree, I don't think that we should, and I never want to posit that physicians have to become business men or women, but I think that you have to have at least some tangential understanding of what are the processes that are motivators, that are that are behind the scenes, with regard to where and how patients get or get care, and are able To get care and are permitted to get care according to what the financial burden is to them. Like, I think it's important us, for us to have at least some understanding of that. And the more understanding I feel, anyways, that that you have of that, the more that you become empowered to say, well, I'm going to take control of how I am able to deliver that care to my patients.

Dr. Tea  9:19  

 I like how you framed it because it's more about educating us and our patients as to how we're able to deliver medical care. And it is convoluted, and I don't think I knew that until I went into private practice myself, realizing that, oh, hospitals have to charge in order for their services to be paid for and to to maintain a viable business practice and also in private practices. Why we're diminishing is because reimbursements are declining. Expenses for things are going up, but the reimbursements aren't matching that. But at the other end of the spectrum, where is the money going? You know, through the pandemic, who made the most money? Insurance CEOs, right? And so we have to start questioning the system that we just automatically accepted and finding if that's going to be something that's aligned with our value, and if not, then here's another doorway, another pathway. And I really liked how you framed that. I wanted to talk a little bit about the logistics of your private practice. So you help people who have pelvic pain, but you also still contract with one insurance, and it's called Taro, which is a DPC and type of insurance. Can you elaborate what that means and how you came about finding that? 

Dr. Romeo Lucas  10:29  

Sure. So my wife is a DPC, and she's been practicing here since 2019 as a direct primary care physician. I found out about taro through her. And this is a novel insurance company that is a health insurance company. I should say that they're operating here in Maine, and I think they're in Oklahoma as well, if I'm not mistaken. And the idea is that, you know, it's, it's essentially creating a hybrid model for insurance, where you say, this is health insurance in so far as it's the coverage that is mandated under ACA, so you're buying an actual insurance plan that gives coverage, you know, in a broad, comprehensive way, as is dictated by law. And that's for imaging, for doctor's visits, for medication, it's health insurance, but included with the premium, the monthly premium that you would pay to have this health care coverage, you have direct primary care access that you pick. So you pick who your physician is going to be, you pick who your direct primary care physician is going to be, and taro will take a portion of what you pay on a month to month basis in your premium and make sure that your primary care physician receives that payment in accordance to what their charges are. We know that direct primary care is a superior model with regard to patient satisfaction and physician satisfaction. So this allows you to have a direct primary care that you don't have to have, you know, as a supplement to what you pay for your premium for your health care coverage. It basically marries those two ideas together. It gives you, you know, health insurance coverage, but also allows you to have a direct primary care. And again, it allows you to pick who it is. You know, I've always been a firm believer, but if you think that something is good, then you should. You know, my hope is that more people or more insurance companies come up with this idea, or develop and offer vehicles or plans that are similar to this, because I believe in a direct primary care I believe in a direct specialty care model. And for that reason, that's why I accept this insurance, because I think that this insurance is something that's novel and innovative, and I like to see more things go that way. So that's, you know, that's the insurance that I accept, and that's one of the reasons why I accept it. And I can say that the experience that I have had with Tarot, even after accepting them, is head and shoulders above and better than previous experiences that I've had with third party payers. So in that way, it's, you know, they we work well together. We have worked well together. And given their model of what they do, I'd like to see them be more successful.

Dr. Tea  13:13  

So when you're saying DPC, you're saying practices who offer primary care in a membership form, right, right? They're paying for that monthly whatever that monthly membership fee is within the scope of their primary care practice, correct, which is a little bit different from direct specialty care, right? Because a lot of our specialty colleagues don't have a monthly membership option so much. So does that offer an avenue for specialty care where maybe they're wanting to see a DSC doctor, uh, once or twice. Is that covered? Or does it have to be a membership based type of practice?

Dr. Romeo Lucas  13:47  

This would be, this would be for direct primary care. This isn't going, okay? Taro and again, like I there's only so much that I could speak for Taro. I don't work for them. I don't did their business, it is not exactly my business. I just want from what I understand but, but I can tell you with my you know, I'm in network with them. Okay? So we have negotiated like we would with any other health care. I'm sorry, with any other health insurance, you negotiate what your reimbursement is going to be, right? But you know, for anyone who's outside, who's direct specialty care, who accepts no insurance, well then you're going to be working with them the way that you would as any other out of network, being out of network, but their coverage is for specifically direct primary care. You know how that changes over time, and don't exactly know what their plans would be or how they would structure something like that, but for right now, it's purely direct primary care.

Dr. Tea  14:39  

Is it cheaper than what's out there, the Blue Shield, the anthems, the United, whatever. What's the price difference?

Dr. Romeo Lucas   14:48  

I now that's going to depend exactly on a person to person basis. I really can't tell you that, but I can tell you that you know, from what I have seen and the cost analysis. That I've seen, it's been comparable or cheaper than other third party payers that I've seen, at least here in Maine. I can't speak for anywhere else, but I can tell you that in Maine and in my county, I can tell you the cost analysis that I've done that, you know, inputting information, it's been cheaper compared to other options. So, you know, in that circumstance, it's been, yeah, impressive where it's like, Hey, listen, not only do you get full coverage, but you get, you know, this DPC option. And again, this also depends on, you know, plans are different within, you know, different third party payers will offer you different plans according to what deductibles are going to be, according to what what coverages are going to be, what their different, you know, silver, bronze and gold plans are going to be. But I can tell you that Taro, specifically, that I run a cost analysis, has been cheaper, if not comparable to other plants that offer the same amount of coverage or reasonably similar amount of coverage. 

Dr. Tea  15:58  

I like the idea that you choose your doctor and then you just get reimbursed for it. That's very much like a Health Share Plan, which is new to me, because when I went to practice, I just thought it was just going to be the big box Corporation insurance that you just go to what they provided you, you get a list, you pick your primary doctor, and that's all there was to it. But when I was introduced to Health Share programs, where it's usually like a religious ministry, and there are non religious ministries where they funnel the money and you get the benefit of choosing whoever, and they just, you just reimburse, you get the reimbursement stuff. So that makes a lot of sense for what I see is happening with this company, and I don't know anything about this company either. I'm not advocating for it and sharing information about what works for you. So that's great. Has that been an opportunity for new leads, new patients in your practice?

Dr. Romeo Lucas  16:48  

Yes, it has. It's been an opportunity for new patients, patients who are coming through from other direct primary care physicians who are in the area, and patients that have that insurance, and therefore, hey, listen, I want to go to someone who has my insurance, you know. So in that, in that respect, it has been, it has been helpful, as far as you know, patients coming through and utilizing services here.

Dr. Tea  17:13  

What do you love about your practice right now?

Dr. Romeo Lucas  17:15  

There's so much. I mean, where do I start? The autonomy. I That's the one thing, right? I mean, I'm I'm able to call my time, you know, as far as how long I'm here, what I'm able to do, how much I want to do, when I want to do it. And that's not to say that it's like I don't have to work as much, no. But that is, it's to say that. But also the thing of, if a patient contacts me and says, Hey, listen, I need to be seen. And it's in a day that I typically don't come in, I can come in and say, like, No, listen, I want to see you. Like, I want to make sure that you're okay, you know. So, yeah. So there's the autonomy as far as my time, the autonomy as far as what services I provide, the I really enjoy these this problem. I really enjoy this puzzle, and it's difficult, you know. And a lot of people told me, you're like, you're doing what? I'm like, Yeah, I'm opening clinic dedicated pelvic pain. Like, good luck, you know. It's like, Hey, listen. I was like, kind of feel like that's not just, you know, good luck business wise. I kind of feel like that's, you know, some people told me flat out, like, yeah, no, but I don't want to see those patients. I was like, yeah, exactly. Which is why we need a place where they can be seen. So I really love that I'm doing this work, specifically in this field, in this arena, in this region. And I mean not just the region of the country, but I mean this region of the body, which I think is a place that, you know, gets, you know, overlooked, or just, you know, kind of gas lit, you know, brushed aside for so many different reasons. So I love that I'm doing this work that I really feel needs to be done, you know, it is, you know, I really feel like it's a calling, and, yeah, so I'm kind of on a bit of a crusade here to kind of fix this problem. And I like that I'm engaged in that. What else great staff, you know, I yeah, there's so many reasons why I really love doing this, if I want to, if I want to bring in a new treatment, if I want to, you know, explore or go deeper into something, you know, a new therapy, a new modality. You know, the decision rests with me, you know. And I do a lot of due diligence, you know, a lot of due diligence in what I'm actually using and employing here. And I like that. I get to make that decision, right? And I don't have to go through, you know, a lot of bureaucracy. There is no bureaucracy. Listen, it's me, you know. And there are circumstances where that's good. But like, you know, I ultimately, decision rests with me, you know, from a from a medical standpoint, from a clinical standpoint, from a financial standpoint, you know, it rests with me, and I have resources and colleagues that are trusted colleagues and experts that I can go to, that I do, but at the end of the day, my clinic is run. By how I see fit, and that's really, really super rewarding. And I think that that's a big frustration. A lot of people that work within, you know, healthcare systems, they really feel that frustration, right? I mean, like they feel that, like I am not in charge. I think it's two things. Not only am I not in charge of my own destiny with regard to my time and what I do, but for all number one, but number two, for all of that that I gave up, I'm not actually really helping anybody, right? And that's that that contributes to the burnout. And, you know, having my own practice directly meets those two things and says, like, No, I'm in charge of what I'm doing, and I'm having a good outcome. And if I'm not, I am able to course correct and say to patients like, No, we're going to stay with it, you know, I'm going to, I'm going to stay on top of this until we get to a point where we say we are actually doing something, you know? And some patients say, Hey, listen, I'm not, we're not there yet. But you know what, at least, I feel like I'm being heard. And that's a difference. That's you are making a difference. I know I'm not feeling better yet, but to know that you're engaged in my care and in me getting to a better place already feels different and already feels like it's something that is better, that you're helping me. We're getting this was worth it.

Dr. Tea  21:15  

How do you price your procedures? How do you work with surgery? Are you doing surgery? Or is that something you're offloading? What does your practice look like?

Dr. Romeo Lucas  21:24  

Sure I am operating. I do surgery. There are two local hospitals that I have privileges and I do robotic surgery. My biggest, most common thing that I do, and we biggest, but for me, biggest, the most common surgery that I perform is robotic surgery for endometriosis, excision or, you know, addressing pelvic dysfunction, pelvic pain, in whatever capacity that that is right. So, you know, a lot of patients that come through, yeah, do have endometriosis or adenomyosis, which is a specific subset of endometriosis, and I treat those patients surgically insofar as it if it's appropriate, right? Or the other thing that I like is that that's not just the one thing that I do though, right? So I will offer patients modalities and therapies, medical and, or manual and, or alternative and, or, you know, supplementary, as far as you know, suppository therapy for COVID, fluor dysfunction. I am able to do that again here in the office, whatever I can do in the office. Otherwise, I'll do surgery, one of the two places that I have privileges. You know, we kind of work out with patients. You know what their third party re payer reimbursement is going to be. We help patients after the fact. And generally, what we do is we accept a deposit for surgery, and then we afterwards, we go through and we give them a super bill, and we say, Listen, the deposit that you gave is more than we did. So here's the front refund. You know, if the amount at the end of surgery ends up being more than a deposit, then we talk about the remaining balance and how exactly that's going to can and can get covered, and how it's going to get covered. And we kind of come to an agreement on how that's going to work. I try as best as I can to tell patients like, Hey, listen, you know, we're not going to, we're going to do everything we can to get you to to get the surgery that I feel is appropriate, or at least the treatment that I feel is appropriate, even if it's not surgery. We have different options that we have for patients to to get money for that, you know, to get that deposit covered. 

Dr. Romeo Lucas  23:34  

So, you know, and as far as, like, developing, you know, your fee schedule, like, well, that's that's highly individualized. And there's a lot of different ways that you could do that. You could do that. There are resources online that you can see what other facilities are charging for the same CPT codes in your area. That would be the first thing that I would recommend. You know. The other thing is, if you're opening a clinic and you're and especially if you're buying an existing private practice, they should already have a fee schedule, and at that circumstance that they can pass that on, because you always want to be careful about, you know, what do they call price fixing? You know, like we, what we can't do is get together as physicians and say, Hey, listen, this is what I'm charging. What are you charging? You know? And then basically base it off of that, unless someone places that information publicly right? So if you went to my website and I said, Here, look, here's my fee schedule, which some people will do, you know, to some circumstance or a full circumstance, you know, anything that's public knowledge is public knowledge. It's a different story. But otherwise, if you're developing your fee schedule, there are different resources that you can apply. And I can't think of the websites right now, but I know there are websites that you can say, Hey, listen, I'd like to compare this CPT code to every hospital that's nearby. What are they actually charging? Right? And then that's a good place to go to kind of start to gauge what you feel. And it's with good reason that there's not a universal number that everybody agrees to is going to be you. Reimbursed. I mean, you may feel that your services for a particular code may be superior, and that's why you feel as though you should be charging more, and as long as you're transparent with patients about what that is, and I do that as as best as I can, to be transparent with patients as to like, if you want to see my fee schedule, you can take a look. I'm not hiding anything, you know, it's that's, that's one way to go about, or several ways, I should say, to go about, you know, determining if you schedule what's appropriate to charge. Because, again, there's no one authoritative figure resource that you can go to and with, with good reason for the reason that I just said. 

Dr. Tea  25:32  

Isn't it funny that lawyers don't go through this at all. There is no average lawyer fee. I've had people quote me as low as $175, an hour to $15,000 a retainer. And so it just goes to show that medicine has a long way to go to provide transparent fees, which I think is unethical for not knowing. And you brought up a really valid point where we're not allowed to congregate or get together and price fix, which is a whole nother, like rule. I'm not really good with rules. I don't know if you know that, but I'm not. I don't like regulations. I don't like being told that that's all my value and you know, that's all there is to it. But no other industry has to face such scrutiny unless we're working with insurance, right?

Dr. Romeo Lucas  26:23  

Yeah, there are even rules that, if you're not working with insurance, that we have to do that, right? And it's, you know, I mean, yeah, I mean, like, there's really nothing stopping every mechanic in your town from getting together and saying, like, Listen, guys, what are we going to charge for an oil change? They can do that tomorrow, if they wanted to, and there would be nothing illegal about it. We do that. It's a problem. So, yeah, I understand the rules. I'm not wild about rules, but I understand the need for them. My problem is when the rules are not universally applied to everybody, you know. And it's the idea that you know. I mean, we can talk about the lawyer thing too, like, Hey, listen, lawyers can set whatever price they want. And truth be told, we can set whatever price we want. We are not held to the same standard when we, when we when the prices are what patients would consider your anybody else would consider right, and that's valid I'm not. I think that that's a fair debate or discussion to have. But you know, yeah, I mean, how exactly those fees are broken down is also something of note, right? I mean, nobody makes nobody really, nobody likes but everybody certainly understands that lawyers are going to charge, you know, by reading emails, and I spent 10 minutes reading an email, right? Or I spent 15 minutes on the phone, you break that down like you owe me. You owe me. We don't expect a physician, matter of fact, people, and there is a structure for charging for them. I just don't think a lot of physicians do, because we'd say, Hey, listen, you know, we're getting in touch with our patients. But at the end of the day, if you really think about it, like, well, you're paying for my expertise, you're paying for my time, you're paying for the knowledge that I'm giving you. But if I serve you with a bill and say, Hey, listen, we're 15 minutes on the phone, most patients are going to get really, really upset, you know? But again, there is a code for that, you know, there is a structure for doing that. But I just think that the zeitgeist, you know, the way the patients perceive that, is completely different. And we kind of expect the lawyer to do that, but if a doctor does it, it's kind of like I, you know, I think it meets with a little bit more blowback. I could be wrong here, but I just that that's my experience. So, yeah, so I understand rules, and I understand, like, common practices, but when they're not universally applied, then we basically say, Well, this is this is different. It's like, I kind of come back to be like, yeah, it is different. It's more important. So why aren't you valuing it as such? And we value the things that we pay for, and if things are so important, then you can't just expect them to be, you know, just given away for free, even though they kind of are thinking that there needs to be a little bit of changing of how we view these things.

Dr. Tea  28:42  

Yeah, it's because we've been hiding behind the veil of someone else paying us. And I think that's cyclical, right? If we don't tell people our billable rates, first of all, we're never taught that term billable rate. We do lots of stuff for free. So that's problematic on its own. And so these general doctors accept that, and then patients accept that. And then when we move away and we start having money conversations, it becomes awkward. Whereas everybody in other industries have normalized that we have been the only industry who has not normalized billable hours. 

Dr. Romeo Lucas  29:14  

I completely agree with you. I completely agree with you. I kind of feel that we've been trained to be like, Well, it's kind of distasteful for you to talk about money. It's making us small, yeah, and I'm very upfront with patients, probably too from like, listen, I hate to say this, but, like, I hate talking about money, because I'm kind of, like, you know, Pavlov's dog. Are we talking about money? Oh, my God, I have, like, this dirty feeling, you know, 

Dr. Tea  29:36  

but we just want to do the work, right? 

Dr. Romeo Lucas  29:39  

And you've been trained. And then also, you know, I think that, you know, I don't want to get into conspiracy theory issues here, but I kind of feel like the corporatization of medicine has kind of even further ingrained us with, like, don't talk about money. That's not cool, right? That's not for you. Let us handle it, you know. It's happy for you to do that, you know. And we get in. Rained in our heads that it's tacky for us to bring up money, but at the same time, hey, listen, these are things that we're doing. I can't expect to continue to do the work that I'm doing, unless I can keep the lights on, if I can't pay my staff, if I can't, you know, pay for my supplies, right? If I can't pay my rent. So then at that point, I do have to talk about money, you know. And I don't deal with insurance companies. You know, I just deal with the one that I do. But by and large, like I don't work with insurance companies for the purpose of things being more transparent, more straightforward, more understandable, and so that I'm getting appropriately reimbursed for my time, I think that you can understand that the care that I'm giving you is different in a lot of circumstances, better, according to the patients that tell me that are happy with what I'm doing, right, which is, thankfully, has been the majority of patients. So in that circumstance like, well, then if you value what I'm doing, then we do have to talk about money. I know it's not fun, but listen, this is just me being totally honest with you, and this is what things cost, and this is the reasonable idea. And you can compare that somewhere else. Patients at the end of the day find that reassuring. The more you have that conversation, the less of that tacky, uncomfortable feeling that you have, because this is just real world stuff, and there are rules that we have to abide by, but at the end of the day, we will abide by the rules as they are, some of which seem completely unfair, but we'll abide by them. But when we do have that conversation, patients, I think, get that and we become better at having that conversation. But yeah, rules need to be rules for everybody, not just for some people.

Dr. Tea  31:28  

I like what you said tacky. Where you say tacky, I say disempowering, and that's why we're in the situation we are today, right? 

Dr. Romeo Lucas  31:36  

It just takes something away, like we kind of shrink. We go from being like, Oh, listen, these health care heroes, quote, unquote, kind of a cheesy term, but whatever I but whatever, you know you're here, you're confident, you know, you're talking like, oh my god, I think I got figured out what your problem is, and this is what we're going to do. And you know, you're confident in your knowledge and what you can offer this person. And you are excited. And then we talk about money, and, yeah, we kind of shrink down, and we become small again, like, I'm so sorry, I'm so sorry. I have to talk about money. You know, then it flies in the face of the confidence we had two minutes before with the care that we're providing. Right?

Dr. Tea  32:08  

I think about this all day long, because I'm like, why are we so afraid to speak about money? Who taught us that? Why is it important? And it's the veil of not knowing the price of things that disempowered physicians from leaving the system. So now we just need to learn some of those skills. Like you said, it's learnable. It's nothing secretive to learn about business skills, right? And then we can move along and just get used to nice things that cost money. Good care costs money,

Dr. Romeo Lucas  32:34  

right? And also, you know, when we talk about people who are still in the system, like I've had this conversation with friends of mine who are physicians. And you know, whether it was my prices or prices of someone else, or like, can you believe that they're charging X amount of dollars for, you know, a routine procedure or routine visit? And I used to be like, oh, man, I would again. The cow would be like, Oh, I guess that's bad. I guess that's bad. Now my answer is this, yeah, okay, that's what they're charging. Let me put it to you, you work for such and such a hospital that's a mega corporation. How much do you charge? Oh, I don't know. Okay, well, then can you kind of see that it's a little bit, for lack of a different term, disingenuous for you to basically look down your nose and say, I can't believe independent providers charging X when you have no idea what you charge. Do you have any hospital charges? You know, charges a patient to see you, and how much money they collect up front, and how much they go and they've contracted with the insurance company like you have no idea. So, you know, I just don't think that that's really appropriate to say, I can't believe they're charging this than the other, if you don't know, because for all you know, you're where you work, might be actually charging more, but you don't know that, because you're kind of like, oh well, ignorance is bliss, and I'm under that love the way you said it, like the veil of somebody else pays for it that, you know, I think that you're a better physician. You're in a better position to your patient. When you have I don't get. You don't need to know every single insurance company what they cover, because it's impossible. But having a little bit better understanding of how these things are actually carried out, and what the the facility, the the corporation that you work for, and how they charge and what their billing practices are, or at least, what their what their billing fees are, it, then maybe you shouldn't really be making comments about what people are doing on a private basis.

Dr. Tea  34:23  

I love that. Just call them out and say, Well, why are you judging? First of all, we all went to the same, you know, we all have the same medical education. You just happen to not value what you do. So what does it matter what you charge?

Dr. Romeo Lucas  34:34  

You know, I want to, I don't want to start a fight with people, right? But at the same time, I don't want, I don't think it's fair for page, you know, for people to say, like, Oh, this is ridiculous. So like, in comparison to what you know, right? Like, okay, well then tell me when comparison to what. Because maybe you are right, you know, maybe you are right. Maybe that is an exorbitant amount of money to charge, right? Or maybe it's not like you really have no basis with which to, you know, you to compare that to. So, and I know you don't work hard, if you're happy working in the system, then stay that way. But you don't unless you really know. I'll tell you, that's one of the things that also for me, real quick. I'm so sorry, but, you know, kind of going along with this thing we're talking about, that was one of the things for me that was really, you know, a motivator, or eye opening, or whatever you want to say. That was kind of like, Wait a minute. I've been asking for years. Hey, what do you I was asking that question, what do you charge patients when they come to see me? If a patient comes in and says, I have no insurance, but I would like to see this person, how much is this going to cost me? I spent years asking, I have? I spent years with that email asking, Hey, what are you charging? And was I never got a response. And that really does, like, what are you trying to hide? You know? Why don't you want me to know that information? You know? And maybe one of the reasons why our colleagues who bring up the Hey, did you see such and such as charging this much money for their private clinic? Isn't that crazy? Well, you know what? They don't know because maybe they have been asking you, right? Or they haven't, because that's not common knowledge, because it's like, oh no, no, just be a good soldier and go back to seeing all the patients. Because, you know, you don't you care about your patients. Okay? You do care about your patients, then go back to work and be quiet.

Dr. Tea  36:12  

Well, I kind of, I compare pricing to purses. I don't know why people buy Birkins. No idea, no clue. And yet they're throwing down 35k like, it's nothing. And I'm just like, price is very subjective. We can't sit here and pretend that we can compare one surgeon to another price point by price point. One doctor from California from one in Ohio, right? The cost of living is different. Malpractice is different. How we got here is different. Some of us got one year training. Some of us got five year training. Like we cannot sit here and try to itemize medical care. We just can't. So everything is going to argue. So I would argue this is how I set up my prices. I would argue to just use your insurance rate as kind of an understanding of what is good, but you could price yourself. But the reality is, as a business, the price point is what makes you happy. It allows you to pay your bills with a little bit of cushion for you to reinvest in the business. So you're never going to be able to do price point by price point from one practice to another. And you don't want to, you don't want people to walk around saying, oh, that's the cheapest doctor. I'm going to go there, because then you're fighting for the bottom dollar. 

Dr. Romeo Lucas  37:25  

Those are all great points. I love your personality. You hit the nail on the head. I couldn't say it any better. I mean, medicine is regional. Life is regional, and everything is not everything else, you know, and at that point, you know, we allow people to let any other business set what their charges are. And you kind of say like, well, let the market make the decision. And again, we can do that. But I just don't think that there's as much, you know, judgment for people who are doing that for, you know, for mufflers and for purses and for cars, as there is for physicians, although, you know, who cares stakes are significantly, you know, higher, right? So

Dr. Tea  38:12  

I get it, and I appreciate you. Thanks so much. 

Dr. Romeo Lucas  38:17  

I appreciate I appreciate you what you're doing and what you're doing for your practice, and what you're doing for the rest of us, who are, you know, striking out into direct specialty care, you know, who are striking out into private, independent care, you know? I mean, there needs to be more voices like ours and and in more voices like yours, and you are giving us a platform. So thank you. You know, with this, with this podcast, with the DSC Alliance, honestly, this is great, and I'm so happy that I encountered you and Dr. Girnita  and and and Dr Grisel as well. I mean, Dr Kenney, I didn't hyphenate her name, but either way, I'm so super thankful for you guys. I'm thankful for your voices and for your efforts to get us out there and to help us meet each other. So thank you.

Dr. Tea  39:08  

I'm really grateful for you. Thank you for thanking me and us and thank you for being here. It really is collaborative. We can't do this ourselves. It doesn't make sense to do it ourselves. I'm glad you're here to share your story. I wanted to know what has been the most challenging thing in your practice that you'd like to share with the listener.

Dr. Romeo Lucas  39:25  

I think the most, the most challenging thing has been, oh, God, you know, I hate to be like this, but, you know, there hasn't been like one thing that's like, it's been more kind of like the little fires that you put out, you know? But I will, I will tell you an overreaching thing was knowing what I needed and what I didn't need, right, like within, and this is really simple and really pinpoint, probably maybe a little bit too focused, but knowing exactly what I needed to have here right when you're doing you. A new type of healthcare model, right? A new practice for something that doesn't exist very often. It's hard to understand exactly like, you know, what? What should my investment be? What do I need? What am I buying? Right? And I think in that respect, it is more universal, and it's this, what do I use my money in the beginning? And I think that the thing that I needed to learn was to start working first a little bit. And it feels like you're at sea without a raft or without a boat, or without food or at supplies. But I think, you know, ultimately, I think I've made a few purchases of equipment that, you know, ultimately, I didn't really need to do. And I kind of, I spent some money that I didn't need to spend, because I figured, like, Hey, listen, well, I guess I'm going to need this. I'm going to need that. I'm going to need the other, you know, and even some of them were devices and things that, you know, a run of the mill or general practicing OBGYN might need. But given the type of practice that I was doing, ultimately I didn't need it. So I think that that was, like, the hardest thing for me was to kind of really step into my own voice with regard to how I practice and what I do here and in that circumstance also being like, Okay, what based on what I'm actually doing, what do I actually need? That was kind of hard and took, it took a good year for me to really be like, Okay, listen, this is what I really need on a day to day basis, right? So, but again, it's the sort of thing like, you really don't learn how to swim unless you've been like, Okay, listen, I thought about it, and then ultimately you just gotta jump out there and do it. But you know, when, when you go, don't take everything with you in the water. Be out there for a little while and be like, Okay, listen, now that I've been here for a while, I really do need the raft. Or, like, you know, I don't need a raft. I just needed little floaties for my arms. I'd be okay, you know, or a little lifesaver. Or, you know, I mean, like, sorry, I probably took that analogy way too far. But I think that was one of the toughest things to kind of go through, and then in hindsight, it's kind of like, oh, man, that's I would have done that differently.

Dr. Tea  42:09  

That's awesome, because I've gone through the same thing, and I do the same over analyzing analogies myself. So you're speaking the same language. It's okay,

Dr. Romeo Lucas  42:19  

good, good fellow over analyzer, fellow

Dr. Tea  42:23  

guilty as traumatize

Dr. Romeo Lucas  42:25  

her, over analogizer. 

Dr. Tea  42:29  

Listen. There's going to be doctors listening, and they're on the fence, and they're like, do I do this? Do I not? What would you advise them?

Dr. Romeo Lucas  42:36  

I would advise them to absolutely do it. But you know, as best as possible, do a lot of research into what you're doing and where you're doing it. I would, I would have also given the advice of maintaining great relationships with your colleagues, with others with other physicians and other types of practices, you know. And really, before you leap, really have as best of a financial safety net as possible, you know, I had, I had this plan for years, years, you know. And I really spent, like in earnest, about a year and a half, really sitting down and putting pen to paper, with regard to numbers, with regard to what my marketing idea, what my target patients would be, you know, what would be different about my practice and why that would allow it to be successful and to survive? So, yeah, absolutely do it. You know, it's a big undertaking, but definitely look into it. And yeah, I do not look back for all the things that I think could have been done better, the mistakes that I made. I don't for a second regret having made this, this jump and made this decision into, you know, into providing care in this way. 

Dr. Tea  43:56  

Thank you so much for your time and for your insight. I really appreciate having you here today. 

Dr. Romeo Lucas  44:00  

You got it. Thank you so much for having me. I really appreciate it.

Dr. Tea  44:05  

If you enjoyed this episode, please give it a review and share it with a friend so more doctors can learn about direct care. Let's keep the conversation going on LinkedIn so we can help more doctors escape insurance and thrive in private practice. Thanks for listening. I'll talk with you next time take care. Bye.