Dr. Tea  0:01  

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  

When patients are tired of their seven minute visits with the doctor, where their questions feel rushed, the doctor seems disinterested, the answers are canned. Those patients are going to find options outside of insurance. That's just simply the truth, that is the way of life. People have access to the internet, they're going to be shopping around a lot. And it's not either people's fault, it's not the doctor's fault, it's not the patient's fault, it's the system. It's a messed up system. And on the flip side to that, the doctors who continue to take insurance, aka coupon rates, will not be able to sustain their private practice because reimbursements are going down and the cost of running a business is going up. It's not good math, and a lot of people think that in private practice, we have to deliver care to every single person who walks through. I mean, we kind of do right, but they also think that private practice has the same unlimited resources or tax advantages as academic training sites, and so they think they have to take insurance. The reality. The reality is you cannot do everything that you did in your academic training

Dr. Tea  2:08  

and help your private practice thrive by thinking you have an abundance of resources, by doing everything and anything that comes into your practice. That is how a lot of private practices struggle. They don't realize they do have limits, or they don't implement those limits. And for me, somebody who had academic training, I had three years of surgical training in the foot and ankle, and then I did an additional year in fellowship doing exclusively limb preservation, amputation preventions and so on. I took that energy with me into my private practice,

Dr. Tea  2:41  

and the reality was that it is not sustainable. We just don't have the resources to do all of that, and so we do have to be more careful with our time, because we do have limited resources, and we also get paid a lot less than bigger institutions.

Dr. Tea  2:58  

Those were the few things that I didn't know about until I came into private practice, so I hope that by sharing this with you, you're a little bit more prepared as to where you're gonna direct your private practice so that you can thrive and find success in medicine. So today, I'll be answering the most common question about the difference between concierge care and direct care, so that you can then decide for yourself, what makes the most sense for your specialty? And I want to acknowledge a common misconception, this is not just for the wealthy or the elite.

Dr. Tea  3:30  

I know some folks in the Midwest think that all Californians are wealthy, that we all live the Hollywood style. That's simply not true. I opened my practice in Bucha, and that is a farming town, and I live in Santa Cruz, which is about 40 minutes from the Bay Area Silicon Valley. And we just have working class folks, people who are in medicine, people who are teachers. We don't have a big industry here in Santa Cruz, so we're big on farming, education. And then I'm not on the side of tech. The tech folks live on the other side of the mountain here, California is big. We do not all we are not all wealthy. So just know that those who choose to leave insurance or start opting out of insurance, we are not seeking to care for only the wealthy you can. There are doctors who have a concierge practice who niche in high executive people who pay lots of money for this type of access. But that's not the majority of doctors that I talk to, and that's not for myself. I did find a doctor who was local to me, who posts on his website that he does offer executive level services, and I believe the last time I checked, it was $50,000 a year to have access to this doctor, and this doctor does proclaim to be available. 24/7,

Dr. Tea  4:47  

which I think is cool, if it works for you and you love that work, awesome. But the majority of us who are not utilizing insurance as our main source of revenue are really just here for our community, our everyday.

Dr. Tea  5:00  

People, at least I know that is for the people I interview on the podcast and for myself. So I don't have that niche where it's for the elites, the wealthy. They might be wealthy, I don't know, but I'm not targeting them. My service is more for the everyday working class who's just sick and tired of their insurance option and they want something else. So just regular people here in California, that is what I know best, and that's what I want to share with you. So the difference is with concierge care. Concierge care means that you bill insurance still, so you're still contracted, maybe with a few or one, and then you tack on a retainer fee, a membership fee, and those retainer annual fees may look like $1,000

Dr. Tea  5:43  

up to $5,000 and you heard it just shares a doctor who charges $50,000 for that access, and that's all it is. It's access to the doctor. The doctor is reserving their time, their mental space, for these select few who are willing to pay the price, and they continue to contract with insurance. So they just take whatever insurance rates that they agreed upon. And that's the concierge practice. This works well in certain specialties where you know you can't survive without taking insurance, and then you know you can't survive exclusively with insurance, so you tack on that membership fee. You might be wondering what the legalities of that are. And to be transparent, I don't have this kind of practice, but I do know other entities that do something like this, like MD VIP and that sort of conglomerate. You can check them out and see how they're making it work. They have deeper pockets. They have more lawyers. Me, it's just me as an attorney here, so I don't have this. I don't like treading the gray lines. I don't like thinking twice about delivering medical care. I want it to be clean, I want to give them the price and I want them to be financially prepared. That's the type of practice I have, which is direct care. So a direct care practice means either you do have a membership based type of practice where you charge a monthly fee, or they charge you as they need to see you in specialty practice, a lot of us are kind of blending the two, where if we do chronic care of some sort that needs long term care, then a membership type of model makes sense. Whereas some of us offer more episodic care, you only need to see me once or twice for an ankle sprain, for instance, and then you just pay for those visits,

Dr. Tea  7:31  

we can blend the two. So for me, I do have both, because I take care of a sub population that does need me long term so I offer them a kind of membership where, really it's more of a package type of deal, where I charge them less if they were to pay up front for this long term service, and then I still have, you know, pay as you go, pay for the initial consultation, pay for the follow up, and it's as needed. So direct care, none of us bill insurance, and I love that the hallmark of direct care is transparent pricing. So if you see a direct care doctor, you're going to know what you're going to pay, and there's no hidden fees. There's not going to be a bill months down the road that it wasn't paid for whatever you see online or whatever quote you were offered at your visit is going to be the price. Of course, with medicine, people aren't black and white, and so if there needs to be some attunement or changes in their plan of care, the prices change. That's really no big deal. But the point is, they will always know the ballpark of the cost of things. And the reality is insurance based practices. The reason why people don't know the price of things is because it's hidden, and when the price of things are hidden, it allows institutions to raise their prices. You can't compete when you don't know the price of things. And I believe in competition, and I believe in price transparency, and so if I want to go somewhere to get medical care, I want to know and be prepared for how much I need to save up in order to get the thing that I need from a doctor. Now you can have a direct care practice where you don't deal with any insurance or their regulations or their codings,

Dr. Tea  9:18  

and offer a concierge level type of care, high touch points. So it's more access, it's longer appointments, maybe additional perks like 24/7 communication. Now Asterix communication does not mean you have to be on call at three o'clock in the morning to refill medication. It means that they have your email access, maybe your cell phone or mobile number that you assign to your assistance to triage before it gets to you, or it might be that you want direct communication with your patients. It totally depends on what you want to offer, and that's the thing that's key here in private practice when you don't deal with insurance.

Dr. Tea  10:00  

There aren't a lot of rules. It's whatever rules you want to set. So I don't have a practice that is available 24/7 but they can email me 24/7 and I'll get back to them for non urgent issues. And patients know that they're pre educated to know what the limits are to my practice. Maybe only one time that I had a patient who was hospitalized and he demanded that I see him in the hospital, that I had to explain to him that's not what I can do, because I wasn't credentialed there anymore. And when you talk through things with your patients and you communicate with them, they will understand this is a human to human interaction when you have a direct care practice patients, for some reason, they seem to be more genuine or more willing to be understanding by having a direct relationship with the doctor, versus what I saw when I was taking insurance. People kind of treated me like a doormat. They kind of just walked all over me because they thought or assumed or had this entitlement that because they paid a lot of money to insurance, that they can treat me a certain way, but now they know they can't. So creating that healthy boundary so that you have a working relationship with your patient is very important, and you get to do that when you don't have the red tapes of insurance getting in the way between the two of you. You establish what's a working relationship, and you call it good. So the key differences with concierge care, you bill insurance, you tack on a membership fee for access. It's sometimes marketed to high income earners. Sometimes it's marketed to a high income earner. But in this day and age, what is a high income earner? I mean, that's kind of a rhetorical question. Here in California, you could be making $200,000 and still can't afford a house. That's an issue for another day. But you see what I mean, these numbers are relative. So the payment model in a concierge practice might be a viable option if you wanted to go into the legalities with an attorney at your state level and see what is allowed and what's prohibited in that type of hybrid. Or you can just make a clean cut and say, I don't want to deal with any insurance, and I really don't want to deal with attorneys. No offense to my attorney friends, of course, but you want to be straight about what you offer. You want to just tell them your price is your price. This is the value you offer. Maybe you have a membership type of setup, or maybe you say, you know, come as you need, you can totally decide, and all that these two models allow you to get less dependent on insurance, so you have fewer insurance hassles. You lower the cost of your overhead if you're a direct care practice, maybe in a hybrid. You can also lower your overhead too, if you're only dealing with one or two insurances and going through their 50 pages of restrictions and things. But in essence, if you can become less dependent on insurance, you're going to be better off in the long run. You're going to be able to see fewer patients. You're going to have your sanity back. You're going to have a lot of free time to do the stuff that you really have been putting off, and I think that's just a wonderful place to be, that you have total control in your practice, in your overhead costs and the income you want to make. You may have even heard of practices who say they're direct care, but they offer concierge level type of care. And I kind of like this direction, because I think most people, the general public, understand the word concierge. They know when they drive their car to valet, they're going to have concierge services take their luggage to their hotel room, and they're going to park their car so you don't have to worry about that hassle. I personally love that high touch point. And in direct care, the difference is we don't bill insurance and we still maintain that high level touch point, because that's the whole point, when you have fewer patients to take care of, you can focus on each one individually and give them a really personalized experience, and that brings so much more joy for both the patient and the doctor to be able to be attentive to one person at a time and solve their problem with the time that you need to solve it. Appointments are often 30 minutes, 60 minutes, 90 minutes in a direct care type of practice versus insurance, I think I was spending as low as a minute with the patient, pop my head in and out, and maybe 15 minutes that was kind of long I would be put behind if I did spend that much time in a high volume type of practice. But nonetheless, now that you know there are key differences with the two, you can decide what works best for you. So to put things into perspective. I transitioned out of insurance about three years ago, and so I was kind of in a hybrid period where I only took a few insurance, and if you had insurance that I didn't take, then it would be self pay.

Dr. Tea  14:56  

It still was a little bit messy, because I still had to maintain it. The upkeep of my insurance contracts. And I just hated all that. I hated coding. I hated the phone calls back and forth, the peer to peer review. I hated that patients saw me as an insurance provider and expected me to do all the heavy lifting and do unpaid or unbillable work. I really hated that I got paid so little, and I had to do extra work to get that money so that, for me, did not make any financial sense, and I lost a lot of peace with that. And so finally, one day, I decided to drop my last insurance. And it's been three years, I think, and it's been fabulous. I cannot even begin to express how wonderful it is to have control of my time and to have peace in my practice, and that's why I'm here to share it with you, so that you can see what's possible and avoid the things that didn't work for a lot of us, so that you can take that shortcut to building your dream practice direct care is really old school medicine before there was even insurance. That was exactly what medicine was. You had your neighborhood doctor go to people's homes. They took care of the patients. The patients had gratitude. They paid the doctor. Right? It was really beautiful, if you go back in time and read about what doctors used to do before there was insurance, and this year 2025 I'm claiming a more simple life. I hate things that are complicated. I think medicine is complicated enough. Why do we have to make access to medicine more complicated? It's just frustrating. This is not how I envision medicine to be. And so I stepped out of the matrix, they call it, and created a practice of my own that works for me, and I know you're going to be able to create a practice of your own, too, by being prepared for what's up ahead. So you can choose to have a concierge type of practice. I do advise that you get an attorney to make sure that your paperwork is in order so that you know when you have to bill insurance and when you can accept cash and prepare yourself by learning how to market yourself, how to provide value, how to find your ideal patients. All that is part of my course, which you can find on my website. But nonetheless, I hope you found some useful information as to why it's important to understand the difference in the words that you use, whether you want to call yourself a concierge practice. It has its implications. It assumes the public assumes that you take insurance, but you just charge that membership fee and direct care, which the public does not really know what that means. This is a new frontier. It's a new word because it's a new generation of people who are just fed up with insurance, and we have to educate people that direct care is where we don't bill insurance. And that word is not in our everyday vernacular just yet, but I know that it will be with our alliances. In both DPC alliances and DSC Alliance, we are making a concerted effort to help doctors know their options and be able to convey their value to their patients, so that they can have a thriving business without insurance dependency. Both models offer personalized care more attention, because they are decreasing their volume, decreasing the quantity of patients and increasing the quality of care that they deliver. Direct Care specifically is built around price transparency and independence from insurance regulations. If you've been frustrated with traditional healthcare, or you are serious about making the switch and you want me to work with you, to help you through, to guide you through your next step. Use the link down below to get connected. You can also find me on LinkedIn, and I would love the privilege to help you get to that next step. Thanks so much for being here. I'll check back with you next week. Take care.

Dr. Tea  18:58  

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 you.