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  

I'm of the generation where it was once exciting to get a letter in the mail that was personal and wasn't just junk mail, it's snail mail. I'm very, very sentimental, and so I have to gush over this recent letter I received from a doctor who writes, and I'm gonna paraphrase to get straight to the point, he says, I read your contribution to this article with great interest. I've been in practice for many decades, but the last three years, I've not been able to take any money at salary, and used much of my retirement to keep the practice going. He goes on to share, using the money to support his staff members, and he asked me how I was able to pull it off to leave insurance. He's looking to retire in the next two years. All right, let's just call him Doctor Anonymous. First of all, can I just say how much I appreciate personal letters? I just love connecting with people that way. And this was actually how I started my practice. I wrote, hand wrote letters to people, referral sources, new patients said, thanks for coming. Thanks for thinking of me. And often patients would say, you know, it's very rare to get handwritten letters anymore, so I really appreciate that. I appreciate that greatly. And doctors comment on that as well. 

Dr. Tea  2:16  

They said that was really nice of you, you know. And they remember that. So if you're looking to build your practice, your reputation, I recommend handwritten letters. However you decide to do it, it sticks. Trust me. Okay, so let's get into how I can help this doctor, or maybe you're in the same situation too. I think it's really important to point out the timeline the doctor mentions here that they are looking to retire in the next two years, so they don't know if they are going to be mentally prepared to do what I did in my practice, right? So through my lens, I started direct care early on, I pivoted out of it insurance quickly, maybe within the first two years of my practice, I was already thinking about leaving insurance, I was like, There's no way I can live the rest of my career this way, and so I'm able to have kind of the vision of a long term game. So I didn't go into my practice saying I've only got one to two years to do this. I mean, I tried in the beginning, and that was awful. Because the reality is, it takes time, and I can say that now, because looking back gives you a lot of clarity. In the beginning, I was pushing really hard, and when I pushed so hard and I didn't see any results, I felt defeated, like most people do, right? It's kind of like when you go to the gym and you expect to have a six pack after six years of not working out, having a baby and so on, right? It doesn't happen that way. Building a business takes time, and especially if you're going to pivot out of insurance

Dr. Tea  3:47  

into direct care, you're restarting your business plan. Because you know, when you start with your insurance practice, people came to you because there was a network. They just flowed into your practice, whereas with the direct care practice, you are proving to the world, to your community, why they gotta choose you and pay out of pocket. So you're learning how to communicate, you're learning how to market. You're learning new demographics, new psychographics, behaviors at which the people who are actively and proactively choosing to pay out of pocket. You're learning a lot along the way. With that in mind, I built my practice with the intention that I'm gonna do this for at least 20 years. I am in year six of 20, maybe more, but let's just kind of ball park that idea. But if you're somebody who is already thinking about leaving clinical practice in the next one to two years, you don't really have a lot of options, because you're not really giving it time and maturity to get to where you would really enjoy it. The first three to five years of building your business is always the hardest. It's developing your plan, and it's seeing it through. You can't do that if you're only going to limit yourself to one to two years. So that's it. Challenge now for this doctor, how would I make the recommendation as to what they can do next? Because it is insufferable to see a doctor who has been in practice for so many decades, my friends, my colleagues, and still not be able to pay themselves after all of what they've worked for, after all of the struggles, sacrifices, they continue to sacrifice. And that's not what business is. That should not be the way that should not be normalized. But unfortunately, if you run a business that takes insurance, insurance takes a cut, or they cut your payments, it will definitely affect your bottom line. 

Dr. Tea  5:40  

So back in the day, people said taking insurance is security, and this doctor is proving that it's not. He's not been able to take a salary. And I think that is just terrible. So what can you do from here? Well, let's take it a step back. When there's something that's not going right in your practice, you have to take inventory. You have to take an assessment, just like a patient, a patient may come to you with lots of problems, and you have to step back and say, Okay, what's really the problem? What is the area of focus? And you have to do the same thing with your practice. Where is money leaking out? Do you need a professional to do that assessment? Are you willing to invest in making sure that you get the right diagnosis for your practice? This is a business diagnosis now, so you've got to look at what you're billing, who your audience or your target audience is, your target clients, like, how do they find you? Are you actively marketing for them? What's going on there? Your billing codes. You have to stay up to date if you're taking insurance. So are you billing correctly or appropriately? Do you have a biller to help you with that? You know, we shouldn't really try to do everything in our business, even though most of us will persist, we will choose to do so anyway. But some of the stuff you gotta outsource, or you gotta figure out a more efficient way to do it, because you're gonna get burned out. You're not gonna make the money you need to make. And so find out where the leaky holes are and plug it up. You know, if it's an insurance issue, okay, let's talk about that. If your insurance reimbursements are going down, you gotta start actively thinking about either leaving it or accepting it, right? I'm gonna say, you don't have to accept it. I'm gonna say, increase your cash flow by selling non covered services and products. 

Dr. Tea  7:27  

This, these two things, is going to help you so much more. And if you already offer that, then I would say, focus more on it. Sometimes doctors trap themselves and say, I already do that. It's not enough. I'm not doing something that's not working, whatever right you've committed to not continuing to learn, and that's going to keep you stuck too. So if you already do it, do more of it, focus on it exclusively, or raise your prices, or find more people who can benefit from it. So for podiatry, the services I offer that are a non covered service include things like laser therapy for pain and Fungus Treatment, shockwave therapy for pain. There's orthobiologics or regenerative injections. We've got fat allograft injections for fat pet atrophy. I've got esthetic services like Carrie flex to improve the appearance of the nail, even though that's not a medical treatment, it's a service line that I offer a lot of. So start thinking about non covered services as an anchor point to build your practice around. That is the easiest way to do it, especially if you're just looking for a quick cash injection. So again, look for non covered services that you can start offering. It might be another investment into a new technology. It might be leasing that technology so that you ensure that you don't cripple yourself financially and just find that one patient per month to cover your expenses, to get used to selling stuff that insurance doesn't pay for. There's a lot of different ways to do it, and so you've got to put on your creative thinking hat and start problem solving, instead of burying your head in the sand saying, There's nothing I can do. I've tried everything. I've done it all. No, you've not tried everything, because if you tried everything, you wouldn't be in this situation. You've got to think a little bit differently to make this work. So if you're in a situation where you want to improve what the next one to two years in your practice is going to be financially, you got to think differently. And I told you exactly what you can do, increase non covered services, add products that you can sell. These can be physician dispensed only products, and you can find a lot of options. If you go to conferences, there's always a vendor who's got something to sell. You can test out the products, see what others are doing, use their experience to decide if you want to add those products into your practice, and then if you already do the two things I've shared here, then increase your prices. It's very simple, inflation has gone up. Our rent has gone up. Your staff needs more money, right? You need more money, so increase your prices. Like every other business industry, it's a normal practice. For some reason, it's not normal in medicine, which is wild, but I'm going to break that down. You can make this work. Focus on the services. Focus on having weird money conversations, telling them the thing that you want, I can help with. This is what it costs. This is the service. It's a conversation. It's a communication tool. We're giving patients options. You can let them decide on their own, or you can educate them to tell them why it's worth investing in. 

Dr. Tea  10:41  

Okay, now the next thing you need to be prepared for as you consider the next one to two years, whether you're choosing to opt out of insurance, leave clinical practice, or you want to continue on this path for many years to come, you got to work on your mindset. You got to work on changing your own mind, and sometimes that requires a professional to help you and to step in to see where those roadblocks are. This is you writing a news story. So you have to learn to stop relying on the things that you are already doing because it's not working, and you've proven it to yourself that it's not working. The human mind is so amazing. We often much prefer to do the thing that we know that we are comfortable with that gives us a predictable outcome over something that is new and unknown. This is why it's so hard to help patients who are non compliant, non adherent to our medical recommendation. It is uncomfortable. It is inconvenient to change. Humans really want to be comfortable. Our brain doesn't want to keep doing hard things. But if you want something different, you have to start thinking differently. Change is hard, change is inconvenient, but watching my friends and colleagues suffer when I know that they can improve their situation, but they are just so unwilling to take that chance is really unbearable. So how do you change? How do you actually not live a life that tortures you, right? Well, the first thing you can do is start doing uncomfortable things. 

Dr. Tea  12:26  

Get used to being uncomfortable. Get used to having really awkward money conversations. Get used to telling patients what they need to pay to get your service. So I talked about adding non covered services. Here's an example. If a patient comes to me and they are having pain in their foot, and they try other options, nothing's working, I would often say to them this, I have this laser therapy that has proven to work to improve your pain. Do you want to give it a try? It's very simple, right? So what I do is I give them the first treatment, which is about 10 minutes, and I say, if you feel better, then I would recommend doing this sequentially, because it's kind of like an antibiotic. You gotta do a bunch of them back to back in order to see improvement. It's cumulative. So I would give them a free treatment and say, Okay, if it makes you feel great, then you can purchase the package. This is the best way to get the treatment. If they get the treatment and they don't have a buy in, or they don't really feel like it's gonna work for them, that's okay too. I'm not trying to sell them something they don't want, but if they come to me for a pain problem, I have a tool that can help. And if they ask questions like, Is this covered by insurance? I say, No, it's not. Period. That's all there is to it. And if they start having conversations and say, Well, I want to go somewhere where they would take my insurance, and I'll educate them and say, laser is not a covered therapy anywhere, whether you go to somebody who takes your insurance or not, it's just not covered. And then they might say, okay, maybe I want a steroid injection instead. And then it's my opportunity to share with them. Well, steroid injections are temporary. Do you actually want to heal instead? Right? So that's the conversation I have with patients, over and over and over again. I'm giving them options, I'm educating them, and I'm telling them what it costs, and I sit with them when things start to get uncomfortable, when they say, Okay, that sounds like a lot of money. I stay uncommitted. I don't care what they choose. If they don't want to get better, that's their prerogative. If they do, I have that solution. I'm not one to say that this is the only way that you will experience a demise, you know, if you don't do it, no, I'm not that person. I'm the person who is in favor of advocating for patients and giving them choices and allowing them to choose, freely giving them that autonomy, and if they choose the wrong thing, despite me educating them as best as I could, I'm unattached. I do not take it. That rejection means anything about me. It's their choice. It's their money. I don't know what's happening in their personal life. I don't know what money struggles they have. And it's not for me to judge. They came to me to solve a problem. Here is the solution, and here's the price. That's really all there is to it. A lot of doctors really underestimate the value that they bring, even if they're not treating the patient right, an opinion is incredibly valuable. And if you don't believe me, speak to a lawyer and see how they run their businesses. If you want to talk to a lawyer, have conversations, review paperwork, you will get an invoice. You will be charged something right? Only in medicine are we asked to do more with less. We do so much for patients. We bend over backwards, we get underpaid, we sink our business because we've accepted that this was the only way that we need to take insurance, that we need to tolerate the circumstances around that lowered reimbursement, more paperwork and so on. So it's time to think a little bit differently, a lot differently. Actually, you gotta start convincing yourself you're gonna figure it out, that you will find a way to make it work. So whether you have the next two years to consider doing something different with your business, for the next 20 years, you can certainly choose to do something different right now, so that next year looks different, and then the following year continues to look different. 

Dr. Tea  16:27  

You have to actively make that intention every single day. And yes, it's uncomfortable, and yes, it's inconvenient, and that is what it takes. So where do you go learning about this stuff? Well, it's literally everywhere on the internet, at conferences, through colleagues who are already doing it. There are associations, organizations talking about direct care, even social media. You have to take the initiative to actively find it, and sometimes it might be as simple as calling a friend, a colleague, somebody in your community who is already practicing without insurance. They're probably in plain sight. You've probably already dealt with them in one way or another, and you start asking them. Say, Hey, I would love to know how you leave insurance? Do you want to grab coffee? Do you want to grab lunch? I would, I would like to know some things, and in exchange, I will pay you for your meal. Okay, so make sure you're generous with what you're asking for. The last thing you want to do is become the person you don't want to attract, somebody who's really cheap and somebody who's unwilling to pay for expert advice. 

Dr. Tea  17:32  

Now there's a little neuroscience magic trick that I'm going to help you with, and that is to say this out loud, I am ready to do something different. I am ready to take action. Send me a sign. Okay, so go ahead and look crazy. This is something that I say to myself all the time, every day, bedtime, morning, time in between, patient time. I am actively looking for ways to improve my business, to improve my life. And I will say that out loud, or I read it in a notebook, and you might even find that the answers are often in plain sight. It is an awareness that we're calling for when we become aware of a red car, for example, suddenly we can't stop noticing those red cars. This is what our crazy brains are capable of. It's bringing things into awareness. It's it's not actually magic. This is all neuroscience. So I'll share with you a story if you haven't heard it already. I did this thing when I was in podiatry school, many years ago, on a scrap piece of paper, I wrote down that I would own my practice at age 35 now, I had no intentions of opening my own practice. I was just listening to a practice management lecture during lunch time where we got free food, because that's what students do. And he said that. He said, write down what your dream is on a piece of paper. Look at it every day, repeat it to yourself, and that's how you get what you want. I only did like 1% of the things he said. I wrote it down on a piece of paper, I crumpled it up, and I called it a day. I was like, That was a fun exercise for this lunch period. And never looked back, never thought about it, until I was 35 years old, and I found myself very unhappy with my job, and that was also the same year that I had my daughter, which is kind of wild now that I think back. But why didn't I open my practice at age 40? I don't know. Somehow I managed, in my subconscious, to create that a reality, and I own my practice at age 35 okay, I didn't pay any attention to it whatsoever. But imagine if I did, imagine if I took initiative to be more aware of what I truly wanted. So it's wild. Don't try to use your logical brain in this. It won't work that way. So let go of the need to make sense of it. Don't intellectualize everything. This is not how it really works. And all of the successful people will always talk about the woo that they utilized for them to be in a space of delusion where that's all that they know, that they've created to be real in their mind first and then eventually became real in real life. It's really weird. It's crazy. I'm not even like that kind of person, but my freaking autoclave just turned on. So I apologize for the buzz in the background, but I just want to wrap it up. You got to be a little crazy. Okay, I'm telling you, people who are able to pull things off are very delulu. So learn from that. And you know, I hope you find a little bit of magic in your future. If you like this neuroscience stuff, I want you to check out the book called Mind Magic by Dr James Doty. I'll put that in the show notes for you to check out. You're gonna be blown away to make any of this work. Yeah, you gotta be a little bit crazy, is what I'm saying here. Okay, enjoy. I hope you find some magic in your day. Today, take care. I'll check in with you next time.

Dr. Tea  21:06  

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.