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  0:54  

Welcome back to the direct care podcast for specialists in today's episode, I sit down with a world renowned podiatrist and peripheral nerve expert, who made a bold move, he left the insurance base to grind, to reclaim his time, rediscover his other interest, and he's redefining what success in medicine looks like. We talk about why he walked away from the traditional model, how he built a life aligned with his values and what's possible when you carve out time and space for creativity outside of the clinic. If you've ever wondered what life could look like beyond patient charts and prior authorizations, this one's for you without further ado, welcome Dr. Stephen Barrett. So I've reached out to Dr. Barrett, because a couple years ago we talked about him leaving insurance, and I kind of wanted to get an update as to what life is looking like since then. So welcome to the podcast. 

Dr. Stephen Barrett  1:50  

Oh, thanks for having me Tea, I really appreciate the opportunity to talk to you and learn from you, and you know, so I think it'd be great conversation.

Dr. Tea  1:58  

First off, your podcast is mind blowing. So if you haven't had a chance to listen to Dr Bear's podcast, I'll put the information in the show notes. It is highly intellectually stimulating, and some of the accomplishments I wanted to share with others is that you are the inventor of the Endoscopic plantar fasciotomy. Is that true? (That's true.) Oh my gosh, making you the top 50 most influential podiatrist ever, and you're here with us, talking to us about your private practice journey. You also opened us neuropathy centers. So tell us a little bit about your neuropathy center. How that came about. 

Dr. Stephen Barrett  2:35  

Well, it wasn't I wish I could say we had this grandiose plan, and we're going to plan everything out. And you know, it would just go from there, but it's kind of like life. You can make plans, but then life happens. And so I was fortunate to cross paths with Dr. Dellon back in around 2000 and as you know, he's a very prolific peripheral nerve surgeon. He just retired from Hopkins about, I think, two years ago, Professor of plastic and neurosurgery and I don't know why I was so fortunate, but I I got hooked up with him and ended up helping him teach his lower extremity peripheral nerve surgery workshops. And so then all of the things that I learned from Dr. Dellon, combined with all of the stuff that we had before I went from basically what you'd call a general reconstructive podiatric surgical practice to strictly a peripheral nerve surgery practice. And we're, you know, at this time, probably 95% of what we do at the neuropathy centers is just nerves or neuropathy. There's occasionally, you know, we'll deal with things like heel pain and weird things, but they always have kind of a neural comeback to them, a little bit, so to speak. But so anyhow, I was fortunate enough to learn a lot of things from Dr. Dellon, and when I started going back to my quote, regular practice, it soon became, it just evolved. And the more you did peripheral nerve, the more peripheral nerve you did. It's kind of a weird thing, how that happens. But probably, I don't know, five or six years after I really started focusing on peripheral nerves, I learned very quickly that all of the nerve surgical procedures that we were able to deal with, we were able to do, you know, really amazing things. But there were all of these things that we still weren't hitting grand slam home runs on, and we were kind of struggling, you know, why would patient A and patient B have the same profiles, same condition, and A would do great, and B. Wouldn't. And so then that kind of forced us into looking at, you know, peripheral neuropathy from a more holistic view, and really trying to dial in. Well, what is this? What? What's going on with this patient? Why didn't this decompression get rid of all of her symptoms, or why was it only partially, you know, affected. And so then that kind of forced us into looking at these other things. And then after four or five years of that, then all of a sudden it's like, well, we need to really take a really, you know, dialed in approach to peripheral neuropathy, because nobody really wants to treat it, to be, to be honest with you, I mean, even my neurological colleagues, they, they'll say, yeah, we'll diagnose it, give them some, you know, Lyrica, and move on, because we don't want to deal with it. There's nothing you can do with it. And we found that we could do a lot with it, but we had to approach it from a different way. And so the practice evolved, I think, primarily because of two things, one our focus, and then the need, you know, there's, there's just a tremendous amount of suffering out there from peripheral nerve issues and neuropathy. And I hate the word neuropathy, because it really doesn't mean too much. I mean, as you know, neuro and apathy. I mean, something's wrong with the nerve that doesn't tell you, did you have your nerve cut or, you know, what is it, right? So, anyhow, that's kind of how it happened, but looking back on it, I was very blessed. Because, you know, you don't, how often do you get a mentor with somebody like Lee down, you know? I mean, it's pretty incredible. And, you know, I thank God, you know, for that. And you know, so that's kind of how it happened. I wish I could say, I wish I could say, when I was in my MBA program, I wrote a business plan, and that's how it happened. It didn't happen that way, 

Dr. Tea  6:54  

but, but then we all think it's supposed to happen that way, even though we have no evidence of it ever working out the way we planned it. 

Dr. Stephen Barrett  7:01  

Right, right? Yeah, I remember one of my professors in the MBA program, which was a great program at Texas Tech for physicians and dentists, and so it really focused on medical practices. But they said, you know, the greatest business plan that you create is good for about 10 minutes

Dr. Tea  7:22  

for a passing grade. 

Dr. Stephen Barrett  7:23  

Yeah, so anyhow, but yeah, so that's kind of the story of how I ended up in that space. So

Dr. Tea  7:31  

Let's move into your private practice. You had been practicing peripheral neuropathy, peripheral nerve repair, for decades, and then you came to a point where you realize insurance is just it just sucks. It's inhibitive, prohibitive. It's doing things that are not helping your practice. What were the struggles that you had with insurance in regards to trying to take care of patients, especially one where lots of people don't like to deal with this pathology. It's a difficult pathology. That's why people want to bounce it off and put it away, but you're seeing something on your end, because you do take care of these very complex patients. What happened there?

Dr. Stephen Barrett  8:10  

Yeah, so that's a great question. About five days from now, I can finish my answer, but there are two things that really led to my decision to just leave the insurance world. The first was that we could not provide the ultimate care for a patient inside the way insurance is constructed. Now they would, we would have a patient with a particular condition. They would need pre authorization. The pre authorization, they wouldn't agree with it, because they would say, well, that's not medically indicated, or that doesn't exist. Or, you know, some untrained person in a country that you know is not ours is telling you, sorry you can't take care of Mrs. Jones. What she has isn't, you know, it isn't meeting the criteria. So I think there's a lot of problems with that, and there was for me, because now, and this is happening to medicine all over the place, right where you are now, everybody talks about evidence based medicine really, it's, reimbursed based medicine. That's really what it comes down to, if there's not a CT, CPT code for it and ICD 10 or 11, or whatever it is. Now it doesn't exist. So the whole system has skewed everything away from optimal treatment and optimal care to cookie cutter algorithmic and let me tell you, folks with peripheral neuropathy, complex issues, they don't fit into algorithms really very well at all. And so that was one part of it, and then the other part of it was that the reimbursement was, well, there's three, three parts. Really, the reimbursement was just totally ridiculous. Okay, so you could spend hours on a. Complex nerve repair, and they would pay you virtually nothing, right? And, and then you would look at this and go, Wow, I spent all this time doing all this now I have to follow this patient up for all of this time. And, you know, they don't want to pay me anything for it. It's like the most screwed up thing that you can imagine, well, you you know, because you're, you know, in the belly of the beast with all of us, but you know, and then you would find yourself spending more time creating these grandiose EMR records so that you could get paid this paltry sum for where they were grossly underpaying you. And then one day, I remember, I got a letter from one of the insurance companies. I can't remember which one that said, and this was maybe two and a half years ago, maybe a little more than that. It's like. So that would have been 2022 or 2023 probably 2022 because I left insurance in 2023 but anyhow, long story short, they said, Hey, you owe us 1300 bucks because we overpaid you on five surgeries back in 2017, or something like that. And it's like that was the match that lit the fuse that said, I'm done with this whole thing. So I think that that kind of, you know, encapsulate, encapsulates my story, but I think that's also very indicative of what everybody else in the insurance world is experiencing right now and and this is leading to, in my mind, catastrophic future events, because the system that the providers are just not going to be able to continue to keep up With this type of ridiculous demand and still provide optimal care to the patient.

Dr. Tea  11:44  

We're the only industry where we provide a service and they can come back and reclaim what was paid to us. 

Dr. Stephen Barrett  11:50  

Right? What other industry had a set rate for a procedure, let's say, a bunionectomy for example, all right, in the early 90s, they would reimburse, generally speaking, maybe $17, $1,800 for a bunionectomy. And now some companies are paying $350 or or $500 for you know, what really is, you know, people don't think a bunionectomy is a complex surgery, but it's actually a very complex surgery, and it has a lot of hidden things that nobody thinks about when they they hear the word bunion, oh, I've got a bun. You know, it's a crooked dog. Well, it's, it's much more than that. But what other business could survive over 30 plus years on a reimbursement for their product or service that is 20% 30% of what it was in 1990 1993 salaries have gone up. Electricity's gone up, everything's gone up. And in that time, the dollar has deflated tremendously, right? So that, let's say that, for just math sake, the $2,000 they paid you for that procedure in 1991 in today's dollars, is probably $5,000 or whatever the inflation rate is. So I just don't see how this industry can continue the way it is. At some point it has to be changed. 

Dr. Tea  13:23  

You hit a nerve with me when you said bunionectomies paying hundreds of dollars. But some of those implants can cost the facility $5,000 plus. So even the implants that we use, the plates and the screws, they would not tolerate a less reimbursement. They also in that industry, know what inflation is, know the cost of R and D, and they're charging appropriately, but meanwhile, we the physicians at the malpractice taking care of the patient, we are valued less and less every single year. 

Dr. Stephen Barrett  13:55  

Yeah. Well, it pays much more to be the striker rep or one of the, you know, spinal hardware reps than it does to be the orthopedic surgeon in that same or without a doubt,

Dr. Tea  14:07  

yeah, we're not bitter, all right.

Dr. Stephen Barrett  14:10  

No, I've just, you know, I think, I think it's one of those things where, you know, people will ask me, where do you think direct care is going to go? And I think the answer is it's going to go positively, much more in the direction of direct care for a couple of reasons. One is physician sanity. You know? I mean, it's just an insane system the way it is right now, and people can't. You can only stay in the insane asylum for so long before you either just capitulate or you escape. But the second thing is, people are getting tired of being told after they've paid all these huge premiums. Sorry, that's not medically indicated, or we're not going to cover it at this facility. We'll cover it at another facility, or all of the myriad things that you hear about. The regular day to day, I just don't see how it doesn't grow, because I think there's a subset of our population that gets it and there. And you know this from your practice being direct pay. People will say, Man, you spent an hour with me. You went over everything. The experience I had was great. Well, they had to pay their office visit and maybe an ultrasound fee or whatever, but they actually got a real service. They weren't one of 70 patients that day that the other guy had to see in order to just make his overhead. 

Dr. Tea  15:34  

So you had talked about leaving insurance two years ago, but something else has changed in your practice. Tell me a little bit about that.

Dr. Stephen Barrett  15:42  

Well, I've enjoyed not being in the office a lot, so I really take kind of a concierge level, but I'm just at the point of life where I just really love doing other things. And you know, I still do a lot of teaching. We're doing some incredible medical clinical research right now, and I think that we'll have huge translational benefits. So why am I not seeing as many patients as I was before? I have more time now to actually think and enjoy life, and I think that I didn't, you know, I don't want to say that I didn't enjoy life, because I've been very blessed. I've enjoyed everything, but I didn't realize until I kind of shifted gears a little bit, how much stress there really is in trying to maintain everything and running on that treadmill and just dealing with the nonsense like, Well, I gotta call this lady for a peer review, and then you're on hold, or they don't get it on, and now, all of a sudden, you burned a half an hour of your time. Well, how much is that worth, right? And now, you know, they ask me for a peer review. It's like, No, I'm not insured. I'm talking to somebody else. It's not me, you know, so, no, I'm enjoying life much more.

Dr. Tea  17:04  

So you have your clinical practice, you've opted out of insurance, you're seeing fewer patients. How do patients get access to you?

Dr. Stephen Barrett  17:13  

I don't know. They just, they just find us. You know, we don't show up. They just do, I mean, you know, a few years back, we looked, and I think my practice, I think more than 80% were from out of state or out of country, right? And so they find, you know, articles that you've written on the internet, or, you know, their chat groups or whatever. But we don't really actively market at all. We just try to, you know, give them the best care when they come in. 

Dr. Tea  17:49  

So you are able to do that because of the crutch of your reputation. You've been doing this for decades. You teach, and you know, the first time I met you or saw you was at the A E n s conference, and my mind was just blown away. So Little did we learn about nerve sourcing and treatments? You know, we used to just cut things out and call it good, but now we know we don't have to cut things out. We can cut out the fibrosis and all the things. And I thought it was such an amazing experience to have as an early resident, learning about the different ways we can take care of people. And now you even introduce the idea of helping patients holistically. You know, we talk about functional medicine, and it just seems so feasible to leave insurance behind, to be able to, like you said, have the mental space to just think about how you want to run your practice or things you're interested in, and also offer patients a new perspective. Because that's where innovation really is, is having the brain space to escape the administrative work that we're so trapped in doing, day in and day out, right, and be able to just do things that we deeply love and enjoy. So you're kind of modeling what you can do in your life. As a physician, you can do direct care, a little bit here, teach a little bit there, innovate, continue to build on your reputation. What else is up your sleeves? What are you hiding from us? Where are you going,

Dr. Stephen Barrett  19:21  

Oh, I'm not hiding anything. We know, I think that there's so much out there. And you mentioned ANS, which is a great group, and I'd encourage all of your listeners to maybe take a look at it, because even if you don't dive into the the the nerve world full time hanging out at that meeting will raise your antenna to different things, and you'll when you get back, literally, the next day in clinic, after you've been to that meeting, you'll have a little bit of a different perspective, which empowers you now because and none of not everybody, has to be a. Peripheral nerve surgeon. There's still a tremendous amount of work that can be done, but if you're able to identify these problems, then you've got great power, and you can help a lot of people. One of the things that we're working on right now is a I don't know if you've heard about the Phoenix sign, which is we discovered that in 2017 where we could put in a small amount of lidocaine, two tenths of a cc under ultrasound guidance, which is next to nothing, and you would have somebody that had zero out of five motor strength, and they might get four out of five, or five out of five, just by getting a little bit more blood flow to that nerve, and so it was very diagnostic. Well, then we've gone to another level now where we can, I think, help even more people. And that is, you can do the same Phoenix sign with D 5w and you don't have to use ultrasound guidance. So you put D 5w and people are going, well, D 5w is sugar water. It's like, yeah, it is. But when a nerve is focally entrapped, its metabolism is impaired, and particularly with glucose, and by putting a little bit of glucose next to the nerve, in about three or four minutes, you see the same thing as the Phoenix sign. Now this is really powerful, because there are a lot of people that don't have an ultrasound, or don't have the ability to really get the training, or have the training to be safe around the nerve. This is strictly a subcutaneous situation, but here's an example for you. There's what 600,000 or more total knee arthroplasties are done every year in the United States, and they say that the incidence of common perineal nerve or common fibular nerve entrapment, depending on what you read like point seven to maybe three and a half percent, something like that. I can tell you, it's a lot more than that. And a lot of the orthopedic surgeons don't even realize because they know they really haven't hurt the nerve, but they don't realize that it doesn't take much traction on that nerve to cause a problem. And now you can, you know, do this very simple test, and it's very diagnostic, and it's also very prognostic, because if they have a positive Phoenix sign, they're 90% more of the more than 90% of the time. If you decompress that nerve just like a carpal tunnel in the hand, they're going to get a very positive benefit. Now, a lot of people run around with chronic pain after a total knee arthroplasty, and they're told, Well, they're not stretching enough, or they're, you know, it's a range of motion, their capsule scarred down, or whatever, you know. But the bottom line is, you can take all that nonsense out with just this simple infiltration, and you can, you've now isolated a peripheral nerve entrapment. So you know it's not coming from their back. Well, you look at their X rays and they have herniated L, 405, and s, l5 s1, or whatever. But no, this is where it's coming from, because they got that motor strength right? So we're, we're working on a big clinical study with about 10 clinicians throughout the world, Belgium, Australia, and hopefully we'll, we'll get that work published by the end of the year. But I think that's kind of the cool thing that I'm really excited about, because a lot of people are running around. In fact, I've got a neighbor coming over tomorrow, had a total knee done in July, and I guarantee you, I'll give her three cc's, A, d5, w9, ultrasound guided, and she'll have more range of motion. Her pain will be gone. It's like, This feels great. How long is it going to last? And then you tell them, 10 minutes, and it's like, well, but it's the diagnosis that it makes which is so important. So that's kind of the cool thing. And if I can very cool, if I can get that out, I will help more people by orders of magnitude than than I did in my 38-39 years of practice so far,

Dr. Tea  23:57  

absolutely. Oh, that's fascinating. Yes, using small amounts for a diagnostic test is incredibly powerful. So you have the mental space to think about this. It sounds like,

Dr. Stephen Barrett  24:10  

Yeah, well, that's the whole thing, right? I mean, and then, you know, circling back to direct care, right? What do people really want from a physician? What's the number one thing that they want, you first have to listen to them, right? And you're seeing 70 patients in a day. You can't listen. There's no time to listen. And so why do you get really positive reviews? Many times, it's not because of the treatment necessarily that you rendered, or the exotic diagnosis that you picked out, it's because they listen to me. I've never had before, you know, and it's that that's a very powerful thing. There's still, I believe there's still a lot of art, and there's still a lot of art in this, in. In addition to the science of medicine, because when you go to a physician, you want them to be able to to listen to you, and then, if you listen well enough, usually they tell you the problem.

Dr. Tea  25:11  

You're right. No, no one's ever written a Google review and said, Well, I went to a fellowship trained podiatrist. No one cares about the equipment I bought the number of certifications and papers I published, nobody really cares until you connect with them on a human level, 

Dr. Stephen Barrett  25:28  

Right and the other thing is, if you take that time with a patient and you listen to them, the next thing that emanates from that is, oh, this person actually cares about me, cares about my problem. That's a big part of medicine too, because there's a definite mind body connection there. I mean, it sounds pretty woo, woo and everything, but you know this from your own experience, if you go to a practitioner and they just kind of blow you off, they might have given you great medical advice, but it's jaded a little bit now because of the way that it was conveyed,

Dr. Tea  26:05  

absolutely, I don't think it's at all. It's exactly what the human body is. It's mind-body connected, right, right? If a patient wants to come to see you, they pay out of pocket, they do. And if they wanted to use their insurance, what would you do from there?

Dr. Stephen Barrett  26:23  

Well, we give them a bill, and then they can take that and submit it to their insurance company, and then that see, this is where physicians mess up, right? We lost control of our own industry, right? No other industries like that, right? It's managed by some third party, not by you. It's not a contract between you and the patient. It's a contract between the patient and the insurance company. But somehow we got wedged in between the two, and the insurance company always wants to demonize the provider, because that makes them look better, and so that the answer is, they will pay for the service, and then we will give them a super bill, and they can submit that, and then they can deal with the insurance company. But I didn't go to school to become, you know, a negotiator with insurance companies.

Dr. Tea  27:16  

And it's not really a negotiation. It's really unilateral. It's, you know, we overpaid you overpaid. You were going to take it back, 

Dr. Stephen Barrett  27:25  

right? Yeah, exactly, exactly. And then, you know, and then they'll do cute things with you, like, you know, they'll tell you something's covered, and you go and you do the service, and then all of a sudden, they decide it's not covered after the fact, what's that? That just, it's astounding. So that's why I think direct care will be the way of the future, because I just don't see, no, I think there's a lot of prevailing reasons why it's going to take some time. One is the these new grads are getting out with tremendous amounts of debt and have to pay their bills, you know. And it's, it's much different in the direct care world than in the, you know, okay, I'm going to go to this hospital, they're going to pay me $ 300,000 or $400,000 a year, and blah, blah, blah, I get that. But at some point in time, patients are going to revolt, and the physicians will will revolt, and more people will say, You know what? I want, good quality care. I'm going to pay for it. Look at, look at what's going on in internal medicine with concierge level, you know, I mean plastic surgery, they don't take insurance. You know, if you want new eyelids, you pay for that.

Dr. Tea  28:36  

Since you're an educator and a trailblazer of sorts, I don't think we can solve this problem.

Dr. Stephen Barrett  28:41  

I don't know. I think the only way to solve it is to just keep, you know, persistence, you know, just keep pounding your head against the wall and, you know, trying to render the best care that you possibly can. And I really think the public is starting to, they're starting to wake up a little bit and realize that, why am I paying all of this money and I have a $10,000 deductible that doesn't pay anything. Why? What? Why am I doing that? And I think that pay, you know, patients and people with hard stuff and complex, you know, complex pain issues. I think it's an easier sell than somebody that is maybe not in that space, because patients have, they've tried everything they're willing to, you know, whatever they have to do to get the next level of care. But I think really what it comes down to is you have to deliver optimal, outstanding care, and just like a restaurant, if you open up a restaurant and you serve mediocre food, you're not going to be in business for very long. And I think that that's really the secret, if you got to love the patients, you got to care for them, and you got to give them the proper amount of time, and then you're able to take your expertise and meld that in and. And I think you're going to see things that will be very well received from the consumer, because the consumer is really not that happy right now. I mean, think about it, you know? I mean, I don't know if you've had people tell you this, but I hear it all the time. It's like, yeah, I got this big deductible. What am, you know? How am I supposed to use up $10,000? I'm pretty healthy. I just need this one thing taken care of. 

Dr. Tea  30:25  

Yeah, well, luckily for me, patients come pre educated, so by the time they come to my door, they already know the system's messed up. So that's the luxury of a drug care practice, is I select for certain people, right? And so there's always the argument for, oh, she's being greedy. She's charging more than I ever could and whatever you know, they're projecting. Have you ever encountered that when you were talking with others about direct care?

Dr. Stephen Barrett  30:50  

Not really too much. I guess, you know, I never really opened up that discussion. But I think if you go just general human nature, if you're if you're outside a certain perspective, then you tend to want to demonize the other perspective without really looking at it, because the direct care person is, I mean, they may charge a little bit more, but factor in the quality and The time that you're spending with them, and it actually comes out to be equivalent, or maybe even less. You know, I have one of my direct care surgical patients who reached out to me today, and I took, took time to talk the situation over with him and I didn't charge him anything, because he's still on the global. I only operated on him a year and a half ago, right? That's my global. I want the patient to get better. 

Dr. Tea  31:48  

Well, wonderful. What advice do you have for I don't know, students, residents, physicians who are interested in direct care. Should they do it or should they not? What are the caveats? What are your lessons? 

Dr. Stephen Barrett  32:00  

Well, I think that the first thing is, you really have to try your absolute best. You know, you have to be able to deliver something that people are going to be, you know, happy to pay for, and they're not going to be happy to pay for things that, you know, if you're not listening to them, and you're not, you know, astute and do good work. I think that goes without saying. I think probably what I would recommend is, instead of just pulling the plug completely at one, one time, do it gradually. Maybe look at, you know, do a deep analysis on who's really paying you. There's always that 80/20 rule that comes up, you know, 20, you know, 20% of the people are paying 80% of the revenue. Well, why do you keep the other 80? Right? So maybe you start, you know, weeding that out, converting your practice over a period of time. But I think it can be done. I think some of it depends on the situation of the practitioner, where they're located, what their focus really is, you know, it's complex. I wished I had something that I could say, hey, this is, these are the three magic bullets. You do this and you'll be but I can't say that, because I honestly don't know, you know, but you would be more. I mean, you're this is really something that you focused on. I would say, What? What do you think about that? Because your expertise is much greater in this than mine. 

Dr. Tea  33:30  

That's very nice of me to say, I do think you're right about, you know, you make a plan, and sometimes it just doesn't follow through. You kind of just ride the wave and see what comes up. But financial security is always going to be number one. Whether it be marrying Rich is something that I joke about when I do lectures, I'm like, You got to marry rich. Have money somewhere, second income, whatever it takes to give you some stability. To make choices that don't come out of fear. You need to make some choices for the long term. So that's the first thing I always advise. And the second thing is to have a community that supports what you're doing, because too often we're asking for validation or advice from people who're not doing what we want to do. And guess what happens? They tell you they get back the opposite. They tell you to not do it, that you're crazy, that it's not worth it, you'll fail. And so just being around the right people is important, and you have to protect your mental bubble for that. The third thing is your mindset. You have to be in the right mindset to understand that this is a long journey. It's not a quick fix. I mean, a quick fix could be you implement a cash service and then you get people in for that, but long term, you're developing a brand. And so some people think that if you start your practice with insurance with the intention of opting out later on, it's actually a rebranding, you're actually doing the work twice over again, because now you're having to talk to a different type of demographic. You know, somebody who is frustrated with the system. I mean, there is so much to say. I wish I can help everybody and say, you know, if you just follow these three steps, you're golden, but the lesson is really in what your internal struggle is. And a lot of our internal struggles are unique to us, our fears, our mindset, our resources, and so that's kind of why I like working with the consultant or a coach one on one, because then we can dive a lot deeper to help people with where they're at,

Dr. Stephen Barrett  35:25  

Right, right? No, I totally agree with you and and I think you made a really great point, just like I made with, you know, complex pain and neuropathic patients is that there's no one algorithm that you can fit everybody into. And I think this is with direct care. I think it would be great if there was a little algorithm that it's like, all you got to do is this, this and this, and you'll be successful. But I just don't see that happening. I think it's one of those things where it's super individual.

Dr. Tea  35:52  

Well, I'm so grateful to have you here sharing your knowledge with us. It's such a blessing to be able to talk to you. You're one of the giants in podiatry and beyond neuropathy and to see you still in practice, enjoying what you're doing and teaching it really gives me the perspective of what could be. You know, I'm not trapped in one situation or another. You're kind of giving us the imprint of other possibilities. So I really am grateful for you for that. 

Dr. Stephen Barrett  36:19  

Well, thanks so much. I'm grateful for, for you all that are doing this and what you're leading in the direct care thing is, I think it's a very needed thing. I think it's very early in the curve. I think probably 30 years from now, you'll look back and go, Wow, that was the seed that I helped plant, and look at how it's grown now. But it's a struggle. You know? It's kind of like it's not an easy thing to get it, to get that little seedling into a full fruit bearing tree. It takes time.

Dr. Tea  36:48  

Yes, lots of watering, lots of oil, lots of sunlight, 

Dr. Stephen Barrett  36:53  

yeah, and hopefully not too many freezes and winds. You know,

Dr. Tea  36:58  

completely any last words or any questions I missed that you'd like to share with the listeners?

Dr. Stephen Barrett  37:03  

No, I think it's great that you're doing what you're doing, and you know it's anytime you can have a community of people that are interested and can share their expertise and give you a little nugget like, wow, I never thought about that. And then all of a sudden, you can take that and plant that and grow that, you know so but no thanks for having me on. I really appreciate it and love what you're doing. Keep doing it and don't give up.

Dr. Tea  37:35  

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 and take care, bye