Dr. Tea Nguyen (00:00.0)

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, 

Dr. Tea Nguyen (00:30.648)

who's looking to be free of the grind of insurance and your craving 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 Nguyen (00:54.138)

episode today I'm going to share your recordings that you sent to me through the speakpipe link and answer them so let's listen to the first question together. Hey Dr. Nguyen, I just wanted to ask you a quick question, obviously like I hear a lot of doctors say that they're afraid of transitioning to a cash pay modality because they're afraid that their patients won't pay. 

What is your opinion on this and how do you typically navigate this question with a lot of other providers that are looking to transition to a self-pay model? 

I feel I just had a few episodes on this about being afraid that the patients won't pay and my answer to that is They will. They will and they will find a way to pay for the things that they value. I've shared in the past that a patient of mine Doesn't come from a lot of money, but I recommended 

Dr. Tea Nguyen (01:47.83)

a non-steroidal injection for her pain. And I told her the price point and she said, that's a lot of money. I will find it. I will ask for more babysitting hours. The kids that I babysit for free, I'm going to ask my children to get this money together so that I can get this service. And that goes to show you that when people really value something, they will find ways to pay for it. Whether it be more babysitting hours, 

Dr. Tea Nguyen (02:16.91)

credit card payments or maybe other types of ways to get it paid. Care credit could be an option if you wanted to bring that into your practice where they can finance their medical care or surgical care. So yes, people don't want to pay, period. You'll hear it at the front desk. They complain about a copay. They don't even think you're worth $20 or $35 for the specialist, whatever it is. People will complain at 

Dr. Tea Nguyen (02:46.062)

any price point, whether it's $20 or $2,000. But what I found to be true is patients complain less the higher your price point is. There's a book about the psychology of money. Of course, it doesn't make sense, but it does work out to your favor. The higher your price point, the more desirable you become. And as specialists, I think we forget how much studying we had to do to 

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get to the place we are today. We take it for granted. We think the things that we do are easy and therefore easy needs to equate to affordable or cheaper, right? We know that's not true. If it took us 10 years to get here to be able to have a license to prescribe, to diagnose, to provide treatments and all the things, nice things cost money, period. And doctors who do one-on-one care, 

Dr. Tea Nguyen (03:43.874)

That is a nice thing to have. That is in some sense a luxury. Now, if people didn't want to go to a private practice, then they can go to the emergency room, the urgent care center, the academic institution, Places where they can take insurance and get that care. Now, do I recommend that as a first line? Of course not. But nice things cost money. Say it with me. Nice things cost money. 

Dr. Tea Nguyen (04:11.646)

I provide nice things. What are my nice things? I have a clean office. It's not cluttered. I provide patients with a lot of time and attention. I listen to them intently. I don't double book. I don't overbook their appointment. I respect their time. And if they pay for my time, they will get it. These are nice things. This is very hard to do with insurance. I know none of us intend on short-cutting our patients, but the reality is 

Dr. Tea Nguyen (04:41.676)

If we're not getting paid or compensated well for our time and our expertise, well then we continually work in a volume driven practice where we have to see lots of people to make money. And most people understand that if you go to a private practice, it just feels different compared to a bigger institution. And so we might as well meet the standard, meet the expectation of a private practice where it's a nicer place to be. 

Dr. Tea Nguyen (05:09.132)

It's a quieter place to be because we don't have to overbook. We don't have a room full of people just waiting in line, waiting past their appointment times, right? That's a luxury to be able to be seen on time. So if you believe that you have nice things to offer, then you should also believe that nice things cost money. And you should also believe that if patients want the nice thing, they will find a way to pay for it. 

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It's really not your responsibility to balance their checkbook, to know how they spend and what they prioritize. They might even drive nicer cars than us. They might be wearing watches and purses more expensive than ours. And that's fine. That's their prerogative. All we're here to do is to provide the expert level of service without rushing them out the door. We are going to take our time. 

Dr. Tea Nguyen (06:04.504)

to educate the patient to let them know that we are here listening intently to them. And there's a cost for all of that to get the treatment from us. So my solution to the problem where people won't pay is to find the people who will. The bigger your reach is, the more people you'll find who are desperately looking for you and they are willing to pay. Listen, the bar is really low. 

Dr. Tea Nguyen (06:35.054)

Patients make an appointment with the specialist that could be three months. That could be six months When they get to the doctor's waiting room, there are a bunch of other people there When they get to see the doctor the doctor spends all day staring at the computer Dismisses the patients in their stories Hands them off with a prescription that may or may not work tells them to make another appointment in the next six months so 

Dr. Tea Nguyen (07:04.628)

That's what we have in modern day medicine. We have people treated like cattle. They come in, they go out, they come in, they go out. It's all very transactional and people hate that. How do I know they hate that? Because they go online and they complain about how much they hate that. And then you'll see the testimonials from patients who see direct care doctors that say things like the doctor was very thorough. They gave me their attention. Yes. 

Dr. Tea Nguyen (07:32.29)

They didn't take my insurance, but they were totally worth the money. They solved my problem. Nobody else was able to give me the time or the diagnosis or the treatment that I was looking for. So believe that there are people out there who are desperately looking for your services. You just have to keep reaching out further and further out until people are sick of hearing about you until you become a household name until you over saturate your community. 

Dr. Tea Nguyen (08:02.262)

with your name and the thing that you do, the thing that you do really well. People will find the money for things that they value. That's all that there is to it. So if the people you have right now are unwilling to pay, find more people who will. They are out there. They are waiting for you. And if that information is not practical enough for you, then I highly recommend you shadowing one of your local doctors who don't take insurance and 

Dr. Tea Nguyen (08:30.702)

start asking them questions as to how it works for them in that community. Next question up. What are the most important products or instrumentation that I need to purchase for my brand new direct care podiatry practice? All right, podiatry back in the house. Welcome, welcome and congratulations. Listen, you don't need a lot. You really don't because the first few months of your opening are mostly consultations. 

Dr. Tea Nguyen (08:56.526)

at least in podiatry, and this is relevant for all specialties. As you're building your name, people are going to have questions. And so your initial consultation will kind of teach you or guide you as to what people are even calling you for. So the initial consultation oftentimes is, OK, my feet hurt. What can you do? You can educate them. And I would say the first biggest equipment to invest in for a podiatry practice is going to be the autoclave, because we do a lot of office procedures that need sterilization. 

Dr. Tea Nguyen (09:25.696)

And an autoclave can cost around $5,000 or so. I believe that's what I paid for seven years ago and it's still going pretty strong. You can definitely get them used or get a cheaper model, totally up to you. You can look for dental autoclaves which are a lot smaller if you don't need a bigger size one. So shop around, ask around, and you can save some money there. But it does last you a good long time. 

Dr. Tea Nguyen (09:50.86)

And I tend to buy new things because of the warranty. You just never know with equipment and so far across my fingers. The only thing I had to do with my autoclave was to change out the rubber ring which wore out eventually and I only had to do that once. If you really wanted to save money, don't buy anything. Just buy your bare essentials. You have your computer, your cell phone. That should be enough. Regarding supplies, we're talking about gloves, things to clean. 

Dr. Tea Nguyen (10:19.978)

you like exam chairs down with the exam chair, you can get that used as well, or you can get an aesthetic chair, which is a lot cheaper than the podiatry chairs. There's a lot of medical offices that sell equipment as well. Maybe they've sold out or they're closing down or whatever the situation is. You can certainly get it cheap for that. I had a friend who was a plastic surgeon and when he first started out, he had the manual chairs where you had to pump with your foot because he was 

Dr. Tea Nguyen (10:48.846)

pretty savvy in the beginning and to me personally, I don't think I would ever do that, but it's nice to have options. It's nice to know that you don't have to spend seven grand on a chair like I did. But again, that seven grand of a chair lasted me seven years and it's still going. you can always look around, shop around, see what other people are doing. And for me, I did buy an ultrasound, an x-ray unit. 

Dr. Tea Nguyen (11:17.922)

but I'm going to pause right there. I bought an x-ray unit, but then I sold it last year because a friend who has been in practice much longer than me says she never even had an x-ray unit. So I went out the gates buying all the things and I didn't have to. I could have waited. I could have built up my capital for that. So up to you if you really want an x-ray unit that can run around 20, 25 K for the lower end products. 

Dr. Tea Nguyen (11:47.116)

What I do now is I just write the prescription, but I also have a mini C-arm fluoroscopy in-house for my minimally invasive surgeries. So I felt like I didn't really need both. If I did, I would just write the prescription to a local imaging center and the patient can use their insurance for that if they wanted to, as long as they don't have a closed network HMO type of plan. And in that scenario, they may have to go back to their primary care doctor and advocate for themselves to say, 

Dr. Tea Nguyen (12:14.998)

I saw this other doctor, they recommended imaging. Can you write the order? You can send your notes to them. Sometimes this gets kind of funny. I try to send my notes out to one of these closed networks out here and they just send it right back. Anyway, teach your patients how to advocate for themselves because oftentimes these other offices are just too busy to stop doing what they do. And it would also be to your advantage to find a local imaging center that offers cash prices so that you're prepared and you can give them some info. 

Dr. Tea Nguyen (12:44.386)

You can go to greenimaging.net to find cash friendly centers. Oftentimes this company contracts with local imaging centers that can also provide some cash prices outside of the insurance rates. So you've got lots of options here. Other diagnostics like the ultrasound. I got the high end, of course, because why not? That was like 25 K, but you can get the handheld one, which I personally don't like because it's not clear enough for me. I don't. 

Dr. Tea Nguyen (13:12.886)

read ultrasounds very well, so I needed the high resolution one. But you can start around there or just borrow somebody's or again, write out for it. Ultrasounds are tricky because some facilities may have it, but they may not be really good at reading it. at your discretion, can just now treatment modalities. Laser therapy is always a nice cash flow option. It's a non-surgical treatment. You can sell those as packages if you like. And if you sell them as a package, you can 

Dr. Tea Nguyen (13:42.126)

finance the equipment and the low end you can get a $15,000 unit and I think the higher end is around $60,000 depending on what your needs are, the specs, the size, all that stuff. And as you know, inflation changes. So if my price point changes, like that's just how life goes. you know, inflation goes up, your prices need to go up too. And this needs to be part of a regular maintenance of your practice. 

Dr. Tea Nguyen (14:09.132)

I worked in a practice where their prices had not changed in the past 10 years, so they missed out on a lot of opportunities to financially grow. Don't let that be you though. Every time I hear a specialist say they're starting their direct care practice, it's like a direct care fairy earns their wings. So congratulations on where you're at. If you have more questions for me, I am just dying to hear from you. So use the speak pipe link down below to send me a voice memo. 

Dr. Tea Nguyen (14:37.354)

and I'll be here to answer all of your questions. Just know that if you're thinking of the question, many others are thinking it too. Thank you so much for submitting your questions. I hope that I was clear. Sometimes I get really excited answering a question that I forget to actually answer the question or I leave out some of the details, but nonetheless, utilize the link below, send me your questions. I'd love to hear from you and thank you for ensuring that this podcast... 

Dr. Tea Nguyen (15:04.0)

is not a forever monologue. I appreciate you so much. Take care for now. One last thing, if you took anything from this episode, whether it's a small dose of inspiration or even an aha moment, could you please share it with a friend or post it on LinkedIn? The direct care community depends on doctors like you because no one is coming to save us. So it's up to each and every one of us to keep the conversation going. 

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to a point where direct care becomes a normalized path for private practice and not some secret that we have to mine for. 

Thank you if you've already done so or if you've given this podcast a review, it really does mean a lot to me. Sending you peace and possibilities. I'll catch you next week. Take care.