Dr. Tea (00:01)

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.

If you're new here, welcome. If you've been listening for a while, I'm so grateful you're still here. Have you ever watched a movie over and over again simply because you love it and you find new bits of things that you hadn't noticed before? Today's episode is a good story. One that will highlight the benefits of direct care to both your future patients and to you as the owner of a successful direct care practice. I recently gave a lecture about direct care.

And a great question that came up was, well, what do you do about the people who can't pay for your services? And I had to pause and reflect in the answer because I wanted to be thoughtful. And here's the reality. If you want a profitable and purposeful practice, somebody needs to pay. Your business needs to have money, which is a tool to pay for your utility bills, to pay for your staff, to pay for your malpractice insurance, to pay your bills, right?

So with the business, you want to be able to fulfill the needs of your business first. And then when you have extra leftover, then you can pour that into your passion projects. But doing the opposite, which is what a lot of doctors do, is the thing that's keeping them stuck. They want to help, but they're not sure on how to make it profitable and sustainable. So unless you can funnel money somewhere somehow through donations, or you're selling services or products,

and a percentage of that goes towards the charitable organization. The common theme here is that you need money to run any kind of business, whether it's for-profit or a non-for-profit. In episode 181, I talked about the different ways you can continue to serve the underserved, and it goes into depth about the different ways you can do that. But the entire premise of a business is to ensure long-term viability through those profits. Otherwise,

You go bankrupt in time, in money, in energy, and then you can't really help anybody if the business no longer exists. So if you're going to choose to run a direct care practice, you need to make it very clear that you're running a for-profit organization. Now you can choose to run a nonprofit one, but by doing so, you still need to find money somewhere to pay for the necessities in running the business. Most of us do not have an unlimited amount of resources or even tax advantages to rent

A non-profit private practice. And so you have to carefully curate the type of practice that is sustainable, works for you, and fulfills your cup first. And therefore, you have to realize that you cannot serve everyone. In order for you to make money in your private practice, these three things have to exist. Number one, the person needs to have the problem that you can solve. Number two, they want it solved. And number three,

They can pay. It's very simple. So they have a problem you can solve, they want it solved, and they can pay are the ingredients to running a successful, profitable private practice. So why is this important? I'm going to give you the seven benefits of a direct care practice for the patient's point of view and for you as the CEO of a successful direct care practice. So let's start with the seven benefits of being a direct care patient. Number one, the patient gets a lot of time with their doctor, more than that seven minute clinic. So these visits are unrushed, which means the patient has the time and the space to ask questions and to understand their plan of care. Most patients don't come with a medical background and a lot of times they just need more time to digest their new diagnosis, the new treatment options that they didn't know were available.

And just bringing all the pieces together. So when the patient chooses a direct care doctor, they're going to immediately find that they're not being rushed out of the exam room. They're going to find that the doctor has all of their attention on them and they can ask as many questions as they need to understand the next steps that they need to make in order to get better. Number two, patients coming to a direct care practice know that the treatment plan is personalized. We have AI at our fingertips.

We have Google, we have YouTube, we have all the things. But the patient still wants to know what's best for them. They want to know everything in a concise manner. And sometimes it's really noisy out there on social media or with all the tools that are available to the lay person. They don't really know the nuances that the doctors know. And so when they choose a direct care doctor, they know that all of their questions related to their care plan

It's going to be specific. It's going to be customized for that individual rather than a generic plan that is just covered by insurance. Or maybe they've tried that generic plan and it's still not helping them. And that's why they're choosing to pay out of pocket because they are in desperate need of much more personalized care. It's kind of like getting a tailored suit. Can you get one off the shelf? Yeah, you can.

But can you get a nicer fitting when it's tailored to your specification with the materials that you like, with the number of pockets that you want, so on and so forth? That's personalized treatments. That's a personalized, tailored plan to the patient. So that is what they're getting and that's what they're paying for. Number three, patients really enjoy the easy access of a direct care practice. Oftentimes, we are happy to see them the same day or the next business day, or they can get their questions answered through direct messaging, they can email, there's a patient portal in some of the EMRs, probably most of the EMRs now. There are fewer barriers to being able to get expert medical care and people love that. And that can restore the patient physician trust that is often being broken because when people are treated like a number in line or a cog in the system, it's easy to dehumanize the doctors, it's easy to dehumanize the patient, right?

We're all kind of treating the system as if it's a conveyor belt of people to treat in the mass. But when you step away from the system and you have a direct care practice, it's a lot more intimate and it's a lot easier to be able to accommodate the needs of your patients. Number four, direct care patients really enjoy the preventive focus that direct care practices offer because the care goes beyond giving them a prescription or a surgery. It really does emphasize prevention and long-term wellness. 

A lot of direct care practices are integrative where they look at the patient as a whole person. It's holistic care and that's what people really need to get better. They just don't always need another prescription and you can marry the two, modern medicine with holistic care in order to help the patient understand what prevention actually means when it comes to chronic diseases and long-term wellness. Number five, direct care patients know exactly what things are going to cost. So there's transparent pricing. We don't really see that with the insurance model. So the price is the price. The patient shows up, your office visit is your office visit price. Or if you've got a membership, you've got a monthly membership fee for your practice.

And there is no surprise bill or balance billing where the insurance model, maybe the insurance pays a fraction of it and the patient has to pay the rest or they have a copay or they have a coinsurance. You have to account for a lot of the insurance jargon that just dissipates in direct care. The price is the price. This is what you need to pay in order to get the service. And we always have an account receivable of $0.

I never sent out a bill, I never send patients to collections. I don't have to pay somebody to look at my accounts receivable. It's amazing. So the patient sees that their price is clear and then they can shop around if they choose to. Now mind you, I don't say that I am the cheapest option. I say that I am affordable and my prices are transparent. So if they want my service, they'll know exactly what that's going to cost. Number six.

Whole person care. This goes back into the preventive focus of a direct care practice. The patient knows that when they have a relationship with their doctor, they're going to have a lot more attention towards things like lifestyle management or modifications. We're talking about functional medicine, integrative medicine, where the focus is the root cause. We're not just throwing steroid injections at them, but we're looking as to the mechanical faults that's leading them to have pain. And it's just not symptom management.

It's not uncommon for patients to find me somewhere on social media driving a distance to get to my office because they're looking for this kind of care. A lot of patients know when they're paying out of pocket, they're paying for a certain luxury. And that's what direct care doctors offer, whole person care. And lastly, number seven, peace of mind. When the patient pays the doctor directly, the doctor answers to the patient or the doctor serves the patient.

the doctor does not have to deal with whatever insurance decides to change up. And so when we take away that middleman, we take away that barrier, the relationship between the patient and the doctor is real. Now, if you offer a membership type of plan where you get to see the patient more frequently, patients develop a trust that you will be there for them when they need you. That doesn't mean that you have to be available 24/7 as a doctor. You must have some boundaries around that expectation.

For my patients, when they pick up the phone to call the office to tell me that they've got a new blister on their foot, they know that I will address it in a timely manner. They'll text me, they'll email me, they know when I sleep, they are respectful of our relationship and of my time. And I am respectful of their time and that's why I don't overbook. Now those are the seven benefits for the patient who's choosing a direct care practice. Now let's turn it around and talk about the seven benefits of being the direct care doctor.

And I know you already have an idea of most of these, but let's just put it all out on the table so you can see the benefits of being a direct care doctor. Number one, you get to have autonomy in what you do, in how you build your practice, in what you charge, in the services that you want to provide. You are literally building your dream practice however you want to.

Now I know this can be a little bit scary for those who like more structure and those who just want to show up and be the doctor, but I think there's also beauty in you designing your perfect practice. Because if there is something that you have right now in your practice and you're saying, I just don't love doing that, well guess what? You don't have to do it. When you don't work for the insurance companies, you're not accepting money from insurance, you can say no to lots of things.

And in fact, a direct care practice has to say no to a lot of things because we only want to make room for the stuff that we truly enjoy. And when we do that, we create momentum for building a business that works for us. So having professional autonomy means you have the freedom to practice medicine the way that you think is best, not the way that insurance thinks it's best for them, because you know, they don't care about us. They just want the system to keep going, right?

You don't have the insurance interference getting in the way of what you think is necessary for your patients or for your business. Number two, you will develop deeper relationships with your patients. Having fewer patients to serve means that you get to build stronger connections with each and every one of them and even their family members. And that builds on a more meaningful patient physician trust. What a lot of doctors dislike about the insurance-based model is that patients kind of treat them like they're the insurance company, right? 

It could be a little disrespectful. They're complaining about things that are totally out of our control. They're making our lives harder by being the intermediary between the patient and the rules of insurance. And that's frustrating, and it builds up walls between the two. But when you take that all away, you peel that all back, and what's left is the doctor and the patient.

We rehumanize the entire medical experience. We can understand that individual on deeper level. So if they came late, well, we can understand that it was probably traffic or maybe they had to drop off their kids at school and we can understand and empathize what's going on. You're not worn out, you're not burnt out and you're not bitter. And that is a good thing. So having a smaller patient panel means you can take care of each and every one of your patients in more depth than you could possibly in the volume-based insurance practice. Number three, your schedule is sustainable. So you can see fewer patients in a day. What I used to see, 20, 30 patients a day. Now I'm seeing six to eight. What does that mean? That means less burnout, less paperwork, a lot more energy for the stuff that I truly enjoy. And that's the same for you too. If you decide to build this type of practice, you can choose

what you want to do. And when you get to choose what you want to do, you get that autonomy, right? You also get the energy, that momentum to keep doing it, to keep your business running in a sustainable way. And if you happen to have a day where you just don't feel like seeing patients, that's really okay. You're not in an emergency room. You don't have to be open. Oftentimes patients are very receptive to you as a person who needs time off, who needs time with the family, personal time all of the patients who come through seem to just be very aware that the system does not treat the doctors well. 

And they want you to be well because they've probably seen a lot of doctors come and go in their lifetime and they just want you to be okay. That's the level of respect I have received in my direct care practice and I know that it exists for you too. And it exists in more abundance. It's not just once in a while a nice patient comes through. It's like every single patient who comes through you're really excited to see them. It's like seeing an old friend again. 

So a sustainable schedule because you get to make the call and you get to set the prices, which brings me to number four, financial transparency. Financial transparency is great for the doctor because you can predict your cashflow and for patients, this was also a benefit to them. They know what they're gonna pay and they're not going to get a surprise bill. So when the prices are clear, your business is predictable.

And you don't have to chase reimbursements, which is the best part. Trying to chase money that's owed to you, you're never guaranteed to ever get it in full. You're going to get a fraction of it because if you have to hire collection agency, they're taking like 40 % of whatever is owed. So you're losing money once they leave the door and they're not paying. So financial transparency helps everybody. It helps your business and it helps your patients plan for the cost of medical care. Number five, you get to be creative.

You can design innovative therapies around functional medicine, holistic medicine, integrative medicine, lifestyle medicine, whatever you decide to do, it's yours. You're creating a niche designed perfectly for you. So if you ever thought about expanding beyond what you already know, what you've learned through your medical education, and you're like, that would be really cool if I can just add this. You don't really have an insurance company saying that's not appropriate or that's not a medical necessity. This has been a really joyful part of my practice where I get to create

whatever I want to create without any limitations. So if a patient comes in and I feel that they would benefit from a deeper dive into their nutrition, I have the freedom to do that and I don't have to attach it with a CPT code. It's just part of the treatment plan. I don't have to say, well, I really can't do that. I really can't have this conversation. know, the time doesn't permit it or whatever. It's personalized medicine. I get to decide.

what that looks like for the patient and we co-create it together. So if the patient wants to talk about supplements, for example, and I feel comfortable talking about the types of supplements that they need, we just have the conversation. There's no issues with that. Now, of course, I stay within my scope of practice. So if it goes beyond what I can offer, then I just refer out. That's really not a big deal. But I think the more doctors that can contribute to the idea of holistic healing,

and reiterate what other doctors are already saying, this can really help patients change their habits, which can change their life. Number six, work-life balance. If it's not obvious yet, you can absolutely have a work-life balance because you are controlling your hours, where you practice, how much you wanna grow, how much you wanna charge, how many patients you want to see. In the beginning, all this might sound overwhelming.

But with time and experience and really with the audacity to build your dream practice, you can have a work-life balance. In the insurance model, we are beholden to doing insurance things like over-bloating our charts, like staying up to date with coding, like seeing a bunch of patients because reimbursements are going down. There is no winning in that model for private practice. Direct care is absolutely going to give you a work-life balance.

So if you wanted to start taking a day off of your work week, you don't want to work six days a week anymore, maybe not even five. You can even work just two days a week. Totally depends on how you want to design your practice and the price points and your financial needs and your creative needs and your energy needs and all those things. You get to decide, you get to call the shots. If my daughter decides that she needed me one day to attend one of her field trips, that's not a big deal for me. I can just say, okay, I'm closing out on Wednesday.

Gonna spend all day with you, let's do it. And I'm sure you can find other things that you would love to do instead of feeling trapped in your business. So work-life balance is very real and it exists in abundance in a direct care practice. And the last benefit to being a direct care doctor, of course there are many, but the last one that I'll share with you here is the one that is most meaningful for me as a doctor helping other doctors understand direct care. And that is you get to have a renewal of joy in medicine. A lot of doctors are burned out from the insurance model. We are being treated unfairly. This brings us back to the reason why you decided to become a doctor. You wanted to take care of people. You learned what you needed to learn in the eight to 10 plus years to learn it. You might have even taken out a quarter million dollars of student loan to earn that education.

And when we got out and started practicing, we then began to see that the system is really broken. How doctors are being disposed of and replaced, how patients are being pushed through, having to pay an enormous amount in their copays, their deductibles, in their premiums, and they're still not getting the best care. They're getting good enough care. And this renewal of joy in medicine is really all about helping people heal with what we know without the interference. We did not become doctors to become paper pushers. 

We became healers. We want to make a difference and we want to do it in a system that supports us in doing so where it's sustainable. So having a direct care practice where you cut ties with insurance does give you back your time, your energy, and it renews the joy that you have in medicine.

If you love working with patients, you are absolutely going to love direct care. Now, once you realize the formula for success of a private practice, where this model exists to number one, help the person who has a problem that you can solve. Number two, they want it solved. And number three, they want to pay. They are willing to pay. Then you can strategize your other business ventures and even start a nonprofit if you like. Now, if you help everybody without discretion, then it will be a lot more challenging to sustain all of those businesses. It's kind of like trying to build a bridge to your end destination. If you're building multiple bridges, you're using up a lot of resources and you are delaying the path that it takes to get to your end destination. But if you focus on just building one bridge at a time, then you can use all of your resources effectively. And once that bridge is completely built, then you can build other bridges.

I hope that gives you some kind of visual sense as to what I mean when I say you need to fight for your focus. You need to focus on one path at a time and understand how direct care would work for you so that you can then have the experience to build other businesses in a sustainable way. So I want to encourage you to fight for your focus. What is needed now and start there. 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 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, really does mean a lot to me. Sending you peace and possibilities. I'll catch you next week. Take care.