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 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.

I want to welcome Dr. Vanessa Rodriguez, an endocrinologist in South Florida here with us today because we will be talking about how Dr. Rodriguez started her direct care practice, which is a membership-based practice. And you know, me as a podiatrist, I'm only really gathering the data as to how I'm going to create a membership. I have packages, but I don't have the traditional like DPC practices where it's exclusively one price and it's a done deal.

Mine's a little bit more complicated, but that's how I like it. That's how my brain works. And I'm wondering how things are going with you. So welcome to the podcast, Dr. Rodriguez.

Dr. Rodriguez (01:30)

Thanks for having me. really a pleasure being in the show.

Dr. Tea (01:34)

Awesome. Let's get into it. Why did you choose direct care? Like what was life like for you before you had your practice?

Dr. Rodriguez (01:42)

Well, I've been in practice for 21 years and I've been through the whole gamut of different types of practices. So I first started with a multi-specialty group, physician-owned, later on on a hospital-based physician practice, later on a small group. It doesn't matter where I was working. It was always kind of the same theme. You got to see more patients.

You know, gotta be quicker with your appointments and I just couldn't do it. ⁓ I've been always ⁓ one to believe in education. So I take my time with my patients. believe that, you you can take care of your diabetes if I tell you exactly how the insulin works and why we do this. So I would really spend a lot of time with my patients and unfortunately, didn't matter where I practice, it was always the same thing. You have to see more patients.

So I decided to open my own practice ⁓ approximately 11 years ago. And I said, I'm gonna do this better. I'm gonna do it my own way. I'm gonna take my time. So, but I still continue with insurance space, right? That's what I knew. And ⁓ fast forward, you know, nine years later, I was in the same problem, right? I was taking my time. I was doing things how I wanted to do them. I was big on customer service and taking, you know, making sure that the patient felt comfortable. ⁓

you know, that they felt heard and I was there for them. But, you know, insurance is unfortunately, you know, had forced me to be able, I needed to see more patients in order for the practice to survive. And it came to a point that I said, okay, I'm leaving medicine. I just couldn't do it anymore. And I told my husband one day, I'm like, I'm done. You know, I'm going to do something else. You know, I tried it my way, it didn't work.

Actually, I started looking for jobs and like, I love patients so much. I couldn't see myself maybe working for, ⁓ know, even a non-for-profit or maybe a pump company, insulin pump company, just, you know, a desk. I needed to see patients. So I started looking for more and I was very fortunate to come across the DSC Alliance. ⁓ And I had heard about DPC. I knew that.

DPC was a wonderful way to practice, but I never thought as a specialist I could do it. And I remember that evening when I saw the DSC, I'm like, okay, wow, let me see, can endocrine do this? And ⁓ in a matter of minutes, I found 10 different endocrinologists across the nation, nobody in Florida, but 10 different endocrinologists that were doing this. And I remember I said, this is what I'm gonna do.

Dr. Tea (04:33)

So you had reached out to the Alliance and you saw other people doing it. So how did you decide to create it for yourself? Like what was your thinking process in creating a membership for your practice?

Dr. Rodriguez (04:47)

The decision about, once I made the decision that I was going DSC, I was gonna go full force. was either all, because I see practices that are hybrid, right? Some are taking chance and some are membership based. And I said, if I'm do this, I'm gonna give one last try at medicine and I'm gonna go 100 % direct care. And I was gonna do only membership. And I have to say that I,

I'm not entirely membership and I'll tell you how that process started. When I said, okay, I'm gonna only do membership, then I started thinking, okay, membership is wonderful. And I know that all my patients with diabetes, this is exactly what they need. But I, even though as much as I love diabetes, I have type 1 diabetes myself, this is the reason I went into medicine. ⁓ I love diabetes and it's my passion, but I also love all endocrine.

So I was thinking about my patients with osteoporosis that would see me only once or twice a year, and the patients with thyroid nodules that I would do their ultrasounds, you know, maybe, you know, once or twice a year. I wanted to be able to do all endocrine. So initially when I made the decision and I was trying to sort out, you know, prices and I was gonna, you know, what services to include and all that.

Then I decided for the patients that were transitioning to my practice, because I had already had an established practice transitioning to DSE, I figured, okay, well, I'm going to offer the option of fee for service or paid per service. And ⁓ diabetes, has to be membership. So that's kind of how I started. And I would say about half of people signed up for the membership and about the other half were fee for service.

You know, I later on, about a year later, you know, now has been two years since I've been in direct care. So about a year later, I realized I, it's difficult for me to differentiate, ⁓ you know, who, how much services or how much I offer, you know, to each patient. So in other words, like I wanted to make sure that the members had, you know, my cell phone number in case of emergencies, they had access to me.

⁓ And everything is covered. So if I need to do a prior authorization for a medication or they need an ultrasound or they need a biopsy, everything is included. But I came into the problem that for those fee for service, then I felt limited. Like I wanted to communicate via cell phone. wanted to, you know, if they needed a PA, then I had to ask for their permission. Hey, you know, remember we have a fee for prior authorization.

And I felt like I was not giving my, you know, I cannot give my 100 % as I do with my members. So to give an example, if I get a prior authorization for a diabetes medication, like I get it and now as direct care, I can take care of it right away in a few minutes, I'm done with the PA and I usually get an answer within, you know, the same day or the next day. But with a fee for service patient, I'm like, okay, do I do, you know, can I do the PA? Is it okay? Is it okay if I charge you a credit card?

And then I felt like there had been a delay, know, that they wouldn't answer me. And then it's a week later and I'm still not done with the PM. like, ⁓ it's been frustrating. So about a year ago, I decided, okay, I'm gonna keep the fee for service that I have. And right now I'm not taking any additional fee for service. It's all membership because I figured it's just easier for me and not only for me, but also to the patients, you for them to get the full experience of direct care.

if it's all seamless, right? You need something, I take care of it right away. You know, have a question, you know, I don't have to bring you in for, you know, another visit. I just, you know, we take care of it right then and there. And that's the beauty of direct care. That's why, you know, I even though initially I had decided to offer both right now, you know, I'm only doing membership, but I'm keeping, you know, those fee for service that I had, which were, you know, my patients, you know, that I've had for many years and

but I'm not taking any new patients as fee for service. It's all membership.

Dr. Tea (09:06)

I think what you've just described is what most of us will ultimately do when we jump out of insurance because we do all the things, we serve all the people. And I heard Alex Hormozi on his podcast say something that has stuck with me until now to this day. He said, when you build a business, you really want to focus on one avatar with one service line until you hit your $1 million.

And he just simplified that with such ease. And it made me think about why myself, with all of these great ideas that we have, why we keep feeling stuck or overwhelmed. And it's because when we come from the insurance model, we were literally serving every single body, every body that came through, right? For whatever problem they have, sometimes it's a mixed gamble. It's not just diabetes, it's like a complication of it or it's...

something else that shows up in it, or it's like, I've got one more question doc kind of patient, or they come late. And I think you hit the nail on the head as to the value of a membership. If you just have the membership, you don't have to sort out and penny pinch the patient's interaction each time you do something for them behind the exam room, right? Or when they're no longer there, we're still doing follow-up care. We're still charting, we're still talking to the people we need to talk to so they can get the things that they need. And I feel like I'm in that place right now with you. I've opted out of insurance three years ago, but I still kind of wax and wane between my surgical procedures into the medical care that people really need, which is educational. It's preventive care. It's making sure small things don't get big, that you don't end up with an amputation or you don't end up with a chronic pain issue. 

And...I really just wanted to highlight the idea that membership is just the way business goes to offer financial stability. So once you decided to have that membership, what else changed for you? Did life get easier? Did they get harder? Did you still have conflict? What did it do for you?

Dr. Rodriguez (11:13)

Well, think it's much easier. I still have a big portion of those people for service, but it makes it much seamless, as I said. think that's when you think about direct care, that's how I envision it, right? So it's seamless. People, ⁓ you take care of things as they come. What I would say, and just to kind of segue to that, what really made a big difference, and I would say mostly, financially is when I changed my, ⁓ you know, when I left my office, I used to have an actual office space and ⁓ my lease expired and I thought it was the end of the world. I didn't have an office space because I had been negotiating with my landlord and it turned out that ⁓

You know, we couldn't come to an agreement. So ⁓ I find out on a Sunday evenings that ⁓ he was not gonna renew the contract. He wanted me to do a 10 year lease and I didn't want to. And ⁓ I find that on a Thursday and ⁓ my lease expired on a Monday. So I only had a few days to leave the practice, you know, grab, you know, find a mover and ⁓ grab all my stuff, put it in a storage. ⁓ I found a friend who's a DPC that I met at the Chamber of Commerce. And she was using this coworking space and she really, really loved it. ⁓ And I was able to find a spot and got started on the coworking space by Monday.

And I'm telling you, it's one of the best decisions that I've made. I never thought that that was gonna make a big difference. I thought it was gonna be temporary, but I've been there for a year. And I really, really think it made a big difference in the practice financially. Controlling overhead is one of the biggest things that we must do as we're doing direct care. And, you know,

Not planned, but it just happened. And I am so happy that it did happen because it's been one of the game changer, definitely, in the practice financially. So ⁓ I highly recommend to keep your mind open. We always think that we have to have an office space, but a co-working space in the direct care. We don't need a lot of space, at least me as an endocrinologist. just need a room. That's it. I just need a room to see somebody.

⁓ So ⁓ it's really financially made a big impact in the practice.

Dr. Tea (14:09)

Could you elaborate a little bit more on what this co-working space actually looks like for you? And what were the terms? Were they month to month?

Dr. Rodriguez (14:18)

So they do have a monthly membership that I opted to use because then you get a lower fee per hour. But this monthly fee is minimal in compared to what the rent was. We're talking a couple of hundred dollars versus 4,700 rent. And then you just rent per hour. So I usually rent the same room so that there's some consistency.

⁓ These rooms are very modern and very kind of stylish. ⁓ They have a little waiting room where the patients just text me, hey, I'm here. I just bring them to the room. ⁓ Very comfy, has a desk and a couple of couches. And I just rent it per hour. So if I'm on vacation, I don't have to rent it. The days that I'm on telemedicine only, then I don't go. I just see the patients telemedicine from home. ⁓

I just had to reserve a couple of lockers there just to have my stuff. I have my ultrasound machine over there, so I have it in a little cart. So when I do my ultrasounds, then I just bring my ultrasound there to the room. So I have all my supplies over there in a few lockers. But it's very, very kind of quiet and...

⁓ It's all medical, so it's ⁓ kind of a nice vibe on the East L. Ray, which is a nice place near to the beach and touristic area.

Dr. Tea (15:53)

I've heard about co-working spaces out here in California, like in the Beverly Hills district, where they would do, as you're explaining, subleasing it, but I never knew what that would cost. So are there more companies now doing shared spaces for medical?

Dr. Rodriguez (16:10)

I don't know if it's considered a shared space, right? Because literally, there's maybe 16 rooms over there. So people just run them as they need them. So I just happened to, because I'd like to have the same room, then I just reserved it months in advance. Like, I have it reserved probably till February of next year. So I always have the same room. But then I go ahead and cancel it.

⁓ For example, Wednesday I'm all telemedicine, so I just went ahead and canceled my day for Wednesday. ⁓ So it's very flexible. But I personally like to have the same room just so there's some consistency and people see like it's kind of my office, but it's really not. Anybody can rent that room if I'm not there.

Dr. Tea (16:54)

Let's hop back into your practice as to who your best patients are. Could you give us an idea of those who maybe are new to the idea of direct care? Who actually pays out of pocket for your services and why are they choosing you?

Dr. Rodriguez (17:08)

So we know, when we were thinking about direct care and when usually you think, well, this is for the wealthy, right? And to be honest, ⁓ doesn't, or for people that don't have insurance. And I was looking to the practice and I would say everybody has insurance. All my patients have insurance except for maybe two of them that don't have insurance. ⁓ My population, because I live in South Florida, we have a lot of Medicare.

So always my practice has always been at least 50 % Medicare. And looking now at my DSC practice, it is about 50 % Medicare as well. ⁓ So the demographics haven't really changed a whole lot as when I had it at my previous practice. ⁓ So I think the ones that ⁓ get the most benefit are my patients with chronic diseases. ⁓

You know, there are diabetes patients, pre-diabetes, weight loss, ⁓ but I have the whole gamut of endocrinology. So I still have my patients with osteoporosis and I have my patients with thyroid disease. ⁓ So it's not only for the wealthy, as most people think. I think what I've come to notice is that ⁓ the patients that really care about their health, they will figure out how to pay for it.

because I've had patients that I didn't expect were gonna join and they have. And if you think about it, people spend their money however they wanna spend it. They wanna spend it in nails and they wanna spend it on clothing or they wanna spend it on health. it really surprises you sometimes who join. So I think what I notice is that it's usually people that wanna get better, which is awesome because you're spending a lot of time with them and those are the people that you want to help, right? Those that want to be helped. And usually are those that are very pro lifestyle changes and they really want a work, they want to work as a team ⁓ for their own health. Preventative medicine is a big part of our practice as well. So I think it's really

It's not about what insurance they have or what income they have. I think ⁓ it's about the desire to get better and have better medical care.

Dr. Tea (19:43)

How do they find you or how do you find them?

Dr. Rodriguez (19:46)

So I was very fortunate that I had my previous practice, right? So I would say that in the beginning, was about, I was able to transition about five to 10 % of my practice, ⁓ transition into the DSC practice. And ⁓ over the first year, there were still some that were trickling in that maybe they went to another end though, they didn't wanna do DSC, they went to another end though, they were not really happy and then they eventually came back.

⁓ I do have some referrals from local VPCs as well, which is nice because then the patients already know what type of care to expect and they already know how the system works, which is very nice as well. But I would say the most are coming from just picking up the phone call and just calling, looking for an endo. ⁓ In endocrinology, there's very few of us.

So there's always a big need. And in my previous practice, never had to, well, most physicians, don't never advertise ourselves in any way or form because there's such a lack in our specialty. And I think that's the case for most specialties as well. So when I transitioned into DSC, we still get a good, I don't know, seven, eight phone calls of new patients per day.

And of course, not all of them join because the first question is, we take insurance? I want to use my insurance. So that's usually the first question. So not all of them join, of course, but most of the new patients that we get are people on Google and finding us. And I think that's one of the very important things of having good ⁓ Google presence and making sure that your patients really, that's how patients find physicians nowadays, you know, they just Google how many stars do they have. So ⁓ it's good to make sure that you have, you know, your patients review you online until, ⁓ you know, they're the ones that are gonna promote you the best. you know, then we get, you know, from other patients, you family members, and that's the other sorts of referrals that we get.

Dr. Tea (22:03)

I saw your Google reviews. You're doing amazing. Do you pay for your Google ads at all or is it just all organic?

Dr. Rodriguez (22:13)

All organic. And to be very, very honest, our Google reviews were not good. We had like, I ⁓ don't know, three or it was like either all fives or ones. Across the years, I didn't care about my Google reviews. I was worked out. I was so exhausted. I really didn't care. ⁓ But as I was thinking about DSC, I said, know what, in those six months, know, transition, right, I decided I was going to do DSC and we started six months later. So one of the things that before I even announced it to the patients, I started to, you know, send, ⁓ you know, tell the patients, hey, you know, here's how you can review us, you know, when the patients were checked out, know, hey, just Google, you know, we review this on Google.

And we actually started to get those reviews before we announced that we were going to DSC because I knew that that was going to be important at that time. So then once we changed to DSC, then we continued to say, hey, remember you can review us here. And that's how slowly we've been getting our reviews better. ⁓ I've never paid for Google Ads or anything like that.

I think that if you're having your patients review you and you encourage them to do it, ⁓ it actually helps a lot when you're trying to get new patients. And that has been, to be honest, our best form of advertisement, and it's free advertisement.

Dr. Tea (23:52)

That's a really good point. We tend to throw money at things and just hope that it grows. And I am guilty of doing such things. Just let somebody else handle it. I just want to be the doctor. Can you just, you know, do all the things? ⁓ But here we get to simplify it. And I wanted to know, is your area saturated with endocrinologist options? Like I imagine nurse practitioners, PAs, other insurance bound endocrinologists are present, but then you also said that there isn't a lot. What does that look like in your community and how do you, I guess, stand out or out-compete, you know, with those options?

Dr. Rodriguez (24:33)

think there's enough endocrinologists nationwide. diabetes is growing faster than the endocrinology pool is growing. So at least in our field, ⁓ there's not enough of us. Doesn't matter where in the map you look at it. It's really, there's a big need. There's a big need. Most of diabetes is taken care by primary doctors, but there's still not enough endocrinologists.

Dr. Tea (25:02)

So it's not saturated and you're not worried about the competition. that's, which is a healthy attitude about it, right? It's just.

Dr. Rodriguez (25:11)

Yeah, I think it's, you you have to have a a good ⁓ reputation. And that's one of the things that, you know, if you have a good report with the doctors in the community, ⁓ I think one of the things that helped me ⁓ is that I'd been in this area already for about 12 years. ⁓ Even though don't go to the hospital anymore, ⁓ you know, I, when I first got to this area,

You know, I went to the hospitals and that's how you meet, you know, the different primary doctors and the people that are referring to you. ⁓ And then, you know, slowly you build your reputation. So eventually once I stopped going to the hospitals, you know, still those PCPs were referring to me. ⁓ So, and then it just becomes word of mouth and, you know, and so on. But I think your reputation is so important. And so you have to be really... ⁓

You know, got to protect it. And that's why I think the Google reviews and your online presence is important because then people will follow. And ⁓ I think one of the things that helped me a lot is that I, and maybe you can see that in my reviews, is that I take my time with the patients and I listen to them. know, people want to be heard. ⁓ So they're so used to about these five, 10 minute visits, go, go, go. And they had 10 questions and nobody even heard them.

⁓ So I think that's where my reputation comes in, is that I always, even when I didn't have time, I would sit down and listen and ⁓ try to address all their questions. And that's why in my ⁓ previous practice, I used to be 30 minutes to an hour behind. People didn't like it, but I'm like, this is the way that I'm going to practice. And again, eventually burned me out. But I think that's important, right?

⁓ listen to people and make sure that sometimes it's just, you know, you would have maybe taken the same medical decision, but you took the time to listen to them look at their eye when they're talking and ⁓ they feel they feel hurt.

Dr. Tea (27:22)

The owner of a successful direct endocrinology practice. Did you encounter early mistakes that you wish you hadn't done as you transitioned out of insurance into the practice that you have now?

Dr. Rodriguez (27:35)

Controlling overhead is a big, big one. And I wish I would have known about this co-working space before. So ⁓ I think it's important to have good staff, right? Some people start on their own, right? So they may not have staff. ⁓ I did have, ⁓ I do have a virtual assistant and that's been very, very helpful. ⁓ So over the years I've learned that it's important to have ⁓ good support. And ⁓ I think that was, you maybe not with DSC, but I've learned it in my previous nine years of having my own practice. I always thought that ⁓ having somebody with experience or somebody that has done endocrine before, you know, that they knew, you know, the EMR that I was working with. 

⁓ But I could tell you with you know, it took me so long to realize that what you need is somebody that has a good attitude, somebody that ⁓ has positive view of things and is willing to help people that have that service attitude. Everything else, you can teach them. You know, you can teach them the EHR, you can teach them, you know, endocrinology, you can teach her, you know, what a sensor and a pump is. ⁓ But it's important to have somebody that you really work well with because she's going to be the one picking up the phone and she's the one, you know, she needs to believe in DSC as much as you do because she's going to be the one that's going to be able to convince that patient that calls in and says, you know, do you take insurance? That's their first question. I've picked up the phones before. You take insurance? Well, this is what we need to do. You know, this is the beauty of this. We accept all the patients, doesn't matter what insurance they have.

So, know, depending how you, you know, you can easily say, no, we don't take insurance. And then they hadn't up on you, right? But, you know, so we've come, we try to find ways to say, you know, yes, we take any patient with any insurance. We just don't bill the insurance, but we take any patient with every insurance. So it's just kind of opening up the way to ⁓ listen to what DSC is about. ⁓ So, yes, so having a, so I've learned definitely having a good, good, ⁓ virtual assistant, in my case, she's been amazing. And ⁓ she's the reason why our practice grows, because she's the one picking up the phones and convincing those about what DSC is. ⁓ So I've been blessed.

Dr. Tea (30:13)

You've given us some so many great tips, especially overhead control, finding a place where you can just rent hourly. I don't know if I have that in my town, but I'm going to look after we get off the call here. So the doctors are listening. They're interested in direct care, but they're on the fence. They're afraid. They're afraid of something. What would you be telling that doctor about direct care?

Dr. Rodriguez (30:38)

I believe direct care is not for everyone, right? But if you've come to a place that you really want to serve the patient and you're not being able to do that with insurance, I think honestly is about educating yourself about what TSC is and taking the leap. Unfortunately, I had to wait until I was quitting medicine to find it. So,

I'm hoping that most people don't have to get to that point and hopefully find this as an alternative to practice medicine as it should be. So I would say, if this is for you, don't think about it any longer. The decision is difficult and you can think about it over and over again, but at the end of it, is just close your eyes and take the leap.

I wanted to take the leap. Once I found out about DSD, I wanted to start it right away. I told my family, I'm like, OK, I can start this in next month. We're going to start right away. But I was fortunate to have a good husband and my sister ⁓ who really helped me with this transition. And my sister told me, OK, we have to plan this. So we have to plan this. If we're going to do this, you only have one opportunity to do this. So we're going to do it right you know, she set up a timeline for me. You know, this is when, you know, we're gonna finally be DSCs. So then we're gonna announce to the patients three months later, we're gonna do letters, we're gonna do town hall meetings. ⁓ So it was a three month process for us to get ready, you know, set up a website. ⁓ I watched this, I read a couple of books that I highly, highly recommend which are Dr. Faragos book, The Official Guide to Starting Your Own DPC Practice. ⁓ I read it twice actually. I really enjoyed that book and ⁓ Julie Gunther's Spark Starts Fires. And I listened to as many podcasts as I could, just like this one. ⁓ I woke up and I was listening to podcasts on my drive to work, at bedtime, every... 

⁓possible minute that I was awake and I'm not seeing patients. I was listening to a podcast and writing notes and writing notes, taking ideas, taking ideas. ⁓ So, we planned it and I was very fortunate ⁓ that all of those resources were very helpful. ⁓ now we're in our two year anniversary and I couldn't be happier. I didn't think it was possible. But I'm happy to say that it was the best decision, the best professional decision I've ever made.

Dr. Tea (33:32)

Congratulations on your two years. I'm so happy for you and I'm so glad we got to connect. It's not every day we get to talk to other business owners about what sparked the fire and I am going to check into that book. Thank you so much for that recommendation. You are a wealth of information. If people wanted to connect with you, what's the best way?

Dr. Rodriguez (33:51)

⁓ They can reach me through my website, which is endocrinologywellness.com. And our email is there, which is info at endocrinologywellness.com.

Dr. Tea (34:00)

Awesome. Thanks again, Dr. Rodriguez for being here and I look forward to, I hope I get to meet you in person someday, but we'll get to collaborate through the Alliance and in all the places. 

Thank you so much again for being here with me. 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, it really does mean a lot to me. Sending you peace and possibilities. I'll catch you next week. Take care.