Tea Nguyen, DPM (00:53.996)

I was chatting with a doctor who said she went a period of time without taking insurance. She was a direct care doctor and at some point found that she wasn't making enough money. So then went back to taking insurance contracts and now she's saying they don't pay enough. So what could be going on? If you are a doctor who's feeling this kind of fear, experiencing it or thinking that it's not working out, this episode is going to dive into some actionable steps to help you navigate that so you become the owner of a wildly successful direct care practice. As you can imagine, there are many layers to this symptom of, quote, it's not working. If I translate that correctly, what doctors are actually saying is that they're not making enough money. And the simplest way to break this down starts with a few important questions. There are other interpretations of what it's not working means. It could mean that the owner feels trapped in their business or it could mean that there's a lack of fulfillment and that'll be discussed on different episodes. But for today, I've got 20 minutes or less to help you understand what could be going on, let out your whistle a little bit and help you not be overwhelmed. So here are some things to take inventory of if you find yourself in this predicament. 

The practical point of view I have for you are these four things that could be going on that could be inhibiting you from your growth in your direct care practice. My first question is, what is your overhead versus revenue? Because I came from an insurance-based practice, I know personally, and I've talked to a lot of doctors who are spending a lot of money in their overhead to catch that money from insurance. For example, if you take insurance, you have to have a system or a software to bill insurance. You need to have somebody tracking it especially when there are claim denials that are beyond your control, like they changed a CPT code or modifier or something, you need somebody to keep track of that. A doctor shouldn't be doing that because as a doctor, if your hourly rate is $500, $1000, like you can pay somebody to do that, but nonetheless, overhead is more when you take insurance. And even when I was starting my practice early on in 2018, I bought a lot of equipment because I was kind of promised the idea of if you just

Tea Nguyen, DPM (03:18.776)

buy the thing, people will just pay for it, right? And that's not true. You need a plan. So if this is your situation where you realize your overhead is exceeding your revenue, which also affects your profits, this is an operational skill. You want to be able to remove the redundancies and the things that are nice to have until you actually have a financial foundation set. For some, a financial

Foundation is through your savings, through a business loan, through a supportive spouse, through a side gig, and having good control of the flow of money. That's a skill that not a lot of doctors have because I think it's because we envisioned having a six-figure income indefinitely, but it's 2026. Things have changed drastically in healthcare. The cost of running a business is going up. Your reimbursements are going down. So...Ultimately, this ends up being an operational skill and knowing your profit and losses month by month. So recognizing where your overhead is being spent and where your revenue is coming in from is going to help you see if you are financially viable from an operational point of view. right. So number two, a practical point of view of what could be happening if the direct care practice is, quote, not working, a.k.a. not making enough money or a lot of money.

So number two is do a lot of people know you? Unless you're being transparently honest with yourself, lot of doctors will say things like, well, I've talked to so and so, I've talked to 10 people this week, I've talked to, you know, like they've done the work, I get that. But if your schedule is not full, then you need to have more people know you. They also need to have the problem that you can solve. They also want to have it solved and they are willing to pay. Okay, so

This is a formula. People need to know you, they like you and trust you, but if you don't take insurance, you have another barrier. This is a marketing skill. So the barrier in this is really having better communication skills and marketing skills. So when it comes to marketing, you want everybody to know your name. This is a visibility issue. This is if people don't say your name in circles that you're not in, then you're not well known.

Tea Nguyen, DPM (05:37.688)

So you need a lot of people to know you because they may not need you right now, but when they do, you need to stay top of mind. So that's why there are funnels and systems that you can pay into so that this marketing strategy works on your behalf even while you're sleeping. So if not a lot of people know you, the first thing you can do that requires zero dollars is to meet more people and to meet them more often because not everybody you meet is going to have the problem that you solve right away.

and not a lot of people are willing to have it solved and not a lot of people are willing to pay for it to be solved. Which means your effort needs to be so much more purposeful than ever before. And this is simply a marketing skill. We were never taught it. Don't feel bad about it. And that's okay. This leads me to number three. If you've identified, yes, overhead is expensive. It's killing you. Revenue's not coming in. Number two, you realize not a lot of people know you. You just gotta learn the marketing skills. Number three,

is really about your offer. What are you actually solving for? Because your offer is the thing that's going to entice people to come or not come. Now, if you're a direct care practice and you just exist, getting all of your services available without something that makes you unique, then you now have become equal to insurance. Meaning, if you offer pay-per-service type of care, that's what everyone's doing. How do you stand out?

if that's what you offer, if that's what insurance is paying for, right? A lot of doctors do this and a lot of doctors are doing it successfully because number one, their overhead is low. Number two, they have a strong funneling strategy, meaning they know how to capture new people into their practice. They have a whole sequence of events that happen starting from the minute they show interest on like a Google ad to when the patient receive educational emails until

They make a decision to call the office to book the appointment. That's a sequence of events that needs to happen and it's automated. But also a lot of these doctors who are doing this successfully, they've just been around for a long time. And so time is the ingredient that is missing for a lot of us who are very impatient. We are living in a world of I wanted it yesterday, right? Amazon Prime, two day prime. Well, we wanted that yesterday. And unfortunately, when it comes to nurturing your business, having the operations in place,

Tea Nguyen, DPM (07:57.538)

developing that marketing skill, learning what an offer actually is. All this takes time. So it's really important if you're going to have a direct care practice that doesn't rely on insurance for revenue, that you have an amazing offer. This is something that I can help dive into more a little bit later as well. It's about communicating. It's about packaging. It's about making sure that you are the best option. And this is a sales skill, which is why I host the ethical selling masterclass on Wednesdays. If you follow the link below, you can register and join me.

This is where I show you the 4C method, which is how you help patients foresee their care with you and also how you make more money with less effort in an ethical way. So if you need help understanding what an offer is, what you sell to people, hop on the webinar even before you open your direct care practice. This is that important. And even if you have a direct care practice and you're not seeing people buy your stuff, even more important. So check it out. All right. So now I've covered the top three things that are

really logistical more than anything. Controlling your overhead, making sure people know you, making sure you can sell your offer. And number four might come to you as a bit of a surprise because it's not as tangible. Now what is that? Number four is about letting go of the identity of you having to take insurance in order to make money. This might sound a little weird and it's easy to miss but it's really important to understand. So this is what I'll be diving into.

more today. Before I get into that though, I have a little bit of a backstory to paint the picture of what this means. And I kind of hesitate to share this, but if you've been with me long enough, you'll know that I was married to a general surgeon who I love. He is kind, skillful, and a wonderful dad and a thoughtful husband. We met when I was 19. He was the guy that before I even met fulfilled a checklist of what I wanted in a partner.

So when he proposed 6 and a half years later, I remember being afraid of that commitment. But I said to myself, whatever we go through, I hope we go through it together. We then got married in medical school, had a kid, and this year I filed for divorce. Divorce is a funny thing. Some people think you have to experience something terribly tragic in order to justify the divorce. There's a lot of untangling and trauma for all parties involved.

Tea Nguyen, DPM (10:22.626)

But this was a mutual decision, even after therapy and having a kid. We didn't take this lightly at all. He's a nice guy. I'm a sufficiently nice girl. We just didn't connect. We were no longer a match. And I'm sharing this because I do have a point that I'll get to. And I'm not fishing for sympathies, but rather I want to share with you the process of grief, of letting something go, an old identity, an order for you to move forward. I was a married person for a long time.

more years with him than without. So I hung on to this idea that I should stay married, right? People in this community know me as Dr. T, but also the wife of the other doctor. And I hung on to this partnership, this idea of staying married, because that was our commitment to one another, that then eventually turned into a silent divorce. I wasn't ready to admit that we could actually cut ties until we buried it all.

in the therapy sessions and I found myself saying I'm unhappy. And I felt incredibly guilty dragging him along in my unhappiness too. What was happening was we were trying to make each other something we were not. We were asking for something that we could not provide to each other. Now could I have shared a less traumatic story? Sure, but hey listen, I have the mic. So I don't know, I might delete this later. But I'm not saying that you need to divorce your partner.

This is not marriage advice. What I'm saying is sometimes you stick to an identity because it serves you a purpose. But if you want to move in a different way, that old identity may not be serving you anymore. So you might be a doctor who has identified with the person who takes insurance, for example. Maybe you were the doctor who said yes to all of the referrals and this model had succeeded for you in some way and it has helped you get this far. The thing is, if you want to change your ending,

Your old identity is actually holding you back. What has worked for you before got you here, but that same way of thinking won't get you somewhere new. So if you want to be the owner of a successful direct care practice, you have to take inventory of the silent stories that are keeping you stuck, such as, I'll be abandoning my patients who need me to take their insurance. If this doesn't work, what will people think of me?

Tea Nguyen, DPM (12:44.266)

Or if this does work, what will people think of me for not taking insurance? Or I don't have the business skills to do this. Or good doctors don't care about money. And there is so much more, I know. When you leave the insurance model, it is a grieving process. It is an identity shift. There is guilt involved. But I want you to be gentle with yourself through this change and say something like this to yourself, whether it's a relationship or an old identity. You can say,

I got what I needed, now I'm onto something new. That's basically what I said about my marriage. I had a great time, thanks for the ride, the story is now over. As a doctor in conflict about insurance or direct care, you need to come to terms that what has worked for you will no longer serve you in the next chapter. That means you have to learn new skills, which you can do. You've been learning your whole life and you've been learning really hard stuff in medicine.

Business skills are so much easier. It's just new and you're unfamiliar with it. That's all that it really is. The most underrated process of business ownership isn't the six or seven figures that you can make. That is a side effect of putting the systems in place and changing your identity. But what you get out of owning your direct care practice is far more valuable. It's becoming the person who can do it. It's growing into this version of you that your future self is

proud of, or that your children can witness and say, damn, she did the thing. Or where you can look at yourself in the mirror and say, yeah, I did that. Imagine what you can do with your life. If you had more time, more money, and more fulfillment in your business, what would you do with this newfound wealth? If this is your first time hearing that there is more types of wealth than just financial, there's a great book called The Five Types of Wealth, A Transformative Guide to Design Your Dream Life by Sahil Bloom. I'll put that in the show notes for you to listen to or read. But that's why people who make lots and lots of money are unhappy. Because there are other things that need to be balanced. Time wealth, social wealth, having purpose, physical wealth, and financial. So what are you going to do with this information? Your action is up today. If you find yourself in a position where you're feeling hesitation, kind of plateaued, maybe a little bit stuck, write out a journal prompt answering this question.

Tea Nguyen, DPM (15:09.622)

If I don't change, where will my practice be in five years? Okay. Second prompt. If I do change, who do I have to become? This is about the evolution of you. I'm happy to announce that the doors are now open for the Direct Care Society, the Continuity Circle or the Circle, which is a monthly growth and strategy hub for direct care physicians ready to reclaim their energy, surpass their revenue plateau and get

expert feedback without the overwhelm of doing it alone. Everything will be down in the show notes. Thank you so much for being here and for allowing me to share my story and I hope to talk to you soon. Take care. 

Thank you for listening to the Direct Care Podcast for Specialists. Remember, you always have the power to choose. So what will you be choosing today? Wishing you peace and possibilities.