Tea Nguyen, DPM (00:54.08)

If you ever thought, what if I can't do this anymore? What if I left employment? Could I actually start my own practice? If so, where do I start? If that thought has crossed your mind, even just once, this episode is for you. Because leaving employment is not just a financial decision, it's not just a career decision. It really is an identity shift. You go from being a physician within a system where you're employed to becoming a physician who builds the system.

And before you make the leap, there are a few things every doctor should understand first. Before you think about business models, before you dreaming up about opening your own clinic, there is one simple place to start. And it starts with your employment contract. Specifically, does it contain a non-compete clause? Many physicians' contracts include restrictions that prevent you from practicing within a certain distance from a certain location in a timeframe.

after leaving that employer, a typical clause might sound something like this. You cannot practice within 10 to 20 to 30 miles for one to two, I've seen some aggressive ones five years after leaving. The purpose of these clauses is intended to protect the employer's system, what they've built and their patient base and their referral relationships. But the legal landscape is quickly changing, or it's actually causing patient harm if the patients don't have the choice to have

continuing care with their chosen doctor. Some states no longer allow physician non-competes at all. An example of such a state is my state of California. There are others, Colorado, Massachusetts, Minnesota, Oklahoma, I believe, generally ban physician non-compete agreements. So for example, in Texas, non-competes are only enforceable if they meet strict requirements, like limiting the restrictions down to one year.

or a smaller geographic radius. So what that means for you is simple. Your contract may not be as restrictive as you think. They may not be enforceable, but this is also why step one is always to have a healthcare attorney review it with you. A lawyer who specializes in physician employment contracts, because some of the biggest barrier is not the contract itself, it's not understanding it. But once you understand

Tea Nguyen, DPM (03:20.502)

the contract limitations, then the next big decision is will you build a practice taking insurance or will it be a direct care practice instead? Both models have advantages and I come from both so I can share with you the pros and the cons so that you can decide which one suits you better. So let's start with the traditional insurance model. There are three benefits. The first one is the built-in referral flow. If you're in network, you're in the club, it's easier to get patients this way.

It's the plug and play situation like the hospitals, the PCPs, other specialists who might refer to you. They already operate inside this ecosystem. So oftentimes these referrals come easily, naturally with just a click of a button. Benefit number two is having continuity of relationships. If you've been practicing in the community for years, staying with insurance can make it easier to maintain those professional connections. But realize once you opt out,

your reputation will not carry with you. Those relationships do not go with you. They will be severed. One of the doctors on the podcast says she felt she was as good as dead when she left insurance. And I have to tell you, breakups are bad. They feel terrible. But breakups are necessary in order for you to go somewhere else, to be with somebody else, to become someone else. So it's not all that bad. Just stick with me here. Benefit number three.

Prices are predetermined so you don't have to stress about how to charge for stuff when you take insurance because insurance have already set your reimbursement rates. So if you take two doctors and one takes a longer time with one patient than another, you both get paid the same. And for some physicians, that just feels easier to allow somebody else to dictate how much to pay you for what you do. But there are also trade-offs, right?

Because those reimbursement contracts don't match the actual expenses of running a private practice, such as the overhead increases, your staff wanting their annual raises, the administrative burdens increases and so on. Yet those reimbursement rates stay the same. This forces practices that take insurance into a very familiar pattern, one that we all trained in, and that is having a lot of volume, lots of patients to take care of. And that also means that you have to

Tea Nguyen, DPM (05:39.904)

see more patients in those visits, and those visits are very short. So let's talk about the alternative, which is direct care or cash-based practices. This could be a membership for certain specialists, or it could just be pay as you need, pay as you go, or you have packages that you sell at a very high ticket price to get that high value care. Whatever you decide to do, not taking insurance, not having contracts with insurance,

is a totally different model. So instead of you having to optimize for volume, meaning having to see patients every 15 minutes or so, having a direct care practice, you are optimizing for your protocols. You're giving more time to the patients for the access that they have with you. It's a relationship-based practice. You're giving patients options in this model without any insurance or reimbursement incentives. But here's where a lot of doctors get stuck.

They assume that because we didn't learn the business stuff of running a practice that they can't do it. Now, it might be true that we didn't learn some of this stuff, but it doesn't mean that you can't learn it. These are skills that you can learn. You are just a few skill sets away from being able to run a successful direct care practice. So let me tell you what these three skills are specifically before you decide to leave employment so that you can decide if you're willing to learn these or not. These skills are so much easier to learn.

than all the things you've learned in medical school. What are they? The first one is marketing. It's relationship building. It's having people know who you are, telling them what you do, and earning their trust. Marketing does not mean that you have to dance on TikTok if you don't want to, or to tell jokes, or to be funny, or any of those things. It's not about becoming an influencer so that you can get attention. You're trying to build a business. You're trying to get paying patients. Those two things are totally different.

So making sure that you are in front of people at the right time for when they need you, being top of mind is just marketing so that they know where to go when they need you. The second skill set to learn is about operations. This is about the patient's entire experience from start to finish. It's about scheduling, it's about their experience on the phone and their experience in person in your office. This is the workflow.

Tea Nguyen, DPM (07:56.162)

Now, a direct care practice, we do this so much simpler than how it used to be done with the insurance-based practice. Here's an example. If you're an insurance-based practice, the patient has to submit their insurance information. The staff has to verify their insurance eligibility and know what is covered and what is not. They have some more paperwork to fill out. They may or may not be seen on time. The doctor may or may not be behind. These are all workflow things. Contrasted out with the direct care practice,

Here's what my patients experience. They call the phone, we schedule them within the same week, the patient comes in, they are seen on time, and I spend 30 to 60 minutes with the patient exploring their options so that they can fully engage in their care and become consentable should a procedure be needed. And then at the end of that conversation, they hand me their credit card or I keep it on file.

And in some cases, patients pay cash, cashier's check, whatever, right? The payment is made, their account is closed. So that's operations for direct care practice versus the insurance-based model. One is so much simpler. So don't let the word operations fool you into thinking it's complex. It doesn't have to be. It's very simple when you don't deal with insurance. And now skill number three, communication and ethical selling.

This is the one that makes the doctors stop or that makes them very uncomfortable, the word selling. But in healthcare, everybody is selling something. Selling is simply explaining the value clearly so that the patient can make an informed decision with their dollars. For example, when a surgeon recommends a surgery, that's selling. Recommending a prescription with a bunch of side effects, that's also selling. Direct care makes the conversation transparent instead of hiding behind

insurance billing codes. So these skills are learnable. Marketing, operations, communications, none of these require an MBA, but it does require you to learn them, to practice them, and you will get better over time. Now the real difference between quantity versus quality is not just that it's a business model and how you accept payments. It is a mind shift. It's about how you think about the problem.

Tea Nguyen, DPM (10:17.292)

So insurance medicine rewards volume, right? The more patients you can see per hour, the more you can generate, the more codes you can bill, or the more procedures you can do, the more you get paid, right? That also means more documentation to prove that you did the thing on paper so that the insurance people say yes or no, that they'll pay you. Whereas direct care, it rewards depth. So these visits often are longer, meaning there are more conversations. You can adopt newer innovative treatments more quickly and

Giving patients that time means they will understand the plan a lot better. They won't leave confused. Now, neither system is perfect, but they do produce very different types of lifestyles for the physician. One creates pressure to move faster, to see more patients, to do more work, and the other one creates space to slow down. If you're a physician thinking about leaving employment, here's what I would tell you. Start with where you want to be years from now.

Be clear about what you want without paying attention to all of the noise that's out there, about what people expect you to become. And I know that's really hard, but sit with yourself, whether it's through meditation, through prayers, spiritual support networks, whatever it is that you do, wherever you go to find clarity, get that peace of mind written down on paper, and that will guide you to what your next step should be. And then knowing what your contracts are to help you logistically and legally,

as to what you can or cannot do and what the timeframe looks like is really important. Get a healthcare attorney to help you with that so that you know your option. And then from here, you now know there are different business models. You can take insurance or you cannot take insurance. But knowing where you want to end up is the thing that's actually going to guide you as to which path you choose because they're both hard. It's just different kinds of hards and different things to learn. Once you see that path, the one that aligns with the future that you want to have,

the next step does become obvious. And the truth is the healthcare system does not change unless physicians are willing to build something different. If the old system is not working for you, this is your call to build something else designed just for you. That is what direct care does for you. So the real question at the end of the day really is, which future are you willing to fight for? They are both hard.

Tea Nguyen, DPM (12:42.296)

When you come from a place where you were employed, patients were just on your schedule, you collect a paycheck every two weeks or so, the systems were in place. But that system, if it was not working for you, if it's killing your very soul, if it makes you dislike your job, then you have to create a brand new system, one that you want to build just for you, that's custom fitted to the lifestyle you want to have and the care you want to provide.

and the paycheck that you want to give yourself. I wish this was the information I knew before I decided to leave employment and start my own practice taking insurance and then eventually leaving insurance to have what I am very proud of today, which is my direct care practice. One that I never can see myself taking another insurance contract ever again. One that gives me freedom to do whatever I want, even talking to you here, sharing what I've learned so that you can get there sooner. I'm so grateful that you joined me here today.

If you want to continue working with me as your consultant, follow the links down below and I look forward to chatting with you. Until next week, take care. Hey docs, I'm finally ready to share some exciting news. If you've been listening and thinking, I want a direct care practice, but I don't want to do it alone, then keep listening because I have something special for you. If you've been exploring the idea of building a simple, efficient and profitable direct specialty care practice once and for all,

One of the biggest challenges is simply knowing where to start. Most physicians were never taught the business side of medicine. So when you start thinking about direct care, you're left trying to figure out things like, how do I actually structure this? How do I price services that feel right? How do you paying patients actually find me? That's exactly why I created the Direct Care Society Launch Course. It's a 12 week self-paced program designed specifically for specialists who want to build

a sustainable direct care practice. It walks through the four pillars for success, such as discovering the right model, finding the right patient, pricing it right, and installing the right system for a lifetime of freedom from insurance. So if this is something you've been thinking about, you've been listening for a while, and you need one final sign to take a bet on yourself, well, here it is. This is the step-by-step framework

Tea Nguyen, DPM (15:08.098)

that details the four pillars to success and I'm officially opening it up for you, but you gotta act fast. Here's the catch, I'm offering a substantial early adopter discount to the next 20 doctors who go through the program in exchange for your feedback. My goal is to make this one of the most practical and effective programs available for specialists who want to launch and sustain a direct care practice. So I need your feedback.

Over the past few years, I've had the privilege to help many specialists just like you successfully launch their practice. One doctor said she made more in two days in her direct care practice than being employed. Another doctor was suddenly let go from her employment position and was able to open in under 12 weeks to see patients. And another doctor who said this is why he went into medicine in the first place. And he has already seen his practice grow in so many ways.

making a profit in his first month. This is a program that I wish I had when I opened my practice many years ago. It's everything I've learned since then now organized into a clear, self-paced course you can go through at your own pace. As an early adopter, you will have lifetime access to the course materials and updates, and I will continue to work with you until you see your first cash-paying patient. This program is designed to help you avoid many of the common mistakes

physicians make when trying to build a direct care model and move forward with much more clarity and confidence. I'm doing this intentionally so a small group can go through the material, implement it, and help shape the future of this community. Changing the experience in medicine starts with you. If you're ready to stop waiting for medicine to change and start building their practice made just for you, follow the link below to get started. 

I'm excited to be part of your journey. I'll talk to you again next week. Take care.