Tea Nguyen, DPM (00:54.616)

Hey there, doctors. It's spring around here in Santa Cruz, California. The weather has just turned and we had a heat wave and it felt very uncomfortable. And by uncomfortable, I mean, we've been pretty spoiled living by the beach side here. The weather around here typically runs pretty moderate year round from 68 to 72, 74 degrees. We had a heat wave and the heat wave was like 77 plus degrees Fahrenheit.

And I know some of you might be thinking, well, she's spoiled. And I would say I am. So we are in a new season and it got me thinking about spring cleaning. I'm doing a lot of spring cleaning around the house, decluttering, getting rid of stuff that just, you know, has been hiding for so long, taking up space. You know, it makes me thinking about the way we think about things too, that if we don't take inventory around our thoughts, our mindset, the things that we're choosing to believe is true, then it kind of just sits in your brain like clutter. And it can cause confusion. It can make you feel exhausted, tired, making decisions seem to get harder and harder every day because you're overwhelmed or overburdened with all these things in your brain. So in this episode, I want to help sort through some of the most common things that doctors tend to think about direct care that we need to sort out right away.

Because there are a lot of misconceptions out there. And if you stay stuck in believing that they are all true, then it's really hard to shift your practice from what we've all known, which is the insurance-based model, into a direct care model where doctors who are just done dealing with insurance and are finally taking charge of their own life. You need to have a different operating system. You need to think differently in order to have something different. But if you don't catch yourself annoying how to think differently, then you kind of just ruminate in those old thoughts and that's what's actually keeping you stuck. I was having an online conversation with a doctor who was frustrated with her reimbursement rate and she was asking how to navigate this problem. Now, I'm sure she was looking for a solution in how to code better, how to appeal it and how to make sure this doesn't happen again because it is so stressful to do all this low leverage work that's unbillable.

Tea Nguyen, DPM (03:22.126)

We're constantly having to check coding, call insurance administrators, write letters or appeals that may or may not get read in a timely fashion in order to get paid for work that's already been done. So in other sectors, they call the work unbillable work. But in medicine, we just make it part of our work culture. So when we do the thing, we feel productive. We feel like we are responsible for dealing with those insurance claims. But if you take a step back and you realize that this system will not fix itself and realize that doctors are just adapting to the system, something that we can't control, where rules are constantly changing, then you'll see that the system is problematic and we have to step out and create our very own system through direct care, through something else. By not contracting with companies that really don't care about doctors or they treat us like we're disposable and replaceable. So with that doctor, I had a lot of compassion, a lot of empathy because I wasn't too far away from where she was. Frustrated that she's not getting paid what she deserves. She's providing high value care, high technical expertise level care. There are people out there who are charging hundreds of dollars for their consulting fee.

Who are not doctors, who are not attorneys, who do not have advanced degrees, who did not spend a whole decade or more in knowing their craft. But they are charging really well. But when it comes to doctors and we try to charge what it actually costs, but we're doing this through insurance, there's just no way because insurance is a coupon code. The agreement is you're going to take their rate and that's all there is to it. That's what a contract is. It's unilateral.

So once you start realizing that you can do all of this unbillable work to try to claim a few more dollars in what you truly deserve, just realize that we're just doing more work that requires more effort, more stress, and there's no guarantee at the end of the day. Meanwhile, there are others who are on a different path, who stepped out of the system, who have a direct care practice, and their prices are clear, the value is understood,

Tea Nguyen, DPM (05:47.008)

And the doctor never fights to get paid. Okay. So these are two different models and the effort is the same. We both practice medicine, ethically, and evidence-based, but the direction is totally different. One trains you to tolerate friction. It trains you to work around the insurance, billing, the coding, the compliance and so on while the other removes it.

So at some point you have to ask yourself, are you solving the right problem or are you just working around getting better at it? So this is why I think direct care matters. It is a model that removes friction. It clears the clutter instead of having to do a workaround. Every time you fight with insurance for the patient, it's a new battle. It doesn't accumulate to make positive change. This system will not change. So there are five friction points that needs to be identified, needs to be named so that we can start sorting stuff out for what they truly are and declutter your mind so that you can have clarity and start thinking like a successful direct care doctor. So what are those beliefs that are holding doctors back from having a practice that they truly love that is efficient, it's profitable, and it's really fun to run? Doctors have said to me,

They think having a cash practice is having to push for sales for unfounded treatment. And I understand this point of view because if the only thing you've seen were businesses pushing stuff that you don't believe in, or maybe it wasn't part of your training, or you don't see any evidence behind it, you might be thinking they're selling something that doesn't work. Because why would somebody pay them more when you both have the same training, but you're taking a contract with insurance, which is supposed to be our safety net, and they aren't, but they're making more money. 

And so maybe there's a little bit of jealousy, or maybe there's just an automatic belief that we think that there's something special and that something special is that they're doing something sleazy. I admit it, the first time I heard about other practices making a lot of money, it made me think about, like, what are they doing that is so radically different from what I'm doing?

Tea Nguyen, DPM (08:09.27)

Yeah, it created some uneasiness within me. It revealed my insecurities. And so you have to check yourself when you start feeling that way. When you start jumping to conclusions that you think they're doing something that is unfounded, but they're making more money with less stress and you're sitting over here in survival mode. Yeah, it's easy to compare and assume, but I want you to kind of pull back and think about this. There are a lot of practices, whether you take insurance or not. doing unethical things, right? There are doctors who are taking insurance, but they're overbilling, for example, or they're coding incorrectly. And there are cash practices that are selling things that don't work. Two things can exist at the same time. That doesn't mean you have to follow that path. If you don't want to take insurance, but you want to be paid appropriately, and you're asking the patient to pay you directly, you can make money without taking insurance, without being unethical.

So it is not true that you have to push for sales, for unfounded treatments. You get to choose what you do in your business. You get to decide if you're going to recommend something or not. You call the shots. When you're working with insurance, it may feel hard to do that because oftentimes you make a recommendation and you're restricted. The insurance says it's not covered. Patients have a hard time digesting that information, even though they were the ones who chose their insurance.

We end up being the doormat for insurance companies. So they can't get mad at their insurance company because they don't have a door to knock on. But we do. And because we are so willing to help people, we are so willing to bend over backwards to ensure their wellbeing that we do end up absorbing a lot of the stuff that we have nothing to do with, which are the insurance regulations, the compliance issues, and et cetera, et cetera, right? It is not true that you have to push for sales for unfounded treatments. We just need to squash that right away. If you don't like that, don't do it. If you're an ethical doctor, don't do it. If you're somebody who's following along with me, you'll know I don't sell anything that I don't believe in or it doesn't work. Or I'm very transparent with patients. If they're the first one to experience something, if I bring in a new treatment, I'll tell them, you're the first patient who's going to have this treatment. Are you willing to take a chance on the science that I've looked up?

Tea Nguyen, DPM (10:37.504)

And do this with me because ultimately in my practice this is a partnership. This is not a top-down situation where you do as I say, not at all. It's do you trust me to take care of you? If they do, we proceed. If they don't, they can move on. This is how you have a simpler practice. This is how you make more money. You don't overcomplicate the system.

And a lot of people are already having problems with their insurance options and they're looking for a way out of their current problem. And they're ready to pay out of pocket. Those are the people who see practices like mine. And those are the people who I serve best. And there are many different models out there. There are people who offer a low monthly membership to get access to their medical care that is provided. And then there are people who sell big ticket packages. You decide. You're the boss. You own your practice.

And when you don't have insurance contracts, you can literally decide your price point, who you serve, the services you provide, whatever you want to do, it truly is up to you. So belief number two, you've heard this before, if you've been listening for a while, is that you will lose insurance patients. There is a deep attachment that we have with everyone that we've treated, regardless of their outcome, good or bad. We are human and I don't want you to forget that. Yes. you will be attached to your patients, but realize they will not be as attached to you. I'm sorry to be the one to tell you that if you didn't already know. So when you opt out of insurance, a lot of patients will not continue with you if you become cash. That's just how it goes. You have to take the risk if you truly want a different outcome. 

But here's the thing, some doctors know how to transition smoothly so that their revenue is not affected or it's minimally affected. Meaning if they were going from an insurance-based practice and they're trying to pivot out, they're offering cash services now, stuff that's not even covered by insurance anyway. And so they're building this financial bridge. So that is something that is a strategy that you can utilize if that's what you're thinking about. Now I will tell you, patients who come into a direct care practice, most of them do have insurance.

Tea Nguyen, DPM (12:56.002)

And so they are making an active choice to pay out of pocket for a reason. And when patients come through, if I need to write a prescription, a lab order, advanced imaging, or make referrals, they can still use their insurance to some capacity so that their expenses are minimized. So yes, you will lose some patients. But remember, if they chose you with their insurance, they didn't really choose you. They chose you through their plan. Whereas in a direct care practice,

Once they know I'm not in the plan and once they decide to work with me, they work with me for a very long time. And I never have to be concerned about them changing insurance because my doors will always be open for them. And they have the security in knowing that it doesn't matter where they are in life. They can just pick up the phone and give me a call or a text and I will be ready to serve them. Belief number three, direct care selects for wealthy people. Also not true. Wealthy people have the right

to choose what they want to do with their dollars. They don't splurge. That's how they became wealthy in the first place. They're actually very careful with their money. And I get lots of people who are farm workers, they're teachers, retired people on a fixed income. This is such a huge misconception about who chooses direct care. It is not just one income tax bracket. It is a whole spectrum. Once you offer direct pricing, this becomes honest pricing.

And it allows people the freedom to prioritize and plan and be prepared to pay. So this actually removes the barriers from patients. When they know the price of medical care and they can plan for it, and my favorite part is you as the doctor get paid the same day and they will never get a surprise bill. So the accounts receivable for us is always $0. And for them, peace of mind, the bill has been paid. They're not going to get a bill in the mail months later. I remember getting a bill from my pediatrician and I was frustrated because I was thinking, you luckily I have a job, but if I didn't have a job and financial circumstances change, I don't know if I would have been able to pay for it, right? And a lot of people go through that. They go through changes in their finances months later who may not be prepared to pay anymore. And I hate that uncertainty. And you can remove that uncertainty for your patients as well by having transparent pricing. Belief number four.

Tea Nguyen, DPM (15:22.198)

If I don't take insurance, patients won't see the value. Let's take a step back. There are people who don't have insurance. They still need medical care. There are people who have insurance but are high deductible. They still need medical care and fair pricing. There are people who have insurance, have tried their insurance options, still unsatisfied, still unresolved, looking for another option. There are many people to serve.

You have value in what you do if you believe in it. Believing is just step one. Step two is communicating that to a lay person who doesn't know your experience, who doesn't know the medical problem they have, who doesn't know what their future can look like once this problem goes away. So we need to paint the picture for the individual on how you solve their problem, regardless of how it gets paid. So you're talking about the solution to their problem.

First, creating a bridge of trust through the way you communicate the value to them and then giving them the choice to pay out of pocket. The value you provide is through the way you communicate. It's not validated by whether or not insurance will pay for it or not. This is just a skill that you can learn. Not everybody is going to understand this. So you have to be patient with yourself in learning about what the value is for them to get rid of the problem.

So if insurance pays for it, great. If it's a non-covered service, that's a bigger advantage for you as a direct care practice. And if you want nothing to do with insurance whatsoever, then you have to learn how to frame the solution that you offer in a way that gives them the value in return. So their return on their investment. So for example, if your treatment costs $2,000,

but it gives them back their life where they don't have to take off two weeks from work or even six weeks from a surgery, right? How much in dollars or opportunity is lost by not investing in that $2,000 treatment. So now we've crafted a visual, a story for them in a way that they can understand and that's the communication skill. And the last belief that we need to dismantle here today is I need to have everything perfect before I start.

Tea Nguyen, DPM (17:48.238)

Hold your hands up if you're an overthinker like me, where you think everything needs to be lined up perfectly. The website needs to be up. You need to have your business address. You gotta get your insurance. You gotta get a really nice logo. You think all of those things need to line up perfectly before you start seeing patients. And the friction point here often is paralysis by analysis, they say. It's a cute wordplay or information overwhelm where you're completely stuck in having too much information because you're seeking information, you're absorbing, you're consuming, but you're not taking action, which is the thing that's going to help you learn and decide for you when you look at the data. But all of us are going to be guilty of this, myself included, thinking that we have to have everything hyper prepared. 

We are hyper vigilant people, especially if you are taking care of patients and they're going to take a medication that has side effects or you provide a procedure or surgery that may have really negative outcomes despite the best of your doings. So in medicine, there is a level of perfectionism that is expected and I'm going to brace you for what I'm about to say and that is in business, you have more flexibility. I hope that takes the weight off your shoulders that you don't have to be perfect to have a thriving business. You just gotta do the work and you gotta collect the data and you gotta interpret the data of what it means and not personalize it and make it mean something about yourself if it didn't work the first time around. So there's a lot more leeway when it comes to business ownership. You don't have to have everything lined up. Some of us didn't have that luxury. Some of us just lost our jobs and were scrambling.

And the next thing you know, two, three months in, they have a direct care practice. Why? Because they did the work. They didn't take a year to think about it. They didn't wait around for somebody to give it to them. They got to work. They did the thing. They didn't let fear overcome the next necessary step. That's not to say you are not allowed a period of grieving. You absolutely can and should be able to take some space between one job to the next and really decide what you want.

Tea Nguyen, DPM (20:14.008)

But all I'm saying here is you don't have to have everything perfect before you start. And you'll see once you get started, what you thought how things were going to go doesn't always go your way. So you also have to be flexible in the way it takes you to get there, but don't lose sight of the goal. I hope that makes sense. So I broke down the five beliefs you have to dismantle. And just to recap, the first one, you have to push sales for unfounded treatments is false, only sell what you believe in, there is true value in what you already do. Belief number two, you will lose insurance patients and that's okay because the right ones will come through. Belief number three, direct care selects for just the wealthy people. Totally false. Ask any one of the doctors on this podcast, anywhere else in the wild. We see the whole spectrum of people regardless of their income and it's not like we ever really know.

We don't ask for their tax returns, right? How would you know? Belief number four, if you don't take insurance, patients won't see the value. Also false, value is an experience. It is not validated by insurance. And then belief number five, I need to have everything perfect before I start. And that's the thing that's gonna hold you back if you want to believe that. And the reality is in business, you gotta start to learn. So the clarity comes through your action not the preparation. So be flexible with how you need to learn the lesson. 

I hope today's episode gave you a fresh perspective and it inspires you to remove the mental clutter that might be holding you back in your practice. I'll catch you next week. Take care. 

Hey, docs. I'm finally ready to share some exciting news. If you've been listening and thinking, I want 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?

Tea Nguyen, DPM (22:37.698)

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 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.