Tea Nguyen, DPM (00:54.03)

Do you ever catch yourself saying, I feel like I need an MBA to run a successful private practice? This is one of many distractions that will ultimately delay the success of your business. Today you're going to understand that running a direct care practice does not require another six-figure debt. And I'm not knocking on advanced education. If you want to get an MBA and have the means to do so, and you want to create those connections, I think that's incredibly valuable. But you have to ask yourself,

If you're saying this in regards to creating a direct care practice, you want to know what you will actually gain and if it's really going to teach you what you need to know to set yourself up for success, or is this just a way to delay the inevitable hard work that you have to do? Today's episode is about confronting the I don't know enough type of lies, which keeps you stuck in indecision.

It's actually not uncommon where I talk to another doctor who is new to the idea of a dirt care practice and I'm sharing all the insights as to what is needed to create one. And then they get overwhelmed. And then they start saying things like, we were never taught this. We never knew. I feel like I need to go to business school in order to know these things. And the thing is, you totally can, but I'm gonna break it down for you here in this episode in about 20 minutes or less because

The reality is there are a lot of direct care doctors who never had an MBA and they are thriving because this model is so simple. But what does it need? It really comes down to having an offer. It's telling people what you do, who it's for, and the price tag. It's a way for you to convey value to complete strangers. Last week I hosted a workshop to help doctors craft one direct pay package, and it was so fun.

And it was for me always a joy for when that light bulb goes off and doctors just see and they understand the value that packages have instead of selling one-off services. And it dawned on me that no one really taught us this. No one taught us what an offer actually is. We were just told to get the medical degree, open up shop, and people will come in because you're the specialist of this thing. But when you're a specialist of many things, your message in order

Tea Nguyen, DPM (03:18.22)

marketing gets diluted, which means when people speak of your name in different circles and you don't have a clear offer, they don't really know what you do, which means they don't come to see you because it's confusing, or they find somebody else who has a better offer because their messaging was much more clear. So if you don't have an offer, you end up defaulting and competing on the price points. And as you know, if you compete on prices, everybody loses.

But with a clear offer, which is essentially your unique selling proposition, when that is strong, you will grow faster. Your money will multiply faster. Because when people can pinpoint exactly what it is that you do and who you do it for, and then the price point for that, it makes it so much easier for the consumer to say, Yep, that's the doctor who does the thing. I want to see them. When I ask doctors, what problem do you solve? I often hear doctors explain to me.

The cost of their services, they're pulling up their price sheet, they're sharing their credentials or how long they've been in practice, why they hate insurance, all the things, except for answering the question. And listen, I love having conversations with doctors. I love sharing the hate or distaste of the healthcare problems that we're having right now. But when I'm asking you a specific question, it's really for you to see how much more room there is to grow.

in this space because if you don't know what your offer is, we gotta create one. So I will share with you in this episode what comprises an incredible offer that people are willing to pay out of pocket for. And so don't feel bad if you don't know what the offer is. That's what I'm here for. I'm gonna lay it all out for you to know exactly what's in it so that you can start having these conversations with people so that when somebody else asks you, what do you do, you can say it seamlessly in less than 30 seconds.

And people will say, you're the doctor who does this thing. Specificity is very important. And let's take an example of that. If you drive an electric car and you're asking around for where you should get your car serviced, would you choose a place that takes care of all of the different cars, gas, diesel, electric? Or would you prefer to choose the one that knows electric cars specifically?

Tea Nguyen, DPM (05:39.042)

The answer is most likely the more specific one. And people are like that with medical services too. The more specific you can be about what you do and who it's best for, the more of that will stick and resonate with others. Okay, so what is actually an offer? An offer is not a general statement of what you do. So for example, if I say I treat all foot and ankle problems, that's not really an offer. I'm not being very specific. I'm not saying the problems

that I specifically solve for. I'm just saying what I do. And that is very different what you do from what you offer. The offer is what do I get and what do I need to pay to get it? Indirect care, there are three specific types of offers. So broadly speaking, the first one is when you offer a la carte, which means you're offering all of your menu items, like a restaurant, every little thing

Has a price point with it. You do an office visit, there's a price point for that. You do x-rays, you do advanced imaging, you do an injection, you do manipulation. All of these things end up having a price point. It's pick and choose as you go. The second type of offer is you're offering access. So this comes in the way of an annual membership where access to you and all that you offer comes at one single price point or monthly price points. Or

A monthly membership, kind of like a gym membership. You have access to everything that's in there. And the third type of offer is an offer for a transformation or an outcome, which is a service-specific package. So maybe you do pain relief or weight loss or headache care, you manage fatigue, menopause care, and so on. That has an outcome. So in episode 224, I went into depth.

As to how doing things a la carte or also known as fee for service, that is going to keep a lot of practices stuck because there's no recurring revenue. And it's just more expensive to leave the door open and hoping the patients will either come in or come back. So every time you take care of a patient and their problem goes away because you treated them, the cycle to obtain a new patient is just generally more expensive to acquire. And it takes more effort to get the next one.

Tea Nguyen, DPM (08:07.166)

In. So won't go into further detail about a la carte pricing because it's not really what's going to move your practice towards financial sustainability. You can start there and over time learn what really works for your practice, but I don't want you to end there. Because if you want more money in your practice with less effort, it's really the membership or the package that helps you stay sustainable. So let's talk about your offer as a membership.

Maybe you're charging monthly or annually for access. So let me just clarify the difference between concierge versus direct care. They're not the same. Traditionally, concierge means that you bill insurance and you charge an annual retainer. That's not truly direct care or direct primary care. Direct primary care for primary care doctors means that there is no insurance involved in billing the patient.

Patients may still use their insurance to obtain medications, lab, advanced imagings, and referrals, but within the practice, it's self-pay through a membership. It could be monthly or annually. But for specialists, we don't always necessarily have longevity in our membership. Like it doesn't make sense to charge annual membership if we are specialists for certain things. That doesn't apply broadly. For example, I know of a neurologist who does.

Annual memberships because she's managing something long term, like Parkinson's, for example, or headache medicine, or even endocrinologists who manage patients with long term issues. That's not what I'm really getting at here. What makes more sense for specialists like mine and many others is creating packages that have an endpoint. Now, asterisks here. There's a little bit of nuance. I do have patients who have seen me for seven plus years.

on a monthly membership schedule because they need help with their feet. So I do have a portion of that in my practice. But predominantly the higher ticket items are the packages for pain. So injection therapy, for example, is something that I've been doing and it's been really nice to bring in additional revenue. So that brings me to point number three, packaging for a transformation or an endpoint. Realize that people aren't necessarily buying

Tea Nguyen, DPM (10:29.026)

your time. Unless you're a therapist, a psychologist, or even a psychic, most of us in specialty care aren't selling our time. Patients want to get to the end point. They want to have a solution to their problem. And again, there's a little bit of nuance. There are apps like BetterHelp, which is an app that connects people with therapists, they're functioning on a monthly membership as well. So you can't just pay as you go. You're paying for access to those

Services. And yes, I did say psychic because you gotta check out their business model. Many are charging fifteen dollars a minute, fifteen dollars a minute to contact a psychic for their services. And I bring that up because it's it's kind of funny, it's kind of cool at the same time. It's a big business industry and it's a fun conversation for another time. But nonetheless, business is just business.

So when you're putting together a price package, you are selling the outcome. People don't really know or care how many minutes it's going to take to be out of that problem, out of that pain. They just want to know, can you help? And what does that actually look like? They want a plan. So people buy into a plan that keeps them accountable and keeps them on track. They want to know and understand what the timeline is going to look like and

reasonable expectations. Now if you leave them out to come back as you need, you're basically leaving them out in the cold because most people don't want to be at the doctor's office. But if you create a well thought out plan, you walk them through what is expected in which you have already helped others be successful in, and then you package that like like a little gift basket and you just hand it over to them, that becomes a no brainer. You slap on a price tag.

And what you're selling there is your expertise, your experience, and the convenience in getting better. And yes, as you know, people buy things for convenience, for not having to guess, and for not wasting more time and money. And in that, when you're creating this value, that's how you create more cash flow in your practice. So instead of hoping that the next new patient walks in and pays your $200 visit.

Tea Nguyen, DPM (12:52.428)

I'm just throwing out a random number out there. You can actually create a valuable package for $2,500. Why? Because you're selling a transformation. And that comes from your expertise and your experiences. This is your magical recipe. And that means that you can throw in there whatever you feel the patient will need in order to get the outcome they're seeking. I'm hoping this makes sense. So as a podiatrist,

An example is I sell an injection package, but I'm not just selling the injection. I'm selling them the diagnostics, so ultrasound imaging. I'm assuring that we're on track on the right diagnosis, or I'm interpreting their MRIs. I'm also giving them a plan that includes laser therapy, shockwave therapy. I'm also counseling them on nutrition and stress management. So these are all of my experiences and which I know have helped people.

get out of their pain cycle. So that is a transformation. That is a package that I sell. At minimum, $2,500. And I've spoken to doctors in pain specialty areas and they're charging $14,000 for this type of care. And when you understand the value that goes into that, it becomes a no-brainer for the patient that they're choosing that because the plan is clear.

Remember that you're not selling your time as much as you are selling the outcome, the time that they save working with you. Because remember, you know a thing or two about your area of expertise. So the offer is a solution-based package that has a price tag. So this episode is really focused on creating a package that does have an endpoint. And that could be a short-term care package or it could be long-term. It depends on the problem you're trying to solve. So let me set you up on

Thinking or refining your offer because with your offer, you also need to clearly communicate the value that they receive, which means you have to address objections, reasons why they're hesitating. And you don't just stop when they say, I'm on a fixed budget. Okay? That's an invitation to get clear. Is that what they really meant? Or did I say something that kind of went over their head and it needs to be revisited? Patients don't want to

Tea Nguyen, DPM (15:13.496)

Pretend that they don't understand sometimes. It's like an ego thing. They nod their head. It looks like they're getting it, but sometimes they're not. And it comes in the way of an objection. And I hate to be the first one to tell you, but people aren't always truthful. They often hide the truth underneath a convenient excuse like, I can't afford that, or I'm on a fixed budget. I'm just saying.

I have been in the same exact situation where my office visit of two hundred and seventy five dollars was deemed too expensive, but in the same breath where we started talking about the problem, and this person wanted that problem to go away, I made my offer, which was a two thousand dollar package, and guess what? They were like, just charge the card on file. So communication is everything. This is the art of medicine.

All right, I promised you there would be a structure for an offer. And there are six parts that you can easily write down right now and walk away with something to offer your patients. Number one, you want to get clear on the problem you solve, a specific problem you solve. Not just I treat everything underneath the sun. Please don't say that. But pick one problem that you can solve. If you do pain, then it would be I fix pain problems of this body part as a specialist.

Pick one problem and stick to that for now. Pick the one that you do a lot of because you really want to anchor your practice with one specific package that you will then be known for. That's not to say you can't have a bunch of different packages to sell. You just want to get very clear on the one. Number two, define the outcome. Define the outcome of that problem you solve. So for me, I have a heel pain package and the outcome is no heel pain, right?

So define it. You can walk better, you can have a better quality of life, you won't have aches first thing in the morning. So you're being very specific about the outcome or the transformation of this package. Number three, the timeline. What is an estimated timeline or what does healing look like for them? In regenerative medicine, the timeline typically might be at six weeks, you are 50% improved.

Tea Nguyen, DPM (17:36.78)

That gives the patient an idea of how long this is gonna go on for and it gives them a relief that there is an endpoint inside. It may not be perfect at six weeks, but as you know, surgery, we can do our best guesstimation and help them along this journey because healing is not linear. It takes time, accidents happen, we have a misstep in our nutritional planning and so on. Right? So just a general timeline is kind of what we're going for.

Number four, give them a convenient experience. If you're doing pain management, I'm just using that as an example. There are many other examples. This one's just simple because with pain, people want to be out of pain, right? But what does it take to actually get out of pain? For me, with foot and ankle stuff, it's going to include laser treatment. It's going to include orthotics. It's going to include

you know, pain, creams, whatever. And I'm not trying to create a whole big package of everything that's confusing. I'm just picking a few select things that I know most patients will benefit from. And so now I'm packaging that as a gift basket. So it's a convenient experience for the patient. So they've got diagnostics included, they've got immediate pain relief, they've got long term relief with injections. And then they have, you know, some ancillary extra nice things to have.

Number five, you are now going to put a price tag on that. And if your price tag is very high, and I say that in air quotes, price is always relative. And if you feel that the price tag is too high, you can offer a payment plan. For me, I don't necessarily offer payment plans because my packages are intended to look like a cost saving option. So instead of coming per visit,

The packages actually save them money and time. So that's gonna be up to you if you wanna do a payment plan or not. I know for surgeons, there are payment plans like care, credit, and a few others, because their price points are like $5,000, $10,000, $20,000 and so on, then payment plans make sense. Nonetheless, have one clear price and maybe a payment plan. And number six, do not skip this part. Hold space.

Tea Nguyen, DPM (20:00.568)

For those difficult conversations, when they come back to say, that sounds expensive, I don't have the money for that. I'm on a fixed budget. I don't have the time. I'm not sure this is for me. Don't fold, don't walk away. Get curious. Dig deep. Remember, people just say things as a convenient excuse to escape this discomfort. But for you as the physician who has the authority to help people, you have the knowledge to help people.

You also have to develop this emotional intelligence and hold space for these very difficult conversations. And I'm not talking about difficult conversations about a bad diagnosis. I'm talking about that difficult conversation around money. Because I know a lot of doctors have difficult conversations around money. So this is where you hold the space and get curious because you're either spending money now or you're gonna spend money later. And the longer people wait to solve a problem, the more expensive it gets.

So you want to make sure you hold space for these difficult conversations to really get curious as to what is holding them back because sometimes it's just clarity. They were unclear or they were scared or whatever it is, you want to dig into what it was that needs clarification. So at this point, you know exactly what an offer is. It's the problem you solve, it's a defined outcome, there's a timeline, you're packaging it in a convenient way.

Way so that they have a convenient experience. You're providing one clear price, and then you're holding space for difficult conversations, which means you're one step closer to building your sustainable direct care practice without relying on a constant renewal of patients for a lower price. The gap between a struggling practice and a thriving one is not the credentials, it's clarity. It's clarity on what you're offering and who it's for.

And why it's worth it. And when you get this right, pricing conversations stop feeling like a fight. It stops feeling awkward and it starts feeling like a natural part of a conversation to help the patient be fully informed. If something in this episode landed, if you heard yourself in any of it, you don't have to figure out the next step. The Direct Care Launch Lab is an eight week program where I personally work with specialists to move from thinking about direct care to actually building it. Not someday.

Tea Nguyen, DPM (22:27.702)

Right now. The link will be down in the show notes. If you're ready to meet the version of yourself who makes this happen, come find me there and let's get started today. Thank you so much for being here with me. I'll check in with you next week. Take care. 

Thank you for listening to the Direct Care Podcast for Specialists.