Tea Nguyen, DPM (00:53.91)

A doctor asked me this, I work in an MSO. This is the management service organization where they handle non-medical operations. It allows a doctor to be the doctor. And she's asking, I'm thinking about branching out on my own. What do I start with first? If that's you, here's one thing to master before you start listing off the prices of your services in your new practice. Now MSOs sound like a good option for many.

It's where they handle the non-medical operations. It's hiring, the paperwork, the insurance contracts, the systems that it takes to uphold a medical practice. But for some, and even if it's not an MSO, it's like a traditional private practice. Like where I came from, I took a job where the systems were already in place, the funnels were in there, the insurance referral patterns were there. It was a nice setup, but the thing that I didn't have control over was my schedule.

my time and the staff and the staff thing really bothered me because it's really hard to have a cohesive experience for the patient if the staff is not on the same page as you. And especially if they're getting turned around from one doctor's protocol to another. So there's a whole different layer involved when you're in that kind of a setup. And so it's not uncommon for a doctor to say, I don't like this setup. Can I do it better on my own?

And my short answer to that is, of course you can. But here are a few things you gotta learn. So in this episode, I'm gonna be talking about the one very specific thing I teach all of the doctors to know, to work on, so that they can have a thriving direct care practice. There are actually two parts, right? You gotta have a funnel. Where do patients hear from you? That is a marketing strategy. But the one I'm going to focus on here today is this question.

Can you sell your services? Can you sell your medical services? It's having the discussion of how much does your stuff cost? It's navigating questions like why isn't this covered by insurance or why don't you take insurance or ooh, that sounds expensive. Those are conversations that we were never taught to have, but you need to master them in order to move effectively within your practice and to grow it in a way where you're truly independent from insurance.

Tea Nguyen, DPM (03:17.538)

Now, if I was the kind of person who found a job and it was within a company where we were both aligned, their vision is aligned with what I have to offer and what I want to give is aligned with where they can take me, I would totally be an employed doctor. But I didn't have that. I didn't have that in my location where I wanted to live, where I was having my family. But I love the idea of stability, a stable income having designated time off every year so that it's predictable, being able to co-direct a business's vision, like I would totally be all in. I have the skillset for this. A true partnership is what I deeply crave, but it just didn't exist for me. And therefore, I had no other choice but to build a business for myself. And so I share that to let you know that I never really envisioned myself owning a medical practice.

I thought about it, I've gone to private practice conferences, like it was a tickle in my brain to say, that could be possible, cool, let me park it in the backseat. But for the longest time, I avoided it because it was easier to look for a job. It was easier to keep my head down and let people create the systems and I just show up and do my medical stuff. But the compromise was it never really fit my lifestyle. It never really fit me and the stuff I wanted to do.

It's like a square peg shoving it into a circle. It will not fit unless something gets compromised. And I don't like compromises and I'm unapologetic about that. So here I am with my very own platform sharing with doctors that you don't really need a whole lot to start your medical practice. There are just a few skills to master which do not require formalized training. It does not require

a business degree, but if you want that, you can totally have that. This type of practice, a direct care practice that's less dependent on insurance or independent from insurance requires vision forecasting and grit. Now I'll say this though, as long as you're willing to learn from your experiences, you will always be on track. There really isn't a wrong way as much as it is the lesson that you needed to learn. Of course, if you want to take the shorter path,

Tea Nguyen, DPM (05:39.382)

Listen to the people who are already doing it, who have already done it. But skepticism, ego, fear, all those things, they can get in the way. But if you're learning, then it was never really a wrong choice. It was a necessary lesson. Otherwise, you wouldn't have chosen it. Everything happens for a reason, and it does work out in the end. So when this doctor reached out to ask me, how do I do this? What do I need to know? Oftentimes, I'm thinking in terms of a checklist, the location, the hiring process, what equipment do you use, the cost of things, do I need to take out a business loan, what vendors do I use and so on. Like these questions all matter, but I would actually strip it down to this one thing. Can you sell your services? Because if you can't, you don't have a business. Businesses solve problems for people who are willing to pay it. Think of all the different business services you've reached out for, maybe a gardener, babysitter, the person to cut your hair, these are all service-based industries. You had a problem and you were willing to pay for it and therefore the business transaction took place. Those people were able to sell their services, you can too. Now in medicine, we forget that someone is always paying, even if it's not directly to the doctor, it's convoluted. There's a third party. They're deciding what they're going to reimburse the doctors, the facilities.

There are insurance premiums people are paying into. There are copays, there are deductibles. So the payment is indirect between the two people who need to make medicine happen, the patient and the doctor. And when there's interference, when there's something in between the two, that sacred relationship gets eroded. We've all witnessed it. You see that the patients need a thing and they gotta go through their insurance to find the person who can help them.

But then the people don't get what they're paying for. They're not getting the time with their doctors. They're not getting meds or treatments covered. They're not getting a whole lot of time with doctors because in their insurance-based model, it's a volume-based model. You've got to see 20, 30, 50, I've even heard of 70 patients a day per healthcare professional. That's insane, but that happens. You got to see lots of people to make the money. And that's what happens in the system. Time is cut short because

Tea Nguyen, DPM (08:03.0)

To make more money, you've got to see more people. You've got to build more codes. So what happens is this relationship that was once sacred is now transactional. People are not getting what they need from their medical care. They leave frustrated, confused. They go online, Google, AI, whatever tool is now at their disposal and their doctor shopping. Because no one's really spending the time with them that they need. Or if the doctors are spending the time that they need, the system is so constrained that time is limited. Doctors are doing the very best with what they have, with the resources that they're given. But in the constrained model, it gets more difficult to take care of patients. And that's why even doctors who have a full schedule, even doctors who are employed, they're getting paid every two weeks, are still frustrated. They don't like the system they're in because they don't have autonomy. So anyway, going back to this idea of this third party interference between the patient and the physician.

That is why people who don't pay directly, they don't have skin in the game. They're not paying the doctor for that time. Their time is truncated and they're asking for more of it. They're demanding more of it. They're becoming entitled to free care. That's how we end up with endless inbox messages. Patients are getting frustrated that whatever treatment or medication was recommended, it's not covered or it's too expensive. And now the doctor has to backtrack and review the history and remember what that conversation was even about to create, to offer alternatives. All this is very time consuming. And of course you multiply that with your long patient list of 30 plus a day. It's no wonder there is moral injury. It's no wonder that the doctors are feeling the crush. They wanna regain their power. These doctors, they wanna start their own practice. They wanna make the call. They wanna see certain pathologies. They wanna eliminate certain pathologies.

They just want to get paid. They just want to take care of patients. And I know that's why you're here. doctors, we are getting crushed. It's called death by a thousand clicks, metrics, check boxes, compliance, whatever, right? And so now in this broken system, we've got two disconnected parties, both frustrated by the same thing, medical care that is just not good enough, not enough time, not enough quality. So the care is fragmented and the doctor wants to leave clinical practice and the patient goes around doctor shopping until they can get what they want.

Tea Nguyen, DPM (10:31.342)

So the problem is the system is broken, it's disconnected. The solution to that is what? The doctors must take the lead and create their own system. That is why direct care exists. We are filling a gap. In our current healthcare system, where it's broken, there are gaps to fill, and that's why we exist. That's why we have been growing exponentially. So we all recognize the problem.

So the solution is to become less dependent on insurance reimbursements in private practice, finding a way where revenue is reliable, restoring the trust so that patients actually get better and doctors have work fulfillment. Because now their work feels sustainable. It feels more valuable. It feels more meaningful. So what does that take? Doctors need to know how to sell their services directly to the consumer.

The patient. can no longer hide behind the insurance paywall on whether or not they will pay for that code or this code or that modifier. Now this is going to feel weird. Not because you're bad at it, but because no one's ever taught us how to have these conversations. We were told we don't talk about money, but then suddenly our income never meets its fullest potential or our work satisfaction doesn't exist. We're not satisfied.

And here's the thing, doctors who don't know how to talk about money are easier to underpay. But you can take control of that narrative right now. So if you're employed and you want to know what it really takes to run your own medical practice, it starts with having a well-crafted package service. Now, does that sound weird to you? It should, because all of us were trained in a system where we had an ICD-10 code followed by a CPT code.

followed by whatever new modifier they decided to implement in order for you to get paid for that service. So we're providing transactional care, itemized care. Every visit, every treatment, every recommendation, there's a code associated with that. And it makes it really hard to have a clear picture for the patient on what they need. It's kind of like you go to the grocery store, you wanna bake a cake.

Tea Nguyen, DPM (12:50.168)

but you gotta pick up the sugar over here, you gotta get the flour over there, and then maybe you gotta throw in some fruit or whatever additives in it, right? So you're shopping around and then you're confused, tired, exhausted, perhaps, lots of decisions to make versus just buying the box thing that has everything in it, right? The convenience of that, it's easy, it's accessible, it's a no-brainer. And that's what you're doing when you're creating bundled care or a package service.

And for some specialists, you're doing a membership where you don't have to do any thinking as long as you're a patient and you pay the monthly membership fee, all of the medical services are included. And that totally happens in specialty care. That is something that I have in my podiatry practice. So for example, if I'm doing preventive foot care for individuals who are older, they've got PBD, they've got complex foot problems, they can't go anywhere else, they need to be seen once a month, I have a preventive foot care package or a membership.

So they pay into this once a year, they get year long access, one visit per month. If they happen to sprain an ankle, they just need a quick workup. do that, I don't charge additional for that. It's just the value of being part of my practice. Because oftentimes they also have insurance, but with their insurance options, it might take weeks to months to be seen. So that's an added value of being part of my practice. So that's one thing I offer. But I also do offer an end point.

service treatments. If somebody has heel pain, for example, this is a limited time treatment. They get shockwave, injections, lasers, prescriptions, whatever. That is a package they can get. Custom orthotics is another one for us. So they sound the same. They're similar, but they have different purposes. One is longevity. The other is episodic, requiring a few office visits. Okay. So now that you have an idea of what a package service could be for your specialty,

You really want to think about how you're going to create your menu item. Menu item meaning pay per visit, pay as you need, fee for service. Many doctors will start there, but will find that their revenue doesn't really get high enough or fast enough. Many doctors will find that doing fee for service takes a long time to generate the money that they want to make. So if you want to exponentially grow your cash flow, then the package

Tea Nguyen, DPM (15:13.248)

The offer is a no-brainer because instead of selling a $200 visit, you're selling now a $2,000 service plan. So here's what happens when you can articulate the value of your packaged services. Four things come to mind. First, your revenue becomes easier. You can multiply it faster. You don't need a lot of patience for this. You just need a few high quality patients to make this work. Now that doesn't mean you eliminate other people who maybe don't need the package or want the package.

It just means that your focus is a lot more narrow, which allows you to exponentially grow your cash flow. Number two, your systems get easier, meaning you're just selling the same thing over and over again. So you're repeating your conversation. You are addressing the clients or the patients' objections. You're learning the script. You're building the script. You're having conversations that flow easier. And ultimately, when you get to this place, you can then train your staff on fewer protocols your system becomes easier. Number three, when there is a clear guided plan, your patients commit. Because you're not giving them a laundry list of different services, you're not sending them off to the grocery store to pick different ingredients to bake a specific cake. Instead, you've given them all of the ingredients to your cake, the very cake that you make over and over again that everybody else loves. Now you can personalize this per patient, but the goal is the framework.

is to create a type of plan that patients can understand, it gets them excited, and that's how they commit. And that's when they're willing to pay out of pocket, like big money out of pocket, because you've shown your leadership, you've shown them that you're the right person for their care, because you've made life so much more easier for them. That's when people pay good money. And number four, once people know exactly what you do, and that you can indeed deliver a high quality service, they tell others, people just like them with the similar pathology, with the same patient psychographic, the type of buying behavior, they all hang out together, you know. So this will naturally filter for your favorite kind of patient and your favorite kind of pathology. Now, if this sounds good to you, I wanna invite you to start investing in yourself to learn about how to curate your direct care packages.

Tea Nguyen, DPM (17:36.704)

I periodically host a 90-minute workshop where doctors are leaving with a package plan and they're comfortably charging $2,000, $5,000 offers to the patients that they're excited about, all from practicing good medicine. They're not selling anything they don't believe in. There's nothing scammy about this. It's just in the way that you've put it all together on a silver platter, removing that decision fatigue for the patient, and helping them commit to a clear guided plan. So if you're a doctor who's not ready to burn it all down, you're not ready to quit your job, drop all of your insurances, which by the way, I don't recommend, don't do anything cold turkey, unless you have a well thought out financial plan to do so, one step at a time. The simplest first step to take is learning how to sell your services in an intentional and thoughtful way so that you don't come off as sleazy,

You don't come off as someone who's pushy. You're just selling and practicing good medical care. Doctors who attend the workshop all walk away with one high value package service that they are selling the next business day or as soon as they're opening their direct specialty care practice. So there you have it. If you are currently employed or in a situation where you're thinking about running your own practice, learn how to sell your stuff.

Learn how to navigate those really awkward conversations and practice being uncomfortable. The workshop is there for you to do all three of the above, to create it, to navigate questions and to practice. Hop onto my email list to be the first to know when the next session takes place. Link will be down in the show notes. I will host these for as long as there is interest. It's one of my favorite ones to host because it's a small intimate group. I help every single person who shows up.

And at the end, you get a real framework where there is no upper limit to how much you can charge. That is entirely up to you. Thanks so much for joining me today. I'll chat with you again next week. Take care. One last thing. If you've been listening and saying to yourself, I want a direct care practice, but you're overwhelmed and you don't know where to start, keep listening because I've got something for you. Most physicians were never taught the business side of medicine.

Tea Nguyen, DPM (19:59.182)

So when you start thinking about direct care, you're stuck on questions like, how do I actually structure this? How do I price services that actually feel right? How do you cash paying patients even find me? That's exactly why I created the Direct Care Launch Course. Just like your treatment plans, success starts with knowing what to do and when, and navigating the doubts and fears that inevitably creep up along the way. The Direct Care Launch Course is a 12 week self-paced program built specifically for specialists who want a sustainable direct care practice. It walks you through the four pillars. First, finding the right model, membership or fee for service. Second, finding the right patient. Third, pricing it right. And four, installing the right systems for a lifetime of freedom from insurance. Over the past few years, I've had the privilege of helping specialists just like you launch their practice. One doctor said she made more in two days as a direct care specialist than she did as an associate.

Another doctor was let go from her employment situation and opened up her cash pay practice in just under 12 weeks with no prior business experience. And another doctor turned a profit in his very first month just by following the structure I laid out in the course. This is the program I wish I had when I opened my practice years ago. Everything I've learned since then is organized into a clear self-paced path you can move through at your own pace.

It's built to help you skip the common mistakes physicians make building their direct care practice. So you move forward with clarity and confidence instead. And right now listeners get an extra bonus. You will receive an additional three months of live coaching calls valued at $3,600, which will be included at no extra cost because this is a summertime special. That information is not going to be seen at the checkout link because it's a surprise bonus just for you.

All you have to do is follow the link down in the show notes and if it's still available, that means you will also get the free live coaching calls. Changing your experience in medicine starts with a proven plan that has already worked for others. This is the kind of practice that'll last you a lifetime. I'm so grateful that you're here learning about direct care. If you're waiting for a sign, this is it. Follow the links below and I'll talk with you again next week. Take care for now.