Tea Nguyen, DPM (00:53.57)

Hey there. If you're new here, welcome to the podcast. If you've been listening for a while, I'm so glad you're still here with me. It's been about four years since I started this podcast, and I think the information I provide here is mostly the same. And I might as well give you some updates as to what life is looking like over here. I just got back from a trip. I went to Norway and Amsterdam with a girlfriend. This was a fun trip, not a business trip.

So I had a lot of free play and this was good timing for me because you may have already heard from me online, in person, in a different episode, that I'm going through a divorce. And so this is kind of the closing end of that event, of this life event that I'm happy to share now because I'm in a better place. While it was heartbreaking to go through and it's not something that I would just do mindlessly, I do feel a lot lighter these days.

And I share that because I think we have a way of teaching ourselves to compartmentalizing work and life, but they are well integrated. So you may find in your circumstances that your personal stuff leaks over to your business stuff and vice versa, your business stuff leaks over into your personal stuff. So it doesn't really make sense to isolate the two.

I'm here to provide you with a more holistic point of view that everything is integrated, so everything matters. Although it's been hard to digest, I am processing it and you're kind of witnessing how I'm processing the turn of events here. So things are good, things are lightening up. And what I want to do for you here today is to help you think about your practice a little bit differently. Whether you're employed or you have an insurance-based practice.

My job here is to deliver information that is practical so that you can move into a mental space where you think like a direct care doctor. You may not realize this, but the insurance based model has you thinking a certain way. And the direct care model has you thinking differently, different from our training. And so I've taken it upon myself to help you see through that so that you can ultimately get on the other side. So before you can have direct care.

Tea Nguyen, DPM (03:13.038)

Practice, you need to start thinking like a direct care doctor. And this is a lot like your residency training. There is a prerequisite before the training makes sense, right? So there's medical school before you get your hands-on surgical or advanced training in residency, before any of this stuff makes sense. And I would say direct care is exactly like that. When you have a direct care practice, sure, you can open the doors.

Have an LLC, have the bank account ready to go, but if you still think with the insurance mindset, your practice will stay stuck. So in this episode, I'm going to reveal four specific beliefs that will help you move away from the insurance mindset, one that we're all trained in, into thinking like the doctor who has a thriving direct care practice. So the first one here is number one, there is a belief.

That seeing more patients will equal more revenue. And of course, that makes sense, right? Because the insurance model is based on CPT codes. And those are the ways we measure how much money we're going to get paid. We also believe that busyness is equated to profitability because of the volume. So in the insurance-based practice, we know we have to see a lot of patients.

To make money. That's just math, right? But what we're seeing over time is the reimbursements are also going down, but the cost of running the business is going up. So how do we make the math work? How do we make more profits instead of it getting eaten away? In the insurance model, it is not unusual to see 20 to 70 patients a day as a norm. And that varies between specialists, but yes, I've heard of specialists being very proud of their productivity because they're seeing a lot of patients. Now, how can they see 70 patients a day? That's a story for another time. But the point is the insurance-based model, because of the way we are getting reimbursed, requires more effort. It requires more people to see more procedures, more volume. And that mentality is not true in direct care.

Tea Nguyen, DPM (05:37.122)

We don't have to see a lot of patients to make the same amount of money. And for some of you, that might sound a little bit wild because you might have some feelings around how we charge patients. And I think the math is obvious. If you want to make the same amount of money and it comes in a way of seeing fewer patients, then the obvious answer is charge more. But I know a lot of doctors who hear that are gonna feel some kind of way around charging.

More when insurance can pay the doctor less. So, right off the bat, the discomfort with charging patients for more has a lot to do with the inner dialogue you have around money. This is instilled in our training. It's not a you thing. This is a literal systems thing. They taught us to not talk about money, that it's tacky to have conversations about making money and so on, right? But the reality is.

To think like a direct care doctor who sees fewer patients and makes the same or even more has a lot to do with the way we think about generating money, generating profits. So the shift that needs to happen from having that insurance mindset where you have to see a lot of patients to make money into one that is not volume dependent, but rather we are shifting towards having more depth, more care with the patients where you're seeing fewer, but you're taking care of their problems more thoroughly. Relationships are deeper, you're spending more time with them, and having better margins per patient comes in the way of slowing down. It means taking on cases that require time and nuance and expertise, and probably the types of cases that the insurance based model doesn't want to take care of or can't take care of because time isn't enough. In the insurance-based model, on average, doctors are spending seven minutes with the patient. And that is very difficult to get to the bottom of a medical problem when you're pressed for time and your model is volume driven. You've got to see a lot of people, right? And I know you've experienced this yourself. So if you want to take care of a certain population

Tea Nguyen, DPM (07:58.818)

That requires more time, more depth, that is where the direct care model works. That is where you can shift away from a volume based model focused on quantity and shifting it into quality type of care. The insurance based practice is like fast food. You'll get fed, you'll feel full, it comes at a cheap price, it's mass produced, you can get it real fast, but that's not for everybody. There is a little bit of a compromise. There is a health compromise that comes with speediness, right? Same thing in the way we deliver medical care. There is a compromise that happens when we try to speed through care. So if you want more of a sit-down dining experience where people know they have to pay more, that's where direct care works. The second thing that we learn in the insurance mindset is limiting our offerings to what insurance covers. 

Now If you're running a busy practice, you're having to see 20, 30, 40, 50 patients a day, you don't really have the luxury of time to go through all of their treatment options. You've got the few that you know are covered by insurance, but for some of us, when there is a self-pay option, sometimes we withhold that because it's a difficult conversation to have with patients. It takes more time to explain to them why insurance doesn't pay for that.

Or to convince them why they should seek it out and pay out of pocket. So what happens is doctors offer what is covered by insurance because it's easier, it's faster, and it's in some ways validated because if insurance covers it, then it should be worth having, right? But if you're in a regenerative space, functional medicine, integrative medicine, something that's more holistic, that requires depth and time, you already know.

That the allotted time you get now in the insurance-based model is simply not sufficient to take care of the patient. So, in the insurance mindset, we are limited by time and therefore provide limited options to the patients or even withholding options for cash services because doctors feel funny about talking about money, or there just isn't enough time to talk about all of the available options. So the care and treatment options become rushed. But in the direct care,

Tea Nguyen, DPM (10:13.422)

Practice, that is what we specialize in. We take care of patients regardless of what's covered by insurance. We provide them with all of their options because we have time to talk about it. And many of us are choosing to specialize in those non-covered services because it's what we're interested in. It's what works for us. And it makes sense to have a practice that doesn't depend on insurance so that you can have these open conversations, lay it all out on the table.

And help the patient advocate for themselves because you have the time to do so. The third insurance mindset phenomenon is thinking that taking insurance is a safe bet because that's how we were trained. That was part of our residency training, that is our first few jobs that we took. That's what most people are doing. That's how most people are getting paid. But there will be a time where it will become very obvious that taking insurance is not safe. It's limiting, it's frustrating, it's exhausting, it's taking away time from taking care of patients and instead we're on the phone arguing with the peer-to-peer call or fighting with the billing department because a modifier was written incorrectly or whatever the circumstances were. Many of us start to see that taking insurance only feels safe because it's familiar.

But if insurance contracts change, they decide something that you've been doing for years is no longer covered, or you've gotten paid in the past, but they decided to do a clawback and withdraw money from your bank account without your permission, then you'll see it's not always safe. There's always conditions. Because ultimately, doctors who take insurance work for insurance. You work for the person who pays you. And in this unilateral relationship, there's not a lot we can do to fight it. Sure, we can try, we can appeal. We can try to have the laws changed and complain, like do all the things you need to do that is in your right to do so. But ultimately, and this is the reason why I left insurance, I felt incredibly powerless because I wanted to spend most of my time with patients. I don't want to fight with a bunch of strangers whose job is to literally deny medical care. So the direct care doctor realizes this, that their time is incredibly valuable, that it does not need to be spent on the phone.

Tea Nguyen, DPM (12:31.308)

Arguing with somebody who raises their blood pressure, only to be talking to somebody who has no idea what the patient is going through and what they need. That is between the patient and the doctor. Period. So taking insurance may feel safe because it's familiar, but on the grand scheme of things, it's unilateral and it's not safe. Now, contrast to that, having a direct care practice may feel unsafe because it's unfamiliar. It's new. Not a lot of people are doing it, right? But those of us in the direct care model.

Already knows this is a mindset shift. We have to start learning how to have money conversations. We need to start valuing our own expertise, the investment that we took to know what we know, to the caliber that we know it in taking care of people. And that takes time. But once you start seeing people who value what you do pay out of pocket freely, happily for your care.

That's when you'll start to recondition yourself to start valuing yourself as well. But my hope is that you get there sooner, that you're not waiting for the payment to justify your value as a doctor, but you start to see that you've always had this value with you. Which takes me to number four. I just kind of led right into the fourth insurance mindset that we need to deal with, and that is being blind to your own value. And when doctors don't know their own value, that benefits the insurance companies.

That benefits your employers. So being neutral to your own worth is harmful. It costs you potential revenue, potential income, but also your mental peace because you're constantly going up an uphill battle fighting against somebody who could care less about the patient's care. Doctors are the people who care most about patients. They are the ones who are carrying the liabilities when things don't go right with the patients. So doctors should be the ones who lead the care and get paid.

very well for the expertise and the liabilities in that relationship. Physicians who are undervalued are easier to underpay, easier to retain. There is more compliance because that's just how it works. But once the physician starts to recognize their own value, they start demanding for more, they step out of the system and have a direct care practice. These are the doctors who once they experience self-employment and not working with insurance, most will not go back.

Tea Nguyen, DPM (14:52.734)

The employed model or to work with insurance. And then we have 2020 vision, we backtrack and we're like, wow, we were also convinced that there was only one way. And now we have to unlearn a lot of those things in order for us to have a thriving direct care practice. So here's what has taken a lot of us to realize direct care is not instant gratification. It takes time to build this type of practice. It takes time to attract the type of patient who is ready to pay out of pocket, to build trust with new people who

Simply get it, who value the work that we do. So, right off the bat, yes, it's going to take time. Setting up these systems in the beginning is slow work, unless you're really lucky and you get hired into a direct care practice, which I hope we will see more of that over time. But right now we're kind of at the forefront. We are the ones building this from scratch. And it's something that we should be proud of. We are pioneering this model. But there will become a tipping point.

Where once you've built your system, your new funnels, your reputation, your brand for being a direct care doctor, your growth will then compound and things get easier instead of harder. I don't know if you notice this, but in the insurance-based model, it seems to get harder to take care of patients because of the volume, the volume that is needed to make up for lost revenue with the declining reimbursement rates. That does not happen in the direct care practice.

Over time we can charge more because the demand has increased to accommodate that. Just like any other business model out there. Once you build the system, once you get it to work, it will get easier. And you will have more profit over time rather than less. So there you have it. The insurance mindset that you have to overcome to start thinking like a direct care doctor in order for you to have a thriving direct care practice. Less patients.

Can equal more revenue because more time equals more quality care, which equals more money for you. Offering cash services is not unethical. So we shouldn't just default to what insurance covers because it's easier to avoid money conversations. You should have money conversations and feel good about it. Nice things cost money. The mistaken belief that taking insurance feels safe. It's only safe because it's familiar, but it's actually not safe. It's not viable long term. And recognizing your own.

Tea Nguyen, DPM (17:14.74)

value in what you've already invested in to know what you know to the caliber that you know it has a value and it's not limited to what insurance will pay you. It is so much more. If you're a doctor interested in working with me, hop into my email list where I announce when the next cohort will be available. This is where I take a small group of doctors to help them launch their direct specialty care practice with a proven framework and fewer costly mistakes.

You can download the direct care guide down in the show notes and that'll get you onto my email list. I hope you enjoyed this episode. I look forward to chatting with you again next week. Take care.