Partnering for Better Care: Dr. Annis and Dr. Nayo's DPC Journey

this episode is sponsored by Dr krono by everhealth the number one mobile all-in-one EHR built specifically for medical practices Dr Chrono includes an integrated feature that powers a seamless payments acceptance experience Dr krono payments offers multiple ways for patients to pay as well as insurance credit card processing as a Dr krono customer you can easily activate our fully integrated payment solution that will streamline your cash flow and help you get paid any time from anywhere deliver the best patient experience with a fast and easy way to collect payments visit dro.com revenue-management for/ tolearn more about Dr Chrono today hint Summit 2024 is just weeks away and limited tickets are still available to be part of the DPC event of the year if you are a DPC clinician administrator Enthusiast or employer looking to learn more about the DPC model do not miss this opportunity to hear from industry experts network with peers share ideas build meaningful new relationships and celebrate the impact of DPC all to grow the movement and make DPC the new standard in US Healthcare take $50 off your hint Summit 2024 registration with promo code my DPC story all one word at summit. hint.com [Music] Eli help wants to provide all my DPC story listeners with a free copy of their new ebook entitled new direct primary care practice checklist learn everything you need to know about planning to open a new DPC practice from Medicare opt out requirements to legal advice financial support to marketing knoow and the technology resources available to DPC Physicians Elian health is a clinical first EHR built for you and your DPC practice with over 23,000 clinicians Eli allows you to focus on what matters most providing phenomenal patient care visit Eli health.com mypc story to download today direct Primary Care is an Innovative alternative path to Insurance driven Healthcare typically a patient pays their doctor a low monthly membership and in return builds a lasting relationship with their doctor and has their doctor available at their fingertips welcome to the my DPC story podcast where each week you will hear the ever so relatable stories shared by physicians who have ch Chen to practice medicine in their individual communities through the direct Primary Care model I'm your host Mariel conception family physician DPC owner and former Fifer service doctor I hope you enjoy today's episode and come away feeling inspired about the future of patient care direct primary [Music] care direct Primary Care is an amazing vehicle for me to bring to patients the great medicine I always dreamed of doing what I didn't see coming was what great medicine they were going to end up being for me direct primary care has saved my professional Soul by giving me ownership quite literally to practice Primary Care the right way I felt empowered by direct Primary Care to care for my patients and also to care for myself and my family I truly believe that direct Primary Care is accessible affordable sustainable and highquality solution to primary care in our country I'm Dr Corey Annis and I am Dr Amy nio we are unorthodoc and this is our DPC [Music] story in 2015 Dr Cory Annis opened an orthodo in carbro North Carolina after many years in the traditional insurance-based model she experienced the mounting barriers that middlemen created for Primary Care and knew there had to be better way she envisioned a practice that gave her patients what she felt they deserved affordable relationship-driven Primary Healthcare without the constraints of profit-seeking third parties Dr Annis is double board certified in Internal Medicine and Pediatrics and enjoys hiking dancing and spoiling her dogs her beloved Kaden and their two spaniels Dr Amy Nao is a family medicine physician after obtaining an undergraduate degree in the history and philosophy of science where she thought big picture about theories of knowledge Dr nio traveled to Togo West Africa to serve as a peace core volunteer while working with an association of people living with HIV and AIDS in Togo she found a spark for medicine she returned to the US to work marry start her family and several years later matriculated into medical school at the University of North Carolina at Chapel Hill School of Medicine she chose family medicine because she believes in the power of relationships and preventative care and initially worked in Aur community's feif Service practice doing broadspectrum inpatient and outpatient care she transitioned to direct Primary Care in 2020 when she joined unorthodox direct Primary Care initially as a general contractor as of 2023 she is proud to be co-owner of unorthodox and loves practicing in the direct Primary Care [Music] model thank you so much everyone for tuning in find more about DPC including resources discounts my favorite tech tools books and more at my DPC story.com the mapper has been updated so you can look for practices by specialty follow us on your social platforms at our social Handley DPC story and be sure to subscribe to our newsletter and of course the podcast feed so you won't miss when the next episode drops if you're new to the podcast check out the blog accompanying this episode also at my DPC story.com so with that I'd like to welcome our guests welcome to the podcast Dr Anis and Dr noo hi we're happy to be here I am so excited as I shared before we we hit the record button you guys are doing this together I love that even in your opening statement you said we are an orthodox and I think that that is so important for people to see there have been Partnerships highlighted on the podcast before but not enough and so I think that it is wonderful that you guys are here and I'm so excited to hear your story so Dr Anis I want to start with you because back in 2015 you opened a DPC in a world where there were not a lot of dpcs that's almost 10 years years ago at the time of this recording so I wanted to really hear from you what was going on before 2015 that made you even think there has to be a different and a better way to practice medicine oh my God that is a huge question well direct Primary Care actually didn't have a name when I started putting it together I heard on your podcast Garrison Bliss say something about maybe the first time the term was used was in 2009 is and in 2010 is when I started thinking I had a conversation with an entrepreneur patient of mine who wanted who wasn't coming in for his visits and I said you have got to come back in three months and he said I'm going to be in Singapore can I just Skype you and I said no he said why not I said well because Skype isn't hippoc compliant okay we'll use FaceTime then that's fine but and I I will FaceTime you and I said 'well no we still can't do that your insurance won't pay me for it and he saidoh but I will and I was like I mean I remember this I remember the the moment clearly because it was like you would value my time you would pay me and he said yeah as an entrepreneur I lose a lot of money when I get up from my desk and drive over here to your office and sit and wait and then do the the thing and go and then reverse my steps it would save me so much time and money if you would just come to me so he swed a seed I said are there any more like you out there and he he swed a seed the I I started thinking wow there are a lot of people particularly small business owners who need somebody who's more flexible who can need need somebody who can give them care that's more flexible than what we've got available right now and I realized this guy had highlighted a really important problem for what he was doing so I started thinking about doing this for entrepreneurs initially I was initially the MD for entrepreneurs but as I started following this guy around the globe I realized that actually his wife with four kids at home need did me more than he did because she had to get an emergency babysitter anytime A kid got sick and I just from there I just started tumbling over all the ways all of the things that I could do as a doctor if I wasn't having to follow Insurance dictates of the person has to come in and be under your roof for you to get paid oh well if we take that away the what I can do and how I can deliver service becomes unlimited um and I knew you were probably going to ask me where we came up with the name unorthodoc but I don't know I was in the shower I was in the shower and I trademarked it because the first tedmed I went to somebody actually said unorthodox oh we need that for our new Endeavor I'm G to steal that so I came home and called a trademark lawyer and decided that if if the whole thing went belly up I could at least sell the name and that's that's a that's a gem people right there if you have not as the movement grows there are there is real estate in do in buying domains there is real estate in trademark your name that you have worked so hard to be the brand behind and so if you are listening and you have a name that is amazingly unique like an orthodox trademark that it is worth the investment I have done the same with big tree's Health which big tre's MD runs under and nobody can take that because in the in the world of medicine it is mine and so I think that that is such a empowering statement an empowering gem for people to hear early on we're not even like the first five minutes podcast it's amazing so when you let me ask you there because when you were the physician for entrepreneurs and you were starting to do this did you have any issues in Breaking Free from the system in terms of contractual obligations in terms of how to handle the patient care after you left from your previous um place of practice were there any snafus that you experienced in going into Direct Care no not really because I owned the practice I was leaving and so I as I kind of unique in in some in your podcast PHS just in that most of my practicing life I've worked for myself and I the building where where unorthodox lives right now is on the corner of the building that we that me and my partners P purchased together when we decided that our digs were too small and we needed some place for our independent practice so it really worked out so nicely I I didn't feel the the need to leave because I'm it's my building and and so I just sort of gently transitioned into into doing this with the blessing from my partners my partner at my my Maring partner at that time who did not want to join me because she's she is a a wonderful incredible doctor she likes to follow rules and I don't and so or I don't I don't follow I don't like to follow rules that don't makes sense and we came to the the veritable if you think of partnership as a marriage we came to the veritable point where we were having that discussion about kids versus no kids so DPC versus fee for service was that conversation and I that you asked me why unorth why I opened unorthodox the final straw was something you don't see much in the systemic world but it was a clawback our independent practice got a certified letter from a big insurance company who shall remain nameless that the certified letter said you owe us $20,000 out of the blue no no argument blah blah blah because we were apparently coding pap smears wrong we were coding them the way Medicare advised us and we can go into the the details don't matter so much as the day that we we with all the appeals that we did the day that we lost that I called my accountant and said please file the incorporation papers for an orthodo and because and this came up in my my partnership discussion my part felt unsafe with the idea of just going out into the world and throwing oursel on the mercy of our patients and I I to I at the time I realized that I felt safer throwing myself on the mercy of patients I didn't even know yet rather than remaining in a system where without impunity a big big deep pocketed Corporation could just walk up and say hand me enough money to ruin your practice you know and get away with it so I my safety I felt much more confident in my ability to actually take good care of patients and and make people happy make make have give people a great experience I felt much more confident about that than I did wrangling the insurance system and I think you have more people in the audience now nodding their heads especially after we experienc what happened during the pandemic and private practices closing left and right and people not having access to care any longer because of things like this they have continued and they've gotten worse so now this is perfect to this is a perfect place now Dr Nyo if you can share your story in that I mean you're coming from having a kid before you even started med school and then you're choosing to do DPC after being a person who was in a rural community doing inpatient doing outpatient what was it that you were experiencing that pushed you towards finding Dr Annis and joining on in unorthodoc I mean I think so many family doctors who have practiced in the feif for service World there were so many straws that broke the camels back probably too many right I worked for one of the last independent County Health Systems in North Carolina I went there very intentionally I thought being a family doctor in a rural community would allow me to practice broadspectrum medicine and I thought working for a small system that I would have a voice and would be able to implement positive changes for the community um as a returned Peace Corps volunteer I think I always wear my public health hat right of thinking about how I can serve populations as well as individuals and suffice it to say the system I work for had no interest in my opinion I mean honestly at the end it was quite the opposite one of the leadership at the uh county level said to me one day I'm surprised you have so many opinions and I said to him are are you speaking to me as a physician or as a woman because Physicians by definition have opinions about their patients care I mean it was all the things right it was the 15minute appointments it was the constantly being gaslit about requests for improving patient care it was the workload I was working on labor and delivery and doing impatient pediatric so I was rounding in the morning doing circumcisions going to Clinic not seeing my family being called into the hospital in the middle of the night and then being treated like I was crazy when I asked for things like another ma because I was one of the most productive physicians in their system it was a really sad day when I turned in my resignation because I love that Community I'll probably get emotional just talking about it wonderful patients who really need good doctors so it was a hard decision but 100% by the end was the right thing for me and honestly for those patients and for my family so stay with us we'll be right back join us at Rosetta Fest 2024 Rosetta Fest is the Premier event for direct Healthcare change makers featuring Cutting Edge sessions inspiring speakers and unparalleled networking opportunities don't miss out be part of the future building the new healthcare ecosystem this September 11th through 13th in Washington DC use code my DPC story 100 to get $100 off live or virtual registration register today at Rosetta fest.org see you in [Music] DC and how was it because right now you guys are looking for someone to join you at an orthodo but how was it that you guys came to find each other I think I saw it so um yeah I was kind of looking at her practice a lot so I mean the short story is that I found the direct Primary Care model it really spoke to me I know I knew I wanted to do it the two barriers for me were one was Financial my husband is a social worker so we are riant on my income and I still have student debt so that was an important barrier and then the second barrier in all honesty was I love having a clinical and now business partner I worked with a family doctor friend of mine in the rural independent system and really valued having someone to talk about clinical cases with having someone to cover vacations for me my husband's from West Africa when we go on vacation we really go on vacation and I don't want to take any call and so I was hesitant about the idea of going independent with direct Primary Care um interestingly though a lot of Physicians site fear about the business part of direct Primary Care care that was not at all the obstacle for me I knew I wanted to be involved in running a business thinking about a business is future so long story short I took a night job at a prison to pay the bills because it didn't have a non-compete and then realized I wanted someone who would partner with me to practice direct Primary Care as we're going to talk about more that can be a complicated thing right there were direct Primary Care practices in our area that were to hire an employed physician but I was very clear that I wanted a pathway to partnership um so Corey posted a job ad on I think I saw it on Facebook and I was like I don't know her I've never met her she's a med pedes doctor I'm a family doctor we're different Generations but what the heck what's it going to hurt to talk to her and the first time we talked I got off the phone and my husband just said you look so jazzed and excited because I felt felt like I had found someone who had such similar values to me oh that makes that makes me emotional I'm gonna probably make you get out the kleenex now because I I want to ask even more about that because Dr jice when you were in this space of I have a practice it's been open since 2015 five years later you're putting out an add-on Facebook it must have also been scary to make sure that you found somebody who was in alignment with the way that you were delivering care to the community so how did you go about intentionally finding someone and eventually finding Dr nio to be that person who you were looking for who you advertising for well I tried to be very intentional about finding her but I still think it was a a a an act of divine intervention that it was her specifically I couldn't have asked for better and and I I'm going to get emotional talking about why I went looking for her um when I started on orthodoc I thought this is it I'm going to retire here or they're going to find me dead at my desk with a smile on my face that's that's all there was to it but when I was in I was actually in British Columbia sitting at the bedside of my very dearest friend my soul brother who was dying from multiple system atrophy and I thought to myself if I were retired I would be here with him until the end and and it it struck me at that moment that I had no succession plan that I that as much as I loved what I was doing and I love what we do as much as I loved what I was doing there were a few things in my life that I loved even more and I wanted to be there with them and part of the reason I went went towards unorthodoc was to Great create greater freedom in my life but as a single proprietor I was lucky enough to be able to work out some things with my my previous partners because they would sort of watch the shop while I was gone but I still didn't feel like I could leave for two weeks I was very um circumscribed about what um or circumspect about the time I took off and um it was then that I thought as a matter of fact it's I saw this I ran into this the other day when I was filing some old journals it was the on my way home on the plane I wrote find a partner at the top of my to-do list and so I I thought about it a bit and then I put the ad out and I put it only on Facebook and Instagram and I thought Instagram for me I'm 67 advertising on Instagram just seemed oh so naughty and so bold in 2020 and I I thought that it was the Instagram post that that got her attention but she'd actually been hearing from the community that I that there was a doctor in carboro that was going to be looking for somebody and so she was literally like there when the post went up and within 24 hours we were on the phone talking to each other and so I I thought it was the magic of Instagram but it was it was more luck favors the prepared I I love that I love that and I I think that one thought I have is that and this is hearkening back to the patreon recording that Dr Julie Gunther did is that she has chosen to stop practicing as a direct primary care physician and she's not thankfully like in a critical Health situation that forced her to do that you are also in that boat of you know what I love lots of things I love being a great doctor and taking great care of patients I also love that I have to take care of myself in order to be there for other people and to be there especially for myself so I think that just that that space to think in the in the Hat of what do I need doesn't come easily when you're in feif for service when you're getting gas lit when you're getting passed over by every person who does not have a medical degree and they get to call the shots as to how you practice so I think that it is wonderful that you were also in a space you were prepared in the sense that you had a DPC practice that you could play in this space of what could retirement look like so one question there though because when you were thinking about hiring you were a phys you were a physician assistant before you became a doctor so oh yeah long ago in the galaxy far far away yeah and I I found I did not know that until I was looking into your guys's presence I on on what I could find in the internet but I'm just wondering because there is this there there are many voices talking about oh just hire a mid-level or I can't find a physician I need to hire midlevel did you ever give thought to a non-physician provider joining you as a support person as another person practicing alongside you with their own panel what was your thought process in intentionally looking for a doctor versus a non-physician provider yeah this is a conversation we had not too not too very long ago and and realized that sort of both it's both funny and Incredibly true that our name is on orthod do not on ortha midlevel and so so we're kind of I I went out of my way because my previous practice was caror Pediatrics and Internal Medicine I went out of my way with the name of unorthodox not to tie myself or even myself I didn't put my my own name in it I didn't put a place name in it because I wanted it to have the ability to go anywhere that that that it it wanted to if we needed to move if we needed to change if I needed to leave or whatever I didn't want unorthodox to be impaired by that but I did realize that putting Doc in it did give us a bit of a limitation so but as a physician's assistant when I was originally a physician's assistant and things have changed a lot in the way Pas and nurse practitioners are trained the ways extend extenders are trained now I mean now it's a master's level program and when I did it it was a bachelor's level program but I was trained it it was a wonderful whole thing and that I was trained to be the idea at that point was that doctors had terrible bedside manner especially when they were rushed and they needed somebody whose job it was to form the relationships and take care of the the emotional and and connection needs of the patient so that's what I was hired for that's what I was trained for and actually my training my training in medical terminology and in suturing and in psychology were way better when I was a PA than anything I got during my residency or med school because that's what we were that's what we were designed for we were designed to literally extend the relationship of the Physicians so that they could just make decisions and we could make people happy but that was where I realized I didn't know it then but that was the same I ended up becoming a physician then for the same reason I ended up becoming a direct primary care physician in 2015 I cherish that relationship and I can't stand doing all the work to create a relationship and then having somebody who is totally unin olved in the relationship come in and tell us what to do and I didn't know that actually I did not really realize that until I was filling out the the P the stuff for you the questions that you asked is oh my God it was already there it was already there what I was ultimately going to do let's see did I answer your question can I jump in I'm gonna jump in too so I think part of why Dr Anna looked for a physician initially was because she was not only thinking about someone else to help with clinical care care but she truly was also thinking about a secession plan right and she wanted a physician to Captain the ship so to speak of unorthodox since then we've had dialogues because we're looking for a third physician and it is not easy to find the right person in the right fit and we have enough demand where sure we could bring in a midlevel and we could probably fill their panel and so we bounced that idea around but at the end of the day at least for me I went to medical school to take care of patient and that's where my joy is right I think that is 100% true for Dr Anis I didn't go to medical school to supervise APS no offense to APS right that's just not what brings me joy in clinical practice so I'm not interested in hiring an AP for selfish reasons because I want to do clinical care I want to work alongside bright-minded intelligent fellow Physicians and I'm good being trained as a physician's assistant and then going back to medical school I have a really unique perspective on the the what what we know or what we don't know and as a physician's assistant I didn't know what I didn't know I either had to assume I knew nothing or assume that I was pretty damn good at what I did but I didn't know what I didn't know and when I went to PA or went to medical school and and to residency particularly it was like oh my god there are so so many things I don't there's so much that I don't know and I will never know will never know I mean I was dumb enough to double board in Internal Medicine and Pediatrics good luck with that yeah good luck with that I we'll never know and there's something about that there's something about that that is beautiful in that it keeps me really humble about my own knowledge base stay with us we'll be right back thank you to Spruce health for supporting the DBC story podcast the ways we communicate have changed dramatically over the past decades but technology and tools in healthcare have not kept pace patients want more access and digital convenience as well as the ability to text their care teams care teams are inundated with more communication and Rising expectations but are still using tools and Technology stuck in Prior decades Spruce Health created a solution for the tech forward DPC practice by creating a communication product designed to serve both the patient and the doctor through intuitive hippoc compant workflows tagging scheduled messages and triage templates ready for use whether you're on your phone or in the exam room new users get 20% off for the first 12 months of a paid plan with code maral 20 that's m a r y a l20 so check out Spruce Health today at Spruce health.com or check out the link in the show notes [Music] and I think this is so important for people to hear because if you are a listener who is is about to graduate residency and you are not aware that in a contract it can say that this role requires you to supervise a particular number of APs like that is a thing and that is something this this podcast celebrates the transparency that we bring as drug primary care physicians but that is so important for people to be aware of if they're looking through their contract Draft before they sign the dotted line that it takes away time from what your job is as a physician to show up to be flexible enough to in to take in the new guidelines on Hepatitis B screening of which there are new guidelines if you don't know check it out and to then just spend the time with the patients that is our jobs it's what we went to doctor school for never did I have a didactic on how to super vis a non-physician provider and that is not part of that should not in all of our opinion be part of the job description but yet it is and so I think also it's so important to hear your perspective Dr Annis as a person who was a PA and then became a physician because just like Dr Jennifer Allen who was a nurse practitioner before becoming a physician there is the the you nailed it you don't know what you don't know and there isn't a level of training to become a physician if you are not a physician so I think that that is so important also for people to hear in terms of the thought process of who are we going to bring on in your case at an orthodo so Dr now let me ask you because you the serendipitous relationship was created after Dr Anis posted and you saw the post but in terms of your experience transitioning because you you resigned from your PR position and you said that you love the community and I'm sure that that was one of the driving factors to take another position is something where you could be part of be a significant part of the health of a community but you also mentioned how you are the primary bread winner and you are a mom of multiple children which is really freaking hard and of itself but when you were so quickly going into this relationship with Dr Annis what what drove that that that swiftness of the of the signing the deal because I don't know if in the job description it was it was mentioning like this is a potential Pathway to partnership like you wanted originally yeah I think there were multiple factors so I left the independent County Health System quite rapidly I was done on so many levels that I felt ethically compromised I felt burnt out I felt unheard I felt like things weren't safe during the pandemic so I was done there I needed to Pivot quickly from a financial perspective and was very blessed to find the nocturnist work at a prison so the financial box was checked and I knew that our family would be able to pay our bills I will say Co my joining Corey was done more slowly and carefully in that because I didn't want to mess it up right like I really felt that direct Primary Care was kind of my hope for longevity and primary care and was where I wanted to go ultimately um so Corey and I took it slow I agree with um Dr anas's uh comment that partnership in practice is like a second marriage right you have your professional husband and wife and then you have your personal husband or wife so um we agreed that I would come on as a 1099 general contractor we kind of did a understanding handshake about the fact that if things went well Corey would entertain bringing me on as a partner and having me buy into the practice but we essentially said okay Amy you can 10.99 for a year you're G to find your own patients if new patients call asking for Dr Annis you can have them and then after a year we'll evaluate whether it was a good fit and whether we want to stay together and if we do then we'll work on figuring out buyin which is incredibly complicated FYI that took a long time that part was way harder than like figuring out fit I think we figured that out confidently in the first year and we also had a handshake I think we actually put this on paper that there was no non-compete for me so if at the end of the first year of Contracting either of us felt like it wasn't a good fit I could take my direct Primary Care patients hang my own shingle and be on my way so we took it slowly at the beginning and I encourage anyone who's exploring partnership with another physician to do the same it's a big decision totally and just working with my husband like my actual husband who's also business spner that's a it's a lot a lot yeah so I 110% agree with that statement take it seriously folks because it is you do so much that you don't even know that you're going to do as an entrepreneur um you you don't know who's going to call and what questions are going to be randomly asked from your community if you can do this or if you have a response to a question you have to develop those things all of the things that we do as entrepreneurs I I it's I it just goes back to Dr Annis you being a physician for entrepreneurs um and you understanding as an entrepreneur yourself how crazy busy it can be so I think that that is wonderful that you address the non non-compete um it it it addressed for me when I when I hear that that says to me I don't have any I I it's really hard for me to see that you would want to leave because this is such an awesome Clinic to practice in and you literally can do what you need to do while not having to worry about starting from the ground up so I think it's it speaks a lot to the culture that you were that you had created already Dr Annis that Dr n joined into to so I want to ask now about your guys's having two people who help in the practice you have Becky and jod both both of them are medical assistants CMA and Ma if I'm correct on that how did you guys find Becky and Jody to be able to partner with you guys and to help you focus on what you need to do why don't you tell Jody's story and I'll tell Becky's yes well when I was forming be there was a lot of work that went in before 2015 when we actually opened our doors and one of the things that my the partner who I was starting to separate from let me do is hire a medical assistant that I would take with me the intention was that I was going to hand hire and hand train this person but also thank God be able to have this person trained by the other Mas that were in our practice and they were all really wonderful people so it was it's interesting I had originally hired jod as a scribe she was an off-site recording scribe and she had not she had not done an actual impers person scribing before she'd been translating translating dictations for the one of the major hospitals right at the end of when they started doing a away with transcribers at transcription services but she had been running her own transcription service but so she was listening to my conversations and and making notes out of them and not too many months into it she said Dr Anis I really want to work for you I want to come in and I want to be part of your clinic because she was blown away by the quality of care that Dr Annis provided her patient yeah she got she got a to got to listen to me in a way very few people ever do outside of the patient themselves so thanks was sweet you know but yeah it was really sweet and and of course I was flattered at the same time I was entertaining a resume from a a very bright upand cominging techsavvy young person who had just graduated from GW and loved the idea of an orthodox and direct primary care and just just dying to help me and so I had Jody's criteria and this gal's criteria in front of me and I presented it to my husband and I said well here's jod she's mother of three she's she is younger than me but not not so young that she's like social media Savvy or whatever and then I've got this girl and my husband said hire the mom and I was really disappointed because I wanted the techsavvy young person to do my tech forward DPC practice the front face in my DPC practice he said no Corey you need the young Savvy Tech person is going to work for you for a little bit pad her resume and move on said you need you need a doctor Wrangler you need the mom who she said I have no doubt that a mother of three two of whom are twins can keep you in line and it was incredibly good advice and yeah and she is she is she keeps the she keeps the clinic humming she keeps everything in order she stays ahead of me sometimes she stays behind me kicking me you chasing me right yeah whatever she's she and and I swear to God many of our patients are part of unorthodox because of her because they love to see her and she just took to the arena of being face Toof face with patients like a duck to water and it makes her happy and it makes me happy that she feels such meaning in the work that she's doing and and she's she was born to do it I mean when she walked into the office she didn't know how to give a shot or draw blood or do an EKG she just knew how to transcribe notes but she she was very familiar with medical terminology which helped a bunch so then so she became the mama bear for unorthodoc and you arve that was in 2015 so unorthodoc jod has been with unorthodox since the beginning so then when I joined I started with zero patience and grew very slowly since I was working another full-time job so I did not have a medical assistant initially which which I actually think overall was a positive thing I learned how to do all of the ma tasks but I was blessed because we had jod in the organization so when I was like how do I do a prior authorization she was like oh let me tell you about cover my meds um so I learned a lot right and then as my panel grew we knew that we needed hire an Ma I'll keep the story short but we hired someone off of inded initially who was great who was Young Who social media Savvy who was tech savvy who had worked at a front desk of a a fee for service clinic and was bilingual Spanish which is something that I really wanted she was with us for about a year ended really cordially we had just had different needs and she had different needs and then I was blessed again so Becky our second ma was my medical assistant when I worked in rural fif for service and she is amazing she's been an MA for 20 plus years we're the Dream Team she doesn't know I call her that but I do she we're the Dream Team I know we're all the Dream Team essentially I was a young physician first attending job and there is nothing like being paired with a medical assistant who had seen and done it all she had done rural Pediatrics rural OBGYN rural primary care so she just kind of knew what I needed before I knew I needed it and would hand me things as we did procedures that kind of thing so anyway I had a I don't know how what you call it but I wasn't allowed to hire employees from my prior practice for two years so the timing worked out perfectly that when my first ma left I was able to make a job offer and she was on the market looking for something different so we have two fabulous Mas they do everything for us they room patience for us they do our prior o they collect fees we're currently thinking about whether to add a virtual assistant to team um to pick up some of the back of the office work and just increase our consistency um with some of our work uh flows we're not quite there yet but um that's how unorthodox is staffed currently for fabulous women I love it I love it and tell me about how in terms of the hours that they work the benefits that they get from what you know if it's retirement benefits 401k or if it's just you know like that they get their direct primary care practice membership paid for whatever it is but how do you guys what I guess do you have any perks for them as your dream team members I'll take this one you yes yes we do offer benefits unorthodoc if anyone's looking so in all seriousness we've kind of built our benefits over time but when I wanted to hire Becky last year health insurance was is an absolute must for her and it really pushed us in a good way to be like if we're going to attract the best and the brightest and keep them we need to offer a living wage and have great benefits right Corey and I have dealt with our insurance outside of unorthodoc I get mine through my husband come on Medicare awesome so as of last year we offer a full health insurance package which we pay a lot for but our Mas need that we're adding a retirement package actually this quarter so we're really excited about that we try to pay a competitive wage I think we have to invest in our team if we want longevity and continuity and to truly make the best hires so I feel really strongly about that the other thing that I think is is really attractive about working with us whether it's Physicians or the Mas is we cre we have built in a tremendous amount of flexibility in terms of scheduling and the the schedules can be very demanding but we let Becky and jod decide let them dovetail how are they going to dovetail who's going to take care of who on what day and what other needs do they need to meet and it's it's lovely to see the two of them just work it out they are about 5050 so they're about 50% in the office iners rooming patients with us and doing all of the inperson tasks and 50% working remotely from home doing the fax box all of that and we trust them to be motivated adults who can figure out their schedule as long as someone is Staffing Us in the office when we need them fantastic now I want to ask about locations because an orthodo started in carborro and then closer to Dr nao's home is Durham and so you guys opened a second branch of an orthod do in Durham how was that process because definitely people especially as more patients are joining on it sometimes can make it easier to find a physician if they're able to open another branch in the place that they live already stay with us we'll be right back have you tried an AI scribe in your clinic well I've tried so many and I can say hi heid health is the best AI scribe I have come across thus far with Heidi health I can create unlimited customizable templates for my notes to help me truly cut down on the time I'm spending charting template for Pediatric well child check done template for weight loss management done some of my favorite things I've built into my AI template beyond the general soap note are having a list of actionables for our team to take after a patient visit having the diagnoses listed and creating an after visit summary for our patients not only have I found Heidi Health to be the most helpful customizable AI scribe so far it's also more affordable than most out there so try Heidi Health today and see how you can harness the power of an AI scribe for your practice to get an entire month of Heidi Pro free go to the homepage of my DPC story.com and click on the Heidi Health [Music] ad I'll start that one too well no I got I do have to say something here first of all I don't I think maybe it was our second date when she said we will open an office in Durham someday you setting expectations yes right exactly no that is one thing that I really appreciated really appreciated about the way Amy came to the job is she was really clear about her expectations and and it was like I hadn't really thought about I hadn't put a whole lot of energy into branching out because there was just me but truthfully from the very beginning I have to admit world domination was on my mind so I mean it's a really cool name after all deserve to be spread but when she said she wanted to do something in Durham I'm like okay well let's just work in that direction and see what happens let's let's see if we get to the partnering phase and whatever but yeah you were very clear about that and I took it as a good sign I took first of all initiative that's what what I have looked for with anyone who's ever work for me is do they take their own initiative do they self start and I was like she had self start in Spades yeah so my husband and I have four kids between us I grew up in our city without a car I don't like commuting I like listening to podcasts including yours in the car but I don't like commuting so I knew uh that I wanted have a Durham location Dr Annis was in carboro for historical reasons because she owned a building there and her prior practice was there and she already had a patient footprint there and I had no problems starting there and continuing to work in caror but I knew Durham was my ultimate goal at least half of my clinical time per week it was hard figuring it out and you'll love this story because this I think to me epitomizes how collegial and enthusiastic and welcoming the direct Primary Care Community is so we essentially wanted a part-time space in Durham initially as we started to open our Durham location and I just couldn't stomach these long commercial leases and that you have to pay to fix it like this is all nonsense I'm not doing any of that so I started looking around for a sublet in another clinic and found some options but wasn't super thrilled with any of them so I went to my personal direct primary care doctor who takes care of my family who is biking distance from my house and said would it be weird if I sublet from you would that be like competition or is there a non-compete between us I don't know and not surprisingly because Dr Tanisha Balo who is amazing and is a direct primary care physician in her heart of hearts was like that sounds great you want to rent a room for me when do you want to start so we sublet a clinic room from another local direct primary care doctor two days a week we just increased our footprint there to two days a week it's logistically challenging happy to go into that further but important for me in my quality of life so the beauty of DPC is you can do whatever you want with it yeah well the the kicker here is that we actually live about three miles apart from one another I bought my first house in Durham and and couldn't could not duplicate that house anywhere else in this area for the same price and so i' I stayed even though I was attracted to carboro to start the work my my very the beginning of my career so I've commuted 35 minutes each way my entire practicing career I'm going to have her see patients parttime before she retires in Durham so she doesn't have to commute yeah oh my gosh that's for those of you who have commuted it's it's like some of you might be saying like that's nothing like that's a that's amazing but it totally is a drain like I Dr n when you talk about that you where you grew up and you didn't rely on having a car to get you places I grew up in Sacramento where I knew exactly like where the line was on my Volkswagen Beetle that I still had 12 miles of gas even though it said I was empty and I knew exactly time between home and high school but here I complain about it's 2 minutes to drive in my clinic on our Highway like our One Direction each way uh situation that we have in Arnold California but it's really hard to unsee how awesome it is to practice close to home so definitely something to think about for those people who are looking at location for growth or looking for location to open um location matters again it's just you're able to really focus on what you need to do and that does not include having to gas up the car and drive places if you don't have to so I totally hope that as your career as a family physician at or orthodoc is finding an end point that you are able to practice even closer to home so you get that too Dr Anis and I think I think it makes us better at direct primary care doctors to practice close to home if someone I like doing procedures if someone after hours has a CL eration and needs a tetanus like I might think about doing that if it's 5 minutes from my house I'm not going to do an hour round trip right so I think my patients will actually have better access to me in a way that fits in with my quality of life at home love that and now as you guys have talked about the practice how you guys have come together to continue this practice as Physicians with Becky and jod who are you taking care of at unorthodoc well in the first year that unorthodoc was open I I got my my help my the My Mentor was Dr Brian Forest who opened a few years before me and when DPC really didn't have a name at all and he made a statement once about how in in his waiting room one morning he had a guy who was actually living in a homeless shelter who had gotten there on a bus sitting across from a guy who had driven up in his Cadillac Escalade or whatever and that they were both there because they valued the quality of attention that they got and it wasn't very long after starting on orthodo that I had essentially the same experience and but we're I would say that we're heavy on either people who work for small businesses or small business owners we do have a lot of academics and because we're 10 seconds from UNCC and 20 seconds from duke we have a a lot of doctors and Healthcare Providers as well but what Amy noticed the minute she started seeing patients there was that the health literacy was real different in carboro and and that's that seems to be true regardless of socioeconomics stask but yeah I mean I'm very proud of the fact that we've kept the price point at a place where hairdressers and and finers come to the same practice yeah this is a great question um as a family doctor who's always done underserved care and really has a passion for that I'm Peace Corp background I worked with homeless in Chicago when I came back from Peace Corp I've worked with refugees I've worked in an fqc setting I've worked in a rural setting that is where my heart is and so concierge was an absolute noo for me and I was worried about who am I going to be caring for in direct primary care but Dr Annis is totally right we take care of all comers I've got refugees I've got immigrants we landed a great small business it's a fairly large Cooperative grocery store in our area so it's all I call them eclectic very diverse mix of people who work for this Co-op grocery store I love them so yeah we have people who can barely afford our $75 a month and who but we look at it as an investment in their health Y and if we need to float them for a month or two here or there because it's hard we do and then we've got people who are like you don't charge enough we need to pay you more and we have great diversity now is there room for improvement sure do I think our Durham footprint will bring in a different patient population that I'm really excited about yes yeah and in our in the in Dr Anna's retirement future quote retirement we're working with all different kinds of ideas about what unorthodox looks like next can we can we create something that expands even further the kinds of patients we take care of can we do a nonprofit can there be a nonprofit arm of orthodo can we do a benefactor practice can we in what ways can we take this model and stretch it and so when I say I retire I always I always feel like I put air quotes around it because you know I just need I need some time I need some protected time to see what unorthodox future is going to evolve into and that's that's exactly what I wanted to ask in terms of what does the future look like because I think that again you hit the nail on the head when it comes to retiring as phys Ians we're so active and creative especially those of us who choose to go into direct primary care and open a business from nothing that it's it's really hard I mean we hear it all of us who see adults all the time oh I retired and I'm like I'm struggling because I I'm actually like not dead I actually have a lot to be able to give back to my community still um just trying to find a way to do that and I think that the again just like the p ship that you showed doing this when it didn't necessarily have a name to it when it wasn't where it is today speaks a lot to that you may retire from taking care of patients on the day-to-day but you're you're still able to continue enhancing the relationships that you guys have built at an orthodox no matter what you choose to do after so I think that that's awesome and in terms of you guys have also touched on what the footprint will be and Durham Dr ni do you have any comments as to what you want to see in the future going forward as you're looking to get more patients in Durham expanding and having another physician join you I think there are so many options it's overwhelming so we're currently in the phase of deciding what we're most committed to and moving forward with that I would like to see patients more than 50% of the time but one day I would like to be doing some more macro work around primary care whether that's an expansion of unorthodox either in a for-profit or a nonprofit model I would for sure liked hire another physician because having partnership in terms of clinical practice is important to me I want to make sure that Dr Annis has an exciting Runway to retirement that uses her macro thinking skill set for the good of direct primary care so we're currently in that kind of listing all of the things that we could do and honing in on what's most important when you work in DPC you sort of feel like the world is my oyster but you also really want to protect that time with my family time to take care of myself so working to prioritize is really important yeah it is if I had stayed in the feif for service world as much as I loved it as much as I loved the practice that we built I I would have probably either either died or I would have retired quickly and in and and probably with a bit of bitterness and and not really KNN what to do with myself because leaving that it's well I certainly can't fix that but moving into direct Primary Care it made me 10 years younger 15 years younger I mean I'm 67 I feel like I'm 47 when I'm working with DPC I'm yes the worlds are oyster everything's possible because the things the DPC movement has already achieved at one point looked impossible and now it's well hey no I mean it's becoming the standard one of my biggest dreams that I hope that I want to with unorthodox I wanted to create something that was bigger than me and would last longer than me and I have this hope that what we're doing is we're helping patients uh raise the bar for what they demand from Healthcare that whether or not we actually storm the bastions and tear the system down we just if we're giving people a whole new definition of what care looks like and our patients are giving us this whole new definition of what it is to be valued and validated as a as a primary care physician that virtuous cycle I'm hoping ultimately reaches the system and says no we want better this stinks we want better and what what a terrific Legacy so that's what that's that's where I see my retirement going is trying to figure out how to maximize this experience for the greatest number of not only patients but my colleagues my physician colleagues and I can't I can't think of anything more fun to be doing in my quote retirement my so-called retirement well I love it and that is today's episode everybody we are going to have an awesome conversation about sustainability sustainability is business partners with your staff what to look for in terms of what is going right and how to sustain that in the future and how to be sustainable as entrepreneurs and Physicians so it has been such an honor please join us for that conversation over on our patreon community Dr andison Dr noo thank you so much for joining today thank you Marielle it's been fun thank you for joining us for another episode of my DPC story highlighting The Physician experience in the world of direct primary care I hope you found today's conversation insightful and inspiring if you want to dive deeper into the direct Primary Care movement consider joining our my DPC Story patreon community here you'll have access to exclusive content including more interview topics and much more don't forget to subscribe to my DP story on your podcast feed and follow us on social media as well if you're able I'd greatly appreciate if you could leave us a review it helps others to find the podcast until next time stay informed stay healthy and keep advocating for DPC read more about DPC newws onth daily at DPC news.com until next week this is Marielle conception [Music]