How Value Based Care Pushed Dr. Stephanie Huhn Towards Direct Primary Care

Today's interview features Dr. Stephanie Huhn, founder of RoMo DPC as she shares her inspiring journey from traditional and "value based" primary care to Direct Primary Care (DPC) in rural Missouri. Dr. Huhn discusses her medical background, decision to pursue a DPC model, and how the transition has allowed her to offer personalized, patient-centered care without the constraints of traditional insurance. Throughout the conversation, she highlights the challenges and joys of working in a health professional shortage area and her dedication to improving healthcare access for her community. With her unique experiences in the Navy and academic settings, Dr. Huhn emphasizes the importance of following one's passions in medicine. She also shares successful community outreach strategies to educate patients about DPC, express her passion for patient care, and the rewarding aspects of the profession. For those interested in how rural healthcare can thrive under the DPC model, this episode offers valuable insights and practical advice. Join Dr. Huhn as she redefines healthcare delivery, ensuring patients experience the relief of having a physician in the family.

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Transcript

Dr. Maryal Concepcion: 1:01

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 chosen to practice medicine in their individual communities through the direct primary care model. I'm your host, Marielle Conception. Family, physician, DPC, owner, and former fee for service. Doctor, I hope you enjoy today's episode and come away feeling inspired about the future of patient care direct primary care.

Dr. Stephanie Huhn: 1:50

I am a calmer, more peaceful, more content person since I transitioned to direct primary care. I'm Dr. Stephanie Huhn of Romo Direct Primary Care and this is my DPC story.

Dr. Maryal Concepcion: 2:07

Dr. Stephanie Huhn attended Lindenwood University in St. Charles, Missouri, where she graduated with a BS in chemistry. She then went on to earn her osteopathic medical degree at KCOM Kirksville College of Osteopathic Medicine of AT Still University. She decided to transition from traditional practice and enter Direct Primary Care to give her more time to spend with patients and to provide the type of care patients deserve. Throughout her time in traditional primary care, she witnessed the limitations that insurance and fee for service healthcare placed on patients and their health. By directly partnering with patients, she can provide extended appointment times, minimal wait times, and flexible scheduling so that you can see her within one to two business days, either in person or online. Dr. Huhn collaborates with her patients to ensure they get the quality care they deserve at the best possible price. Welcome to the podcast, Dr. Huon.

Dr. Stephanie Huhn: 3:05

Mariel, it's so glad to be here. I'm so excited to be on your podcast. I've listened lots of times. So I'm just great to share my story.

Dr. Maryal Concepcion: 3:13

Well, I'm so excited for you to be here. I think it's been a while since we've had somebody from Missouri. And this is wonderful because you're coming from a day where you've actually been, lobbying for the physician experience and the physician patient relationship and at your capital. So I'm excited to, bring relevant and up to date information about Missouri to this podcast. Thanks. So let's start with your background because we all have a journey into medicine. And I'd love to hear how a BS in chemistry then led to I'm going to be a family physician.

Dr. Stephanie Huhn: 3:45

Well, it actually deciding to be a family physician took me a while. I'll be totally honest. So Linda Wood University is in St. Charles, which is on the outskirts of St. Louis. And I thought I was going to do biology, but then chemistry is just way more exciting. Biology to me is just memorizing. And I thought that was boring. So chemistry is, solving equations and it was just more exciting because I knew I wanted to be a physician. I knew I Had to do something in undergrad that fit. But actually my journey wasn't straightforward, but it was exactly what I needed. So when I was a junior in college, I applied to a bunch of medical schools. I'm from actually Illinois, Southern Illinois, but so close to St. Louis, I just say St. Louis. So I applied to a bunch of MD schools and I was a young kid. I didn't know anything. I didn't know that if you're supposed to have three letters of recommendation, you should ask five or six people. So I asked three. And one of them didn't think deadlines mattered. And so all my applications like didn't even get considered. And so I was devastated. I was like, Oh my gosh, I'm never going to be a doctor. But it was during that intervening year before I could apply the next time that I learned about osteopathic medicine, I had never even heard of that. And so the following year I got admitted to both MD and DO schools and I was hesitant. I was like, I don't want to be some weird quack doctor. And then I went to Kirksville, which is where KCOM is. It's the original home of us. You know, osteopathic medicine was founded there. And I was just like, Oh my gosh, this is me. This is what I love. And so I just decided that was kind of the beginning of me following what I love about medicine into doing what feels right to me. So then during medical school, I got a health professional scholarship program in the Navy. And so after I graduated, I did one year of a traditional rotating internship. And then I spent three years as a general medical officer. And essentially, you're just a general practice doctor and it was like the most exciting and scary I've ever done of anything in medicine because it's like, I've been a doctor for 13 months and people come to me. I vividly remember the first time I prescribed certain medications and they were like, it's okay. I trust you. I'm like, but I don't, I've never prescribed pancreatic enzymes in my entire life. I guess they're fine, right? And so it's just, it was really fun and I learned a lot and I wasn't even sure what kind of medicine I wanted to do because. I love family medicine. I like a little bit of everything. And so during that time, I was like, okay, I, this is, I love family medicine. I should just do family medicine. And so then I applied to residency and I started my residency after my four years in the Navy was complete.

Dr. Maryal Concepcion: 6:25

So this is awesome. I think Dr. Frank Kalish was the last person who served in the Navy that was on the podcast and Your experience, just like everybody else's, whether they were in the Navy or not, is so different. And so I'd love if you could share about how that worked, because if you did not go from medical school to residency directly, was there any issue with you having worked and then applying to residency? Because, I think about going back to your letters of recommendation, if we needed letters of recommendation from. a med school or, a med school teacher. Did that at all impact you? Or was it, because you had that training that you were more sought after for residency?

Dr. Stephanie Huhn: 7:03

I, I do think I was more sought after just because of my experience. There was a few programs I interviewed with that were actually like, well, if you already did this, we could technically sign you today outside of the match. And I was like, Why are you so eager? Let me interview other places. So it didn't matter for as far as letters of recommendation went for me personally, because I was able to get them from my command, from the, XO and all the different people on base. And so it's like, if an Oh six in the Navy writes you a letter of recommendation that says she's the best doctor I've ever worked with. Yeah, that's pretty good. It works. But what was. different for me is I went to, university of Missouri or Mizzou. It's a big program. There's like 12 to 13 per year. And so tons of faculty and I kind of thought everybody knew I had been in the Navy. And so sometimes I would say things and it would sound like I was totally bragging, but I was really trying to be like, I don't know, they're like, I haven't done this in four years. And they would just look at me like. What are you talking about? And so I felt like I had to explain my whole life story every time I said, Oh, I did this back in however many years ago. So similarly, cause it's Missouri and I went to med school in Missouri. They're like, Oh, you're a first year resident. You must know. So and so I'm like, no, I don't. They're like, well, but if you graduated last year, they were in your class. I'm like, yeah, I graduated four years ago. And they would just be Oh, okay. And think flunked out for four years or something. So sometimes I end up explaining like my whole life story just to say when I graduated med school. Which is, it's fun, but it's a little bit awkward sometimes.

Dr. Maryal Concepcion: 8:38

I can imagine that, especially when every week your schedule's changing, and every month you're in a different rotation, so I can totally see that. Tell us about your love of family medicine that you found while in the Navy and what were you looking for specifically as you went into a residency program in terms of training, in terms of experience, in terms of patient experiences, and skills you wanted to develop?

Dr. Stephanie Huhn: 9:01

So, I I love procedures and I thought about doing surgery. I thought about doing like gynecology or OB where you have a little bit of surgery and a little bit of face to face. But then honestly, I was nervous about like never having a male patient again in my entire life if I did OBGYN. But I just found that to be honest with myself, what I love is the connection with patients to help them move from this uncertain state. To identifying an illness or situation and fixing it and, and getting to know them as a person and that's what fuels me and that's what drives me. So, when I was searching for a program, I wanted one that was heavy on the academics because that's what I needed. So, you know, like when I'm teaching med students or whatever, I say it's, it depends on your personality and it depends on what you need. So for some people, an unopposed program where it's just them. It gives them the freedom to like, Hey, I need the nudge or I'm not going to do it by myself. Well, I was doing it by myself for three years. I don't need that. I need. Okay, well, how would you do this? And what's the next structure? And how? And so that's what I wanted out of a program. They were willing to work with me with my, some of my credit for my intern year. And I took some additional master's classes, like on teaching and education and research and stuff. I didn't finish the research project to actually do it. Get my master's degree, but I still really enjoyed the stuff I learned at that time, so.

Dr. Maryal Concepcion: 10:28

Awesome. And I'm sure you still impacted patients in the way that only you could. So for me, that's a very small footnote. And you're making such a big impact now. So, let me ask here, because There's a very big conversation about value based care. And, there's a lot of people in the, institutions that lump us in with value based care. And again, this goes back to the fact that you were literally in the capital of Missouri talking with your representative today with other physicians. How do you view value based care and how is DPC different?

Dr. Stephanie Huhn: 11:00

So, this kind of goes into my story of how I'm transitioned into direct primary care. So I moved to Missouri. Well, it's actually this story is going to go over a whole bunch of stuff. So I worked in Jefferson City. Actually, I worked in Jeff City for five years after residency. And then my husband got a job in Texas. And I was getting burnt out. I was halftime. Assistant program director for the residency program there and halftime in clinic, but really it was 75 percent time in two jobs and I was getting burnt out. And so we were like, let's do this. And we moved to Texas. We never found steam? My kids didn't like it. We're just kind of like, and then in 2020, like a lot of people, we kind of reevaluate our priorities. And we were just like, what are we doing? We love Missouri. Let's move back. And so I searched all over and ended up here in Rolla. A fellow doc I went to residency with actually practices here. And so I was like, you like where you work, right? And so, When I first started with that hospital system, they had just implemented a value based care reimbursement for primary care. So you were paid based on the metrics, you know, we all know how to gain the metrics, the metrics. as a percentage based on the number of patients enrolled and assigned to you, which was awesome for quality. And it was difficult because there was no RVU component to it. So for a period of time, I was the only person within like two hours on either side doing IUDs or an And so if I did an exponent for my partner's patients, I get zero. Reimbursement for that. And part of what fuels burnout is consistent choices that are dichotomous. So it's like, if I take five more minutes with this patient, I'm running behind. Or if I do the right thing and put an next one on in my partners. 15 year old patient who's been in and out three or four times that doesn't reimburse me, but that's the right thing. And so these constant opposing forces, I feel like in family medicine, we're all used to that. Like you get comfortable with it and you just do. So for, for three years, my practice panel, I grew it with, I'm going to take my time. We're going to talk about everything. I'm going to talk about. Things I'm going to order your mammogram. I'm going to do all this stuff and my patients loved me, but I was hard to get into, I mean, four to six months was a common for routine followup. Well, I had said this kind of when I was emailing about Oh, let me come on your show. No one probably listening is going to be surprised when they switch to a complete value based component. Across the board, family medicine saw less patients because we didn't have to. So when I was explaining it in a positive way, there was an episode where I had a patient who went to the emergency room and, they had a x ray or I think a KB I'm assuming that showed a kidney stone. She was still having pain. She needed a CT scan. So I got the message. I reviewed the ER report and I ordered the CT scan. Now, I could do that because I was paid based on keeping her out of the emergency room, not based on RVU. So that's the wrong answer for an RVU system, but it's the right thing for the patient. So, then when they kind of started wheels turning, they switched to RVU and quality together, but you had to get the minimum of both. So with the RVU minimums for both quality and RVU. If I did nothing different, saw the same pace of patients, my income was going to go down by 35%. And I, I don't know your audience, so I won't, but I am a cursor. And so I went to my boss and I was like, this is effing offensive. Like I know my value and this isn't it. And so I actually had an hour long meeting with my new administrator saying all of the things that were frustrating me. And she was surprised because, our office was an open concept where, the nurses and all, all of us worked in the same area. So if the administrator walks down, Hey, how's it going? First of all, I got four patients waiting and my nurses are all right here. I'm not going to complain to you. Things flow a pill. I'm not complaining in front of right. I've that military hierarchical thing. I don't complain. In front of people who are lower than low, you know, it's not not intended to be mean. That's just how it is. And so she had no idea, none. And so, a month later when I put in my notice flabbergasted, they were all completely surprised and I was like, why, like this is, this isn't working. So, I mean, What I tell my patients here, because I have a lot of patients who followed me, to their credit, I think they took me leaving as like a holy crap, maybe this is too aggressive, and have tried to make some changes based on that. Because, I don't begrudge them. They're just trying to make it work in a system that doesn't work for family medicine. It just doesn't. And everybody who's DPC or does DPC knows that already. Like it just, fee for service is not the same. When you're dealing with long term health and you're developing and establishing patient relationships, it just doesn't work. And so I had thought about doing direct primary care for a long time. And I was finally like, I'm doing this. This is, this is the sign I needed. Right. That's why I started with that story of not getting into med school the first time. I thought this was a huge blow, but really it was God just being like, Nope, here's what you need to be doing next. And so I opened almost exactly six months ago in September. So I quit. Oh, so this is just me kind of being petty, but it's funny. The proposed changes for work, our views was going to take effect July 1st. And my last day of work was June 30th. So I was like, okay, thanks. So I quit work June 30th of last year and I opened my practice in September of 2024. And so I'm coming up on my six month mark. I've got a hundred patients. Woo. So I'm really excited and, it's, going great. And my patients love it. It's been a really good process so far.

Dr. Maryal Concepcion: 16:50

You absolutely deserve that congratulations. That is 100 patients who absolutely Recognize and invest in your value as a physician And that is incredible because you just like me are very rural and so for your practice to have gone from zero to a hundred patients And for you to have escaped that system by one day, I'm like high fiving you through this computer, man, because that is amazing. That is so, I mean, I, I literally wanted to have a mic drop their end of podcast done. No more needed part two later on because. A lot of people do not understand the difference between value based care and direct primary care. Yes, we do have value based care, but our value based care is based on different values and not working for a person who says, Oh, well, I don't even know. What that even means, that was your experience, but I get paid to be an administrator here at this facility. So, it's so interesting, and I want to ask here, because as you have just come from the Capitol, what types of things did you hear from your colleagues, or, what types of things did you educate your colleagues about, And your representatives potentially about, what it means to have high quality access to a physician as a constituent in any region of Missouri.

Dr. Stephanie Huhn: 18:07

So, what was going on today, it's called Physician Advocacy Day. So there was actually a Family Medicine Advocacy Day like two weeks ago, and I just couldn't make it work with my schedule. But it was a joint effort with the MSMA, some of the Missouri State Medical Association, and MAOPS, Missouri Association of Osteopathic Physicians and Surgeons. And so we got together and had breakfast and coffee and talked about all of the reasons that we're here today. And then dispersed to the Capitol to just chat with whoever we could find. And so it was really great to see multiple different specialties. all aligned on like physicians need to step up and and do something for ourselves. So interestingly, my husband came with me just for fun. I mean, that's a two hour drive. Why not? And he was like, you know, it's kind of weird to me. Considering how many doctors there are in Missouri, there's really not that many people here. And I said, I know that's why we're trying to make it such a big presence. And we were all wearing our white coats since we had the students were walking around the Capitol. I just think most doctors don't have time to get involved. We have put the patient at the front of our lives, right? We're sacrificing our time. with our family. We're sacrificing our life. Like, I mean, how many people eat lunch, during a daily basis? Hardly any, they're shoving food in when they can. And so to think that in DPC, now I have the flexibility to actually advocate for my specialty and for my career. It's, it's a blessing and it's a difference. And so what I really was heartened by. is most of the physicians I talked to when I said, Oh, I just opened a DPC practice, all excited. Everybody was like, Oh my gosh, that's so amazing. We need more of those. Nobody asked me, what does it mean? What are you doing? All the medical professionals completely understood. And so then I, had to explain to some non medical people, this is what direct primary care is. I take insurance out of it. It's just me and the patient and everybody has, I think. experienced this in their own time, it's like, Oh, wow, that sounds really cool. I hope it's working. So, in my area, so I'm in Rolla, Missouri, we're about two hours from St. Louis, I guess about an hour and a half from just city. I'm the first direct primary care in the area, so the closest is 90 miles from me, and so being the first in the area has its pros and cons, so on one hand, it's great, because I can kind of just do what I want to do, but on the other hand, I'm educating the entire community on this is what it means to do direct primary care, and in doing that, I've had a lot of these conversations, and it's really funny to me, the variation of reception, and So I've had some patients who, like, like, I, this, I almost didn't tell people this because I thought it was HIPAA, but then I'm like, wait a second, she didn't join my practice, she called some lady, I don't even know her, I blocked her on Facebook after that, by the way, felt really good about it. She called and left a message and said, I don't know what you're doing. Concierge medicine isn't going to work here. My daughter lives in California. It's all the rage there. I hope you go out of business and I was like, well, I'm glad I missed that call. Um, but then I've had other people who are like, wait, that's all you're charging. Are you going to stay in business? Like, I'm not going to need to find a new doctor in two years. Am I? So it's so amazing to me, the variation that people have. Most of my patients, obviously they see the value. And so they're like, oh, that's it. Yeah, great. Sign me up. Let's do this. I had a few patients just actually last week who found me from my hospital based clinic because the hospital did not tell people at all where I was like they, were trained to say, Oh, I'm not sure I guess she moved. And so one of my patients just, I mean, they walked down the hall and we hugged and I was. So glad they decided to see me and they're on Medicaid. Like these aren't wealthy to do people. These are hardworking folks who haven't been able to find a doc that they could connect with since I left the system. And so that kind of thing is really rewarding and it just, it makes me know I'm doing the right thing and I'm on the right path.

Dr. Maryal Concepcion: 22:04

So I'm just gonna throw this out there for Dr. Huynh, as well as any listener, if you're a physician who has a copy of what the corporation sent out about you, if they did even give you the courtesy of that, send it to support at mydpcstory. com. That's s u p p o r t at mydpcstory. com because yes, we will black out identifying information, but I would love to see a wall of these because it's just so laughable. You know, the things like I retired. According to my letter, my husband was just moving on like, it was just a factual letter, not, I'm sorry. And the person who signed, my husband's letter is the one who bought a Tesla soon after that, after she got her magical raise. So if you're out there and you have a letter, definitely like open invitation, send a copy to that email, because it is so unreal how we do not matter and you have now transitioned to a practice where you do matter. Um, yes. Be well to that lady. Uh, be well. But when it comes to you educating a rural community about your way of practicing, I'm wondering if you can even take us a step back because what is the access like, like people on this podcast have heard, where am I in relation to the nearest trauma to center, et cetera. But give us a geographical sense because, Kansas city absolutely is going to have services. The Capitol is going to have services, but how do people access care typically and what access do they have to APPs to physicians? Give us a picture about your geographic area.

Dr. Stephanie Huhn: 23:31

So, Rolla is a town of about 25 to 30, 000. There is, a University of Missouri system here. It's called Science and Technology, so we call it Missouri S& T. And it really adds a lot of vibrancy to the Rolla community, which is fabulous. But if you want to see a specialist, there's a hospital system in town, and then the hospital based clinic that I worked with is a system that extends, like, from St. Louis to Oklahoma. So they're a bigger system. And so if you want to see, ortho, general surgery, ENT, ophthalmology, dermatology, we have all that in town. That, that kind of the basic specialist is about it. Any subspecialist or depending on insurance, people were often traveling to either St. Louis, Missouri, or Springfield, Missouri, because Rolla is about halfway between those kind of along the Southern part of the state. I'm a long route 66, if there's any history buffs out there. So, about two hours to the St. Louis area, two hours to Springfield, like I said, an hour and a half to Jefferson city. And for a lot of people, insurance dictated that. So the hospital system that's in town doesn't take one of the Missouri Medicaid's and doesn't take a few other insurances. And so the reason I chose to work for the hospital system I did is they took all insurances. I didn't want to have to think about that. And so if that's the insurance you have, you're traveling to St. Louis to get your care. So, I wasn't saying that to brag about my follow up appointments were four to six out. It's a legitimate issue with. Availability and there's just we're a health professional shortage area have been at the I'm pretty sure the highest level for a long time. And so, there's advanced practice providers in my prior office, the nurse practitioners like the only one taking patients because they are awful. And so, people are just striving for good care. And, I love telling patient stories. It's like we collect them over our lives. Part of the reason I was at the Capitol today is we were talking about scope creep legislation, and independent practice rights for advanced practice providers. And so I have several of my friends, my former place nurse practitioners. I love them. They're great. But they even agree like having that collaborative relationship is what's so key to good care. So when I was at my former hospital system, I had a patient who saw me and his primary care forever had been a PA. And this PA kind of was in his own clinic and acted like he was a doctor and, I'd heard mediocre things about him before, but I'm just like, yeah, whatever. So then I'm talking to this patient. He's like, I'm just kind of tired all the time. And he just checked a few labs and that was it. Never said anything. I'm like, okay. So then I start to do his exam and I'm like, huh, how long you had that murmur? And he's like, what are you talking about? What murmur? He was getting his mitral valve replaced within three months of establishing care with me. Right, because it was like, the first visit, I'm doing all the labs and the echo and all the things and he'd been seeing a PA for like six years. So, it's not that there's not a place for advanced practice providers, it really needs to have that the education and training that physicians bring to have a bigger picture approach as opposed to kind of a narrower lens. On a funny side note, he was a relative of one of the administrators of the hospital I work at. So most of the hospital administrators sent their family members to be my patients because, oh, Dr. Hume takes so much time with people. But then they'd be the same people a week later, be like, if you could just see two more patients per day, maybe we could get more staff. Right. It's just, again, everything in our life that leads to burnout is opposite choices. And It's really hard to make the right one.

Dr. Maryal Concepcion: 27:52

It's so crazy because, ironically, I got a fax this morning from the, dermatologist in the next county over who said, We're no longer taking patients. I'll only take you if you have a skin cancer already diagnosed. Here's the name of a family nurse practitioner in the county that, he was also in, send your patients there for dermatology visits. I'm like, it's real. It's so real. And, I think that is also so relatable to so many people who have, gone through and who, recall their own patient stories over time. So I think that that's wonderful that you have the time to advocate for your profession, which all of us in DBC, have the ability to carve out our schedules the way we need them to so that we can do the things that we need to do in our lives, which includes advocating for our specialties. So I love that. when, when June 31st rolled around and you were like, I'm gone, people. At what point did you start planning for your DPC? Because to have gone six months and to have already accepted 100 patients, I'm wondering what was the planning like specifically for your DPC to be able to get to this place?

Dr. Stephanie Huhn: 28:58

So, the announcement for the different pay structure had been ongoing for some time, so I knew this was coming. I think I put in my notice in February, and I actually started looking at several different business models, because I'll be honest, I know I wanted to do my own practice. It was hard to give up all the knowledge I have about insurance. It's like, I build great. I know all these extra codes for extra time and the modifiers. And so it was almost like I had to grieve over the loss of that knowledge that would now be inconsequential. Because I thought about opening my own practice that did accept insurance. But the concierge model that takes insurance and then also bills people that I don't know that that would fly as well in a rural area, just it's geared more towards the affluent. So I just decided to go with DPC in general. So I looked at a couple different ways of doing that. And I ended up going with a company where you pay one fee, flat fee, and they help you launch your business. And so. How I always explain this to folks is I know I'm smart enough that I could probably figure out how to make a website, but I don't want to. And I was also still working, right? So this started in February and then I kind of started working with them in about, April because my time is not best used learning how to do software, learning how to do social media. It's, best used to seeing patients. And so I liked their approach and the fact that it was more of a flat fee as opposed to some of the other businesses that focus on direct primary care, they would take a percentage of. My revenue and I'm like, yeah, but I'm the one seeing the patients I don't like that model. So, they had a lot of processes in place and helped me with checklists and getting things up and running and off the ground. So, one of the questions we had discussed before getting started is like financially, how did I do this? So, my prior hospital system. Is a nonprofit. So one of my retirement plans, you have to cash out if you're not going to work for another nonprofit. And so instead of taking a business loan, I just use that as my nest egg. And, been whittling that down less quickly over the last six months as I'm kind of really, I'm really close to breaking even and I'm really excited about that. And so, that's kind of where I am as far as the planning goes, but my mental planning started in February, logistics planning really started in April. I opened in September and now here we are, March, almost a year later. So

Dr. Maryal Concepcion: 31:24

and almost six months into the business and you're about to break even. So that's fantastic. I'm so excited. As you should be. And tell us about your first patients because you said that, your patients did follow you. But what was it like for those first, handful of patients who are like, Oh,

Dr. Stephanie Huhn: 31:38

it was. It was. It was joyful because these were my loyal patients. So, I use a charting system and they have billing software built in. And so one of my, my first group was a family who saw me at my hospital system and didn't have insurance, self employed and just paid the cash price to see me. And so they were the first ones. Soon as they saw it on Facebook, they signed up. And then another patient of mine who, like, do you ever have those patients where you know if it wasn't a patient doctor relationship, you would totally be friends, right?

Dr. Maryal Concepcion: 32:09

Yeah.

Dr. Stephanie Huhn: 32:10

And so, when I saw her for the first time, she was like, I was so pissed. I was invoice number four. I wanted to be the first one. I cannot believe you signed up somebody before me. I was like, it was a family of three, if that makes you feel any better. She goes, okay, it does a little. But, so my first probably month or two, it was, A few people who weren't really sure, but a lot of people who had already seen me previously and just like were excited for me to open up my practice. And then word of mouth starts and the marketing gets going. And so I would say maybe 60 to 70 percent of my current patients were my prior patients. Not as much as I anticipated, but still a lot, or they heard about me from my prior patients.

Dr. Maryal Concepcion: 32:53

And they will keep coming. I promise you that. It's like, they'll try something else. They'll try what insurance covers, they'll try the value based care, and then they'll be knocking at your door for sure. Especially because you were already known in your area, in your rural.

Dr. Stephanie Huhn: 33:07

It makes a difference. It does.

Dr. Maryal Concepcion: 33:10

Well,

Dr. Stephanie Huhn: 33:10

I firmly believe a lot of patients who were negative about me leaving think that the good quality care they were getting was just What is expected and they're going to realize 6 to 12 months later that it's because I was going above and beyond and I was working, till 8 p. m. If my husband was home to pick up the kids from school every because there's just so much charting. And so, everybody who's listening, if they've done that big value based care or they've done our view based system. You're not looking at every ER report for your patients. You're clicking select all and deleting. And so I like to know that stuff, right? I like to know what's going on with my patients. I don't like to see them four months later and be like, Whoa, you've had a surgery and two follow ups since I saw you last. I didn't even know this was happening. That makes me feel out of sorts. And so being able to have a smaller number of patients where I can keep a handle on what's going on with them, it's just a peaceful way of practicing.

Dr. Maryal Concepcion: 34:07

I love that. Tell us about how you started educating your community beyond the word of mouth that was spreading because of your patients experiencing DPC, because you pointed out earlier how, not everybody gets it. There's a lot of different responses. Apart from the nasty lady, what are some of the things that you found really useful to say specifically in your community, to help you heal? As the word of mouth was growing.

Dr. Stephanie Huhn: 34:32

So a couple of things, and I bet many DVC practices do this, is instead of just automatically starting a new patient visit, I would have a free meet and greet appointment so that I could explain what I'm doing and I could take the time to discuss with them the different price structures and the cost and the pros and the cons and kind of who we are and what we do, that I've has been very well received because then people can come in with their questions. My nurse is also very well educated on, you know, you get direct access and it's just us and we can help you get cheaper labs. and then a big two month push on social media and and then since I finished with that, I've also been on the local radio station. So I'm on there, they have like a morning show and it's a lot of local businesses and it's just cute and fun. And I come on and talk about like, Hey guys, flu season, this year's terrible. Wash your hands, and then of course that'll segue into talking about it would be great if you had a primary doctor, you wouldn't have to go to urgent care. And then I talk about, membership based, then you don't have to worry about a copay and you don't have to worry about, have you met your deductible? It's just one flat fee. And so I emphasize that a lot because so much of my area is. So fixated on, but I have good insurance. Why would I see you? I mean, over and over again. And so, I'm glad you have insurance. I'll still bill your labs through your insurance. I'll still bill your x rays through your insurance. But I always say your monthly fee covers everything I can do for you as a physician. If I can do it, it's covered. So you don't have to go all over creation to get a bunch of stuff done. If I feel comfortable with it, it's, it's going to be something that's part of the membership. And that's, I think, really clicked the light bulb for a lot of people.

Dr. Maryal Concepcion: 36:13

That's great. And I just came from interviewing some DPC patients and commonly the comment was, you just don't really get it until you get it. And then it's, it's like, how could I not have had this until now? I love that that works for you. We got to figure out a way to share this with other people in words that they will understand. So I think that, by you doing what you're doing, just taking care of your patients, as you have already shared, you're almost breaking even six months in with a hundred patients already. And the word of mouth is spreading because only people in your area of rural Missouri are going to understand and buy in as fast as they are because of hearing. other DPC patients in your area of Missouri. So I love that. Exactly. Yeah. Now tell us about your typical week and your typical day because, when you had the, like, can you just see two more patients on the table to peace out and doing it my own way? What does life look like now?

Dr. Stephanie Huhn: 37:05

So I, went out of town two weeks ago and it was kind of unexpected. Had needed reschedule a couple days, but then we'd also had a snow day because it was terrible weather. And so then the following week. I was really busy and I saw eight patients in a day. And it was awesome because it was all follow up patients. It was people I already knew. So it wasn't the long intake appointment, but I spent an hour with each patient. And a lot of my patients, even if they saw me before, there's just so much about me. They didn't know because I didn't take the time to talk about me. Right. Like they were my patients for four years. I'm like, I didn't know you were in the Navy. It's like, yeah, I know. It's I didn't have an office. So I didn't have my thing on the wall that has the poster of it. And so it just was really, very rewarding that my busy days are half or less of what I was doing on normal days in a fee for service model.

Dr. Maryal Concepcion: 37:57

Love that. Talk to us about other surprises, good or bad, that you've experienced already in the first six months because, there's a lot of things that we don't even see as much as we prepare, as much as we talk to other people. what are some examples at your DPC?

Dr. Stephanie Huhn: 38:11

So one of the unintended benefits that, I knew it would be a benefit for patients to see me regularly. We all promote that and we talk about it in our marketing. But what I didn't realize internally is what a benefit that is to me as a physician. Because if I don't have openings for four to six months, I have to plan your care for that entire time. So first you're going to start the metformin and then after two months, you're going to start the glomepiride. And then if that doesn't work, you'll send a message to my nurse and then we'll send for ozempic. And then if that doesn't work, but come and get your A1C before you see me back and then I'll see you in four months. Okay, thanks. Bye. Like that is unrewarding as a doctor. And then there's so many things you're just trying to catch up with. So what I didn't realize was going to be a benefit is now I don't have to plan that far ahead. I can be like, okay, look, we're going to talk about this one thing today. And then I'll see you back in a month. And we'll address some of those other things that aren't as important today. And so it's, really been a benefit. And you were saying about how patients appreciate it. And a patient who had followed me, I changed her meds around and she sent a little chat message like, I just, I don't know, I think maybe we need to go back. And I replied, I'm like, girl, I'll just call you. She's like, Oh yeah, I forgot. So I called her on the phone and was like, Okay, how are you feeling? What's going on? And she's like, yeah, I just forget about all this DPC stuff. It's awesome. Thanks. And so a lot of those personal interaction benefits where you don't have to worry about if you saw them face to face, because then you could build a full visit instead of just the telephone conference call. It's like you're doing what's right for the patient. the negatives are also seeing patients regularly. So, I don't know that I was surprised by that, but it is always like, I guess I'll see you next week. Right? Like there's a few of those who just are high utilizers no matter what you do. And so, trying to find appropriate ways to set those boundaries is something I've never been great at. And I've just had to work hard at that just because it's like, okay, yeah, I have an hour, but we can't spend this whole time talking about your kids and your stress. make some decisions here. And so I've just been learning to be more direct and saying just that, like, we have, we have some priorities we need to cover. Let's get to those, instead of feeling like I'm always being rude and always rushed and behind.

Dr. Maryal Concepcion: 40:21

And I think that those are coming from the words of a person who's six months into DPC and what I definitely would say that all of us who have gone seven months, eight months, 16 months, whatever it is, I definitely encourage people to lean into that, feeling of like, hey, it might not be like boundaries and establishing and, honoring those boundaries might not be the natural strong suit for some of us, but leaning into that just as you've done makes it. Easier to deal with those situations in going forward. And I know every single one of us who's opened our own clinic has had those experiences. And it's really awesome to be able to then, like you will in three years, in five years and 10 years from now, be able to look back and tell, a person who hasn't yet heard your podcast. Hey, you know, something like that happened to me. Boundaries are a thing that you need to have in your practice as a business owner.

Dr. Stephanie Huhn: 41:10

Uh huh.

Dr. Maryal Concepcion: 41:11

Mm

Dr. Stephanie Huhn: 41:11

hmm. I agree. Love that.

Dr. Maryal Concepcion: 41:13

Now, tell us about your patient panel, because you have not only patients, 60 70 percent of your patients followed you, but who else is on your panel making up the remainder of your 100 patients?

Dr. Stephanie Huhn: 41:25

I would say Most are people who are just sick of the same thing we all are that, that rigamarole several have some chronic illness, some diabetes or depression, but most of them like they have it and they were just getting annoyed with, every time I call for refills, they do it wrong. I see a different person each time I saw this doctor for a year and then they left. I saw the nurse practitioner and then she left and they're just like. I just want to get to know one person. And so some of those patients I've been kind of surprised, right? Like they're relatively healthy. They just want to know they can see me when they need to. And I've seen them twice since they'd been a member for five months. And I think that's part of getting the word out of the, that ease of access that is really helpful. So I have a patient who has a couple who have Medicaid and they just see the value in not going to the emergency room a bunch of times because they can't get in to see anyone. And I have a few that are professionals in town, and they see the value because they don't have to rearrange their schedule. They can just send me a message and I'll see them telemed or I'll squeeze them in before they start their work. So, it's been really joyful to see the variety. It just, it's great. I love it.

Dr. Maryal Concepcion: 42:37

It's fantastic. And do you have members who are getting DBC through their employer?

Dr. Stephanie Huhn: 42:43

I have just signed up a few, so I'm trying to work on my spiel on that a little bit better. I love what I do, but I'm not a great salesman about what I do, which I think people, they can feel that and they don't really want a doctor who's a great salesman. That's not what they're coming to see me for. But I've signed up a few businesses and that has been really great. Actually, one of them just was starting, On February 28th. So I can't tell you how well that particular one is going because we just you know, this is our first week but it's been very well received to the you know, I own a small business I can't provide health insurance because there's five of us But I heard about you This is going to be great and I told all my guys at the shop and this is what we're doing

Dr. Maryal Concepcion: 43:25

Well, that is so fantastic. That's how, we ended up getting two patients at our practice because that same thing, like we don't have enough to pay for health insurance, but we do have enough to pay for your practice, which is so, ironic because it's like, so what you're telling me is you don't have enough money to pay for insurance, but you do have enough money to pay for health care. Fantastic. Right. Love that. Right. Yeah. Right. so when it comes to your clinic and your brand, tell us about Romo in terms of how you got the name and how has it, stood out as a unique beacon in your community? Because I heard you saying that you have a university, branch in your community. Mm-hmm A lot of us know the big names in each state because of university connections, but tell us how you got your branding and how that has stood out in your community.

Dr. Stephanie Huhn: 44:11

So, ROMO just stands for Rolla, Missouri, so that's, there's Columbia, Missouri, which is not far goes by Como. And so that's kind of the cutesy name that Rolla has a few places have heard of, and they do that. And so I liked the simplicity of ROMO DPC, like it's. Who I am, it says what I do. I kind of debated if I wanted my name in it or not. And then I was just like, it's too long and clunky and people mispronounce it. It's like, eh, remote DPC. And so when I was working with the company to help me launch, they had a marketing part of it and they helped me with my logo. But I've really leaned into that. And so I have my logo on my marketing materials on my business card and I got, little goodie bags whenever patients come in. And so it's been something that I've really stuck to. And I think that's helpful. I think having a recognizable brand, because, really as a physician's, we're the brand, but making it like. This is the practice and here's who we are. I think that really is helpful. And I've been very, very rewarded. I think as far as that goes, it's a, blue and white logo and I put it on everything.

Dr. Maryal Concepcion: 45:20

Yeah. Easy to, I've said this before, but easy to do thread count, easy to do single image, printing. So you don't have to do multiple colors. I love that. And one of the things that I really love is, this is on the bottom of one of your pages. your copy on your website reads experience the relief of having a physician in the family. So I've heard other people say, it's like having a physician in the family, but that is stabbing right to the heart, like, experience the relief. Oh,

Dr. Stephanie Huhn: 45:47

for saying that. Yeah, I really love it. It's

Dr. Maryal Concepcion: 45:50

so sweet. It is so relatable for sure. When you look at your community, again, because you're rural, even though you do have, access to some, specialist, not necessarily, as you said, the subspecialist, in your community with the patients who are getting care through you, how do you see your community changing, especially when it comes to what people expect from their doctor because you and your clinic exist?

Dr. Stephanie Huhn: 46:14

So, the expectations I think change the longer people are a part of my practice. So initially they just. expected, Oh good, I'm going to pay you and you're going to be my doctor. Fabulous. Like I actually had several patients during my first visit be like, Oh, I'm so sorry. I'm taking up so much of your time. I'm so sorry. We're talking so long. I'm like, I scheduled it this way. It's fine. I want to talk about these things. And so, I think as I grow in my practice, patients are growing with me and getting adjusted to it as I am kind of moving in that, you know, getting bigger and getting people knowing what direct primary care is all about

Dr. Maryal Concepcion: 46:51

and Looking to your, next six months, what are some things that you're really excited about to bring to your clinic and your patients?

Dr. Stephanie Huhn: 46:59

actually, I wasn't even sure if I was going to end up talking about this, but I had, a psychiatric nurse practitioner approach me because she wants to do non insurance based practice as well and take time with patients and really spend time to help them and also do IV ketamine therapy for severe PTSD or severe depression. And so she approached me and we decided to just be kind of like two LLCs who exist next to each other as opposed to her working for me. So I'm still her collaborator. She's going to work in the same building as me, but bringing an option in town for cash based psychiatric care. Because currently there's only one system in town and it's a big like it's all over the Midwest system and they do great job But the challenge is I actually had a lot of patients at my hospital job who worked for them and it's like well I can't go see a counselor because they're my co workers and The next closest one is an hour and a half away. And so it's just really great. We're also not that far from Fort Leonard Wood, which is a large army installation here in central Missouri. And so she's already been in talks with their health and wellness section about doing IV ketamine therapy for people with PTSD. From the base. So it's just really exciting to have that as an option. I'm not sure if your listeners are familiar with that. I wasn't either. And I was kind of hard on her about, I'm like, okay, I want some of the data. We're not just going to do some random stuff. That sounds good. But the data is really the best when it's used with intensive psychotherapy together. And so low dose, you do it, IBC, you can turn it off and on. You're not just like doing it. I am. And it increases neuroplasticity. And then that psychotherapy the next day is what helps finally break patients out of either the severe refractory depression or some of the severe PTSD symptoms. So it's, really life changing for a lot of folks.

Dr. Maryal Concepcion: 48:48

And I believe Dr. Picascio in Texas also mentioned that he was doing it, in his interview. So definitely, if people have questions, you have a example from Missouri and an example from Texas that you can reach out and talk to them about their experiences. So that's awesome. when it comes to. Your nurse, tell us about the story of how your nurse joined you at your practice because, I wonder if she came from where you worked before or if you had known her before.

Dr. Stephanie Huhn: 49:14

She came from my former employer and Honestly, it was a blessing for her too. So she's an MA and they had switched to having all LPNs. And if you were an MA, you had to go through certification program. And so they had talked to, Oh, we're going to make you the lead MA. You're going to do this. Oh, the training got canceled. Nevermind. It'll be six months. So she never got more responsibility. She never got a raise. And, she was in a back office doing prior authorizations all day. That was all she did was talk on the phone to patients and talk on the phone to insurance companies. But prior to moving to Missouri, she was an EMT. She worked in the ER. She worked at a urology office. She helped with procedures. So she was a phlebotomist. So could you imagine you have all these skills and you're stuck talking to insurance companies all day? And so I approached her and I was like, Cheryl, girl, seriously, why don't you come work with me? And it's, it's, Amazing. So, you know, that whole like work to the top of your license, she's getting to do that, right? She's drawing labs on patients. I have patients on GLP one therapy. they don't want to do their own injection. So she does it every week for them and just, she's talking on the phone. She's reviewing labs, she's drawing blood. And then we ship the tubes to quest it's using her full scope. And I mean, I don't want to speak for her, but I think she's just much happier and content with this job compared to what she was doing before. And so it was a leap of faith to hire somebody before I had the patient panel to support it. But you know, knowing what I wanted and I don't want to do prior offs. I don't want to have to do some of that clerical work. I don't want to scan stuff. I don't want to fact stuff. I know that's not As lean as a lot of DPCs are at startup, but I had faith that I would get there and that investment and having her with me from the beginning was going to be worth it. And so far, I'm pretty sure that's how it's going to work out.

Dr. Maryal Concepcion: 51:02

Awesome. So a few rapid fire questions for you and then we'll go on. what's one of the weirdest or funniest things that a patient's ever said to you?

Dr. Stephanie Huhn: 51:10

As I've grown in my career as a physician, I have gotten more open with my patients where instead of being this like reserved, I'm, you know, Perfect. Lieutenant Hune. I'm done. I'm very calm. And this is, everything is great. I'm more real. And so, excuse me if you have to bleep my coming up stuff. So I had a patient one time who spent like the whole first five minutes, look at my new amazing tattoo. It's so awesome. I just got it. This ink and like, like a whole sleeve. And so then I was like, Oh, that's great. What have your blood sugars been? And he's like, Oh, I can't afford the test strips. I was like, well, that's bullshit. That tattoo costs like 300. Don't even get me started next time. I see you bring me some numbers. And so. I said that kind of without thinking because I was used to sailors, right? I was used to the Navy guys. I could be like, yeah, yeah, I'm calling you out. And that guy like wrote a letter to the hospital I was working with at the time for Doctor's Day saying I was the best doctor he ever had. Nobody ever like helped him like I did. And I think it's just talking to people like they're real. And so, um, just a lot of kind of funny, funny, funny things like that.

Dr. Maryal Concepcion: 52:22

Love that. And what do you consider is your superpower outside of medicine?

Dr. Stephanie Huhn: 52:26

Outside of medicine? I don't think it's a superpower, but I do really enjoy, like, I have property, so we have 150 acres, so I, hike or I garden. I make my own kombucha, which my family hates, but I love. So it's doing some of those, home type things that, that really brings me joy.

Dr. Maryal Concepcion: 52:47

Love it. And if you were walking into your clinic and you had a theme song for Dr. Hugh and herself, what would that theme song be?

Dr. Stephanie Huhn: 52:55

Ain't nothing gonna break my style. Nobody gonna slow me down. Oh no, I got to keep on moving.

Dr. Maryal Concepcion: 53:04

I

Dr. Stephanie Huhn: 53:04

mean,

Dr. Maryal Concepcion: 53:04

you know, you're singing, you know, you're singing it with her because I was for sure. So good. So

Dr. Stephanie Huhn: 53:11

better on the radio when you're listening to the DPC story later. We'll just pretend like I don't have a cold and don't have a scratchy throat. It's fine,

Dr. Maryal Concepcion: 53:17

girl. I would do karaoke with you with that song any day. Let's let's do it, man. I love it. It's been so wonderful to hear your story. I love, hearing your theme song, hearing how, your patient you know, because, because if you stopped and you didn't hear the end of that story, you could have guessed, like, did the patient write her up, but he did not. Yeah. I wonder, because you can already look back, you started transitioning February of last year mentally into DPC, what would be one really big piece of advice that you would give people who are not in DPC yet, who are maybe a medical student or resident looking to the future or an attending and one of our colleagues who is, considering Maybe I should leave medicine. Is there another way? What would you say to that group of people? I

Dr. Stephanie Huhn: 54:06

would coach them to really look at what do you love about medicine and find a way to do that, right? I jokingly call it the gift of the millennials, right? Like you don't need to work your entire life doing something you hate because you feel like you should. So find what you love, find a way to make it happen. And I think that's the most concise advice I could give. Find what you love, find a way to make it happen.

Dr. Maryal Concepcion: 54:29

Beautiful. It has been so fantastic, Dr. Huynh talking to you today. Yes, I am so excited. We're going to continue the conversation over on our patron community. So please join us over there. We're going to be talking about how to choose an EHR and how Dr. Huynh chose an EHR that was earlier on in its existence and that experience of working with a new DPC EMR and also more about practicing in rural America. So Dr. Huynh, thank you so much for joining us today. I'm so glad that others get to hear your DPC story. Thank you so much for having me. This was really fun.

55:03

Thank you for listening to another episode of my DBC story. If you enjoyed it, please leave a five star review on your favorite podcast platform. It helps others find the show, have a question about direct primary care. Leave me a voicemail. You might hear it answered in a future episode. Follow us on socials at the handle at my D DPC story and join DPC didactics our monthly deep dive into your questions and challenges. Links are@mydpcstory.com for exclusive content you won't hear anywhere else. Join our Patreon. Find the link in the show notes or search for my DPC story on patreon.com for DPC news on the daily. Check out DPC news.com. Until next week, this is Marielle conception.