Going A Little Outlaw: How Dr. Katie Burden-Greer Built Her DPC On The Creek Nation Indian Reservation

Today, Dr. Katie Burden-Greer, founder of Outlaw Medical, highlights her unique path from her rural Oklahoma roots through her comprehensive medical education and training, which included a residency at the prestigious Mayo Clinic. She discusses her choice to establish a Direct Primary Care (DPC) practice on the Muskogee or Creek Nation Reservation. Despite access to Indian Health Services, Outlaw Medical is building stronger physician-patient relationships and overcoming the access challenges posed by IHS. Already, Dr. Burden-Greer's patient panel is composed of over 20% Native People. Dr. Burden-Greer shares compelling stories from her journey, insights into her practice, and her motivations, including a deep connection to her community. The episode also touches on broader issues in healthcare accessibility and the impact of the DPC model in a rural setting.

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Transcript

Dr. Maryal Concepcion: 1:13

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.

2:01

DPC to me is being able to connect directly with patients and having a relationship with my patients and them having a doctor they know they can count on. I'm Dr. Bergen Greer and this is my DPC store. Before we dive in, I wanted to share that this episode was recorded on location, about an hour and a half outside Oklahoma City at the home and clinic of Dr. Katie Burden, Greer. today's guest, she graciously welcomed me out to her 140 acre property, gave me a tour, introduced me to her dogs, horses, and cows, and even fed her bison a little extra so I could grab some video to share with my sons. It was an incredible experience and truly gave me a glimpse into the heart behind her work. Now a little bit more about Dr. Bird Greer,

Dr. Maryal Concepcion: 2:47

Dr. Katie Birdin Greer, founder of Outlaw Medical, grew up in rural Oklahoma where she witnessed firsthand the gaps in the healthcare system, specifically the Indian Health Services Healthcare System or IHS. And rather than accept the status quo, she went a little outlaw and launched her own direct primary care practice. Dr. Birdin Greer is double board certified in family medicine and obesity medicine, a graduate of East Central University and the University of Oklahoma. Boomer Sooner and completed her residency at the prestigious Mayo Clinic. She's led through crises as chief of inpatient medicine at Chickasaw Nation during the height of COVID-19, and continues to fight for better care in every setting. She touches outside the clinic. She's Dr. Aunt KK to a big crew of nieces and nephews. She and her husband also have an adventurous spirit and they enjoy being outdoors, gardening, forestry, traveling, scuba diving, and taking care of their cattle and bison. Ranch. ah, It's nice in the shade. Yeah. It's awesome. So this is, this is a, today's interview is, is very different. It's very unique. I'm super excited. Dr. Bird Greer had met me and I met her at, in Dallas last year, and it was it totally stuck in my mind this whole time that she said, yeah, I'm, I'm opening Outlaw Medical is my practice and I'm in Oklahoma on the Muskogee reservation or the creek. Nation reservation. And I just think that in such a time that we are in, in healthcare where there's so much there's so much unhappiness with the system. Historically there's been so much happiness in the Indian Health Services system. So before we go there though, I just wanted to say that really just to put a geographic location and like a just paint a picture in, in the listener's head, but tell us about your even choosing to go into medicine because you grew up in Oklahoma and you are. Still in Oklahoma and came back after you went to Florida for school. But what, when along your journey in life did you say, I wanna be doctor, I wanna be a physician doing family medicine? Yeah. It's

Dr. Katie Burden-Greer: 4:55

kind of a unique story'cause my mom was an LPN and she worked at the ER in Oakmulgee, which is, the capital of Muskogee Creek Nation. And she worked there and she'd come home telling me stories and I just ate it up. And I always had an aptitude for science, so I kind of decided at a pretty young age that I wanted to be a doctor. Plus I was kind of sick as a kid. Like I would get asthma attacks. Mm-hmm. Get pneumonia. And I would be in the Creek Nation health system as a patient and I'd be like, okay, I wanna do this. I wanna take care of people, you

Dr. Maryal Concepcion: 5:28

know? Yeah. And so. The assumption there, because I didn't actually ask you this before we started talking. Your heritage is you are Muskogee Creek Nation heritage. I don't even know how you would say that. How Yes. Is your bloodline of the Muskogee Creek Nation?

Dr. Katie Burden-Greer: 5:46

Yes. Yeah. Yes, I am mostly Muskogee Creek. I am also part Cherokee, part Ucci. And then I like to tell people I'm a quarter white, but I can't prove it. That's

Dr. Maryal Concepcion: 5:57

awesome. My mom says I'm aqua like this, this I don't know, one, 100th or whatever, like fraction Cherokee. I can't prove that. Yeah. So love it. That's that's the go-to. Yeah. Love it. It's like I am, but I can't prove it. So when you, when you, as you mentioned, your own health history. How easy was it for you to get to, to be seen? Because, you, you had a little leg up in compared to other people. You had somebody in healthcare in your family. Mm-hmm. But what, what was it like if you were like, my asthma's not controlled. Mm-hmm. I do need to be seen. What was your access like growing

Dr. Katie Burden-Greer: 6:29

up? That's the thing. It was even with, quote unquote free healthcare for the tribe, the access was so limited. I mean, I can remember going to the ER a lot as a kid because it's not like you can just make an appointment with your doctor or text your doctor or call your doctor. So it was very limited. I mean, there's just way more patients than there are doctors in the system.

Dr. Maryal Concepcion: 6:52

Mm-hmm. And when you, as you were growing up, how far geographically did you live to either a doctor or one of the acute care centers?'cause it's my understanding that before a few years ago, there were two acute care access hospitals. Mm-hmm. Wouldn't necessarily take care of unstable patients, but for someone who's having a stable but needing to be controlled asthma attack, I would assume that that would be an appropriate place to go to.

Dr. Katie Burden-Greer: 7:19

Right. There was a small community hospital in Okah, Oklahoma, which you probably drove past on your way here. And that is where we would go for er visits, doctor visits. Mm-hmm. It's about 20, 25 minutes away. 20 ish from where you grew up? Yes. Yeah. I actually grew up here. Oh,

Dr. Maryal Concepcion: 7:37

not on this exact land, but yes, in willka. Wow, okay. So that's that's, and I like what would, what's the worst it got when it comes to like snow and conditions? Because it is a it's, it's paved, up until here, even to the door of your property. But I, I just think about living in Omaha that sometimes. A 25 minute drive was not a 25 minute drive if there was a lot of bad weather. Oh, right. Like

Dr. Katie Burden-Greer: 8:03

when there's bad weather, I mean, you just stay home.

Dr. Maryal Concepcion: 8:05

Yeah.

Dr. Katie Burden-Greer: 8:06

Our system is just not built for snow and ice and usually I feel like maybe twice a year we get a bad snow storm or ice storm and everybody just stays home. Yeah.

Dr. Maryal Concepcion: 8:16

So I I, I am just like thinking in my head that that is probably one of the, the things that people have most likely found so amazing about your care now as a DPC doctor. So I, I think about your going off to Florida for training and then you making your way back to Oklahoma. Mm-hmm. Did you ever think about not coming back home or did you always intentionally train so that you could come back home and take care of the people you grew up in and around? This community and,

Dr. Katie Burden-Greer: 8:49

When you're a teenager you think about running away and never coming home. But once, my head was in reality. Yeah. It, the, all the plan was always to come back and work for my own tribe. Yeah. My goal was to work for Crete Nation, actually. Sure. My whole life. Yeah. And so I went to East Central, a small college in Ada, Oklahoma, and then OU for medical school, and then Jacksonville, Florida at Mayo Clinic for residency and. I real it, living in the bigger cities made me realize how much I am not a city person. Sure. I really needed my space again. Yeah. I needed land and I knew it was gonna be rural Oklahoma.'cause I wanted to work, specifically for my tribe. But I was open to working for other tribes. Yeah. So, it was always gonna be back in Oklahoma as soon as I decided I wasn't a city person. Sure. When

Dr. Maryal Concepcion: 9:34

you, had that self-discovery and you then came back here I, I wanna ask about your preparation for coming back here in how you either crafted your rotations or how you intentionally went about learning and residency. I just spoke with medical students who were like, very much interested in the DPC model, but were wondering about oh. But if the system only teaches you one way of doing things mm-hmm. Fee for service way, how do you train enough to be able to be a DPC doctor to be confident to be serving patients without. Being in that system. So how, how did you address, your future coming back here and like you, you mentioned even thinking initially that you wanted to work for the Creek Nation itself. How did you, how did you craft your, your experience in especially residency?

Dr. Katie Burden-Greer: 10:25

I would say for me, I was in such a good program that really taught a wide scope of family medicine more so than average. Because Mayo Clinic, they want their specialists to only see the really weird Yeah. Hard to treat stuff. So with, in family medicine, we were seeing everything. Yeah. We were taking care of all the stuff that maybe other places would refer out to a specialist. Mm-hmm. But for us it was like, oh yeah. Type one diabetic on a pump. No, they're not going to endocrinology. Yeah. Like, we're taking care of that.

Dr. Maryal Concepcion: 10:54

It's wonderful that you had that experience. so Here I wanna ask about your thought then about wanting initially to work for the Creek Nation or, or anywhere. Mm-hmm. In terms of, I'm assuming Indian Health Services. Yes. When you say that, when you were in your third year residency, getting all this amazing training and not necessarily worrying about could I be a doctor in, in any system? Mm-hmm. What were the thoughts about what were, what was the decision tree like when you were thinking Indian Health Services versus anything else? Were you even thinking of anything else?

Dr. Katie Burden-Greer: 11:28

There really wasn't even a versus for me. Yeah. Like I knew I wanted to do Indian Health Service. Yeah. I wanted to do tribal healthcare and. I had toyed with the idea of opening my own clinic mm-hmm. Within the Creek Nation boundaries and maybe partnering with, the tribe to try to fund it. But the legalities and the red tape and the funding and the Medicare reimbursements and all the things that were just so against that plan I just knew I wanted to work for IHS.

Dr. Maryal Concepcion: 11:54

Yeah. And it's interesting because for the listeners, something that I learned literally driving here to your, to you, your, your property and, and your, the town where your clinic is in I did not realize that one, if a, if a tribe and nation is recognized federally mm-hmm. That's one. And then two a tribe can choose to either take a grant from the Federal sur the federal money that funds IHS or IHS can give money as a grant to a tribe to do with, with. To do with it what they want. Mm-hmm. So the Creek Nation in particular definitely has participation in IHS. There's not a necessarily, not a separate grant that is funding the access points in, in this area, in this, in this, on this reservation land. But when you were in your third year, were you having IHS people like talk to you to try to

Dr. Katie Burden-Greer: 12:48

recruit

Dr. Maryal Concepcion: 12:49

you?

Dr. Katie Burden-Greer: 12:49

Unfortunately, no. I actually had to chase down the IHS recruiters and the tribal recruiters and say, Hey, I wanna come work for you. I wanna come work for you. Give me an interview.

Dr. Maryal Concepcion: 13:47

Yeah.

Dr. Katie Burden-Greer: 13:47

So I mean, the recruiting budget is I think, very underfunded. So nobody reached out to me at all. Like I had to reach out to each individual tribe and IHS facility that I was interested in.

Dr. Maryal Concepcion: 13:58

And I ask this just because some tribal nations are doing this where like there's a, a ear, nose and throat surgeon who had come to the, one of the newest healthcare centers through IHS at, what was the cancer treatment center in Tulsa? Yes. Council, which became Yes. Which became Council Oak. I was hearing about, there is an ENT surgeon who was put through medical school by, and I don't know if it was this nation or a different nation, but medical school was funded. Mm-hmm. Was any of your education

Dr. Katie Burden-Greer: 14:30

funded by the tribe? Yes. I applied for and got the IHS scholarship while I was still in college. And so that completely covered my tuition. I still had to pay for, like books, living expenses but my loans are, were massively, I say were,'cause I've gotten paid off now were so much lower than. A lot of my colleagues that came out with 300,$500,000 in debt. Yeah. I was like, a hundred thousand.

Dr. Maryal Concepcion: 14:54

And it just wonderful. I'm Congratulations on that, that you got the scholarship, but also it's just it makes you wanna bang my head against the window because you're, you are an ih a scholarship recipient. Mm-hmm. There's not too many people, I'm assuming, who take that and go to become a physician. Mm-hmm. And then the fact that you didn't even have a recruiter, even with the limited resources. To me, it's just, that's ackwards. Yes it is. And oh my goodness. And so, if, if there is a listener out there who is also an IHS scholarship recipient who's going to doctor school, like definitely listen into this interview because this is, that's crazy. When it comes to you reaching out saying, Hey, I wanna work for you. Why didn't you continue down that pathway of becoming. Like to this day still employed with IHS.

Dr. Katie Burden-Greer: 15:40

So for me, I started out working for my own tribe. I was happy as a clam. I was doing covering our critical access hospital with, a handful of patients a day covering the clinic. And then on my days off, which were Friday, Saturday, Sunday, I would usually pick up er shifts at the same hospital. Yeah. And I very much enjoyed it. What got me was the tribe got into a financial crisis, I guess you would say, and one of the way the administrators decided that they needed to make more money was they started having patients come in at smaller and smaller time intervals. I actually took a picture of my schedule one time when I had a five minute appointment slot for a patient with multiple comorbidities. Oh. I couldn't even filled her medicines in five minutes. Yeah.

Dr. Maryal Concepcion: 16:21

I just, I think that this is where, as I was hearing the transition from when Council Oak was created. The, the the, the way that the administrator was speaking about, oh, the innovation, the accessibility, the affordability, all of these things. I, I kept thinking that it is still an admin run system. It is, even though it is not the traditional BUCA plan system. Mm-hmm. It is still not direct primary care. And we've been talking very recently on the podcast, Dr. Stephanie Huon, who's in Missouri, in Raleigh, Missouri rural town. Just like yours was talking about how when it comes to what is value-based care and what is not this is where there's a distinction. What is system-based care and what is not system-based care and how does that differ is a little bit easier. But for you, I mean, it's, that is, it doesn't matter where you are practicing that. Yeah. But then we're gonna, the, the the quality of care, the, just the obnoxiousness of somebody telling you who's not a physician, that you have five minutes on your schedule for this one person with, like you said, chronic comorbidities. What did your mind start doing then with the, the knowledge that this isn't tenable for you to be able to practice like you need to?

Dr. Katie Burden-Greer: 17:42

Right. I'd say like the straw that really broke my back was. Like I mentioned, I was covering the hospitalized patients as well as the clinic patients. I had an hour blocked in the morning to see my hospitalized patients and I was expected to follow up through the day with no shows. If I had a nohow, that's when I go back and check on the hospital. So, well, what if I don't have a no-show or what if I have, 20 patients in an hour? I mean, it's just not possible. So I was doing the best I could. I had a patient with a UTI checked her white count looking better, went and talked to her, feel better. Great. Awesome. Go home. Went and saw all my clinic patients. I was staying there late. I was there till probably about nine o'clock. Just checking charts, making sure I didn't miss anything.'cause you're gonna miss something when you're having to rush through. I missed her hemoglobin was 6.9. Oh geez. Called her back, got her transfused, got her taken care of. Luckily nothing happened. But I mean, she could have had an MS. Stemi, she could have had a heart attack from that.

Dr. Maryal Concepcion: 18:29

Yeah, totally.

Dr. Katie Burden-Greer: 18:29

And I was like, I can't keep being a part of this. Yeah. So that's when I started looking into other options and started applying at other places. Yeah. Yeah. And still within the nation or still within IHS? Within IHS, yes. Okay. So, when you have the IHS scholarship and you pay for four years of medical school with the scholarship, you're expected to work for four years for IHS or tribal facility. Got it. So I was only two and a half years in, so I knew I had to work for another tribal facility or IHS facility. Yeah. So I applied, with the Chickasaw Nation, with the Cherokee Nation, I was looking at IHS funded and Woca which is primarily Seminole, but they're more IHS funded than tribal funded. So I looked at all those and the best fit for me was back in Ada, where I went to college is where. The Chickasaw Nation has a hospital and they had a hospitalist position open and I applied and I really liked their model. They were very patient centered, patient forward, so many hospitalist positions make you see 20 plus a day. Their average was 12 or less. Wow. So that you could actually spend time with people Yeah. And explain things. So I really liked that. So that's when I went there in the very end of 2016.

Dr. Maryal Concepcion: 19:38

Got it. And were you also doing, were you also having to do outpatient as well as inpatient somewhere? No. Okay. That

Dr. Katie Burden-Greer: 19:44

was a strictly hospitalist position with Open ICU. Got it. Got it. And

Dr. Maryal Concepcion: 19:49

I wonder knowing that you had to at least commit four years to serving NIHS, when you were looking to transition away from oa, did you ask questions in particular of the different locations that you were you, that you were looking at with administrators or doctors or staff? I really wanna know, know what you're, what I'm getting into. Because of my experience in Chea,

Dr. Katie Burden-Greer: 20:12

I found the best question for me to ask was, when did the last position leave and why?

Dr. Maryal Concepcion: 20:18

Yeah.

Dr. Katie Burden-Greer: 20:18

That's usually a good tell. And with Chickasaw Nation, the last person to leave that type of position left because they had advanced cancer and they had been there for decades. Yeah. It

Dr. Maryal Concepcion: 20:29

speaks, it speaks highly to the importance of that question. Mm-hmm. I think it's, it's a very good question for any, any person who's looking at a, an employed position. Mm-hmm. So. What was that like because 2016, how long did you stay there? Because you have eventually became the chief of inpatient medicine during the lovely pandemic era.

Dr. Katie Burden-Greer: 20:50

Yes. So I absolutely loved the week on, week off schedule. They were long grueling days. 12 hour in-house shift is rough.

Dr. Maryal Concepcion: 20:59

Yeah.

Dr. Katie Burden-Greer: 20:59

Plus the, two and a half hour round trip driving down there and back.'cause I was dead set on staying in my own bed. Sure. And staying with my husband who had previously been in the Navy and deployed and we were sick of being apart. So I was like, no, no, no, we're living together. So the biggest thing for me was whenever I became more involved in administration at the very end of 2019, right before the pandemic hit is. It was a lot of work. I mean, there was one week I worked 114 hours. Geez, Louis. Yeah. That was right at the beginning, end of March, 2020. Yeah. Right. When all this was really hidden. Yeah. And and I felt like I was doing so good. I was like, wow, I feel like I'm making a difference in admin because I came into admin when it was really important, decisions were being made. Like I was able to set up a tele ICU, whereas before we were just family medicine. I say just family medicine and internal medicine. Managing the ICU patients, previously if they were intubated more than a couple days, they'd be transferred. That was not an option during covid anymore. So we were figuring out how to do paralytic drips, prone high settings on ventilators. So luckily I was able to set up that backup with an actual critical care trained group to. See what we were doing with our patients and advise us if we need to change this, that, or the other thing. Wow.

Dr. Maryal Concepcion: 22:13

And that was via the, your telemedicine stuff? Yes. Yeah. That's fantastic. I just, in rural Nebraska, we had the, the third time I went back there as a resident, there was a, a camera for a trauma surgeon or trauma doctors mm-hmm. To be able to quote unquote zoom into the room. Mm-hmm. To help in the role access hospital that is Broadstone Memorial. Mm-hmm. So I totally get the, the importance of that going through the hell that was the pandemic for those people, especially who were in the hospital at that time. When did you then even think about Hey, one, clearly you just had to survive and get through your stuff. Mm-hmm. But two, at what point did you then say, I need an even different model of practicing. I've done chea, I've done this. ICU, I'm, I'm head here. I'm involved in admin, but it is still not what I wish to do in the

Dr. Katie Burden-Greer: 23:05

future. So a few different reasons. Number one, I'll say I cannot imagine working in the hospital with a better administration or better colleagues. I mean, we had the absolute best doctors, respiratory therapists, nurses, awesome. It was amazing. It was like the worst hell that I would never want to go through again, but if I ever did, it would be with them. So number one, I absolutely loved him. It was kind of, it was really hard to think about leaving, but my heart was never in hospital medicine. Yeah. I wanted the relationships of primary care. So, once Covid calmed down and when admin became more tedious than what I felt was like immediately helpful the way it was during Covid, I I started getting antsy. I missed my primary care relationships I had with patient. Oh my God, it was so hard to leave Che when I left primary care there. I mean, I had so many patients that really, liked that I would spend the extra time and listen to them, even though that would put me behind and I'd get in trouble. But, it was what needed to be done. And then, I mean, I had another patient too because, being rural Oklahoma, not so many people or open-minded. I had a patient, she would fly all the way out here from Arizona. She was native and couldn't find anyone to give her healthcare. She was trans couldn't find anyone to give her hormone therapy, anything. And I was like, absolutely, I'll take care of you. I mean, people are people like, why do you have to be mean? Yeah. And this was, in 2014, 15, this was before, it became a little bit more. Common for people to be open to that. Totally. So I was the only doctor seeing trans patients there. In my little town of Oke. I think I had four.

Dr. Maryal Concepcion: 24:38

Oh my gosh. It just, I, I shake my head because, and then you look at today in 2025 where, there's, I read a meme yesterday, there's more people with measles and people who are playing trans sports, and it's really? What are we going to, have a fit about? We're going back

Dr. Katie Burden-Greer: 24:51

in time.

Dr. Maryal Concepcion: 24:51

Yeah. So, yeah. I, I completely am in the same boat. People are people. We went to human, human doctor school. Yeah. Don't ask me to take care of a zebra, but ask me to take care of a human does not matter. Yes. Period. So I am amen to that. People are people. Yes. So I love this focus on people. Mm-hmm. Being a people doctor, re wanting to refocus and resume in on relationship-based medicine. Mm-hmm. Why direct primary care and not going back to another IHS clinic in a different, like a one with a similar administration or an outpatient clinic where maybe the doctors just don't leave because they like it versus coming back here to Ika and opening your own DPC.

Dr. Katie Burden-Greer: 25:35

Yeah. A little wild kind of crazy to go that direction. Some people might think I'm insane, but the biggest thing is, I learned a lot about leadership and administration and my role at Chickasaw Nation and I figured if I am able to help navigate the hospital through a COVID pandemic, I could probably start a monthly membership, primary care clinic. And worst case scenario, I always think worst case scenario, that's where my er ICU brain goes. Worst case scenario, I do go back to work for somebody. Sure. I mean, it's not the end of the world. Like at least I can say I tried. So, and honestly I was. 50 50 on whether it would work or not. Yeah. And I just felt like I had to take the leap. So I set myself a goal of getting around, maybe 80 members, 80 membership patients at one year. So February was one year, so we're now 14 months and I'm at 142 patients deal. I know, it's insane. My gosh. I mean,'cause I'm really starting from scratch. Yeah. I didn't have a primary care panel that I took with me. I was being a hospitalist for, seven years. Closer to eight, I guess.

Dr. Maryal Concepcion: 27:29

Well, and you have, you are in a place where there's supposed to be healthcare mm-hmm. That is provided. And even your decades ago growing up. Dr. Re is not old, but she is at least multiple decades. That could be three decades. Just said 40. We can put it out there

Dr. Katie Burden-Greer: 27:46

just

Dr. Maryal Concepcion: 27:46

last month. Love it. You're supposed to have the responsibility of the, the, the agreements, the treaties are supposed to be ending in people who have been discriminated against. There's so much history there that is a completely separate podcast robbed of its lands. People just, I mean, this is, this is so, there's so much maddening history when it comes to the native people of what we call the United States of America and how rights and other things have been taken from Native Nations. When you think about though, this idea of the IHS is supposed to be providing healthcare and not just insurance to people in tribal nations. You still have people who are paying you to be their doctor, where again, you cannot, you cannot go into IHS and have your personal doctor, Dr. Burden Greer is a person's physical real doctor. But why do people pay you, why do people find value in Outlaw Medical? Because they, they're supposed to have healthcare covered just like Medi-Cal recipients. And Medi and Medi Medicare recipients are supposed to have healthcare. Mm-hmm. And I'm making all these quotes, air quotations, like physically picture me frustrated and making these air quotes with my fingers as I'm asking her this.

Dr. Katie Burden-Greer: 29:12

Yeah. That is one thing that actually I was a little bit worried about opening a DPC clinic in my area.'cause my area is about 21% native. That means 21% of people can go to one of the tribal facilities and get their healthcare. On top of that we have Medicaid and other things where people will get quote, unquote free healthcare. But when I opened, one of the things that I knew from my own experience is getting in to get established with a primary care four to six months is pretty standard weight. And to see a doctor, maybe longer because they have a big supply of nurse practitioners and PAs, but not so much on the doctor side of things. So people that wanted physician care, people that wanted access greater, sooner than every six months. If you wanna get in for a same day appointment. Almost always you're told to go to the er. Yeah. Versus, I had a patient actually this morning, I haven't mentioned to you yet. I had a patient come to me, I saw her yesterday. She clearly has a pilo, a kidney infection. So she called this morning saying she was in a lot of pain, or her husband did. And I'm like, Hey, gimme 15 minutes to put on clothes. I'll meet you at the clinic and we'll do a Toradol shot. That's usually the best for kidney pain. And if you're not better after that, we will figure out what to do next. So, I mean, I did that a couple hours before you got here. Wow. Wow. And that's just an impossibility. Yeah. With in the system. Totally. 100%

Dr. Maryal Concepcion: 30:37

you're going to the er. Yeah. And. Just as a side question there, what is the weight in the er? Once you get there,

Dr. Katie Burden-Greer: 30:44

it's hit or miss. If you go at a time where they're not too busy, you might get in pretty quick. If you go at a time that a lot of people, kids get outta school on a weekday and everybody's coming in with their colds and flu and covid, then it might be, several hours. Yeah. So you're talking about the drive to the hospital? Yeah.'cause nobody lives next to the hospital and then you're talking about the weight and then you're talking about being seen mm-hmm. Testing, getting out of there. Your, your whole day is the er. Yeah. Yeah. Versus,

Dr. Maryal Concepcion: 31:11

calling you less, less than 30 minutes with this patient. It's amazing. And right now, your patients who've seen you again, I'm so excited that you have so many what is their geographic span? Do you still have patients flying from Arizona to see you? Because I, I, I think about how in my fee for service practice, even people would drive an hour and a half to see us. Mm-hmm. But what is it like for you? In the, in terms of the geographic footprint of your patients?

Dr. Katie Burden-Greer: 31:38

I'd say the vast majority are within a 45 minute drive. And for Oklahoma, that's not very far. Yeah. For reference from where we're at right now, it's an hour and a half to Oklahoma City. It's an hour and a half to Tulsa.

Dr. Maryal Concepcion: 31:49

Mm-hmm.

Dr. Katie Burden-Greer: 31:50

So a 45 minute drive, from Seminole or Holdenville or some of these other towns that are, nearby but still rural they'll drive to see me or we'll do virtual visits. Sure. That's the majority. I do have some patients in Edmond, which is north of Oklahoma City. Mm-hmm. Norman, the Tulsa area that we do most of our visits virtual, they see us, see me in person when they need to. Yeah. But otherwise, we handle most things virtually. And

Dr. Maryal Concepcion: 32:15

do you physically go to different locations in Oklahoma once in a while to, to meet patients where they're at? Or do you even if it's home visits or do you. Just see them once in a while because they're coming here to Wika.

Dr. Katie Burden-Greer: 32:29

I just see them in person in Wika. Mm-hmm. I don't have any other locations that I travel to. Got it. Got it.

Dr. Maryal Concepcion: 32:34

So I think about Willka having around 800 people here. Mm-hmm. And then people are driving typically 45 minutes as the, the longest to see you. I, I just think that that's still not thousands and thousands of people. Mm-hmm. And yet you have over 120 people mm-hmm. Who are choosing to see you. I mean, this is where I, I think about Phil, Esq, jd, NBA Do who has said, DPC can happen anywhere. Mm-hmm. And you are absolutely proving that. That's why I'm so honored to be out here. I'm so excited to have your words be shared, amongst the, the airwaves. On the airwaves. Because for those people who are hesitating for whatever reason, it's like you are definitely providing a, a so unique and hopefully not unique example in the future, right. As more people do this. But I wonder about I wonder about the, the things that you are seeing not only in people who are not of. The creek nation, but who are also just in rural America mm-hmm. In rural Oklahoma. What are the, what are the medical issues, especially like when it comes to chronic disease that you are seeing and how are they different if a person is of a tribal nation?

Dr. Katie Burden-Greer: 33:46

So, native populations tend to have higher rates of diabetes. And most people know that, but most people don't know. Native populations have a much higher rate of autoimmune disease. Wow. Which I find very interesting, and that's one of the things that kind of got me interested in medicine as my mom has. Mm-hmm. A lot of autoimmune issues, rheumatoid lupus, things like that. So I had kind of a special interest in those things. Yeah. And I mean, I would say last week I diagnosed a new patient with lupus because she had been through the system, given, 15 minute appointments in and out, never had the hour long appointment that she and I had talking about everything in detail. And I'm like, you're checking all the boxes of lupus. And she even described a butterfly rash. I'm like, okay. Well. I think this is what's going on. Let's get you checked out before we go down these other routes. Yeah. And that's what it was. Wow.

Dr. Maryal Concepcion: 34:34

And when it comes to, I I, I go back to this transition period that the Creek Nation in particular had to, to opening, this, this brand new facility where one of the things that they touted was we're gonna have amazing mental healthcare, behavioral healthcare access. We're gonna do work in the community to not make mental health addiction alcohol substance use disorder a stigma. Mm-hmm. Do you think that that has changed within the nation in particular when, when they are supposedly having access to more healthcare options?

Dr. Katie Burden-Greer: 35:08

I'm not working within the tribe anymore, but I have seen that they are doing more to try to make access happen. So I do think they're making great strides. I mean, it's been. Almost a decade since I've worked for the tribe. Yeah. And from what I've seen, it's a much better administration. It's much better as far as what their goals are. Sure. Putting patients first. And so I think lots of strides are being made, but it's, it's, it's never enough.

Dr. Maryal Concepcion: 35:34

Yeah, totally. And but that, that is good, that there's a positive change there. That's really great. When it comes to your typical day, because you live an hour, an hour, you live a mile and a half from your clinic. That's just like me oh, I gotta see you. I'll be there in 15 minutes, but it's actually two, but I'm just gonna say 15. For you, what does that look like in terms of your typical week? Do you go in every day? How many patients do you see on your busiest days? So it

Dr. Katie Burden-Greer: 36:01

kind of depends on the day. I am there every day of the week, except for one day a week. I work for Woca IHS. Okay. That's kind of my side gig to help, fun things. Yep. And my hours are nine to six because I wanted people when they get off work to be able to have access to a doctor. Sure. So, a lot of the teachers in town get off at three o'clock. A lot of people that you know work the nine to fives, I can see them at 5, 5 30. And then I do one the first Saturday of every month, I'm there for a half day. Okay. So I have, so a handful of patients that can only see me on Saturdays and otherwise they just wouldn't have a doctor at all. Yeah. So I like being able to have that kind of flexibility. Yeah. And then, it's a Saturday morning now and I was able to take care of my patient this morning. I don't guarantee weekend availability or after hours availability, but if I'm sitting around, in my nightgown watching Grey's Anatomy on Netflix, then I can row on some

Dr. Maryal Concepcion: 36:52

clothes and meet you and, take care of you. I love that. And how much of your everyday work is telemedicine versus in person?

Dr. Katie Burden-Greer: 37:00

The vast majority is in

Dr. Maryal Concepcion: 37:01

person. Yeah.

Dr. Katie Burden-Greer: 37:01

Yeah. I would say maybe 10% is telemedicine. Okay. And my patients know that. I like to stab them. They know that I like to, you know, if they have something, you know, I had a patient with a cyst on her face that everybody else had refused to remove'cause they were worried about scarring. She's like, wow, I don't care about scarring. I was like, okay, well if you don't care about scarring, I'll do my absolute best. And I, you know, did some did some buried sutures after remove, remove the inclusion cyst. And she's been very happy with it. Knee injections, PRP injections, platelet rich plasma mole removals. Yeah. People know that. I like to cut things. It's good. Good solid family medicine doctor. I like, I like to joke at'em like, patients know I like to stab them.

Dr. Maryal Concepcion: 37:39

Oh my goodness. Well, I think it's, it's great also that you're able to, because there have been some residents who, like I met one in the Central Valley in California who asked, do DPC doctors have opportunities to learn procedures?'cause I'm not learning anything. And she's going to a very, very well known, medical school. And so it was very, sad to hear that. Mm-hmm. Because also being a person who loves rural medicine, who loves being able to do these things mm-hmm. Everybody should be empowered to be able to choose to do these things after residency and be trained to do them. So I, I think that's great. And,

Dr. Katie Burden-Greer: 38:12

Shout out to my attendings and training too. Mm-hmm. Like Dr. Sally Ann Patton I can remember presenting a patient to her that had a large lipoma on his back and I was like saying that we needed to refer to surgery. And she said, absolutely not. We're not referring to surgery. We'll schedule him for a procedure and we'll take it out right here in the office. I was like, oh, we can, even in, they're that, that big. And she said, yeah, absolutely. I remember that so vividly. And then a colleague that she was in residency with me, her Dr. Hernandez and Dr. Sayer worked to open a free procedure clinic Wow. For like homeless and underinsured. So we did procedures. A lot heavier than other programs, I think. Yeah. That's great. That's great. Especially because those skills are serving you. Now I will say the very last patient I had at Creek Nation she needed a biopsy. It's so hard to get a biopsy.'cause it was just me and one other doctor that pretty much did procedures at the time. Sure. For the whole tribe. So you would have to refer to dermatology. If you don't have a cancer diagnosis, you're not getting a referral to dermatology. So I biopsied her, turned out to be melanoma. She did have it in her lymph nodes. I met her about a year and a half later and she hugged me and said I saved her life because I was able to actually get her the diagnosis and get her the treatment. And I was so glad to be able to lean on my training and know that I'm able to do that thing, that kind of thing for people. That's awesome.

Dr. Maryal Concepcion: 39:31

How did you look at pricing for your services and your membership? Because there are other DPCs in Oklahoma. Mm-hmm. But again, you're, there's only one Dr. Bird Greer. So how, how did you determine your pricing? So

Dr. Katie Burden-Greer: 39:43

I pretty much looked at every place in Oklahoma. Mm-hmm. And saw what they were pricing and tried to pick kind of a price right in the middle. But then I also went a bit lower on my young adults age, like 20 to 35. Mm-hmm. I set their price lower at just$50 a month because we have a big population here that do pipelining welding, like working young guys like my family members Sure. That don't ever see the doctor because they can't get, they can't take off work. So that's kind of why I set the Saturday hours and the after work hours. Yeah. And I set the price lower because, job variability is all over the place, especially when you're involved in pipelining. It's hit or miss. You save your money when it's. Wow. Good times. And you pinch the pennies when it's bad times. Yeah.

Dr. Maryal Concepcion: 40:27

And when you look at your overall, because you go from, and correct me if I'm wrong$25 per member per month for a certain age group, as long as they're with a person who's in that adult range. Yep. That's children. And then you also have from 32 to 64, a$75 per member per month membership. Yep.

Dr. Katie Burden-Greer: 40:47

From,

Dr. Maryal Concepcion: 40:47

from

Dr. Katie Burden-Greer: 40:48

yeah. So the youngest are up to 19, kids with a family member 25 and then 20 to 35. The young adult range are 50, and then 36 plus are 85.

Dr. Maryal Concepcion: 41:00

And then on your website it says age 64. So are you still opted into Medicare? Yes.'cause of your your other quote unquote side gig? I would, I would, I would classify the side gig. Job? Yes. Yes. Got it. I'm still opted

Dr. Katie Burden-Greer: 41:15

in because I still need that one day a week to. Kinda make me feel secure. I, I'm thinking when I get to around 200 patients yeah. I'll feel secure opting out. Yep. But for right now, I like having that safety net of that set income, working that shift there once a week. Yeah.

Dr. Maryal Concepcion: 41:30

and when it comes to ideal panel for you to maintain, your lifestyle, but also to make sure that you're not making your list go down to, and it would never happen. But the five minutes per patient situation that you had before in Chea, what is your, what are you thinking is your like, full

Dr. Katie Burden-Greer: 41:51

number? So, I have two different ideas in mind. If I stay right now as a micro practice, just me answering the phones, doing everything, doing my own phlebotomy and my own ultrasounds, like everything I'm thinking 300 be, would be the sweet spot Uhhuh. If I decide to hire a MA or a LPN I'm thinking I could, pretty easily do 500. Yeah. But, I'm honestly really enjoying not being in charge of anyone besides me and my patients. Mm-hmm. After, the administrative role for sure. I had before. This is just such a nice break. Yeah, well, especially during the Covid pandemic too. Yes.

Dr. Maryal Concepcion: 43:56

That's a lot of coordination. It was. Because you also are not only board certified in family medicine, you're also board certified in obesity medicine, and you have offerings on your website just for people who are wanting to see you for obesity medicine services. How does that work in terms of if a person is already a member? Mm-hmm. And then how, who are the people who are coming in just for obesity medicine services? Right.

Dr. Katie Burden-Greer: 44:23

So if

Dr. Maryal Concepcion: 44:23

somebody

Dr. Katie Burden-Greer: 44:24

is. Already a member and they want help losing weight, I don't charge any extra. Mm-hmm. I consider that part of primary care. Sure. And I just spend extra time with them at no extra charge. But if somebody comes to me from outside, they say, I love my PCP. I like them for everything that they do for my blood pressure. I just need help losing weight. And they weren't sure what to do. Then I kind of see them as a consultant and I will send my con consultation note back to their primary. Got it. And I will strictly focus on lifestyle. Check any labs that may not have been checked. A lot of people forget about B12 iron, things like that, that affect metabolism that may not be checked in a routine panel from primary care. And we decide what medications are best, what type of, diet and exercise they need to slowly start incorporating.'cause if you try to do too much at once, it's just not gonna work. Totally. We focus mostly on habit stacking and Yeah. Goal setting. Yeah. That's great. And,

Dr. Maryal Concepcion: 45:15

In terms of the balance of potentially 300 people, if you are Micropractice mm-hmm. Going forward, versus if you had somebody and you had, a higher number of patients, how do you foresee obesity consultations playing into that number?

Dr. Katie Burden-Greer: 45:31

I like kind of where I'm at. I think I'm about a third obesity medicine and the rest is primary care. And I, I think that's a good ratio. Yeah. Like I think if I keep that ratio, it'd be just fine. If I ended up with too many, like over half obesity medicine, I think it would be overwhelming.'cause I do see those patients at least once a month. Sure. And I spend a lot of time counseling. They're a little more involved. Honestly, I probably underpriced myself with my obesity membership, but you know, it's already set, so I'm gonna keep doing what I'm doing. Yeah. And you can

Dr. Maryal Concepcion: 46:00

always change. Yeah. When it comes to the. Coordination of like you doing a consultation note and you sending it to their primary one? I, I, I, I think about how many times does a, a, a person who I send a note to one receive it. Mm-hmm. And then two, do they, do you get any people on the outside of your DPC wanting to talk more with you, collaborate for their patient, who they're taking care of as the primary?

Dr. Katie Burden-Greer: 46:28

I haven't had a lot of primaries reach out to me directly. I actually randomly had a church counselor, a, a preacher reach out to me saying that he was working on, lifestyle and behavior and mood, obesity and just primary care. And he reached out to see about if he could maybe help pay for some of his members'. Wow. Primary care, obesity care. Yeah. So that's kind of in the infancy stages. Yeah. But for the most part, when I first started, I went around to different primary care doctors and said, Hey, I am obesity to medicine. I have way more time than you guys have to do a lot of counseling for sure. So if you wanna send someone my way, send'em my way. And I, that's where most of my referrals have come from. That's

Dr. Maryal Concepcion: 47:05

fantastic. And these people are also seeing you once a month in person, or are they doing everything virtually because

Dr. Katie Burden-Greer: 47:10

mostly

Dr. Maryal Concepcion: 47:11

in

Dr. Katie Burden-Greer: 47:11

person, but I have some that live a little further away McAllister's a little over an hour away. Okay. So I maybe see them once in person and then the rest virtual. Yeah. Same thing with Norman or, further places.

Dr. Maryal Concepcion: 47:20

Okay, awesome. And I hate

Dr. Katie Burden-Greer: 47:23

naming this towns like everybody knows where they're at.

Dr. Maryal Concepcion: 47:26

It's okay. People, people can access the map. I've said superior Nebraska so many times on the podcast, so people, people can look it up. Have you already had, medical students or residents. Ask, Hey, can I actually come out and see what you're doing? Can I shadow? Can I learn from you being a DPC doctor in rural ika?

Dr. Katie Burden-Greer: 47:47

Yeah. Actually, when I was in the kind of transition period, I was still working part-time down at Chickasaw Nation as a hospitalist. There was a student rotating there from oh shoot, I think she was from OOSU. Okay. Oklahoma State. And she was very interested in lifestyle medicine and obesity medicine. And so one of the docs told her about me and I was like, yeah, absolutely. Come on out. And she rotated with me for a day. I just had her get the histories and present the patient, like you normally would. And we talked about the plan, we talked about lifestyle, we talked about all the different mechanisms of the medicines. And then I was like, you need to learn how to draw blood. And so I let her draw my blood and she was stoked about that. Oh my gosh. It was before I had my point of care ultrasound, so I didn't get to let her play with that. But like she was stoked to draw some blood because she saw me. I think I drew blood on somebody that morning.'cause we were checking, iron Thyroid. Sure. Vitamin D. Yeah, vitamin.

Dr. Maryal Concepcion: 48:33

And do you have point of care lab equipment in your,

Dr. Katie Burden-Greer: 48:37

In your clinic? So everything is send out. Okay. Quest or DLO is what it's called. They will send a courier to pick it up, and then I get the results the next day. Okay. I'm, I'm like

Dr. Maryal Concepcion: 48:48

so jealous when you said courier. I'm like, oh, girl has a courier and I can't get a courier. Oh, yeah. Oh, I'm

Dr. Katie Burden-Greer: 48:52

fancy.

Dr. Maryal Concepcion: 48:53

Oh my gosh. I, I love that. I, I,

Dr. Katie Burden-Greer: 48:56

I have, well, I think it helped because there's an in town there is a PA that she's been here for a long time. Sure. I think she's getting close to retiring. She's hired a nurse practitioner that's picking up some of her panel. So they were already coming and picking up labs for them anyway. Yeah. So whenever I started, even though I'm lower volume, it's oh, we're already going to Wika anyway. We can

Dr. Maryal Concepcion: 49:14

pick up. Yeah. I will throw a shameless plug for anyone. If you have any Quest contacts, especially in California, please tell them to reach out to me because I have asked Quest multiple times. I'm the only person who has a Quest account in our county, and they won't come. So that's, it's maddening, but I'm very happy for you. I'm not happy for Calvers County. So when it comes to when it comes to you thinking about your medical journey mm-hmm. And when it comes to students coming into your clinic, clearly you said, you, you should learn phlebotomy. Mm-hmm. Which, that's a very big, very big, very, very big pro tip. Mm-hmm. I am so frustrated that I did not learn that skill in medical school. What other tips do you have for people who are coming up in training or they're in residency and wanting to do independent DPC practice, especially whether it be rural or mm-hmm. Suburban or urban. What are things that you really encourage people to think about? Whether it be business learning, whether it be procedural skill learning, what are things that you recommend people learn to be confident in before doing something like DPC? So

Dr. Katie Burden-Greer: 50:25

I think the biggest thing is to focus on the variety of locations and the variety of attendings that are teaching you That way, you have exposure to different styles, you have exposure to different ways of learning and taking care of patients. So that is one thing that I liked, even being at Mayo Clinic. Yeah. We still rotated at the Naval Hospital Oh wow. To do our newborn rotations. Wow. And I rotated at university of Florida Shands to do trauma rotations. So I feel like I got. A lot of variety and I think that variety is what really helped. And even starting in medical school, we had, some of our electives, I picked, rural medicine to see this doc out in rural north east Oklahoma. And he, covered a hospital and had his panel and covered a nursing home. And I thought that was pretty cool.

Dr. Maryal Concepcion: 51:13

Yeah. Spoken like a true family physician, his full scope. I love it. Lot

Dr. Katie Burden-Greer: 51:17

of, lot of variety.

Dr. Maryal Concepcion: 51:18

Yeah. I love it. And when you think about not only just where you could go if you remained a Micropractice doctor or if you had staff, like you mentioned, what else do you see happening for Outlaw Medical now that you have been in, you've been doing it for a while now, you've you have over a hundred patients. I, I, I think about, I think about how. Dr. Berger who opened, who was not sure if it would work, so to speak, has already proven that it, it's working. Period. So what, what do you foresee yourself doing, in the next three to five years? I mean,

Dr. Katie Burden-Greer: 51:57

just enjoying the ride, mainly. Like once at this rate I'm gonna be to my, happy place within a year or two and I'm just loving the life, man. Yeah. I really enjoy Dr. Cook down in Ada. She's the closest DPC doctor to me, so I think she and I have talked a little bit about maybe covering for each other Sure. To allow us to have more true vacation versus, right now when I go on vacation, I'm still answering texts and phone calls and things like that. But, I see a little bit more of a a setup, an agreement between, me and her to cover for one another to have real vacations. Yeah. But other than that, I just, I love my clinic, I love my patients. I mean, I'll show you the clinic later. I don't, I don't anticipate a lot of need to expand. Yeah, no, it's fantastic. I'm not, I'm not trying to open multiple sites. I just, I just wanna take care of my patients and live my life and actually have time for my family, for once in my life and animals and all

Dr. Maryal Concepcion: 52:54

the things, and be financially able to do these things without having to see two to 4,000 people. It's fantastic. And then, so speaking directly to those people who are not necessarily committed to doing DPC yet, especially mm-hmm. What would you say to that person, whether, no matter what healthcare system they may be in or whether they're in training or not, or al already an attending, what would you say to that person? to challenge themselves to think about when it comes to the reality of DPC versus being an employed physician.

Dr. Katie Burden-Greer: 53:29

Go shadow a clinic. I mean, like I mentioned Dr. Cook let me shadow her clinic. The whole reason I even found out about DPC was I went to a DPC Mastermind that Kelsey Smith Dr. Kelsey Smith was hosting, and it just made me think, oh, maybe I can actually do this. And maybe you don't wanna start your own DPC, but you could work for a physician owned DPC group. Yeah. And still have the lifestyle without the overhead and the admin. Yeah. I mean,

Dr. Maryal Concepcion: 53:56

there's so many ways to do it. That's awesome. And I do think that's really great advice, especially because the movement is growing so quickly. Do you ever think that if someone said, Hey, I'm in Edmond, I'm in a different place in Oklahoma could I open a branch of outlaw out here? What would you say to somebody like that? You mean open a branch? Like

Dr. Katie Burden-Greer: 54:16

of your, of your own DBC of my clinic. I honestly hadn't even thought about that. It has not crossed my mind. I mean, I'd be willing to help and get started. I'm sure.

Dr. Maryal Concepcion: 54:26

Yeah. Yeah. I just, I think about that because it, it is very true that there are a lot of people who are looking at this in that DPC is less intimidating if they don't have to the, the day-to-day, inventory, cleaning the toilets, doing the books, all the things that we do. But I think about that because of, with branding, with you, establishing the quality and the type of care that you bring to outlaw Medical with obesity medicine, but just also with these procedures that you're doing. I, I think about how would you even look for a person to. Replicate, but still be, a a a very independent physician under your brand.

Dr. Katie Burden-Greer: 55:07

Yeah, I think it'd be hard to find the right person, but I mean there's, plenty that I know that I think would be amazing that I've had as colleagues before, and if they ever wanted to run away and escape the system, I'd be happy to help him escape. Yeah,

Dr. Maryal Concepcion: 55:20

that's awesome. We're going to continue the conversation over in Dr. Verden Greer's clinic and I'm also gonna be asking her about her experience with this CO. Crisis that she was managing, as the chief of inpatient medicine at the Chickasaw Nation and how that translates to how she thinks about being prepared during natural disasters. Especially just recently in, in Oklahoma there was very significant tornadoes especially and how to be resilient as a rural doctor. But also just, asking questions about the, the ins and outs with the physicality of what she has as tools in the space that she has. So join us over in our patron community and we'll continue the conversation over there.

56:01

Thank you so much for how having me out here, this has been extra special and I'm so glad that we were able to do this. Oh, I'm so glad you came out. Like I said, I've been fan Droll here, defense podcast for years, way before I actually got the nerve to open my own, so it's awesome. I help lots of people.

Dr. Maryal Concepcion: 56:19

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.