Taking the Leap: Dr. Joel Schumacher’s Path from Employed Physician to DPC Owner

In this episode of the My DPC Story Podcast, Dr. Joel Schumacher of Schumacher Family Medicine in Plymouth, Indiana, shares his journey from traditional hospital employment to launching his own successful Direct Primary Care (DPC) practice. Dr. Schumacher reflects on growing up and practicing in rural America, the pitfalls of fee-for-service healthcare, and how DPC restored his love for medicine by prioritizing meaningful doctor-patient relationships and autonomy. He candidly discusses overcoming burnout, the challenges and rewards of entrepreneurship, building his patient panel, and the power of community engagement. Dr. Schumacher also gives actionable advice for residents and new physicians interested in DPC, emphasizing mentorship, financial planning, and the value of attending DPC conferences. This episode is packed with practical insights for doctors seeking a more fulfilling primary care career and patients interested in the benefits of direct primary care in rural and small-town settings. If you’re looking to learn more about DPC, rural medicine, or practice ownership, this episode is a must-listen.

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Transcript

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.

Dr. Joel Schumacher: 2:01

Direct primary care has been a lifesaver for me as a physician because I love to take care of patients and put them first, and the systems around me, we're not putting patients first. So this system of direct primary care is better for the physicians, it's better for the patients and is better for their families. I'm Dr. Joel Schumacher of Schumacher Family Medicine, and this is my DPC story.

Maryal Concepcion: 2:33

Dr. Joel Schumacher began practicing medicine in Plymouth, Indiana in 1995 when he joined Dr. Kent Guild. In 2017, Dr. Joel was thrilled to return to where it all began to establish Schumacher Family Medicine. Dr. Joel grew up in a two stoplight town near Fort Wayne, Indiana After moving there in second grade, currently, Dr. Joel lives on a farm west of Plymouth with horses, chickens, more barn cats than he prefers, and a dog. He and his wife, Lynn, have been married for over 30 years and have. Three children. Dr. Joel graduated from Hillsdale College in Michigan in 1998 with a BS in Biology, and then earned his MD from Indiana University Medical School in 1992. Dr. Joel completed his training in family medicine as chief resident at St. Vincent's Hospital in Indianapolis. He then moved to Marshall County in 1995 to begin practice with Dr. Kent Guild, establishing Plymouth Family and Internal Medicine. He is board certified in family practice. In 2013, Dr. Joel jumped off the primary care treadmill to help pioneer a new way to deliver employer based healthcare in Valparaiso and Merrillville with an Indianapolis based company. His passion for Direct Primary Care grew as he connected with a growing number of US doctors who are quietly revolutionizing healthcare. In 2017, Dr. Joel opened the doors of Schumacher Family Medicine in order to bring direct primary care to Marshall County. He is passionate about the benefit of patient care that restores the old fashioned doctor patient relationship, and reduces out of pocket expenses for individuals, families, and employers. Welcome to the podcast, Dr. Joel. Thank you. When we think about your roots growing up we've had multiple guests now, and even just the two prior to you, Dr. Katie Bird Greer, who grew up in the small area of Oklahoma where she's currently practicing on a reservation. Please, if you haven't listened to that episode, go back and listen. And then last week we had Dr. Jillian Cloudy who shared about practicing in Sandpoint, Idaho. So I'm just wondering if you can tell us about your exposure to rural America, as a person who needed healthcare before you went to become a doctor yourself.

Dr. Joel Schumacher: 4:44

Yeah. Great question. So definitely I, I mean, that's all I really knew was what small town Indiana, small town America was, because I. From eight years old on, that's where I lived. But it wasn't until going away to school and medical school living in Indianapolis that you start to notice there are some differences and there's some overlap for sure. But I mean, relationships, family, those type of things are so much more noticeable in small town and more rural areas and the importance of that. And that has its pros and cons sometimes too. But that's what, as I went through my training, one of the things that helped me decide on family medicine was the relationships. And I just love that. And sometimes I know I'm not alone in this. I've heard other people say that too. Sometimes I feel like how lucky am I that my job is actually just making relationships with people and then finding ways to help them, and I get paid for that. It's this is great. So.

Maryal Concepcion: 5:42

I love that. And I definitely will say that that relationship ability that we have, especially in DPC, because we have more time with people, it's such a common thread in all of the guests who have come onto the podcast. So I absolutely love that. I, I'm sure that there are people out there who are thinking about their own ability to have relationships with their own patients because of this model. So let's talk about back in the nineties when you graduated medical school, but then you also opened with Dr. Guild. So tell us about that. Because, back in the nineties we were not as, as crazy in terms of the healthcare. Debacle that we have right now in terms of HMOs and all of the things that keep physicians well in Indentured Conservancy. So what, what was it like when you graduated in 92 and then you decided to go into private practice versus opening opening under a corporation?

Dr. Joel Schumacher: 6:38

So when I was doing my training, all the other residents were signing on with hospital employment positions and, having signing bonuses to help with their student loans, that sort of thing. And so I looked around, it was really scientific Marielle. I, my wife is from Holland, Michigan, and I was from around south of Fort Wayne. And so I just, back before we had Google Maps, we had these things called atlases and they were on paper and I drew a big circle between those two towns. And I thought, family practice, I wanna be in a town somewhere between 2000 and 20,000. I don't wanna be in a big city. And, and so I just circled those towns and when we'd go home from residency and visit our families over holidays, we'd drive through the different towns. And so, um, we kind of narrowed it down that way. And then I visited a couple of hospitals in small towns and I met the doctor who became my mentor, Dr. Guild. And again, because I'm a relationship person, that was really important to have somebody who was a good example and who would take me under his wing and just, really helped me in my professional development. And he was just a great guy. And I came and visited the town and everybody, everywhere you went, everybody knew Dr. Guild and had a great story about him. He was kind of the quintessential old time family doctor and the team physician for the local high school delivered tons of babies, the whole works. And so, um, I decided like, Hey, this is where I wanna practice. This is the guy I would like to practice with. He was in private practice at the time, and that was a time when not many people were going into private practice. In fact, he was looking at his exit strategy and he's well, the hospital came along and offered to buy his private practice and employ me. And at the time seemed like what everyone was doing. And that's what I did. So I came to town and joined him. And got busy pretty quickly and his access strategy was to go from full time down to about three days a week. And then a couple years later we ha brought another doctor in and he went down to two days. And I'm like, that's a great way to kind of slowly go out. And I will be honest with you, the first, I would say the first five years, it was great. I didn't mind. I mean, the hospital said, as long as you're doing good medicine, as long as you're seeing patients, we're gonna just keep hands off and you do what you wanna do. And we did. And part of it was Dr. Guild, I'd say he would always bring us back to task if we kind of got off track his saying. And it has stuck with me for 30 years. We're here to serve. So whenever we'd start to complain or like, Hey, I wanna get out early, or I wanna go do this, he's like, Hey, we're here to serve our patients. Oh yeah, good reminder. but as long as we were serving our patients, no one said anything. And then the honeymoon started to wear off about year number five when the hospital got bought out by a bigger hospital. And the further you are away from the decision makers, the worse it gets. And so more and more rules and regulations and red tape started coming down. And so I'd say for the next five years it was okay, but not as fun. And then we grew to four physician practice foreigners, practitioners, a dietician, and I'd say the last three to five years were a struggle. And so that was kind of the evolution of it. I was an employed physician and yeah, after 17 years, I got off that bus.

Maryal Concepcion: 10:48

When you signed on initially, were you employed by Dr. Guild's practice and they just had a contract with the hospital or how did that work?

Dr. Joel Schumacher: 10:57

No, he became part of a larger hospital group and I became an employee like right next to him.

Maryal Concepcion: 11:03

Got it. And then when it comes to the, the last, the last legs of your being able to, to survive in this environment, it, it speaks, to the heart of all of us when we, in, in whatever capacity as residents, as attending physicians, when we know exactly what that means for our own lives, when we're further from the decision making capabilities of a clinic. And I think that that's so important for, for the listeners to hear, because that literally is, opposite of the heart of DPC, where we have the autonomy to do things in our practice for our patients. And if the workflows are not working, if something's not working, we can change it because we have that autonomy for you. What, what was it that kept you in, those last few years versus after the first 10 saying peace out?

Dr. Joel Schumacher: 11:50

Right. Good question. Part of it is I didn't know what else to do. You are running on a treadmill and you're working so hard, and then you try to go home and you're trying to be a good spouse, parent, community member, and the margin is so thin and there's not enough hours in the day. And then you get, then you get back on the computer and finish up, work late at night.'cause the next day starts with a whole new thing. So you don't really have time, or I didn't feel like I had time to even explore what my other options were. I, I didn't know about DPC or Direct Primary Care at the time. It was still fairly early. And so you just kept, you just keep going and you just keep going and people get burned out and you hear a lot, people talk a lot about burnout. Why are people burning out in family practice Primary care? And my opinion is we go into primary care, not because we wanna make a lot of money. If we wanna make a lot of money, I'd go into business or some other specialty, right? I mean, we get paid, well don't get me wrong, but you don't go in it to get rich if you're going into family medicine generally. And so why do we do it? Well, we get paid in other ways and I think a lot of family physicians, we feel like we get paid with those relationships, that feedback, the appreciation. And that's really what lights our fire and keeps us going. You can't have a significant relationship if it's in five minute blocks. And so I feel like what was happening is whether it's venture capital or a hospital employment, whatever they're telling you, you need to see more patients for the bottom line. You're running people through. All right, what I get paid for, I'm not getting paid for that in five minute slots and I just have to keep going back and going back. And that I think is what is burning out a lot of primary physicians is they're not getting fed with those relationships as well.'cause they're having to see too many people in a day.

Maryal Concepcion: 13:43

Totally, and something I think about when you are sharing just then in terms of, burnout in general as well as your last years at your practice. One, I think about being an adult and after you pass your 10th birthday, the year goes by really, really fast. Like it's no longer like, oh my God, in elementary school you'd be like, this year's never gonna end. But once you're an adult it's oh my God, three years has flown by. And then I also think about. Something that's been shared on the podcast that I know that I've experienced, and you probably too, is that when you're with patients, you're in your element when you close the door and then you have to face your EMR or your EHR, and then you have to deal with the admin burdens of like, everyone must have an A1C of 7.1. You want to not have that job, but you want to have the job where you're actually working with patients. And so I think that that also\makes that time go differently because you have those little, blips of patient you've taken care of for six, 10 years and you really love seeing them, even if it's for less time. I think it's so relatable that, you, you did have those last three to five years and they weren't, they, it was progressively getting worse, so to speak, but you stuck on because you're a doctor and that's what you went into service for. So let's talk about now the fact that you joined on. With Dr. Guild and this idea of people are opening out of residency or even while in residency, many have shared on the podcast some of the fears that I get from residents and medical students who are planning on going into DPC is, I don't know if I could do this because I'll only have my residency training and not, having a mentor easily accessible is a reason I'm not choosing DPC. And Yes. I mean, training is different now compared to, the early two thousands compared to the nineties, fine. But in general we see people learning a lot less procedures. There's a lot more opposed programs and unopposed programs for training, especially in family medicine. What would you say to the person who has that fear of, I don't think I could open while in residency in my third year or after residency, because they don't have a doctor Guild with me down the hall. Mm-hmm.

Dr. Joel Schumacher: 15:49

Well, I would say one thing that I think is really cool about the DPC movement, and if you haven't had a chance to go to one of the meetings like the DPC summit or some of the other ones that are out there and the DPCA puts on masterminds, which are smaller ones. I mean, there's such a feeling of collegiality and of doctors wanting to help doctors there. The, that I don't think you typically see just when you go to a regular conference it's not a competitiveness. It's oh, I've succeeded at least what my level of success, what I would consider successful. I want you to succeed too. And I've had um, some people in their training or doctors who've thought about coming to town here, which by the way, yeah, we have a need here. So we, I would help someone do that. But I like, if you wanna open right next door to me, I don't really wanna employ you. I mean, I don't wanna become big. I love how it's going right now, but. I don't see that as competition. I see that as that's help. I can help you, you can help me. And so we've actually had quite a few physicians who either are coming outta practice or maybe they've been in employed practice for 10 years or five years and they want a different way. I'm like, just come and spend a day here. And we've had a lot come and it's been really fun to see them contemplate it. And you get to that point where, oh, can I do this? This is fearful. What's my income going to do? And all these different questions. And then you get to that point where you have to make that leap and then see them succeed and flourish. It's great. So I guess what I'd say is grab onto a DPC doctor that's somewhere near you because most would be help. Happy to help in any way and kind of maybe not like onsite mentor like Dr. Guild was for me. But there's plenty of help out there and you can do it.

Maryal Concepcion: 17:34

Totally. And I will say here, because we're in the midst of planning in California for our California specific DPC summit, so definitely if you're in California and you're listening to Dr. Joel there are doctors just like he's talking about that will be, conglomerating in Newport Beach. So cali dpc.com/summit is where you wanna go for that. We still have a few tickets left, so definitely think about that, especially if you're wanting to practice in California in particular. So, and I love that and I think that it's so true. I mean, how many times have, probably you as well, like how many times have I texted someone to be like. Where do you get this or on this platform, which one of these syringes do you buy? So it's it's little things like that where I'm definitely one of those people who will get texts and will also text other people who have done this longer than I have. So I think it's a great way for people to think about, practicing in 2025 is also different because we have things like texting and we have things like cloud-based based platforms that we can share information on. So I, I love that and I hope it helps people address that fear of, I couldn't do this out of residency, or, you know, I couldn't do this in general because I don't have a doctor guild with me.

Dr. Joel Schumacher: 18:44

Right.

Maryal Concepcion: 18:44

let's talk about your. Reprieve from, working in this system that you went into when it was a quite, when it was a small practice, it grew you decided to leave. So what was it that ultimately, was going on that said, yep, this is the time I'm done.

Dr. Joel Schumacher: 19:04

in a way just all the pieces kind of fell together. I would say it was like a, a God thing some people would say, but I remember, I mean, there were a lot of things that went into it, but I, one thing that I remember that sticks out in my mind, I remember coming home, and this is hard to think about even now, when I think back, it's coming home one day is probably about 15 years, 16 years into practice. It was probably like six 30. And usually we're done seeing patients supposed to be done at five. I do the stack of charts, emails, whatever, you know, I'd do the things I had to do and then go home, rush home, do the family thing, get the kids in bed, and then I'd go back and finish the message that weren't as urgent. Right? So I usually call all my wife and I'm like, Hey Lynn, yeah, I should be home like five 30 or I'll be home at six or something, and here, this one day I'm walking in and I look at my watch and it's six 30. And there's my family. I have three kids, they're young at the time and sitting around the table having supper and we're about halfway done. And I'm like, I'm sorry again for the hundredth time. Sorry, I'm running, you know, running late. And my wife, and she didn't mean this in a, in a, in a bad way at all.'cause she's so kind. She. But it cut me. She said, it's okay. Don't worry about it. We've just kinda learned it's easier just to go ahead and do life without you when you can catch up and join with us, that's great. But, and I'm, it stunned me because I thought, this is never in a million years the kind of father or husband I ever wanted to be. And this is what I, this is who I am. I, and that was the day I didn't know what I was gonna do, but that was the day I knew I cannot keep doing this till I'm 60 or 65. I'm gonna either kill someone or kill myself or burn out. Something's gotta change. So that was the tipping point. And I, but I didn't know what to do. so then we were driving to Ohio to some state park on vacation. And I remember getting a phone call outta the blue on my cell phone as we were crossing the Indiana, Ohio line. And this doctor that I had met a few years ago didn't know him really well. He said, Hey. I'm part of this really small Indianapolis startup company. We're doing near site onsite clinics, and it's mostly around Indianapolis, but we'd like to get a presence in northern Indiana. We're gonna open like a near site and an onsite clinic in Merrillville and Valpo, which was like 45 and 60 minutes from my house. And I said, nah, I mean, I, I don't think I can do that. Well just meet with me. Okay. And that was the start of it. And the next thing I knew, I met with the owner of that company who was a physician. And it was just a really small, I think there were maybe 13, maybe nine clinics when I started. And that was my offloading from the employed hospital. Big thing. At least I was still employed, but it was small. What I found out was, I didn't know what DPC was at the time, but there was very similar to DPC because I didn't have to bill insurance. The employers paid and I had long visits. Nurses were happy, doctor was happy, patients were happy, employers were happy. So I did that for four years.

Maryal Concepcion: 22:08

tell us more about this, because,\ I can see it, when you say cut, like I, my husband is also a physician and it's as we've had our two boys, like that really, really hits home and. He even left a fee for service after I did. And I, I think about how it, that doesn't leave you, even if you're in DPC already, like that, that, you know what some people call moral injury or the burnout like that, it does not leave. That feeling is really hard to just let out in the ether or wherever it needs to be, and not inside your head, heart, or soul. But when it comes to, this opportunity to, to really have a smaller practice, not be under this employed agreement with the hospital, but yet still being open to being an employee, I I can imagine the sense of freedom that you got from that. But I'm wondering, in terms of knowing how long you had been in fee for service with a hospital contract, did you come to the table with your own, we need to make sure that this is in my contract, if I'm ever gonna begin employee going forward in whatever contract I pursue.

Dr. Joel Schumacher: 23:13

being a relationship person, I guess. When I met with the owner of the company Jeff Wells, who is a, a fantastic guy I trusted him. And yes, I looked at the contract I talked to people who had been doing it in Indianapolis, some of their Indianapolis clinics, and I'm like, all right, I can see how they're being treated. This is, this is what I want. And yeah, it's about the people. For me, and even, I think I need to say Marielle, when I was employed at, at the hospital, one of the hard things was feeling like you're giving up on your patients, you know, leaving your patients. And I heard that a lot'cause I continue to live in that small town and go to the grocery store and church there and like they. I heard about it. But I, the people I had no beef against, the people that I worked with, the other doctors, the nurses, all of them. And in this place that I was going to, it was about the people. There were great people there. And even though I'm not there anymore there's still some really good people there.

Maryal Concepcion: 24:08

I think here about how, you're physically in the same community wearing different hats when you then transition to Open Schumacher Family Medicine. What was it that was going on in your head, from being an employed physician under that employer based program to opening your own family medicine practice?

Dr. Joel Schumacher: 24:28

Right. So that was one of the, I mean, there were a few reasons that led me to then leave that. I. Zo site. I practiced there for four years. I'm really thankful for those four years. They were helpful because I didn't feel like my brain was getting squished all the time. I had time to think and start to explore, and that's when I started to hear about direct Primary Care. I'm like, Hey, this sounds a lot like what I'm doing, except these people own their own little practice. And the other thing that led to it was I found that at this site, if people would retire or leave the job, I lost them as a patient. They couldn't follow me, they couldn't stick with me. And so I had some conversations with some of the leadership of this company and. I said, Hey, what would it look like to let me keep those people on? Or what would it look like if I would go to my town? I'll do the legwork and go to the businesses. I'll get some businesses and let me open up in my own hometown. And I get it. Their idea was their sweet spot was companies of 300 to 500. If they could get three of those together. There you go. And so that was kind of their mission and I like smaller and I thought, well, why couldn't we do 10 or 15 companies of 50 or something like that? And that just wasn't what they were doing. So eventually that's sort of what led to me parting ways with them on good terms. But um, but I had time because I wasn't getting crushed from the hospital system. I'd get home at night, have dinner with my family, and then I didn't have to go and do three hours of charts. So I was able to explore that and um, go to some summits and some things like that and yeah.

Maryal Concepcion: 26:04

That's awesome. And I think about here, that's a really good call out in terms of if you are looking to, work with an employer to have the ability to also have the employees if they. Breakaways if they get laid off or whatever, and they're no longer, they're no longer with that company to be able to still see you for, the, the same price that a regular member would see you, which is, which might be the same as what the employer was paying and so I think that that's a really good way to think about, if you are faced with a contract, something to think about going into protecting that autonomy. So. You then opened your own practice and I think it's so cool. I wanna ask you about the building that you are practicing in. So tell us about your journey about opening Schumacher Family Medicine in the building that you are in right now. Yeah.

Dr. Joel Schumacher: 26:55

So while I was at my near site onsite clinic job for those four years, and then as I started to explore DPC and realized I. I think this is what I was made for. This sounds too good to be true. I, I wanna do this. But there's so many decisions you have to make, and you hear it said many times, I forget who it's attributed to, but you know, if you wait till you're a hundred percent ready, you're never gonna wait. When you feel like you're 70% just jump. And so, but one big part was where am I gonna do this? I have to find a building and or rent some space. So we spent time, some Saturdays going around with realtors, looking at different places in town and um, nothing felt quite right, but the practice where I came and visited my mentor, Dr. Guild when I was in residency it was an old building that when he first came to practice, his predecessor. Built and in 1962, it's a little brick building on the side street in downtown Plymouth. And that's where they were practicing. And I mean, when I came to visit him, believe me, I decided to come to Plymouth because of Dr. Guild, not the building. I mean, it was old fake walnut paneling, dark 19, 60, seventies, low ceilings. Everything was chopped up. I'm like, Ooh, I'm glad that the hospital's buying your practice'cause they're gonna build us something new and shiny. So I never looked back to that building, never thought I'd be back there. But what had happened after he sold his practice and the hospital bought his building as part of the deal, it just sat empty. It didn't get used. It maybe got used for a few things here and there, and then about. Maybe 10 years before I moved back, they decided to renovate it and make kind of like an indigent clinic out of it. But because it's a hospital, they had certain specs they had to build to, so they had to have handicapped accessible things. They had automatic doors put in. I mean, they dropped a lot of money on this place. Got rid of the low ceilings, put a skylight down the middle. I mean, it's, it's still a 1960s building, but it, it looks a lot better. And so fast forward, I'm like, well, I can't find the right spot. There was a podiatrist that had bought it about a year before. And I knew her, Mary and I called her and I said, Hey, would you just lease out a room to me to start?'cause I've heard other DPC doctors just lease from another doctor or a chiropractor or podiatrist. And she said, well really, I didn't want this building. There was another section that's much smaller that all I needed. But they said, buy it all or nothing. And they made a great price for it. How about you buy the building, but let me keep the small part and I'll renovate that and I'll lease from you for a year and then I'll move over. Great. So that's how I stumbled upon it. Another, another God thing, I walked in there. The other kind of interesting thing I found out later that she told me was when she went to buy it from the hospital, because it was a Catholic based hospital, I. They asked her a lot of questions like you're not gonna do abortions here. You're not going to do birth control procedures. You're not going to, and she's a podiatrist. So they're like, oh, we're not worried about that. So they just sold it to her. So if I would've gone to buy it, and they would've asked me, are you going to dispense birth control pills or things like that, I might have run into a problem there. So the fact that she bought it for a year and then I bought it from her, it worked out great.

Maryal Concepcion: 30:19

I think that's so awesome. I think that is so awesome and it, I think it just highlights also like it doesn't hurt to ask and it doesn't hurt to think outta the box. So I think that is fantastic. Now tell us, because you went from, this journey of being an employee and then buying this building, you also opened your GPC with 75 patients. So tell us about, yes, you were known in the town, but like how did you get so many people to be ready for this new thing called direct primary care, but under the, the flag of Schumacher family medicine.

Dr. Joel Schumacher: 30:52

Right. So I yeah, I'm thankful that the people that helped me, the EMRI went with, they're like, Hey. If you're gonna open in September, we'll let you use the EMR free for a couple months before that just to get used to it and stuff. And we'll start billing you when you start seeing patients. So that let me have a way to get people signed up. And so, after I put in my notice at the direct site, the onsite place I made a Facebook page. I got a website, had paid someone to do a little website, and then I just started putting stuff on Facebook and word of mouth. I had two not an open house, but like a town hall at a little area in town, and we had about 70 people come to one and about 50 come to the other. And so I just had word get out that since I was, had been in the community practicing for 17 years and then another four years, I still lived there. Even though I was practicing out of town people knew me. And so I just tried to, I. Utilize that to my benefit and say, Hey, I'm coming back, for all of you who stand in the grocery store behind me and say, why did you leave? Why did you leave? Here's your chance. It's gonna be different. I mean, you come to the town hall and understand how it's gonna be different than insurance-based medicine. So I think that helped. And then I told them, if you wanna come in, you can sign up and be my, you can sign up now. And I think I had a, I think it's a 70 or$75 enrollment fee. Because I had heard from other people, you can have a hundred people tell you they're gonna sign up on day one, but people get busy and they won't. So if they have a skin in the game, I felt a little more confident that, okay, at least I'm gonna have some income coming in on day one. And so, yeah, by day one we had 75 people signed up.

Maryal Concepcion: 32:33

I love this. So my next question is. When you are opening as your own boss, it's your clinic. How did you, how did you approach this? Because, it's one thing to be the doctor and see the patients for whatever they come in for, but it's another thing to be like, oh I have to look at the website. I have to make sure that the person building it is going to represent exactly what I'm doing. I have to be able to, to talk to the community about it. Is, it is a different model like you did in the town halls. How did you balance everything or start to learn how to balance everything with, with all of this entrepreneurship stuff layered onto your doctorate? Mm-hmm.

Dr. Joel Schumacher: 33:13

Well, I mean, at first it's a little intimidating, but then as you start doing it, it's fun. It's okay, I'm, I'm not doing this work for some. Hospital system or someone else. I'm doing this work for my patients, my patients who are signing up in the future patients. And so, I mean, it's fun. And same thing like when you have, if you come in on a Saturday or something for somebody, it's for your patients. It's for your practice. I mean, it's wrong to think that you're not gonna work hard at DPC, you're gonna work hard. There's gonna be times, but it's totally different when you feel like you're working for yourself and your patients instead of you're working for someone else. Right. And just having those town halls and I created a couple little PowerPoint presentations purposefully. I tried to make them brief and then leave a lot of time for questions. And yeah, the people that were there really drove the conversation'cause they had all kinds of questions and, and that, that was great. One piece of advice I'd tell people is keep your PowerPoints brief and short and let the people ask their questions.

Maryal Concepcion: 34:16

I love this. And it's ironic, we had a muffins with mama program at my son's school. And the, one of the moms turns and says, oh, I, I heard your practice is closed on Fridays. And I was like, oh, actually we're only open when we see patients. And so even when people can't make. Normal hours, eight to five because of their job. We can even see people on Saturdays or whatever because exactly of what you're saying. Like it's not oh my gosh, I have to go in to cover the weekend shift. It's, oh yeah. I only need to see a patient just to make sure their lungs are doing okay. They're, they physically are good, going good into the rest of the weekend and I'll check back on them on Monday. You're doing stuff that's not a burden. It is something that, it is literally you just being free to be a doctor. And for you, I think about how over the years you've had, people you were with Dr. Claud Ryan and Dr. Lee Gupta at, at one of the masterminds that you guys had hosted together. But when it comes to, talking to people what are the things that you experienced as a DPC doctor who's opening with these PowerPoints that are universal patient questions that are still pertinent to people opening DPC today in whatever community?

Dr. Joel Schumacher: 36:12

Yeah. Well, I think almost everybody will ask you don't take insurance. Why don't you take insurance? Can I, can I come if I have insurance? Still, people ask me that all the time. How does that work? It's the whole, the whole payment model is so different that that question comes up over and over again. And I've had some people who ask me, well, would you take my insurance? Or, well, no, you can have your insurance. So I, and this is what every DPC doctor probably has had to tell patients is no, you, you can come here and have insurance. Just keep your insurance card in your pocket while you're here and you can use it for other things you need insurance for. I can send you to the hospital for things that you need. But we may have have better options, as that would be more affordable if you don't do that. And so when, when some people kind of hit that block and they seem like they have a mental block if we do a little deeper conversation, I just try to explain to them, look, the reason I'm doing this is because I want what's best for you and I want what's best for me. If it's you and it's me in the room and we have a conversation and we say, this is what is best for your cholesterol, or this is what tests we think you need, or this is, it's just you and I, that's who should decide that. If you want me to start using your insurance, now we have to answer to an insurance company or I have to answer to a hospital if I'm in a hospital employee. So don't you wanna keep this as simple as we can and keep other people out of your business? And that seems to get a lot of people where they like, I never thought of that. Yeah, that's right.

Maryal Concepcion: 37:51

Now tell us about your growth because you grew pretty quickly in 18 months. You were, you were just taking names when it came to Yes, I am. I'm open, I'm enrolling new people. Welcome to Schumacher Family Medicine. How did you grow and tell us about your growth.

Dr. Joel Schumacher: 38:09

Yeah, so it's a two-edged sword, right? I mean, I'm blessed. I'm glad that the growth came quickly. I hired a staff right from day one because when I saw we already had 75 and it seemed like there was gonna be a lot of momentum. I'm like, I don't wanna do this by myself. And besides I'm a relationship person, so that's not just with patients, but I don't wanna be a micropractice'cause I like having someone else around to, to joke with and have fun with and stuff. So, I. I had a very seasoned experience and medical assistant. She had done some employer stuff, she'd done a little bit of everything, so she helped me. I couldn't have done it without her, without someone to help. And so, yeah, I will say those first couple years it was like drinking from a fire hose because people were coming in and growing pretty quickly. And so I had watched what other doctors had done in DPC before me, and it seemed like the sweet spot was around 600 patients. If you're doing full-time, maybe 600 to 800, I thought, well, when I hit 600, then we'll slow down and we'll take a pause. And before I knew it, we were like between six or 700. I'm like, whoa, wait a second. Slow down. And there were days where I thought, man, this is not as slow as what I thought DPC medicine's supposed to be. But you know, when you have new patients, they take more time, they come in more often, you just have to kind of get. Things figured out. And so we put a slow pause on it. We stopped for a while, and then what happened was remember earlier I said people will tell you like, oh yeah, we're gonna sign up right away and then you don't hear from them. I had somebody that I knew pretty well who owned a company in the county and he had about 50 employees, and he said, as soon as you open, we are there. And then I didn't hear anything from him for three or four years. And so now I'm like between 600, 700 patients, maybe seven 50 actually. And then he comes calling and he says, Hey, we are ready. We've got to our insurance person, we're getting killed on insurance. He said, I need to switch how I do it and go to a partially self-funded. I'm like, yeah, I tried telling you that a few years ago, but okay. He's so I wanna, I wanna bring on my 50 employees and their dependents. I'm gonna pay for the dependents too. So we're looking at like a hundred and a hundred patients and I said, man. I'm kind of capped out here. I can't do that. And he was persistent and kept persisting and persisting. And the other patients I'd had, things were kind of getting tucked in and it was becoming a little more manageable. And, and then I'd also had hired a full-time nurse and then had the part-time ma so I had help. I'm like, okay, I think I could do this, but here's how we're gonna do it. You have a hundred lives you want me to take care of. I, there's no way I can take care of a hundred new patients in a month. You can pick out the 20 sickest people or whoever you want to be seen. I'll add 20 people per month. And so after five months, we'll have all your people in. You're gonna pay me for all of'em from day one, so that he didn't even blink. He's like, thank you. Yeah, let's do it. So that pushed me. I'm a little higher than where I'm right at about 900 patients now and I always thought I'd be between 600 and 800, but part of it was because of that business. And then a couple of the businesses that have been successful have added a few employees and I've told them that I would take new employees. So,

Maryal Concepcion: 41:33

and again, I think that this is so great for listeners to hear because it's thinking outta the box. It's, it's, you get to. Go to the table and have the discussion with people like the employer or the benefits advisor, whoever, to say things like we talked about earlier, if this person also leaves the company, I can still see them. Or that I'm going to only take this many per month and we will still be negotiating to have you pay just like you did and you shared for everybody, even if they're not onboarding all, in, in the same month to start. So I think that is fantastic for listeners to hear. Now let's talk about your the, the relationship at your practice because you are a person who is, who believes in faith. You have a Christian worldview in particular, but also in this time where people are what's happening with politics and the news and everything. We, I, I feel in DPC also that no matter, what creed a person is from religion, shape, size, gender, it doesn't matter. That because of the relationship that we have with people, it's really provided an extra value proposition for people in this time of craziness. and So I'm just wondering if you can talk to how you bring faith and how you bring the family doctor who is there to serve, that mentality in in, in your community.

Dr. Joel Schumacher: 42:59

Yeah. Great question. Yeah. So as you said, doctoring or everything in my life, I do, we all, we all come with a worldview. We all have a worldview where we come from and where we get our values from and how we think the way we think. And mine is definitely, molded by my Christian faith. And so most of my patients know, I mean, I'm not overt about it. I don't sit there and whack'em over the head with a Bible and things like that. But you know, just some of the pictures on my walls or the things like that, there may be scripture verse or thing, or people have known me and there's a small town. So, but not everybody does. And this doesn't come into every act interaction in the office, but I have had people who've said, I'm really struggling with something home or family, would you pray for me? Because they, they're a Christian, they know I'm a Christian. I'm like, I'm happy to pray for'em. And I just think, why would I not do that? I mean, we talk about holistic medicine all the time. We're always addressing their physical needs. And as family doctors we address an awful lot of emotional issues too. Right? But I believe sometimes, and I've told people this, I said, sometimes what you need more than a medicine or. Counseling session is you need some sort of a spiritual healing or you just need someone to pray for you, or that may be the most important thing that you get outta this today. And they're like, yeah. And I'll tell some people that I said, I'm not gonna bring it up all the time, or I may get busy and forget it and I'm not gonna be pushy about it, but you have the permission to stop me and say, slow down. Would you just pray for me? Because I realize that's important and I think they appreciate that I'm open about it, but that I'm not gonna push it on them. And I have patients who, I mean patients from all faiths or people, people who say they have no faith. And they understand that. And it's just a respect, it's a mutual respect between people and like you said, I don't care what their race, sex, gender, religion is, I'm gonna respect them. And one thing early on, I told you I got on Facebook and that helped build my practice quickly. But like a lot of people, I think I've sort of become burned out a little bit on some social media. I got my Instagram hacked as practice. That was, I try to get that undone. You can't talk to a person. It's ugh, that was horrible. I wasted a whole day of my practice trying to get ahold of someone because I had someone had taken over my social media stuff, but. So I still have a Facebook account. I don't do a lot with it, but I got kind of, it's crazy world. Like you said, Marielle is, people throw out these little bit things and then they sit there and they start getting so nasty with each other. And I just really believe that whether someone's a Republican or a Democrat, a Muslim Christian, if they could sit down two people together, I mean they'd find that there's a lot of things they have in common and they have respect for each other. It's great and you're just not gonna get that on social media. So that's where I think the relationship part comes in. And a small town family medicine is, we can disagree on a lot of things, but we can also agree on a lot of things and show each other respect.

Maryal Concepcion: 46:10

Absolutely. And even if you take the, the faith lens out and you think of just the medicine lens, who out there has had every single patient agree with every single recommendation that they've ever given says no one ever. Right. Because literally even with the oh, now I know my LDL is 1000 and I'm still not gonna take a statin or exercise. And it's like, that is your choice because I am, I am only here to educate and to guide and to give evidence-based medicine, but I cannot force you to take that statin. Right. And this is why I wanted to mention this in particular, is that yes, when you have the ability, you're not stressed, and, and yes, like DPC is not an a cakewalk, but like you have a different stress, you're able to just. Be with your patients. And we know, especially in DPC, if they're grieving for whatever reason or they're extra stressful because politics in their household is not the same for all of the, the different people who live there and they're stressed about something and just talking about their, their whole person, no matter what faith you are assigning yourself to or whatnot. It's that's not, and again, this is why I, I point this out because it's really that just being there for your patients, whoever your patient is, it's amazing.

Dr. Joel Schumacher: 47:27

Yeah.

Maryal Concepcion: 47:28

as you have continued to practice in Plymouth and your practice has grown, what are the ways that people have have understood your value proposition?

Dr. Joel Schumacher: 47:40

Yeah. There's always the, the financial side of it, right? People talk about that at the meetings and I can go and say, Hey, look, I know you're paying me this much per month for the year. This is how much it is. And if you look at how much you would have to pay out of pocket to go to your family doctor your medications, your labs that I save you on here, here's how much you could save here. And for some people that is a win and it can be convincing, but in my experience, that's not the people who really are attracted to you. I think the other people that I would get early on so I have some patients and then they'd 65 years old, they're like, Hey, I've got Medicare. Now I'm gonna go back to who I used to go to and use my Medicare card. And so many of those, like six months later, would call and I wanna come back because. If they couldn't get in to their doctor, they're like, what? I have to wait two months for this issue. Or they finally did get in and they would sit in the waiting room for 45 minutes. They'd get five minutes. And you know what? 75-year-old can explain what their problems are in five minutes. I mean, you're just scratching the surface, and so even the ones that have that golden Medicare card they value you because they know you're going to sit there and listen to them. Nobody listens to anybody anymore, it seems and so the DEPC beauty, one of the things that's beautiful about DPC is you have the time to listen and listening is powerful.

Maryal Concepcion: 50:43

Totally. And I think about, even when it comes to the, the Medicare comment that you said, I think about somebody just contacted me they're a nurse and they were saying how something that I saw definitely when I was in, in fee for service, like the Medicare wellness visit is being done by not the doctor at this particular clinic that the nurse is calling from. And I'm like, there's a lot of clinics where the Medicare wellness physical is not being done by the doctor. I don't know if that looks like that when the, the person signs a note at the end of day the day if that's a doctor. But when it comes to staff who are not MDs or DOS doing the Medicare wellness physical, where you're not supposed to listen or touch people that's happening. And so it's, it's really, I saw, and I had, I still have comments about it too from my patients who are like, that's, that's bs. Like I literally thought that Medicare would be my ability to get. Free healthcare and I can't get in, like all of those things. It's so relatable to so many of us, no matter what geographic region we're in. Mm-hmm. So, so let's talk about you multiplying your impact beyond your patients and your practice, because you are talking to medical students, nursing students, high schoolers having DPC doctors shadow you, and, and also going out, like I mentioned with Dr. Ryan and Dr. Gupta and, and mentoring other people. tell us about what are you hearing as the most, common reasons that people are on the fence about DPC?

Dr. Joel Schumacher: 52:13

one of the things I hear a lot are just financial, i, I'm the breadwinner in my family. For me to stop and go from this guaranteed employment kind of payment to this is scary. And I totally get that. It is scary. I would say that's probably, yeah, that's gotta be number one. Because most of the time, by the time I talk to people or they come here or meet them at a meeting, they're already feeling the burnout and I've gotta do something different. I don't know what it is. And so they're ready. But I would say that's the big hold up.

Maryal Concepcion: 52:48

Love it. And I think that that is I, I think that even us who are in DPC already, like we understand that. And so I think that it is it, it's just another, it's another layer of relationship this time with, with our colleagues in terms of understanding that fear and also having, potentially been there ourselves when it comes to we, we talked about, the, the mentorship and the concerns about mentorship. But when it comes to people opening up as a business owner as well as an MDDO, especially do you hear common business questions about workflows or how to do the actual business portion and how do you talk to people about whether you, should continue thinking down the line of Micropractice versus having staff?

Dr. Joel Schumacher: 53:32

The, the old saying you've seen 1D PC, you've seen 1D PC. Right? It, it really is true. And so I don't feel like I can tell someone like, here's how you should do your practice, model it after mine and it works for me, but it may not work for you. And someone else may wanna have just like 200 patients and work half halftime and that's fantastic. Or some people wanna grow their practice. I mean, I have some friends in the DPC movement who are growing like crazy and having extra clinics and sites, and I'm like, I'm happy for them, but that's just not me. And part of that may be where I where I came from because. I mentioned when I first started, it was just Dr. Gild and me, and then we added a doctor. And then by the time I left, we had four doctors, four nps, and the hospital bought, hospital bought hospital. And I'm like, who's running this show? I don't know. I don't think anyone knows who's running this show, but it's not me and my patients. I'm outta here. And then I went to that small site onsite clinic, which was like nine clinics at first, and it started growing too. And so sometimes I think success, whatever that means, success can be your biggest enemy. And I remember a year before I decided to leave that and open my DPC they had an announcement. They're like, Hey, this is great news. We just got a 25 or$35 million promise from a venture capital. From some other state. So we're going to go kind of sell out to them and we're gonna grow big. And I, and everyone's cheering and I'm thinking, oh, I've seen this before, where I practiced before. And so that's why I like small. It's not that it can't be done well, I guess large. And I know people, people like Clint Flanagan, who's done fantastic work out in Colorado with his clinics. And Paul Thomas, a friend of mine up in Detroit, is doing some great things there. And I'm happy for those guys, seriously. They're doing a great job. But for me, small, so I guess to answer your question is you can dream it however you want to and you can make it whatever you want to make it. I

Maryal Concepcion: 55:40

love that. When it comes to also protecting your time and your, and to not be overextended never ended, how do you balance mentorship with your own practice and your own life?

Dr. Joel Schumacher: 55:55

Yeah. Great question. Yeah, I think the mentorship part I see myself doing is not really all that time consuming. And what it's kind of added up to, at least to this point is I'll have a doctor usually within an hour or so and somewhere down Indianapolis, which is two hours away, or Fort Wayne, and they'll say, Hey, I. I've been looking into this, I just think it would help me to see what it's like in real life. And I'm like, just come. And so they'll just come and follow me around for the day, or we'll do it on a Wednesday, which is less patient stuff, more business stuff, and we'll just talk. And so it doesn't really take that much time. And like you said, I do like you do, I'll email back and forth. Patients will say, Hey, I ran into this issue. How do you solve it? And so we just build this network of doctors, emailing, texting, doctors, and it's a pretty cool thing. We also have high school students who are thinking about going into health professions. So we'll have them here half a day. We've had some residents. I work with a medical school in Indianapolis and about three months a year we have a medical student from there. And yeah, we really enjoy it. When they leave, we enjoy getting back to just small and simple too. But we do enjoy having the mentorship and. What I would love to happen, and this is what I would picture, because I have to figure if you haven't, you haven't asked me yet, but you'll probably ask me what's my pain point or what's, what am I looking at in the next, what's my big challenge? And I'm trying to figure, because I turned 60 at the end of this year. I've been practicing medicine for 30 years. I love it. I especially love DPC. And so now I could see myself continuing. I don't know how long I wanna keep going, as long as I've got my marbles, but I don't wanna keep going at the same speed. And what I'd love is if somebody else would come in, either as a partner or maybe do their own DPC next door or something we could share, and I could kind of go maybe a few less days, a little more time off. I don't know what that's gonna look like yet. And so that's my challenge point is. How am I gonna make that happen? But I keep hoping that if I host medical students and residents, they're gonna say, Hey, I like this DPC and this is a pretty nice town, hasn't happened yet, but I'm hopeful. So part of that is just giving back, I think, to the movement, the DPC movement. And if they don't come here and they wanna go to their hometown or somewhere else, I mean, I'm happy for them. I, I really am. Because I think, I think the more the DPC movement grows, the better it is for doctors and for patients. So,

Maryal Concepcion: 58:29

amen. Absolutely. And yes, you read my mind.'cause that's what I was gonna ask you next. And when it comes to talking to people out there in the world who are, getting into this physician entrepreneur journey I'm wondering if you can. Say two to three things that a doctor can start doing if they're a doctor in training or they're a doctor already. If, if they're wanting to, really understand DPC even more so than they might understand right now.

Dr. Joel Schumacher: 58:59

Yeah. If they haven't already, for sure. Like we've mentioned, going to some of the conferences, like you're having the one in California for people in that area, or the DPC summit or the DPC Alliance puts a lot of those things on that can be so helpful because in a short time you will network so much and learn so much. There are a lot of good books out there. Doug Fargo has good book. there's a lot of information out there that can be helpful. But I would say in the small sense, find a DPC doctor near you. Call'em. And I'm almost certain they would say, yeah, you wanna come spend a day. And then you have that one-on-one relationship where you have undivided attention and can ask your questions and develop an ongoing relationship where you could probably continue to email back and forth and get some information. My other bit of information to, especially to residents or maybe new physicians coming out is if,'cause I've had some residents tell me this oh, I love the DPC model, this is how I wanna practice, but I've got a ton of medical student debt and I can't really afford to take that risk because maybe I've got a little family too. And I'm like, I totally understand that. And so I've heard a couple people say, I'm gonna go work for the hospital system or do something for a few years, get some debt paid down, and then I'm gonna launch my own DPC. And that sounds like a good model. Don't put the golden handcuffs on. I guess that's what I would tell them. If you're going to do that, then do it that way. Pay down your debt. Don't buy faster cars, bigger houses, more and more things, and you're going to be stuck with that job. But just try to get outta debt. Don't go deeper into debt.

Maryal Concepcion: 1:00:45

I love it. And what would you say to a person who's about to check out a DPC in person shadow, whether they be a medical student resident or an attending physician. Do you have anything that you recommend people making sure they ask when they're at the DPC site?

Dr. Joel Schumacher: 1:01:04

Yeah, I think it would be important to ask how do you communicate with patients, I guess, because some people just really hate having patients text them and other people are like, are you kidding me? I like that that's on the fly. And so, so I guess the question. Would be dependent on the person going, what's important to them? What might be important to you might be less important to somebody else. But that's one I think I see a lot of times people will say oh my goodness, wait, you're, you're the only person for these 800 patients. You're gonna get killed on call and how? How do you do that? And so just ask how it works. And I did the math when I worked for the hospital system, there were like 12, 10 doctors maybe in the county that shared call, and we had 2,500 patients. I'm like, so I'm carrying this beeper for a weekend. I could get a phone call from one of 18,000 different patients and 80% of'em. I don't know. I'd rather get a text from someone that I know well than from someone. I don't. And so the odds of me getting contacted from 800 patients versus 18,000, and it's somebody I know, okay, that sounded better. But that's important to know how they communicate and where they set the boundaries. Because I'll tell my patients like, if, if you really have a question, I want you to text me. I don't want you to sit there and say You're bothering me. But if you call me because you're dealing with three months of constipation and you call me at two in the morning and now it's all of a sudden it's an emergency for you, we need to have a talk about boundaries because I'm in this for the long haul and if everybody calls me about things like that, I'm not gonna be doing that for the long haul. And people I think are generally respectful of that.

Maryal Concepcion: 1:02:48

Totally. And I think that it's also a great call out to say, it's gonna, your questions are gonna differ depending on who you are as a person. And I definitely would say. Whatever your own, questions are, or concerns or fears, if they've been prompted by this conversation or whatever write those down and have those in your head and you might see some themes around your, the questions that you're asking, whether they being financial, whether they be, what are the hours that a person's gonna work, et cetera. So I think that's wonderful. Well, thank you so much Dr. Joel for joining us today and sharing your story. I know it will be inspiring for people out there as you go into the future, and I hope that there's someone listening out there who's interested in practicing in Plymouth, Indiana.

Dr. Joel Schumacher: 1:03:28

Thank you, Mariel. It has been a joy.

Maryal Concepcion: 1:03:33

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.