My DPC Story
As the Direct Primary Care and Direct Care models grow, many physicians are providing care to patients in different ways. This podcast is to introduce you to some of those folks and to hear their stories. Go ahead, get a little inspired. Heck, jump in and join the movement! Visit us online at mydpcstory.com and JOIN our PATREON where you can find our EXCLUSIVE PODCAST FEED of extended interview content including updates on former guests!
My DPC Story
DPC for Women: Dr. Marcy Meyer’s Mission to Transform Menopause Care
Today's guest is Dr. Marcy Meyer of Destiny Direct Primary Care, a physician who transitioned from the US Army to opening a Direct Primary Care (DPC) practice focused on menopause care in University Place, Washington. Dr. Meyer shares her unique medical journey, insights into the challenges of traditional insurance-driven healthcare, and the freedom and impact of practicing DPC. The conversation covers her military background, lessons learned as a flight surgeon, the evolution of her clinic from general family medicine to specialized menopause care, and tips for physicians considering a similar path. Dr. Meyer also discusses the importance of patient-centered care, breaking menopause myths, and leveraging resources like the Menopause Society for ongoing education. This episode is a must-listen for clinicians interested in DPC, women's health, and entrepreneurial practice transformation. Listen and discover how empowering care models like DPC are reshaping the future of medicine.
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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. Marcy Meyer:There's no denying that our American healthcare system is broken. It's broken for the healthcare providers, it's broken for the patients and direct primary care, while not perfect, because nothing is, fixes much of what's wrong in our healthcare system, at least between the doctor and the patient. And that's a beautiful thing. I am Dr. Marcy Meyer of Destiny Direct Primary Care, and this is my DPC story.
Maryal Concepcion:Dr. Marcy Meyer, MD began her medical career in the US Army, graduating from the Uniformed Services University of the Health Sciences in 2004, she started postgraduate training in psychiatry, but left that program and practiced as a flight surgeon for the remainder of her army career. Upon leaving military service, she founded NET Health DPC in the north end of Tacoma, Washington, which she rebranded to Destiny Direct Primary Care when she bought a building and moved her practice is to nearby University Place. Now passionate about serving women in midlife, Dr. Meyer is a menopause society certified practitioner and has shifted the focus of her direct care practice to providing dedicated menopause care to the South Puget Sound community. Welcome to the podcast, Dr. Meyer. Thank you. It's good to see you Marielle. It's good to see you too. This is a long time coming. I'm so excited for our conversation today. I've just been preparing for your interview by, scrolling on your, that purple haired doc, uh, Instagram feed. And so it's just, it's really exciting to really delve into the topics that we're gonna discuss today.'cause you and I have seen each other in person. We've talked about many a thing. but in the past it's been much more of like workflows and EHRs and whatnot. But today we're gonna be talking about different stuff. So let's just take a step back and I'd love if you could tell us more about this time that you had in the Army, because I think about when you graduated in 2004, what was it like in terms of having a career in the armed forces versus having a civilian career?
Dr. Marcy Meyer:So, um, I went into actually my pre-med education as a single mom. I was a non-traditional student about 12 years older than my peers. And, um, I, I was bringing a, a little girl along with me. So when it came time to, uh, applying for medical school and accepting an offer, um, although I got numerous acceptances, the Uniform Services University offered me a. Full ride, like the full salary. I was a Army officer and it just was the best opportunity for me to raise my daughter while going to medical school. So, um, that, that was kind of the choice there. Also, I had been in the military before. I had served, uh, as an enlisted person, um, just a couple years out of high school. Uh, I wasn't quite sure what I wanted to be when I grew up, so I spent a little time growing up as an enlisted soldier.
Maryal Concepcion:Awesome. And we're still growing up, so I love this, even though as it plays into your shift in how you're practicing every day now. So Yeah. Let, let's, and I wanna ask you there as a follow-up question, um, because you were, you know, because you were in this place where you had less financial burdens to think about when it came to especially medical school loans. I'm wondering how did you, how did your trajectory change because you weren't as financially burdened?
Dr. Marcy Meyer:Um, well, a couple nice, nice things was that, especially during the first couple years of medical school, before everything got crazy with clinical rotations, um, I was able to do things with my daughter, uh, that even during pre-med I had, you know, I was either at school or working, seemed like all the time. So, uh. My first year or two of medical school, I was taking writing lessons with her. She's quite the little equestrian and, um, I was able to do some, some school activities with her, uh, if I, if there wasn't a, a conflicting lecture or something. So I was able to kind of focus on, on that little bit of time being a mom. Um, and also I was able to bring my mom out to live with me so that I had, you know, someone to take care of her, someone to do things around the house. I mean, my mom was essentially my, my housewife, you know, getting through medical school. So
Maryal Concepcion:I think it's cool because it's a little bit of a taste of what work-life balance can be in DPC. So I, I love that you found that time, especially when your daughter was young. Um, younger, I should say. And yeah. And now, after you finished your medical school in postgraduate training world, you went into psychiatry first before, before becoming a flight surgeon. So tell us about that, because I love these, I love hearing the history behind the transitions within specialties.
Dr. Marcy Meyer:Yeah. So I mean, part of the reason that I didn't know what I wanted to be when I grew up and I did some enlisted time and I was a non-traditional student, is because I have a DHD Surprise. Surprise. So, um, I. So I went into psychiatry. I really enjoyed it and, and seemed to pick it up pretty well, but the documentation was very voluminous and, um, with some of my executive function and, and some of my issues with follow through, even with medications, I was falling behind in documentation and just kind of having more and more trouble with that. And, and it was at the beginning of my fourth year, I just said, I, I can't anymore. It was just more than I could do. So, uh, in the Army, when you leave a residency, you go out to be what we call a general medical officer, and one of the options is to go to the flight surgeon school and, uh, work for aviation unit.
Maryal Concepcion:And tell us about that time because, it's fascinating hearing, former guests on the podcast who have been in the Navy Air Force. We've had Dr. Glover share about her time in the Air Force. Dr. Kosky change talked about her time in the Army. And I'm just wondering, what did you take away from your time as a flight surgeon that especially impacted the way that you practiced after you left the, um, your military career?
Dr. Marcy Meyer:Well, because I was A-A-G-M-O, um, I. Was embedded in a unit all the time. So I, I had a patient panel of about 700 patients always, and I only saw eight to 10 patients. A really busy day would've been 13 to 15. And, um, and I never had to wonder how my patients were gonna pay for their care. I never had to wonder, I never had to try for a prior authorization or ask anyone permission if my patient needed an MRI, I ordered an MRI, they got an MRI that was just, uh, that simple. And so when later down the line, I was looking at getting out of the military and looking at what the civilian landscape was, especially in primary care and the rates that people were getting burnout, um, I just knew that that really wasn't something that I would thrive in. I was looking at other nonclinical options for myself getting out of the military. And uh, then I was introduced to it by a classmate of mine from Uiss and to the concept of, of direct primary care and. That just made sense to me immediately. I think in a way I was spoiled in the military in a way that made going into DPC almost mandatory.
Maryal Concepcion:I could totally see that. As you're talking about how you wouldn't need to do prior auths. You would just order things and they would be done. It's so interesting that, even that does exist for people or that did exist when you were a flight surgeon, and then when the veterans go out of the,, out when they go to the va, that's not always the case. And so it's, it's so interesting to, to just think about that, but also I absolutely understand when you're like, going into DPC was mandatory because how could you backpedal, you know, I mean, you, you have to if you have to, but I just, I, I totally get what you're saying.
Dr. Marcy Meyer:Yeah. And, um, you know, this will come into play also a, a little bit later in our conversation, but, uh, I did not realize when I left the psychiatry residency that getting into another residency was going to be an issue in the army. Um, there were, now, now to set the stage, I was about 42, 43 when I was making that transition from psychiatry into, uh, the general medical officer arena. And, um. I was having difficulty maintaining my weight in the Army and their, and my fitness levels. And they are very, very strict about if you don't make weight, you get what we call a referred officer evaluation report. And once you get a referred officer evaluation report, you are no longer very competitive to get into other residencies. So despite being actively recruited by the air, uh, aerospace medicine program that particular year, they had a glut of, of applicants and I was the one with the black mark on my evaluations. And so I didn't get picked up. And, um, you know, and, and then kind of the spiral of depression and more difficulty with, with weight. And so that just kind of set the, the stage for me in the military. Um, so when I got out of the military, not only did primary care in the system not sound appealing, but it would've been very difficult for me to have landed a job in the system.
Maryal Concepcion:Wow. I think It's eyeopening hearing that because, I think especially as primary care, there's weight and then there's health. And, to clarify when you're talking about that these, these physical, demands, is it like an annual test that was required of everybody in the service?
Dr. Marcy Meyer:It was actually semi-annual, so we had to do it twice a year. And, um, I was able to and had time to hire personal trainers and I got so into nutrition and fitness while I managed my weight. My health markers were phenomenal. I mean, I was in good shape and I mean, my weight was around 180, 180 5 and that was too much, but partially because of how I'm built with my little pencil neck and my, and my bubble butt. But, but, uh, yeah.
Maryal Concepcion:I definitely know now why you're saying that it's pertinent to the conversation later, because I do think that, you know, my, as you're saying that, my next question to you is, um, as, as you talk about access to fitness and nutrition, whatnot, um, was there anybody that was a specialist in talking about, um, women and aging in women and the body changing as a woman ages?
Dr. Marcy Meyer:Oh, no. Now keep in mind, in the Army it's about 20% of the population is women. And, um, and most of the army population is enlisted. And so those are usually from age 18 to 38 ish. And even officers generally retire between 42 and 50. So you don't run into a lot of menopause women.
Maryal Concepcion:This is just, it's so eye-opening, everything that you've, you are saying. And so I'm really glad that you're sharing, because I'm sure that there are other people out there who are, who can relate whether it be a very similar level or just different aspects of your journey so far that they can relate to. I'm, I'm really glad, that they are hearing this right. Yeah. When it, when it comes to you, then. Hearing about DPC and really feeling like it was mandatory. And I co again, I completely get that. Had you had any business experience going into physician entrepreneurship, from your time in the Army?
Dr. Marcy Meyer:No, absolutely none. That was, that was of course my biggest, uh, learning curve going into DPC, but it would've been no matter what. Um, one of the things that I was considering, I have a friend who, uh, flips houses or he flipped houses at the time, and there were a couple of companies that would go, uh, uh, market to families who had elderly parents who needed to liquidate their homes to go into long-term care. And so we were looking at forming a company that would buy these homes and flip them. And the ones that were, would be appropriate to turn into, say, an adult family home. We would do that. That was the, the proposed, business model. We would turn those into, uh, adult family homes and then I would be the medical director for our group of adult family homes. But I, I knew that was just kind of a, that's what I can do with my degree kind of thing, rather than something I really wanted to do.
Maryal Concepcion:Absolutely. And. Now when you opened your first, version of DPC that has now been rebranded, you opened in the north end of Tacoma. So I'm just wondering if you can tell us about that geographic area in particular and where you lived with your mom and daughter. Did, was it in the Washington area, before you opened your DPC?
Dr. Marcy Meyer:No, I grew up in San Diego and so, uh, so the, my undergrad years I was down at San Diego State and then, uh, went to uniform services in Washington DC and after my intern year, my mom went back to San Diego and I, my daughter and I went to, uh, Hawaii for my psychiatry residency. Um, that was rough duty there, but, um, Washington just happened to be the last place that I was stationed in the army. And I met my husband shortly before I got out of the army and he had an established career here in Washington, so that's why I stayed here.
Maryal Concepcion:Got it. And Tacoma itself, when you opened, what was the climate like? Because I think about Washington is where doctors, Garrison and Erica Bliss had Q Lions. But I'm wondering about what was the climate like and what was the support like when you were opening?
Dr. Marcy Meyer:So I, as I was kind of looking into DPC and learning about it and all of that, that was right about the time that Q Alliance was closing. And so while I knew about them and, um, had wanted to reach out and, and learn from them, they were closed before I was really in, in the spot to, to be, doing that, that part of the planning for my practice. One of the docs from Q Alliance, Roxanne Ho, had established A DPC here in Tacoma, a very small one because she, because she was a primary breadwinner, she was also working for hana, which was more of an employee based corporate DPC. Um, but she had some patients that didn't qualify for that, and she wanted a practice where they could go to without having to deal with the system. So she was a mentor. And then we also went down to one of the Northwest DPC meetings and. That was where I met Julie Gunther and, Rob and Neil Douglas. Yeah. So I met a bunch of, of really good folks down there and learned so, so much. Um, and so I had that, that kind of support going into it is just wasn't super local support.
Maryal Concepcion:And, uh, I I love that all of those, uh, doctors who you have mentioned, uh, are, are you, you are now amongst the, the crew that has all now shared their story on my DVC story, so definitely Awesome. Dr. Rob Ross Row, Dr. Neil Douglas, Dr. Julie Gunther, uh, has been on a couple times and so it's so exciting to hear, this history also, especially when people out there can listen to a little bit more of the history of those people who you just mentioned. So yeah, with you having, at least mentorship local to you, it wasn't necessarily the bliss, but having mentorship and then opening, can you take us back to the opening time of your practice because doing things like everybody has to do, pick a name, get a website, onboard their first patient. Can you, can you tell us about, you know, really memorable things that you, uh, could pull from
Dr. Marcy Meyer:mostly it was kind of fi thinking about who my, patient popula who I wanted my patient population to be. And, as much as I like the idea of DPC being an accessible model, I felt that to get started to kind of get off the ground, I needed some people who were a little more financially stable and, and people who would be willing to entertain the idea of, uh, something outside of insurance. Because it seemed to me, like here in Washington, people were just very married to their insurance. It was a lot of education and a lot of, quick talking. With the elevator pitches to get, get people to understand what the model was and how, how it would benefit them. Eventually, once I got, of course a few people signed up and, and words started getting out, how it benefited various folks then that snowballed into more people than my original, uh, population I was targeting.
Maryal Concepcion:when it came to you opening your DPC and managing these patients as the, the snowball was happening, tell us about your staffing situation and how it has changed.
Dr. Marcy Meyer:From day one, I had visions of a wellness center, um, because I had worked so hard to stay healthy and try to manage weight when I was in the military. And kind of as I was on the way out was when, the obesity code came out and the high fat, low carb, intermittent fasting thing was really catching on. And, and so I wanted to offer a, a metabolic repair program, if you will. But I also had not drawn, and I wanted part of that to be looking at labs, not just weight, you know, looking at how are your metabolic markers improving from the beginning of the program to the end of the program. And so I knew that I wanted to gather labs at least twice on each patient. And I hadn't drawn blood since second year of medical school, so I wasn't gonna do it. So right away, I, I kind of started looking for, or almost right away, within the first year, I was looking for, somebody who could just be part-time with me, be a little, little bit of a phlebotomist, a little bit of a cheerleader at our, at our group meetings for the metabolic program. Um, and so I started pretty early with a, a part-time ma.
Maryal Concepcion:Awesome. And now I wanna ask about your name because originally opened as, net Health DPC, and I'm guessing that that was for the north end of Tacoma because Uhhuh, yeah. Okay, good. I guessed right. And that was totally like lifetime guessing here. And you then shifted your name to Destiny Direct. And so I'm wondering if you can tell us about how. What was going on in your mind? When it came to Destiny Direct DPC, like, this is the future of my practice. And how was that for your patients and for the community in terms of growing your practice while undergoing a name, while undergoing a brand change?
Dr. Marcy Meyer:The space that I started out in was in a very nice little part of town. Very cute, quaint, kind of older, architecture and all that good stuff. But I was also tucked into this little building and it was hard to see my practice. And, and I had a very limited time I that I knew I would have the lease. The owner of the space wanted, that space for his father to,, run his behavioral health practice after a certain period of time. So I, I knew I had a limited time, but I also hoped that I would grow out of that space in that time. So, um, so it was kind of planned obsolescence. But it was very important to me when I opened that my name reflected my community. And so that's why Net Health North End, Tacoma Health was, was the name that I started with. And when I moved out to University Place, which is only. 15 minutes away. It's not that far, but, um, you know, north End Tacoma just didn't seem to be the, the thing to reflect the community there. But Tacoma in the larger sense is known as the City of Destiny. And so when I was trying to come up with a name that also reflected the larger community, that's where Destiny Direct came from.
Maryal Concepcion:in terms of just physically moving locations, with the brand change, did you, did your patients just roll with you? I, I think about Dr. Andy Chun and how he was like Chun Family Medicine and then Chun Family Medicine, direct Primary Care the next day, and his patients just came. So I'm wondering if that because you had already established yourself as a DPC, should they just go to a different parking lot when they had to see you?
Dr. Marcy Meyer:yeah, pretty much. In fact, I had like one couple who signed up with me, at least in part because I was within walking distance of their health. I did lose them, but, but everyone else, it was just, we gave them directions and they found their way over and everything was, was fine., I bought the building during the pandemic, so I was doing a lot of, virtual medicine then anyway. And, it was kind of, we moved kind of just as we were really getting rolling again in the clinic. And, uh, so it was, it was good timing.
Maryal Concepcion:I'm wondering if you could share for the listeners, how was that for you and any advice out there for people listening who are also looking to buy a space or move into a new space?
Dr. Marcy Meyer:get a very, well, first off, the biggest mistake I made was I used the same real estate office that was selling the property. And so they had some conflict of interest there and they weren't willing to be as, they weren't willing to set and enforce boundaries the way that they should have been. But what happened was the, the practice that owned the building before me, this who sold me the building, because it was during the pandemic, it took a while. It was like, just as everything shut down. So people were figuring out how is this work from home thing gonna happen, you know? And um, so it took like six months for that transaction to go through. And in that time. The practice, the selling practice lost the space they were supposed to move into and they knew that they wanted to move from that space'cause they were a little persnickety about, the setup in terms of HIPAA compliance. It really wasn't any different than different than any other medical practice where you come up and you give your insurance information and give them your name and I'm here for my appointment. But they were very concerned that it was a small waiting room and that, um, HIPAA information would be overheard by the people in the waiting room. So, um, so they really wanted out of that space, but,, they didn't have a place to go to. They said, okay, we'll go through with this transaction, but we want up to three years to find a new space. And, um, during that time there, there were a couple of, uh, there are a couple of residential rental apartments on the lower floor of the building. And so, um, we ended up moving my practice into a 650 square foot one bedroom apartment and running it there for two years and nine months, which is how long it took them to find a new space to move into. So, um, yeah, my biggest piece of advice is don't use the selling real estate agent. Go, go with someone who will go to bat for you.
Maryal Concepcion:Yeah. I, I remember you saying that and I was like, oh my goodness. It's so reflective of so many of us that, like, you're very specific on the two years and nine months because it's like, whether it be, you know, the day that our, non-compete ends or our radi geographic radius, uh, you know, restriction ends or whatever the, these things we carry with us, so I, I love that. But it also, you know, it's, I I'm glad you're past that point also. For sure. Yeah.
Dr. Marcy Meyer:So two years ago we were finally able to move into the main clinical space and, and actually, that space was large enough that now I have a new direct primary care establishing their practice in my space, which is awesome.
Maryal Concepcion:That's fantastic. And tell us from 650 square feet to what now? Uh,
Dr. Marcy Meyer:1440. Yeah. Five exam rooms, a lab and office and a admin area. Break room.
Maryal Concepcion:Yeah. And the waiting room not used for waiting. I love it. Love it. And now I wanna ask you about your transition from focusing on family care to focusing on the woman's journey, especially with menopause. As you shared earlier, this was information pertinent to you as an individual, but also, you seeing even in the army how this type of care was not prevalent I think about how many of us have said, who learned a ton about menopause in medical school and no one raises their hand typically. Especially like, maybe, maybe, you know, I'm a little jaded'cause I graduated a few years ago. But, uh, when it comes to you leaning into, I'm going to really focus my practice in on menopausal care, your website says, you know, we're no longer accepting patients for family care, but we are accepting new patients for menopausal care. So tell us about the shift in your practice focus.
Dr. Marcy Meyer:a few things kind of happened all at once. The end of 2023, I happened to run across. It was, I was a little late on the, the whole TikTok bandwagon. And so I, I started kind of scrolling through band through TikTok and I ran across a post from Mary Claire Haber. And I recognized her from back in my army days when I was trying so hard to lose weight. And she was just then starting to get the Galveston diet off the ground and or she was just starting to kind of put it together. And so I was listening to her and, and of course by the time I found her in 2023, she was full on into the menopause care. She was getting ready to come out with her book, the New Menopause, but she was laying out this information about symptoms of menopause that I had never known were symptoms of menopause. And I'm going, wait, I recognize that that happened to me and that happened to me, and that happened to me. And I had no clue that any of that was related to perimenopause. Um, and I, and I could put it together with my journey in the Army with the difficulty losing weight with, um, what should have been a pretty simple injury, kept me non-weightbearing on one of my feet for two months. And, you know, there was more weight gain and, and less fitness and. Um, and then the, the, uh, brain fog and having depression issues when I didn't get picked up for the aerospace medicine program. And, you know, here, I, I had all these reasons for what I experienced, or I thought I had reasons, but never realized that they also could have been, you know, related to perimenopause. Um, and then at the same time, my mom had been in, in long-term care, in memory care for a little over a year, and I started recognizing, you know, she has osteoporosis, she has dementia, she had terrible sarcopenia. And so she, she lost her mobility, she lost her eyesight with age-related macular degeneration and glaucoma. And, um, I just saw she had recurrent UTIs, uh, a couple of times landing her in the hospital. And so I realized at that point, that doesn't have to be my fate. It, because I'm still within the, the period of time that I can seek. Menopause care and hormone replacement. And so I started really learning everything I could about it. And I mean, I was, I was in my third year right at the beginning of my clinical rotations. My second rotation was in August of 2002. It was OB GYN. And our, our, my very first, journal club, we went to some little restaurant in San Antonio, the whole OB GYN department. And we went over the women's health initiative that had just been published. And, um, you know, from that point on, it was habu to think about hormone replacement. And we didn't learn anything about menopause or menopause care or the symptoms.
Maryal Concepcion:I recall just reading a post from somebody who's been on the podcast, Dr. Jalen Pritchard, who was echoing the same things back when, when she was practicing, hormones was a way to get in trouble to talk about that versus a way to actually have a conversation with your patients. So here I wanna ask, what are the things that you see in traditional care, you know, hearing from, your patients', stories of their friends who have looked for support in traditional fee for service. What are some things that you've seen in fee for service that you purposefully are able to address differently or treat differently because you have more time in DPC?
Dr. Marcy Meyer:Yeah, so my first visit with a new menopause care patient is not that different from my first visits with a new primary care patient. I have the time and I want to know all the detail of their medical history, of their reproductive history, of, you know, their, their menstrual history, of their family history, especially when it comes to risk factors for, for various things, uh, related to menopause care. So, uh, my being able to go into the kind of detail that I can in my first visit and, um, because of the rates through the GPO with my labs, I'm able to include labs. It cost me, you know, a whopping$40 to do the whole panel that I need to make sure that medically I've cleared them that this isn't due to other medical stuff, and so I'm, I'm getting a lot of women who, you know, they wanna, they want someone who's going to take the time and listen to them and believe them and treat them. And not dismiss it.'cause I was, that doctor that was dismissive before my epiphany with, with menopause., I was the doctor when they came to me, I've got brain fog and I'm tired all the time and I'm like, welcome to your forties. And, and, and now I, I kind of shudder to think that that's, that's how I treated my patients. And so they're, they're hungry for someone who will listen to them and believe them and treat them. But again, they're still really married to their insurance. And so being able to include those labs at a price that's affordable for me, but they feel like they're getting good value, it really, uh, makes a difference for them signing up or not.
Maryal Concepcion:For sure. And I'm wondering if you can, say some myths that you hear from your patients when it comes to menopause
Dr. Marcy Meyer:mostly it's just that, that being dismissed thing. I mean, so many of them come to me just because they went to their primary care and got dismissed and then they went to their OB GYN and got dismissed or got told, oh, we don't treat that until you're done with menopause. And, you know, most of the symptoms are in perimenopause, so, you know, they kind of miss the bus there. The number of people who were told because of ridiculous things that they're not eligible for hormone replacement and they're, they, they really don't have any, any true contraindications. They're just these kind of nebulous. So I don't feel comfortable prescribing it in these, in these situations. Things like second and third degree breast cancer or, you know, relatives with, have a history of breast cancer or, oh, I have migraine with Aura, or I had a, a Provoked pe and they think that they are not eligible for, for hormone replacement, but, you know, we find out now that they are, things are starting to turn, that tide is turning as more information is getting out there. I am finding that I'm getting more of the patients who are kind of iffy on their, whether it's contraindicated or not, I, I have those more, those patients that I have to do more and, really have a deep conversation with the patient about the, these are what your risks are if you wanna pursue hormone replacement. and if, if you are okay with that, then go ahead. We can go move forward. And I just have to document that carefully.
Maryal Concepcion:Got it. One of the things I saw on your social media was that you and other clinicians came together after a screening of the M Factor and you did a q and a. So first I wanna ask, can you tell us about what is the M factor and how has that been helpful or impactful for your community?
Dr. Marcy Meyer:So the M Factor is a documentary, the first of its kind in the US that kind of, uh, covered a lot of the information that, that was, um, inspirational to me in, in learning about menopause and perimenopause and the symptoms. Um, I actually saw this Kelly Casperson up in Bellingham, Washington had a, a screening just. Like the day after it came out and I was there. And uh, one of the things, uh, one of the scenes was a dentist talking about like, 40% of women will lose a tooth in the first five years of menopause. And you could hear the whole audience gasp.'cause they just had no idea that, that it affected dental health, it affects musculoskeletal health, it affects genital urinary health. And, and so the, the q and a session was really wonderful. I mean, I had to stop it at a point because we had to let the, the theater close down, but it was a good hour or more of, of q and a because people were just so hungry. Women were so hungry for that information. And, um, having someone who, uh, knew a little bit more who could, who could say, Hey, I'm, I'm certified in this stuff, and could answer their questions. They, uh, they really ate it up.
Maryal Concepcion:And I'm wondering if you can talk to what brought people to the screening of VM Factor, because if a person is wanting to bring the M factor to their, their community or if they're wanting to highlight their menopause care at their DPC, I'm wondering what, what have you found that helps people understand that? Like, I'm here for you. I'm not here to dismiss what you are experiencing.
Dr. Marcy Meyer:I have not done as good a job on social media as I would like to. But, the social media posts that I have put out have gained some traction, uh, especially Instagram that seems to be, um, a, a good platform for this kind of thing. women of this age are starting to talk among themselves, amongst themselves on the things that they're experiencing and like, you know, why am I being dismissed? And, and things like that. But also a lot of women don't realize how young perimenopause can start. And so when they go to a doctor about something and they get dismissed, especially when the dismissal is, oh, you're too young for that, and they're not. Um, so they, they tend to be less inclined to advocate for themselves because they don't know that it's perimenopause and, and then they're getting dismissed. Um, so for instance, I just happened to have a, an appointment with my hairdresser who's in her early forties. It was, it was just before the screening. Um, and. I said, you know, you're in that age group that it's you, you probably would really enjoy this. You probably learn a lot. And she brought a couple of her girlfriends and at the end of it, they were just like, oh my God, I'm already starting to experience some of these things. I had no clue. You know? And,, and so just being able to get the word out, especially to the younger women, because the, the perception of a menopausal woman is,, the gray-haired lady with the cane and, you know, kind of dry shriveled up and dried out. And, for a lot of women, in fact, there's, there's a movement now toward, working toward work benefits, menopausal work benefits, um, because it's right at this time when women are at the height of their career and they're getting brain fog and they're wondering if they can, and they're getting mood swings and they're irritable, and so they're having difficulty maintaining their position. And there's, I, I don't even remember the statistic, but there's a huge number of women that leave the workforce at, at a time when it should be their, the height of their career because of the menopause symptoms.
Maryal Concepcion:Yeah, I just, I think about when you were saying, you know, the, the stereotypical menopausal person is the gray-haired lady, and I, I'm a huge fan of the Golden Girls, but it's like, I think about how, there will be memes about like, you know, Betty White was 50 and when she was doing in her fifties when she was doing the Golden Girls, and J-Lo is also in her fifties and she does not look like Betty White did in when they were filming the Golden Girls. It is definitely the dominant stereotype still.
Dr. Marcy Meyer:And part of it also is, um, you know, with, with our aesthetics and youth culture, um, women of, of this age, women are in their mid forties, early fifties, are keeping themselves looking much younger for the most part as well. So, um, people would be surprised at how, how young the symptoms start.
Maryal Concepcion:Yeah. Yeah. And I, I think that that's awesome. I just, I, and the reason I say that here is because I can just picture. Your hairdresser and her friends then going out to tell more people about, like, did you know, because they probably have other friends that are, you know, like you're saying, potentially, you know, experiencing symptoms and not necessarily thinking about could this be due to perimenopause Or
Dr. Marcy Meyer:in fact, at the end of that night, she took a stack of my cards so that she could give them to clients.
Maryal Concepcion:That's awesome. So that's one key takeaway is if you do something like this, make sure you have your contact information, your business card. Yes. That's awesome.
Dr. Marcy Meyer:Yeah. And then other things, um, Oprah's recent menopause show, Mary Claire Haber was on there and she, she, highlighted the menopause.org website and how to find a practitioner there. And after that show aired, I probably got five calls, like within the next two days looking for menopause care and they found me on the menopause.org website.
Maryal Concepcion:Yeah, that's fantastic. And just for those interested. The North American Menopause Society is where you can go and sign up and it's only a couple hundred of dollars to, register for amazing content that they have. Mm-hmm. Um, I think it was last fall they started doing videos the very first video is about perimenopause, and then they just keep going from there. And so, I think that, you know, as we wanna have time in DPC as we have patients asking, there's affordable, accessible resources out there and Im, yeah. Yeah. so turning the page a little bit, you have become that purple hair doc. And so I'm wondering if you can tell us about, you know, your, your personality and your individuality coming out as part of you in your hair. Because I think that's, it's so fun, but it's also, I, I think it's so representative of the freedom and the life that we have differently when we're doing things like preserving our autonomy and practice.
Dr. Marcy Meyer:Right. Throughout my time in the military, I was always kind of a, a round peg in a square hole. So I, I never quite fit in that, in that regimented, uh, environment. And, um, and so when I finally got out, I mean, here, here's a fun fact. So when you're overweight in the Army, you are not allowed to have any positive personnel actions. So they would not allow me to go to CME. They would not give me, I would, I couldn't get any promotions. I couldn't go to residency. They would not allow me to resign when my, when my obligation was up, because that was considered a positive personnel action. They, and it was, it was actually, um, I got out from a medical evaluation board. I was found medically unfit to continue service, but that only started because they were trying to put me out for overweight. Yeah. So they, they got my service outta me and then they, they wanted to just kind of kick me to the curb. But that's another story. and so. I, I had played, played by the rules all these years. Um, kind of toward the end as I was going through my medical evaluation board, um, I knew that I was going to go lavender or do something fun with my hair. And as a precursor, I went silver because in the military, you can do any color that occurs in nature. And I had very silver sideburns and so I, I went full on silver, my, my whole head. And of course, it, it raised some eyebrows, but they couldn't say anything because it was within regulation. when I did get out, I then I went to lavender and I've gone through a little bit of lavender, a little dark purple, a little pink, but I always come back to the lavender family. Yeah. And, um, so that's, that's kind of where I plan on staying. I just, I really like it. I find it better than the mousey brown that God gave me. So, And the nickname, the the Handle came from. Uh, you know, I'd gone to 2D PC conferences, one Nuts and Bolts back in 2018, and then that first, uh, DPC summit after the pandemic. And, you know, I was always kind of that, that weird doctor with the peripheral hair. And so the, the next DPC summit, the one in Minnesota, I, when I signed up and it asked for your name and then it asked for, what do you wanna go by? And so I thought that my name would be like the big print on the badge and that what I wanted to go by would be like, you know, Nikki underneath, you know, underneath it. So I put that purple haired doc. Well, it turned out what you wanted to go by was the big name on the badge. And, and my actual name, name was a little tiny print underneath it. And so, um, so I went through that conference with big, that purple haired doc across my badge. Um, and it just kind of stuck. So that's what I use for my, my handle.
Maryal Concepcion:I love it. And I remember that badge and I'm laughing because it was just like, wow, that's like, how did she do that? So it's, it's so cool. Yeah. I love hearing this history. Oh my gosh. So, turning back the page in terms of, your practice, I'm wondering how when you changed your website such that it says, you know, I'm no longer taking family care patients, but I'm taking new menopausal care patients. How did you turn off the spigot for the family practice patients and how did you handle patients who, like you said, you're treating and onboarding people pretty much the same way, whether they're under the quote unquote menopausal care, versus the family practice branch, with existing patients at your practice.
Dr. Marcy Meyer:So I started with, once I made that decision, I started with sending out a, a mass message out to all my patients and, and letting them know, Hey, I am, I am shifting my focus, but I am going to be your doctor for as long as you want me to be your doctor. Um, it, it's not going to, you know, change. The, the way that I treat you, you're still my patient. I'm still your primary care physician. I had a couple people who kind of, you know, men mostly who brought it up. Are you, are you still, are you still gonna be my doctor? Yeah. and we still allow, like if a, if a current patient has a spouse or a sister or a parent that they wanna bring into the practice, I'll still take them. but, other than that, it's, it's just the menopause care patients. Yeah.
Maryal Concepcion:I'm wondering if you can share some more resources here that you found helpful on your education and learning journey when it comes to men menopausal care
Dr. Marcy Meyer:so, um, I got a lot, believe it or not, from the social media posts of various, menopause experts. There's a group they call themselves the menopause on, on Instagram. And in their, under their bios, certain of them had like a lot of kind of the sentinel papers that talk about the data and, and the current guidelines and things like that. So kind of gathering that information and reading through it, deciding to go through the, they're now the menopause society as opposed to the North American Menopause Society. But going to the Menopause Society page and uh, signing up to. Take that certification exam. I got the, the textbook, but then they also have like an A to Z slide deck and practice pearls, and there's just so many resources there on the website. None of that though, was very practical in terms of what to do in the clinic with a patient sitting in front of you. And so I went ahead and, and spent the money to take a course from Heather Hirsch, who is one of the menopause. She has a clinician's prescribing course. After I finished that, I also took their, she had a mini course with Dr. Corin men, for prescribing HRT after breast cancer and kind of knowing how to, how to handle those with a breast cancer history. And then Rachel Rubin also put together, she, it was, it was her pilot course, so she decided to also do a menopause clinician's course. Hers had a, a little bit more emphasis because she is a urologist. Hers had a little bit more emphasis on sexual health and, and the genital urinary, uh, syndrome of menopause. But it was just nice to get a different perspective of the, the clinical care. And so those were my, my resources.
Maryal Concepcion:I love that. And this is, we're recording just after, uh, Dr. Rubin was on, uh, Peter att the Drive. Drive. Yeah. So that's definitely a, yeah. A must listen if you haven't listened yet.
Dr. Marcy Meyer:Absolutely. In fact, I just recommended it to a patient today.
Maryal Concepcion:That's awesome. That's awesome. So this question is coming from, because how you said earlier that when you were practicing, you may have been a person who could have dismissed somebody when it came to menopausal symptoms because, you know, education, right? And, I'm wondering if you can speak to how to shift one's own thought process or the way that they, have thought about, symptoms. Or if somebody out there is thinking like, I think I did that to a patient, or, I know I've done that to a patient, because we're all human and, can't change the past. But I'm wondering in terms of mindsets, mindset shifts or ways that are, e even if you're not focusing on menopausal care, ways to, think about entering a visit differently, because of what you know now.
Dr. Marcy Meyer:A major thing for me was not allowing myself to think that 35 is too young for people to start having these symptoms. Now, I don't immediately jump there, you know, when they're in the 35 range, I'm kind of going, okay, let's really rule out other things before I start going there. I just realized in the last few weeks that one patient that to me was kind of a, what do I do with this? Um, she, she had like legitimate diagnosed premature ovarian failure and you know, thankfully she was managed by someone else who was more familiar with that at the time. And, and now I've taken over that care and, and we're kind of tweaking some of her, her regimen and she's getting better relief of symptoms and things like that. But just kind of being more aware that, that this can be a young woman's, younger woman's, uh, issue as well. and then just being careful about teasing out, um, medical issues. Um, for those, you know, with my practice, I, everyone goes through a, an evaluation package and that. Consists of that first visit where I gather all those, I draw all those labs and I go through the family history, medical history, menstrual history, all that good stuff. Um, and then I have a second visit where I do a dedicated vulvar exam and physical exam, and we go over the labs in detail so that I can tell them, yeah, your, your thyroid looks fine. Your vitamin D looks great. You're, you're not anemic. Your iron levels are fine. You know, that kind of thing. Or that, hey, you're, you're really short on vitamin B12 or vitamin D. Let's get you supplemented on that and see how you're feeling. And so we, we go over those labs in detail, and then we come up with a plan. And so for those who we decide, hey, maybe hormone therapy isn't right for you, then we go over, you know, in, in a lot of detail what they can do lifestyle wise, what, what other things, what non-hormonal things we can do to put together a, a regimen that will give them the best outcome that they can have. Because, you know, a lot of, a lot of what also drew me to, because of my mom's health, drew me to menopause care, is that you can prevent osteoporosis. You can, reduce risk of. Of cardiovascular disease, which is the number one killer of women. You know, you, you can have a good effect on mood and cognition and, um, and so it's those long-term health benefits that I'm really after
Maryal Concepcion:That's, fantastic, but also, very much a family medicine doctor's journey. So I really love that because our specialty is for the lifetime of the patient. And I think that that is amazing to, do what you're doing. Thank you.
Dr. Marcy Meyer:I love it. I absolutely love it. It's super rewarding.
Maryal Concepcion:So you mentioned how within your 1400 square foot space and, your five clinic rooms, you have a DPC doctor who is now, basically incubating their own practice, in the physical space where Destiny Direct is. And so I'm wondering if you can tell us more about how that came to be.'cause I think that that is something that, is really, I, I hope that that is something that gives people ideas who are listening out there today.
Dr. Marcy Meyer:Yeah. So, um, one of the DPC docs in Olympia, Kim Wadsworth reached out to me and said, Hey, I, I've just been speaking with. This, this doc in the area who, who wants to open a DPC,, up there near Tacoma, would you be willing to talk to her and, you know, kinda let her pick your brain? I always say yes, you know, and, so she came to visit and she was at the point where she wanted to get started and get moving, but she had not quite started the, the search for a space yet. And so we got to talking and, and a lot of our philosophy and, and, uh, ideology, I guess revolving around community and, and healthcare and, and primary care, um, just kind of jived, we seem to get along well. I, I just told her, you know, I've got all these rooms, if you wanna rent one from me, you know, I'm, I am gonna be kind of shutting off my, my primary care practice.'cause it was just right. The timing was just right for that. So we worked that out and. she's a do so she offers things that I can't offer. She, she does OMT and she's wonderful, and her husband is a pediatric ER or emergency medicine. And so there's some talk about as they grow and, and expand, potentially doing pediatric urgent care, which is awesome and very needed.
Maryal Concepcion:Totally. And
Dr. Marcy Meyer:so, yeah, we, it's just been a really good fit and a really, really good timing. So whenever I have someone who calls our office asking for a primary care spot, I just send them right over to her.
Maryal Concepcion:What do you see in the next three to five years at Destiny Direct, in particular?
Dr. Marcy Meyer:Funny you should ask this because I am, I'm kind of at a crossroads right now. From the very get go. I wanted Net Health. And then obviously Destiny Direct to kind of expand a little more into the wellness, arena. I had gone down to Healthy Kitchens, healthy Lives in Napa, in one of the first two years that I was open. And I was so inspired, you know, about building a teaching kitchen. And when I bought this building with the two le levels, my, my thought was, well, as I grow, I can gut the lower level and turn that into kind of a multipurpose space with teaching kitchen and workout space and maybe physical therapy, you know, that kind of thing. that's kind of been the goal even as I transitioned into menopause care. There's so much need for that because of the fitness and nutrition needs of, of women in midlife, but that's gonna take a, a lot of work and b, a lot of capital. And, and while I'm doing okay for myself, I mean, I, I am not doing that okay. For myself, you know, and I turned 60 at the end of the year, and so I'm wondering, do I. Just kind of ride this out and plan my exit. Um, my husband and I, for various reasons are looking at retiring somewhere warm outside of the US and, um, it's, I'm kind of, okay, do I pursue this dream or do I just enjoy the ride and plan my exit? So I'm still grappling with that.
Maryal Concepcion:It's a very healthy and normal place to be in terms of your honoring the thoughts as they come. And I think it's much better in my opinion than someone telling you, this is what you're gonna do next year. This is what you're gonna do next month.
Dr. Marcy Meyer:Yeah. And I'm, I'm, I'm grateful, very thankful that I have the freedom and the opponent of me to make those decisions and to change course when I need to.
Maryal Concepcion:So, in closing, for our main interview, because we're gonna carry on this conversation on the Patreon, but. For those clinicians, physicians out there who are feeling drawn towards practicing a model similar to yours as it exists right now, especially with a focus on menopausal care, what do you have to say to those physicians to inspire them or empower them going forward in their own DPC journey?
Dr. Marcy Meyer:So don't be afraid of, um, being a specialist of sorts in the direct care arena. You know, we have direct care or direct specialty care. There's a whole alliance, uh, with Laura Kenny and, and all of that. Use what you can out of the DPC playbook, like the discounted labs, the discounted meds. My patients love that I can dispense some of their hormones cheaper than they can get it, uh, at the pharmacy. And, um, but mainly you, you're almost a primary care doctor doing menopause care. I, I, from early on when I started learning a PO about menopause care, I said menopause care is
Maryal Concepcion: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.
Dr. Marcy Meyer:primary care. And, um, I do kind of draw some boundaries with my people that have lots and lots of chronic illnesses that, hey, I'm not your primary care doctor, but, um, but it really isn't that different and follow the DPC playbook, it'll, it'll do you. Right.
Maryal Concepcion:Love that. Well, thank you so much for sharing about your journey, going back in, into your army days all the way to now. And I'm so excited for you. No matter, what the future looks like in at Destiny Direct and for you as a physician and as a person, because I think that again, it's really awesome that you have this journey that you can still be autonomous in going forward.
Dr. Marcy Meyer:Yeah. Thanks so much, Mariel. I really enjoyed sharing all this.
Maryal Concepcion: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.
