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
Resilience and Beans and Rice: Launching Oxford’s First DPC Practice
Dr. Jason Hoke, founder of Hoke Direct Primary Care in Oxford, Ohio, shares his journey from insurance-based, network medicine to launching the town’s first and only Direct Primary Care (DPC) practice. Dr. Hoke details the burnout and inefficiencies he faced under traditional healthcare models, and how the DPC model restored his passion for medicine by prioritizing personalized patient-physician relationships and affordable care. Dr. Hoke discuss practical tips for transitioning to DPC, building a loyal patient base, managing rapid practice growth, and team collaboration. Dr. Hoke also reveals how DPC empowered him to provide innovative, accessible care during the COVID-19 pandemic and improved his work-life balance—impacting his family and inspiring the next generation of healthcare clinicians.
Register HERE for HINT SUMMIT @ ROSETTAFEST!
Download Elation's New DPC Startup Checklist HERE!
Visit hint.com/clinical to learn more and get your first month of Hint Clinical for free.
Schedule your ELATION demo today!
Learn more about CERBO today! Click HERE to get started!
Be A My DPC Story PATREON MEMBER!
SPONSOR THE POD
My DPC Story VOICEMAIL! DPC SWAG!
FACEBOOK * INSTAGRAM * LinkedIn * TWITTER * TIKTOK * YouTube
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.
Jason Hoke, DO:for years I was practicing in network-based and insurance-based medicine and feeling more and more discouraged. And so if you as a physician are finding yourself in that situation direct primary care can be the answer that you're looking for, to give you life, to give you energy, to give you enthusiasm for medicine again to have that patient care that you had always dreamed of as far as being personalized and not being restricted by the structure of a network or the restrictions of an insurance or Medicare. I'm Dr. Jason Hoke of Hoke Direct Primary Care, and this is my DPC story.
Dr. Jason Hoke, founder and physician owner of Hoke Direct Primary Care feels that the burdens of Medicare and insurance are detrimental to the doctor patient relationship, and the efficient delivery of healthcare. Upon completing residency in 2001, he and two partners started an independent medical practice in the small college town of Oxford, Ohio, as Medicare and insurance reimbursements failed to keep up with the rising cost of providing care, the practice joined a local hospital health network, Dr. Hoax. Soon discovered that network medicine only introduced new layers of inefficiency and physician burnout. He saw that physician charting was prioritized over patient care, which created an extreme sense of apathy and burnout. He contemplated leaving medicine altogether. But then read about direct primary care, a model of medicine that was revolutionizing healthcare by prioritizing the patient physician relationship. After attending the DPC summit in 2017, he felt energized by the stories of practicing medicine the way he dreamed it would be when he first began medical school. After the following year's summit, he returned home confident and equipped to make the leap five months later. After fervent prayer, countless hours of planning and the unwavering support of his wife and six children, Dr. Hoke opened Oxford's first and only DPC practice now six years into his practice. He wants to share his DPC story, hoping it will encourage other physicians who are feeling apathetic and burned out. There is a better way where you can rediscover your love of medicine.
Maryal Concepcion, MD:Welcome to the podcast, Dr. Hoke.
Jason Hoke, DO:Hello. Thank you for having me on your show.
Maryal Concepcion, MD:I'm so excited to chat with you. We just saw each other a few months ago at the Ohio DPC uns Summit. So make sure that in February of 2026, if you're in Ohio or able to travel to Ohio, make sure you check out the state focused on summit in Ohio. It's been going on longer than the DPC summit. So I, I just, I really, I, I hope that your introduction, your bio really moved people already, and we haven't even started our conversation, but I think that your calling out of. What happened after you transitioned your guys' practice to a hospital in-network practice was not necessarily a way to save the practice and it was actually pushing you more towards contemplating leaving medicine. So I wanna zoom in at that moment in time because the feeling of leaving medicine or wanting to leave medicine is quite significant for someone who's dedicated their entire career. Training, education, everything, sleepless nights, delivering babies, all of the things to then to then step away. So bring us to this point of you had done independent practice, but it was still insurance based and you tried to find a better way, but it still was not working out the way that you would envision starting medical school.
Jason Hoke, DO:Sure. So, In 2001, I had graduated from residency and myself and two partners from residency, we started a practice in Oxford. And on day one we had one patient and that quickly grew over the course of about 10 years to four offices with a total of 11 providers. So we were quite successful here in, in our small college town area drawing patients from a quite a large area. But what we saw is, there was just a lot of stress and frustration with trying to deal with insurances tightening burdens from Medicare, making it harder and harder to try and just see our patients and get reimbursed for our care. And so what we saw was we needed to be proactive and move forward with making a change so that way we could continue to sustain a, a very successful practice. And so what happened is we then my Oxford location, we joined a local health network with the idea that, now we can get back to being doctors and we can let the health networks, attorneys and billers argue with the insurance attorneys and billers. And what I found is very quickly, that was rather naive. We found is that a lot of the hassles that we were dealing with before now were replaced with new hassles and new requirements from the health network. And I became very quickly disillusioned with what was happening in healthcare. I worked actually quite, I. Closely with the CFO of our health network, trying to come up with a new reimbursement model that would allow the primary care care physicians to take care of patients the way that we knew they had to be taken care of, and that personal approach and not doing it based on an RVU model. And the CFO and I, we came up with a great idea that we thought would go really well until it then got presented to the board. So my point in telling you that is that we actually, I tried to work within the network model to make it a better place for patients and for physicians. And what I was finding is I was just banging my head against the brick wall that was not going to relent. And then when we had primary care meetings and every meeting every month was about billing and coding and charting, and never talking about disease management, I saw myself getting disillusioned, getting very burned out, feeling like I had to see more patients to maintain a reasonable salary. But then at the same time, Marielle, I saw young physicians, I mean, talking about folks who were just outta residency for two years already talking about wanting to give up and leave medicine altogether. And so I knew that I wasn't alone in this idea that this isn't right. It's just a matter of, I, I didn't know where to go, where to turn.
Maryal Concepcion, MD:Totally. And how relatable is that? I know that there are audience members out there, some have even opened their DPC clinics and have been in practice for as long as you have, and they're still nodding their heads because that is a real thing. I, I talk all the time to people in medical school, even pre-meds, by the time you graduate medical school, what is the training levels that you'll have in business? And I get these dumbfounded looks, which I think is really sad, especially in this day and age when the corporate practice of medicine is so corporatized and it is so focused on the exact things that you're calling out. Dr. Maggie Abraham called this out. Dr. Edta called this out. So many people have said over and over. We have tried as physicians to do our due diligence in the clinic and take that due diligence and that advocacy to the boardrooms, to the admin tables. And yet we cannot make changes. And when you say, you know, banging your head against the wall and you say, you are ready to leave medicine. These are real things. And so for those listeners out there who have experienced that, this is exactly why we're having this conversation today, this is exactly why we're getting stories out there of what life can be as a physician who's able to just be able to focus on their patients. So, yes. Because you are the first and only DPC in Oxford now, I'm wondering about the conversation that happened between you and your two partners, because you guys opened together mm-hmm. And then you opened DPC. On your own. And I'm just wondering, did you guys converse as the, the corporate situation was happening about, hey, like this is really unsustainable? Did they stay in the practice? What happened to your two partners as you explored your own DBC journey?
Jason Hoke, DO:Sure. So, we had the four offices and the US original partners, we were each in charge of one of the three offices. One of my partners actually went more of the functional medicine route after being a, what I would consider a traditional family practice physician about 10 years. So he continued with doing functional medicine and, and remained independent. My other partner his office is actually in Brookville, Indiana. Oxford is a border town only about five minutes from the Ohio, Indiana border. So his practice actually joined a health network in Indiana. I. And then my office and the other office that was in Ohio, we joined the same health network. Having that conversation amongst all the three offices that were what I would consider traditional family medicine, we all came to the same decision saying, Hey guys, this is not sustainable with the way insurances are just squeezing us as far as trying to being an independent practice. So we were all in agreement that it was time to join a health network and we just kind of did it a little bit differently at shared offices. Yeah.
Maryal Concepcion, MD:I think about as you responded there, you still went the DPC route. You did not leave medicine, you. Talk to people who had opened and had the exact same practice experience as you in terms of opening as an independent continuing fee for service through hospital networks. But you stayed and I'm just wondering what was it that made you stay and pursue something else?
Jason Hoke, DO:Sure. So when I was getting very frustrated with the situation one of the things that you get as a bonus when you're a network physician is you get CME money. And so one year I was looking at different CME conferences and I just happened to stumble across the DPC on summit sorry, the DPC summit on summit is in Ohio, the DPC summits. And uh, and so I looked at this and. Was reading about what DPC was and like this is what medicine is supposed to be. So I was telling my wife about, I said, I, I need to go to this conference because this is really how we as physicians should be taking care of patients. And so I attended that first conference in 2000 and 17, and I was in awe. So for anybody who's been around in DPC for long enough, I, I got to hear a presentation and meet Julie Gunther I mean, pioneers in DPC as far as just, and they were so enthusiastic and loving practice again. And wow, look, they go to work and they have a smile on their face and they're loving what they do. And at that point, like that, that's just so awesome. And I came back and told my wife all about it. And uh, so, and then it kind of just, Hey, that sounds great, but now I need to go back to work
Maryal Concepcion, MD:and. In your bio, it was mentioned that by the next year, the second time you attended Summit, you were like, I have all the things that I need to just keep the ball rolling and I'm gonna do this. So I'm wondering if you can bring us back to that moment in time when you're prepared with a lot of stories, a lot of inspiration, and a lot of enthusiasm and a a, a glimpse as to another way to practice, and then you spent the next year, what was going on in that year as you were preparing for the next summit.
Jason Hoke, DO:Sure. So, that next year was full of a lot of things. So I I continued to work with my health network. I was still in that mo mode of I can make things better, we can do this better. And then it became obvious to me that it was not improving. And I had a patient encounter that really solidified for me. How broken the system is, and, and briefly it was, I was dealing with a teenage girl who was in my office. Horrible, horrible otitis media, which is an ear infection, and to the point where it looked like the eardrum was getting to Rup ready to rupture. So I talked to the mom about, the best option here would be to give her a shot of Efen. Give her that quick antibody, give her that quick improvement so that way we can, get her some relief. And the, this family was cash pay. And so I went to my receptionist and said, Hey I want to go ahead and give them a shot of reception. They're asking how much this would be. And she said, that's gonna be$160 for that injection, plus the injection fee. And I said, okay, well wait. Remember they, they're cash pay. And she said, well, unfortunately, the network only gives a cash pay discount for the office visits, but not for procedures. Which again, I thought was so bogus. And I said, well, hang on a second. Let me make a quick phone call over to the pharmacy and we'll just find out how much a vial of efen is. You go pick it up, bring it back, and we'll just give you the shot. So I called over to the pharmacy. The efen injection would've been$10 for the vial, but we don't have it in stock. We'd have to order it, it won't be here till tomorrow. And so mom is left with this heartbreaking situation. Do I let my daughter suffer for another day? Or do we just go ahead and pay the 160, 170 bucks and do this shot here in the office? And she chose to go ahead and give the shot for 170 bucks. And at that point, I realized that this is so unethical for our patients that they're having to make this decision on a medication that costs 10 bucks. So by the way, now we give her seven shots in my office and it costs$8. So, I went home that day and told my wife about that, and I said, I, I look in the mirror now. And I said, I hate my job. This, this is, it's gotten to the point where I just truly hate my job because I just feel like I'm being pulled between what's right for my patients and what's right for the network. And so, I then, and that was shortly before I went to the second DPC conference and got more and more information, got more and more excited. But again, I'm feeling anxious and nervous about the situation. I mean, at the time I. Was 44, 45 years of age. Six kids, I've got a couple that are coming up on high school and that's college. In a network you have good health insurance, you've got retirement. And all of these things are going through my mind as far as can I make this leap at such a big stage. And on the last day that I was at the conference, I'm sitting there at, at lunch getting ready to leave and I, and I order my sandwich and get a drink And I got this bottle of tea and on the bottle of tea was a saying. And I still have it on my website'cause it's so inspirational to me. And it said to dare is to lose one's footing momentarily. Not to dare is to lose oneself. And that was said by Kierkegaard And I just look at this, say, this is a sign that it is time to stop talk, stop talking about it and actually take that step forward because I am losing myself. In this medicine practice that I'm in. And so, at that time then we said, this is what we're gonna do. We sat the kids down. I said, as we said, we have six kids and we had what's become affectionately known as the beans and rice talk. And so this was in August of 2018 and said, kids, we gotta save some money. So as a family, we said, we're gonna eat beans and rice and eat peanut butter sandwiches for the next several months. We're not going out, not doing anything fun'cause we have to save up some money so dad can make this transition. And then five months later, in January of 19, I opened my practice.
Maryal Concepcion, MD:All I can say is how effing resilient I am. So oh my God, I am so moved by that, that. Just serendipity if that's what was on your tea.'cause it's like, how many snapples have I had in my lifetime? And not ever have I been as inspired as I was with your tea label, but, or your tea saying. But if that is not resilience and if that is not, showing your kids vulnerability, if that's not showing your kids, this is standing up for what's right. I mean, that is so powerful. It is so powerful. Everything that you did. But also it sucks. It sucks to go through those moments when you're, you're still the same doctor. You're trying to do your best and the system is not allowing you to not have those moments and that just take care of patients. So I, so going from there, this moment of the beans and rice talk, I feel that need, need, that needs to be put on a t-shirt I would buy that. The, the moment of. You're done with the beans and rice talk, your family's backing you, you are making the next step. What was that next step for you?
Jason Hoke, DO:Sure. So, that decision was made in August of 18. And I met with the physician liaison at my network and said, you need a 90 day notice. I'll give you a little bit longer. But here's what I'm doing now. Thankfully, when I made the transition from private practice to network, and I would encourage any physician who's gonna be having a cut track to put this in there, is they wanted to have a open peak clause. And I said, well, I'm fine with the no clause. I won't go ever leave and go to one of your competitors, but you have to let me have the opportunity to go back into private practice if I feel this isn't working. And so that one sentence in allowed me to break my contract with them and open a practice, a DPC practice just a few blocks from my old office. And so, during the next four months, we diligently did anything and everything to build up the practice to get advertising out there. And we held three community events because nobody in Oxford knew what direct primary care was. They were held at a local church and we had about 50 attendees at each of those community talks. And so by the time I started my practice in January of 19, I already had two patients already on 200 patients already on the schedule in January and February. So that way I could start off with having a full schedule ready to go.
Maryal Concepcion, MD:I'm wondering if you had the anti beans and rice talk at that point, because that's a lot of patients and I mean, it's incredible to think about August to January, February and to have 200 patients in that amount of time. I'm wondering if you could tell us what your patients said to you when you were doing these talks and the patients in particular who were part of that 200.
Jason Hoke, DO:Sure. So I'll start off with the one that is, is still fresh in my mind'cause it's kind of funny. I had one patient of mine at my previous practice when I told him what I was doing, he said, Hey, that all sounds fine and good, but when you're over with that fad and come on back here, I'll be happy to rejoin you. So that patient did not follow me to my new practice'cause this was not a fad. I knew that I was making a decision that was gonna be for the best long term. Yes. So when I gave these community talks just lots of people just I mean, glued to what I was saying, like they'd never heard of such a thing. Like we're going, I basically said we are going back to old style, small town family medicine. With the 21st century technology, we're gonna have computers, electronic records, you're gonna be able to reach your physician by phone, by email, by text. We're gonna have the secure portal and all of these things that you expect from big hospital networks. We can do this at a small office. And that return of that personal connection, a lot of my patients had been with me for 10, 15 years and they saw the transition. I had many patients pull me aside and said, Dr. Hook, I saw you were getting worn down. I saw the heaviness in your eyes. You did not have that same flare and energy that you had years ago when I first started seeing you. And they also got tired of having to wait two weeks to get in to see me, which I would be upset if it took that long to see my doctor as well. So they were excited about this opportunity to kind of regain the old Dr. Ho and have that interaction again.
Maryal Concepcion, MD:I think that's so cool though. I mean, it really speaks to the relationship that people want in DPC because especially, to, to hang with you through your different iterations of practice. I think that is awesome. And I think that that is truly one of the things that drew me into family medicine is that generational aspect of taking care of a person through their lifestyle, their through their life transitions. Mm-hmm. So that's, that's incredible. And you also open, as you, as you mentioned, you're on a bordering town between Indiana and Ohio. Tell us more about Oxford in particular because it is a small, small college town, but what does that mean in terms of like population and resources?
Jason Hoke, DO:Sure. So Oxford is probably a town of 16 to 18,000 if you consider the greater Oxford area, if there is such a thing. And when Miami University's in session, the town essentially doubles in population very. Large rural community lots of farmers. So it's fun because I get the full gamut of experiences as a physician. I am taking care of for lack of better terms, uneducated farmers. I'm taking care of college students, I'm taking care of college professors, taking care of small business owners here in town. So it's neat'cause I truly get the full experience. I mean, obviously birth to death the whole gamut as far as the age ages go as well. So, yeah.
Maryal Concepcion, MD:And when it comes to this group of 200 fine, amazing individuals who are like, yep, Dr. Ho is still my doctor, or Dr. Ho is gonna be my doctor going forward, how did you handle 200 people and onboarding those people to your practice?
Jason Hoke, DO:Sure. So we were fortunate enough to find a really good electronic record system that allowed patients to kind of just register and get their information in online. I started the practice with just one assistant. And we were really nervous about starting on day one with just one person and just out of the blue, a Miami pre-med student said, Hey I'm interested in learning more about this DPC thing. Do you, could you use some help at the front desk? And I could kind of learn from you, but I could, you could use my services for answering the phone. And we're like, hallelujah. That's an answer to prayer. And so he was with us for the first five to six weeks until he had to start back to classes. And that gave us time to then do some interviews and hire a, a second person so we could uh, run the office because we were very quickly busy. I mean, I look back at my first month in practice in January and seeing seven and eight new patients a day. When you spend 45 minutes to an hour with every new patient, I was full. And and the word got out and people were telling their friends. And next thing you know, within, I think by October of that first year, so in 10 months I had reached my capacity. My practice was essentially full at around 700 patients. So once people heard about it and saw that it wasn't just a fad and I was here to stay it very quickly grew.
Maryal Concepcion, MD:That's incredible. And I think it's also amazing that, you have this tea phrase and tea bottle phrase, and then you're like, yeah, this is this is a sign. And then all of a sudden you have this Florida medical student who's like, hello. That's incredible. Because you're, balancing the entrepreneur hat of hello, I'm Dr. Hoke, I'm also Dr. Hoke, who, is like doing software things on my EHR and I'm doing all of these things as, as the, the sole business owner. How did you make it such that the student was able to help you with your daily things, help with the practice itself as you were building it?
Jason Hoke, DO:Sure. So thankfully my assistant was a registered nurse who I'd known for years, very, very. Organized almost to the point of OCD, but very, very organized. And so during the time that I was seeing a patient, she was helping him to understand this is why we do what we do. This is how you do things efficiently. And to help to, to do that. Telling him what to say on the phone as far as encouraging patients and answering questions. And the student was a very. Very much a go-getter. Very it savvy. So he handled a lot of things as far as with the website and things like that, that, at my age, in my forties, like I just don't even know how to do some of this. So anything you can do to help me with is, is awesome. And then he really, really saw the, the benefit of DPC and he remained enthusiastic about it. And kind of just a fun little aside, Mario, that same student is coming back this fall as a fourth year med student to do a family practice elective with me. Specifically learning more about how to run a DPC practice.
Maryal Concepcion, MD:How awesome. I absolutely love that. That is the best ever to hear the, it's so full scope right there. That is amazing. And, I, I wonder where is he intending to practice? Is he intending to prac practice in Oxford, Ohio by chance?
Jason Hoke, DO:I don't know. He still has to do his residency yet. I guess we'll talk then.
Maryal Concepcion, MD:When he hears this, I, yes. That was a very loaded question and yes, that was a very loaded question. So, awesome. So you are in this town of, as you said, and that's I, I know that feeling like I went to uc, Davis and Davis at the time. It's crazy all the time now, but at the time it was like, wow. When school is not in session, it's a totally different, it's a totally different experience for you. How has your practice grown? Especially because you have college students who do need healthcare and student healthcare is not always the best.
Jason Hoke, DO:So, students are, are, are, are probably a minority in our practice just because they are transient. But we do have, a a handful of students a lot of professors especially those who really understand the benefit of DPC. We actually have a wait list now of professors that are still willing to get in to see me. But as our practice grew we continued to have more and more phone calls to people coming, wanting to be seen. And like, guys, look, I, I have a cap at 700. I, I'm not gonna get myself back into the same situation before of just feeling overwhelmed and stretched too thin. And then over time, as we still had more and more phone calls, I said, well, it's probably time to look at adding on another clinician just so that way we can continue to provide good care to the area.
Maryal Concepcion, MD:And so Julie is your nurse practitioner and I'm wondering how did you guys connect? Because definitely it sounds like you need clinical help at your practice given those numbers.
Jason Hoke, DO:Yeah. So, kind of a fun backstory. Julie was one of my first nurses at my initial practice years ago. At the time she was an LPN and then she left the practice to go get her RN degree and had a very successful nursing career as an RN in one of the local hospitals. And then went on to get her nurse practitioner training and just out of the blue she called me saying, Hey, I need to do my family practice. Clerkship and so can I come to your office and do that? So I'm like, sure. And so we reconnected. Then when she is in her nurse practitioner training she gets her diploma, she goes to work for a network. Practice is in practice for about a year, and I'm like, at that time I'm looking for somebody. Trying to recruit a good physician, one that Marielle knows very well from the DPC on summit and who has been on the my DPC story? Dr. Andy Chun. So I, Andy Chun and I actually went to residency together, and so I knew he'd be a great fit for this practice, but, and Andy also has a very successful practice of his own. So in my attempts to try and recruit him my way for DPCI essentially encouraged him to start his own DPC practice. So that was, that's kind of a fun aside. But anyway, so as I'm going through this and looking all, all these different options, my mind keeps going back to this great connection I've had with Julie over the course of 20 years. And so I just give her a call and say, Hey, Julie. Are you ready to leave the network and just come join me here and do DPC? And she's I have been waiting for this call. Thank you so much. And so she has come on and she's doing great. She has actually, this is her two year anniversary this month and she is up to 300 patients of her own right now.
Maryal Concepcion, MD:Wow. And when it comes to and I will make a note here definitely I will link Dr. Chen's blog and his interview to your blog. That's awesome. I love that story. When it comes to your patients your panel has grown, your panel has closed, to new patients because you're maintaining that quality of care for the patients you do have. how was it for patients who were on the waiting list to join, to join Julie? Did they, did, was, was there any question about, well, if I'm not seeing Dr. Hoke, is it a different price? If I'm not seeing Dr. Hoke for my day-to-day, do I still have access to Dr. Hoke if, if needed, because he's there? How did patients come on from that wait list to Julie's practice?
Jason Hoke, DO:Sure. So, when the wait list, we opened it up, we, we called those patients and said, here's the situation. Dr. Ho is full, but he has brought on Julie, who we have great confidence in, and she's got, she's experienced and she's gonna is open to taking new patients. Probably about a third of the people that we talked to came on with Julie. A third said, go ahead and keep me on the wait list. I'll wait for Dr. Hoke. And then the other third said, well, we have already went on and found another provider. Because that wait list was probably there for a good two years. So as far as the, the care, we never really received much pushback as far as keeping the pricing the same for patients, whether regardless of whether they're seeing Julie or seeing me. And the reason for, that's actually pretty simple in that if they're seeing Julie, they're essentially getting two for the price of one, because Julie and I have the same office hours. Our desks are right next to each other. And just like any good medical system where the providers trust each other, we're talking to each other throughout the day as far as, hey, just bouncing an idea off of each other. So it is not a problem for Julie to come out of a patient exam room. I'm sitting working on a chart and she'll come over and just ask me, Hey, what do you think about this? And the neat thing about it is I want her to do that. Nurse practitioners the really, really good nurse practitioners know what their limits are and they're not afraid to ask questions, and they are worth their weight in gold. And that is definitely Julie Green. She, she'll come to me, she'll ask me questions, we'll talk about it, think through what's the best option for the patient. But if there's ever any question, I just get up from my desk and go in and talk to the patient myself.
Maryal Concepcion, MD:That's awesome, and I appreciate you sharing that because that has been a question that I've gotten from many people. Like If I add a non-physician provider, does the price change? So I'm, I, I appreciate you sharing what's happened at your practice now when it comes to now when it comes to the back office side of things, your, with your patients, a significant number of patients there already, and then you're adding people from a wait list and you are, building a team. It's growing. I mean, it's definitely grown. It's very even family oriented with your son as well Now, let's start by talking about how it's grown in terms of personnel, and then I wanna talk more about the, the, the back office to help keep everything copacetic for your patients and you guys.
Jason Hoke, DO:Sure. So, Monday is, is our busiest day as many offices have with coming off of the weekend. And so we have, Julie and I are here. We each have a assistant working with us, and then we have one receptionist up front. And then every other day of the week, Tuesday through Friday, it's typically just one assistant in the back and one receptionist up front. And that works out fine. And the reason is because we can be efficient. Our patients understand that we run a lean office. And the other thing is that Julie and I don't mind stepping in and filling in wherever's needed if. The phone is ringing and the receptionist is on the phone, and a nurse is in with a patient. Julie and I have no problems picking up the phone, and of course patients are shocked when they say, wait, is this Dr. Hope? Just. Am I actually talking to Dr. Ho? Yeah, I can answer a phone too. I'm not above doing that. And so, so we each pitch and do what needs to be done. There's been times when the nurse is on vacation or is out sick. I've given injections. The only thing I can't do, and I don't think my patients want me to even try is draw blood. I I have to draw the line somewhere. So, but yes, so it, it's great because even though we have people kind of assigned a task or a duty for the day, we just all fill in wherever it's needed and it works out great.
Maryal Concepcion, MD:That's awesome. And yeah, I, I love those conversations when you're the doctor talking and they're like, yeah, so can you please make sure that you give Doctor conception the message? And I'm like, absolutely, thank you so much. Have a good day. So it's like, oh boy. But that, that is so funny and very relatable, I'm sure from many out there. When, so. So thank you. That's, that's great. In terms of how you guys organize your week, in terms of the tech and just things to organize you guys on the backend and keep everybody copacetic and on the same page. Tell us about how you created your tech stack. Because you mentioned your electronic health record, you started off with that. It allowed you to really quickly and efficiently onboard those first 200, but how have you built your tech stack beyond that?
Jason Hoke, DO:Sure. So we we're still using the same electronic record that we started with. We took the ability to register for, as a new patient off of the online segment because we wanted to have the ability to answer questions directly with patients. And that's something that actually is so unique these days. Most of that time when patients call a doctor's office, they get that endless phone tree. And so. People are shocked when they call this office and somebody actually answers the phone. So, so we, we can continue with that. It has a nice portal system so patients can message us through the portal which is basically a confidential email that helps to cut down on the number of phone calls and also it actually allows for a more accurate description of what's going on.'cause it's in the patient's words. And it's actually a part of the medical record now too. We have the ability to do texting which is great for when we just need a real quick yes no kind of answer. Just boom, send them the quick text. The texting has on the display it has our office phone number so that way patients know where it's coming from. And also that's good as a provider to have confidentiality that they don't know what our own personal phone number is. And then we can use that same texting option in the evening if we're logged into our computer system. We have, we do labs in the office. We, we use a, a national lab provider that that runs our labs. We have a direct interface into the charting system, so that way we get results the very next day. And that's very quick and efficient because it's the interface. We do scan in paper documents and we do mostly anything that you'd see at a typical family practice office. We do EKGs we do your urine tests. We do strep tests, the flu tests. Pretty much we love doing skin procedures, lesion, removals, things like that. So yeah, full gamut of family practice.
Maryal Concepcion, MD:I love it. And any best tips for other people as they're developing their tech stack? Because they think about especially with so many people in your practice, patient-wise, automations and ways to maximize the tech you already have are really helpful to anybody no matter how many years they've been open.
Jason Hoke, DO:Sure. So, one thing I would say, and, and this might be unique to our practice, but we try to find something to provide value to the DPC monthly membership. So with having the labs, which of course are deeply discounted compared to standard lab prices, we also have a small pharmacy. So we have your common antibiotics, high blood pressure meds, diabetic meds, antidepressants, things of that nature. So one of the things that was important to me is I did not want to ever have to be in a situation where I would have to figure out whose fault is it when this interface doesn't work? And so I searched. Really hard to find a electronic record system that could do our EMR, do our scheduling, do our billing, do the and do the pharmacy dispensing. And so thankfully I found one that has worked well for us from the get go and I see no reason for us to change because the program just continues to improve. And so, yeah, that was a big thing to me, Muriel, is I did not want to get stuck in a phone call conversation argument between two tech folks saying it's the other person's fault. This way I can just call one company, say it's not working, and they fix it.
Maryal Concepcion, MD:And I hope that that is helpful for people as they're looking at EHRs or looking to switch EHRs if they're not happy with their current one. When it comes to ways that you guys have personalized your messaging, do you, say that there's like new guidelines that come out on treating something or there's, somebody has called out like, oh, this, this saved phrase, phrase, macro could be improved upon. How do you guys reevaluate the day-to-day operations to say like, okay, yeah, here's something we could make an improvement on, let's change it.
Jason Hoke, DO:Well, one of the advantages with being a small office is that we just talk about it, and if we want it change, we change it. I'll just say, Hey Julie, what do you think about this? And if she likes it, we we can make the change. Yeah. Yeah. Actually, I mean, that's a great question. Our EMR is very user friendly as far as being able to individualize and customize things on it.
Maryal Concepcion, MD:going back to the patients who wanted Dr. Hoke and followed you throughout your different iterations of practice, and then you're open and, it's years later and they've been your patients, what, what are some of the things that you've heard from these people or just anybody at your practice in terms of how DPC is valued by them as the recipients of your care?
Jason Hoke, DO:it's actually been quite humbling now that you mention it. We, we have like many practices that are growing and trying to get the word out there. You take reviews. So we have right at our checkout desk, a a little scan thing that takes you right to our review page so that way patients can leave a review. And the, the one, the, the, the reviews that are most humbling to me are the folks I've known for. 20 years that have, like you said, followed me through thick and thin and to to hear them all say, this is the best thing that could have ever happened to Dr. Hoke. Or this is the best thing that could have ever happened to his practice. Or This is the best thing that's ever happened to me as a patient in this practice. Because they'll talk about that personalized care. And just how it really is the way it should be. I mean, our little catchphrase here at our office is medicine simplified because it really is, we're getting back to a simpler form where it's not so complicated, unnecessarily complicated. And our patients see that and they know that when they talk, we're listening and we're not just trying to run them through the mill. So
Maryal Concepcion, MD:that's so powerful, especially. Given, how frustrated you were with that fin example that you gave and also just the, the doctor in, even in that same example, calling the pharmacy to ask how much does this cost cash pay? Like I never would have asked that as a fee for service physician. I didn't even know that paying cash was an option except for GoodRx. So like calling the pharmacy and figuring out cash price for anything other than here's a GoodRx card, figure it out yourself was, was foreign to me. So I think that's amazing and it's, it's very cool to see your patients experiencing that this also is not a fad for you and your practice.
Jason Hoke, DO:Right.
Maryal Concepcion, MD:in terms of challenges, I would love to go there because as, as we work very diligently to deliver on our promise to our patients and our promise to affordable, accessible, quality, primary care. I'm wondering what challenges have you guys gone through over the years that you really want listeners to hear about?
Jason Hoke, DO:Sure. Great question. Because, when we go to DPC summits, we talk about all the awesome reasons why we should do this and, and those are all very valid. But, it is work. I mean, we're talking about, I, I am the physician, but I'm also the office manager. We run lean and mean, and I know how to do basic accounting. I know how to write a check for a bill. I mean, those are things I don't need to pay an office manager to do. So I have to, set aside time to, to do that. So for example, I work on Fridays a half day and then seeing patients, and then usually Friday afternoon I'm doing that administrative side of things. But that took some time to, to get used to, to kind of develop a a routine for and there's times when, you know you, you do get busy in the office, I do have 700 patients. I practice very similar to how I did when I initially opened my private practice. Which means that there's days when I'm gonna be very busy even though I may only have 12 patients on the schedule or 10 patients on the schedule. There's, there's a ton of, I. Portal messages and phone calls and message to return. So there's so still sometimes you have to work out that balance. But in the end, even my, my worst day busiest day here is still a, a fraction of what it was in my previous practice. So there's, there is that challenge. The other challenge is sometimes butting heads with insurances because patients need an MRI, I still want to give them coverage. I mean, if, if, if their insurance will cover it, we wanna do that prior approval. And then the insurances will be like, well, we don't see you in our system. That's because I'm not in your network. So that, that can be frustrating. And the PAs for medications like every physician has to deal with. But and the other part of it that we run into, probably the biggest frustration we have is we are not on the large, MR that pretty much every health system is on. That epically big one that seems to be in every hospital. And so we call an office and say, can you please send over your consult letter? And they'll say, well, it's on the EMR, just get on and look at it. No, just can you please fax it to us? We are an independent office. And that's probably the biggest frustration and challenge we run to because we know we miss some data in that respect. But our patients are also well educated.'cause we tell them, when you see a specialist, follow up with us, make sure we actually get that consult note. If you get labs done by a specialist, we us know and we'll track it down because they know that we, we mean what we say. If we say, if we say, we'll track it down, we'll get it for'em. And so it, that takes a little bit of time, but that's okay. I, I would rather have that stress and frustration than deal with the stress and frustration of feeling like I was being asked to practice unethically.
Maryal Concepcion, MD:Love it. And on the opposite side of things, when it comes to only because of DPC, you could have done X, Y, or Z. can you give us some more examples from your patients about how you as an accessible, affordable, quality physician, were able to give them something that they, it's hard to put a price on.
Jason Hoke, DO:Mm-hmm. So, I, I can give you two really good examples. The first one might take a little while to explain, but it, it really resonated for me that DPC is the best medicine. I started my practice in January of 19. I think we all remember what happened at the end of 2019, beginning of 2020, come February, 2020 when we're shutting down the country. And I'm seeing. People are basically isolating and not allowed to go into doctor's offices. I had a tremendous amount of time where I was able to do some research on what was going on with COVID. And I started sending out newsletters to my patients every month. They were getting a newsletter and update from me as far as what to watch for with COVID and to to, to, how to stay safe. And just really being active and involved and telling patients at the first time your symptoms call me. I may not be in the office because we went down to seeing patients just two or three days a week. We saw patients in the parking lot actually. Which I know probably would've been severely frowned upon if we were in a network. But we did what we needed to do and I had a conversation with my staff. I said, we're gonna do what we need to do, take care of our patients. Are you comfortable with that? And they all were, as long as we were outside and in a well ventilated area. So we did it. And I am very proud to say that of those 700 patients, I, I did not have a single patient die from COVID during that time. Now, and that's not because I'm taking care of young, healthy patients. I mean, I had 80 year olds. I had folks who we sent them to do the monoclonal antibody infusions. And why, because I knew about it. I had time to research it. And because I'm not part of the health network, I could go to any hospital system in the area and say, go get what you need. I can only imagine if I was in a health network and they said, well, you can only send your patients to us and we're all out, or we're all booked up. So that very much solidified for me very early in this practice that DPC was the best way because I knew I could take the best care of my patients. So that was COVID. The other, the more fun one that I've been able to do is I love procedures. I love doing stitches. And in my old practice, because you're double booked and patients can't see you for two weeks, if they cut themselves during the middle of the day, I like, I'm sorry, you have to go to the ER in urgent care. No, no, come on in here. We love this. During COVID, I actually had a guy who, like many other PO folks during COVID, was doing some house remodeling and landscaping, and he pulled out the chainsaw and it kicked back and it left a nice big gash in his leg. And so, we met at the office and I stitched him up. I've had guys who were hunting. I mean, one of my favorite stories is a hunter who accidentally cut himself with his hunting knife. And I met him out at our, at my house. He sat on the back of his pickup truck and I went ahead and stitched him. And I told him, I said, look, I've done mission work where we're out in the, the boondocks and you don't have an operating room in a sterile environment. There's nothing wrong with doing stitches outside. We had all the clean supplies and everything. We did that. And then there's been countless times where it's in the evening and a kid needs stitches. And I just tell'em, come on over the house. And we bring'em in, lay'em down the kitchen table and my kids gather around.'cause I think it's so cool to watch Dad stitch. And so, yeah, so that, that's something fun that I would've never been able to do before.
Maryal Concepcion, MD:I love that. And it makes you think about Dr. Lauren Hughes, who's a pediatrician in Kansas City. She'll, she has, has mentioned like, yeah, I'm taking care of the kids, but come on, I'll check out in the driveway and then drive away. Here's your, here's your solution. Bye. Take care. Gimme an update later. I, I just, it's, it's fantastic and I just, it, it makes you wanna ask because your son is on your website. You, you mentioned how your kids are like fascinated by what you do and I think again, it is awesome that they saw this, this, this dad of theirs going from physician to physician, entrepreneur after the beans and rice talk to bring in the patients into your guys' home if needed. How, how has it affected your family, especially your son who is going into healthcare himself?
Jason Hoke, DO:So I have my, my, I have three older boys who are 16, 18, and 21. And then my girls are all 11 years old. My boys, when they saw me at my old practice, they had said, there's no way I will ever be a doctor. A dad spends too much time every evening. I mean, at that time it was two to three hours every night, catching up on charts, messages, things like that. That's it. There is no way I'll be a doctor. And now all three of them are going into healthcare. My oldest actually was starting chiropractor school this fall with the hope to come back here to Oxford, and he wants to be here in this office as a chiropractor with me. My second son starts college this fall as a pre-med major. With the goal of, he tells people he's gonna take over my practice. I said, how about you just join me first and then we'll see what happens. And then just last week, my third son who just finished his sophomore year of high school said, I really think I wanna go pre-med Dad. And again, that's a conversation that would've never, ever happened six years ago. And I think about, the I, I think about how your kids are seeing healthcare as generations did long ago. It's so fascinating to hear over and over stories like you shared, people who are of a community and they might, they usually are older, saying things like, wow, this is innovative healthcare. And it's I know that I say that in the intro to my DPC story, but really it's old school medicine. This is fantastic and I love that your kids get to see this because, but, but I think also, I think about. Overextended never ended. Family medicine is also not how it has to be. Like you get to choose what you want to do within your DPC and you get to determine 700 is where I stop, I'm gonna bring on another person. You don't have to just keep, keep, keep going. You don't have to keep going, keep going, keep going. And I think that it's, it's really speaking to the younger generation, really wanting to have a work-life balance. Especially since we saw what life could be like during the pandemic, if you were fired from your job and you weren't necessarily needing to do the, the day-to-day eight to five. in closing for our main interview, definitely join us over on our Patreon conversation, but. I, I would love if you could speak to the physician who is at the is at or approaching a similar point to where you were, where you were thinking about, wow, this might be the time that I need to leave medicine. And what would you say to that physician to, to give them, to give them words to think about after hearing your interview? from my standpoint with talking with physicians since I've made this transition, I think any physician that's been in practice for 10 years, we'll just say that they have got enough of a loyal patient following that they will be able to make the transition successfully because patients know good medicine when they see it. You don't need to fill out metrics and have patient surveys and all the meaningful use stuff that we did years ago. Patients know what a good doctor is. And when you take a stand and say, I'm not going to continue to, to play in this false sense of reality that I think network medicine is, is these days and they see that you're willing to take a stand for what's best for their patients, they will follow you. They will.
Maryal Concepcion, MD:Well, thank you so much Dr. Ho, for joining us today and sharing your story. I'm so excited for everything that's going to happen in the future. And again, I wonder if your medical student is going to be coming to Oxford, Ohio when he finishes.
Jason Hoke, DO:Thank you so much. I wonder too.
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.
