Opening North Dakota’s First Direct Primary Care Practice: Lessons from a DPC Trailblazer with Dr. Kristine Martens

In this episode of the My DPC Story Podcast, host Dr. Maryal Concepcion interviews Dr. Kristine Martens, co-founder of Resurgent Health, the VERY FIRST Direct Primary Care (DPC) clinic in North Dakota. Dr. Martens shares her inspiring journey from traditional insurance-based practice to launching a trailblazing DPC clinic in Fargo with her business partner, highlighting the challenges and triumphs of being a DPC pioneer in her state. The conversation covers starting a business from scratch, navigating collaborative practice with Alyson Dahl, PA, building a patient-centered practice, staffing choices, and integrating unique services like OMT and aesthetics. Dr. Martens also discusses patient education, working with employer groups, and importance of community relationships. Whether you're a physician considering the DPC model or a patient seeking more personalized care, this episode offers invaluable insights into building sustainable, relationship-driven healthcare in underserved regions. Listen in for firsthand advice on overcoming fears, finding business partners, and rekindling the passion for medicine through Direct Primary Care.

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Transcript

Maryal Concepcion MD: 1:16

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.

Kristine Martens, DO: 2:05

DPC has helped me get back to. The reason why I went into medicine in the first place I was losing my love for taking care of people. And this has really ignited that for me again and made everything really exciting again. I'm Dr. Christine Martins of Resurgent Health, and this is my DPC story.

Maryal Concepcion MD: 2:34

Dr. Christine Martens was raised in a single parent household in Billings, Montana, where she learned the value of resilience and hard work early on. She earned her undergraduate degree from Concordia College in Moorhead, Minnesota, and went on to complete her medical education at Nova Southeastern University College of Osteopathic Medicine in Fort Lauderdale, Florida. She then pursued specialty training in family medicine at the Rapid City Regional Hospital Residency Program in South Dakota, completing her residency in 2013. Before returning to Fargo, North Dakota where she has practiced full scope family medicine ever since. Throughout her career, Dr. Martens has remained deeply committed to building meaningful, trusting relationships with her patients time and again. She has heard patients express frustration at feeling rushed or unheard in traditional healthcare settings. Determined to change that narrative, she helped launch the family medicine residency program in Fargo in 2017. There she had the unique opportunity to shape a new generation of physicians, not only by teaching clinical excellence, but by emphasizing the heart of medicine, human connection, empathy, and the power of truly listening. After the inaugural class graduated in 2020, Dr. Martens returned to full-time patient care where she feels most at home by her patient's side. Outside the clinic, Dr. Martens is happiest with her family. She loves supporting her husband as he plays guitar around town, whether it's classical, jazz, or electric with a full band. And is always his biggest fan whenever she gets the chance to cheer him on. These days, she spends much of her time with her two children, juggling soccer and dance practices, and savoring every minute of the beautiful chaos that comes with being a mom. Welcome to the podcast Dr. Martins. Thank you for having me. So if you did not know already by all of the, excitement in my voice that we are able to bring Dr. Martin's and her voice from North Dakota coming onto the podcast today. I'm so excited because you are delivering an example of what you're doing in a state where we do not have representation before you coming on. So I'm super excited to have this conversation today.

Kristine Martens, DO: 4:39

Me too.

Maryal Concepcion MD: 4:41

Jumping in there, you and your partner created the very first DPC in North Dakota. And I'm wondering in general, just what, what are the takeaways in terms of the feelings that you've had being a trailblazer in your state? honestly, there've been, it's like a, been a rollercoaster I guess. There, it started out really, really high, right? Like we had a bunch of patients that were with us previously that sort of just kind of jumped over with us. So we started out doing really, really good with a bunch of patients and everybody was so excited. And then because we started out clinically like kind of full force, there wasn't a whole lot of learning how to actually run a business. That happened in the very beginning. So then, there's the lows of like, wow, like no one has signed up in three months. This is no good. Like, so financially it's a huge change for me. But then as soon as you talk to a, a patient or like get a new family, it's like, I don't know, you raise back up the high, high of the rollercoaster again. So, yeah,

Kristine Martens, DO: 5:48

it's been up and down

Maryal Concepcion MD: 5:50

and I appreciate that honesty and that vulnerability because I think that it, there's so many ways that a person can ride that rollercoaster because the rollercoaster is different depending on a person's locale in terms of a person's state, and you have a state with zero DPCs opening your guys' clinic. So, I mean, that's fantastic to hear that there was so, so much excitement. Going into the opening time especially of, of your clinic. can you tell the audience when did you guys officially open your doors?

Kristine Martens, DO: 6:17

we say that our official opening was June 17th. It's funny because, so we, like, we left a previous position on May 15th, and then I had a one, one of my patients sign up on like May 28th because they needed medications or whatever. We were just like continuing care. So technically, I guess that was the first member, although we didn't have, like, they couldn't come to the. The clinic, the clinic wasn't open that we didn't have an exam room or anything like that, like set up. So, but June 17th is sort of the day that we say that this is like our hard opening for, for anniversary purposes and celebration purposes.

Maryal Concepcion MD: 6:56

Absolutely. And I love that there's so much momentum already, as, as you shared it, it may have been earlier on fine, but at the same time I know that a lot of momentum goes unspoken and unadvertised on TV interviews and newspaper interviews, whatnot. When you're seeing more patients in your clinic, you're making a bigger impact in your community. So let's go back to your journey, before that person signed up in May and before you opened your doors in June, because I think that this is really, important for people to hear, especially given that you have the history that you do, and yet you, you pursued opening a direct primary care clinic and Fargo, you've trained in, all over the country like many of our guests, and yet you eventually went to residency in South Dakota and then went up north to open it again in Fargo. So mm-hmm. Tell us about your journey in education to become a family physician. I'm just wondering, what was it that put your, your sights on even residency in the Dakotas after you finished medical school?

Kristine Martens, DO: 8:01

Sure. So it's funny, I think I just. As a small child, always just said I wanted to be a doctor when I grew up. And then, when I went to college here in Fargo at Concordia in Moorhead, Minnesota, and it was like maybe my sophomore, junior year or so where I kind of wondered if that was just me saying that or if I actually wanted to do it. So I took like a, I call it my midlife crisis when I was what, 20 years old. And thought, well, what else would I wanna do? And CSI was cool. So I was like, well, maybe I'll be a forensic scientist. And then I realized I was needing to go to school for longer. I loved school a lot. And then I was, I don't know, I just came to the decision that no, that is actually what I wanna do when I talk to people and help people and know people, I guess. I learned about do school there, like when I was taking the Kaplan courses to study for the mcat, right? And so I'd never heard about them either. They're not huge around this area. And it just seemed more like me. It was more holistic. And so I went for it because I couldn't afford to apply to both types of schools. I just picked the one like the do route and, and did that. And that's sort of how I ended up in Fort Lauderdale, at Nova down there. And then honestly, so in med school was a different, like the way that the training was down there, I. Super did not like ob. Like all of the OB doctors just seemed to just do the surgeries and it was like midwives and stuff that were doing that fun deliveries. So I thought, I'm gonna be med peds, like that's what I'm gonna do. So I actually applied to bunch of med peds residencies and ended up ha scrambling into a family medicine residency back when we had, it was an actual anxiety ridden scramble. So that's how I ended up in Rapid City and thank goodness for that. Like things happened for a reason. But I like fell in love with obstetrics there as well, which was what I was trying to avoid the whole time, which is hilarious. But I don't know. The residency there had a lot of dos. So even though it was an MD residency, there was an osteopathic preceptor and we had an OMT clinic and so we've got to continue like our skills and stuff, during residency. I met my husband actually on vacation during my fourth year of med school. And so then we just decided to have a long distance relationship for a year and then he like moved to South Dakota when I went to residency. So it was a huge leap of faith. But like he is the reason, one of the biggest reasons that we ended up back in Fargo,'cause he wanted to do his like master's in. He's a guitar player, so he did his master's in classical guitar at NDSU here. So then I knew I was gonna come here, so I just applied for the two main big hospitals that are in town. Basically told them I'm moving here, so I hope that one of them gives me a job. Yeah. And so then that's how I, that's how I ended up back in Fargo. I was doing deliveries in like, the whole scope, like when I moved here and I feel like just over time, I don't know if it was like EMR and just all of the after clinic work that just started getting to be more and more, and I don't know if like my paranoia or like my incessant need to know everything about everybody was just like getting worse and worse or something that it just felt like over, eight years or whatever. At that point it was harder. I'm like, isn't this supposed to get easier? Like I was just working longer. So I made a lots of different changes thinking, oh, I just need a fresh start. So I would, I at one point cut out deliveries. And, but it was nice here'cause they allowed me to still keep my newborn nursery privileges and so I did all of the prenatal care for my patients and then would transfer them to a different family doctor to do the delivery. So they'd still get that benefit of like, knowing who's gonna deliver them. And then I would just go up when the baby was born. So it kind of kept me in the loop there, kept my practice young, which I liked. And then I, one of my colleagues started the residency here in Fargo. And she was like, so she sent out an email to the whole staff and I like deleted it, like, nah. And then she called me and was like, I think you'd be really great.'cause I was, I was like, really only what, three or four years maybe out of residency at that point. And she was like, I need someone who's close to residency.'cause she was like super far out from residency. Yeah. And so I started that with her and yeah. And did that for the first, I saw the first inaugural class graduate. And then even during that time I felt like I, I had to give up a lot of clinical time with my patients and it was extremely difficult for me. So it just felt like I was doing two full-time jobs and I, so I ended up going back to full-time, just clinical practice then again. And then after another couple of years, two, three years doing that, it started to feel the same. Just like, I don't know, like burnt out. Nobody was happy, patients could never get in. I could never see my patients for like, if they're actually sick or if they need to be seen. I mean, even within a month around here, if you call as a new patient, you can get an appointment with a family doctor in like nine months, maybe even if it's your own doctor three months out. So it was, it just got to be a lot. I had heard, I don't know, everyone's like, oh, it's better in, private practice, right? So I was doing the public service loan forgiveness, and so this, the, the system that I was working for qualified. So I was like, well, I'm here until this can get resolved or whatever. Forgiven. So that got forgiven in January of what year? What, two years ago or whatever. And then, or maybe it was three now, either way. So that was sort of my like, okay, now I can actually go and do something at that point, ally. So I had known Ally. I trained her when she was doing PA school. Like before I did the residency stuff, she had already left the, this. System and went to a, a private practice and was trying to get me to come over there. So I finally was like, okay, it's gonna be better. And there were lots of tears'cause I loved my colleagues and, so then I went over to private practice about two, that was two years ago. It was probably six months in when I really realized how doctors get paid by insurance. And like, I felt like I was doing a great job with my patients. I felt like I was at home with my family when I needed to be. I was able to answer messages'cause I wasn't like overwhelmed with, 20 to 30 patient appointments every day and or anything like that. And people could get in when they needed to. But then when you look at reimbursement and like how much you actually are getting paid, I mean, it wasn't sustainable for life for me. Totally. So luckily I had, a guarantee that year, but I knew it wasn't, I wasn't gonna be able to stay there. So I had heard about DPCA lot actually. A lot of family doctors will be online talking about burnout. And there's always someone who's like, you gotta start a DPC. So, and then Allie had been in the same situation, so she was the one who was like, I'm out. I'm doing this with or without you. And I'm like, oh gosh, I don't know. So we just decided it's this or I didn't know what else I would. What, what to do. It's like, go back to a system and be burnt out.'cause I couldn't financially support my family at the job I was at. And we finally were like, Nope, we're gonna do it. So then we, we started the first DPC in North Dakota. You did it. That's how I got here.

Maryal Concepcion MD: 16:13

I love it. I love it. So I, I wanna, I wanna dive into the Dr. Martins who was being approached to help this residency program get off the ground. Yeah.'cause I, you've spoken so much about even just access to care already, what it looks like, for your geographic location. And Fargo is not the entire state of North Dakota, so I'm sure that that definitely changes, right? The, the farther you get out from the city. But when it comes to the, the person who's three to four years outta residency, who's still very much like, because I feel that in three to four years, and even when you're in a, in a system, you're not as jaded as you could have as you as you are at six years or 10 years later. And so I'm wondering, if you can bring us back to that, Dr. Martins who was like, I am going to make an impact in the way that people are practicing as physicians in the pe in the way that people are focusing on relationship driven care as you did as, the, the person seeing patients on your own panel. Because I think that that also, I I, I wanna ask more about how that, if that. Dr. Martins in particular, if that person was, was changing as you were exploring private practice especially?

Kristine Martens, DO: 19:55

Yeah, no, well, so that Dr. Martins was definitely passionate about improving the physician patient relationship. I had a great relationship with my patients. I've always just been like a talker. I guess. Like at one point my patients knew to bring books. They knew they were gonna be waiting there because I've spending way too much time with the person before them. But I'll do the same thing because I genuinely just feel like that gives people better medical care when you actually know socially what's going on with them and like what's actually happening in their life, and it makes them trust you. So then they'll actually tell you when things are going on anyways. So like, even at that point there's people complaining about, such and such provider, doesn't listen this, whatever, lots of complaints, right? So I was like, I'm gonna teach doctors to be great doctors and like keep their passion there. Dr. Walker was the program director. She was like, I mean the, the passion that that woman has for just like. This community. She grew up here. She did the first residency when it was here. She, she was a big influencer in my, like, motivating me to actually come over and do it.'cause it's not that I didn't wanna do it, honestly. It was like I was four years outta residency. I was like, I don't know enough to, to be an associate program director of a, of a residency. Like, are you sure? So it was really just my own imposter syndrome probably. Or not feeling like I would be good enough for her to do a really great job. Like, I knew I wanted, I wanted doctors to be loved by their patients. Again, we just get such a bad name around this area. So, that was a, once she boosted my confidence, it was an easy switch and, and the residency was so much fun, like trying to figure out how to get them the best experiences and, and seeing them become better doctors than I ever was. Like, it just, it, it was amazing. It just was that my, my to my core, I missed, I missed my patients and I missed my family, never home. So,

Maryal Concepcion MD: 22:19

yeah. Two full-time jobs is a lot. And then you add being a mom on top of that, and that's, four jobs right there. So yeah. Yeah. I totally get it. And I'm wondering when you guys were creating this residency from the ground up, I'm wondering, did you, what was the acceptance like in your community? Because I think about, when I applied for residency, I wanna say 2011 or 2012. I, I, I was a winter grad, so I, it's a little off there, but the number of residencies has been, it's, it's so different now in California. And I'm wondering, as more residencies are being created, especially family practice residencies. Do you have any can you share with us your, your guys' journey in the community support and how maybe other residencies could lean into really making a great experience just like, as you you've described, to help these residents become amazing physicians?

Kristine Martens, DO: 23:14

Yeah, so it's interesting because like when I was applying. Well, and I had a sort of a different like route obviously, but you know, you look for those, the residencies that are unopposed, right? Like, you wanna be like the only residents that you can do all of the things. And this system already had like surgical residency, podiatry, psychiatry, internal medicine ortho, maybe ortho started when we, when we started, but there were still, there were already like tons of residents. So it wasn't a hard sell for the institution itself, obviously. And our community of patients, I guess are all very well aware of the residents in the hospital system. I think the biggest difference was trying to, I had to change my mindset even on like selling a, an an, an opposed residency and, and why it's actually amazing to like go and do trauma surgery with the trauma surgeons because then you're not gonna do it, but you're gonna know how to better inform your patient who might be doing that. Or like psychiatry. We got to have like a psychiatry resident or preceptor at our, the family medicine residency so that you have like sort of that specialist education for primary care. I think continuity was a new concept to the system because I don't, I don't, I shouldn't speak to like internal medicine, like what their requirements were or anything, but it seemed like that was a really the hardest thing was to be able to get the same patient with the same residents all the time and like to grow an actual panel and to get the system to realize that a family doctor isn't just like, wipe in noses and we don't need to refer to derm. We want to keep all these procedures here in the clinic. So there was there was lots of battles to get our way so that we could get them that, that education. But I mean all in all, honestly, I think it wasn't like once I said it out loud even, I was like, that's a great sell. Like we're a, you get to see the highest of acuity people at the hospital. It's not the rural hospital, but you can see how the rural hospitals would've handled it and what you should do, because now you're the one accepting the patient, right? What you'd want them to do in a, in a rural setting. So, when you're out, what to do in the rural setting and how to get a good, when someone needs to go to a higher acuity. So it, it was a, it was definitely a different mindset, but I think it was, it's, they filled every year. So like, I think Fargo in the area. Not in the United States maybe, but it's like more of a desirable place to be than a lot of the other, where the other residencies in North Dakota were sure. Or are.

Maryal Concepcion MD: 26:05

Yeah. And when you, as you spoke about how in Florida OB wasn't a great experience, but then in residency it was a totally different ball game. You, you also spoke about how you were able to maintain your newborn nursery privileges after you left the residency. And so I'm wondering like, just over your span of being an attending what's been your outlook on being able to be there for women who are pregnant even though you might not be doing the deliveries, as well as how you've maintained, that population of moms and their babies, especially that, that particular branch of your population as you've gone between all of these models and into DPC?

Kristine Martens, DO: 26:43

Yeah. Well, it all comes down to like the relationship that I have with, with my patients, right? Like I, when I was delivering, I guess I would get some referrals, I guess from, the PAs or NPS in the practice that would send them to me for their OB care. But like, after I stopped delivering, I'd still have all my patients who would get pregnant. And even, even then, it's like they. They trust my opinion. They know that I'm gonna choose somebody who is going to mesh well with them. It's not gonna be like this question mark of who's gonna be there when, when I'm delivering. And I still get to do the majority of, of the care. And I, we have a good back and forth between myself and the delivering physician. So, and then I think the idea of me being able to be up there for the, for the baby, it was comforting to them. But it was also a little bit selfish for me, just'cause I just wanted to be involved. I felt like I probably would've continued delivering if I felt there was better support from the OB department. I wasn't used to, I kind of realized leaving from residency to a different hospital system that not every hospital systems play as nicely inter the interdepartment. And so it just was a little like, I loved doing it, but then I, I also, like, I loved doing it because I knew I was really supported if I needed something and if I lost any amount of that, it would just got to be too anxiety ridden. So it was really nice that this. System still allowed me. And I think there was one or two other family doctors that were still doing prenatal care with just the newborn nursery. Cares.

Maryal Concepcion MD: 28:26

Yeah.

Kristine Martens, DO: 28:27

And then I got to still do that with the residents too then. So, in their clinics, their prenatal care and everything, they still got to have a lot of preceptors who were very capable of, of helping them with those types of patients.

Maryal Concepcion MD: 28:42

I love it. So now I wanna fast forward into this time of you're in private practice and you're like, wow, the compensation that we're getting from the insurance companies is not at all what you know, it should be, or, what, in a lot of people's cases, what a lot of people thought it would be once mm-hmm. A person went from salary to an RVU based model. And so I'm just wondering if you can talk to us about that, Dr. Martins, when it comes to having this conversation with Allie, but also going from being an employed physician to like, I'm gonna open up my own DPC because I've read about these, I've read, it, it does exist. But again, just really like, how did you guys overcome? There is no one yet in North Dakota, and yet we're still gonna do it. Yeah,

Kristine Martens, DO: 29:35

I,

Maryal Concepcion MD: 29:36

I guess

Kristine Martens, DO: 29:37

the fir, the first part of that is I really was unaware of the amount of overhead costs for clinic, right? Like, I had no clue. So even when I see like, oh, the revenue brought in was this X number, but then I am only getting whatever, 40% or 30% of that. And then I look at all these specific visits and I'm like, well, I, I did, I double coded this or I double, why didn't this get charged? Why didn't these things get charged? Or you can charge for all these random things that are just ridiculous now looking back. But then I learn, oh, well you have these, each clinic has a different contract with each individual insurance company, and you may not get as much money for that visit if you worked for this bigger company who has much better negotiating power. And there's just, you just feel like defeated, I guess. Like what is the, what's the point? Like I just spent three hours and a lot of brain power on this for 20 bucks, and it's just, it sounds terrible because it's not why we all go into it for like money, but like at some point you still have to be able to support your, you gotta be able to support your family and you have to. Value what you, what I do, I have to tell myself this all the time. What you, what you know is valuable. Amen. So that was a, Allie was much more, I think when she grew up, she wanted to own her own business. I went to med school and I was like, I can't wait to be an employee for the rest of my life. I had no interest in like having to learn all that. A hundred percent of me wanted to just like, take care of people and let somebody else figure out the behind the scenes stuff. So I think the idea of it was, came a lot easier to her than me mostly.'cause I didn't know, I, I don't know what I don't know. And I know I don't know a lot when it comes to business stuff. So yeah, it was, it was a really, really hard reality for me that I really thought if you're just taking really good care of people, you'll be compensated appropriately for it. And it's just not true in the

Maryal Concepcion MD: 34:29

insurance world. Yep. And I know that there's so many people out there nodding their heads, whether they're open or whether they're not even a physician and they're just, a person who works in the DPC space that everybody knows that this is true. It is ammunition for those people who are like saying otherwise on social media that were like, oh, we're in this for a gazillion dollars. It's like, not family medicine. Thank you so much. Have a good day. No one who went into family medicine went in for a gazillion dollars. For sure. Absolutely. So as you guys were exploring opening this model, and you guys are two people coming together, you opened up as a 50 50 owned business. Yeah. So tell us about that, because you guys are almost to your one year anniversary here and you know a heck of a lot more now than you did then. Every day we are in these businesses. We know more than we did the day before, but how did you guys set up the clinic on the backend of things such that, responsibilities were laid out as well as compensation.

Kristine Martens, DO: 35:27

Allie was the first one to reach out. There's one lawyer in the state who will work with. A pa I think that was the thing, is like that would work with an a like a PA or a nurse practitioner opening their own business. So she had reached out to that person. Initially, nobody in the state knows anything about direct primary care. So then we were talking to the closest direct primary care to us is in Alexandria, Minnesota. So we were reaching out to them to get some ideas and try to figure out like, what do, wow, what did you do? How do we do this? The, and then, comp was something we had to like talk about mostly because in my mind, like her patients are, are paying the same amount as my patients. So it didn't seem fair that, oh, 60% goes to me and 40% to Allie. But like we've, we fully have like separate panels. We are not like, I'm the doctor and she's like my pa she is a great primary provider and her patients love her. She takes care of them and I ca take care of mine. So at, at the end of the day, we're like, we're just gonna have to have it equal. And then I'm a medical director, PAs have to have a medical director in North Dakota. So we just came up with like a separate medical director salary that would set us apart. That much. But that, that amount stays the same. So, but that's, I think that the biggest thing was just to sort of both of us needing to like, sort of check our egos at the door. Like she knows that she isn't a doctor. I love her for this because she'll like correct her patients. She always asks for help if she needs it. But like, likewise, I, I will ask her things that she's more passionate about than I am and might have done more research on than, than I did. So at the end of the day, we just decide not to be, I don't know, upset about, upset about it.

Maryal Concepcion MD: 37:32

When it comes to marketing and financial decisions, how do you guys come together to, decide what the money is going to be spent on when it comes to getting in patience and then what happens if a patient wants to join the practice? Do they get to then choose and do a meet and greet with both of you? How does it work from the whole flow of deciding to spend the marketing dollars? And then what happens when the patient is like, yep, I'm ready to sign up.

Kristine Martens, DO: 38:00

We very naturally sort of like split the types of business things that we, I don't know, enjoyed the most. I very naturally went the clinical route, so like getting the stuff for supplies for the clinic and like, um, that type of financial stuff, sort of as like my realm, setting up the lab. She went marketing. Thank God I, I don't, I don't, I'm, I'm not great at it. I don't. Know anything about it and I have made little efforts. She's great at that. So we're just gonna, we let her do marketing stuff and decide which marketing things to do. If it's a big cost, we always talk about it together. We have two business meetings a week together, so we have a lot of time that we just spend sort of brain dumping is what we call it.'cause there's just so much that we just have to literally brain dump. And then sometimes we'll just pick one to like talk out. Patients can, when they, like, when prospective patients come for like a meet and greet or something, they can do it online. If they do that, they have to pick one of us, like just for the EMR. So they pick one of us and then it gets scheduled on that person's schedule and then they meet them. But like I did a meet and greet with somebody who, when we were talking, I was like, you are so perfect for ally. Ally is much more, I'm integrative and I'm holistic. Right. But Ally will go above and beyond to like appease. And look into hormone discrepancies and really do all those types of things for like perimenopausal women And this person just was very much like, oh, I do all my, all my own research. I do all my own this. And just, she, she just reminded me of, of Allie. So I was like, so it doesn't necessarily mean that they're going to be with me just'cause they're doing the, the meet and greet with me. Most of the time it works out that way. But if it's someone who I really feel like they're gonna click better, then I'll send'em her way if they're calling in. Our nurses actually are really good at deciphering like, oh, this seems like Martin's patient, or This seems like a, an Allie patient. And we've had a couple of people who did. As long as we're available, we'll both go in and, and talk to them.

Maryal Concepcion MD: 40:22

Mm-hmm.

Kristine Martens, DO: 40:22

But it gets hard with our schedules to like, have us both be available for all of those.

Maryal Concepcion MD: 40:27

Understandable. And then at the end of the day, you guys just split that income 50 50, right. Minus your medical director and then any staff that you guys have or expenditures that you guys have at the clinic. Right. Yeah. And then what is your guys' legal structure? Are you guys an L-L-C-P-L-L-C-S Corp? What are you in North Dakota?

Kristine Martens, DO: 40:47

We're A-P-L-L-C. So, and I think we file something different for taxes, but again, that's why I have an accountant tells me what to do. But we're an LLC, not a corporation. Got it.

Maryal Concepcion MD: 41:00

So you guys are about to have your, your physical doors open. Tell us about finding the space that you guys are in, because I'm wondering, being where you are, what is the availability of spaces that could be used from medical clinic?

Kristine Martens, DO: 41:16

So the, the majority of these spaces are all completely dirt floors, right? Like, like you build them. And so at first we're like, had a realtor taking us around and looking at all these space and they're like, oh, this is the great space. You just, we would give you x amount of money to, to build it up and then you'd have to spend all the rest of your money to do the rest. But it's such a great investment. And we just, were like, for who? This is an investment for you. You're the, I don't, I'm gonna rent the place. So it was a lot harder to find the spaces that were already used. Like there was one place we looked at that used to be a, like a chiropractor had leased it. And then the space that we're in right now we just like lucked out. It's like in the perfect, it's like a little mini mall. I don't know if you guys call it mini mall, whatever, like a. Strip, I dunno what else it's called strip mall. It's called them mall. Strip mall. Yeah, strip mall. So it's like main floor. It's, it was a insurance company I think was there before. So we just, all we had to do was a couple of different tweaks to add, like locks on certain doors and take out the carpet and put in flooring. But otherwise it was set up really, really nice for just a small clinic. And it's right next to, so there's another family doctor next two doors down from us. Our, our, our landlord. I really appreciated this that he just made sure it was okay with like all the other people in the, in that complex if we moved in. And luckily everybody was good with that. So, so yeah, so that's sort of how we found our, found our space. It was a really lucky.

Maryal Concepcion MD: 42:57

That's amazing. And I, I will say that that's a great call out because landlords are all gonna be different, just like we're all different as DPC doctors, but at the same time, especially around here, the fact that I was a medical doctor when I was looking to rent spaces, people were like can you sign today? Can you sign today? Just because, I'm not a chronic pain, chronic pain clinic. I'm not, the, the fact that I was family medicine people are like, oh, you're gonna bring amazing families to our, our strip mall. We have our own little strip mall here in Arnold, California. But yes, it's it's, I do think that, I, I say that to, to say to the audience members who are looking to rent, don't sell yourself short when it comes to medical clinics looking for space. Because I do think that you're bringing a massive value proposition to the property owner, especially when you're bringing, comprehensive medical care to your community. So That's awesome.

Kristine Martens, DO: 43:45

Yeah, they were every, honestly, like everybody we talked to about it, because like, no one's ever heard of Direct Primary Care is like, that's awesome. I want that here. Like the, the, the landlord was like, really, really excited. So he's like, no, we want you here. They just, he just really wanted to make sure, probably specifically with that family doctor, that he wasn't gonna be put off by it. And I was like, we're completely different. We'll send our insurance people over there.

Maryal Concepcion MD: 44:09

Yeah. And I mean, that's a, that's a pro tip in disguise there.'cause it's like. If they have vaccines and you're a person not necessarily getting vaccines as easily, you can send a person to a fee for service clinic. Yeah, just for their vaccines. It depends on the, the owner, but especially, having that culture of like, that, it wasn't like, oh surprise, it's another family practice open next door to you. It, it just feeds into the, this just the overall culture and then the future culture because of that. So That's awesome. That transparency that your landlord had. So you guys are now about to open and you have your space. And I'm wondering were there any unexpected challenges that you had, going into that first week of practice? Because I see the smile and I see like most people are like laughing and just like, or shaking their head in pain. Thinking about that first week, but I'm wondering what was it like for you guys prepping in that first week of opening?

Kristine Martens, DO: 45:04

The exam tables took a while to come in. So the first, so luckily I had a massage table that I think they required me to buy in med school for like do, so I like had this that I've lugged around. I'm like, and this guy, I had a patient who just like needed a pre-op and I'm like, well, I mean, I think we've got this stuff for it. So I. He came in and like, luckily, pretty much everybody was so excited about us doing this, that they were, they were like loving being part of like, the growth of the clinic, like to see it changing and everything. But I feel like not knowing how long it takes for some of those bigger items to come in was a surprise. It was also there was a really good one. I was gonna say it was well, the visits themselves. Okay. So like, I don't know why they felt so different, but like, I remember both Allie and I would come out and be like, I feel like I should be doing more than I was. Do. Like, there'd be like one patient that would come in that day and you just wanna like, hang out with them all day because I mean,

Maryal Concepcion MD: 48:11

why not? Why not?

Kristine Martens, DO: 48:12

Because you can. And so I, we, we would just like be talking shop and talking about like how we, how we're doing at the business. And I'm like, at one point, probably half an hour in, I was like, should we talk about like your medical things? Or maybe you wanna make an appointment tomorrow'cause you can like, it's just like really, we were just like all so excited about it. But I think that just like the vibe of the appointments have still just all been so much, I don't know, they're different. Maybe it's the non rush thing, but I never really felt rushed even though I was always rushed. I was just. I was like, well, screw it. I'm just going to like spend as much time as I'm going to spend. But that surprised me. And then people were still, our patients who signed up for DPC still did not understand the concept. So then they would be like, how much do I owe you? And it's like, no, no, that's what works. Like nothing. You already paid it's membership. Like it's, yeah, they're so ready to pay that copay. They're like, what's my copay? Yeah. They're like, well, whatever. We'll jump off the cliff for you. So here, sign me up. And then, but they didn't really, most of them, not most of them, but a lot of them still just did not really understand that you can come in when you need to, or like, you don't have to like stop calling. We, so we use, we have our direct contact number and then like you can call the other phone number to get basically a hold of the nurse. And they were still just like, I gotta talk to the, my nurse. And like, then she's like relaying messages to me again and I'm like, why don't they just call me on my number and like, they still don't get it. So then I'm calling them. It's hilarious. So it's a, it's a learning process

Maryal Concepcion MD: 49:59

as you're saying that, I'm like envisioning like, you're standing right there and they're like, insisting still I have to talk with the nurse. And you're like, no. Like literally your physician's over here. Like, yeah, but I'm right here. Do you wanna talk to

Kristine Martens, DO: 50:11

me? No, no. I don't want, I know you're busy. I know. They're all like, oh, I know you're busy. I, I'll just talk to Megan. I'm like, but, okay.

Maryal Concepcion MD: 50:20

Sounds good. Such a different world. And I wonder here, as your patients joined, but they didn't necessarily know what they were getting. And they, they've definitely learned now that you've been in practice for almost a year. But I'm wondering what did you hear from people in terms of why they signed up? Because again, you're the first clinic to open up in North Dakota. So the, and yes. As DBCs grown around the nation, people could hear a little bit from other people outta state, but it's like, why would people join your clinic when they didn't even necessarily get what you guys were doing?

Kristine Martens, DO: 50:53

Right. Well, okay. So like, my patients who I had seen who like moved from the system, then moved to the private practice, they were just moving. They didn't need a reason. It was just,'cause I'm going where Dr. Martins is going. It doesn't matter where she's going. The, I had patients who had. Decided, okay, well that's, that stinks. I'm not gonna pay it. Why would I pay for more when I already have insurance, whatever. So like, they tried it out. They tried it out, going back to find a, a primary back in the system, and a majority of them come back later because they either did meet somebody and were super un dissatisfied or didn't feel like a connection, didn't feel like they were heard, didn't get any of their needs met, or they've tried, but they can't get in anywhere. So they just come back. And the people that we've gotten that were like maybe never associated with us, like from the community that have never heard of me particularly it is usually I'm not being heard. I'm nobody cares. That's usually the reason. Like,'cause I've, I've had a couple of patients who come in, they do the, the meet and greet mostly because they, they, they know that they need to do something different. They're just not getting the care that they need. But they've got like, fabulous insurance, right? Like their jobs paying a hundred percent of their insurance, and their insurance is one of those that just pays for everything. So it's free no matter what. And so then they're like, why would I, I need help. Like, defending, paying$125 a month. When I'm already getting it for free. And I'm like, well, the value is the relationship and how you are actually taken care of, and that your needs are actually being met. And I am trying to tell people to separate primary care from insurance completely. Like that's the best way that I can try to figure out how to like, navigate the comparison between us and insurance. And like they, some people think we're insurance. It's very confusing for people. And I'm like, no, we're just like, consider us a different benefit. You have your insurance, that's great. You use it at the hospital, at the er, anything outside the clinic, but you also need primary care and that's different. And this is the cost for primary care and hopefully you won't have to use that insurance as often. So that's worked a little bit that it, it's usually dissatisfaction.

Maryal Concepcion MD: 53:34

Love it. And as you talked about in the very beginning, the, the waxing and waning, the rollercoaster of entrepreneurship. What, what, what do you see has impacted those, the, the, that rollercoaster itself? Because we're, we're speaking at a time when there's been a change in administration. People are much more worried about their finances in particular. So I wonder what have you seen as to things that have impacted your your journey thus far? I.

Kristine Martens, DO: 54:01

I can't say that we had, I was listening to a bunch of podcasts. Yours maybe probably about like, we're seeing it's, it people are canceling, people are, whatever, like needing to save money and like, I can't say that I've seen that, but I don't know that we've had, we've been around long enough maybe to like, have people who are like, oh, I've been paying for this for three years. Do I really need to do it anymore? Whatever. So we'd really see an impact that way. If anything, more people have signed up because of their I guess nervousness for where healthcare is going and what their insurance is going to cost and what it's even going to cover. So we've had a benefit in that sense. I would have to say it clinically, I feel like I've had a lot more people with depression or anxiety, I guess because of everything going on, but at least they can come in immediately when they just need to vent, which is sort of what I've turned into for a lot of patients. Like, I'm not a therapist, but I'm gonna, I'm gonna try my hardest.

Maryal Concepcion MD: 55:06

And that is, that is the, the social worker hat of family medicine for sure. Like that is a lot of what we do. Absolutely. And. Tell us about your staff, because you've mentioned your nurses, you have both Megan and Kayla with you mm-hmm. With you guys, and I'm wondering at what point did you guys bring them on or did you bring them with you on day one?

Kristine Martens, DO: 55:26

Yep. They came with us day one. So Kayla actually was a nurse at the system with Allie when she started working after PA school there. And then, so she moved with Allie to the private clinic that we were at. And so it was like a natural progression for her to continue on her, patients all loved her, you know, Megan, I met at the private clinic that I was working at for that year, and she was like, brand new out of nursing school. And I love that because there's so malleable and she's still was like, desiring so much to like, please me and like, do anything that she need, like whatever it was that I needed. She was, she and she would get it done and taken care of. So, we just brought them with us from that clinic. The clinic ended up closing, like after we left, so, they didn't have a job there anyway, but either way we, it's like we got to do a whole one year. I guess interview to see how they work. And they are both just amazing. So it just naturally flowed over.

Maryal Concepcion MD: 56:40

That's incredible. And then how did you guys adjust financially to have two RNs come on? Because I think about, they're not virtual staff. They're, they're well-trained, they're, they're well-trained in the sense that, like you guys have worked with them before coming into DPC. How did you guys financially plan for that? Did you cut your salaries back in order to float them until your practice grew?

Kristine Martens, DO: 56:59

Oh

Maryal Concepcion MD: 57:00

yeah. So

Kristine Martens, DO: 57:00

like, basically, so I'm like the only, I'm the sole breadwinner for my family, so I wasn't able to cut back the amount that Ally was. Ally basically took a zero salary for a while. But we knew we wanted to pay our nurses well. So we had to take out a business loan, we to cover the startup costs and like salaries and stuff like that. And then I think that honestly, like the two RN thing definitely sets us apart for most EPCs, probably even more than the whole like PA do thing, because it is a, it's a much higher cost than if we were to just have one ma, doing some of these things for us. Had we not known them, and we were just starting, like honestly, like we would not have out of the bat, hired two RNs had we not already known them and had a relationship with them and our patients loved them. And I just, I honestly don't know how I would function without my, without Megan. So we've, we've made it work. And then because they're RNs they're able to do some other, like, revenue building things, and that's sort of where their aesthetic stuff comes in. So.

Maryal Concepcion MD: 58:18

And I think that in terms of the listeners out there who are thinking, what's my five-year plan? It, it's definitely something to think about in terms of if you know the person either personally or the ideal person, it's, it's very much something to consider in terms of like, what is the, the overhead going to be at day one, because I'm already thinking about year five and what that overhead would be with the amount of patients differing between those two time periods.

Kristine Martens, DO: 58:46

Yeah, yeah. It was, it's definitely hard. But I think that the nice, the, the best thing about them coming over and is the, the fact that they, they knew us. They, we were like. I don't know, friends, I guess like, Megan's probably 20 years younger than I am, so I don't know how friendly, but it, it's like they, we are starting this new business and both Allie and I are like, we don't know. Like let's just see how it goes, like processes of the clinic, how we wanna do anything. It's all been like an all hands on deck. So all four of us try to figure out, well what works best for me? What works best for the nursing?'cause I don't know what you do. And I am happy to like, alter whatever. It makes it more efficient, but it, it looks really, really messy, right? Like they don't it, especially in the beginning on a day-to-day basis, knowing like, what to, how do I do this? Am I supposed to do this first or do I have her do it? If you didn't know us and you didn't know coming in that it was gonna be like that, you would've been so out of there because of how disorganized it was. Like this is, just the most unorganized company ever. But like they, they knew that coming in and they were like both excited to try to figure out how to get it to be efficient and work the best that it can. So, not considered, there hasn't been like, struggles with that because we want there to be like a way to do things. We just getting to that has been hard'cause we've got lots four female, perspectives on everything.

Maryal Concepcion MD: 1:00:22

Oh my God, it makes me think about my, like, six girls in the same dorm at, at college. Yeah, everybody's cycling together. Oh my God. That's, yeah. That's awesome. Oh my gosh. So, so here I, I wanna ask about how you guys then are working as a team, because walk us through, like, if a patient is calling the clinic or contacting you guys, what is the workflow with everybody's roles on the table? Because I'm, I'm guessing there's like, yes, anybody can come in if they need to, but also is there, what, what is the, what is the standard of care in terms of like, somebody talks with Megan or Kayla first and then talks to you, or does it directly to you and Ally? How does it work

Kristine Martens, DO: 1:01:00

If they're calling our clinic number, like the office number, then most people know that they're going to be getting either Kayla or Megan. So they'll call or even text the number just to like, say hi to them or whatever. So they know that they're probably not gonna be talking to me or Ally if they're calling the office number, if they're calling for an appointment to, the nurses know how to, in our schedule, like where to put people, we always leave room for like same day acute things. If there's seemingly nothing there, then they'll just tell them, oh, well let me talk to Ally and see, see what she can do. Or like, they might say, Hey, have you tried sending her a message? She can probably take care of this without you having to come in. So there's a lot of communication that way. Most patients wanna talk to one or the other too, so like, because they all know them. It's hilarious. Like, people are very siloed, people are very, they know their nurse, they know their doctor, they're not gonna talk to anybody else. no matter what. So they'll talk to Kayla and they'll be like, well, just, when's Megan getting back? It's gonna be rough when Kayla's pregnant and is gonna be on maternity leave. So that'll be fun for her patients. They're all gonna have to talk to Megan.

Maryal Concepcion MD: 1:02:11

Oh my goodness. And as you guys grow, especially knowing how Megan and Kayla are just part of the fold at your practice you guys are already above, you're almost you're on the, the, you're past the half point to almost to 300. And, and I'm wondering in terms of what is the feel for, do you have an, a, a number that you're looking for in terms of this is the number where I think we could cap our practices to make sure that we're, having great practices, quality of care, but also that we're able to just have time to be ourselves?

Kristine Martens, DO: 1:02:43

Yeah. I feel like that number has been changing a lot for me. I have asked, I, I feel like this is like a, almost like an accounting problem for me. Like I know where I need to be financially. But I haven't quite figured out how to determine what that actual number is.'cause it's not as easy, it's not like a simple math like, oh, 125 times x number of people equals not most must of. That's not, not coming to me. So, three 50 to 400 is sort of where we were aiming, like each, so like where I would have three 50 or 400 and Allie would have 350 or 400. I think that we go through these, the rollercoaster of like,'cause there's weeks that are like so busy and I'm like, I, I only have 130 patients. How am I gonna do this with three times the amount of patients? And so then that gets, defeating a little bit. But then there's weeks where it's like super ideal and there's like openings in the clinic and I'm able to very quickly get back to people's messages and I can talk to them on the phone and handle problems virtually. And that feels really good. And I feel like on those weeks I'm like, okay, yeah, I can definitely handle more clinical work. The other part of it is that we spend a good amount of our week right now doing like business related things, trying to like figure out how to recruit patients. And it's still been difficult to get the word out about direct primary care in the, in the community. So a lot of that is like we just have to like. Go out and literally tell people about it. So then that takes time away from the clinic. Yeah. So like I'm hoping that that amount of business sort of focus will be able to go, like cut back so that I can have more clinical time when we have more patients. But I'm thinking 3 50, 400.

Maryal Concepcion MD: 1:04:41

Yeah. And, and on top of that, just growing with patients who are signing up as individuals. You also just signed your first employer. So tell us about that, because that is something that a lot of DPCs are, being asked more about because more self-funded people are out there wanting to have DPC at the core of their, he of their health plans going forward.

Kristine Martens, DO: 1:05:04

Yeah, and honestly I think that this is gonna be like. Where we are gonna need to go, like in order to like grow the company where to where we want to is to do small employers. We, so yes, we, we just signed a small employer. Luckily we, I knew her, the owner from like a networking group. She happened to be like my insurance lady for the last 20 years or something like that too. So like we, we knew and so she knew me and so she was happy to be sort of like our Guinea pig on how to like, on roll them onto the EMR and like, I didn't know that the process would be different for employers than it is for like anybody else signing up individually. So we had to work those kinks out. Luckily with somebody who is very understanding of that, because that was my biggest worry is like, I don't wanna roll something out and not know that it's, I don't wanna feel unorganized to the employer, right? Like, I just, I don't even wanna feel, I don't wanna feel unorganized to anybody. I want everybody to think I've got my poop in a group. Like I don't, I don't, I just wanna put that out there. So I was happy that she was able to like, roll with it. I was like, we gotta change your enrollment date. Sorry. Like, I didn't know this was on the first, like, like, sorry about that. It, it also big learning thing that we learned from that was that even if the employer. They understand what direct primary care is. They don't either. They really don't. And then we, we need to talk to the employees as well because we knew how many employees they had. This employer was gonna pay for a hundred percent of the membership for all the employees and their families. And then, you get it and there's like three people and we're like, why is, why isn't everybody enrolled? Like it's free, free healthcare. But then they're like, oh, I have insurance. Or like, even one of the, wasn't the owner, but like the person who's gonna probably take over the company comes in. And after that appointment it was like, well, how much do I owe for today? Like, they were all just very confused. I don't, I don't know how to get it through their, it is really, really difficult to change the mindset of a mid-westerner. Like it will not change.

Maryal Concepcion MD: 1:07:30

Oh my gosh. As someone who went to, who lived in Nebraska for five years I think of so many people who fit that category. Why I left. Yes.

Kristine Martens, DO: 1:07:38

Like, oh my. No, nothing. Nothing. You already paid and you didn't pay. Well, how much is it gonna cost my employer? Nothing. They already paid your membership. It's paid. Nothing gets paid today. I know how to be more clear. Oh

Maryal Concepcion MD: 1:07:54

my goodness. I definitely will say that that is so echoed in the, the, the, the practices that we run, but also when benefits advisors are trying to build these health plans and employers don't necessarily get it. That it's changing, that landscape is very much changing, but it is very true where it's like the culture is by default, health insurance is healthcare and we're trying to show them that health insurance is not healthcare.

Kristine Martens, DO: 1:08:21

Yeah. And that you have to pay, somebody has to pay or somebody has to give something for every service. Yeah. No matter what, whether it's free to me, doesn't mean it's free to my insurance, but it, you know what I mean? Like, there always has to be some sort of transactional like thing that happens with every encounter in everyone's minds. Yeah. When it, it just doesn't have to be like that. And it's just been, it'll get out there, but I feel like the only way it is my patience going out and actually like telling people how, how it's not too good to be true. It is too good to be true. I think is what everyone's mindset, everybody's waiting for like the other shoe to drop. They're all waiting for like that surprise bill. Like, oh, well now it makes sense. Like, no, it, it is just that, just the month monthly membership. But, and they're all aware of concierge too, is the other thing. There's like a concierge place in town. So they, they do this membership for the concierge, but then they bill insurance or there's always a charge of some sort for like the visits. And so that's like, they get that a little bit better, but

Maryal Concepcion MD: 1:09:34

Nope. Yeah. And I think that it is very much speaking to how our patients can help move that needle a little bit when it comes to people out there, they're hesitant to change. And then if somebody who's very near and dear to them, has an experience at A DPC that can help change their mind or help them understand a little bit better, it, it absolutely makes a difference. Yeah. So, I hope

Kristine Martens, DO: 1:09:58

that's my favorite is when a patient is like texting and then I'll text back and she'll be like, my friend is just cannot believe I'm texting you right now. And she's like, I'm like, well, tell her to sign up. Ah. But yeah, seriously. Yeah. That is the, my favorite part of it. I love that I can just text a patient because it's all already documented. Love it.

Maryal Concepcion MD: 1:10:22

Now, because you are a do and you have the time, like you, you talked about bringing your massage table in from medical school, which is awesome when it comes to OMT and when it comes to treating your patients. I'm wondering how you're able to bring OMT into the fold.

Kristine Martens, DO: 1:10:38

So I use my current DPC patients as sort of my like. Retraining myself or like more like regaining my confidence, I guess. Like,'cause like I had done OMT in residency, right? Like then I graduated in 2013, so I hadn't done it since then'cause I didn't do it at all. When I got into practice, we had an, there was an OMT referral. There was like a one doctor who was doing it for this system. So I'd send people, people knew about it, but I wasn't doing it. So for the first like six months or so, I just like, if I saw somebody who I was like, oh, migraines like, do you want, will you come in, come in once a week so I can do some of this stuff and see if it actually helped. And then, then I feel like the more people are like, wow, that actually helps, then I'm like, okay, this is doing something.'cause I, I love to do the subtle OMT. I don't crack, I don't do like the high velocity like techniques. It's a lot of indirect techniques that are so subtle that sometimes I'm even like, I don't know, hopefully that did something and, but when patients are like, wow, that I didn't know, but the next day I was like, wow, I don't have a headache. I was like, okay, good. It's working. So then after that I decided, okay, now I have to come up with some sort of price. And I know I'm probably underpriced, but I also like, I wanted people,'cause OMT again is another sort of thing that nobody really knows about around here. People know chiropractors, they know massage therapists, they know physical therapists, but they have no idea really the difference about OMT. So I didn't want, I wanted people to utilize it, so I didn't wanna make it too expensive. Plus, I have the imposter syndrome, so I'm like, well, I can't charge this much. Is it going to be worth that? Like, what if it doesn't help? So I set it at a certain level for members and a little bit higher for like, non-members and have had a really good response to like, my current patients, like almost too good of a response because, A, it's super affordable and b, I don't wanna fill my whole clinic up with just OMT. So that gets, it's a, it's a balancing act. So I'm not currently like telling a bunch of people not at the clinic that I'm doing it.

Maryal Concepcion MD: 1:13:08

And that's, that's so important because again, you're, you're just keeping, you're, and you, you have the time to reevaluate, like what do you want your ideal practice to look like? And that absolutely includes things like, things like OMT in addition to primary care. So I'm wondering also, you've brought different value propositions to your patients in addition to OMT. You guys have brought microneedling and derma blading and cryo to your population as well as like on your website. You guys have your weight management care as well. So I'm wondering how have you guys envisioned the balance going forward with your primary care practice patients as well as people just coming in for these services?

Kristine Martens, DO: 1:13:48

I'm hoping that, so the microneedling and the, and the dermaplaning are primarily performed by our RNs. So ideally they would have a, it doesn't have to be super busy. I certainly don't want it to be, because like I said, I utilize my, I'm a nurse for like, anything that I can, so I can't have her just be doing my needling. But even if it was like even a couple of them a week or something like that, it'd be nice to have that sort of steady extra revenue to support their salaries and to support the clinic and everything. And then cryo, we've always offered to like our current patients, but then realized that at one point Allie and I were talking about like. Well, should we do any type of just onetime visits? Like sometimes people are talking about or asking about, can I just come in for once? Just pay for once? And so cryo seemed like a pretty easy, not too medically complex reason for like, come and have a work, whatever, like frozen off. So I'm thinking of that as more, more than like the cosmetic, I guess, way that we would can use cryo. Again, like I don't know that that's actually been marketed in our area yet because it's another thing to do and I, I'm not a great marketer. But yeah, cryo is super affordable. We could probably bump that price, so, microneedling is like the high dollar, like aesthetic procedure, derma planning people like, because I think just the cost is lower and you can come in more often. A lot of people will do it in conjunction with, with the microneedling, like do derma planning first and then come back later and do a microneedling. But I think both of those, for me, they like kind of go hand in hand. They're just sort of like the nurse aesthetics. It's their love and happy nurses make me happy. They love doing it. I don't wanna be a spa because I love that it still feels like a clinic. And I want like our old like farming men to come in and not feel like they're going into a spa. So I have to have a balance I guess between it be getting to be too, too spa-Like I see the drive though. I mean people spend, it's kind of frustrating actually. Like it is easier to get people to spend money on microneedling, to shove needles in your face to like regenerate collagen than to spend a quarter of that per month on good primary care.

Maryal Concepcion MD: 1:16:28

Yep.

Kristine Martens, DO: 1:16:28

Or just call'em the kettle block there. Like it's it's so true. Okay. So yeah. But at least I, but I'm glad they have it'cause it makes them happy. And like I said, if, if they can get some good revenue there, then I can focus more on my, the patients that I have and like maybe the total number of how many I need to be able to support my household can come down.

Maryal Concepcion MD: 1:16:52

You guys have also started your own podcast, the direct effect. And I'm wondering how this plays into, I know you're saying, you're not the best at marketing, but in terms of just sharing what you're doing and speaking as a physician who's a direct primary care physician now, I'm wondering how you guys see the direct effect having a direct effect in your community.

Kristine Martens, DO: 1:17:13

this really came around mostly because every time that Allie and I would get together, we would get so excited again, like talking about it. And anytime that we like did an interview with the news or like went on some agriculture podcast, everybody would talk about how you could just see, you can see the passion, when you're talking, you can see it in your face. And I am really bad at like recording myself for some sort of reel on, Facebook or something. And my husband even would be like, you just record. Like I'll talk to him for like two hours about my frustrations and like why this is going to save the world. And he is like, you should just record all that and like cut it up. And so honestly like that's sort of how it came out.'cause we were like, we should just like talk in front of a camera and probably some really good stuff's gonna come out. And we also just really wanted to kinda talk about direct primary care, right? Like the difference in the between. That, and like fee for service, whatever, like what people around here are aware of. But then also maybe talk about like ourselves, like what we're going through as parents, as moms, some wins and, hard times just so that people can understand us as human beings and trust us as human beings, I guess, too. You gotta do all these all the time so you can be that doctor that, that they trust and when they're finally fed up, they'll be like, oh, I'm gonna go to that person I'd seen on Facebook a million times and I'm gonna, I'm gonna go, I'm gonna go now. So it was sort of that too, like, just to like keep us out there. So people can see us as, as people. I, I feel like it's so hard to market this because I'm marketing me and it's, you can't put your relationship with your doctor on like a one piece of paper. It's hard to convince anybody in like a ad why they should sign up for a doctor, right? Like, you wanna know that person and feel'em out. I think that,

Maryal Concepcion MD: 1:19:21

It's, it's probably even more, pronounced when you have a, one of us who's a, a quality based primary care physician who's focused on the relationship driving by a billboard. And I'm like, yeah. Human kindness. I don't think so. Like, I, I get so, I get so sarcastic when I drive by these billboards and I'm like, keep it in. Do not say these things out loud because they're not, not always appropriate. Oh my gosh. But yeah, I mean, I, I do think that you really make a good point in that when you're, when you're talking to people about whatever you're talking to them about people do over time get a sense that, oh, this isn't just a, a billboard but I just, I think that when it comes to you also speaking to the reasons why people join your clinic. Yeah. It really does. It, it combines people who want a relationship with their doctor. They want somebody to know them, and they are willing to invest in that. And you guys are delivering that amazing place for them to go to. Yeah.

Kristine Martens, DO: 1:20:18

Yeah. That's what made it really easy for like a current patients.'cause they didn't have to like prove that we could have a relationship. They already had the relationship. And I think that, that over time, that's really what we've figured out'cause every time we talk to anybody, right, like around here. They're like, that is so great. Even the bank, when we went to the bank to like open up their loan, they're like, you guys are gonna blow up as soon as like, everybody hears about this. It's just gonna be so huge. This is such a great idea. But like, none of them sign up. Right? Like, it's such a great idea, but like, it's like everybody loves it and they wish that their doctor was doing it because they already have a relationship with that person. So I get it. I get like, it's hard to commit to for a relationship that you haven't started yet, like, get married and then let's see if it works out after the fact. So I feel like having a podcast or some sort of like way for them to see who we are personality wise and whatever, like helps them get, get that relationship before they commit to the, to the membership. I love it because it's been hard. Yeah. Yeah.

Maryal Concepcion MD: 1:21:24

And I, I'm excited to see what the next year has for you guys in store. As you, celebrate your one year anniversary and it'll be passed by the time this podcast comes out, so that's awesome. Yay. So when you think about the listeners out there who are potentially feeling stuck in the system or, you know, they're afraid or they're feeling different feelings about, there's not necessarily not, there's not a DPC in my area. It doesn't necessarily have to be the state, like you guys just check that one off for yourselves, but, yep. Even, even when it comes to a county or a city, what would you say to those people who are in this place of, I am feeling stuck and I'm not sure what the next route is? And or the person who's like, I want to do this, but I am having all these feelings, including potentially being afraid

Kristine Martens, DO: 1:22:16

From a patient perspective, I guess. I would, I would ask them to just have faith ha like look around and see if there is, if they, if they've heard about it, they're dissatisfied with the system, they know that they would thrive or like wanna do something like DPC to, to look around and see what's nearby because they don't necessarily have to live next door. A lot of the care can be virtual and like I do have, I have somebody who lives three hours away, saw on like a news cast or whatever. And when he is in town, we get'em in. So it's not impossible. It might be harder and you might not get. To come into the clinic all the time, but it doesn't mean that you can't access your doctor and get the advice that you need and get the care that you need. For doctors, I feel like you just need to like, if, if they're anywhere where I was and are dissatisfied, not feeling like they're really helping anybody just consider it. It's scary. It's super scary, but you will survive. There's a lot of people to support you. The whole DPC community has been, I don't know what I would do without everybody. It's, it's amazing how much just free advice and like help that everybody wants to give you. And when you're opening a business, anything with free and it's like, yes please, I will take it.

Maryal Concepcion MD: 1:23:36

And in terms of those doctors who are not necessarily sure about opening their own business, what would you say to those people?

Kristine Martens, DO: 1:23:44

If I can do it, you can do it. Or find a really good business partner who, who did want to do that for her life. Or really good business coach. So we also have a really good business coach and that has been helpful too to sort of like navigate two separate opinions on something.

Maryal Concepcion MD: 1:24:02

I'm so grateful that you came onto the podcast today. I'm so grateful to hear, what's going on in North Dakota, and I hope that it also inspires other people, specifically in your state, to take the leap and open in their community.

Kristine Martens, DO: 1:24:16

Same. Thank you so much for having me. This was really fun and way less intimidating than I thought it was gonna be.

Maryal Concepcion MD: 1:24:26

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.