Navigating Healthcare Change in Maine: Dr. Lisa Lucas and the Future of DPC

In this episode of the My DPC Story Podcast, Dr. Lisa Lucas of Fulcrum Family Health in Maine shares her journey from fee-for-service medicine to owning a thriving Direct Primary Care (DPC) practice. Dr. Lucas, a board-certified osteopathic family physician specializing in obesity medicine and menopause, discusses how DPC empowers her to provide relationship-based, patient-centered care—especially valued in Maine’s tight-knit communities. She highlights the importance of building trust, prioritizing personalized care plans, and creating a welcoming clinic environment. Dr. Lucas also offers insights into navigating finances, transitioning out of insurance-based models, and collaborating with her partner, Dr. Romeo Lucas, in direct specialty care. The episode covers the impact of recent legislative changes expanding healthcare access in Maine, the future of DPC with wraparound insurance plans, and how DPC is attracting the next generation of primary care doctors. Tune in to learn why DPC is revolutionizing family medicine, making healthcare more accessible, and restoring joy for both patients and physicians. 

Download the 2025 Employer Trends Report from Hint.

Register HERE for the Physician Attendees ONLY RiseUP Summit brought to you by FlexMed Staff & My DPC Story!

Join me at AAFP FMX in Anaheim at our My DPC Story LIVE event sponsored by SmartHeart! Get your copy of our DPC Magazine, the Toolkit, and your limited edition Disney-themed DPC swag! Send me a message on the contact page HERE and let me know you'll be there so I can send you more details on the event! 

Transcript

Dr. Maryal Concepcion: 0:55

Direct Primary care is an innovative alternative path to insurance-driven healthcare. Typically, a patient pays their doctor a low monthly membership and in return builds a lasting relationship with their doctor and has their doctor available at their fingertips. Welcome to the my DPC story podcast, where each week. You will hear the ever so relatable stories shared by physicians who have chosen to practice medicine in their individual communities through the direct primary care model. I'm your host, Marielle conception family physician, DPC, owner, and former fee for Service. Doctor, I hope you enjoy today's episode and come away feeling inspired about the future of patient care direct Primary care.

Dr. Lisa Lucas: 1:43

Direct primary care is the answer from patients and physicians alike of there's gotta be a better way. DPC is restoring the trust between physicians and patients and teaching the next generation that primary care is valuable and necessary for all people. I'm Dr. Lisa Lucas of Fulcrum Family Health, and this is my DPC story.

Dr. Maryal Concepcion: 2:08

Dr. Lisa Lucas is an osteopathic family physician with more than 10 years of experience caring for patients in community hospitals. Certified in both obesity medicine and menopause treatment. She focuses on primary care and metabolic health, helping patients manage and even reverse conditions like obesity, diabetes, and PCOS. In 2019, she stepped away from the insurance-based system to open her own clinic, fulcrum Family Health, where she delivers patient-centered care and. Specialized programs for weight management, hormone support, and women's health outside of medicine. Dr. Lucas lives in Cumberland, Maine with her husband, Dr. Romeo Lucas, also a physician and their three children, Sophie and Henry and Oliver, who happen to be twins. She loves bringing her own parenting experience into her work, offering families practical and compassionate approaches to building healthier, happier lives. We are recording here at Fulcrum Family Health in Maine. Oh my goodness. So thank you so much for coming on

Dr. Lisa Lucas: 3:04

oh, I'm thrilled to be here. This is, this is a blast. I feel like I've been thinking about this for years and we're just continually crossing paths. So this is about time.

Dr. Maryal Concepcion: 3:11

You're originally from New York, your husband's originally from New Jersey. We will we will parking lot your husband's episode for another time because he's doing his own thing in direct specialty care. But for you, what even brought you to Maine?

Dr. Lisa Lucas: 3:27

Oh sure. I joke all the time that I was like slowly creeping up the coast. Starting in New York. I was born and raised in Rockland County, just like 20 miles north of the city. So, we still call it the city'cause it's in our mind, still the only city. But regardless, I then went to college at Holy Cross in Worcester, mass. And so then I was in Central Mass, then I lived in Boston, then I lived in New Hampshire. And when I was looking at schools I lived at university of England, which is in, it was that time in Biddeford Has since moved to Portland. Yeah. And I. I don't wanna go to Maine. That sounds, that sounds too far. And then I came up here and I just fell in love with it. And, and then we went to school here, met my husband here and I ended up going back to New Jersey for a while for training, but we moved back when we had kids. Yeah.'cause it's a great place to raise

Dr. Maryal Concepcion: 4:07

kids. When it comes to Maine, I would love also if you could tell us here, what has healthcare been like because the building that we're sitting in, you're, you guys have been here for over three years. You've been in Maine long enough that you've seen the transition and now with the quote unquote big beautiful bill having passed. I'm wondering if you could also tie in what is on the cusp of happening for Mainers when it comes to healthcare in the future.

Dr. Lisa Lucas: 4:33

Sure. Probably similar to lots of locations. We are we are a state that has a couple of established. Healthcare entities. Mm-hmm. So they have multiple hospitals and clinics that are run by the hospitals, and so we kind of have to deal with the, the business and bureaucracy that goes along with that. So I think patients here have been looking for an alternative for a while. When I first started in 2019 I didn't really know the landscape very well because I worked only randomly as a hospitalist and then I worked in a, in a residency, but. Mainly trying to work around my husband's schedule and take care of our kids. Yeah. And so I didn't really know what it was like to train here. I didn't know all the specialists here. I feel like over the past, what now? Six years, I have been able to sort of. Really observe what Mainers are looking for. I think we would joke here that Mainers are sort of known for wanting to do things on their own. They want to pull themselves up, but they're bootstraps. They want to be able to, like they're farming and running into their eighties. I mean, they really want to be independent. Yeah. And I think that they appreciate the independent nature of direct primary care. And so I think that they come to us. We get some people that come to us just for that. But I think when it comes to changes. We're recognizing the limitations that comes along with a hospital owned entity. And I think that really showed its face at during COVID, which I think is probably the same for most other locations. I opened my practice the June before COVID and I got so many patients that just were frustrated that couldn't get in, just again, the bureaucracy of it all. And so they just wanted that relationship based care and so I really didn't have to market in the beginning. It was hard, but it was still great. It just worked out beautifully. But I think people here are really looking for relationships. They very much value that. And again, I'm sure that's very similar to other places around the country, but they're tired of being a number. Even the independent practices are too big. Mm-hmm. That they just feel like mills. And I think that when patients come into our space, they just, common amount, it just feels lighter in here. Everything feels calmer. My blood pressure feels better. I know that if I call you, you're gonna answer. We get that sort of response often, which is really reaffirming. Yeah. So when it comes to, now obviously with all these changes and this bill that's going to improve access when it comes to payment, when it comes to HSA and such, I do think we are going to have a lot of Mainers that, are, have been on and off what we call main care or, um mm-hmm. Or Medicaid and, and they're not gonna know where to go. Yeah. And I think luckily since. We have, we have exploded here with direct primary care. Mm-hmm. People know we exist. And I think that we are gonna try to find these patients and just tell them that there is another way for us to be able to give them their care. But I, I do expect us to have more people knocking on our door.

Dr. Maryal Concepcion: 7:09

That's fantastic and, and so relatable to so many places. But also I just wanna highlight the relationship of your office. Like for the audience out there who weren't present. When my 4-year-old walked in and needed to use the potty it was like, hello with me with my dark sunglasses. Nobody knows who the hell I am. And then Dr. Lucas was here and she was like, okay, yeah, like she's cool. Like she's not just some stranger, but like literally there's children's toys and you offered my boys seltzer water. I mean it literally from the get go. The opposite I think about is like the carpet squares that can't even be glued correctly in a Medi-Cal clinic. In our world, it's Medi-Cal and nobody cares. It's like it's decent enough. Or could we try to make the relationship. At the forefront of care, and so, no matter what state, you're exactly right, no matter what state you're in, people all over this country, rural, urban, doesn't matter, are really asking for, but I want a, I want a doctor, I actually want somebody who knows me. And I'm not just, getting processed by somebody who will just ultimately send me to the emergency room or make me wait eight to 12 months, or not even go in because it's not worth my time. So I, I love that, all of the things that Direct Primary Care is known and loved for are really, coming to fruition. And especially the fact that the community is growing in Maine. And by sharing your story, you're helping empower people to know that yeah, sure as heck in Maine, but also sure as heck, anywhere where, where a patient wants a relationship with somebody, that's where DBC can thrive. So amazing. I'm, I'm so glad that you're, you're sharing more of the main journey on the podcast.

Dr. Lisa Lucas: 8:43

Thanks. Yeah, we are very careful about how we curate the right type of environment here. Yeah. I think it makes a big difference with our patients. You met some of our front staff that are phenomenal. We have Emily, that's a registered nurse who's worked in all aspects of healthcare. Kristin, who has worked in different offices and is just the person you want on the other end of the phone when you have a problem. And, and Camille who just joined us as a medical assistant who graduated medical school and is taking a bit of break before she starts. And so it just happened to all be women, but that all worked out for us. Yeah. Which So I just, I think we want people to feel like everyone that is an extension of us mm-hmm. Is there for them. Totally. And we really do feel we get that feedback all the time. Yeah. And I think it's really important to find the right people Yeah. When you're hiring. Yeah. Amazing.

Dr. Maryal Concepcion: 9:25

Tell us about what was going on before you opened, because as many of us know fee for service is, the, the biggest option out there in terms of number of jobs, but you didn't choose to stay in fee for service. Mm-hmm.

Dr. Lisa Lucas: 9:39

Yeah, I think like a lot of us, I, I stalked the idea of DPC for a while. I, I knew about it ever since, probably around 2012 when I graduated residency, and I kept saying, yeah, at some point I'll do it at some point. And then it never really made sense. I had my. First child in 2012, and then I ended up having twins in 2014. And, and really I don't think, I mean, having three kids under two is probably just, just became the priority, right? And so the thought of that again, just became an in in the future. And then I worked at a residency in New Jersey, the residency I went to, which was wonderful, still did inpatient, outpatient. I kept saying at some point we're going to do it, and then we decided to move to Maine. And then again, it's like, well, I don't wanna start a new panel. I don't know where we're gonna land. And so there's a lot of those conversations. Totally. Again, my husband is a he's a physician as well, and he's a ob. GYN trained at that point was, was working in full spectrum ob and not that his job became a priority, it was just more that his hours were so difficult to navigate and I just became the flexible one. Yeah. Hence the hospital work and, and such, which worked fine. And I worked with the medical school, but I really loved teaching. I think that was a huge part of just a big part of, of, I think the way I expressed myself in medicine. And so I went and actually worked up at Mean Dartmouth in Augusta. Nice. Which was wonderful. And staff is wonderful and I love teaching. But we just ended up, my husband and I were passing each other on the highway with children and we don't have support here, so that just, it got hard. And we said, you know what, again like, maybe, maybe I'll start a practice. And again, just didn't feel like a great time. And my mother had moved up here with us. My mother is a French and Spanish teacher at that point, retired, but you know, just, just loved, wanted to be near the babies and she had ms. It was really hard for her to get around. And so we would, we were a scene going anywhere. It was like two little babies, another toddler and my mom in the wheelchair so it was hard for her to get around and we would talk all the time about the day I was gonna open my own practice. I think she was just a really big inspiration for me because as most people know, when you have a MS or another chronic disease, it's just really hard to, to be mobile. Mm-hmm. And so she would get intermittent fevers or. Any sort of ailment and just wanna talk to, I mean, not only the same person, but a person. And they would say she had to keep coming in and, and then we would just sit there and complain about, oh, why do I have to keep coming in? Why can't someone talk to me? And then there was me with my three kids trying to navigate if one has strap, the other do too, and so we just talked about how the system just didn't make sense. And so it was always a plan. And unfortunately my mom, uh, my mom just got, she got she progressed a little bit faster'cause in addition to ms, she also had breast cancer, which is something that runs in our family. So my grandmother died at 57. And my mom, unfortunately she got pretty sick while I was working at the residency. And so, obviously we handled, the acute illness and then we realized we needed to take her home on hospice. And so, so she was home on hospice in my house, and there was no other place I wanted to be, but I was stuck working. And I said, well, then I think I, I think we're done here. And so I think that was the moment I, I really decided I needed to do it. And, and I had plenty of time with her, but of course you always want more. And so she ended up passing in my house. I went and got a prophylactic mastectomy to make sure I was safe after many scares. Sure. Getting mammograms. I tell the story'cause I think it's, I think it's important to, to realize that the dedication is, needs to be there. Like you, there has to be something that makes you so angry. Yeah. Right. And I think we've all had those experiences. Whereas I was healing from my mastectomy and couldn't really lose my arms. I was making my website and saying, I gotta be out, and so my mom motivated me, my children, my husband was very supportive throughout the whole process, and we were lucky in that he still could work. I calculated exactly how much money I had to make to make sure it wasn't a strain. And I opened in June of 2019 and I got about, I got about what, six to eight months in before and before everything changed and I, I sent my opt out notice in after having my wait list for Medicare, and it was March of 2020. And man, I mean, everyone knows how it changed after that, but I will say, I think it actually saved us because if I didn't, if I hadn't have started my practice I would not have able to be home for my children. Sure. So I had two kindergartners and a second grader, and as many parents know, you had to be there while they were on the screen. And so I was doing, nighttime. It's urgent care, taking care of patients in Minnesota and Arkansas through telehealth and, and being there for my kids during the day. So homeschooling and all the things. That was, that was a lot. But, but otherwise one of us would've had to quit and it probably would've been me. Yeah. Which again, I would've done obviously for my family, but it, the timing actually, when you look back, it was perfect. Yeah. And so it worked out.

Dr. Maryal Concepcion: 15:28

Well, and that everybody is badass. Dr. Lisa Lucas. My God, as my dad has passed also, I just, I think about that both of our parents are just like giving us high fives. Even having this conversation, because we are telling more and more about the direct primary care experience and also how you were at this crossroads and you, like you said, you, you, you figured it out that. I can't do this anymore. I'm pissed off enough to not keep doing this because I don't wanna be complicit in treating other people the way that the fee for service world treats people. It's beautiful. It's bittersweet for sure. Mm-hmm. But when it comes to this time of you could have quit, but you opened and yes that time was crazy for so many people who opened. I'm assuming your husband continued on his practice. I'd love if you could talk to us about how you guys. Had any discussions about, growing the practice. Now he's direct specialty care as well. Did you guys talk about it then to have him possibly join you? Because I, I think about, there's listeners out there who are partners with a physician or partners with a physician and they're, they're thinking about D pc, but. One of the things that is mentioned so many times, is, financially, I don't think this is gonna work.

Dr. Lisa Lucas: 16:44

Yeah, I think this is probably the biggest question we get and especially now that my husband is open to some practice, but I think even more so, there's just a lot of, well, it was easy for you because your partner had, he was working and, and Yes. Did it make it easier? Absolutely. He had health insurance, he had his. His salary and it did make it easier, but, our salaries mattered also. You gotta get real deep on your finances. Yeah. You gotta, you gotta make the spreadsheet, you gotta find out exactly how much you have to make. And if it is worth it to you, you will find a way to do it. Yeah. You do have to get a little creative. Right. I mean, I think I held onto my, I still did hospital work mm-hmm. After I left for a while and found out again exactly how much I had to make to make sure that this was gonna work. Yeah. I could have done it longer and he would've been very supportive of me if I wanted to do that. But I think sometimes you have to pare down a little bit. Sometimes you don't. I think it just depends on your situation. Yeah. And what it's a value proposition, kind of just like with direct primary care, we're trying to say like, is something worth it to you? If so, then you'll find a way to do it. Yeah. And I think it just, it's, it's the fear I think that holds people back. Mm-hmm. But it absolutely is doable. And of course, remember when you own a business. Their salary that you're making is different than what you'd be making as a W2. Sure. And so I think that sometimes people don't fully understand that and they just hear a number and that gets scary. And so I think finding someone to kind of walk you through it is, is nice because then they can show you, well that's exactly the way it's supposed to be, and let's work on the numbers and let's. Kind of take a different perspective. Mm-hmm. And when you talk through it with people, they go, oh, well, well that makes sense. Right? Yeah. But I think as physicians, we're not taught these things. It's not something that's a class in school. They, if anything, I remember specifically someone saying, well, you're never gonna do that.'cause that's not possible. Yeah. Don't even bother. Even though I, I graduated residency in a time where an independent doctor still existed. And in New Jersey, my program director Yeah. Was on practice for a long time. Wow. And so. That changed very much when we came out. And so I think, I think it's just, it's fear. Just like with our patients is, is a driving motivator and our population in general. And so it's the same with physicians and we're used to a certain level of living and that's not meant to be a judgment, but I think sometimes we just have to say, well, what's important and

Dr. Maryal Concepcion: 18:49

mm-hmm.

Dr. Lisa Lucas: 18:49

And truth be told is you can make a, a fine living, working less and doing a better job for your patients.

Dr. Maryal Concepcion: 18:56

Yeah, totally. When you talk about better job for your patients, I'm wondering if you give some examples. I mean, I'm literally sitting in a very inclusive chair. I commented on that before we started recording, but it's like the, the way that you've built your practice, you've been intentional about everything that you've put in, how you've designed everything, when it comes to actual care plans, coordination, what are some examples of how you've done things in DPC that you could never have done in fee for service?

Dr. Lisa Lucas: 19:23

That's a great question.'cause I think that that is something that. A lot of physicians will respond to where I say I am board certified in obesity medicine. And I also am a do so I do osteopathic manipulation. And I also then went on to get a, a special a separate menopausal certificate because at the end of the day, that transition all happened because I kept talking to patients. Mm-hmm. And. Either I felt like I didn't have the exact knowledge, or I wanted some more framework, but I really, in the end just wanted more time. Yeah, because I, I'm a former chemistry major, a big, big old nerd. And I really like, I like the science of it all, and I think that very much rooted in evidence-based medicine, and I think that if we have enough time with patients mm-hmm. That they've, they appreciate that approach. I think unfortunately the Instagram influencer world that we're in is fast and easy, but really when you sit and chat with them for a while, they appreciate the comprehensive approach. And so here, I think I was just always trying to create and be the doctor I wanted. Mm-hmm. And I, everything down to, again, the chair you're sitting in and where are the children gonna go? Yeah. And that they can color on that special part on the wall and the toys that are behind me. Because again, I always wanted that. Mm-hmm. I couldn't even fit my stroller around the corner. It was so difficult. But when it comes to patients now, I mean, I very much focus on. Metabolic health. Mm-hmm. And again, now hormonal aspects of that.'cause you can't, not, it's part of medicine. Totally. But when I see patients either, again, that are direct primary care patients, but I do also do some separate hormonal consults. It's, it's a full hour of Yeah. Of a, a pretty comprehensive history and walking them through how all of it matters. Mm-hmm. And I want to hear their whole story and really showing them that you're feeling all of these things. And I'm sorry that you've been dismissed. I feel like some of it is we're doing a little bit of therapy when they come in, they've been Yeah, totally. They have been dismissed and they're frustrated and you have to build that trust back up. Right. But it's so therapeutic and it's so worthwhile. And then they very much are open to listen and understand and they know they're not being shamed here. This is, we just meet people where they are. So in our office we'll do comprehensive intakes. We do nutrition audits. We educate them on the physiology of obesity and, and sometimes, thin people have metabolic health issues, right? Sure, absolutely. So, so we're kind of teaching them through about all of these things and we use body composition and talk to'em about why this matters and why is this being suggested. And, and and they just, they're listening. Their ears are wide open. And I, when we see them come back after doing an intensive three month program with them, which we've started to develop some and see that they are happier mm-hmm. They feel better. They're sleeping a ton of non-scale victories, right. Where they just, they feel so good about themselves, they accomplish something. And they also lost visceral fat, which is something that is really, obviously we hear about that all the time with inflammation, right? The vapor inflammation, but, which is important, but this is consistency and support. Outside of direct primary care. There's just not enough time. And I'm lucky enough to have Emily as our registered nurse who is basically an extension and she, and I'll talk about patients and, and really meet them where they are and just really try to support them and she'll help coach with them and. It's just been amazing. Like I would never go back and when people experience that, they, they don't

Dr. Maryal Concepcion: 22:29

want to go back.

Dr. Lisa Lucas: 22:30

Yeah.

Dr. Maryal Concepcion: 22:30

It's, it's so interesting'cause I just recently, the future of family medicine conference happened and I was making a comment to one of the presenters about, how, how are you talking about lifestyle medicine in a fee for service dominant world? I mean, it's very interesting'cause I'd love to hear. How that's actually going to say it very facetiously and sarcastically. I literally am wondering like, how is that going? I absolutely firmly believe 110% what you're saying. I think that it is something that especially the. Medical students and residents are really waking up to. So on that note, I'd love if you could talk to us about what you're seeing on the ground, what you're hearing, because teaching is so much of like how you, how you exist in medicine what are the, the future generations saying

Dr. Lisa Lucas: 23:13

yeah, I think I, I've stood by this for, for years and I, I feel like it's finally coming true. I, I've worked with medical students and residents in, in every level. And I truly think that most people go into medicine because they actually do wanna have something like what we have here. They want to. Really get to know patients, especially in family medicine. They can see like we have actual relationships with patients. There's definitely some med students where this is just not for them. I get it. They want to do surgery or whatever it might be. Sure. But when you really talk to them, that is what they want. What they don't want is to be seeing 30 patients a day and doing chart audits and click in boxes. Right? Yeah. And so when they see that they're turned off immediately and then they hear things like, you're too smart for family medicine. And, but when you really sit down one-on-one and when you show them what it's like here. We've had a couple patients, actually we have a couple medical students and residents that have come through, especially because my partner is an ob, GYN, and so they're kind of doing the, oh, can I, how about I get to spend time with him and I get to spend time with you? And they do a lot of, what's the difference and why would I do this over, OB, GYN? And again, I don't ever wanna dissuade anyone there are a lot of people that really want to do family medicine with a focus on women's health. Mm-hmm. So we always say, if you want surgery, then you go that way. Right? But if you want, like there is a world where you can very much take care of patients Yeah. In this intimate way. And you don't have to go down that route. So I've recruited a few students, which has been really lovely. And then they follow up with me later on and say, I'm so happy I made this choice. And then they start asking me about my practice and how can they do that? And so I think it's modeling. Yeah, absolutely. So I don't unfortunately get to teach as much, but I am gonna start going back to our medical school that's now moved closer by and we're gonna start doing some case-based learning and chatting with them and showing them like we know a lot, we see a lot, it's not coughs and colds. Like we have very complicated patients and, and it's really fulfilling. Yeah. And I do think that's actually what they want, but we have to show them that it also is fun. And they're gonna like it. Yeah,

Dr. Maryal Concepcion: 25:09

totally. I, I love that.'cause even just when you say that, I think about the people who, even though it was fee for service, the attendings who loved their jobs were pretty much the people who have been generational doctors, like typical rural family doctors who are like, oh my God, we get to do this, I delivered their, there's their generation. And I'm like, oh my God. But it's, it totally makes a difference when you have something modeled. Also in alignment with your goals, what you think you're gonna actually achieve in medical school and residency. And I do, I encourage anybody who's out there, even if you're not a medical student or resident, if you're an attending who's has their own job, you can still call one of us and just say like, Hey, I'd love to know more. That's absolutely something that is happening all over the country, Tell us about just comments in general that you're hearing from people who are in practice and who are. Looking to DPC for a way out. I think about the fallacy that DPC is gonna cause a physician shortage. These are from people who believe that the fee for service system typically is not the thing causing the physician shortage.

Dr. Lisa Lucas: 26:08

Oh yeah. I think the system is causing a physician shortage. I think it's specifically causing a primary care shortage. Mm-hmm. It's, it's not fun. It's, it's miserable and, we are all too smart and we are all too accomplished and dedicated to be put in those positions. And I, I, I like to think that we are, that the society is starting to see that and that these alternatives are popping up and they're recognizing that this is the way it should be. But I've spent way too much time. I've missed way too many birthdays, way too many vacations firsts with my kids, right? Where I think I'm not gonna do, I don't have to do this. Yeah. And I think what's interesting is we get phone calls all the time from. Non-primary care doctors. And so some of these are specialists, right? Er doctors and, and different specialists that just say, how are you? What are you doing? Mm-hmm. How are you doing this? And, and truthfully, I hear in their voice some jealousy, right? Yeah. Where they're thinking, man, I kind of wish I did that. And so, sometimes it's possible for them and sometimes it's not. But you kind of hear them almost say, I kind of wish I had thought of that. And, and now they're stuck, maybe where they are or they feel like they're stuck. So it depends on the person. But I think that, there's just this opportunity to show that medicine in its bare bones, is just a beautiful thing. And, and people really enjoy it. And I think that if we can prove that, and honestly just by, just by doing what we're doing, you don't have to do anything else but just, telling whoever you can tell and letting them see you. I think that we're gonna show like, this is really the direction we need to be going in. Totally. We need more of us. We don't need as many, especially with right. AI and software and all these other things, like we need more people. With more experience with a broad breadth of experience to be able to really like, sit across the table from a patient and put hands on a patient. So we just, I, I think we're gonna win in the end. We're playing the long game in the end, right? Yeah,

Dr. Maryal Concepcion: 27:49

It also goes back to your comment on modeling. If you have, the model is that, oh, you don't do anything but just ai, whatever, or just hire a non-physician provider for whatever. It's like where is the knowledge going to go at some point? And so by modeling that, this is. A a very sustainable way of practice. And it's the, it's the desirable way of practice. It's not concierge medicine for people with seven figure salaries. That I, I am absolutely with you. And that this is, this is the way of the future. You have an interesting view of this whole ecosystem also because you are a medical director of a, of a plan that is a CA compliant that allows a person to have the DBC membership paid for as part of the insurance plan, which you, you and I have definitely seen the conversations online about oh. Which said DPC and insurance in the same sentence. So tell us what your, what your take on this plan, being very mindful of no one is wanting to go back to what we have right now and how when we're at the table, we can actually craft a different future

Dr. Lisa Lucas: 28:50

Mm-hmm. Yeah, I think, I think, your listeners are obviously a mix of people that are thinking about it and then some people that are already doing it. Mm-hmm. And I think after doing these for this for a while, I think what we're recognizing is that we have something really special. And I think the way you know that is by it's like directly related to the amount of phone calls you get from either venture capital or somebody who's got their handout right now. Everybody wants a piece. And what's beautiful about Direct Primary Care is we. Don't really need all of them. I mean, some of it could be helpful. Absolutely. But everyone is trying to kind of get in on the movement and so I think all of us are naturally skeptical. Mm-hmm. But I do also think that we know that we have a nice piece of the puzzle, but the puzzle, there's more pieces to it that need to be a part of it. So after a few years of having my own direct primary care, we have a good amount of other physicians that are here. And we were having a conversation about marketing and how do we kind of, maybe we collectively market and things of that sort. And I remember seeing an advertisement about tarot health and I was like, well, they said something about marketing, so let me just call them. And I ended up connecting with them. And that was kind of what they were doing. And, and to be fair, they were doing some market research in the beginning offering website health and, and, and it wasn't nefarious. It was just them really trying to understand. I never would've gone down this path if I had any feeling like they weren't genuine. Yeah. And so to this day, I stand by, I I would never do that unless they truly understood DPC. Yeah. But many people say, well, I don't want somebody else, selling DPC for me. And I completely appreciate that approach. And so I was very wary about it in the beginning, but. But I had wonderful conversations with them about, we're trying to figure out how to fix healthcare. And of course that's, that's interesting to me. And so kind of got my ear, we chatted a little bit and we talked about how people have always talked about, well, direct primary care is wonderful and handle about 80 to 90% of what people need, but what about a wraparound plan? Right? And so in Maine, we've. Sort of vaguely talked about, talking to some insurance companies, could we help them to create something? And, and, again, s skeptical, but still we need to figure out how we fit in. And my old program director used to always say this, where he'd say. If you don't have a seat at the table, you're on the menu. Mm-hmm. And so I remember very much calling that back and saying, well, I have this opportunity where these people who genuinely understand DPC and have spent years trying to understand it, want to try to do something different. Mm-hmm. Is it gonna be perfect? Probably not. Is it gonna ruffle feathers? Absolutely. But I think that if we are not there to help guide it, it will inevitably not represent us. Mm-hmm. And it will hurt us. So I went down this path of. Talking to our local docs. We have a pretty good density of, of primary care physicians here at DPCs here. And I said, well, I kind of was testing the waters. What does everyone think? And so we got enough people that were interested enough and it was a long process, we didn't wanna be told what to do. Yeah. We didn't want to affect our day to day. I said, I'm not doing a prior authorization. Mm-hmm. Right. All those things. And really, they heard everything we said. Yeah. And we got, we got some wonderful DPC lawyers involved and we did it all the right way. And we said, let's just, this is a, might just be a beautiful experiment. It might fail, but we're gonna give it a go. Yeah. And so Tarot Health started offering plans in 2022. Started just in Cumberland County and that includes this greater Portland area that we're in. And then from every year on, it has expanded. We're now now into four counties. And it's interesting, it's, what I think people don't recognize is now with this ability to collect data. I remember from the beginning saying, all right, I want us to collect data and say I need us to prove mm-hmm. Sure. That if we do a better job right. That there will be fewer admissions. Mm-hmm. And, and fewer higher acuity visits. And you don't often get an opportunity to talk to an insurance company about this. Because truthfully, in the end, we all know they don't have a lot of incentives to make things cheaper. And so they really were on the same mission of let's just give this a go and let's just try to see. And so now we're sort of in this process of trying to collect some of that data and. And sort of see how we can prove and we, we do have some data to already show what we already know. Yeah. That our patients are not admitted as much. Yeah. And we take better care of them. And so it's been a really, it's been a really interesting ride. And again, there are some people that do not think we should be working with insurance at all. But I would say it's been a really good experience. And could things be better? Yeah. But they're also great and our patients love it. Yeah. I mean, they love us, let's be honest. Right. But, but they also are then able to also get their colonoscopy and their mammogram and. And everything else covered. And if something terrible happens, a cancer diagnosis or something, ter, they still have, the ability to be cared for. So it's been interesting

Dr. Maryal Concepcion: 33:18

and I, I love that, how you're describing a wraparound plan, because that is precisely what it is. you're still Dr. Lisa Lucas at Fulcrum Family Health. This is where I think it's important for people to hear what you just said Insurance as we know it. Nobody is wanting that again, but insurance so we can actually help people achieve healthcare and prevention, especially when it comes to cancer screenings. Things are, that are too expensive ways to. Work with people to figure out can we lower the cost of doing this, surgical procedure, colonoscopy, whatever. Because I, I think that, like what you said is so pertinent, especially now, now that this HSA portion has passed the Primary Care Enhancement Act this is the time we have to do the work because this is a time where so many people are gonna lose access to healthcare because they think healthcare is insurance. And we have an opportunity to show up and to speak to how we can do better because we are already doing better. But how do we get this to more people? So I, I love, just the the transparency of you were, on guard, but you're also like willing to listen. It's a big place that a lot of us can benefit from being in. When it comes to your husband tell us about that, that moment when you guys decided to both be in direct care because I, I know that journey well,

Dr. Lisa Lucas: 35:02

It was terrifying, honestly. I mean, I, I am I'm my husband's biggest fan. I think that he has this really interesting history of education where he, prior to becoming a do was a chiropractor. And so he has this amazing understanding of anatomy, and I think at every level he's just been able to perfect that. And so then when he was working as an ob, GYN. He liked delivering babies, but he did sort of prefer surgery. Mm-hmm. And then he started recognizing that he, he had this interesting model of understanding musculoskeletal medicine. And then obviously, so he'll joke about that. It's like a. They say it's a what? A seven headed beast, pelvic pain. And it doesn't mean that to be in any way, except to say it really could be anything. We are very complicated. Yeah. But he understands musculoskeletal, the GI components, urologic all of it. Putting it together. Totally. And so when patients come in to see him, he is able to consider all of those options. It's not that everybody needs surgery, but the patients that he sees, he saw when he was, working that really got him to think, I really think I wanna do this on my own, is. Is the patients with endometriosis. Yeah. That had seen, 10 other physicians and, and it's been eight to 10 years before they were able to get a diagnosis and they're in horrible pain and he just would come home and say, I just feel awful for them. And, and unfortunately the hospital did not really support for him to do the kind of surgery he wanted to do. He does robotic assisted endometrial implant excision as opposed to just going in. And burning. Mm-hmm. Which, there's a bit of a discussion in that in the OB GYN world. But, but he's a phenomenal surgeon and he's like, I just feel like I'm not giving my patients enough time. Wow. I wanna be able to talk them through. He's very sensitive and warm and wants to do a thorough exam and they would just keep pushing them through. And when, when you have a partner that's unhappy anywhere, you wanna be supportive. And so I just kept saying, if this really means this much to you mm-hmm then we're gonna do it. If you think. It's not that important to you, then this is going to be a massive hassle and I'm terrified. But, but otherwise I said, no, I'm, I'm here for you. Like, You just, you say the word and I think, between a couple bad days and, and, and lack of support, I think we had some really good conversations. You said, I, I wanna do it. And so, yeah, it's scary. At that point I was up and running and doing fine, but crunching the numbers and thinking how are we gonna get insurance and how are we gonna make ends meet? But you know, I just, I dug a little deeper in my, in my budget and we, I said, well, there's no way I'm gonna let my partner just sit there and be miserable justice for us. So we just, you figure it out.

Dr. Maryal Concepcion: 37:22

whether it be financially or emotionally or both, like it's gonna affect you one way or the other because. Like job stress is real. And so, for anybody who's discussing this right now, in terms of with their partner, with their family, the, the implications of DPC your personal health and your family's health absolutely is, is a card that a lot of people don't necessarily name when they're talking about the finances of DPC and its impact. But therapy costs money too. And

Dr. Lisa Lucas: 37:49

And our decision was just, we made some sacrifices. And because it's a value. Mm-hmm. It's a value conversation again. Yeah. It keeps coming back to the same things of just, if it's important enough, then we'll do it. And, and, we actually started by trying to take insurance. I don't know if we've really talked about this that much, I kind of joke, but I felt like we were gonna go bankrupt. It was very, it was worrisome. And so I said, you know what? Like we, we tried, okay, we tried and we, we just couldn't make it work. Also realizing that we didn't have the right help, so we decided for him to go just complete direct specialty care mm-hmm. And to do what he does really well and we'll figure it out. And so he was able to build that. He's got a wonderful reputation. People know that he's going to give really wonderful care. And so, so we kind of went down that road and then we went and found some help, and now we have a fractional CFO that helps us, and answers questions and, and he may or may not take an insurance here or there. We're not sure yet. We're kind of testing the waters. I think it's important just to keep checking back in. But, but overall, I think he, he truly wants to be able to, as long as he can do the surgery the way he wants to. Sure. And take care of people as he wants to. But he's been doing great. Yeah. Literally teaching hospitals how to do it because. CMOs of hospitals don't understand how they get paid. It's, it's interesting. So don't doubt yourself, because you probably know a lot more than the people that are making big decisions for you.

Dr. Maryal Concepcion: 39:03

Amen. And I just, I, I hope that that also, especially for any listener out there who's felt devalued because, a non-physician provider, an AI bot is the same as a, is treated as the same as a doctor. I do hope that that just gives you a little bit of, boost in your day because ultimately it just, it goes back to what we were talking about before. The relationship is driven by the human connection and not by the code connection. So this is, that's wonderful for people especially who are surgical specialists also to hear. So when it comes to. You and your husband now, being contacted a lot in terms of like, how did you guys do this? Your, your partners and medicine partners in life. And you're also, looking to expand the offerings that Fulcrum Family Health has as well as your husband's practice. Any words you'd, you'd like to share with the audience when it comes to how, how to learn how to do DBC? Because there's lots of resources out there, lots of podcasts, but when it comes to talking with someone, what are good questions that you recommend that people ask when it comes to is DPC right for me?

Dr. Lisa Lucas: 40:10

Yeah, I think that there's the obvious logistical questions and I think a lot of those you could get answered with a local group. Mm-hmm. Right. And so getting, just getting in touch with and looking around to see if there is a local group around you and a lot of direct primary care physicians are happy to talk to you about the basics. What are the laws in your state? In Maine, one of the reasons we have a big identity of, of direct primary care physicians is because we have legislation that was. That was put forth by our predecessors that did this first, these pioneers that said, no, we have to make sure that insurance companies cannot deny our referrals even if we're out of network.

Dr. Maryal Concepcion: 40:41

Yeah.

Dr. Lisa Lucas: 40:41

And so there are states that have a bit of advantage, and so we are lucky to have that. And we, but we still get those basic questions all the time. So I think first is making sure you just tap into that network. I, I would argue, I think that the biggest issues are, does this, does this make sense for me? Do, is this the way I want to practice? Do I want to handle business or not? And so. I have now I have a physician that works with me. She's employed and she's a great friend of mine Dr. Joanna Rolf. She kind of was. She was here for the whole process. She watched me with the idea of it. She came to my first location when I was first looking at it, and she, I bounced my ideas off of her. What am I gonna call it? Where's it gonna be? And so, she was watching from afar and for her, it just wasn't right in the beginning. But at a certain point, she hit the same part of her life saying, I can't do this anymore, and wanting to be present for her children. And so, when we had that conversation, I said, Hey, I'm happy to help you to do it yourself, if that feels like what you need. I also think we could find a way if you wanted to join. And so her decision was to join. Yeah. And that's just a personal choice, I think It just depends on what you're thinking. And so we've designed it around that. Other people have called me just saying, what, what are you doing over there? And, and how do I get involved? Former residents of mine just from out of the woodwork and it's wonderful. And so sometimes I have this conversation with them too. It really depends on what feels good for you. Yeah. And this is, it's hard. It's, I'm not gonna lie, it's hard to run a business. You have to have that enough passion and have that mindset. I, I'm a bit analytical and I like it, that's okay. I told you I'm a nerd. It, it's just the way I like it. But some people just don't wanna do. Payroll and staffing and some of those things to, be able to have a, a practice. And so, so some of those people are interested in maybe like an incubator model where we have them come through, they could build up a panel. Mm-hmm. I don't ever wanna have a restrictive covenant with anyone. I want them just to feel free to practice medicine and it feels like a good relationship for both of us. And then at some point, who knows, we either open another location or they go off on their own. But I think it's important that there are. There's availability, there's access, there's opportunity all over. And you have to think about what do you want your data to look like? Yeah. What do you, how do you want this to be structured? And you truly do have that choice. You don't have to do anything because someone else says you have to do it that way. I think it's important to the emotional component of DPC. It's, it can be heavy and, but also really amazing. And so I think that you just have to sit with yourself a little bit and be like, what do I want? And then. And then tap into those resources and then think about the finances. And truth is, anyone can do this.

Dr. Maryal Concepcion: 43:09

Amazing. Well, thank you so much I appreciate you, talking to the audience about everything you have, especially when it comes to how we can really truly be present to craft our future of healthcare in this country. Thanks so much for having me. 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.