Celebrating Five Years of DPC: Growth, Challenges, and Community Impact

In this special "My DPC Story" reunion episode, host Dr. Maryal Concepcion celebrates FIVE!!! years of transformative Direct Primary Care (DPC) journeys with guests Dr. Christina Mutch, Dr. Jake Mutch, Dr. Lauren Hughes, and Dr. Deepti Mundkur. The episode highlights major practice milestones, such as expanding clinical teams, launching innovative community outreach programs like Walk with the Doc and Sweat with the Doc, and integrating technology advancements including AI-powered EHRs and Open Evidence for patient care and education. The physicians dive deep into how DPC’s small-batch, personalized care model enables stronger patient relationships, efficient specialist coordination, and improved health outcomes. They also address current challenges in healthcare access, vaccination, and navigating insurance headaches, sharing actionable solutions and resources for DPC physicians and patients. This candid conversation is packed with DPC success stories, advice for aspiring providers, and tips on leveraging technology, supporting both new and established DPC clinics. Discover why DPC is redefining primary care and building healthier communities nationwide!

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Transcript

0:50

Hey there, my DPC story listeners, I'd like to let you know that this episode contains some sensitive language. If you have little ones nearby, please use discretion.

Dr. Maryal Concepcion: 1:02

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. this is incredible how fast the last year has passed. We are already celebrating year five of the practices that we are highlighting today. And if you are new to the podcast, please start by listening to the first 10 episodes of the podcast where you can hear the, NIUs of all of these physicians. We've been so fortunate to have them share their stories at year one, year two, year three, year four anniversaries, and now year five. So welcome back to the podcast everybody. Thank you. Thank you. And if you wanna see their amazing faces, go to YouTube for sure. But you know, I was just listening to, as I traditionally do before we were, we do our annual recording, I was listening to your guys' updates from last year, and DP C has changed for all of your lives in terms of one more year under your belt, but also this country has changed in the past year. So we're gonna be talking about that. So I would love if we could start with updates as to what's been happening. So let's start with Defiant DPC, Dr. Jake and Dr. Christina much are here today, and they're going to be talking about what's been happening at Defiant.

Dr. Jake Mutch: 2:56

So super exciting. Over the, the past year one of the things that kind of just happened again by happenstance is we ended up hiring a fourth doctor up to the practice. So it's the two of us, plus Dr. Eileen and now Dr. Derek. And and that has been wonderful. That was earlier this year. And so we've just been kind of getting all of the protocols that we had set up when we were hiring Dr. Elene.'cause that was a kind of a huge thing to undertaking to figure out. We kind of use that same sort of launchpad and those like that to-do list to help make it a little bit easier for the next time. And now we're fine tuning that because we're kind of getting mus from other doctors who have reached out thinking about something similar. So we're very excited about that. We also, just recently, a couple weeks ago, we hired a nutritionist slash wellness coach as what we're kind of putting as a a wellness guide, so to speak, to help bring the, like our vision for what primary care is. So, longevity forward doctors, unparalleled care coordination, but then also having. A wellness professional to help guide people who really want hand in hand service. And so, we'll have a, a wellness membership. There's a, we've just bought a bio impedance scanner as well, and so we're gonna be doing some more detailed measurements for the people who want that really high touch specific tracking. So very, we've expanded our operations team as well. And so, we're kind of getting the crew bigger and just trying to make sure that we're all staying focused on trying to deliver what we see as elevated primary care. So, super excited. Lots of stuff happening. It feels like it's all been happening very, very quickly. But we're excited.

Dr. Christina Mutch: 4:25

I would say the only thing I have to add is that we've expanded our community outreach a bit. Yeah. So we, we started Walk With a Doc now, oh my God, two years. I think we celebrated our two year anniversary this year. And we've expanded that to kind of doc talks around town to different fitness studios to kind of, again, in a day and age with so much misinformation. Oh, and. Resource overload, kind of just taking it back to grassroots and being available in the community. And those have been really well received. And, and I can tell that the people there, really have appreciated it and they're just on basic prevention topics, but they just don't get that time with their doctors and they may not be a patient of ours. So it's like giving them that time to ask questions and dive deep on some preventative topics has been really fun. And then we've also expanded our sweat with the doc series, which is basically where we take our patients and make partnerships with different fitness studios to try different exercises together and just kind of, again, trying to get everybody to find their exercise home. And it can be really intimidating. So we get to look silly with them. I tell them. And so we're doing Tai Chi this weekend. I've never done that before. We've done Pure Bar, we did orange Theory, we did yoga. I feel like I'm missing one. But yeah, it's been really fun and the patients have really loved it, so it's just been a fun way to kind of, I think we're trying to find ways to build community outside of the office.

Dr. Jake Mutch: 5:40

Yeah. Oh, and Christina got menopause uh, certified as well too, which is awesome. And so we have a lot of patients asking about that and so it's nice to be able to kind of pull those resources together and talk about, challenging cases or the best way to move forward with stuff. Absolutely. Love it.

Dr. Lauren Hughes: 5:54

your pause before certified, I thought you were just like, Christina got menopause. I know. I don't think that's your

Dr. Jake Mutch: 6:06

No, you're not dealing with top bras when you're talking to me, that's for sure.

Dr. Deepti Mundkur: 6:09

Oh my God. I thought I was like, sorry, Christina.

Dr. Jake Mutch: 6:14

Not yet. I'm certified. Certified.

Dr. Maryal Concepcion: 6:17

Happy wife, happy life. That's hilarious. Not today. So we're dipping our toes in, and I have so many questions to follow up with what you guys have already mentioned, but let's turn it over to Dr. Lauren Hughes at Bloom Pediatrics and lactation. I would love to hear your update as to the things that have happened in year five for you.

Dr. Lauren Hughes: 6:37

So I, now I, my third doctor is starting on Monday, which is just wild. Still have no staff, still holding strong with no staff. And it's been really fun. I, my social media has, has gotten I kind of like this platform now and I get to like talk and I get to educate and it's opened very unexpected doors. Anytime I talk about DPC or I'm like, Hey, this, guess how much an x-ray is 30 bucks without insurance. And I do that anytime. People are like, excuse me, I have good insurance and it costs me three times that much. I'm like, well, good insurance is an oxymoron, so, Hmm. And, and so I, there's a lot of just like education about people didn't even, people not knowing that they could ask for a cash price at, at, at specialties. Or, or, and for imaging or for labs, not knowing that that is an option. Giving examples of I, here is how d this is how DPC saved this patient money. A lot of education around like other direct care clinics and like how to become what what we are is a Medicaid ordering, preferring prescribing providers. So like we conceive Medicaid patients, Medicaid recognizes our orders, we just don't bill Medicaid. So it's there was a lot of well, what about those kids? And it's no, we actually have a, a gap coverage for that. And so that has been really good. I do every year I do a community fall vaccine clinic because people are really scared of vaccinating kids and so, that has been. Interesting to figure out this year. And and so it's been really helpful that I've was able to talk with like my Pfizer rep, with my VaxCare rep, with all of these different people on, on how access is going to look. And luckily for us this year access is looking equivocal to previous years. I just have to click one more button. Fine. And so that I, that's something I always do, which I think is really important for people to understand, like the importance of, of vaccination, the importance of, of like herd immunity, protection, that sort of thing, but also just as a like, free way to, to provide that to kids and get more kids in the community protected. And like kind of going along with the vaccines is that I, I've had. I can't even count the number of messages of people that are like, thank you for continuing to talk about this and continuing to debunk. I can't, dozens of messages of we were scared to vaccinate. Now we are. And that's been really wonderful. I even had someone from, where was it? They were stationed in the uk and it was just, it like, oh, it got me. She said, just thank you so much for sharing your knowledge, your work matters and has made a positive impact on my family's life. And just like that sort of thing of me yelling at my phone is making a positive impact across the world. What it's just, it's wild. And so it's not even like just my own community now and I just. That's so cool. It's so

Dr. Maryal Concepcion: 9:41

cool. It's so cool. And I just, I think it goes back to even when you opened your practice, all of you,, you probably couldn't have seen this coming. Nobody could have seen what has happened in the past few months happening. But what I will say is that, it really it really builds on why you guys started practicing and the doctors that you were before opening, and the doctors you are now. So. Dr. Mco, I would love to hear about what's happening at my Happy doctor, because one of the things too that you were part of this year that wasn't in in existence prior was you were part of the California DPC Summit. Yes. I was gonna mention that set of speakers. Yeah. And so, community, I, I've definitely boots on the ground wise have seen the impact that you've made in California, but I'd love to hear what's been going on with your practice and your community.

Dr. Deepti Mundkur: 11:53

Yes. So I think I took your advice from, Jake about raising his prices and actually seeing a great outcome. And I did it and it worked great. I feel like I went from being a cheap doctor to a rare disease expert. It's just incredible how money is, your time is valued and money kind of defines how your practice might be. It made a huge difference and I'm so thankful for these get togethers we have every year because it teaches me so much. Even though it's not, we are, we are so different in many ways in how we practice and like how we grow our practices. I just feel like there's the common theme of community wellbeing really being like. Providing personal care, personalized care to each patient and valuing each patient as a person and not like a number that they usually experience in the, in the healthcare system that we have right now in with the insurance model. So one is I become a rare disease expert. It's crazy because I feel like over the five years there were a few patients I've accumulated maybe early on, and it was very challenging to get a diagnosis and like I had to go to Harrison's textbook medicine, which I had time for because I have a DPC. And so in general, I feel like it reached it was very interesting to see how things culminated into finding a mitochondrial disease expert and navigating that and just making connections through other patients', family who are genetics experts and like trying to bring the community together to help me help my patient. And that has been incredible because now with that. With that scale at which I'm able to connect with the community. I have so many connections, like a massage therapist who's massage, and a like, how do you get these people? You just have to be out there and reach out to the community, find these people. And so when I, when I was able to connect to this mitochondrial disease expert and then they told me the usual timeline for diagnosis of this takes about 10 years. And it's crazy that you've come to us in two and a half, three years. And for me it was hard to even believe that two and a half to three years is the timeline for diagnosis. But anyway, so that's been great. Success. It also with my pickleball, I've been up and about everywhere playing pickleball and we went to this one location and the mayor of Escondido. Not San Diego, but Escondido, which is a neighboring city was there and he had never heard about DPC and I was able to share it with him. He is, people with different political views, but having that common theme of, I need care. He was not happy with his care. He was being sent around and I'm like, you're the mayor. And it was interesting to see that he had never heard of DPC and he had never heard that this is something doctors do. They all know concierge, but they, there's, this kind of personalized care. So that was very interesting. Also connected with more doctors since the DPC conference. So they reached out for, just figuring out how to get started. And that's been great to just share and give back. And then I've read a lot of books lately because I have the time and there's this one book I have to share. It's called a, a Well Lived Life by 103 year old doctor, and she's, she's a white doctor who lived in Arizona for the longest time, but she was born in India and like she actually spent years in India. She even saw Maha Ma Gandhi. It's just incredible. I found that book and I shared it with everyone I love because I think she speaks about the true care DPC tries to give with connecting with another human being. And it used to be like that with doctors who are now 103. So, it's, it is great and I highly recommend that book, but that's pretty much, that's pretty much how I've been just, just so happy that I chose this path.

Dr. Maryal Concepcion: 15:56

One of the things I wanted to go back to is Dr. Jake much had mentioned this in the very first episode you guys did about Defiant this idea of small batch practice. And I'm just wondering if you guys could all talk to us about how even though you're five plus years in you've, grown in some cases with multiple doctors grown in terms of more community members, more physician community members reaching out to you, how do you guys still view the quality of care that you're able to deliver and how you actually do that, even though you might have more people in your DPC ecosystem locally

Dr. Jake Mutch: 16:31

I would say that small batch in my mind still means a little bit more proactive. A little, we see people a little bit more often. We're talking about longevity forward stuff. I saw that outlive book. Yeah. On on Dr. T's shelf. Like we use some of this as a framework to help bridge that gap for patients. But we know that no matter what the, the physician curriculum or what they're going through, patients no matter what that looks like, ultimately there's going to be. Stuff on the back, there's gonna be obstacles, roadblocks that need to be paved in order to connect the dots. And so we realized in our area certainly with our I guess, some of our specialist conundrums, we've realized that oh, no, no. Part of what differentiates us is all of the wonderful work that our operations and clinical team does on the background to make up for the shortcomings of the healthcare system. And that's something we're extremely, I mean, it lights a fire under my butt, like you wouldn't know. And because it's so disappointing and to get it wrong is, is often to miss cancer or to delay diagnosis and nothing pisses me off more. And so there is, there's that part of it. And then trying to make a good experience for patients, for sure it doesn't require sheet rock and waterfalls. But we wanted to make sure that it was a good experience and that there are some people who have, who want kind of that, physician care coordinator, but also a wellness professional too. And we're working out and devising what that looks like in the future. We're kind of seeing like the shape that that's taking. So that's how we think about spread care. Even though we're scaling the team, we want to keep a very small field where everybody has people that they can trust and it doesn't feel anonymous.

Dr. Christina Mutch: 18:33

And, and I think just building on what Deepti said earlier, you know about the, her finding the mitochondrial expert. It's like we are, we are curating handpicking specialists for people. We're not just sending'em to whatever cardiologist is in our system. When we click a little box, it's no, no, no. Who's the cardiologist that a specialist on X, Y, and Z? And we'll also their personality will match you. So you'll have a therapeutic relationship and I know you guys will have a good thing. And so I think that is one of the ways we keep it small batch is like the, it is not cookie cutter, it is personalized. And I kind, I know not to knock on concierge, but I feel like insurance-based world is cookie cutter, insurance-based world and some concierge practices run a cookie cutter, but expensive.

Dr. Jake Mutch: 19:10

Yeah. And

Dr. Christina Mutch: 19:11

everybody gets full body MRI and everybody gets a gallery and everybody gets X, y, z. I'm like, that's not personalized. You're just, you're just a cookie cutter in the opposite direction. And what delineates us is that we are personalized for the patient in front of us and we're not gonna take so many patients per doctor that we lose sight of that. And that's really important to us.

Dr. Lauren Hughes: 19:28

Very similar to what Christina said I'll give you an example. I had a one month old that was just in for a well check and I was doing his vitals and I was like, huh, your heart rate's high. So I just left the monitor on and I was like, okay, we'll feed him, we'll get him to calm down, wouldn't come down. And it was like, not SVT high, but it was, it was, and it just made me feel weird. Like enough, the, the doctor Spidey sense, I'm like, I don't like it. So picked up my phone called the cardiologist, called Ped Cards and I was like, I'm sitting here with this one month old, we're staying in the one eighties at rest Room's dark. He's calm. I don't like it. What do you like it? I don't like it. And he was like, yeah, send it down. I'll call the office, gimme the last name, we'll put a Holter on'em, and then we'll give him a call in a couple days. And this is an insurance based cardiologist, by the way. And just things like that, that I can, you just can do things better. The, and I maybe, I don't know if this is true in adults, but impedes, you can just call and consult with specialists. And, and so, I had a kid with an elevated blood pressure on multiple well checks. And so I was called nephrology and I was like, it's not like enough to be anything, but it's something, and he was like, yeah, get him. No one ever calls about elevated blood pressures. Yes. And ended up having some like kidney issues. And so similar exactly what you're saying. Like you look at the patient in front of you. And like you, you were able to figure out okay, the, the one month old, they're getting ready to go on vacation, and it was like a big vacation thing and I was like, and they were driving, so I was like, okay, that way you can on your way home, put the Holter on, they can monitor. They got'em set up, was able to go on vacation. I was texting and calling and then I was like calling the cardiologist and reporting back and you're able to do this. God, this really, what you, what I imagined at six when I was like, I'm gonna be a doctor and help people like this is it, it is what I'm doing. It's cool.

Dr. Christina Mutch: 21:28

So cool. It's like special treatment for everybody, right? It's like everybody gets the It's what I would want for everybody. Exactly.

Dr. Maryal Concepcion: 21:35

Exactly. Yeah. You're like bit biting at the chomp. So go in, go in, just dive in. Oh, right.

Dr. Deepti Mundkur: 21:43

Well, I think this is so cool like this over the years connections with all these different specialists, but you can just text them. I go visit bird conservatories with these doctors because I'm just like, you are cool people. Let's just go hang out. And then they ask me questions about internal medicine stuff when they have a patient who's coming in for a year thing. The ENT doc was like, oh she also has a brain tumor. Like what do I do with this? And so it's just very interesting how we could actually help each other. It's not just one way. And I send gifts to these people whenever they help my patients. Once in a blue moon, random surprise. What do I do? I usually send those all those dipped chocolate dipped strawberries and stuff that they can edible arrangements.

Dr. Christina Mutch: 22:28

Oh, that's my go-to too for all her like fitness studios. It's

Dr. Deepti Mundkur: 22:31

awesome. It's like kind of healthy, but kind of, kind of treat. So I do that and then it's just like, all these doctors find it so convenient to communicate. It's not like they, hard, hard or like they're trying to just please you and stuff. It feels very natural after a while. And so there's just like Lauren gave examples, I feel like there's one who, she was just struggling. She's a psychiatrist, child psychiatrist who by the way, a lot of doctors have become my patients. It's just I think doctors are just so, so, fed up and the, the most burnt out profession. So she was, ketamine for depression. Like so many complicated things going on. And I just listened to her on the meet and greet and I said, you need a rheumatologist. I texted a Dr. Zach Fellows and Carlsbad. I texted him. I was like, I'm sending you a patient. I think it's room. And he is so good that he's not the kind of specialist who will say oh, not my territory. Go find somebody else. He was like this seems hematologic. I'm like, great. Okay, good. So he is one of those few doctors who's like really good internist too. And I think it's so hard to find, like Christina was saying, you want to find a, you wanna cherry pick a doctor who actually cares, who's a specialist, who cares, who doesn't wanna say, oh, this is not my, which is I'm seeing, which is what I'm seeing a lot actually these days. Oh, this is not room, sorry, go find somebody else. Not my problem. And I think those kind of specialists are the ones that have burnt out within the healthcare system. And they just, I would've become like one of them just referring out all the time. And is, it's such a sad way to practice medicine because you did not become a doctor to just refer out. And, and I think all those examples you guys gave kind of really give me, you, me remind me of the same experience I'm having with my practice. It's like I just texted a neurologist because I saw like a one centimeter cyst in the right parietal hemisphere of one of my patients who has balance issues. But she also has parts that I'm like, well, the parietal hemisphere also has balance. So do I do anything about this? Because I don't wanna freak out and send her to a neurosurgeon. And then they, just having that conversation with the patient, she trusts me. It wa there was no crying. You know what I mean? It's so much easier when you know your patients, they know you and they know you will do anything to make sure that, kept safe. And I think that's why he, he just texted me and he's ah, it's okay. It doesn't look like that would cause those symptoms. It seems like that might be parts, but, keep an eye on it. And she didn't even have to see him. And this is a free concert. Like I'm, I think the community you give to gives you back. And, and that is such a big example in five years of practice. It's a really short time to have that.

Dr. Maryal Concepcion: 25:32

Amazing. So I will put out a challenge here for all of the listeners because as you guys are talking about people who we all can picture, our specialists, our go-to people that we love talking with, I will say that this is one of the reasons why I had created the DPC directory. So the dpc directory.com, if you have a specialist who you love, please encourage them to create a profile. It's totally free to start. And what it enables is a place where these people can be. Visible to the rest of us and not based on what your Facebook algorithm says. So I definitely would say to help empower us with pairing with the good people in our ecosystem or the good people who are helping our DPC patients, please encourage them to grab a profile. And then the second thing I will call out is I have created a patient facing, excuse me, a patient facing mapper of physician-led DPC practices. It's at caring directly.com. So if your practice is not on there and you are a physician-led clinic, especially the specialists, go on there because as I'm recording patient stories, this is a whole separate, separate. Stream than my DPC story. When those come out, there is a mapper that, this is what I'm talking about on caring directly.com, where patients can go and find you as DPC doctors, but also specialists. Because if a, if a, if one of us doesn't necessarily know, Hey, I, I don't necessarily know a mitochondrial specialist, but I found a mitochondrial specialist on this map and they're licensed in the state that I am I, that my patient is in, that's a way to help each other also. So I definitely would say the dpc directory.com and caring directly.com. Please add yourselves to those resources because those were built as, as I realized people needed more resources from interviewing everybody on the podcast. And those are just out there live right now. So one of the things I wanna. Turn to is we talked a lot about tools and technology and AI and definitely over the past year we've seen more and more come out. Open Evidence is my go-to place now for You can even create Yeah. Everyone's yes you can. And if you have not just pro Tip, you can even say create, please create a patient handout for Sprain Ankle and it will literally do it for you.'cause I used to have to put my open evidence stuff into chat GBT and now that's not even a thing. But I would love if you guys could talk to us about how your electronic health records are functioning. We just had the results of the Battle of the EHRs come out. And it was very interesting to see the results from the community, but also, AI has, like I mentioned, just continued to blossom. So I'd love if you guys could share with us about tech at your practices.

Dr. Jake Mutch: 28:09

This is definitely a fun one. For me, this is my like nerd alert. And it's because I love like trying to optimize workflows and just looking back at like how we tried to handle all this stuff when we were first starting the practice versus the technology that's available right now. I mean, it's just unbelievable. Now you've got the AI scribes or we'll do like an AI dictation, upload it into the chart, have a note done in, in just a few seconds which used to be, quite, a burdensome operation. But it's also wonderful because sometimes you can ask AI with our EMR like questions about the timeline from years ago where it was like, Hey, they've been having a lot of urinary tract infections. Can you like summarize the, like all the urinary tract infections, what antibiotics were given, what things were isolated from the, from the culture of sensitivities and just B-B-B-B-B-B-B. And that, that makes it really easy. And then it's also wonderful because when you were trying to generate a referral or pull together a coherent timeline from now, we've had patients for so of them for five years, sometimes you really have to go all the way back. And that can take so much time to save them time once they get to the specialist appointment. That requires a lot of backend coordination to make sure that we have a compelling narrative for what happens. So they don't just get to the specialist office and the specialist office says why you're here. Sometimes they don't read our notes anyways, but we stop referring to those specialists. But it, it's very nice because it, it can, it's almost like having a really good intern or resident giving you a report on what has been going on with the patient, the texts, the emails, all of that stuff so that when you get there, you're fresh, you, you've, you understand what's happening with the patient and these people that you've known for so long, you're ready to move on with the next step. So it saves a ton of time from, from that perspective. We definitely use open evidence. That has been extremely helpful as well to whether it's, every now and then for patient education, that kind of thing. But it's also nice to to, help summarize or, or think about a case in a different way. It's nice to get updates on what the newest stuff is, if there's anything we need to think about. And you can also like, for, for, a, a lot of times there were like if you're trying to, there, there are some like radiology guidelines that are just difficult and onerous to access. I'm like, I know what this I know where we need to go. It's just gonna take 40 clicks to get there. Being able to outline a patient condition and then say, this is what the, this complicated MRI finding showed. What is the typical workup? What other things should we think about? You're like, at what point do we do X, Y, or Z? What are the regular guidelines and when do those differentiate? Like, all of those like, complex questions that would've been like waiting on the horn to get a call back from a specialist or like doing an e-consult over a couple of days. A lot of that stuff has been replaced by, by having quick access to the data you actually need and the fact that they're integrated with like medical journals and you can pull up those journals as well instead of like random hallucinated articles from that really that really. Really helps. And so, that has completely changed what we do because we used to give like research to our clinical system be like, Hey, help us out. Pull all of these articles. Like she was, she was our chat bt And so, and now it's oh, we, we don't need to do that. And the more of that, that's easy for the physician to actually do that means that the team can focus on all of the other difficult nebulous care coordination stuff. And it helps keep our team kind of close knit as, as opposed to, having to completely destroy o overhead with payroll for, for things that don't require that they just require a better use of technology.

Dr. Maryal Concepcion: 31:32

I will make a point here that open evidence is free. All you need is your NPI. And I will say that if you are not, if you ask, if you query one question you can set the toggle button on. So open evidence will prompt you to send you if there's an update on whatever question you looked up, as long as you have one question in the thread. But yes keep going guys.'cause this is also my jam.

Dr. Lauren Hughes: 31:56

I mean, I would just like the technology that allows me to see mitochondrial challenges in an airport

Dr. Maryal Concepcion: 32:01

while we're at it. Your, your face is so straight. I was like, oh, was that, oh, it literally took me a minute there. That was great. That was really, that was a good one.

Dr. Lauren Hughes: 32:11

In peds, our patients don't have the extensive health history. So it's if you got a febrile UTI, you're seeing a nephrologist. So. It's not as robust in the peds world. I ha my EHR has the ability, and I've used it a couple times. It's quite judgy. If you can imagine, I tangent in my appointments and there was one that I was like, I wanna try this. The mo parents were doctors and I was like, can I try this, this AI EHR assistant whatever, scribe. And somehow me and the dad got talking about facial symmetry and like the concept of attractiveness and like equal symmetry and like what celebrities have really, I don't know how, I think it was about plagiocephaly, I think was our transition period, but the AI was said, doctor and patient became went off script or like something and it was so judgey about that they talked about irrelevant topics and it was like, Hey, Brad Pitt's face is relevant here. Like

Dr. Deepti Mundkur: 33:22

irrelevant topics.

Dr. Lauren Hughes: 33:23

That's so rude. I don't think it, it was so judgy that I was like, ah, how dare, and the problem is like in pedes. We can't just do standard soap, like our well checks aren't soaps, it's developmental milestones, it's M chats, it's ASQs, it's smoking, it's vitamin D. There is specific targets that like, not for metrics and insurance that I need, but like for healthcare that I need. And then AI just yet, yet cannot go through and fill in my template and I have to phone my demo or I will go off talking about Brad Pitt's face and like never actually get back to the point of the visit. And so for me it is not as helpful and it is mean, but I have used it. I use open evidence constantly. I love open evidence. I, every time I use it, I'm like, sorry, planet. But like I am big fan. And, but for our EHR. Again, it's like not, I act like none of it's really specifically designed for pediatrics because we are not, we are not the money makers in any aspect of medicine. And so for EHRs, the only ever pediatric specific EHRs I've used are like so stupidly clunky and click heavy. And like I just, so I would rather have a very streamlined EHR that I can figure out pediatric workarounds than like a pediatric specific EHR. But like again, outside of open evidence, tech ain't, and maybe that's just my old laziness. I bet it could be super helpful. I bet it could. I just refuse.

Dr. Christina Mutch: 35:07

Can I just add onto that, that I, I don't think AI scribes are meant for DPC world because oh man, we talk too much.

Dr. Jake Mutch: 35:14

Hell no. And

Dr. Christina Mutch: 35:14

so that's why Jake started Transcr, like dictating his note and then just having AI be the transcriptionist.

Dr. Jake Mutch: 35:20

They were getting lost in the weeds. He was

Dr. Christina Mutch: 35:21

getting lost in the weed. We, because we we're talking my Well, did you get the house? Were like, yeah, exactly. Exactly. So I cannot function. It's like this, this is too much. And the better your prompt is, the better it gets at scribing it. But that takes so much time that I, I just haven't gone there. But I like that it has that, that add-on option at least.

Dr. Lauren Hughes: 35:41

What's that? It changes literally every age. So that just seems like way too much work.

Dr. Christina Mutch: 35:47

Yeah, I know. I'm like, I'd rather just type about and I

Dr. Lauren Hughes: 35:49

have it like now that I

Dr. Jake Mutch: 35:51

can just send it in via telegram. See

Dr. Lauren Hughes: 35:54

I have all my F two like wild cards and I have my prefilled common answers. So it's a note takes me 30 seconds.

Dr. Jake Mutch: 36:01

Mm-hmm.

Dr. Lauren Hughes: 36:02

Unless something is wrong, in which case then I do get more detailed. And a lot of times I'm so focused because in DPC I'm not, I'm gonna be like, okay, your 10 review systems, I can sit and I push the computer aside and we talk. Mm-hmm. And so then at the end then I'm gonna go through and summarize because maybe the information we talked about was relevant, maybe it or maybe not. And, and so I myself, with a quite extensively minuscule attention span is like I can't even read through my own weeds of like my talking sometimes and I just need the bullet points.

Dr. Jake Mutch: 36:36

Definitely

Dr. Deepti Mundkur: 36:37

I do have an EMR, which works with AI and for transcribing. And it does gimme summaries. But I do have to go back in and edit it because like you said, yeah, we talk about other stuff and it does a good job. But sometimes I think it confuses me to be the patient because patients ask me how I'm doing and I'm like, yeah, sure. I'll tell you everything about me. And they're like, oh, patient is reading this book. Patient is,

Dr. Lauren Hughes: 37:06

yes. What the heck? I'm like, oh my God, my sciatica flaring. And they're like, patient essay. I'm like, no, they're two months old.

Dr. Deepti Mundkur: 37:13

See? Exactly. And so I think it's useful to just make it easier where you don't have to type everything from scratch and then you can just go edit. But also on my phone front it's anti-tech. I'm like, I. Time limits for websites, time limits for browser, no social media on that. So you might have seen, I'm a little quiet on social media. It is just, I am living a simple life. I've become a mountain girl, even though I live in San Diego. It's there's mountains here, guys. And then there's lots more birdwatching and all these other things. So I feel like technology is like a, you just gotta use it the right way. Use it exactly for what you need, and then say buy, because it's, I'm, I'm needing artificial tear drops, guys from screens. This is like after getting rid of social media and stuff, just because there's so much tele appointments and, and you, you look at your phone because there's like a text from the patient and stuff like that. So there's always gonna be stuff, the technology that also can be negative. And I just feel the fine balance is, but I totally love the AI thing. I use it every single time with every patient. It's just not perfect. And so, we just have to work around it. Yeah.

Dr. Maryal Concepcion: 38:34

I love it. And I, I am the same way. Our AI scribe, just like Christina's mentioning, is, is literally dependent on how the the level of detail is set and how your prompt is set. And so I do think that also, this is a, a, a recommendation for everybody if you have good prompts, depending on your specialty, whatever. This is the type of stuff that we could share amongst each other so that, it's, it's not having to redo the wheel, but I totally hear you. That, that getting the finesse of, the, the prompt so that it works for what you need it too is definitely an ongoing challenge at our practice. So one of the things I think about, especially because you guys are now going into your six I think about there's a lot more people in this movement, a lot more people interested in this movement, medical students, pre-meds, even residents. And I'm wondering if you guys could could talk to us about common questions that you're seeing from them, especially fears about DPC, but also how you're answering them peppering in your ability to balance your livelihoods with the, the practice of medicine because you chose DPC.

Dr. Lauren Hughes: 39:39

Ooh, I can do this one. I take students I like, and I talk about this probably every day with them. I will come back to you. Patient's calling.

Dr. Christina Mutch: 39:47

I'll, I'll take this one too while she's on, on the call. So I, we'll say that we have an influx of physicians who are now burnt out, right? So we're about, what, seven years from medical school. And so, we are starting to hear from our formal classmates, resident, co-residents who are like, I'm done. Please help me out. I need to get out. And it's, it's like this second wave, right? Like I never really considered us early adopters, but in some ways we were, obviously we weren't the ones doing it like fresh, but I would say we're still kind of part of that, the late early adopters or like late wave of the early adopters. And now we're seeing kind of. It gets so mainstream and popular that people are like, oh, they're seeing the social proof and now they're like more serious about considering it and trying to get out. And I relish in getting people out. I will talk to everybody I can to get them out. And so it's been so fun. And it's also how we have found our physicians, right? Like they are coming, burnt out, pissed off. They wanna practice medicine on their terms. And so now there is even more options to not be your own entrepreneur. And trying to team up like our, our patients with other DPCs or not our patients, our our friends with other DPCs, and be like, Ooh, you need to talk to so and so in your region. I think I texted you, Mariel. I was like, Ooh, you need to talk to this person. And so trying to play matchmaker for DPCs now is kinda like my new pastime. And so that's, that's been really fun. And I just be like, it's happening guys. Like it is happening.

Dr. Jake Mutch: 41:18

And it, it's a, a lot of the, I guess the, I'm about to see actually two, I think one's a pre-med, one may be a medical student tomorrow. But they are reaching out proactively. And those flood gates are starting to open because it's catching up, not just in the people coming out of residency and getting burned out, but they're also starting to see it exactly where they should, which is before they hit year three of medical school. Because all these people who, used to dream about being a primary care physician as a, as a premed, or when they get into their first and second years, they see what life is like as a third year in a family medicine office. Lemme tell you friends, that ain't too pretty. And so now they're seeing a different competing narrative that, oh, no, no, no family medicine or primary care in general. Could be quite wonderful if done correctly. It just requires you to talk to people who have lived it. And so they're starting to reach out proactively. And I think that's where we're going to, what are we gonna do with this primary care shortage or maldistribution or whatever. It's not about trying to shoehorn a whole bunch of people into, suffering through 35 years of practice and just seeing 30 patients a day. No, no, no. It, it is restructuring the way that that primary care is delivered to actually make it something that is sustainable and wonderful so that physicians can, medical students re they people who have opted to go to dermatology or whatever because they were looking lifestyle wise.'cause they, they wanted to do primary care and then saw what that specialty was like and said, no thanks. Instead they're re-looking at that and saying, you know what? I wanna make a difference. Not to say that others specialties don't, but they have that, that dream of what they wanted to do and what they wanted medicine to be about and what those relationships wanted to look like. And they say, no, no, no. I don't have to give up on that. I can make that happen. I just need to talk to the right people. So it's very exciting to help people be a part of that and to, to help the movement grow. It's, it's a, it's a wonderful thing. I love coming home after talking to a pre-med or a medical student about this stuff. Because you can see their eyes light up'cause they're seeing us light up too. It's, it's, it's, it's great.

Dr. Maryal Concepcion: 43:15

this is one of the reasons I'm so grateful for you guys all, coming on to give your updates. Because to me, especially when people are in pre-med or medical stu school or in residency, I, this is, it's your guys' voices who I send because I'm like, not only can you hear about how things were going before they started, but also now we're going into year six guys. So it's the, the proof is in the pudding. And also I think that it, it is a way for us to, where whatever our feelings are about our professional societies elevating DPC celebrating different voices in DPC and not having the same people talk about the same topics over and over and over. My DPC story is very excited to be highlighting your guys' stories, the stories of everybody who comes on. Because it's through diversity. People find relatability. And I have heard that, especially from residents saying, I didn't think I could because I'm the primary breadwinner. I didn't think I could because I'm a single parent. I didn't think I could because I live in rural, state, whatever. And so I, I just wanted to say thank you also to you guys and everybody who's come on the podcast and who has yet to come on the podcast because this is how we reclaim the narrative. And so I love that more people are reaching out to you.

Dr. Lauren Hughes: 44:27

my, a lot of my students, I am their, I do, I take a lot of third years. And so I'm usually their first experience with direct Primary care first. A lot of them have never heard of it. And so there is like just even that little bit of exposure, is great. And the most common question I get is they're like, you just have so much time. You have so much time. They're like, how, how is this happening? Or I'll have students come. I'm like, yeah, my kids are outta school. So you can come, they're gonna be here. You hang out with them. If you hate kids, you don't have to. And, and there's, so, there's a lot of they get to see that. And so, especially my students with kids that, you know, that, that's everyone's worry is like, how, how do I be a doctor and a parent? With kids, obviously you don't have to have kids. So with a lot of these students, they're, they're really worried, like, how can I have kids? How can I be present with my kids? And they like, I, they get to see it and I'll tell them, I'm like, yeah, I'm not gonna be here Friday because we have lunch on the lawn. And so I'm going to these school events. I am going to the, the Halloween party, I'm going to the, on the pumpkin patch field trip. I'm doing these things. And it's, that is okay that you don't have to be a martyr in medicine and

Dr. Jake Mutch: 45:46

yeah.

Dr. Lauren Hughes: 45:47

That, that it is fully possible to be a happy, successful, competent physician who actually has a life outside of medicine. And so, they'll, they'll I will tell make sure you're exercising. I have them I have them read like different books that I think are helpful in terms of not like textbooks, but like my favorite that I make them all read is Overkill by Paul Offit. Of I want you guys to learn, even if you don't wanna do pediatrics, you wanna do psychiatry, you wanna do anesthesiology, you wanna do whatever you have, want nothing to do with kids. You need to know how to not overdo medicine regardless of the type of practice you're in. And. It has been, I think really good. I haven't got, they keep sending me students. I got a title that says I'm a professor. So I think it is going well for them too.

Dr. Deepti Mundkur: 46:36

Yeah, so I think in general the DPC conference was like one of my most biggest exposures this year of seeing, doctors who are much more senior in terms of how long they've been practicing and they've burn out three times. What does three times mean? What is burnout? Three times. Like I burn out one time real bad, and that was bad. So I don't know how you burn out three times. So I guess the fear of having to start something by yourself and like the worry about how you'll make ends meet if you have a family and stuff like that is so profound. And the, the system systemically. Trains us to be very scared right from med school. They keep telling you, oh, you got a joint, you gotta, you find a recruiter and this is how you find a job and this is how it's gonna be. This is these ICD 10 codes. This is, and the billing. And this is exactly a, and I still remember this one doctor who I really hated I, I don't wanna use that word, but it was, so she made me see the worst of primary care during my residency. And she had all horrible things to write about me in my evaluations and stuff like that because my focus was on care. And like the patient's crying because they're suicidal and stuff, she wanted the CPD codes and ICD 10 codes written the right way. And I think. I think it could really burden you if you're trying to get outta residency in flying colors. And here you are not, not impressing your professor who cares about that. And, and I think it makes, it makes you kind of think back and see, you just, just because they are professor doesn't mean they're smart. Just doesn't, I mean, Lauren is a smart professor, but No, you are. But I'm, but not there are real idiots in medicine. Yeah, exactly. And they've been, it is like dodos. They've been told by somebody else that this is the way to do it. And here I am listening to the Almanac of NA about how to get wealth and happiness and I, he's my professor. Think about it like you want mentors who've actually done well in life, not the ones who like more to write ICD 10 code and they're like, just. Upset all the time with everybody. And I think if you, if you're writing bad reviews and not actually helping students, that's the worst kind of professor. Get out of that university. Just go, go find something else because you are demotivating these spirit who are trying to like, bring so much health and happiness in the world and you're like extinguishing it by making them think about these stupid insurance codes. And

Dr. Jake Mutch: 49:21

Yeah.

Dr. Deepti Mundkur: 49:21

And honestly I have to just, just say this, in this particular stage. Insurance has gotten way out of hand, like way, way, way out of hand. This is, I mean, I'm even thinking, do I retire already like this? Because it's like you have a mission, but if someone's like sucking the soul out of you every time, like literally yesterday's five appointments we're all about me making calls that needs to be done. And I can see how it can be overwhelming for, when you have way more patients. And that's why staff who are really good is beneficial. And I feel like it may make a difference, but I still won't do it right now. Staff. But at the same time it is, it is very interesting. You pick up the phone, you speak with this person, and a stat MRI takes two to three business days to get a result. Like what? When did that happen? In 2020 when I first started my practice, that was not the case. So imaging centers have gotten sloppy, pharmacies have gotten sloppy insurance has gotten way, way worse. This whole prior auth nonsense is every two months, and they're like, oh, sorry, we already had it. Like, why did you waste my time? And I think, I think, I mean, it'll probably, you probably wanna talk about this too, but I just wanted to say it right here, because this year has been particularly very disturbing. I'm getting texts from pharmacists who are independent, who are saying maybe because of the tariffs, their medicine supply is gonna stop, and they won't have all those, cheaper alternative prices that we used to have for cash. And it's, it is very disturbing to see that we were not in the best place to begin with. And now even though there's more doctors who are burning out and coming out and trying to do this, it's just really shitty. I just wish I could heal people with my stethoscope, but it doesn't work that way. We need medicines and we need the country and the world to just be way, way more proactive about truly caring about humans.

Dr. Lauren Hughes: 51:26

Indeed, if you figure that out, let me know how to get people to care about other people. So,

Dr. Jake Mutch: 51:30

yeah. One thing that I do, first of all, I love your book recommendations. Deepti and Naval Hanza Alman. Oh, Alman. Naval Raman is amazing. But the one thing that, especially for your solo practice that I'm just kind of like riffing on, that I'm starting to see in like the health tech world is like AI agents that can like, make calls for you, sit on hold and also sound like real human beings. Oh, wow. And that is starting to get really, really good. And I'm, I'm just waiting for the right company to come along. Because they're, that, I mean, that space is actively being developed. And so when that happens, and they can. Report back to you on, Hey, is, does the pharmacy have this or that Instead of you sitting on hold with a pharmacist I, I, I actually know the jingles for most of these imaging places. I know. It's so crazy. Do, do, do, do you know, because because it's, I've been on them for so long and not having to ask my staff or I have to do it myself. And this can just be delegated like that. I am so looking forward to it. I think it's gonna be a huge change. And I think that we're kind of in this AI romantic period where it was like, it was like penicillin a hundred years ago. Yeah. And now it's like, how do you make a AI workforce? It's very, very exciting. I just wanna jump in there. Sorry. It was just a random scap brain.

Dr. Deepti Mundkur: 52:36

No, that's very helpful to know because I was doing dishes and I had that thing on and it's I need to turn the water down. When someone's saying you were in the queue and it's dude, I thought you were back. What

Dr. Lauren Hughes: 52:47

heck is it open evidence that we'll do, that'll listen to your prior auths and like immediately send you the. Like studies that they're talking about. I feel like I remembered hearing someone talk. I think it was open evidence that like you have it open like for prior auths and the, you have your phone on speaker and I think it will listen and send studies like proving the need of what you're looking for. Mm-hmm. And I, which is awesome

Dr. Jake Mutch: 53:14

though. Maybe I was gonna say

Dr. Lauren Hughes: 53:16

it's hope I'm not making this up, but I feel, I feel very confident that I've heard. Multiple people talk about this,

Dr. Jake Mutch: 53:23

they can also generate letters to the same effect. I haven't It be,

Dr. Christina Mutch: 53:26

it's gonna be AI versus ai, it's gonna be the insurance. I know, exactly. Because ai, we already know Blue Cross is using them to deny. And so they're docs that was saying that they got a denial and they're like, you approved this. What happened? They're like, oh, that was actually AI's mistake. It should have never gotten approved. Did you guys see that story? and so I was like, oh my God. Like it's, it's gonna be like, whose AI is better at, at this chess match of trying to deny and approve, right? And it's just and just being like, oh, doctor

Dr. Lauren Hughes: 53:52

said we need this to care for the patient in front of them. I mean, yep.

Dr. Jake Mutch: 53:56

Yeah. And I we're seeing, I mean, within the past 12 months, I mean, I was really. Racking my brain with this, trying to figure out our workflows because there is so e especially with the advent and use of GLP ones for weight loss. Oh my goodness. Like it's all over the place. And like there, there are so many dangers to not getting it from a reputable source. Yes. And so you really got I, so I really have to explain to my patients like, no, no, no, this is not something you wanna get in the back alley. There's a reason we're, we're doing it this way, but. It's just so expensive and it's getting a little bit better as they're bringing the price down. But if we're going through insurance, like a lot of patients naturally want to because they're paying these ridiculous premiums it is very, very difficult to get, get covered, and it's just like really hard stops. So the amount of prior auth paperwork we've had to do in the past year compared to the last, five years, it's just been astronomically like

Dr. Lauren Hughes: 54:44

quadrupled.

Dr. Jake Mutch: 54:45

Oh yeah, absolutely. Because we're dealing with one of the most common conditions, right? And so many people can clearly benefit from this. There's so many people, I was like trying to get blood pressure control and like the OSA route and the cpap, da dah dah. And like you can, somebody just sent me a picture of like their before and after from 10 months ago and they, it, it's just like the, the before and afters are just. Fantastic. And so, and, and I don't mean to be like a, I guess an apostle all this stuff, but like, it, it really moves the needle for patients. And it's extremely frustrating that we're getting Roadblocked left and right, where they will actually tell the patient one thing and they will, the insurance company will tell us something different. It's say, oh yeah, it just drives me nuts. They'll, they'll be like, oh we don't see a plan exclusion here or whatever. Your doctor should just try another medication or try a different prior auth. And I'm like, you are giving, you are what, what you just communicated to the patient was, oh, this door is locked. Why don't you just, your doctor try another key? The door is welded shut and you were the one who closed it. Please stop wasting my time and don't do

Dr. Deepti Mundkur: 55:47

that. I'm lying and saying your doctor, they lying. They do, they just make it look, they do, or I think they always wanna make this forever. They've tried to create a hatred towards doctors because they feel like. This is, this is that one thing. Let us just get them fighting with each other and we win. And it's so easy with the DPC model to just go, they're gonna say this, okay. You're gonna get a letter saying, I'm not doing my stuff. Okay. Just be aware. And it makes such a huge difference because patients go, oh, there, I got that letter. Yep, yep. That is very true. Have to, even

Dr. Christina Mutch: 56:21

for prescription refills, I'm like, Hey, we get a bunch of refills that you never requested. They're like, you do? I'm like, yes. I was like, stop, like requesting it through the pharmacy. Just text me. Just text me that you need a refill. That's exactly, and I put you to do it.

Dr. Jake Mutch: 56:33

Who It's

Dr. Christina Mutch: 56:34

like, it is such a scam. They're like, I never asked for this. I'm like, well, they asked for a 90 day refill. I didn't, I'm like, yeah, they're just trying to get you refill that you didn't even ask for. Right. And so, so when I, when I say that and then they get it, they're like, oh, okay. So you're right. At least we can, I only check. So we get a little bit of street cred back that we're not crazy and we're not the ones doing it. Oh, Walgreens said that you didn't you denied, you denied my refill request. I'm like, I didn't get a goddamn thing. Please text me when you need a refill. And they're literally like, they denied it. I'm like, I got, I got Jack. Shit. Like how dare they like say you didn't hear from us, but don't dare you say that you didn't. I denied it. Are you kidding me?

Dr. Jake Mutch: 57:10

No, they do this obviously

Dr. Christina Mutch: 57:12

Marielle, this is a hot button. I'm getting red. I'm gonna

Dr. Jake Mutch: 57:14

flush you. Hit the Trump wire. Oh

Dr. Maryal Concepcion: 57:16

God. But I will, I will say that it's not just a hot button for you. It's a hot button for all of us because it's literally a way to fake deny people care. Yes. And let's, I'll say, let's about PBMs.

Dr. Lauren Hughes: 57:29

Oh my gosh. Well, I will say here though,

Dr. Maryal Concepcion: 57:31

that to Lauren's point open evidence, this came out last year, so December of 24 they do have the open evidence. Again, a free resource. Yeah. All you need is your NPI has the administrative ability to write prior authorization letters, and it does use the evidence. This is for multiple journals like Jake was mentioning, but also citations and references. So absolutely. It is a thing to help with that frustration.

Dr. Jake Mutch: 57:54

Yeah. Yeah. And they sign a, b, a A too like for PHIS, but you have to

Dr. Lauren Hughes: 57:58

like to enroll. Yeah. Yeah.

Dr. Jake Mutch: 58:00

Which is, it makes me feel so good when you're like talking about, or, or trying to figure out a particular patient situation. I think they also have the ability to like. I, I haven't experimented with this, but something about uploading patient information for an avatar to use, almost like as a, a reservoir for when you're asking about a specific patient's history. I haven't played with that, but I just kind saw something like that. I was like, oh, I gotta like kind of look into that a little bit more. But it is especially if somebody's, if somebody's EMR doesn't have native AI features and they're looking for a stopgap or something to take it further, that's evidence informed. That, I mean like I, it has really changed the practice and changed what I use as my default resource for getting Oh, for sure. I

Dr. Lauren Hughes: 58:37

almost like, but I don't know if I use open evidence or up to date more anymore.

Dr. Jake Mutch: 58:42

Yeah. Yeah.

Dr. Lauren Hughes: 58:43

Well, and

Dr. Maryal Concepcion: 58:43

with open being free I mean it was a no-brainer for Well, as a practice professor, I get up to date through my, through my That's right. School.

Dr. Jake Mutch: 58:53

Yeah. Yeah.

Dr. Maryal Concepcion: 58:55

I love it. So talking about hot button topics, as we've been alluding to, this, this entire conversation and on multiple conversations on my DPC story, direct primary care is where patients go to for relationship-based medicine. They go to, to establish care with a physician who they can trust. And in this day and age, misinformation even where to find guidelines for professional use is getting challenging. I won't even go to the CDC anymore right now. No. Unless I have to download VIS sheets for vaccine clinics, use immunized.org. So this is exactly what I wanna talk about. I would love if you guys could talk to us about challenges that you've seen in your own populations and your own communities and how you've been able to help your patients ride the wave of whatever the heck is happening in this country, because you are DPC doctors. I mean, just to call out Dr. Hughes was, just happened to be on a call with Senator Elizabeth Warren that that's cool. That's

Dr. Lauren Hughes: 59:53

what I, I do wanna point out, I was in full blown outfit mullet. I, I had on a blazer and biker shorts, so it was an outfit mullet. I was sitting down and I just, so, yeah. I don't know how that happened either. Wow. We're we are all as confused as you. Yeah,

Dr. Maryal Concepcion: 1:00:14

I I would say it's intentional and it's strategic, right? Because we are literally standing up, just like Christina said, so that everybody can access this quality of care, and we're delivering it in a way that is affordable, accessible, and is expandable when more people are doing this movement. And this is where, I, I would love to see how you guys are, are, are truly navigating the, the current changes and whatever happens with, the loss of healthcare access. That is going to be tremendous. I mean, just to give you a perspective from our rural community for thousand people in our community are getting CalFresh benefits. So fresh food benefits. Yeah. 1500 of those will lose their benefits by March. And then if you throw in work restriction, dah, dah, dah, dah, dah, and the number of people are already in place. Yeah. So I, I will say that, this is, this is where we as DPC doctors can, we, we're living in this place where we can say, yes, those things are happening, but how can we make a difference? Because I definitely have my own answers as to how we're doing things here in Calvers County, but I'd love to hear what you guys are doing.

Dr. Christina Mutch: 1:01:15

I think, I think one of the things that we did pretty early on was was take a stance on measles.

Dr. Jake Mutch: 1:01:22

Yeah, that was a big one. We

Dr. Christina Mutch: 1:01:23

did lose one family from that email, but we decided, so one in adult world, very different. There's a subset of people who may have only received one vaccine and. And Dr. Yeah. They missed that, they missed that window

Dr. Lauren Hughes: 1:01:36

of the two dose. Right? Right.

Dr. Christina Mutch: 1:01:37

Yeah. And so we have a huge population of that. And a lot of them are now grandparents or have small chi or maybe are around small children or daycare workers or, or are, working in the schools and they don't know that they're not immune and obviously Tcell, humoral, blah, blah, blah. But still they wanna be sure we get it as med students. They want their titers. And so we're like, Hey, we did this entire handout. We, I mean, hours of research trying to make it digestible. Jake's awesome skills, making a be, making it beautiful. And we have this timeline and we're basically an algorithm for all our patients. I was like, if you're born here, you're good. If you're born here, you're questionable. If you're born here, you probably need titers timeline. And, and did that whole timeline and then it links to a Google doc and we did a measles titer clinic because the recommendations did not make sense for DPC. They're like, oh, just give people boosters. The titers are too expensive. I'm like, they're 20 bucks for MMR.$9 for just measles. So this is very different. And in adult world, nobody has their childhood immunizations. They're like, I got whatever the doctor told me to get, but okay, well then that's what made me think, oh my God, I need to know the history of this. And so we had to do a deep historical dive to understand what there was, because nobody has their rec records. So it was actually more economical for the healthcare system for us to do a tighter clinic. Next to nothing. Then to send them for a booster that's really expensive, that the insurance may or may not. Pay for, we saw very similar as 10% or non-responders to one. We had a very similar 10%. And some of them were school teachers. Some of them were taking care of grandchildren and they got their boosters and they were like, oh my God, thank you so much for doing this. Thank you for just even talking to us about this. We're scared. We're hearing things in the news. And I did this so much earlier than I feel like anybody else too, because everybody in town was like, huh. And I'm like, I got my kids second MMR booster in October. I was like, I'm not, I'm hearing inklings. I want it now. Yeah. And I'm like, I'm not waiting. There's zero reason to wait. And so, we did this what in the spring and we had a great turnout. People were so appreciative and it was just such a great way to be like, let's focus on what we can do with our community for our people and make intelligent decisions based on the information we have and just drown out all the noise and be like, we're gonna take charge and do what we need to do for, for you guys.

Dr. Jake Mutch: 1:03:45

Yeah. And it really helps to be able, like sometimes, I don't know, in trying to, this is just my own thing and trying to give people the full story of something. Sometimes it dilutes the message a little bit where oh, there's should I get a vaccine? Well, there are like three schools of thought and dah, dah, dah and that and all the patient here.'cause that's the problem

Dr. Lauren Hughes: 1:04:03

with science communication. It's nuance. Right? Exactly. Stand for nuance. And what, what

Dr. Jake Mutch: 1:04:08

they hear is that we have equivocated, so it must not be that important. And so being able to distill to as many patients we have that, no, no, no. Measles is the most infectious disease on the planet and it preferentially kills children. Like being able to say this is where we stand. These are the diagrams, these are all the diseases that you're worried about over here. And this is measles. A way on the right side of the infectivity curve, be are, are patients. Often need to be convinced and want that information. But what I've, what I've realized is they want a doctor who takes a stand and IU and I mean, listen to the early episodes. Oh, like there are, I, I, I, I felt and acted in a different way in the attempt to, try to be as professional and that kind of thing as possible. But what I'm realizing, five years in with the comfort of a full panel being like, no, no, no, I it important. This is who I am.

Dr. Lauren Hughes: 1:04:56

This is what I stand for.

Dr. Jake Mutch: 1:04:57

This is what you stand for. And a lot more people it, it, it is so much easier when I, when you just lean into that and say, this is what's gonna happen and this is what's not gonna happen. This is how I'm gonna be treated in my clinic, and this is not how I'm gonna be treated in my clinic. And if you have a problem with that, the door is that way. And it, it really clarifies things because all of a sudden you're not, you, you, you get to solve the problems that actually matter, right? And you, you just remove all the stuff that's a distraction. I love it. And that's why I love my practice.

Dr. Lauren Hughes: 1:05:26

I, there's so many things I'm scared of. And I think, so for example, like one of the things I've been talking with my families about who have Medicaid, who have kids with complexity I'm like, we are ordering equipment now. Why we have Medicaid. So that standard, you need that gate trainer, you need that bath seat, you need that adaptive wheelchair, you need all that stuff. We're gonna start that battle now while we still have Medicaid. And, and so there, that is like one of the ways which I don't know, just kind of side because I do think this is something that we need to talk about as DPC docs. The big beautiful bill will benefit DPC while it shits on a third of Americans. And that's, that feels very icky. And so that is not something that I am addressing at all is like the benefit of direct primary care from the big beautiful bill, because I don't believe that we as a community, as a DPC community are wanting to do this on the back by stepping on the backs of Americans and like taking away their healthcare. I don't want to force people into DPC, I want them to choose DPC, not because there's not an alternative, but because they realize. Oh, okay. This will work. And so I, I just, I kind of wanna put that out there. Again, like taking the stance like this is, I am always going to do the benefit of everyone, not the benefit of me. Which is again, and going back to what Deepti said, getting people to care about other people is in inherently American issue. But so like that is one of the ways that we are, we are addressing it, is okay, for our Medicaid kids, what can we do now that is going to be expensive and is going to be one of the first things cut. Which I already have had issues trying to get what insurance companies call luxury items for parents because their 3-year-old needs a, a wheelchair and they're calling that a luxury item or a bath seat. And so I'm having to I'm using open evidence to write, I'm like, no, here's how he can drown. And, and like that sort of thing, we're already looking at that. So that is an, that is one area that we are, we are preparing our pa our patients and kind of going back to what, like what Jake and Christina were talking about, which is just like that we can be proactive. We are able to help with just navigating like the. How you were saying like a titer is$9. Like we're having families utilize that and under, and like I am talking about open, like ahead of open enrollment. My, my monthly newsletter was like, Hey, here's if you are a self-employed person, here is some other options. If, if your premiums are too expensive, here are other options. And so just using that as a way to communicate directly to our people and get the information to them as accurately as possible.

Dr. Deepti Mundkur: 1:08:02

So I think the pulse, I try to keep a pulse on what's going on in the community around me because there's pharmacists, there's, in general the, the key people that play a huge role in my patients' lives where they like deliver medicines for much cheaper than the regular system, I think. Over time, this is how, this is how it's been. Even in, even in India there's there was polio and we did all polio vaccines. We went home, house to house and put drops in kids amounts. And I think talking about all those kind of things with my patients over the years has built that trust and there's, there's this trust and confidence that there is DPC that will remain like no matter what my insurance and like employer situation is gonna be. I've had friends who quit the va and similarly patients as well who had lost their jobs and then they were having really good insurance through the va. And then now went to, they, they had me as a DPC doctor, but then now it's like. They were scared. They were scared about being without health insurance. So I had to kind of like help them navigate, you, you can buy and then you can purchase it separately and you can have a private practice. And they're doing really well. And not doctors, but the, in healthcare and doing extremely well thanks to that trust and faith they had where they could comfortably leave that job and, and transition. So DPC made, just this relationship made an impact to the point that they could make such a big career decision and actually see way more growth in their wealth compared to how it was with the va. And I think all I can say is you just gotta stand by. Just like you guys said, just gotta stand up for what you believe in and what you know, science. Tells you for a fact, and there's no two ways about it. And then no matter what the political situation and whatever else going on, if we just stand really strong on, evidence-based science and then have that compassion while, like Jake said, being very clear about how you would practice medicine and never put anyone in danger because. Because of how there's a few nuanced, things out there about the, about the, about the topic, which has been very well studied by like molecular biologists and like all these like vaccine experts. And, and it's really, really hard to,'cause I know someone who was a professor who was like a dean of medical school, molecular biology professor won like the top award when he retired. And I can see the pain in his face because he, he, when, when he's retiring, he expected things to be way more scientific and advanced. And unfortunately it's like a cliff. And, and, and he is, he is very hopeful that the people taking over next will, grow this. But it's, it's hard. It's a hard time.

Dr. Maryal Concepcion: 1:11:20

I definitely appreciate you guys sharing another update year five in, in review, and I'm so excited to hear year six join us over on our substack. We're going to be talking about the challenges that these practices have been experiencing in the last year. And I hope that this is very helpful for those people out there who are considering DPC or who are wanting another set of stories as to what they have looking in the future for their practices. So thank you guys so much. 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.