Building Community and Hope: Dr. Isabel Amigues’ Path to Direct Specialty Rheumatology

In today's episode of the My DPC Story Podcast, host Dr. Maryal Concepcion interviews Dr. Isabel Amigues, the first Direct Specialty Care rheumatologist in Colorado and founder of Unabridged MD in Denver. Dr. Amigues shares her inspiring journey through training in both France and the US, and how surviving stage 4 metastatic breast cancer transformed her medical approach. Blending Western medicine with holistic healing techniques like meditation, visualization, and energy work, she delivers personalized rheumatology care outside the constraints of insurance models. The episode dives deep into her rapid practice growth, patient-centered philosophy, and the advantages of direct specialty care for chronic and autoimmune diseases. Listeners gain valuable insight on patient advocacy, overcoming healthcare burnout, medication access, and building a thriving DPC clinic. Connect with Dr. Amigues for expert rheumatologic care and learn how direct specialty care empowers both physicians and patients. 

Keywords: direct primary care, direct specialty care, rheumatology, Unabridged MD, Dr. Isabel Amigues, Denver, autoimmune disease, holistic medicine, fee-for-service alternative, physician burnout, patient advocacy.

Save $100 on your Hint Summit 2026 ticket through October 31st and join the chorus of direct care leaders shaping tomorrow.

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

Get your DPC Resources HERE at mydpcstory.com!

Transcript

Maryal Concepcion, MD: 0:43

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.

Isabel Amigues, MD: 1:32

I can be the physician. I've always imagined that I would be, and I can see the outcome of my patients exactly the way I wanted them to be. So it's improved my relationships with my patients and to improve the relationship that I have with my own family, and my own community. Because I am more in charge of my life. I'm creating what I want it to be. I'm Dr. Isabel Ami, and this is my DSC story.

Maryal Concepcion, MD: 2:05

Dr. Isabel Amigues is a rheumatologist based in Denver, Colorado. She honed her expertise by studying in Paris as well as Columbia University in New York City. At age 40, she was diagnosed with stage four metastatic breast cancer. A timely meeting with a non-traditionally trained practitioner taught her a different approach to disease where she experienced the power of meditation, visualization, energy, healing and love. Her journey through cancer inspired her to learn more about these alternative techniques, and she now blends Western medicine and Eastern techniques into her practice at UnabridgedMD. Today we're going back to Colorado and highlighting what is absolutely becoming a much needed specialty in the direct specialty care world. And Dr. Ami is going to be talking with us about how she has built this insanely successful rheumatology clinic in the direct specialty care space. But also I'm super excited to be chatting with her because I think it's, it's very interesting when a person is delivering care in the way that we do after they've had a significant experience as a patient themselves. So thank you so much Dr. Amid, for joining us today.

Isabel Amigues, MD: 3:18

Well, thank you for having me. I've heard so much about you. I'm super excited to be here today.

Maryal Concepcion, MD: 3:22

Awesome. So I wanted to, really highlight that you are so passionate about bringing to your patients a way of not just the western medicine that most of us were taught in, but also really focusing on resilience and healing and not dealing with the the, the, the victimhood of being a patient. And so I would love if you could start us off with telling us about your experience as a patient that helped bring you to this space as a physician with even more empathy because of what you've gone through.

Isabel Amigues, MD: 3:54

Yeah, absolutely. Thank you. That's such a cool question, right? So. At a little bit over 40. I was diagnosed with stage four breast cancer. And being a physician and particularly optimistic physician, when it, I thought it was just stage three, I was like, yeah, whatever. I was like, not afraid. I don't know why. I was like, yeah, whatever. And then when it was stage four and I had metastasis to deliver and the bone, then I was like, okay, you've got my attention. And what's interesting is that it happened when I was going for my midlife crisis. So I had repeated my training. I come from France, and I repeated my my residency. I repeated my fellowship and I really love I love learning. So it wasn't, I didn't, I, and I didn't have student loans because in France, being a doctor costs like$500 per year. And yeah,$500. Wow. I know, right? And then you get paid as a resident. Actually, I thought I, I get, I got paid as a medical student, but it was less than if I had been a babysitter, so I was mad. And then I come to the US and I'm like, okay, I should not have been mad. So anyway, and, and so basically I finished all of this and I was, I was, I was I had kids and and I basically went through this really. Like stereotypical midlife crisis where I was like, what am I doing with my life? This is not where I, what I want. And when you want something so bad that that's all you're doing. So just like wanted to be a doctor, wanted to be a a, a rheumatologist, wanted to be a rheumatologist in the us, wanted to have kids, wanted to do research, and here I am, all of it, right? I, I've got all of it, but then kind of like, yeah, but for what? Like, sure, what's the good? And I'm not, I'm not happy now that I have all of this. I'm feeling actually very unhappy. And, and then this diagnosis came and what's really it's kind of, it's sort of a blessing, is that. It's not sore. It is a blessing. It's because I was in this midlife crisis. I was already starting to reach out to my friends in France and to my community basically. And, and in France, a lot of my friends are not physician actually in the US too. But basically I started just like listening and, and sharing how unhappy and sad I was and having phone calls where I was just like crying for a whole time. And one of my friend was, I, I got my diagnosis of breast cancer in France.'cause I had decided on my 40th birthday that I was going to go to France alone for four days. And then I was offering this to myself. And at the time it was like a big decision'cause I was leaving my twins that were like three years old with the au pair and and my their dad. And I felt so guilty. But then I was like, it's my 40th birthday. I get to do this. And then I saw the tumor basically on a Saturday. They got, and I had my tickets to go to France on a Wednesday. That was like two weeks after my birthday. So I had taken those tickets like right away. And at the time I remember they were kind of like, why would you want to go to France now when you just got diagnosed? And we know that it's at least stage three.'cause the lymph nodes looked really bad. And and I remember I was like, well, it's not gonna change anything and I need my community. So I go to France and in France, while, they confirm the type of cancer it is and, and you know how bad it is. My friend basically are like, well, do you wanna talk to this naturopath? And what's really interesting is that as a physician who's done a lot of research, I had always been like, what the heck is this? Like, like, like why are people trusting their naturopath more than they're trusting me as a physician? I've done two trainings. Why are they listening to this? But I had seen this naturopaths work through my friend as more of a talking and discussing than any sort of like weird, supplemental herbs. Mm-hmm. And so I went and what's really cool is that I actually reached out to this naturopath and I said, Hey look, I'm in France only for like four days. And really it's only like one day that I'm gonna be in Lyon.'cause that natural path wasn't new. Is there any chance you can see me during this 24 hour? I think it was like eight hour period that I was there and she actually opened her practice on a Saturday morning just to see me. Right. Like just that by itself or like, hold on. Like this is. This is amazing because I feel like as a physician, I realized how much I had started protecting myself mm-hmm. Against patients, and I'm using the word against because this is how it felt. I was like, I'm against, like, they are not my, my friends, now they are my enemy. Right. Like, but it's not true. Right. But I'm, I was protecting myself because of the way, and we'll talk about this, like the, the way the system is. Mm-hmm. And so I go and what was incredible is that I start just talking and sharing how unhappy I was even before the cancer diagnosis and that I was dying even before the cancer diagnosis. And here she is using the word that I would always remember and the word in French. But she's like, do not see the cancer as an enemy, but see the cancer as a friend who's here to teach you something. And like any good friend, when that time has come, we leave. And I carry those word the whole time. Stage four is very scary. And yet if you start thinking of anything that's happening to you as a friend, as an opportunity to grow, we are. So, I had to come to terms, right? Like now it's easy to say, oh yeah, I did all of this, but like I went deep, I went, I was very vulnerable and I. I had a real talk with myself, which didn't happen. Just like that. It's not like, oh, you have to have a talk with yourself. It took a long time to really be like, okay, do I actually want to live? And it's really interesting'cause from the outside, no one would, I've imagined that I didn't wanna live, but the truth is that there was a moment where I was like, well, I'm being given this option of living and not feel guilty, right? Because yeah, I could leave this, this and leave my kids and not, and, and because it was hard for me to be a mom, it's still hard to be a mom. But at that time I felt extremely guilty. I had a lot of trauma. The kids, it was very hard to have kids. And then they were very preemie. And so I think I had a lot of trauma and no, I don't think, I'm sure. And yeah, just going deep and starting to like talk to myself, talk to my body as if my body was yes, part of me, but also its own entity. It's very interesting. Mm-hmm. And then just not being in a fight with myself, not being in a fight with my body and I started just letting my ego go. Because when you are potentially facing death, I think it's much easier to let your ego go. And and basically I went deep and, and, and like, try to figure out what I wanted for my life, what I wanted, as a mom, what I wanted as a physician, what I wanted as, all of this. And and I did a lot of meditation, a lot of visualization. I did a lot of exercise. I did, I changed my diet to be much more, much healthier and I, surrounded myself with loved ones. And and what's interesting is, and, and I was able to say no to anything that I didn't feel was right for me, which, is incredibly, I, I, I know that I'm very lucky. But it was not an all or nothing. It was just like, I want to see patient. This is important to me, but I only want to see three or four hours of patients per day. That's it, right? And only three times a week. That's it. And I was able to do that. So my institution was like super supportive. They were amazing. And and then, as I healed, I went into full remission. I started like going into the, the science of,'cause I wanted the power of placebo. At that time I was like, I'm not gonna look at if this is proven or not. I'm just gonna do it. Right. I even did like energy healing. And this is where you realize, you're like, hold on. As a physician, my job is to share the data, right? And what those naturopaths are doing is that they are also sharing love and caring and all of those. Which there's no reason not for us to share it. We just have to be super transparent. So I have been very transparent with some of my patients where I would be like, look, I do visualization. At the time when I was sharing this, I would be like, I don't know the data, but it's helped me. Now I'm like, there is data. It's not the best data, but there is data. And that's the thing. Like I, all of those things that I was doing, I realized that there were data to support them. But of course it's not super, like, it's something that anyone can share. And so I think that physicians don't necessarily know about all of those data'cause we have so much to learn already. Right? So it's gonna be hard to go and look at those data. And then it's not like there is a, there is, there is no drug company advertising meditation, right? And it's probably just as good as a biologic, but there is no money to be made on this. Maybe there is, I. And so, right, who do we see in our practice? We see, all those drug companies and we don't, hear about meditation, but there is data and it's interesting, like recently rheumatoid arthritis, the FDA approved a vagus nerve stimulation for rheumatoid arthritis on a very limited amount of patients. So it's, to me, it's more of a proof to con, like it's the proof to concept concept find very, very interesting. And that's the thing, right? Meditation stimulates the parasympathetic system the same way that it stimulates the vagus nerve. So if you meditate, if you do if you exercise, if you put some splash of cold water on your face, if you are in a loving environment, you are more likely to heal. And that's what I had done for the cancer. We know cancer is very inflammatory. I did, of course, all of the chemo and the biologics for my, for the, for the breast cancer. Of course. And all of those. And and I, in rn now we just prove that, I bet work we're gonna be able to prove this in oncology as well. And so because all of those disease, they are basically pro-inflammatory, like they're inflammatory, right? And so I think that that's what's really cool is that I basically started like thinking differently as a patient in addition to being a physician, as a researcher, in addition to just being a physician and be like, hold on, when it comes to actual clinical care, it's not just about the hard data, the randomized control, placebo, double-blinded trial, but it is about do you have hope? Like am I offering hope to your, and, and things like that. And so that is, that is what I have done. Like that's, that's basically what I did as a patient and what I started to do as a physician. And I think that that pretty much, encapsuled, the, the, the way it started.

Maryal Concepcion, MD: 15:05

one, I'm so glad that you are in remission. I mean, that is to anybody who has been through a such a scary diagnosis like that, I am so grateful that you are doing what you're doing and that you are healthy To be able to do that is such a, an amazing place to be. But I also think that this is where it is so awesome that you brought yourself and all of these things that you had realized and learned and practiced to your patients. Because this is really getting at the heart of why people seek out practices like yours and mine. They want to have a relationship with their doctor who treats them like a human being. Just like we are treating ourselves like human beings by leaving the system and going into direct care. So I am, so, so much applause. I'm like trying to not physically clap, so it's not in the mic right now, but I am very grateful that you and your community are celebrating what you're doing. So let's take a step back now into the fact that you trained both in France as well as in New York at Columbia, because I think about how we work ourselves to death in the United States of America. And I think that, when people think of France, they think of the south of France. They think of like, taking better care of yourself walking places instead of, having to uber around everywhere. But I'm just wondering if you can talk to us about also the what you, what you experienced as a person in training between the two cultures. Because I, I always think about how growing up in a very, family centered Filipino family in Sacramento, it was like my way of interacting with patients was very much more it was always very much more family medicine esque, if that makes sense. And so I'm wondering if you can talk to us about, how your mindset was as you went through training in the states, because you were, you were already a physician in a different healthcare system before you came here.

Isabel Amigues, MD: 17:03

Yeah, yeah. Well, another incredibly good question. So the training in France is a lot more clinical, it's very clinical and basically, second year of medicine. So we have six years, right? So we start at 17, 18, and then it's six years. The first year is really just basic. Science there's a little bit, there's a little bit of ethics actually as well. And we did our heart art in the, in the, in our first year. And basically everyone can get in, but not everyone can continue. And so we were like more than 800, and then it was like 60 people can get to the second year so that it's a loss of of time for some, because if you don't get in right, it's like, okay. And and then the second year you start having some clinical training where, so you start like learning, medicine. And then you go into a service like a department of medicine in in the hospital once a week. In the morning, like, so I think it was every Wednesday morning and then the year after you start every day, every morning you are in the service. And then from then on until the end of your. Of your training. You are at least every morning until one or 2:00 PM inside a service. And then you are, you are even doing nights and so on. You're doing nights, you're doing weekends. So they, they rely on having medical students. Mm-hmm. Which is why I was telling you I was upset because we were getting money, but for the hours that we were working, we were not getting so much money. So I just to say, I just to say that it was very clinical and you are being asked to be a good clinician and you're being asked to listen to patients to understand and so on. And you're working at the same time to study, to learn all of this. And and you know that you have another exam at the end of the sixth year where again, everyone is gonna pass an exam and it's the exam that's gonna decide. Where you're ranked and everyone chooses depending on their rank. So the first in, so in the past when it was mostly men, they would choose surgery. As the medicine has shifted to a more woman, surgery became behind. It's actually funny. Right? And so it has, it's been more like actually rheumatology is very difficult. The same way that dermatology is, uh mm-hmm. Is pretty difficult. And you choose where you wanna be and uh, and and the type of medicine that you wanna practice depending on what's left. And so, that, like that training was really, really good. Very clinical. Then you go, do residency fellowship and it's like six month training and there is a continuity of care, right?'cause you're like taking care of your patient for like six months and they're always your patient. It's not like it's only one week and then you have someone else. And like, this drove me crazy when I came to the US and so then I moved to the US right? And I think the first thing that really bothered me, so it was New York, and I know that this is very different from all different places. But the thing that's really bothered me was the absence of continuity of care. Mm-hmm. And realizing that it didn't matter. Like, and that this to me was just so diss, demonizing because if there is no continuity of care, how do you create a report? You are basically talking about a case and I don't know, I just, I remember like one of the first day I actually almost quit and again went back to France and the first interaction I remember I had a patient who had had radiation therapy for cancer of his mouth. And first of all I was like, wow, I'm an internal medicine and I'm like dealing with anything and everything in medicine. Whereas in France it was like this patient would've gone to the ENT group or it would've gone to the ology oncology group or so on. And in the US it's like. Well, you can have a diabetes and then an hypertension case, and then like a psychiatric, case. And then I also like hip fracture, DVT, whatever, like, it's just, it's just kind of like whatever. And this patient that had this ENT what could have been an ENT, I remember like, he would not eat and I open his mouth and no one had cleaned it for weeks. And, and I just felt helpless. Awful. Like, just like as if we had removed the dity of the patient and the process, my own as a physician and just like the absence of caring. And it took me a while, to understand that it's not one person that doesn't care, it's just a system. Right. And I start, like at first I was but to, but, but to head, I don't know what that expression is, but against the nurses, because in France the nurses were really caring of their residents and. And they were nurses that were in the rheumatology ward for years. So really they were kind of nps, but just didn't have that, thing. And they were doing nurses and a nurse would never ever have asked a resident to put an iv. If you were called to put an IV to one of your patients, you are putting a central line. Mm-hmm. So the first time I was called to put an iv, I was like, whoa, like I'm gonna put a central line. Okay, fine, I'm ready for that. And then they're like, no, no, no, no, you need to put an iv. And I'm like, wait, like that's your specialty. Like, I'm not to put a central line, I actually am not really good at putting IVs like crazy. And and it took, yeah, that was the first time I was like, wow, like this is awful. Like this is, this is not care. And I remember telling. My, my partner and the reason, became my husband and the, the dad of my kids. And I was like, if I'm sick, I want you to send me on a plane to France. I don't wanna be in the us. What's interesting is that I've learned letter. I, I had my babies at Cornell University and it was like unbelievable care, but it was just this, it was a community hospital at the time, and, and I think it, it depends where you are and mm-hmm. Which you have and. So, yeah, it was, it was it was, it was rough. It was rough. And so that's the first thing that was, I thought was rough. The second is I was in, taking care of patients in Harlem Washington Heights, so a lot of African American, and I couldn't understand why they didn't trust me in what I was telling. And that was like weird. I was like, why would, like, I, I was like, it's scratching my head. I'm like, wait, like why, why do I feel like they don't trust me until I learn about, what is it like oh, somehow the Tuskegee, like the ies, how they were putting Cies and African American people and, and then you're like, oh yeah, no, no, I understand why you don't trust me. Like, like, and so, history really helps us understand a lot, right? And, and so then I was like, wow, I'm so sorry. And I would actually use the fact that I was French to explain, look. I'm French, I'm, I'm, I've learned to care for my people like you are my people. I care, this is the data. I recommend this, but at the end of the day, it's your choice, right? And yeah, the number of patients that would come, and I have like some really cool stories of patients who had horrible lupus coma and then, totally, totally normal. And that patient who come and African American have said, my friends told me to stop the CellCept. And I was like, Nope. I trust my doctor and I'm gonna continue it. And the number, like you can actually see that this is just the tip of the asberg and he's telling me the story. But for this person that says no, because he's educated, because it trusts me how many other patients did not believe what their doctors were prescribing, right? And with the political climate, now, I don't know how many people are gonna trust us. F but you see, this is like, this was the second thing. And then the third thing was, I had finished everything, fellowship and all this in France, and I'm coming back as an intern and Oh wow. I think that there's trauma to be had there because and I'm a pretty strong personality, but I remember I was like, I'm basically the, I'm sorry for this word, like the bitch of of the resident and for what, like this is crazy. And that was really painful because there is no such thing in France. You are the intern the whole time. You're not the intern or the resident, however you call it, but there's not one resident that's more like powerful than the other. And what it is, is that if you're a resident that have that, that already has three years under the belt as a resident, you just are more knowledgeable. And so the younger resident is gonna come to you as Q So there is this. Symbiotic relationship where the older resident are really happy to share that knowledge to the younger residents. And that didn't feel like that at all. It felt like, well, I, I remember, oh my gosh, I was like in the ER and there's this resident that comes to me. I had not seen the patient. I think he is like, please do a recal exam on patient, blah, blah, blah. And I looked at him, I said, I wanna make sure that of what you just said, you are asking me to not do an intake, to not have a report with this patient, but literally you're asking me to do a physical exam where the only thing you want me to do as a recile exam on this patient. Is that correct? Yes, that is correct. I said, I'll do it. And you're like, how dissing again, is it for the patient? It's, I don't care about Recile exam. Like I'll do whatever, but like, come on. And that was something that I thought was like, we need to change that because. It's, it's traumatic. It's, and there are interns that, commit suicide. They have like no sleep. And they are finally, doing something and suddenly this is what you're sharing them with them. And, and to me it's like when you're seeing a patient, you're from A to Z and then you wanna follow up and what's going on after.'cause you learn so much from that. So yeah, those, I'm sharing about all of the things that are negative. There is a lot of good stuff too, not gonna lie, but that, that was the free trauma that I got, like free trauma.

Maryal Concepcion, MD: 28:45

I, I do think that it really highlights also as, as I tied, the relationship that your patients are looking for when they join your practice. Now, I, I, I pull from what you just shared, how important it is for us to be in existence. So people who are coming up in the ranks of medicine and who are going into attending positions, see that you can actually do medicine the way that you're doing at your rheumatology clinic and I'm doing at my family practice clinic. Absolutely. So I think that this is, so, it's important for people to hear as, as crappy as it is and as, as it as, like, I will call out, everyone who's listening is thinking about like their quote unquote favorite resident who didn't bother to help a dang time when they were on call as the first year, second year. And you're like, seriously, why are you even a doctor? Because you're such a. Fill in your expletive there. Yeah. And so it's like we've all had those experiences and it's also maddening, but I will say for me, it makes me even more it makes me even more lean into the community of DPC when it comes to supporting each other in doing this medicine. So a hundred percent. So I, I think about how you have this rich history of knowing how care is as a physician in two countries, how, it, it was to be a patient, but then also how you opened your own rheumatology practice despite all of the things that you had been exposed to. And so I'm wondering if you can tell us about this moment in your career when you decided to shift to direct care rheumatology as the first direct care rheumatologist in the state of Colorado.

Isabel Amigues, MD: 30:20

And it's funny, I didn't actually, I don't think I fought for, I didn't think of it for myself at first because I had the best deal possible in my institution. I was working two or three days. I can't remember, like maybe at the time I was working three half days or maybe I had four half day clinic. They had not decreased. I, I really like, thank you for my institution. They were amazing. In fact, to the point that when I said I'm leaving, they didn't trust, they didn't believe me. They were like, con contact us in two weeks and like, because I didn't go, it's funny, the same way that my marriage left, which was very kind. I was like, it just doesn't work for me anymore. And that doesn't, doesn't mean that I don't love you and respect you. It just, this is not for me. And that was exactly the same. It's like, I love this institution. Mm-hmm. I really, truly love it, but this is not in alignment with myself anymore. And so I want out and I'm wishing you the best. And truly, actually, truly wishing them the best. And and when I started, I didn't know that I was gonna do this. And what happened is that it was after COVID. So I had, I, I was dealing with the cancer before COVID, then COVID hit I had finished everything actually by the time COVID hit, but COVID hit. And it was interesting to see people go through sort of the same internal, dialogue. I don't wanna say monologue'cause I don't think it's a monologue, it's dialogue what you're saying about what you wanna do and what the boundaries are. And I had already done it. So it was kind of cool to watch this being done. But also I was like, Hey, I wanna live my life now. Like, what's going on? And and after COVID, a lot of my colleagues at the institution I was in were burned out, like burnt out. And I remember like one of my pa my one of my colleague came and it's funny, she just opened. A direct care specialty practice. So she opened it after me seeing, like, I think she wanted to make sure that it can happen, right? And it be doing, but she would come and she would be like crying and, and I was like, okay, let's do an exercise. We're gonna visualize what would it take to be the best care? What would we want to be the best care? And we started sharing like the importance of community. Like it was a free Peter thing. And again, I didn't do that alone. I did it with her Dr. Sergio. I'm in Sergio. But basically we were like, there would be healing of the brain, like the mind healing of the body and healing of the spirit. And the way we thought about it was your mind. It's all the mind, the mind body like meditation, visualization, prayers for some. And so on. The body would be the medicine and how we help our bodies. And then the spirit would be the community. And so then we started doing coexist, which is a meeting. At first it was kind of like whenever we wanted and now it's like every month we and it's funny'cause this was all done with her and then I think she was like, you're doing it now. So I did it. But it's okay. Like I thought it was helping so much. And basically those coexist meeting, we bring someone from the community and I interview them and we have a community. And, and what's really wonderful about this community, I never know how many people are gonna be there. And sometime it's like, 10 and some other time it's like 40. And it's always like someone is gonna bring someone else. Like it's a plus one thing. And it is been really wonderful. And and yeah, and, and starting from there, what's really interesting is I started like just creating how my community would start, like community and I, I really use the word community'cause I think that that's what I'm creating would feel like in terms of with patients and, and the caring, how much I cared. And I didn't continue to care for patients because I had to, but because I really, truly wanted to and cared and got as much as those interaction as I knew I was giving them. Like it was really a given and take meaningful and that, that's how I started. And just one day. What was the story? I started reading a lot on the direct care, rheumatoid direct of DPC. Actually I started like, reading a ton of DPC books and how that was possible. I also started looking at locums and at that point I was single mom.'cause I had divorced, I was single mom and with my mortgage and kids and, and I was like, well, how can I do this? And I asked my ex-husband and I was like, he's a physician too. And I was like, here is what I'm thinking. We had the kids every other day and then every other weekend and I was like, if I do this, I will have to travel one week at a time.

Maryal Concepcion, MD: 35:06

Mm-hmm.

Isabel Amigues, MD: 35:06

For Locums when I'm beating that, are you okay with that? And he is like, absolutely, go for it. I'm totally in support of that, which is super, I'm super grateful because he is, he, he could have said no. But yeah, that's been, I'd started the practice while I was doing the locums and, and then the practice took off and, now. Super, super. Now I'm hiring someone, if someone wants to say, if there is a rheumatologist that wants to come in my practice, plug in, come in, I'm hiring.

Maryal Concepcion, MD: 35:34

I love it. And I absolutely would say, the, the next question I wanna ask is because, there, there has to be, I'm like sending all the good juju out into the world also in that form of visualization that you know, that there is somebody listening if not today, than tomorrow or next month. Because I do think that hearing more about your practice is, it's, it's unbelievable sometimes when you hear where specifically rheumatology has come from in the direct care space to hear your story. So, your, your practice grew fairly quickly. You have multiple staff members on your website. Yeah. And, I just, I love that that your clinic is so successful because rheumatologic disease, rheumatologic diagnoses, it is something that we see a lot of in family medicine and primary care especially, and especially with these diagnoses, it's so important to have that personalized care because rheumatologic disease, rheumatologic diagnoses can lead to so many different symptoms that, can be passed off too often in the, in the quick, quick, quick care of fee for service. Like, oh, you're just a woman. Like, oh, it's not that bad. And it's, this is, I think what also people are so frustrated with, which, shows why One example I, I guess would, is one example of why they would go to you and other direct care specialists. So tell us about how your practice has grown quickly. Because how your practice has grown quickly and what people are coming to you for.

Isabel Amigues, MD: 37:05

Well, I'm gonna share one of the value that we have in the practice, which is really important. And I share this with the team. Almost every week I say we are here to show that a different type of care is possible. It is not just about the practice, it's also about, and this is, this is where, again, remember where it came from. It came from me sitting down with one of my colleague to this to discuss like, okay, what would a better practice look like? Mm-hmm. If our institution cannot be it, how does this practice look like? And then at one point realizing it's not gonna be with insurance, it is not possible in the insurance system. And so, because of all of this, right? And because of who I am and how much I love medicine, like I love it so much. This is, this is my calling this, I, I've been a rheumatologist in France, I'm a rheumatologist in the us. That's how much I like it, right? And just, just always, always sharing like, this is not just about patients. This goes beyond the patients. We are showing that we are like, this system works and that it's successful. And so, to me, one of the really important thing is to show other doctors that this is possible. And it's, it's interesting'cause I could be totally okay. I could have been six months ago, I could have said, okay, that's it. I'm done. Like, I don't need to increase my prices. I don't need to hire someone. I could have been in a very cushioned part and I'm like, no, we want to show that this is successful. And how do I, I remember like talking to a cardiologist who told me, I like you are, because I said, what do you think would success look like? And he said, if you can if you can pay a physician 500 K, then your practice is successful. And I said, game on. I will be able to pay a, a physician. I'm not saying that that's how I'm, this is not where I am right now, but but why not? Right? Like then, then let's push that. Let's push that envelope. And why would insurance based practice be the only one when they are being paid, like really not good? Why would they be the only one that can make those salaries for their doctors? Which by the way, there's not a lot of people who make that much, but you know what I mean? Like, I'm like, yeah, let's, let's make it happen. Like physician used to be very well paid and now. We are paid much less than any CEOs. And so it's like, yeah, no, I am, I think, I, we deserve to be paid appropriately given how much of our lives we've given away. I mean it's, I don't know if away is the word, but we've given a lot. Like, while my, my, my sister is a very successful CEO. She's awesome. I love her and she's had a lot more fun than I ever had when we were younger. A lot more fun than I had, right? Like I was studying when she was partying. She still is a very successful CEO making a ton of money. And I'm like, why not me? And, and it's not about the money. I think if I were not in the US it wouldn't be about that. I don't care, right? Like, it's not about the money, but it's about, about how we prove success. And to me, that's one of the way that we prove success.

Maryal Concepcion, MD: 40:32

I love that. And your practice, is, is close to 300 patients already and you're already looking for another doctor. Again, go to Dr. Emory's website. Oh my goodness. But when, when it comes to the patients who have found you, give us examples of what people are saying about your practice because you, you have amazing Google reviews and a lot of them. And so, your patients are cheering you on even if it's not in person all the time.

Isabel Amigues, MD: 41:04

So, sorry, I just realized that I only replied to your first start your first question because it is so important to me. As you can see patients are finding me in different ways. There are patients that are finding me and, and honestly like I'm looking for oncologist like this, there is no oncologist direct care in Colorado, and I wish there was. Because the la, my oncologist retired and I saw a new oncologist and they looked at me, I think in the 40 minutes of that we were together. They looked at me only five minutes, and it was mostly to ask me about France. And so it's like, that's, oh my gosh, proper care. And I'm not upset at them. I think it's a system, but come on. So I want a direct care oncologist, if you have one, let me know. But yeah, basically they see me, they, they find me either on Google. I think I'm actually considered the first the best rheumatologist in Denver. And so, I've had some patients, I was like, how did you find us? Well chat GPT. I'm like, oh, great. That's kind of funny. I love it. I'll take it. And I do think that we have the best rheumatology practice, and it's not that I'm the best rheumatologist, right? I think that all of the rheumatologists that I work with and or that I've worked with are great. I just think that our system is so much better. And as you mentioned, I have a big team because every time I see my team starting to fall behind, I'm like, maybe we need to hire someone. Okay, let's hire. Because at the end of the day, I want to have the best for my patients, the best outcome, the best con experience for my patients. They find me. So through Google for charge, GPT ai I think some of them find me with the YouTube videos that we do. So they may be like looking, and then some of the ones I think are like cannot get in into rheumatology. Within three months, they come in. Some other one it because they cannot they, they have seen someone and it just didn't work and they just, get tired of it. I mean, it's not like there is that many rheumatology practice out here. And so I think sometimes they want an answer and that, that's another thing is that, there is only so many rheumatologists but we have a lot of I think, and this is my take on things, maybe I'm wrong, but I think what's happening is. We are referring left and right all of the time. And because physicians don't have the time, but also because there's a lot of primary care that's being now managed by a physician assistant and nurse practitioner. They don't know everything and so they refer a lot more. And that's creating this this system where rheumatology practice, I don't do that, but rheumatology practices have to kind of like decide what they see. And so they are losing a lot of their time on figuring out what they're gonna see and what they're not gonna see. And the problem is that you don't know, like the referral might not be well done, and so the patient is being refused. And so I think that that was a problem for me. I was like like one, if a patient has lupus, I don't want them to wait for a month. That's ridiculous. But at the same time, if a patient has a positive a NA and it's a one of a 40. They actually might have like some other type of rheumatologic disorder. And the number of time I actually find that and I'm like, well, basically we don't know. And so yeah, they all deserve to be evaluated. If you have scared one of our patients told them that they need to see a rheumatologist, then we should be available to them. That is how I see it. Totally.

Maryal Concepcion, MD: 44:28

Yeah. I, I will say here a point of frustration with my own patients is like, for example I had a patient who for years was going to see a person that did tons and tons of, of labs and would give binders of results. And then this is like, I think four years later, this patient comes to me, talks to me about their family history, dah, dah, dah. It's like a two hour intake. Yeah. And I'm like, like something rheumatologic is going on. And this patient ended up having Crest syndrome and it's like, out of the binders and binders that you got. Never. Did you actually get a thing to tie these, these symptoms? I know the physical presentations and all of the labs that you paid thousands of dollars for together, and but then I have patients who I'm like, I can literally get you in with rheumatology next Wednesday. Let's go to their website and pick a time. And then they're like, oh, but it's cash. And I'm like, remember that? That's why you pay to be a member here because of access. And I'm literally reminding that, that you can get in next Wednesday. You are choosing to wait for the referral to see if it's accepted at uc Davis. A hundred percent. That happens all the time. And it is, it is mind blowing sometimes that I'm like, but you know, the value of having a physician who works for you directly. And that can even mean more when it comes to something like rheumatological diagnoses. So, it is, it is frustrating. But I will say that again, I'm so glad that you're out there and that patients are finding you. So I wanna ask here about your clinic's name, because Unabridged md just looking at the logo and the reading the name. I'm just wondering if you can tell us about how the logo and branding represents what you're delivering to your patients and your community.

Isabel Amigues, MD: 46:15

Absolutely. So the idea was to offer the whole version of me and to see the whole version of the patient. So not look at just, this technical part of what, they have joint pain and that's all I'm gonna look at. But we're gonna look at, not, not that I look at trauma all of the time, but you know, the other day I have this patient she has, she has had basically, she has like an autoimmune disorder, but she's tried different stuff, but every time she gets side effect and I was like, have you ever thought of this question of is there any ways that if you were in remission your life would be harder and without stopping, like, without missing a beach? He's like, my husband would not be happy if I'm in remission. And I was like, let's talk about this. Let's, let's actually, let's talk about this, and like how much power you're giving your husband. And and like, is it true? Is it not true? It's, it doesn't matter. It's not, is it bad? Is it good? It, it is. If you think that your life will be more miserable if you're in remission, then how are you gonna reach remission? Your body is a whole, I can give you as much medication as I want. You're gonna not appreciate them. Right. And so, the on Abridge md, that's, it's almost a method at this point. It's like, it's this vision of the patient as a whole, mind, body and spirit. It's really what is it and what it is. And yeah, I wanted to offer the whole version of me. And when I say that I love my patient, I truly, truly love them. And I don't use that word lightly. I actually truly love them. I want them to be in remission. I want them. To not need me and to choose. Right? Like that's a thing they choose to continue to be with me. Once they're in remission, they could absolutely decide I'm gonna go in the, in the insurance based practice. Absolutely do it. Like, if you want, if this is your choice, do it or choose to be with me. This is, this is, I don't want you to be in a place where you're gonna be obliged to do one thing or the other. Right? Like, it's a choice. And uh, yeah, that's, that's what the word is. And uh, the logo, which is a kind of like those circular that are together and there's kind of this idea of onward forward. It's the vision of the patient as a whole with the idea. And I think that this is in medicine, not just rheumatology. The idea is that. This is coming from discussion I had with my dad who's now learned how to, he's a judge originally, but now, and, and retired. But he's learned Chinese medicine is really good as, and I can puncture. I don't think he's ever gonna use, but he, he wanted to learn it. So great. And and when I was 18 I was learning medicine. It would have like those long, long I don't know if it was email at the time or just, a letter.'cause it was in Marsai. They were in Marsai. My family was in Marsai and I was in in Paris. And it would be like, yeah, you know, when someone is ill, they are losing balance. And your role as a physician is to help them get back into balance and oh my goodness, how, how wise is that? Right? Because that's exactly this, your job is not to go against, to fight a disease. It's how do we help our patients get back into balance? And so that's the wholeness, the red, the, the, the, not the, the, the circuit, onward forward is this idea that you are not going back to where you were. You are actually going to a better place than you ever were. So it's not like I wa I wanna go to where I was before I had rheumatoid arthritis. No, no, no, no, no, no. We want you to get in a place where this rheumatoid arthritis has actually brought you so much good, because you've learned how to say no because you've learned what you wanted in life because you've, you've learned the importance of healing. And I have a patient I, I just saw yest, oh, I can't remember yesterday. And and after being diagnosed with an autoimmune disorder and being like, she's now in remission. But the really cool thing about it is that she's not only in remission, she's actually helped her vagus nerve to be evaluated to be. Stimulated and so she actually has less stress in her life. Because of that. And she feels better than she for 10 years, for over 10 years. And so that's, that's the, that's the goal. I, I don't know that, I, of course not everyone reaches that, but that's my goal for everyone. So that's on average, MD for you.

Maryal Concepcion, MD: 50:45

I love it. And I'm wondering if you could also talk to us about how you so the, the, this question is coming from speaking with a, a couple of other direct specialty care rheumatologists, and when it comes to. Figuring out the challenges of insurance coverage for medications. I'm wondering if you can Yeah, if you can, if you can, oh my gosh. If you can chime in on that, because I, I feel that like, there's certain things like oncology medicines even, like how do we crack the, the access barrier?

Isabel Amigues, MD: 51:19

It's super easy. It's actually easier than it's ever been. I have a pharmacist that that helped me with getting prior authorization in a record time. So I don't take insurance as the physician. I think my value is a lot more than what insurance thinks it is. So I'm like, Hmm, I don't wanna work with you when it comes to my compensation. I work for my patients and I'm not employed to the insurance. Now my patients have insurance and we're gonna use. Maximum of it. And that's, that's basically where I'm at and the medication. I know exactly how to get all of my meds approved. And it's approved. And we, and, and what's really cool also is that if a patient has no insurance, I also know how to get the drug company to pay for that medication for our patients. So I've actually had, in essence, many patients who've told me that coming to the practice has actually saved them thousands of dollars. But I, yeah, I don't think that that's an issue. And, I'll tell you, I actually wanna reach out. I, I'm gonna send her this recording. I want my oncologist, my previous oncologist, the one that helped me go into remission. I want her to come into my practice and and she was like, well, but, oncology, we need to have medication and all this. I'm like. I'm pretty sure we can find an infusion center that will do that and will help you get all of those. So I'm actually, I think this is something that I'm gonna do. I'm gonna leave her get bored a little bit for a little bit until she realizes that being a doctor is so wonderful and especially in the direct care practice. And then we'll have our first oncologist in Colorado that's direct care practice. I mean, it's needed. Like I don't wanna go to my insurance based oncologist. It's just not like, it's not, I don't feel supported and it's not their fault. I think all doctors need to get out of their insurance system.

Maryal Concepcion, MD: 53:14

No argument from me, but I will tell you also please I'll send it to you afterwards, but please, especially if you're also like, oh my God, I would love to hear a direct oncology story. Dr. Laura Baio Kenney. She was early on in the podcast in terms of years ago. But I will say that she's a great example of how you can succeed in oncology as a direct oncologist. And so, as a direct specialty oncologist. So I definitely will say that's a great one for your colleague to listen to in addition to your own, your own story, which is amazing. Yeah. Continuing on that thread of. Physicians who work for the system versus physicians who do not work for the Insys for the system. I'm wondering if you can talk to us about how you think about other specialties who are doing DPC as a business model. They're not necessarily primary care, they could be, but for specialists like rheumatologists, dermatologists, even surgical specialists. What do you think about the future of specialty care when it comes to access? Because clearly you've seen what patients are wanting and how patients are even finding that it's cheaper. But what would you see in general for the movement of direct specialty care?

Isabel Amigues, MD: 54:23

I don't know that cheaper is the word that's more valuable. The special, I, I honestly think that the system is burning to the ground right now and I love it. Like every time. So this is really funny. Every time, look, I come from being a socialist in France and I'm like in the US and now I'm telling you, I'm not that I'm a capitalist'cause I don't know that that's the word, but I want to be very successful. Mm-hmm. I want, I, I want to prove that physician can be very successful because I, I really love it so much that I want my kids to say, this is what I wanna do. Right. If they saw me, well, not me, but if they saw, anyone like, their, their parents and they think that their parents are miserable, they will never wanna become a physician, but I want them to want to be physician. Right. Like, if they want to, of course I'm not gonna force them. But, it's it's this idea of, i, I think that right now it's been so driven by money, the insurance-based model, that basically the only way forward is to get advanced practitioners. So we're getting advanced practitioners. What's the next step? Is going to go to be ai. So you're gonna ask AI and then it is gonna be so I don't know if they're gonna remove all a all advanced practitioners and then it'll be ai. I have no idea. What I can tell you is that I thought open evidence was pretty good until I started asking them about their set, RA and all this, and then they were like, this is not approved by the F fda A I'm like, wait, what do you mean it's not approved? Like here are the data. No, it's not approved. And until I was like, this is the FDA website and oh yes, it's approved as if they had not told me five times before that it was not approved. So I was like, okay, AI has a lot to learn before I'm gonna trust them fully. But you know, the truth is that it probably is the case that a lot of AI are better than a new a PP. Okay. So that's the first thing. Then the second thing is like you're trying to make money. And so, apps are for now, there's a lot of them that are new. So they are not, they are not burnt out. I think they're gonna be burnt out. One physician are much more resilient than a nurse. I, I, I'm not saying this in a negative way. I think we have been so traumatized during our training that we know how to go through it, which is not ideal at all. But I think nurses have union and so they are able to say no much faster than we ever mm-hmm. Worked. Our ideas like, no, I can always say yes, it's your ego talking. Right. So yeah, I think that that's gonna burn to the ground and it's super sad that the patients are gonna suffer. And this is where it's sad is that I am in a position now that I can't pay for a oncologist in direct care. And my promise is that it doesn't exist in Colorado. But I would like to pay for that. And I think it's worth a lot of money because someone that cares for me. And is gonna back my health that's worth it. Right? Versus a doctor that's looking at their computer because they have, and, and I have no idea. Maybe she's like so overwhelmed. I cannot be upset at her, but I just don't want her in my care because I want the best outcome. That as that is valuable. And so yeah, I think that the future, I have another of my colleague that's opening a specialty rheumatology practice. One of my other colleague just opened infectious disease practice. I told you I want to show that it's possible. And so I'm rooting for them. I have another rheumatologist. This is in Colorado. So one person is opening in Denver. Another person is like this in pulmonary. They're opening in Denver. That might be the first pulmonary specialty. And they are not at a low price. I started at low and then I increased as time went. But I told them, don't make it cheap because otherwise you're gonna be just as busy as before to make ends meet. Right. And yeah, and, and I think that the future of medicine is one where p physician, like I I think five years ago I thought that all physicians were gonna leave being physician. And thanks to you guys, we learned that there was another way in medicine. And so we're leaving the insurance model, but we're staying being physician, which I think is really cool. And some of them probably will not and become administrator and, CEOs of different companies and that's great too. But at the end of the day, I think what's happening is that we are, we are not being valued by the society. As much as we used to. And so we're like, no, I don't wanna be there. So that's, that's, that's my take on things. But it's, it's fun. Every time I've, I have horrible care in a specialty practice, I'm like, Hmm, I don't have to worry about my future. Yeah.

Maryal Concepcion, MD: 59:06

I love it. So, after this podcast, where can people find you to connect with you on YouTube, your podcast, and your website as well?

Isabel Amigues, MD: 59:15

Yeah, pretty much everything is called on Abridged md. So if you go on on average MD in any like social media, they'll find me. And then, and I don't know if I should switch, but basically it's under Doctor, it's rheumatology 1 0 1 that's, it's it's linked on average md. But yeah, rheumatology 1 0 1 by Dr. Isabel am because, I do like lives every, every week in rheumatology. And I, I like doing that too. And then on the website, on Abridge md, so we have a podcast, we have a live and a YouTube videos, and we have our social media and blogs,

Maryal Concepcion, MD: 59:50

A lot. Fantastic. So I am so excited for people to connect with you after this podcast. And thank you so much for coming on today and sharing your story.

Isabel Amigues, MD: 59:59

Thank you.

Maryal Concepcion, MD: 1:00:03

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.