Overcoming Familiar Suffering: Dr. Rob Lamberts’ Shift to Membership-Based Medicine

Today's episode features Dr. Rob Lamberts, one of Georgia’s early pioneers in Direct Primary Care (DPC). After nearly two decades in traditional insurance-based practice and facing severe burnout, Dr. Lamberts shares his journey opening his DPC practice in 2013—one of Georgia’s first. He discusses the challenges of the fee-for-service model, the healing power of direct physician-patient relationships, and the benefits of membership-based care like enhanced access, affordability, and a renewed passion for medicine. Dr. Lamberts also talks about building a sustainable, patient-centered medical practice and the transition to Welcome Health, a collaborative DPC group. 

Physicians considering switching to DPC will find practical insights into overcoming fears of change, leveraging technology for better access, and tips for building lasting legacy and satisfaction in primary care. If you’re searching for real-world DPC success stories, strategies to fight physician burnout, and ways to reclaim the essence of personalized medicine, this episode is a must-listen.

Hint Summit is coming to Nashville, Tennessee, April 8th through 11th, 2026. Save $50 with code MYDPCSTORY. Get your ticket at summit.hint.com today!

Get your DPC Resources HERE at mydpcstory.com!

Transcript

0:53

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

Dr. Rob Lamberts: 1:41

Direct primary care is the recovery of your passion, your mission, your. Love of medicine. Your life, it's, it's a, it's a recovery from all of these things. Taking it back from the hands of the people who are trying to steal money from the healthcare system. All of those people with their hands between us and our patients. And this says, hell no, it's my patient. And I will take care of them. And that's, that's really what it's recovering, is recovering my connection with my patients. I'm Dr. Rob Lamberts and this is my DPC story.

Dr. Maryal Concepcion: 2:35

Dr. Rob Lamberts is a board-certified internist and pediatrician based in Augusta, Georgia, and one of the early pioneers of Direct Primary Care in the state. After nearly two decades in a successful insurance-based private practice, he left in 2012, burned out by a system that valued billing codes over human connection. In 2013, he and his longtime nurse Jamie opened Dr. Rob Lambert's, LLC. One of George's first DPC practices built on access, affordability, and real patient relationships. Known for his 2018 TEDx Augusta Talk, where he described himself as a quote unquote recovering doctor. Dr. Lamberts shares candid insights about the failures of fee for service medicine, and the healing potential of membership based care. His practice grew to serve hundreds of patients, and later evolved into welcome health, a collaborative DPC group he co-founded with two colleagues. Beyond medicine, Dr. Lamberts is an avid musician who plays guitar, mandolin, piano, and cello, and enjoys kayaking, biking, and hiking. His work continues to inspire physicians nationwide to rediscover why they became doctors in the first place. I am so excited to talk with a good friend, but on the podcast this time, Dr. Rob Lamberts, thank you so much for joining us today.

Dr. Rob Lamberts: 3:54

Well, thank you for having me here, Maryal.

Dr. Maryal Concepcion: 3:57

It's such a treat to see you. We were just talking about Halloween costumes, and it's almost Halloween by the time this podcast comes out, so it's so appropriate. I will leave it to the the audience to go on the YouTube and guess what? Famous costume Dr. Lambert's won Halloween contest for.

Dr. Rob Lamberts: 4:13

Yeah. I I, yeah. When, when you do see the pictures, you're gonna say, oh my goodness. I'm, I'm both, I was both happy about it and a little embarrassed.

Dr. Maryal Concepcion: 4:25

I love it. But, I love too though that. You are that we're talking about we're talking about Halloween and Halloween costumes while we're able to be the doctors that we are because of DPC. And so, as mentioned in your bio, you had this amazing 2018 TEDx Augusta talk where you were, calling yourself a recovering doctor. So I'd like to start, at this, the, the time before you were realizing that you needed recovery. What was practice like because you were in private practice for almost two decades before changing to DPC.

Dr. Rob Lamberts: 5:02

Yeah, I, I, I, in some ways I was kind of like the, the frog in the hot water, that, that the myth, it's not probably true from what I've heard. But anyway, that, that I, when I started practice, it was actually 1994 was when I started in, in practice here in Augusta. And I, it was, it was a fee for service, but it was one of those, it was not really much managed care. It was pretty much, if you billed for it, they paid you. They didn't argue with you. The average stay after a baby was born was a week. And even two weeks, if it was a C-section, it was just crazy compared to, and I, it was wasteful and people made a ton of money. All they did, but it was easy medicine in the sense that nobody was really looking over your shoulder. And so practice was pretty simple at that point in time, even though it was, yeah, it was kind of busy, but as. managed care came in and the management of your care and the second guessing all the tests you ordered and all of the other types of things came. I was there through that transition. Just at the very tail end of the, the, the easy time. The where being a doc actually from a business standpoint wasn't hard. But then it became incredibly hard because you're dealing with all of these different insurance plans. You're dealing with all of these other things. And Augusta was interesting in that initially, when I first came to Augusta, we were actually, the, the practice was owned by a hospital. After a year and a half, we left and started our own. And just because they couldn't run us, they, they had no idea what they were doing. Not that, that we had a, a better idea, but at least we were the ones making decisions that we couldn't blame anybody but ourselves. But in Augusta. Pretty much all of the primary care practices out there, or most of them are actually independent of hospital systems. The, the specialists are the ones who are, who are owned by the hospital. But here, primary care in general, so through my, I've formed Devons Medical Group was with them for 18 years and was, we were independent. The practice grew over that period of time. We moved to a bigger building. We're up to about five or six providers when I left. Part of it was running the business, but the business was incredibly complex and part of it was also feeling just unwashed. The having less pay with each patient we were seeing, having less time with each patient that we were seeing. So you needed to see more and more patients and you had less and less time. And then the computers came into healthcare, which initially I thought would be a really good thing. In fact, I was a really strong proponent of that. But in the end, it just let them watch what we did even closer, and we became data managers. And it, it was increasingly depressing. I remember, being in my practice and just imagining there was this line heading out of my office that ex just wound out as far as the eye could see of one person's need after another person's need, after another person's need. And honestly, I felt like I could not, I, I, I couldn't give anybody good care. I mean, how can you give good care when you've got 10 minutes, five to 10 minutes to spend addressing all of their issues? There's just no way you could do that. And so, even though I was taking care of 2,500, 3000 patients, whatever it's a, that's kind of a, a, a difficult number to estimate, but it was, it was a pretty big practice, a mature practice. And it, it I just felt like. Very few of those people were getting excellent care, even though I was trying to very few people.'cause,'cause the system wouldn't let me do that. I couldn't give them the time that they needed. So I was just feeling desperate and I was feeling frustrated and I was feeling burnt out. And honestly, the thing that I probably would've stuck with it for a while longer, but I had a different in, I had a difference in opinion on how to run the practice from the other partners. Mm-hmm. And that's kind of a nice euphemistic, easy way to say it. We kind of went through a divorce and at that point in time, I was floating out there after 18 years and I did get a buyout. So I did have some money to start out. But I was like, do I really want to work for the va? Do I really wanna work for the hospital? Do I really want to work for another group practice and deal with the politics and that stuff? But then the idea of being a solo practitioner in a fee for service didn't sound any better. In fact, it sounded actually even worse. It was like, what the heck would I do? And that's when I heard about DPC. And it was actually kind of an interesting story about how I, I found out, I was actually a very avid medical blogger for many years. I wrote a blog called Musings of a Distractible Mind. And it was. It's one of the more popular medical blogs out there. I was frequently featured on Kevin MD and, and the healthcare blog. And I got to be friends with Kevin Foe actually. And he, I, I, I wrote about the healthcare system. I wrote about you know what, it was the personal side of being a doctor, dealing with a patient who committed suicide or dealing with a patient who was morbidly obese and blaming that him, him, them blaming themselves for every, every problem that they had and, and, and the, the self hatred that a lot of the, the morbidly obese people have. And I would write about that stuff. And again, it got to be really popular. Even New York Times Healthcare blog republished some of the stuff and commented on some of the stuff that I did and. I even got on this American life with Ira Glass for now. Anyway, it was, it was an exciting time, but I had, I had a pretty high profile and I started writing about my frustrations in the healthcare system. And as I was doing that another person who was writing at that time was Dave Chase. And Dave actually was reading my writing about my frustration and, what it was like to, to, to give in care in that circumstance and. And he reached out to me and we started talking because I, I loved what he was writing from the frustration, from the, the insurance standpoint. And he is the guy actually who told me, and he's, he's now a big deal in the, the health Rosetta side of things. So on the insurance side of, of healthcare revolution that we're trying to, to incite. And, and so he kind of guided me. He was my Sherpa at that point in time. And and so anyway, it was, I talked to him and he explained to me, what, the Seattle gang and the, i, it just, the light went off and it was like, oh.'cause I, I thought about concierge medicine, but it seemed like I would just be taking care of wealthy people. And I liked taking care of my elderly people. I liked taking care of my poor people. I, I, I just liked the service side of healthcare. I, I just loved being a primary care doctor. As far as the profession, I just didn't like the job very much. And this actually answered all of the questions. It just made perfect sense to me. So in 20, I left my old practice in, in 2012 and in the, in September, September 30th, 2012 is my sobriety date, the, the date that I stopped taking money from insurance companies. And I opened up my new practice in February of, of 2013.

Dr. Maryal Concepcion: 13:42

So, here, especially as you mentioned, your sobriety date, I think about how there was one thing that you also said in your TEDx talk, and it was that familiar suffering is better than change for some people. Yeah. And I, I would love if you can, think, if you can perseverate here with with, with me and with our audience about why that is, because I do feel that, like I, I have guesses. I'm sure Audi, the audience has guesses as well, but you know, you were in a place where you could write. Blogs. Yeah. Because you could, like in today's contracts, you can't even necessarily express your opinion or you might get fired, right. You were in a practice for almost two decades as a partner and, you had a say in the business, and yet you didn't because you were accepting insurance as your payment system. Right. And so, I, I would love if you could bring us back to, the Dr. Lamberts who was on that stage thinking about that familiar suffering is better than change. Is, is this, it was a valid statement then, and it is a valid statement now.

Dr. Rob Lamberts: 15:09

Yeah, I, I mean, honestly, it's, it's one thing that we encounter as providers, as, as doctors. We, we, the fact is that our patients, they would rather suffer from being out of shape and, and, and having an unhealthy body than do the things necessary to change, to have a life that contains exercise that, that contains, actually it is funny because I, I, one of the things I like to say is that one of the best parts about it being a doctor is you get to see everybody else is just as screwed up as you are. And, and I, I like to share my own quirkiness with my patients and the one that I've just, over the past couple weeks I've been talking about. I, I'm 63 years old now. I have pretty, pretty decent health in general, but I, I get cavities a lot. And it just kind of dawned on me that, maybe the fact that you're not brushing twice a day and you're not flossing, that may actually have to do with it. And it's like, you just realize it's like, but you know, you just, I can't do that. I can't change, I can't be different. And it, and so what I actually did is I, I bought a a hundred dollars toothbrush, one of those quip fancy toothbrush that communicates with my phone and it pushes my dopamine buttons and makes me happy. And so I'll brush my teeth twice a day because it gives me little points that are pretty meaningless. But I don't care. It gets me brushing my teeth twice a day. It gets me flossing every day, and that's gonna save me more than a hundred bucks to, to do that. But you gotta cross this threshold of. Being willing to change and seeing it as a problem that you can do something about, and I think that's the problem. I think it's easier, I think there is a safety when you can be the victim. And not be the agent of your own of your own harm. So, it means to me kind of saying, well, I, my teeth, tooth decay is bad. It's my parents' fault because I inherited their genes. I inherited a bunch of great genes. My dad died at 96 and my mom's 95 and doing great. So I, I gotta say I have great genes, but I can complain about their teeth stuff and when in reality, the problem is right here, at least partly that, that I'm just not, wasn't willing to do the things necessary to change. So when we do the things necessary to change, then we can fail. And I will tell you, going out in 20 20, 20 13, there were very few other docs doing about a hundred or so docs doing DPCI, I did talk to Ryan new Ho Full\ and, Garrison, I, I never talked to him, but he, makes it sound so easy. I don't know. I, I, he just is, seems a man of peace. But I, I, I did talk to a couple of people, but EMR systems were terrible there. There weren't really good communication systems out there. It was just kind of a, it was, we, I had to make up a lot of stuff, so I had to, it took a lot of either, either stupidity or, or rub, I was courageous. Probably a combination of the two, a certain amount of that, of going out there and saying, I'm just going to figure it out myself. And, and that's what I did. I, and figured out how to, I even wrote my own EMRI, I built my own EMR for about, and we used it for about three years. It's just'cause I couldn't find anything that I really liked. And so it was just all of these things that you had to do. But I could have failed. I could have gone bankrupt. And, and there's that risk. And I, I really do think that people are just, they would rather not, they'd rather fail at, or at least. Live miserably and not have the chance to get better, but at least they're not taking the chance that they're gonna mess it up. And at some point in time, you just gotta say, look, it's just not worth it. It's, it's, it's not, I, I, I have to change or I'm going to die, metaphorically, hopefully. But that's it.

Dr. Maryal Concepcion: 19:51

And not metaphorically in some people's cases because yeah, burnout, suicide is so real. Yes. Suicide and just, cardiovascular health, taking a huge dive because of the stress getting, so bad hypertension levels going through the roof. There's so many ways that that could not be metaphorical and it is not for some people. But it just makes me want to recognize you and the physicians who have shared on this podcast because you decided that, the, the other option is not acceptable to not do DPC. And what I will say here is for those people who, might, be might. Identify with that. Familiar suffering is better than change. There's a lot of changes coming in 2026, a lot of changes that are already happening. And so, I do think that it is, it behooves you, if you're already listening to this podcast, gather as much information from Dr. Lambert's story, from every story out there. Because unlike when you opened, there were very few people to talk to. There's over 300 people that I've spoken with just on this podcast platform alone. And that is so many different stories. People at different points in their career residency to people like you yourself who had a private practice, internal med peds like yourself, to family doctors, to ob GYNs, to rheumatologists. Every everybody who has shared on the podcast is literally helping the the next generation figure out tools in case you don't have a job in the future in case you need to pivot to relationship-based medicine.'cause you can't take that old system anymore.

Dr. Rob Lamberts: 21:28

And I would say the eight, 13 years ago when I, when I left my, my old practice medicine was not nearly as bad as it is now. I mean, the system is just. Bonkers now, we get, we get, have to do prior auths for generic medicines now, which I think is totally stupid. And we, we have, we have a bunch of stuff that we do have to deal with now, and, and the system that you hear people having to deal with is, it's just, it's a nightmare. And so we have a much worse system that, and right now, direct Primary care is something that is, there's all sorts of templates out there that you could just adopt and start out, the DPC community as a whole is one that wants to share and wants other people to come on. And, one of my goals, as you get to be older, you start thinking of what is your, what is the story that you wanna tell with your medical practice, with your life? And for me, part of it is giving, having a bunch of people who I've really mattered in their life. That's kind of the primary care job. That's like no other. I have people who literally, I've known for 30 years and I've been through the suicides that they've dealt with, the, the deaths that they've dealt with, dealt with the, the horrible health conditions they've gone through, and they walk into the room and I have all that knowledge and of their other family members and that type of stuff. I mean, doing primary care for 30 years is an incredible thing to be able to do. And so, yes, I, I want to be able to have those people. But on top of that, I. I feel like I wanna leave a legacy to other doctors. So that you can have a really good life in medicine. You can have a really nice existence and do primary care and get paid a reasonable amount and still, have time to go on vacations and not be miserable when you come back from a vacation. And to have just all of these, have time to exercise and take care of your body and all of those types of things. So,

Dr. Maryal Concepcion: 23:56

amen. And. People listening to your story and the stories on the podcast can absolutely pick up on that and what that means. Oh yeah. To different people. And I will say, just taking a little bit of a step back when you talk about it's way worse than it used to be. Like you talk about the generic prior auth. Like our, our typical go-to process with our patients for GLP is like, GLP ones is go onto your insurance, see what you know is listed on your formulary as accepted so that we're not like, throwing darts at an unknown target. And literally the patient today was like, it says wegovy, it says set bound. It says you sent them the orders from Wegovy and Zep bound separately, and they were still denied. And I'm like, here's the direct cash pay option. Because I don't know how to, how to explain the answer from the insurance company when it says on their website that these are the covered meds, but I still can't get them for you since June. No. And we're in October now and it's just like, what else can go wrong in this amazing dumpster fire of American fee for service healthcare? What else?

Dr. Rob Lamberts: 25:04

Yeah. And then the thing is, I would've said 10 years ago I would've called it a dumpster fire. And now it's way worse. It's a dumpster fire filled with manure and, and whatever. It's, it's even worse than it was. So, yeah.

Dr. Maryal Concepcion: 25:22

So. Going into your recovery because you decided to change, right? You decided that you weren't gonna maintain the status quo. You decided that you weren't going to go into being a solo doctor clinic under the fee for service flag. Tell us about how you and Jamie, your nurse, broke off and started Dr. Rob Lambert's, LLC, because that was your pri that was your initial, toe dipping into eventually serving hundreds of patients, almost a thousand patients at your practice. Because you know that that definitely is not just recovery, but leaning into recovery hard.

Dr. Rob Lamberts: 26:00

Yeah. Well, first thing I would say is the busiest day I have ever had in the. 12 and a half years that I've done DPC, the most patients I've seen in one day is 15. And that was just, that's the most, and it's almost never happened. It is just one time. I have saw 15 patients in a day. I think I've gotten up to 13 this year at one, one day, but on average it's so much less. Anyway, that's not what you asked me, but I, I, it's people just, if I saw 15 patients on, on, on a given day in my other practice, it would be like, what's going on? This is crazy. This, I'm not busy at all. Anyway, Jamie and I Jamie was my nurse in, in my primary care practice, my previous practice. And when I, I left in September. I offered her to come along with me, and it took a little while to think about it because she thought I was nuts. And because nobody knew what this practice was, this direct primary care thing was. But I actually, since I was a partner, I was able to actually do a presentation to my patients. They allowed me to solicit to my patients, and about 200 people followed me. So I started out nicely. Now. 200 patients I spent. So, so first thing was I, I took that that time from the end of, of September until February to build to, to find an office space to renovate the office, spend a hundred thousand dollars took out a loan for a hundred thousand dollars to do that. And and started communicating to people and, and inviting them in and got a signup thing. That I used for a couple of years but we just, were just kind of started out and we didn't know which EMR we were gonna use. We had no idea. In fact, we tried about three or four different ones before I ended up building my own. And it, it was, it was just kind of hit or miss. And I remember early on, well, a couple of things that struck me early on. First off, I would have days where I wouldn't see any patients, or I'd have one or two patients. And it was like, and what I realized is that I got paid just as much on those days as I did on the days where I was seeing patients all day long. So you had to kind of get over that, the, the fact that if people were healthy and doing well, it's no big deal. Don't complain. Enjoy it. Enjoy the time you get off. But I, I remember. What I, I was totally obsessed with creating this beautiful healthcare for every single patient and, and making their healthcare be ideal. And, and I got frustrated early on that's like, I, I'm not able to do that with the, a hundred patients that I have so far, or that the 200 patients that I have so far, how am I ever gonna do this? And, and I, I remember actually talked to Dave Chase and Dave, Dave just kinda laughed at me when I was talking about how frustrated I was that I, this is just not going the way it should and that kind of stuff. I'm not, it's not good enough. And he realized, and he, he actually. Told me to read the book, the Lean Startup. And the high idea of Lean Startup is you create a minimum viable product. What does, what do people, if you took this away, they would no longer pay you for it. What is the one thing that you want? And, and so that made me think, what is it that my patients like the best about my practice? And what is it? And the one word that came up was access. People want access. They don't care about all the other bells and whistles that I give them a, a here's your health guide, here's all these other things. And, and what I realized is that people, the healthcare system as a whole but especially the fee for service system puts this wall up between people and their healthcare providers and for people to be able to. Smash that wall and send me, that's why they love the secure text messaging so much. That's, I call that our secret sauce. That that's what people, they, they can text message and they don't expect an immediate response back. But getting any message back from the doctor is like, this is so amazing. It's so, so wonderful. So I, I, what I realized is that's all that people wanted. So the advantage of having an open schedule is that. If people need to be seen, they can come in and get seen. And, and the, the temptation for a lot of folks is to over schedule themselves. And that's what, how, right now, I, I personally have around 750 patients. I got up around 800 at one point, but it's kind of, I have an, I have an aggress gone after new patients in a, in a long time trying to build the rest of our practice. But anyway, the, but I, I was, I'm able to have a patient, a pretty busy practice, pretty big DPC practice and still have, like tomorrow afternoon I have two patients at the beginning of my afternoon. Then I'm done at one 30, and then I can go home and I'll, answer messages from home and do stuff like that. But. I have tons of days like that still, and the tendency is like, oh, I gotta fill up, make sure everybody gets seen once a year and all the other stuff. And you're like, no, you don't. You don't wanna fill up your schedule with folks that are doing just fine unless they want to come in and get seen. But to force people to come in to get seen, all that does is that decreases the access that your other patients have. And so, you just gotta understand what the, the, the business model really is about. It's ideally having folks who are can access you is anytime that they want, and they're willing to go a year between accessing you and they'll still pay you every month. That's, those are the ideal patients. I mean, again, you, if they have, uncontrolled type two diabetes, well, you should try and reach out to them. But if they don't, if they keep paying you and you're reaching out to them and they don't wanna come in. I mean, they're not gonna do any better in the fee for service model, and they are, you are still gonna give them better care. So it, for Jamie and me, it was learning how to do that. And again, nobody else around us was doing it. We were one of the first in the state of Georgia and, and the, the. It, it, it was interesting and exciting and my patients were, they, they just loved, that's, most of those people who came over 13 years ago are still with me. If, I mean, very few have, have actually left number of them have died as one would expect over 13 years. But but it was just really, it's really interesting. And even now, like today, I got a message from somebody who was my patient back in my old practice wound and wanted to join. Now it's like, okay, you finally decided. So it's, it, it's, it was a, it was a very interesting and exciting thing, but it was actually very hard.

Dr. Maryal Concepcion: 33:53

Yeah. And I'm wondering, because you and Jamie knew those 200 patients that joined you, from day one. How did your guys' approach to your DPC practice change from day one as well? Because I feel like, we're so used to doing things the old way. Like, oh, refer to cardiology, and you're like, oh, I actually have time to do an EKG in my clinic. And like, I don't have to refer to cardiology'cause I can do a workup here and track your blood pressures at home and whatever. But I'm wondering, especially for those people who are transitioning a practice or those people who are opening with a big waiting list, how, how would you describe, your mindset in yesterday I was fee for service and today I am DPC.

Dr. Rob Lamberts: 34:42

Well, the biggest mindset change is we look at healthcare as the in, in general. Physicians, especially primary care physicians, look at it as transactional thing. In other words, it's a, you come in for a visit, you pay us, we give you care, and so healthcare is done in the office. The reality is it's way more important what happens between office visits than what happens at the office visit. And so it's what it, it was, and, and I was already playing around with this in my head before I even knew about DPC, but I called it Care on the continuum. The idea of how do we give care that is. Interacting with the person through the process so that we get little bites every couple of weeks of how their depression is doing, how their diabetes is doing, how other things are doing. And we just get little messages back and forth. And if you're not tied to bringing the person into the office and you can, can offer care whatever way works, the, again, the majority of them are gonna be via text messaging. Some people won't. But it's, it's actually so much easier to be able to have, say, Hey, how's your depression doing? How's this doing? How's that doing? And you don't have to, somebody comes back in six months and you haven't heard anything from them. No. You've been hearing from them all along. And so it's adopting this mindset. And the other thing, the other difference is that healthcare. It is the visit to the provider, to the doctor or the mid-level provider. The, the idea of, of it, it's this monolithic person who is the billing source. And so everybody wants to tap into that. Everybody wants to talk to the doctor and the doctor offering care is, is what the care is. Well, really one of the other differences is the, the true healthcare team. And, and if you have really good nurses, if you have, just overall good staff. If people are paying me once a month, they're paying for the whole package. They're not just paying for their visits to me. No. They're paying for the fact that, if they're having UTI symptoms, my nurses can go through the, our standard questionnaire and prescribe for that. And, I, they'll give me a little message saying, FYI, but you know, we have, we have set protocols for those types of things for a lot of stuff. And so I don't have to touch those types of things and the patients are delighted to get that care from my, my staff. So it was just kind of rethinking that through and before you would feel guilty to treat a sinus infection, it, somebody's miserable, but without bringing them into the office. And I remember like, should I ever prescribe an antibiotic without an office visit? Now it's just like, that's, that's crazy. Of course not. Of course I can do that. The, you don't, the physical exam rarely helps for, for that type of thing. So. You just go through a, a whole different mi this, this rethinking the way that you go after, after how, how you treat those types of things. So,

Dr. Maryal Concepcion: 38:19

and I'm wondering, your patients who also were in the, the, that first group of 200, what did they say to you and Jamie that really demonstrated that you were achieving access for them? That you were achieving a different continuum of care for them because, it's, it's one thing for patients like your patient who joined like 13 years later to your DPC it's one thing to be on the other side and to judge DPC as a patient who's, to not DPCI, I'm gonna stick with fee for service. And then the people who do go from fee for service to DPC, they're like, how did, how did we not have this the whole time? Like, this is, I cannot let this go as demonstrated by the people who have like chosen to not leave your practice unless they have died, like you just mentioned.

Dr. Rob Lamberts: 39:04

Mm-hmm. Yeah. A lot of folks just felt like I was finally, they, they knew who I was. I, I, I operate very much from a compassionate standpoint, I always try and listen to people and, and treat people well. And, and one of the things we dis, I disagreed with in my old practice is they wanted to be very much of a business, business, business business. And I was like, no, I love my patients. I wanna take care of them. This is about healthcare. The word care is in there, but they seem to want to just. Take the word care out of it and health service or whatever you want to say. And, you might as well be a vending machine in that circumstance. And so my patients understood that I was that way. And so when they heard, when they came to the practice, most of them, pretty much all of them came because they liked me as a person. And, and, you develop, you develop a relationship with your patients long-term primary care patients. It's a, it's, it's a friendship in a lot of ways, but it's a deep friendship where you know more about them than anybody else in the entire world that will ever know about them. All sorts of things about that they've gone through, they're, struggles with addictions. All of those other times, the times that they were nearly suicidal. I mean, I had a patient say, well, one time you called me up Doc, and I was just ready to, if you hadn't done that, I had another guy who, who I took care of, one of my early patients who, who, sweet guy. But he, he ended up getting lung cancer and I was one of the last persons he wanted to talk to on the phone. I, I just wanted to call you up and thank you. And so for me as a doctor, but my patients said, this practice is you, which, which made me feel very happy. And they just feel like, that they have access to me that they, and, and that. I am keeping very close tabs on that type of stuff. I, if anybody is, is leaving our practice, I wanna know why. It's, I don't look at all of'em, but if, certainly if some of the patients that I took care of for a long time, I want them to still feel like they, they have our care. And it's not just a business.

Dr. Maryal Concepcion: 41:44

And on your website, it says that your practice in particular, your panel in particular is on a, at least a three month wait for new patients. What trip, what tricks or tips do you have for fellow physicians who are wanting to talk to their, Medicare, Medicare Advantage eligible people about benefits going into this open enrollment season? Because I do think that and if you have not downloaded the magazine, definitely downloaded my DPC stories, DPC magazine, the toolkit. But I would say that, this is arguably what I say in that magazine is that this is the time for DPC to shine, especially given that 2026 is coming down the pipeline. But I'm wondering from your perspective, because you do have people, you are internal Med peds, you have people who are in that Medicare beneficiary world who are probably asking you questions right now. Like, what am I supposed to do? Because my plan no longer exists. My plan is changing my employer's, dropping da da. Like, all of these things are happening right now.

Dr. Rob Lamberts: 42:46

First off, I will say, people are like, well, what do you do about this? What do you do about that? First, say, look, we're, we're trying to fix a problem, which is primary care. We are not trying to fix the whole healthcare problem. The problem we're trying to fix is primary access to healthcare and to give people a high touch, high interactive healthcare. So the way that I've always viewed this is I can help out, but I'm not responsible to fix this problem. I just am not, and, and, primary care's not an expensive thing. So it, covering it with insurance would be like covering, covering your gas for your car with insurance. All that would do is raise the cost of gas or tires on your car with insurance. If it just make somebody else have a cut in, in the cost of tires and cost of gas, it doesn't make sense because it's not expensive enough to need insurance for. And primary care is just not an expensive thing to do. And so the fact is that I can offer my service and then I can say, well, here's what I think. I'm not, I've not involved myself in the process of going to people and saying, this is what you need to do Now, going to companies and saying to them, here's how you can pair this along and this can cut your, yeah. You gotta find a partner in that because. Very few of us really are, are bilingual when it comes to speaking of the doctor side of things and the insurance side of things. There are some folks who do, but most of us are, we don't necessarily talk well to employers, and you need to find somebody who's willing to do that and somebody, and, and you can find allies in, in the local market even with the Medicare people who can help Medicare beneficiaries decide between whether it's a Medicare advantage plan or if it's a, a, a secondary policy or that kind of stuff. Those are the types of things that I will tell you truthfully. I just want people to come to me for their primary care, and I'll give my opinion some but what I do say is. You're just talk, you're talking insurance to somebody who obviously has, has strong opinions about the insurance market because I've not been doing it for 13 years.

Dr. Maryal Concepcion: 45:31

Yeah, I, I totally agree with you. We are not, well, some people in our world are benefits advisors as well as DPC doctors. I am not one of those people. God bless them. Yeah. But I, I, I will say that yes, it is important to have people who are trusted partners, whether they be local, whether they be, a particular advisor at a, a ship that's the like centralized place where each state you can ask a person in a ask a person for advice on insurance. And then, I've, I've, if you haven't, it's very interesting to go on to Medicare the actual website and like shop for a health plan. When it comes down to medications, I will say that like, one of the things we're working on locally is offering cash pay and insurance-based pharmacy services to non-members. We're actually working with the pharmacist who has, survived the, the world of. Corporate, big box pharmacies and has decided that that's bs and in our community, we expect that we're going to lose services. Like we've lost all of our RiteAid locally already. And so, I, I do think that there is, without speaking insurance at the level of a benefits advisor, I do think that there are ways to be creative during Oh yeah. Especially about like, even with our patients who are already members, I love having the conversation I've had like twice today already, like, but how much are you paying for your Rosuvastatin because you're getting that through your insurance and you're, you're telling me that you're gonna lose that benefit? How much are you actually paying for it? And so I, I almost feel like we're paying, like the price is right when it comes to giving quotes about medications. Sometimes especially so I definitely would say, like brainstorm with your colleagues, brainstorm with cha pt, whatever it is about how oh yeah, you can, how you can be creative during this time.

Dr. Rob Lamberts: 47:19

And I think those, crisis is crisis times are also opportunity times. And so you've, I mean, when I did it, it was right in the Obamacare thing and everybody was trying to rethink healthcare and they, they, a lot of folks assumed, well, you're, you did this just'cause you want to get away from Obamacare. Nothing to do with, it had to do with disagreeing with my partners more than anything. But, the, the, the reality is that that did offer me an opportunity to, to where people were questioning healthcare. And so I was saying, well, here's another option. And people would come in and look around and say, what am I missing? What's the catch? And I said, the catch is that you pay me every month. That's it catches, I've already told you the catch when you walk in the door, it's a secret. Don't tell anybody except everybody knows already. It's like, and so, but we did, for, well, from the very start, we did labs discounted. We did. And, and, and then eventually a couple years in, I, we added pharmacy benefits where, where, we're doing generic drugs through here. And again, to me that's pure marketing. That's, you don't make money on those. But what you do is you offer somebody something that is so fricking cheap that they can't afford to leave you. And so they lose out on the.$2 Rosuvastatin prescription, that, that, that doesn't cost Didly squat from you. That it would cost way, way more. And so if they left you and they're no longer paying$75 a month for, for the thing, well then they're paying 98 a hundred extra dollars for their prescriptions that they were getting from your pharmacy and, and we're just. You just gotta kind of keep looking at it and saying, what other things can we offer? What can we offer for, for businesses? What can we offer for, for other, other folks? And as, as deductibles are gonna get higher and, and less and less stuff is gonna be covered. I think we're gonna be more and more in the business of being able to do this. And I, I agree. I think going out, we, we've thought about opening up a cash only urgent care to, to be kind of the front door for, for people coming into to, to our non-insurance based practice. And, and, and that they would see it and we'd say, our members would be able to use it on weekends and that type of stuff as part of their membership, maybe with a little copay, but you know, that we'd be able to have X-ray facilities and other stuff. So we're, we're kind of contemplating moving in that direction. But, it's, it'll happen when it happens.

Dr. Maryal Concepcion: 50:10

And you have definitely gone through a professional change like now multiple times because you went from fee for service to DPC and then your LLC combined with Welcome Health. And so can you talk to us about that creation of welcome health? Because it's, it's so, like I, it, it makes me think about how there are people who are graduating medical school and residency and they've already planned on doing DPC, but they know that like they want to join forces. They don't necessarily want to wear the, the business hat, the business owner hat. And so I'm wondering if you can tell us about that transition because I do see that that is a another way that DPC is going to ebb and flow in the future with practices joining each other.

Dr. Rob Lamberts: 50:57

Yeah, we, so, so five years into to the practice, I, I got approached by a local family doc and a pa who they were both miserable working in urgent care. And, and the PA actually researched and found DPC this is 2018. And then lo and behold, they realized there was a doctor in the local area who's doing DPC. So Eds Bolen sends me out a text message and, and I don't respond for two weeks'cause I'm on vacation. And then I like, oh my gosh. And so I texted him back and you gotta get, get here and talk to me right away. And he, he thought I was just gonna be pissed off that, that somebody else's my special idea that I wanted to hold onto. And I was like, no way. I want other people to do this. And and it's rising, tide lifts all boats and that kind of stuff, but part of it is just being able to see other people happy with, with, with medicine.'cause it is better. And so I, I was already full at that point in time and honestly. I had been burned by being partners with other folks. And I, I, the idea of working with other folks really had a strong negative. And so I, I, I was content to just kind of drift along until I was old enough to retire and able to retire. But then they approached me and, and, and I didn't make them partners right away. I actually worked alongside of them. In fact, ed actually Davis set up his, he, he, and, and Ed was his supervisor, but they set up a practice in the, the town town next to Augusta Evans. Out, out in Evans and Ed was actually in my office, but Sep three separate LLCs, ed's, LLC, my LC, we had separate EMR systems, separate billing systems and all of the stuff. And he was actually just paying for half of my overhead, which actually was a really good deal. I I, I was actually getting a decent check from him and it was a good deal for him too, that he was only paying half the overhead he would otherwise pay. So it was a win-win. And so, but they worked alongside of me and then we started looking at doing business contracts together. We actually formed Welcome Health as a company to approach businesses that we could all be paid through Welcome Health, but still be separate businesses. Well then eventually we just decided we liked each other enough and could work along together. And just decided. We knew each other well enough and trusted each other well enough. And my PTSD from having partners before was overcome by my genuine affection for these guys. So we formed Welcome Health in three years ago in September of 2022. And, and created a single, just a single entity. And, and the hard part now has been we had those different cultures, we had those different things, and we're still in the process of getting everything merged together and everything growing. But, we've gone, now we're up to 2300. No. Yeah, I think it's 2300 patients we got right now, so. And, and as opposed to a lot of folks, the majority of ours are not businesses. The majority of ours are retail, still about 90% retail. We understand that the growth will probably happen best through business. But yeah, we have a couple of really strong possibilities. But I've lived through about 10 million strong possibilities that never happen. And that's called running a business. And you just don't count any chickens until they're hatched. I've been through all that stuff, but it's been a good process and now we're adding providers and adding locations and it's, it's, it's exciting.

Dr. Maryal Concepcion: 54:59

It definitely is. And I think about one, it's absolutely hitting on the accessibility factor that you were very much passionate about on day one and two, that it is absolutely building your legacy in your, that's ability to be a DPC doctor. And how does that DPC doctor help the movement, change the community? Yeah, so I think that's so powerful

Dr. Rob Lamberts: 55:22

and change the lives of the doctors. I, I remember two, about two months into when Ed started working here in 20 19 January of 2019 is when they started actually. He comes in and he's seeing patients for the first two months and he was, he was already looking for a job outside of medicine. He just hated medicine. And I came over to him and I remember just, I remember the look on his face, he says, so what do you think? I love it. I love it. It's just what I've wanted to do for, and he and I still bitch and moan to each other on a regular basis. But, as far as, but compared to life out in the other world, the, the fee for service world and certainly the, the, the urgent care it's it's it is just so much better. And so for me, that is the essence of what I would love to do with other providers. Giving them the ability to have that 30 year patient that you can walk into and just spend time talking to them about stuff. My average. Pretty much most visits are half an hour. Some visits are an hour if they're new patients, and, if they're just for a sore throat or earache, they'll do a 15 minute visit. But I, I've got half an hour to sit and chat with people and I just, I like to

Dr. Maryal Concepcion: 56:53

absolutely. I, I laugh because the, I, I spent a 96 year old's birthday with them and they were like, clearly, I'm so busy that I'm spending my 96th birthday with you, my doctor. And we decided to, to hold off on a biopsy that day.'cause I'm like, you don't need a biopsy today. We can do it next week. And they were like, I just love it. Like, it's not like months after that I have to wait to come back and see you. It's literally like, because it's your birthday, let's not do these invasive things today. Let's just like put that off a week. And so, it's it's so beautiful to have. The time. Even just for little things like that, that are, something laughable that when they tell their patients, when they tell their friends at the golf club, they're gonna be like, are you serious? Yeah. And it's like, yeah. That type of stuff happens all the time. That happens all the time. And that's,

Dr. Rob Lamberts: 57:43

that's the organic growth that you do get from a large patient. They're all bragging on their doctor and there's very. There's, there's a very, the thing that nobody gets in healthcare anywhere else is walking away from healthcare thinking that you got a good value, that you got a good deal. And our patients feel that way. They feel like it's worth spending their money on this. And they're every, I I, people are like, do you know, at the start you had to decide, do you want to say if you sign up for a year, we'll give you a discount and if you sign up, and I was like, nah, I want my report card to be every month when people pay me. I want them to tell me. I wanna have my finger on the pulse and know that if, if that number starts going up of people leaving our practice, then I know that I'm doing something wrong and that we need to fix it. But it's never. It's never been a problem in the whole time. Our, our churn rate's been around 2% which is, nothing. So, but what I would say is people are, are people out there looking in, in, who are providers who are either in, in fierce service medicine or residency, or those types of things? Don't, don't think you're gonna figure it out all that ahead of time, to some extent. You just gotta go out there and, and you gotta, gotta pay the, pay the price. Now, that doesn't mean you don't do the bootcamp, it doesn't mean you don't, read the books or, or, do the my DPC story, all of those types of stuff. No, you, you do all the, the research upfront. But your story's gonna be your story. You're gonna go out there and, and you're going to tell the narrative of who you are and what you do. And I had different things and I, I look at, at, guys who have built these humongous things. I, I just wanted to practice medicine. And in, I only started Welcome Health very recently because I found some partners who I could work with and it would enable me to build a legacy and, heck, maybe build, have a better retirement. That's not a bad thing, but, it's not that, that wasn't, that wasn't my goal going in. My goal going in was simply to be able to be able to make a living off of giving care to people That, and, and just enjoying what I was doing.

Dr. Maryal Concepcion: 1:00:26

I feel like we need our own DPC challenge coin now because we are all in recovery from fee for service. Yep. I we totally need one. Oh yeah. Oh my gosh. Yeah. I I love that. I

Dr. Rob Lamberts: 1:00:36

think it's a great idea. I, I, that's it. And have, have people's sobriety, how long they've been sober from accepting healthcare and it, it really is. It, it, it really, it felt like healthcare felt, felt like you got out of an abusive relationship when the, the old fee for service thing, because it was just one of those things that it kept, promised this idea of you being able to care for people and take care of and meet their needs and you can't do that. And you end up, and, and actually it's interesting, one of the reasons that we named it Welcome Health was because the first was,'cause we want people to feel welcome when they come in, but it really was. Instead of saying, I'm sorry, in, in healthcare, you're always, it's like, I'm sorry I made you wait. I'm sorry. I did all this stuff here. We're always saying, you're welcome. People are just so grateful. You, you, you answer a, a, a, a, a mom of a two month old who is worried about their child and she sends a, a text message and you respond. She's so grateful that she has a doctor that she can find, reach out to, and that type of stuff, and people are just, it's just so gratifying to be able to say, you're welcome to that. And that's the point is, is you're no longer in a, in, in a relationship where they're mad at you. You're mad at them for making you so busy and for, for being so complicated. We're all mad at the government, we're all mad at all the other folks. And it was even interesting during, I mean, it's just you, you have this total better relationship and it's no longer an abusive relationship. And when, when you know when COVID happened and when other stuff is going on and people are suspicious of healthcare and that type of stuff, the one thing that my patients will often say, some of my anti-vax patients, some of my other folks who are, I'm like. I don't answer to the government. I don't answer to the drug companies. I don't answer to the insurance companies. They don't have access to my records. Nobody's looking over my shoulders. What I am offering you is what I offer to my family, to my everybody. I would do my, I'm doing it myself. I'm taking Rosuvastatin myself for my high cholesterol. I don't do anything because anybody's bean counting me. And I have people you know, again, who are saying, if there's anybody who I trust in this, it's you because you really are independent in what you're saying. And they may disagree with me about vaccines or whatever. Okay, that's fine, but at least I can have a discussion where they don't feel like they're not looking over the shoulder and saying, what's the government forcing you to do? And that's, that's incredible. The, the whole rethinking of the whole model. I, early on, one of the first things I remember thinking, because I was heavily into the electronic medical record world back in the day, and, and the truth is that, that, that EMR systems are in, in most healthcare are really there to justify the billing. That's the entire reason to do it. It's to list all the things you can do. And if you look at the notes, mo I call it computer vomit now because that's what it is. It's just all of this stuff that, that is just so that they can get paid more for their, their visit and document their billing and, not get dinged for Medicare fraud or whatever. The, I remember coming into, into. This and thinking what would the electronic, what would the medical record look like if the only reason for it is patient care? And that was like a, but that was now most of the DPC folks are, yeah, well that's why we use it for patient care. But that was totally different from, from what we had in the past. So,

Dr. Maryal Concepcion: 1:04:57

and I wanna ask here, because like, you were innovative in a time that there weren't a lot of DPCs. Like you mentioned, you were one of the very first in the state of Georgia, but also you built your first EMR that you were, you built your EMR that you were using for the first three years. And so I'm wondering, as you talked about like the ability to text your patients back as you, as you talk about the accessibility being a root, reason for you doing this, how do you envision tech. As, as a way to help your practice versus tech stack getting out of hand, because I do feel that like there are so many more things coming to market that are like, oh, we can do this and we can do that. But I'm wondering if like, if you can, if you can zoom us out in terms of like, how do you envision tech allowing you to deliver patient care and not be a code collector or a thing for billing purposes?

Dr. Rob Lamberts: 1:05:46

Yeah. I think you gotta first say what's the point of what you're doing? And the point is giving people access to healthcare access. And if, if it improves your access, then the tech is probably a good thing. And by that I don't mean people have access to you 24 7 because my patients know if they text me at two in the morning, I'm not gonna answer. I'm just not. I'm just not gonna wake up and I don't promise that. But what they have is access to it, it's just that, that there's not this wall between us. It's welcome health for a reason. And the, I think you've gotta understand tech that doesn't, that that doesn't improve. I doesn't improve access. I honestly, I will tell you this. I don't do hardly any video visits with any patients because it's like, oh yeah, that'd be great. We can do video calls. I mean, I phone calls just as good 99% of the time. And, and every once in a, and we do have people taking pictures of their rashes and stuff like that, which hopefully is not any, tawdry or anything like that. Every once in a while it is. But the the, the, the, the idea of saying, well, we can do this and have all these things, and it's like, yeah, do I really want to have the, the, the patients really want me to see them, feeling miserable and that type of stuff when I can just have a phone call with them or whatever. I, you, you just kind of have to get real practical about it. The other thing is that, to what degree does it help you offering better care and allow, allowing people to manage their own care better? So, I think smart watches are great. I think, I, I, all my, a lot of my old older folks, you want them so that for fall detection and other types of things. I mean, there's a lot of reasons to do that. But, but you know, that's the thing is you've gotta look at tech as something that can enable care. It can also, I. Drive people crazy and give too much information. There's the, the ear things where, where they can take pictures of the ears and listen to the heart and send you all that stuff. The nonag gone. I think they got bought out by another company, but we use that for a while. But there's, it's that small niche of patients who, who use that. Most folks, it's not really all that. It's gee, w cool, but folks just don't use it. And the fact is, again, get back to what's your minimum viable product. What's the thing that people want more than anything else? They wanna be able to be listened to. The thing that patients said to me over time, you're the first doctor to ever really listened to me. I mean, I'm sure you've had that too. And it's just like.

Dr. Maryal Concepcion: 1:08:51

So sad.

Dr. Rob Lamberts: 1:08:52

How can you be a doctor and not listen, but, or not give the impression of not listening, because that's our job, is to listen and to come up with a plan based on what this person is sharing with us. But people walk away from most healthcare feeling like they're not listened to because they feel like they don't have access. Mm-hmm. They feel like they don't have the time to say what they're gonna, what they need to say, and, and we are able to do that. So just all of the other stuff is cool, but it's probably, it's probably not gonna matter to them as much as you think it will.

Dr. Maryal Concepcion: 1:09:29

I love that. And yeah, I mean it's, it's the, when you are talking about like, are you kidding me? Like, what are you not listening? Like what are you doing if you're a doctor who's not listening or who's perceived as not listening? Like, I literally have a patient who moved away but maintains her membership because the doctor that she came from in fee for service had suggested she go on an SSRI because, and then I was like, why, why did she put you on that? Like, were you having, were you anxious? What, like, what was going on? She's like, I love that you actually asked me, because she just said you should take this and did not tell me why I should be taking it. And I'm like, okay. So the many hours of conversations that we've had, the acute things that were definitely as a result of medical trauma in previous clinics those being, being very different at Big Tre md, this patient literally sees me like, on the phone most of the time, but when they come in it's like, that is worth it to them because they're just like, you listen to me and like, you don't judge me when I'm like thinking things that I might have Googled. And it's like, Uhhuh, because I care about you. Like I don't care about the insurance codes that I'm not getting anymore.'cause I don't care about them and I don't need to.

Dr. Rob Lamberts: 1:10:49

Yeah. I have a, I have a, a patient who moved to Florida and she moved back to Augusta to be with her doctor.

Dr. Maryal Concepcion: 1:10:57

Oh my gosh. How awesome is that? But you

Dr. Rob Lamberts: 1:11:00

understand that that's a real thing. People are so traumatized and this was, this was 10, eight years ago, so, there was nobody there, there weren't other DPCs available, but it was still there. They, people are traumatized by the healthcare system and traumatized by the fact that, that it, it, it's really a, it's a terrible system. And to be able to have somebody who is on the other side, who is actually like, no, I really do care. And, and I have the time I'm going to give to you. It's just, it just lets you line up the stuff you wanna do with the payment system and makes it so my payment system encourages me to spend time with you and to do that type of thing, which is really cool.

Dr. Maryal Concepcion: 1:11:52

Absolutely. Well, thank you so much Dr. Lambert for joining us today and sharing your pioneering story all the way up till now. And I'm so excited for what the future holds.

Dr. Rob Lamberts: 1:12:03

Thank you very much for having me. It's great to talk.

Dr. Maryal Concepcion: 1:12:09

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.