Strengthening Access: Lessons from Dr. Stephanie Lucero’s DPC Journey in Rural New Mexico

In today's episode of the My DPC Story Podcast, host Dr. Maryal Concepcion welcomes Dr. Stephanie Lucero, the pioneering founder of Northern New Mexico’s first Direct Primary Care (DPC) clinic, Hometown Doc, LLC. Dr. Lucero shares her journey from growing up in the Pojoaque (Puh-Wah-Kee) Valley to becoming a board-certified family physician deeply committed to her local community. The conversation dives into DPC’s benefits over traditional fee-for-service healthcare within New Mexico, addressing common myths about DPC being “concierge medicine” and highlighting its affordability and accessibility—even for Medicaid patients. Dr. Lucero discusses challenges like physician shortages, healthcare access issues in rural New Mexico, the impact of restrictive non-compete clauses, and the importance of relationship-based care. Listeners will gain valuable insights into how DPC empowers physicians and community by fostering meaningful patient relationships, improving health outcomes, and creating community-focused innovation. Discover how Dr. Lucero is making healthcare personal, accessible, and efficient for New Mexicans/Hispanos/Nuevomexicanos—and why DPC might be the answer for patients and physicians nationwide. 

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Transcript

Maryal Concepcion: 0:48

Dr. Definitely Lucero is a absolute pioneer in New Mexico. She opened Northern New Mexico's first direct primary care and I'm so excited to talk with her because like I'm a California native, born and raised in Sacramento, moved to rural northern California. Dr. Lucero is a POA Valley native. And also she did undergrad with her biology bachelor's degree in New Mexico med school and New Mexico residency in New Mexico. So she is bringing New Mexico to the podcast. Thank you so much Dr. Lucero for joining today.

Stephanie Lucero, MD: 1:22

Thank you. I'm so excited to be here.

Maryal Concepcion: 1:25

So I was so excited when we connected to have representation from New Mexico on the podcast. I've been to Albuquerque a couple times since starting this podcast and every time I'm like. DPC doctors in New Mexico and I'm like, oh my gosh, that was so wonderful to connect because you are in a place where, unlike other cities in the country, there's not like multiple DPCs to choose from, you know, within a 10 block radius. So because you've grown up in your community, you are of your community that you are practicing and practicing DPC in, but I'm guessing that you've seen a lot of stuff growing up as well as going to school in the fee-for-service world in New Mexico. Yeah, so I would just say growing up around here, I was lucky enough that we did have sort of a home doc, if you will. There was a doctor that lived in the neighborhood who I saw a couple times as my pediatrician and she also worked with the schools to make sure that we got vaccines at school. And for whatever reason that really stuck with me. And I just always liked this idea. Like I knew that she would go to people's houses and stuff and again, like a female doctor, this would've been in the mid eighties. Yeah, I don't know, it just stuck out to me. And then just in general growing up in a rural place we were always like playing in arroyos, which is also known as a small river for those of you that dunno or creek. And I was just always really into nature stuff and I just really was into medicine, so I kind of knew from the get go that was something that I wanted to do. And then, getting into medical school and all that, it was like, I wanna be, this is, this is really true. I have like anxiety about things. And so I always wanted to be prepared and I was like, oh my gosh, I don't wanna be like the person on a plane when, like someone has a medical episode and they're like, is there a doctor on the plane? And then it's oh yeah, hi here. But like I am a neuro-ophthalmologist like, or whatever, like some super subspecialty that just not like the person who kind of like knows how to maybe manage all the things, and so I kind of always had this place in my heart of being that rural family doctor because I had had something similar when I was growing up. And so family medicine was just sort of the obvious for me. And then I did a residency program that was very, rural focused and very sort of self-motivated. I'm pretty self-motivated person. I'm not a fan of people telling me what to do. I don't know if that's common across the doctor world, so yeah, so that's why I did a local residency and yeah, I am literally sitting in my office right now, which is not even maybe a half a mile if even from where I grew up. Yeah, so, and a lot of my patients are people that I knew growing up and they know me and they know my family and oh, and I, a big part of why too like, you know, I did work for like a, a fee for service local corporation that was still in my hometown. But I just, I mean the writing's on the wall, I think we all see it as physicians, how like you're just not, you're not providing what you could and people aren't getting out of it what they could. And, and I really liked doing home visits and stuff like that. And so, when I sort of got burnt out, I was looking for options and that was, this would've been in 2018 and DPC was sort of big maybe in Texas, and I know Kansas obviously as we know and some other places, but it was not something anyone had heard of here. And they all kind of thought I was insane, but. Do it anyway. And all of your patients and you know yourself absolutely. But are grateful that you did this. So I, I wanna delve into this idea though, that you are like, I, I love this'cause you're an autonomous family doctor and I completely get that. Because when you need to do what you need to do to take care of your patients, it's really a drag when someone's oh no, you don't have the time to do that, or et cetera BS that actually is not correct. Right. So tell us about, what, what was, what was contributing to your burnout? Because burnout is experienced differently by different people. The level at, at which burnout is allowed to continue before we say peace out man, I'm done is different. So what was it like for you because you were in a fee for service model in New Mexico amongst your community that you remain in today under DPC now? Yeah. I mean this is maybe a not so great metaphor to use, but I always tell people working in a fee for service corporate sort of environment, it is like being in an abusive relationship. I was getting sick of making money for other people. I was the one doing the work and everyone else was getting paid for it. The whole burnout thing. It's well, you're just burnt out. And it's no, but you're making me burnt out. I'm burnt out because of the system that you built. And I would say a lot of the burnout it is just like I. It's not even really how many patients you see. It's how, it's how ineffective you're being and seeing that many patients. And so at some point you just feel like you're on a, on an assembly line. And now having done DPC, I think most EPC docs can clearly say that knowing their patients and knowing their family and knowing their circumstance is the biggest part of why they have the health outcomes that they do. Hands down, I mean, it, it, it it leeches into the quality of care, the meaningfulness of care, the compliance of care, the word of mouth of your care. I mean, it's literally leaching into everything because it's foundationally built on a relationship. Yeah. So when you talk about that, you are like half a mile or, from where you grew up, I would love if you could just also lay the ground for us in terms of what does healthcare access look like in New Mexico in general, especially because you're in a bigger city compared to some of the more rural areas of New Mexico, New Mexico, but in general, New Mexico is what we would consider a rural state. Yeah. So I am about 20 minutes outside of Santa Fe. I guess per taxes, we're not considered rural anymore, but a lot of people, I mean like. Starlink was like a game changer for us out here. Like we still had literally a couple years ago, like dial up at 1.5 megabytes per second. So it's still pretty rural here. And in general, people say we're about 30 years behind in school, in technology, in all of the things, it's very hard to get doctors to come to New Mexico. Our malpractice laws are not the greatest. Our caps on malpractice payouts are not the greatest. There's a lot of fights going on between that. Also I just think, I've seen them try to recruit younger doctors out of residency and quite frankly, if they don't have a tie to New Mexico, there's really not a reason to come here. We're lowest in education. We're lowest. I mean, we're kind of lowest in everything. We're low in all the good things and we're high in all the bad things. So it's hard to get people to come here. And most of the people have some sort of tie and that's why they come here. But access is pretty terrible.'cause just there's a shortage, there's just an absolute shortage. Yeah, it's just bad. And what about for specialty care? I'm in rural America. We're an hour and a half from the nearest trauma two center, a nicu. 45 minutes. If you choose the wrong direction, you might go to a hospital where there's no peds on call or be on call. Yeah. I mean it's, it's, so I I, I completely empathize with what you're saying in, I'm in fricking California. This is insane. Yeah, yeah. It's 2025. Yeah. But I will say it makes me think of how when I was at Creighton there was a widge program that some of the dental students were part of that they got their dental school basically paid for if they returned to New Mexico. And my girlfriend in dental school was from Albuquerque, so she went back there after graduating Creighton. But, I, I think about that, just hearing everything that you're saying it makes you want to ask you about, what would you say to those people who say, DPC is concierge medicine? DPC is for rich people because that is a big thing that policy makers, ivory tower people who don't actually see patients anymore, who are not boots on the ground claim that DPC is in fact, oh my gosh. And it's not, no, I am, that is my pet peeve. That is my trigger. When people will be like, oh, aren't you doing that concierge thing? I'm like, no, no, no, no. I am not doing concierge medicine where they bill your insurance and the monthly fee is generally on the higher end. DPC does not involve your insurance and it's, trying to stay as affordable as I can within, reality of living in this economy. And I have patients from all walks of life. I have very well off patients and I have patients on Medicaid that are like, it is well worth, they have so many things going on medically and they just need that help navigating the system. And they prioritize their health in certain ways, and that's where they send their money. They'd rather pay me my monthly fee so that they make sure that all the ducks are in the row then sort of be sort of thrown to the wolves in the big system. It, it's so interesting. I was mentioning right before we started recording that I have just come from Washington DC and I was there speaking amongst different people in our government. But I was really excited to hear your Senator, Senator Luhan talk about, we have to go forward and this is not a, a political thing in terms of one party is right over the other. It's literally people in this country need things including healthcare and we're recording this right after there's a claim that Snap will be. Funded To what extent? We don't know when that will happen. We don't know, but I think about, even yesterday I had a conversation with a patient and her daughter, who's also my patient about how do we have too much, too much reliance on the government and whatnot? And, I, I would like to also just call out New Mexico for its innovation when it comes to even basic things. I mean, I'm a mom of two little kids. If I lived in New Mexico, I would have childcare and not have to worry about childcare. You guys have been completely innovative. And I think about that you're really doing things including, and especially your DPC, but you're doing things that are community based and whether or not you believe, we have too much reliance on government or not. I'm like, it doesn't freaking matter if at the end of the day you're just like, dude, I need a doctor. I agree. I think like most doctors can agree that medicine or healthcare, whatever we wanna call it, should be apolitical. It really isn't. I just like I have patients financially from all walks of life, I have patients politically from all walks of life. But guess what, they all agree on this that they like DPC. I mean, that's why they're here. They all want access to a doctor that they can talk to openly. And I mean, honestly, a lot of what I do is just helping them navigate the healthcare system because it's ever changing and they just. I mean, it's totally lost in it. It's no different than, hiring a lawyer to help you navigate the legal system. Amen. And I think that, it's, it's funny because when people are talking about their elevator pitches and whatnot it definitely can change over time depending on where a person is practicing. But I think that that's something that is not commonly mentioned because it's not even something that, it's almost like you need to do that, but you don't necessarily have a name for what that is. And the navigation of healthcare, I mean, I, I just watched one of the best memes, this a comedian was like trying to explain American healthcare and copayments and all the stuff deductibles to a Canadian comedy audience. And it was just like, this is so funny, but also super messed up. Yeah. It's so complicated and it's ever changing. I mean, it'd be one thing if every insurance did the same thing, but not only did they not do the same thing, they change what they're doing in the middle of the year, or randomly, or now your employer, doesn't contract with this pharmacy program anymore. So the place where you got all your medications now, you can't get it there anymore. And it's all unnecessary. And I, I hate to throw a big chunk of people under the bus, but you know, as we say in direct primary care, it's just unfortunately it's getting rid of all the red tape and all the people who. Supply that red tape. It's just, that's why it's called Direct'cause it's from me to you. And there's, there's so many things that we could be doing. All the home testing, all of the, there's so many things that are cheaper, more efficient, direct, whatever words you wanna use. Just efficient, not wasteful. I don't know why anyone in this country, what would it be for things that are gonna save money except for, the reality is people will lose jobs if we move to a more direct way of doing healthcare.'cause there's a lot of jobs in between us and insurance. I was just listening to an episode of The Daily where they were talking about how Amazon has reduced their workforce the person was interviewing the, it sounds like the plant manager maybe in mm-hmm. Louisiana, where they've replaced a massive amount of the workforce with robots. Yeah. So I think that, it's changes are coming. Absolutely. But I, I also thought during that episode when I was listening that, I was an anthem major for my BS in undergrad and it's like people. Evolutionarily want connection. And so absolutely. It's so interesting that as AI's gonna do what it's gonna do, technology's gonna do what it's gonna do. I, I do not think we will ever be in the wrong of, of wanting to connect to connect with humans, especially over their healthcare. For sure. So let me ask you here, because you, were born and raised in New Mexico. You went all the way through residency in New Mexico, and then you worked for fee for service. As you talk about malpractice issues, did you have any non-compete issues in opening your practice? Would love to hear. Yeah, I did. So my non-compete was essentially that I could not work for a facility that had radiology services for a year after I quit within the county. And our county is, well, it's Santa Fe County, so it's sort of all of the hospitals and urgent cares and whatever in Santa or even a clinic if they have an x-ray machine, I couldn't work there. So yeah, I mean that's pretty ridiculous in an underserved state. I, yeah, I mean I just, it's, it's pretty self-explanatory. I don't even know why they exist. It's really just a deterrent, if anything. But it is what it is or it was what it was, amen. And I will say that this is exactly like. Why like why I was even in DC to talk about what we need as, as small businesses, because we are small businesses at the end of the day. And when it comes to restrictive clauses like this, I mean, and you, you like called the kettle black, right there. You're, you're in fricking New Mexico. Yes, let's let's add restrictions for people to access their doctor. Like lovely best idea ever. Yeah. So, it's, it's ridiculous. But when you, now it's not 2018 any longer, it's 2025. And I'm wondering if you could talk to us about the opening of your practice and definitely it's a little bit different from in your story compared to someone who did not practice or do not, did not grow up nor train in the prac in the place where they're practicing now. But what was it like for you to start talking to people about this thing called direct primary care? Yeah, so the good thing about being from here is that I know that this place is very small town and very word of mouth. And because, my parents grew up here and I grew up here. It was a lot easier to spread that word of mouth, but it was a hard sell. Like people did not. I mean, I would say still around here, if you ask someone what direct primary care is, they'll be like, well, that's concierge, right? That's like boutique medicine or whatever the term they wanna use. And I'm like, I'm, I am getting tired. I, I kind of want DPC to sort of like hit the zeitgeist a little bit more around here so that we all kinda don't have to explain it anymore. And then so maybe it would explode. But essentially I just told people, yeah, there's this thing where, and they were like, well, why would I pay a monthly fee? That makes no sense. Why would I do that? I only go to the doctor twice a year and I'm like, I tell people all the time, you're not paying for the medicine. You're paying for the convenience, the trust and the relationship. If those things matter to you, even if you see me once a year for your annual physical and I never speak to you again, that is going to be worth its weight and goals. That physical is gonna be very thorough. We're gonna answer all your questions, we're gonna take our time. And guess what? If you leave and then you think of something, you're not gonna have to call back and go through some phone tree to communicate back to me or a portal message that's gonna go to my, ma or whatever. You're just gonna send me a message and be like, Hey. I forgot to ask you this and then guess what I'm gonna answer? Not some third party, not some ai, and then sort of like all of those DPC stories in a way. Once I got a few patients on board, then they sort of saw what it was and then they started selling it themselves to other people. So then it was sort of like, like-minded people we're telling, like-minded people we're telling like-minded people. And now pretty much everyone on my wait list is someone who was referred by, a current patient or heard about it. Somewhere like that. Yeah. And again, just like dotting that I crossing that t like absolutely what you're delivering is what people want. Like it is in any geographic region in this country, this is exactly what people want and deserve. I right? I was gonna say right now a lot of people, they don't know what they don't know. They don't know that they want it'cause they don't even know it exists. But I guarantee if they experienced it, they would never wanna go back. I mean, all of my patients are constantly, like when they have to go, see a specialist and sort of the regular system if you will, most of them come back and are like, oh my God, I forgot what it was like to have to go and wait in a waiting room and fill out the paperwork and give'em your insurance card and all the things that come with it. And I'm like. I know sometimes I have to access it too, and I'm just sitting there ugh. Absolutely. And I hear, I think about the, the value that DPC brings and Yes. Convenience. Absolutely. But I'm wondering if you can talk to us about even what is the word? Even just soundbites or feedback that you've heard about how your clinic and how you as a physician who have a, who has a relationship with your patients has completely transformed their access or their quality of health care access. Because I, in a world where people are about to lose, their insurance plan, their insurance through their employer you, the, the, the list is endless as to how healthcare is changing, especially in this season. I, I wonder what your patients are saying about your practice, that it's only because you're there that they're able to get X, Y, or Z. Oh, for sure. I mean, again, it just goes back to navigating. So I would say it's navigating the system and it's the efficiency and speed at which they can get in to see me, right? So they have a problem, they let me know, I get them in, we figure it out, and then it's navigate, navigate, navigate the system. Maybe they need to go see a specialist the time that it takes. Me to sort of complete that circle of initial diagnosis to them getting to the point where they need to be is pretty fast compared to, I mean, well also, I would say you just, a lot of patients didn't understand in the, in the fee-based system, I'd be like, okay, your, your, your blood counts are abnormal. I need to, we need to get more blood tests, and then I need to refer you to a hematologist that was sort of lost upon them. And oftentimes they would leave and they wouldn't do their blood work, so then I never got the results. And then they're one of, thousands of patients. So I, I'll like, remember them when I'm lying in bed one night oh, what happened to that person? And did they ever do their labs? And then I'm trying to chase them down and maybe they've, gotten lost in the mix or whatever. And so just the delay in that as we know, can be detrimental. And I would also say that I, I do also do hospice work on the side, and it is so devastating to me how many of those cases would have been prevented by someone having access to a good primary care doctor. Like it is. I mean, there are things that people are dying from in this country that no one should be dying from. Super preventable. But it's just, a lot of it is like people just not going to the doctor. And I don't blame them. There's so many people out there that just the fear of the system, they don't understand it. They don't wanna hear the diagnosis, the, yeah, I, I mean, I think about, we've all had patients where it's oh my God, how did it get so bad? Is like the question we're asking ourselves. I remember the person who had a skin cancer. It was a melanoma that had taken over half of her face, and I was with an ENT surgeon and we were trying to dissect a portion of her ear. And the ear just sloughed off. I mean, it was so diseased. The tissue was so diseased and it's I think about patients who have come over to DPC and they're like, I didn't get this addressed before because I didn't think that I, I could afford testing to follow up for something, or I didn't think that I could afford the medicine, or I just hate going and sitting. Right? And after waiting nine months to see a person who's not even a physician to tell me like, whatever they're typing and not actually look at me in the face. And so, I mean, there's so many reasons that the healthcare system can be improved, and it's literally what we're able to take in all that feedback and then change our practices to, be with our patients and what they need and what they're looking for. And like you're saying, and not putting them in the, the poor house by charging concierge fees as well as billing insurance. So, that, that's awesome to hear though, how you, patients have learned to have, have learned the value of direct primary care and what you are doing as a doctor. I'm wondering here in terms of like, when I was looking for DPC physicians in New Mexico I, I ask this just because I do think that we're gonna see more of this in the future. People on the podcast are very aware that um mm-hmm. My husband was let go because the model that we were working at went to a non-physician model. And I'm just wondering, like in New Mexico, there's a lot more that I can find non-physician providers compared to physicians, A KAU in the state of New Mexico providing direct primary care. And I'm wondering if you can talk to us about trends that you're seeing when it comes to non-physician providers as well as, what, what things are you seeing because of those trends? Yeah, I mean, I, trust me, I am not an expert in New Mexico medical law by any means, but I, I would just say my experience in living here. Is that because we are such a rural state, I know that there are a lot of clinics and facilities that just because of their reimbursement rates that they get they can't afford to pay what a physician might want. And New Mexico is a state that does allow nurse practitioners in particular to do a lot of stuff that maybe in other states they can't. And so, New Mexico definitely is a place where I've seen a lot of, a lot of nurses go the nurse practitioner route because they are able to do so much stuff independently here. And I don't wanna throw PS and Nmps under the bus. It's just like physicians. There's really good ones and there's really terrible ones. And it's the same for PS and nurse practitioners. Absolutely. It's just, the reality is our training is different. It just is. And so there's just certain things that a physician can do that maybe some PAs and other nurse practitioners can't. Legally, I mean, and then I would just say, I have so many friends, colleagues, and sort of remote acquaintances that get ahold of me on the down low to be like, Hey, how's it doing in DPC world? I'm thinking about doing it. I'm moving to do it. And not just primary care docs, we're talking BGY OBGYNs, we're talking dermatologists, we're talking other people who are like, even in the specialized world, it's just not working for them. And they're like, Hey, I'm only getting a certain percentage of whatever company A is billing out for me. I could be making a hundred percent of this and not seeing as many people and giving better care. And I think that the reality of that phenomenon is that we're just gonna need more people because if we all, and I, I'm not naive to the fact that when I left my old clinic, I took a very, very small fraction of those patients to my new right. And so that leaves. Thousands of other people in that pool sort of scrounging to get in. And again, there was already a doctor shortage before, and now it's just I'm not naive to that. And it does make me feel bad sometimes that I don't seem more people because pretty much everywhere I go, someone's asking if I'm taking new patients or how long the wait is or whatever. But I don't know. That'll take care of myself too. And I think about though something that Dr. Anas Mohammed said in his interview, that the idea that. You have good, fast or cheap, and you can only have two at the same time. Yeah. And I think about that when it comes to healthcare. Like I, I totally hear you and I empathize with the that feeling that I think is also put on us that like we are supposed to see more. But it's I, I think about also that, I really love that you said like you have to take care of yourself because hell yes. If you don't have yourself, you cannot take care of anybody else. And so, it is so pertinent and you are spot on when it comes to specialists as well. The conference at my DPC story and Flex Mid Summit just hosted, had over a hundred people, most of whom were specialty doctors not in primary care focused, and also surgical specialists who are looking to do care exactly as you're talking about. Yeah. Directly for the patients. So, there's so many opportunities in this world and I love that. Again, and this is why I'm so excited for you to, beyond sharing your story, is because hearing like how it's going in New Mexico, what services are need in New Mexico, there's so much space for innovation as well as building that innovation with the patients and our, our own ability to survive under the model that we're building in the future or in building going into the future. There's so much innovation that can happen and if we're not a part of it, we're gonna be on the menu like a hundred percent. Oh, for sure. No, I would love to see New Mexico. My, my little, little New Mexico that's always so far behind. I would love to see them be a front runner on figuring out a potential solution to this sort of healthcare debacle that we're in. And I think New Mexico does think outside the box in a lot of ways for a lot of things, and I would love to see them do that with healthcare. Yeah. And when you spoke about access to doctors and just what it looks like in, in New Mexico on the, medicine and in our world medicine type of type of, or in medicine side of things, I'm wondering if you could also talk to us about how you're making community connections, even like within the state, because people like who are doing physical therapy or speech therapy or whatnot people are even in those worlds, are offering telemedicine care. So how are you making connections with people who are, like super excited to know that you're, you and your services exist because you do hospice work also and you do home visits on top of primary care? Yeah, no, I mean, the home visit thing, honestly, I could probably just do home visits a hundred percent of the time. It's huge, especially out here because, well, in general, we all know that baby boomers are aging. And in a rural area there's not a lot of public transportation. So, and then even if there is, even if you live in a, in a place where there's, really great public transportation for elderly, disabled, whatever, the family member often has to, get up, get that person ready, get them outta the house. Often they don't wanna leave the house. The home visit thing is, is huge. I really could just do that a hundred percent of the time. And so there's that. And then I try to do telemedicine whenever it's sort of convenient for people for sure. We do get snow here. For those of you listening, New Mexico does get snow, especially northern New Mexico. It is not just some flat desert. Everyone's always do you go skiing in New Mexico? And I'm like, yeah. So yeah, no during the winter'cause I personally am not a fan of driving in bad weather at all. I will make it super convenient for them, Hey, this, there's a storm coming in. If it snows real bad tomorrow we'll just move to telemedicine. Then you can come in later for like the, just the exam portion. I still need to listen to your lungs or to your blood pressure or whatever. But we can still chat and then like you can drop by whatever and do this. And then, I am trying to be involved as much as I can, can being from this community it's always weighing that thing of I always, my gut is to be very involved and I am constantly trying to draw myself back to protect myself a little bit. But there's all kinds of things that I'd like to do with like the schools. I go talk to my old residency program. I do go talk to this, all of the schools, the school I graduated from, I go talk to'em about career day. I've had kids shadow. I've talked to kids just like randomly when I'm out about they're interested. They wanna know about our, New Mexico has A-B-A-M-D program. So they wanna hear about that type stuff. Yeah, I'm still involved in sports, my kids play sports here and I talk to their friends and family and I took care of a lot of them when they were kids. And so, yeah, I'm like super ingrained. Yeah, always trying to get the word out. People still, again, it's that whole concierge thing. Oh, aren't you doing that thing? And I'm like, oh, no. Well, I hope that especially your the, the people who you are exposing to DPC will also share the story with people and even just this recording. Will this interview will, spread the word that that is a myth that, that you do concierge medicine? Yeah. Yes. What about like with with members of a patient's healthcare team, like the physical therapist or like how do you, people who might also do cash pay services, chiropractic work, acupuncture, how are you how are you building your network so that you're also finding trusted people that your patients can see? Yeah. So good and bad thing about living here is there's not a lot of options. Right. And, I am also a patient, so I definitely make it, no, sometimes I won't, I generally go into something not telling them that I'm a physician'cause I kind of wanna see what it's like. And then like I will tell you right now, I have an acupuncturist who's worked on me and my husband and my mother-in-law, and my father-in-law. And I sent so many patients to her because I've experienced her myself, and she's awesome. I have some occupational therapists that I send people to. I have some physical therapists and I think it's because I have that relationship with that, ot, pt, whatever they are. And they know me sort of like a little bit more on a personal level. There is that connection there. And I, I don't really think that, it's not like we do favors for each other, but there's something about, I mean, it's networking. It's plain and simple networking. It's good old fashioned networking, it's just so and so went to this college and so and so's you know, whatever is on the board and whatever. It's networking. And it's the same thing in medicine. You just sort of build that network of sort of those other providers and, and then, and then it helps because then my patients know that I trust this person and I go to them too. And I would say the opposite is true as well. When they go and they have a bad experience, and I'll give people the benefit of the doubt and I'll still send referrals to them. But if I get enough bad, I constantly ask my patients for feedback, like, how was it? And if they're like, oh, I didn't like this, I didn't like that. Their bedside manner, they didn't answer my questions, I'm like, okay, not going to that person no more. Totally. Because it's just medicine or restaurant recommendations, whatever. It's like it it's part of the trust that they have in you as the recommender. Absolutely. Yeah. Yeah. we talk about that too, like in, in the world. Imagine a world where you know your doctor, it's sort of like, a hair salon, right? You go to the hair salon, you get a bad haircut, you leave a bad review, right? But maybe 5,000 people go to that hair salon and you, that was the one bad review out of the 5,000. Well, we don't really have that for. Doctor's offices and there's so many other variables that, how they were scheduled. Was it AI scheduling it? Was it scheduling online? Was the ma rude? Was the ma nice? Was the doctor rude or was the doctor amazing? There's so ma there's no way to measure and people just don't really have a choice.'cause they don't, they don't even really know what they're choosing. People will ask me, do you know a good so and so? And I'm like, well, either I did and now they're not here no more'cause they left New Mexico. Or they're good. But the facility in which they practice I can't really say a great thing about. So I don't know what to tell you. That's, that's so true. And again, I can completely empathize'cause I literally have one where I'm like, the doctor's amazing. The front staff not so much. But that's where I need you to figure out if you want to go despite the front office being not so nice all the time. Right. And and I, I tell them like, I'm more than happy to help facilitate the conversation or get information. But I will tell you that this is the option locally. Yeah. And this is like someone not locally. Yeah. We're talking two hours probably to drive to see someone if they have openings. Yeah, yeah. No, I definitely I sort of like plant that seed for them. I'm like, okay, I'm gonna send you to this person. Because they are the best person for this problem that you have. But forewarning, they're not warm and fuzzy. Their front desk is not gonna be warm and fuzzy. You're probably gonna have to drive over there in person to make an appointment'cause no one's going to answer the phone. But despite all that, this is the person you wanna see. Just know going into it, they're not gonna give you a hug at the end and tell you to have a nice day. And I really think it helps because, if a patient, especially, coming from an office like mine and then they, go somewhere that where it's just, maybe cut and dry. But if they're going into it at least with this expectation of oh, she said that this is kind of how this person is. And I'm like, especially like with surgeons, sorry, I know there's some great surgeons out there, but it is totally the stereotype. I'm like, they're probably not gonna wanna sit down and chat with you about your life story the way I do. That's just not how surgeons roll. If they're in the room with you for two minutes, like that's appropriate. Just is what it is. I totally hear you. So let me ask you this, because you have, grown in your community to the point where you even have a wait list. I'm wondering if you can, just think about. Changes that you've gone through as a physician entrepreneur either that you had to or you didn't see coming, or you're like, I know that I'm preparing for, because I, I think that there's so many people who are listening to the podcast and listening to this interview who are, in the, in all stages of DPC and at any time in our practices, no matter how long we've been open, we can always learn and change based on, what we've experienced or others have experienced. So I'm wondering if you can talk to us about top things that you've experienced as a physician, entrepreneur that other people might, be other people might benefit from hearing about from your practice perspective. Yeah, I mean, I think the biggest thing is, and it's gonna be different for everybody, but feeling out, feeling or figuring out what you are most comfortable with and what you're not. There's some DPC docs that are super good at the business stuff and they can really market and they can really whatever. And there's other ones like me that, like that is not my forte. I am freakishly private, sort of reserved person. I know it might not seem like that right now, but that's'cause in my head this is a one-on-one conversation. But you know, I would say the biggest evolution has been offering more and more services. Right. So I think when I started out, I bought an EKG machine, which was like, I mean, I'm embarrassed to say, but it was like I had to learn how to do an EKG on someone. Sure, I could read it, but like someone else was the one hooking it up. So I had to learn how to do a machine, learn how to trial and error with the little electrodes and like all of the chaos that came with it. I don't have a s spirometer, which honestly I don't know why I really should get one. But like new and evolving things like home overnight, pulse ox, like that's super easy, right? Like sort of all of these things. Or like I have an oxygen concentrator in my office for emergencies. Sometimes I've lent it out to people because they're sick and they just need a little bit of, a little bit of help, and then just different injections and different medications. I think when I started off I was gung ho and I'm like I basically wanted to offer them a full pharmacy when I first started, and I quickly realized that that was gonna be a lot of work for me. Well, because I will say that there's not a pharmacy within 25 minutes of where I'm sitting. There's no pharmacy in this town. So if a patient comes to see me and you know they need antibiotics, I felt really terrible being like, well, I know you feel terrible, but now you have to get back in your car and drive 25 minutes in either direction to wait at the pharmacy for gosh knows how long to get your prescription. So I do, I continually keep like the, Z packs, like the sort of obvious ones in stock. And then of course I keep fluconazole to go with those antibiotics. So yeah, I learned over time like, okay, these are the most, these are the things that I'm really gonna give out the most and these are the things that I don't need to be spending my money on. But that's just something you learn. And then also I would say with procedures, like I love doing skin biopsies. Some people aren't gonna like doing those, so I have a ton of supplies to do skin biopsies and sutures and stuff, and maybe other DP socks just don't wanna do that. So I think it's for figuring out like. What I dabbled in Botox for a while and then I was sort of like, this isn't for me. Everyone's gonna have their things that they really like and they don't like, and you're just gonna figure that out over time and sort of what's the most bang for your buck and also what's the most bang for your time, because you quickly learn. Especially like in my practice, I don't have an assistant or a nurse or anything like that. It's just me by myself. Like I have to learn like this is worth my time and this is something that's worth me outsourcing. Totally. And it's I think that it really just goes back to your love of autonomy even as a, a person coming up the ranks through through medical training. So that's awesome that you're able to make these decisions. I am so excited for people who are in your state, your, the people who are coming up again, like I mentioned in the ranks in medicine to hear this, but also everybody in the, whose, whose ears are leaning in because they're thinking about DPC considering DPC or like, how can I optimize my clinic? So thank you so much Dr. Lucero for coming on today and sharing about direct primary care in New Mexico. Thank you. My gosh, I'm so excited. I really appreciate it.

45:05

So We are about to close out season five and we are about to go into season six. has been almost now six years since Asher was on the podcast. So here he is to share another message. Hey everyone. Now here's a sneak peek from my mom's Patreon. You can hear the rest of this q and a commercial free episodes plus extra update episodes from previous guests and behind the scenes stuff at patreon.com/my DBC story fan.

Maryal Concepcion: 45:43

Thank you Patreon members for supporting the work the podcast is doing. I hope you enjoyed the main feed interview this week. Now here's some extra content recorded, especially for you. Enjoy. Mentioning that New Mexico has childcare provided to its citizens, I'm just wondering about if you can, if you can talk to us about any grants or subsidies that people. Access through this is a little bit off the entrepreneurship, but, but just the idea that as you were talking, I was thinking about how one of the things I mentioned in DC was like, for small businesses, tariffs are a fricking killer because it's like, are we gonna have tariffs on our generic meds and not have an easy, as easy a time getting, or Zacks and stuff that are like less than five bucks for a whole packet that absolutely you can handle in your clinic. For those of us who can self dispense. And I think about even just the cost of medical tools. Like I, I've had to ask people like, can I crowdsource a box of pap just disposable speculums. And then I ended up buying a autoclavable one.'cause I was like, I don't know if I have to buy zombie apocalypse levels of things or are we gonna be able to afford things in the future? And that said, I said to staffers, I was telling them about how, like where we are in rural California, I got a grant during the pandemic for$10,000 and it allowed me to get a VFC compliant fridge freezer and transport. Oh yeah. And but then when I said that, the conversation was from their side, oh, we don't believe in grants and subsidies. And I'm just like, I like what? I don't understand that rhetoric. And so I'm just wondering if you can, think about your own patients and think about like how grants and subsidies, especially for like how you mentioned the BAMD program. I mean that the, there's things that like, if, if you're gonna be so staunchly against something and not even be open to hearing but actually this actually helps our community. But how, how do grants and subsidies work in your world and like from your experience, your patient's experiences? Because I, it's just, I, I think about this is the crap that we're hearing from our policy makers. Oh my gosh. Policy makers. If you're listening I'll tell you like when the pandemic started, because my office is off of a main road, I was so gung po I was like, okay, I'm gonna get a CD compliant CDC compliant refrigerator and I'm gonna get, the, the state will give all these COVID vaccines and then people can literally like, just drive off the road, we'll vaccinate them. I was all about it. And then they were like, the refrigerator you bought isn't compliant. And I was like, but it was on the CDC list. No, but it has to have the auto thermometer thing.'cause you have to send us the temperature readings every when I was like, well, no one told me that at the beginning. Okay, fine. I'll order the, auto thermometer with the wifi that'll send you the temperature reading all this. And then it was like, well, what happens if the power goes out? Because yes, in a rural area, the power goes out all the time. Oh, well you need a backup generator. And I'm like, well, that's gonna cost$5,000. And it's like, all I wanna do is get these vaccines and vaccinate people. That's all I wanna do. And I'm offering to do like that part I was gonna do for free. It was just getting all the equipment and stuff that even I was, willing to pay for. And in the end, I never did it because there were so many roadblocks. The, the wifi thermometers were outta stock by the way, and they weren't, like the vaccines came out. What was it that, that last, like the first two weeks of December or whatever it was of 2020? Yep. Yeah. And then I was like, they were like, oh yeah, you, the wifi thermometers are back ordered until like March. And I was like, oh, well now what's the point? But I have thought a lot about this also in sense, again, policymakers is like, what if there was a grant that just paid my salary and then I could see patients for free, meaning they wouldn't have to pay me? That's like a whole other safety net. And we're not even, I mean, I've thought about things like if there was a grant to pay me for my time, to go do physicals for the school sports programs, then that's a whole bunch of kids whose parents don't have to try to get them appointments to do sports physicals. Just all, all the, employment physicals, all of these things that we need just for society to run TB testing. I have patients that work at places where they, I mean, I have to get TB tested routinely because of doing hospice, but anyone who works in healthcare facilities, whatever, they have to constantly, be TB tested. It's really hard to find a place to do TB testing. That in itself could be a grant. Like you just give someone money to buy the tuberculin so that they can do TB testing on people. There's just so many simple things that we could be doing, and it's just insane to me that they would be like, we don't believe in grants. And, and I'm like, and it, it is very, well, I am not a nonprofit. And that was simply because, trying to find people to be on my board and all the whatever. And so that just not being a not nonprofit excluded me from tons of grants right off the board. And that was very frustrating. And at some point I was just like, I even talked to a grant writer to see about hiring them to find grants for me so that I could do certain things for my community. And that just got to be too much. And I will say here for our conversation, but also for the listeners do you think about that? Even if you're not a nonprofit?'cause Bigtree MD is not a nonprofit either. If you are doing something in collaboration with a nonprofit, like for example, Dr. Angela by Master healing Grove is funded in part by a nonprofit branch of her clinic. Mm-hmm. And so, like if a church or nonprofit organization wanted to fund whatever you can get the grants through that nonprofit and still be like a contractor or a collaborator with that, that company, or excuse me, of, of that with that nonprofit. So it's definitely a way to get around some of these ridiculous things. But I will say here that this is exactly where it matters. Like for those of you who are like, I would love to share my story. Absolutely. If you have not come on the podcast. But if you have not also talked, to your representatives, this is exactly what. Why it matters to tell them I get that your belief in da da da, because your classic example is, whatever. But it's let me actually actually provide you with 20 more examples of how, this policy affects small businesses, affects physician access to things, even, even, even if we're for profit. And, one of the things too that I think about is during the same conversation in the representative's office when I was talking about PRP offerings, we're talking like hundreds of dollars for a PRP injection and I can get six six syringes of PRP from a person's blood draw. And I'm like, but down the, in the next county over, you could pay$10,000 for the same thing. And so they're like, oh, so but but what's your overhead? I mean, what's your what's your margin? I'm like, like 20%. Like we're not talking 20000%. We're literally talking like hundreds of dollars versus thousands. And they were completely dumbfounded that oh, so you're like not doing this, for the money. I'm like, dude, if we were doing all money, we would not be family medicine doctors. We would not be family medicine doctors. Yes. That is a great point. Like I, I think just like the world needs to know, trust me, and I wish it wasn't true. Family medicine doctors are not out there like bringing it home. We are not, and we are doing this because, I mean obviously I don't wanna speak for Emily, family medicine doc. There are probably some out there that are filled differently. But in general, I would say a lot of doctors go into family medicine because people they want, they really are, they like those relationship, they like getting to know the whole person. I, I don't think I've ever heard a family medicine doctor say, oh, I chose this specialty for the money. Pretty sure that wasn't the motivation. Yeah, a hundred percent. I've the, the people who said, I'm choosing this because I wanna go golfing, or I want to da da. It's not, not once did they say, and that specialty is family medicine, right? Yeah. It was not that one. Yeah. Yeah. No, like I, I, yeah, there, I mean, that just goes back to that misconception about that word concierge and, to, to, to even take this point further. Tell us about your pricing because it's like your pricing for your population that's working for you is, extremely reasonable. And I mean, you have a very reasonable enrollment fee. You have a very reasonable option for home visits if they're within your service area. And if they're not, it's still not gonna put them in the, the bankruptcy arena. So tell us about your pricing and how you came up with it. Yeah. And how it's working for you. So this goes back to family medicine doctors not being in it for money, because trust me, I get a lot of people being like. Are you okay? Are you making it because you should be charging more? And I'm like, yeah, realistically I could and probably should be making more money. But I just, I mean, so going back to this area where I'm from again, the sort of economic bell curve, it's all over the place. And I didn't wanna price anybody out. I really, really didn't wanna price anybody out. And I, I have some people that are like, you could be charging five times that much. And I have other people that struggle to pay me every month. And it just sort of goes back to that thing. It's just like medicine is medicine for everybody. Like everybody is equal upon it. I feel like everybody should have equal access. I'm not really a bougie person. And I just kind of felt like if I raised my rates too high, it would sort of self-select for people. Maybe that expected more of me and sort of got, and I mean, again, that's probably why I am so adverse to that word concierge. I'm not like your, I am your doctor, but I'm not your personal doctor at your beck and call. And I think that went into the pricing a lot. Like I wanted it to be like. This is affordable. This is an adjunct, this is not, something that like, you're gonna be so consumed with paying that you felt like you were gonna have to overuse it almost unnecessarily. Totally. And can you say for the listeners what is your price point? So right now I'm charging a hundred dollars a month. I do have some grandfathered in patients at a different rate for different reasons. And then for home visits that are basically within this sort of general little area where I'm at, there's no charge.'Cause often this is, this is so, it's almost embarrassing, but maybe people will love this. I mean, I live here, right? So like I might go see someone on my way home or i'm going out to lunch and then I'm like gonna go see them and then I'm gonna drop by or they're on the way to the school or whatever. Like I'm constantly driving around in this area anyway. So I don't charge anything for home visits that are kind of within this area. And then home visits that I have to drive past a certain point, I charge for those and I charge mileage, which I'm still told is like less than what it would be for someone to come look at your appliance. Yeah, so again, like trying to keep it affordable. I don't know. I mean, we could get into a whole soap box about like retirement and if doctors ever retired and hopefully I never get hurt or disabled. But yeah, because I mean, it is something that DPC docs and policymakers should hear about, if they're going back to grants and subsidies and stuff if you can subsidize a physician's A DPC doc's salary, then you wouldn't have to charge as much and then you could open access to more people and so on and so forth. And that open access to more people absolutely rolls into. Oh, more people would choose family medicine and primary care. Well look at that. Oh my god. Amazing. Yeah. Yeah. I mean, it, it's so, it's so crazy to think about where we are as a fee for service insurance based system in the majority of, how people get their healthcare access. And I think about how like other countries, the, the pyramid of what is the foundation? And the foundation here is based on specially specialty care and like the high ticket, the things that, like you're already with cancer, diabetes or whatever. And in other countries, the foundation is of the healthcare system is based on primary care and it, it just, outcomes are so different. So it's, it's crazy. Yeah. I mean you and I can probably relate in that you being in rural area in California and me being in a more rural area in New Mexico, but really it's New Mexico in general, a lot of it falls on the primary care physician. It just does.'cause they're, who am I gonna refer to? And in general when I refer someone out like if someone, I think they tore their ACL or something like that. I do that full workup. I get the MRI whatever before I send them because I'm not gonna send them to the orthopedist. And then the first appointment is going to be, yeah, your knee swollen, let's get an MRI. And then they just wasted that whole copay and time and appointment and all of that. So a hundred percent. A hundred percent. Yeah. And. For you to deliver the care that you are because you don't have staff like you explained. What are the most useful tools that you have or workflow hacks that you've developed, because there's definitely lots of people who are opening as solo doctors. Yeah. So I really rely on my portal and I try my best, like even my, I mean for non DPC world people out there, if this is your first time listening, I literally have 80-year-old patients that I bring into my office and I help them log on and learn to log onto their portal. And I download the app on their phone and I show them how to use it to really keep their information safe. Because a lot of them were like emailing me insane things and I was like, please do not email me stuff. And, for, yeah. So for a lot of my technol technologically disadvantaged patients, they still, I'm like, just call me on the phone. I'm probably not gonna answer'cause I'm probably here, there, wherever with a patient, but call and leave me a message and I'll call you back. But for the most part, I tell people, use the portal. I check the portal obsessively. Because I'm super type A person and I don't like things to pile up on my plate. And, and I really do try to get back to people like. I tell people up to 48 business hours. And that's mostly because if I have a day where I have patients all day long, it's really hard for me to sort of look and, and give thoughtful responses back.'cause I really wanna give thoughtful responses back. But generally I get back to most people same day. Or if I'm just sitting here in the office, someone will write something, it'll pop up and I'll write back to them right away. So I generally, yeah, I like to keep my plate as clean as possible. I don't like things to build up, I like to get people their results back right away. And sort of, I mean, it goes back to what we were saying about if efficiency and getting things done. I'll literally see someone on a Tuesday like today, and then they'll go get an X-ray in the afternoon. I'll get the X-ray results back that afternoon and I'm calling them by the end of the day saying this is what it is and this is what we need to do. Mind blowing and it's so sad that this crap is mind blowing.'cause it's it's literally if the system is working well and we're literally working for our patients, I mean, we are behooved to do these things. And, and, and you're still not oh, I will get back to you within 24 hours. I mean, 48 business hours. Totally reasonable and also not heard of in most clinics to even get a call back. Well, I know, and I, I think it just introduces that, as we say, all the people in between the patient and the doctor and you're playing, we all know the game of telephone, right? And so if you're not directly having that conversation and the doc like, I don't need to go look in my patient's chart, like they can call me and I know exactly what's going on and there's not that 20 levels of the game of telephone that by the end the message gets, totally messed up. And, and quite frankly, in our work, that's dangerous. Absolutely. And that's, I mean, I think about your comment about how so many people in hospice who you've seen have pathologies that have totally, could have gone a different way if had they had access. And it's I, I think that danger is very, very apparent in the, the healthcare system when insurance codes are involved. Yeah. And denial of insur or, and denial of, access to healthcare is like the, the top decision maker happens. I mean, I would, well, and I was gonna say, I would say to our policy makers, I don't even know why we're talking about, it's like right now we're, we're just scratching the surface of putting a bandaid on a giant problem. We have the technology and the ability to do purely preventative medicine, longevity and preventative medicine. We have that technology, we have genetic testing, we have full body MRIs, we have all the tools at our disposal, and we're still doing this sort of reactive, not preventative medicine. And I don't know why policymakers cannot see that even in their own healthcare. Policymakers that have had cancer policy makers that have had this, that, and the other. Think about your own healthcare and how what happened to you could have been prevented so many steps prior to that. As a country, we stopped thinking about bandaids and reactive medicine and moved towards super preventative medicine. Like we can do that. And I don't know why we're not. Amen. But DPC could be that road. And it is. I I, that's what I was gonna say in response. Exactly. That is we are not waiting for the policy to, allow us to do what we're doing. Right. We're just saying board certified, licensed physician surgeon, I can do my things.'cause that's what I went to training for. And you did do so amazing. What is one of the most surprising things that you found out about being an entrepreneur? It's really easy. I mean, everything has pros and cons, right? If you work for a big hospital system, you're gonna have all kinds of perks and things, but maybe you won't have control over your schedule. And then when you're, a sole practice, company, I don't have a lot of like those perks, but I have total control over my schedule. So it's two opposite ends of the spectrum. And there's all the in-betweens and, everybody's different and they're gonna choose what's sort of right for them. But I think the most discouraging thing was that when I was a resident, so this would've been back in the, like, when was I resident? 2011, 12 in that area. They were like, oh, you can't survive in private practice doing family medicine. Are you nuts? You'd have to see 50 patients a day and the insurance and the overhead and oh, you'll never make it. And and so we were really sold and that was, I would say now with DPC, there's a lot of people going into private practice, but in general, a lot of those old solo or small group practices were being bought up by all the big hospital based companies because they really couldn't survive. And I mean, I kind of would say it's really hard to survive as a sole practitioner if you're taking insurance these days. But overall, there's people from all walks of life that start businesses and that are entrepreneurs and all different kinds of things, and then is no different. When you take insurance, I hate to say it, but you know, you're working for the insurance company, you're not doing what's right for the patient. You're doing the best possible option you can do for the patient that the insurance company allows on their timeframe or that the patient can afford. So true.

1:06:20

See, watch, talk. Hello, this is Nolan here. Yeah. You got it. See how it, it moves the, it moves the line? Mm-hmm. Did you see that? Yes. See, watch, say Hi, this is Nolan here. Hi, this is Nolan here. See, it moves the line. Okay. Ready? Now can you say. Hi, this is Nolan here. Hi, this is Nolan here. Thank you. Thank you for listening to another episode, to another episode of my DB, C story. Have a great rest of the day.