Thriving on Her Own Terms: How Dr. "Sassy" Weinstein Built a Direct Specialty Care Practice Blending Sports, Lifestyle, and Autonomy

In this episode of the My DPC Story Podcast, host Dr. Maryal Concepcion interviews Dr. Sarah "Sassy" Weinstein, a triple board-certified physician in family, sports, and lifestyle medicine. Hear how Dr. Sarah Sassy Weinstein turned personal health experiences - including Lyme disease and sports injuries - into a compassionate approach for patient care. Discover why she left insurance-driven medicine for a direct specialty care model in Princeton, NJ, empowering her to focus on holistic, patient-centered treatment without time constraints. Learn her insights on starting a direct care clinic, tips for keeping overhead low, and building a thriving practice. She shares strategies for integrating lifestyle medicine, the importance of listening to patients' goals, and balancing her roles as doctor, mom, and fitness instructor. This inspirational episode is packed with advice for physicians interested in launching a direct care or direct specialty care practice. 

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Transcript

Maryal Concepcion, MD: 0:52

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. Sassy Weinstein: 1:41

Why are you doing this, and what do you want to get out of it? And for me it was just taking a step back and realizing this is not what I want to be doing, and I'm not happy and I'm not satisfied doing this. And remembering how valuable you're worth and making sure that you feel really good about what you're doing because. Leaving is hard and totally starting on a new path is really hard, but it's so incredibly rewarding when you finally get to be working towards something that you absolutely love doing and that you are so passionate about. I'm Dr. Sassy Weinstein of core sports medicine and lifestyle medicine, and this is my direct specialty care story.

Maryal Concepcion, MD: 2:29

Dr. Sarah"Sassy" Weinstein, triple board certified in family medicine, sports medicine, and lifestyle medicine, finished her family medicine residency and then headed to Colorado for a sports medicine fellowship. She then expanded her expertise by becoming board certified in lifestyle medicine, now practicing in Princeton, New Jersey. She blends advanced sports medicine techniques with holistic lifestyle focused care, all within a direct specialty care model that cuts out needless insurance barriers. Welcome to the podcast, Dr. Weinstein.

Dr. Sassy Weinstein: 3:00

Thank you so much for having me. Really excited to be here with you.

Maryal Concepcion, MD: 3:03

I think this is such a treat because you started out as family medicine, however you then went on to be triple board certified, so I love that we are going to be delving into your journey and family medicine, sports medicine and lifestyle medicine in a time where we see people asking for a combination of those things, even in a family practice clinic. So I absolutely love that you're joining us today.

Dr. Sassy Weinstein: 3:25

Yes, super excited. I think it's one of the, the greatest combos out there. Obviously I'm very biased, but uh, yeah, I think the combination of kind of what I do is super exciting and, I love doing, it's what I'm most passionate about and I just love talking to people about it.

Maryal Concepcion, MD: 3:39

I love it. So I have definitely been trolling in a good way. The, the podcast feeds and when it comes to hearing your story and definitely it's, this is my DPC story. I love to hear the backstory, but I, I mentioned to you, before we start recording, I would hear things that other interviewers would ask of you, and then I'm like, but I, I wanna know more about that. And one of the big things that I really picked up on is that you said in one of your podcast interviews, you don't know what you don't know. And that is so pertinent to our medical and personal, journeys in life. And you also mentioned that you had a family doctor who, was, it was an impressionable mentor in your life. What, what was it that you picked up on from seeing your family doctor but also deciding to go into medicine?

Dr. Sassy Weinstein: 4:27

Yeah. I mean, I think, yeah, I think you don't know. You don't know. I feel like I am learning that literally every single day. And I think when you start your own practice and you're going into something that is such an unknown and something that we are not taught in medical school is just, figuring it out and just trying to do your best and just talking to as many people as possible and learning as much as you can. And it's when you first start out in medical school, the, the, the curve is like just learning so much at such a quick speed. But yeah, I definitely had a family doc growing up. He also was the one that told me not to go into medicine. I don't know if He was an incredible family physician and obviously he was a, an older family physician that. Practiced in a time where it was medicine was different and they, really was incredible specialty. I still think it's. Such an incredible specialty and I would do nothing else, besides be a physician. I feel so lucky to do that. But he was, he was an incredible diagnostician. He really took the time with people. He got to know them, he knew his patients well. He knew their stories. I mean, we were good family friends with them, but I just feel like how he approached patients was, it was special. And he also diagnosed when I had Lyme's disease. I, when I was in high school, obviously I grew up in New Jersey, so in a place with a lot of ticks. And I grew up on a farm and I also played sports year round. And I started just having all of this different joint pain. It was my ankles, it was my knees, it was my elbows, it was my back. And I was, I remember I was in high school and I kept going back to my physiatrist at the time, and he was like. It's tendonitis here. It's tendonitis there, right? You play sports year round. And I started my basketball season that year wearing a brace on my ankle, my knee, my elbow, my back. And I got to a point where it just hurt to walk. And I'm like, I don't feel like this is normal for somebody in high school. And I was definitely not reading so far into it, but it just hurt every day. And then went to my family doc and tested and he was like, you have Lyme. And so, and it just had progressed to, the joint pain part. And so I remember that so specifically that, it was just listening to kind of the story and also just knowing some of the background and who I was. Right. And so I thought that was. That taught me a lot that, you have to go kind of beneath the surface and, and when I look at patients in sports medicine, and this is where the lifestyle of medicine really comes in when someone comes in with knee pain, right? It's not just the knee that we're looking at. It's, the joint above. It's a joint below, but it's also what's going on in their life, right? So is there a lot of stress that's going on right now? Are they, are they eating a super ultra processed diet that is really high and, you know, has a lot of high inflammatory foods that's now affecting their joints? Are they not sleeping at night because you know, they have a new baby? And so the lack of sleep is just causing more inflammation. So there's so many other factors that go into what people are presenting with, and I think you have to really sit down and talk to someone and listen to them and get to know them. And treat them as more than just a joint or just a tendon issue. Right. And and I think that that's one of the issues of working in a bigger practice, kind of where I started off is you have 10 minutes per patient, right? And so by the time that they actually get roomed and the medical assistant does everything they need to, it's really like you have five minutes before you're supposed to be with your next patient. And you can't talk about any of that stuff. You really are just like, okay, what's going on with your knee? How can I make you feel better? So it just, it taught me a lot about kind of how to approach patient care and what's really important to a patient, who's going through all of this stuff.

Maryal Concepcion, MD: 8:15

I know for a lot of listeners out there, they listen on the East Coast at around five o'clock in the morning. We see the, the spike in the data as soon as the podcast drops at 2:00 AM Pacific. But I'm like, just hearing this so far, this part of your interview, you've talked about your history as a patient. You've talked about the, the pain that we all know isn't fee for service. With that quick, quick, quick turnaround, I wanna just take a little side step back though. When you mentioned that your family doctor said that you should not go into medicine, tell us more about that because I have so many things to say about when people tell us what we should and should not do, but I would love to hear, what was it and what was your reaction? Because, I, I see that as we don't know what we don't know. You have the entrepreneurial, the physician, entrepreneurial spirit, and you continued on to the point where we're talking about your specialty care story today.

Dr. Sassy Weinstein: 9:42

Yeah. So I think when I heard that, I mean, I was still fairly young, right? I think I, I think I was either in high school or maybe early college, and I didn't decide I wanted to go to medical school until I was a junior in college. And honestly, I wasn't the one that really thought about it. I went into college and I was like, I love everything, fitness, nutrition, working out. Maybe I'll be an athletic trainer. Maybe I'll be a personal trainer. Maybe I'll be a physician assistant. Maybe I'll be a physical therapist, right? And so I, and I studied, I majored in exercise physiology and exercise science. And so I was exposed to all of those different things and in that major with people who are going into all of those programs. And I finally just had this conversation with my advisor junior year, and he was like, you should just apply to medical school. And I was like, okay. And I honestly didn't think about it twice after that. And he was like. You have the mindset, you have the discipline, you have, the work ethic and everything. Just you should apply to medical school. And from that point forward, I was like, okay, so what do I have to do? I have to take all these prerequisites, make sure I'm hitting all that. But yeah, so I think whether it was high school or college, when my family physician said that, I kind of, I thought about it for a second, but also I could tell he was at this point in his career where there was such a change in medicine. And at that time I had no idea what that looked like from his standpoint. Right. I could tell that. He probably was not as happy in medicine as he used to be. He had his own practice, but things were changing from a reimbursement standpoint. Things were changing from what was demanded and required of him, how much he had to work, how much he was responsible for the billing, all of that stuff. And, but I had no idea of that when, when he mentioned that, I think it wasn't until later where I sort of understood, and from my standpoint, all I knew was that he was not as happy in medicine as he used to be. And he wasn't treated the way that he used to be as a physician. And it honestly didn't really, it stuck out in my mind because of what he said. But I, and I could tell that there was like a shift in his practice, but it never deterred me. Like it never, I knew that's kind of what I was going to do and I just felt like I kind of set along this path and I was like, I'll figure it out. And again, I was probably very naive back then and. Didn't know the nuances of what was actually affecting him, but I was like, I'll figure it out. Let's just see how it goes.

Maryal Concepcion, MD: 12:13

Amen. And I am, and your patience are so glad, and I know you are glad that you were just like. Cool. I'm moving on with my life. Right. And I will say for the listeners out there, what Dr. Weinstein experienced, a lot of us have had people tell us like, oh, you shouldn't do, you can't do, and one Beyonce's who run the World Girls is singing in my head right now. But also the fact that it's it's probably their problem and not your problem. That they're actually, commenting about. So you eventually went to do training in Colorado, and not only did you do training in Colorado where sports are very treasured, but also you went on to be part of the team taking care of Division one athletes, the Denver Nuggets, and I think about. Your journey into medicine with this description that you just gave of like you had a knee brace, a back brace, and all of these things. And I just think about, what was it that you were bringing as uniquely you to the table when you were with these athletes? Because you are an athlete, you continue to teach private classes in Princeton, which is amazing because only in direct specialty care could you do that as well as be a doctor. That's right. That's right. But also you, I mean, you, you just are going through your entire career. Maybe you don't know what you don't know, but you sure as heck know what it is like to be a patient and to not want to be in a certain way when you're showing up on the court.

Dr. Sassy Weinstein: 13:37

100%. And I mean the, the Lyme story, that was just one, right? And so I feel like my high school career was, I was sidelined a lot. The first big injury I had was a. A traumatic brain injury from playing basketball. And that kept me out for a really long time and I would say changed me forever. And so, I learned a lot about head injuries and I learned so much more now, kind of looking back on everything that I went through when I was a patient for, an incredibly long time and still am. Like I, I still feel like I am dealing with some of that. And so being able to be on this side, and that's why I chose sports medicine is because whether it was the head injury from sports, whether it was the Lyme, whether it was, you know, I had mono, I had, tons of other things that happened, but it just showed me that being a patient, like it sucks being sidelined and like that is so much of who you are as a person being. Being a teammate, being on the field. And so, like, even in high school, I just had to learn to adapt and like be okay being on the sideline when I was hurt or sick or injured and, medically sidelined. And, I learned a lot about like camaraderie and being a really good teammate and making sure that I was still there for people. But it, it hurts. Like it hurts mentally. It hurts physically. And so when I went into fellowship, you know how much of an emotional and mental and physical toll it takes on these athletes when they can't do, especially at a D one level, when you can't do that. Like that's, that's so much of your identity. And so being able to realize that and like being there for them in a different way and not just talking about their injury, but realizing there's so much more of their life that's affected when they can't play. And really making sure that they can get through it and come out the other side and persevere and know it's gonna be okay is I think it was a really, I mean it sucked going through it, obviously, but it's a really important part and really showed me how to be so much more compassionate and be a better physician.

Maryal Concepcion, MD: 15:50

Yeah. And. It really is a testament to now, fast forwarding your patients want you as a physician because you're bringing all of you to the table, including your history as, a person who has dealt with doing sports while, taking care of other people to prevent their injuries or helping prevent their injuries and taking care of your own injuries. I just think about even your website, like you have concussion as one of the things that you treat on the bottom of that, the above the fold. And it's I, I love these little details on people's websites and just their practice because we put our personality and our history into our practices. So you then got lifestyle medicine certified tell us about that journey because definitely lifestyle medicine, I was, I was talking with somebody about, what do people want lifestyle medicine or family practice? And I'm like, in direct primary care, whether we are primary care focused or doing direct primary care as a business model, like in your case lifestyle medicine is very easy to incorporate because we have time with our patients and we have time over time with our patients. And so for you, what was it that, drove you to add lifestyle medicine certification, especially to your sports medicine and family medicine? Certifications.

Dr. Sassy Weinstein: 17:03

Yeah. It was actually when I was on my first, I was on my first maternity leave when I was, you just have some extra time, especially with your first baby and, I was like, all right, great. What's this next step? And. I grew up and my mom was a naturopath and I just grew up kind of being exposed to all of this different stuff. I grew up on a farm, so we had lots of fresh fruits and veggies and, exposure to, natural air and was just outside all the time. And so it was something I was always so passionate about. I actually did a month long rotation in integrative medicine when I was in medical school my fourth year at the Andrew Weil Institute in Arizona. And, that was an incredible experience. And so I was like. I knew I wanted to do something else because it was stuff that I talked about to patients all the time anyway. So I was like, do I decide, you know, integrative medicine? Do I do functional medicine? Do I do? And so I was like looking at all these different things and I had not even heard of lifestyle medicine at the time, but until my research, I came across it and I was like, this is exactly what I want to do. It's, it's evidence-based. It is, it's, and it's everything I talk about anyways, and it makes perfect sense. So ever since kind of finding out about it, I was like, all right, well let's just start, looking at the certification, what does that look like? And I started it while I was on maternity leave and just kind of continued on it while I was at my first practice and got the board certification. And again, it almost felt like I wasn't. Being forced to do anything because I was just learning stuff. And now just like learning the studies and the research and the evidence behind all of these things that I talk about to just feel even more confident talking about it to patients. Not that I had the time on my first practice, but you know, that's why I do what I do now.

Maryal Concepcion, MD: 18:52

With that lifestyle medicine and your other two board certifications, you were in a practice for three years really going hardcore in providing amazing orthopedic care to people. So talk to us about how as a family physician and lifestyle medicine physician and sports Medicine fellowship trained you, you just went wild in the orthopedic world because I, I, I love, when, when we get to do what we want to do in direct specialty care, direct primary care because like I, I think about the people who are family medicine physicians and they still wanna do deliveries after, and they're like, oh, I can't do that in direct primary care. I'm like, yeah, you could. We did a whole conference with, with flexed staff on how you could do locums and how you could do, direct contracting. So don't say no until you actually try. Right. So how did you though, go crazy like a kid in a candy store when you were. Surrounded by people doing ortho all the time.

Dr. Sassy Weinstein: 19:50

Yeah, I mean, I love the ortho world. When I was in residency and even towards the end of medical school, like sports medicine is, is what I wanted to do. And I, I even, I got towards the end of family medicine residency and I probably like a lot of other family physicians going through residency, I felt somewhat burnt out even just from, straight primary care. And I really did not like being in the hospital and I still don't. And I was like, I just, at that point my vision was I was going to fellowship and I was like, yes, I get to finally be doing like what I absolutely love doing. And I get to do that all the time, aside from a little bit of family medicine that I did during fellowship, but. So my, I, it felt like a natural next step for me, and I knew I kind of grew up, not grew up, but in, in medical school, my mentors were from where I started my first job. And so I kind of started talking to them at towards the end of fellowship and which happened to be right as COVID started. And so took a, I took a job with them and then they went on a hiring freeze. I ended up starting just a few months after that. But to me, I was like, okay, great. And I, I knew in my head that working there was not going to be my last job. And, but I also knew I'm a new, felt like I'm a new graduate, I'm a new attending and I, this is a great place to start because I'll be surrounded by incredibly smart colleagues and I can curbside people, which is exactly what I did. And I was just surrounded by people who were so health, like all of these ortho surgeons, all of these PMM and R docs. So helpful. I mean, I would go up to'em in the beginning and be like, does this x-ray look fine? And you're a new attending, so you wanna make sure you're nervous. And I think being in that community and having that support was so helpful. And so, I really enjoyed it there, aside from not, having the time to really talk to patients about what I wanted, but but it was such a great way to start and start seeing like a higher volume of patients, just get more comfortable being in a practice and being out on my own and having the resources there to help me. So it just seemed like a, a really logical next step for me.

Maryal Concepcion, MD: 22:04

I love that. And especially when we talk about resources, like I am of the generation where we didn't have pocus during training. And so I've had to take classes after to incorporate POCUS in, but it's again, just referring to your website, like you're there with your ultrasound machine on the lady's knee, and it's it's fantastic that you have this, it's just a part of how you practice. You have all of these tools that you're able to pull from knowledge, you're able to pull from experience, you're able to pull from. When it comes to job offerings had you looked at. A, a, a bigger corporate group compared to the one that you eventually stayed on with for the first three years as an attending, because I, I think about those golden handcuffs are really pretty, lots of money, lots of benefits, 401k match, all the things, but it's like you didn't necessarily go to a big, a corporate model where you had to work in hospital.

Dr. Sassy Weinstein: 22:55

The group I worked with was a big corporate model in the, in the ortho world. It's the probably one of the biggest groups out there. And so they started in pa really in Philly, was kind of their, their main hub site and then expanded into New Jersey, have expanded a little bit into Florida. So the group that I joined actually was, was a small group that actually got acquired by the larger group. And so it was actually kind of nice because where I am in New Jersey, it almost felt like. I wasn't working for like the large business and I almost felt like I was, able to still do kind of what I wanted to do because I was in this smaller cohort and that was actually really nice. Rather than, I think my experience would've been really different had I been working at one of their main sites that's, insanely busy and just seeing so many people. There's so many docs there, but I think, there's two, there's 200 plus probably more at this point. Docs in the group kind of across the three states and obviously tons of physician assistants and everybody else. So I, that's kind of why I knew that long term, this is probably not going to be where I end up because. For me, being in a model that kind of looks like that and that is, productivity based for me, I'm just like, that model doesn't do much for me because I don't want to work like that and I'm not going to I wasn't even really enticed to, right. I, and so I think I just knew from the get go and honestly my partners kind of knew that about me and I, I kind of told them I need 20 minutes for a new patient with which now looking at, I mean now I have an hour right for my initial patients and, but I kind of just told them what I needed and there would still be things that fall through, you're working for a bigger group. But honestly I felt like my experience there was amazing and I still get a lot of referrals from them and I still have really good relationships with all the surgeons there. And I felt like it was a really good first step for me and I probably would've stayed longer, had another opportunity not come up. But I knew, I knew at some point it was probably not my long term.

Maryal Concepcion, MD: 25:09

Got it. And when you talk about that, the, even the 20 minutes was not ideal. I'm wondering,'cause we, we definitely are familiar with that. All of us who've been in fee for service through residency, even medical school, and then as attendings a lot of us, most of us have been through that as well. What was it that you wanted to deliver to your patients that you were struggling to do within those 20 minutes? Because I think that that would be helpful for the audience to hear because these are the things where, you know,'cause I think about when you have the 20 minutes or 15 or eight minutes, whatever it is, and you are so going through the motions of okay, I gotta ask these questions, I gotta at least ask these questions. And then if I get to anything else it's a great day. But for you, what did you, what were you longing to deliver that wasn't being allotted for in those, short patient visits?

Dr. Sassy Weinstein: 26:03

Yeah. I, I think it's the lifestyle medicine care, right? And I think it's, it's getting to know your patient and getting to know them, who they are, what's going on in their life, what else is affecting. Their story, right? What's, what can't they do because they have pain? What are their goals? What do they wanna be doing? And, and everything else that goes into it. But, and even with the ultrasound, right? Like ideally if somebody comes with knee pain, shoulder pain, I wanna put the ultrasound on every person that comes in just so I can take a quick look and, have a diagnostic baseline. But when you're working in this quick pace, it's, you're almost like, I don't have the time to do it. And you're like, if you wanna come in for an injection, we'll make sure it's ultrasound guided, but you don't have the time to do that. So you like just listening and listening to them. Right. And I, I feel like in my practice now, the feedback that I get and what I really feel like I can do is listen to patients and listen to their story. And I feel like that is. Half the battle with patients, and when they find a provider that is listening to them and they feel supported and they feel like someone's on their side and actually getting to know them and actually cares, they already feel so much better. Right? You're not just coming in for a quick cortisone shot, you're on your way, so you back in three months, right? I wanna have the conversation, why is this really not the best thing to be doing consistently? Let's talk about what else we can, what else we can do to target this instead of just these, these quick fixes. There's just so much else to it that I wanna talk to'em about.

Maryal Concepcion, MD: 28:07

And tell us about your next career pivot, because you went on to be part of a, a different type of group where you were the medical director and I, I, I would love to hear not only if you can tell the audience what was that group like, but also what was it that was just not vibing with your life that did not encourage you to stay.

Dr. Sassy Weinstein: 28:30

Yeah, so the, my pivot was an opportunity came up where I could start the, as you said, the medical side of a multidisciplinary group, which is predominantly pt, but also ot, chiropractic, acupuncture, which to me I was like, wow, what better way than to have this, one stop shop where everything is just connected. You have this, direct, discussion and conversation with all the other providers. Everyone's on the same page treating the patient, which I still think is obviously the best way to do it, right? Because everyone's just on board and you can talk to each other, and I think that gives the patient the best outcomes. So, yeah, and it, it taught me a lot because it was starting a medical practice from the ground up and the guy who started there was no other physicians there, and so I had to. Bring my knowledge of what do we need from a medical standpoint down to what supplies do I need? Right? And what, what does the office need to look like? What other equipment do I need? Which is stuff that I never had to think about. Because when you work in a big group and you just walk into these amazing resources, like an ultrasound already being there, and you know your supplies are ordered for you, you just tell someone, oh, I think we need more, 18 gauge needles, and you snap your fingers and they're there, in 20 seconds. Now it's oh my gosh, where do I start with this? I very clearly remember my first patient that I gave an injection to, and I, I had, I had everything. And then I got to the end. I was like, do we have bandaids? And luckily somebody at the front had a bandaid, but I was like. So add this to this, right? And it's just like you, you figure it out. And so that part was really good. I learned marketing, right? I never had to market before. When you're in a big group, you go out, you meet people, but the patients come to you, they're come to you because they, this group is really well known and they're gonna see you anyway if not referred from somebody else within the system. But this is now a whole new thing where you have to go out into the community and tell people who you are, what you're doing, what you're a part of, what your goals are. And so that was really new to me too, which obviously was an invaluable experience for what I'm doing now. And it just turned out that kind of, the, the vibe there was not for me, and I didn't. I didn't end up having the autonomy that I was promised, whether that was with patients, whether that was just with my personal life. And I got to a point where, and I, and I also just didn't feel super well respected, and I got to a point where I was like, this, I don't need to do this anymore. Right? Like I, I know that I'm better than this and I value myself so much more than this, and I just have to figure out a next step. And I had no idea what that next step was going to be. I, I was like, I can go back to the group that I came from because I know that they haven't hired another non-operative doc yet. And they would, they'd be happy to have me back. I know exactly what it would entail. Or I can take a lot of what I learned and go out on my own and actually do what I really wanna do. And. Practice the way I want to, the way that I feel like patients deserve the, have the schedule that I need. I have two really young kids and I'm just kind of figuring out what worked for me and obviously I chose the latter and which is how I got to where I am now.

Maryal Concepcion, MD: 31:57

I think about different people have shared, what was their breaking point and how did they find out about DPC drug specialty care in your case? And I just think about that. There's listeners out there that are thinking thoughts like you are who have stumbled across your story. And this is real, like this voice of I want to practice differently is a thing. And so I love that, you, you paid attention to what you know was inside. I mean, that is, that is something I, you said, you valued yourself, which I absolutely love. And that's something that is really hard sometimes for us in the patriarchal system of, residency and training. And you're a first year, you're second year, you're a third year, you're an attending, like you have a pecking order, but to. Recognize that one, you're doing this for the longevity of your career, but two, you, like you just said, you have two little kids that you're like, man, I gotta do what I have to do in order to also be like a role model, whether it be something that they recognize now or later on because you're showing them how life can be and entrepreneurship is sure as heck not easy. But I wanna ask here, when you opened what was the timeline that you opened under from, saying I definitely have to leave the role that you were in to opening your own business?

Dr. Sassy Weinstein: 33:20

Yeah, so I think I gave notice, I had to give three months notice. I think I gave notice in, let's see, July July probably. June or probably June or July and I opened in November. So I, I stopped, I stopped at my last job in September and then I officially opened doors in November.

Maryal Concepcion, MD: 33:47

And then I'm a cheating a little bit'cause I heard this from your your other podcast interview, but I would love to talk'cause it's been a while since someone talked about a virtual address. So, can you tell us about opening a practice but not yet necessarily having a physical space? How did the magic happen?

Dr. Sassy Weinstein: 34:04

Yeah, I mean, and those are the things that you just have no idea where to start, right? And so as I was kind of thinking about it, I was like, I don't have an address, but I need to apply for an LLC and I need, I need to apply for my employee identification number and. So I was just looking at the different options and I think New Jersey is probably similar to some other states. You can't use a PO Box as an actual address. So I learned about, I think probably one of my other colleagues was like, you can, there are these virtual addresses, they're actually physical locations that you can go to where you have a tiny little mailbox there, but you can use that as your mailing address. And I was like, all right, well I think that's my only option because I have no idea where I'm going to end up. I, I didn't wanna use my home address and so I just started searching. I went on the website of, wherever I needed to go, and started searching of places close to me that had these virtual mailbox options and just set that up so I could use it as my address for the LLC and from the IRS and everything else. And I am still working on trying to figure out how to switch all that stuff with the with the government to make sure everything is good. But I used it actually for the first. I mean, until, until where I'm at now, because I just, I was like, it'll just be easier just to have that and, nobody really sends me things in the mail anyway, so I just needed, I needed a mailbox to, for documentation, but nobody's sending me anything. Anybody's like sending me something in the mail. They're going to either call me or email me. Also.

Maryal Concepcion, MD: 35:37

when it comes to New Jersey in particular, you are only the third, so we need more New Jersey doctors on the podcast for sure. Do you have any tips for listeners who are wanting to practice in New Jersey, whether that be physically or remotely, that when it comes to things that are unique to opening a clinic in New Jersey in particular.

Dr. Sassy Weinstein: 35:58

I think the virtual address thing was the only thing I really had to learn. But really just knowing that that's an option is important. I mean, I think in terms of everything else, and I, I talked to my lawyer, I talked to my, accountant and I was like, what else do I need to do to make sure I'm legit? Because I think that's still a thought that goes through my head, once a month is, someone's gonna be like, is this practice really legit? And so, yeah, so the lawyer just helped me get everything situated for the LLC and, then I had to get the employee identification number and made sure that kind of, I had all of that stuff in order. I don't know if there's anything else really specific to. New Jersey, aside from, normal business stuff that you would need anywhere the malpractice and the general liability insurance and other things that you'll need coverage for. But I don't think, I mean, unless again, you don't know what you don't know, right? So maybe one of your other people will know something. But nothing that I have come across that's super specific to New Jersey.

Maryal Concepcion, MD: 36:57

Awesome. Love it and super helpful. I, I, I've shared on in my journey that like we legit needed to publish a newspaper ad for four weeks before we could get our county business license. I mean, and we're talking, I did not open up in 1821. I opened up in 2021 and yet we still needed a newspaper. That's wild. Really uhhuh. Yeah. So that is that is something that I love to ask specifically for people looking to practice in particular states. And I will say also that it is important to note that Dr. Weinstein saying that she's an LLC in places like California, you cannot open a medical practice as an LLC. So definitely talk to, the other direct specialty care, direct primary care doctors around you to see what are the restrictions within your locale, where you're looking to practice when it comes to you having experience in so many different clinics in different specialty type of clinics. When you then thought about opening core sports medicine and you thought about okay, now I'm gonna get to do this my way, have the autonomy that I want. What were some of the things that you were like, these are total deal breakers that I must have or else I will not be able to progress in my own clinic?

Dr. Sassy Weinstein: 38:08

Yeah, I mean, I think though, I think thinking about what you want, and I think some of the biggest questions, I did a I did a lecture for actually my fellowship about starting your own clinic and some of the things that you have to think about, and I think one of the big questions is to accept insurance or to not accept insurance. Right. That is, that's. One of the biggest things you have to think about with your practice and how it's going to run, how much staff you're going to need, what else is going to have to be part of that. And so I really went back and forth a lot and I talked to a lot of people, pretty much everyone that I could find that was doing, something similar. Someone who was doing more of an out of network cash pay, direct care versus other models. And I just decided, and I knew in my gut that I would not be happy in an insurance model. And I also didn't wanna have to hire a staff right away. And I didn't wanna have to fight with insurance for. Reimbursement for every last claim. I knew that that was just going to affect the way that I practiced. And I, I know that that's a barrier for some people. And, that's why I, I still like to volunteer at a clinic and, provide care and do other things for the community. But I knew that in terms of my practice, I couldn't provide the value that I wanted to and really practiced the way that I wanted to, while under insurance model. So I think that was really one of the biggest things that I thought about.

Maryal Concepcion, MD: 39:30

And when it comes to the patient experience how did you open your clinic in terms of, did you think about, okay, if I'm gonna see, a particular patient for any new patient visit, I won't want this amount of time. How did you design your workflow as you started, and has that changed over time?

Dr. Sassy Weinstein: 39:52

Yeah, so pretty much all initial patients I have an hour long consult with, or at least, I, I save an hour of my time set aside for them, whether it's sports, whether it's lifestyle. I will tell you that when I first started, I separated the two and, the sports versus the lifestyle because, I was used to a model where sports medicine, great, I can see somebody in a quicker amount of time. And whereas lifestyle medicine, like I'm really trying to learn more about, the six pillars really ask them a lot about themselves. And I got to a point and I like, probably like maybe two months in and I was like, why am I separating these two? My care doesn't change, right? And it shouldn't change. And that's the whole thing that I wanna be doing here is incorporating the lifestyle into the sports and talking about stress and how that is affecting everything else in your life right now. Because when somebody comes in. They often don't want to just talk about one thing and other things are going to come up. And I noted, the first place I worked at it was, you couldn't even talk about two different joints on the same day, so you couldn't have shoulder pain and knee pain. Right. You had to pick one. And so, I even recently had a, a patient call who was like, I, do you see more than one joint and one visit? And I was like, of course. We have, we have an hour. She's because I, I did have an appointment with another place that accepted my insurance, but they told me I can only choose one and so I'd have to make another visit. And so I'm like, talk about, convenience. And so, yeah, so I got to the point where I was like, I'm not changing the way that I care for these patients and I want it to all be the same. And so that definitely changed in terms of my model and kind of how I thought about it because I didn't like having the two separate in my head. They're not, they're not separate and I wanted to make sure they were the same. So that, that definitely changed in terms of my mindset. Timing wise, I mean, it's still been pretty much the same. I just try to give patients time. If someone runs a little bit over, I'm also at a point where I'm not, slammed and I don't ever want to be totally slammed, but if somebody's there for an extra five minutes, that's fine. Right. And, and so I, I just to figure it out and it's, and it's worth it.

Maryal Concepcion, MD: 42:04

Yeah. I definitely will say, it is lovely when, the, the times when you do run over and you do have a patient who's actually using your waiting room for waiting, which I, I'm laughing at that because in direct primary care in, in our world, we, we laugh at the waiting room is not supposed to be used for waiting. It's to play and to, have kids color and whatnot. But yes, when you do go over your patients just like you're, describing your patients are like, sometimes it's hard for us to remember that our patients are just like the one you mentioned. They were like, oh, I know that I get to see Dr. Weinstein for the things I need to see Dr. Weinstein for not the one joint that's bothering me the most today. And they don't get as pissed off or stressed out as they did in fee for service. And I know that there's people shaking their heads like we are on, on the call here. When it comes to flow, I'm wondering about if you can tell us what are your office hours and how do you run your flow in terms of if there's someone with an acute issue versus someone who's a new patient versus someone who's coming in for a follow-up. How do you run your practice?

Dr. Sassy Weinstein: 43:06

Yeah. So I just try to kind of stack them appropriately. I try to get people in as soon as possible, so, and I think people are, patients are still shocked by that because I, especially somebody coming in for a sports issue, they're used to not being able to get in for a month or six weeks, right? When at that point something's usually feeling better. So if somebody, especially is calling for something acute, I try to get them, especially if I'm still at the office that day. I try to either get them in same day or next day. Like I had a patient yesterday text me or call me and, wanting to get her son in because their knees have been bothering them. And I'm like, okay, well what about tomorrow afternoon? And so I think that goes really far, but I just try to. I try to be really accessible to patients, but also have my boundaries, right? And so I take my kids to school every morning and I, with my new office now, it's so much closer. And so the commute is so much better. So I just, I come straight after that. So I'm usually here by, you know, 8 45 or so. And, I start seeing patients then, or whenever available, and I usually cut off around four. But that being said, if somebody is, needs to come in later, then I figure that out with them. And so I have hours, I would say, but I'm also, if I can be flexible to help the patient out and see them when it's more convenient for them, then I do that. But but otherwise, I, I try to stick to my schedule and get everybody in in a timely manner. I wouldn't say I have, at my first practice, it's like you have a block for a new patient, block for a follow. I just schedule people as they come. There's, and just whenever the time is available and I just try to kind of stack'em close together so the flow is a little bit better for me. But then always, leaving, leaving a little time here and there for me to catch up on things.

Maryal Concepcion, MD: 44:57

Awesome. And when it comes to the onboarding for a, a new patient in particular, what are some things that you include in your onboarding, whether it be through a prefilled, questionnaire before they get there or when you're talking with them because you're coming at them from, from family medicine, sports medicine and lifestyle medicine perspectives all in one doctor.

Dr. Sassy Weinstein: 45:22

Yeah. So the, the onboarding process, I would say has changed a little bit. The forms that they fill out have not changed, but I hired my first virtual assistant probably back in, I guess end of August or so, which has been a total game changer. So instead of it just being me on the phone with every patient, I actually have my virtual assistant call them. She kind of knows exactly what I say to them, talks about, how long the visit's going to be, and then obviously the question always comes up, do you accept my insurance? If, if somebody's getting referred to me, they know kind of how I operate. But if it's just a new patient who's questioning and just saw my website. She kind of goes through that whole spiel about how we provide, we wanna provide the value for them and not, and make sure they're getting everything answered that they want to and making sure that they have a game plan in place. And some patients are like, great, others are like, I'm gonna go with my insurance and that's fine. Right? And I, going into this, I think every D-P-C-D-S-C doc knows that this model's not for everyone, right? But it's, the patients that do come, they're incredible. So they kind of get that whole spiel and then essentially they, we send out an email that is, tells them, what time their appointment is, gives them the link to the forms to fill out, which is through my EMR. And that all then just gets uploaded directly into my EMR. So it establishes them as a patient and then just gives them directions on how to get to the office. And that's it.

Maryal Concepcion, MD: 46:51

Love it. And even on your website, something that I was like, Ooh, I gotta add this to my website, was it was like, find directions and it led the person to a Google link so they could look up your directions. I was like, that's awesome. See, I mean, this is like literally doesn't matter how long you've been open, you learn new things every day. Yeah. Our fellow physician entrepreneurs, I wanted to ask you here, because this actually happened to me yesterday and I was like, oh my gosh. I'm so excited to talk to Dr. Weinstein today because I'm gonna ask her. I have been taking care of a patient for probably close to 10 years now, and I'm like. How have we never talked about trocanter bursitis? Like I, I watch my patients when they, get out of their cars when they're walking down the hallway. I'm definitely, I know my patients well enough that I'm like, you're walking a little different today or we're not. But I, I was like, have I noticed any, and I, I probably see this patient every maybe three or four months and I'm like, I have not noticed any difficulties getting in and out of chairs needing to use the, the handrails on the chair. But I'm just, I, I think about when, we've, we've talked about you don't know what you don't know. How do you evaluate your patients in terms of not necessarily like wanting to find procedures to do, but like I did both. I, I did two titis injections yesterday, but I'm like, the whole time I'm doing that, I'm like, how did you not see this? And so I'm just wondering in terms of your patients do you do you have certain questions that you will prompt a person with? Again, not to get a procedure out of it, but just to be holistic about their care because, if they're a certain age, if they have a diagnosis of osteoporosis, if they have a previous knee injury, I just wonder like how you, how you, with the time that you have in your practice now, how do you go about finding out as much as you can about the patient, even when they're not necessarily forthcoming with, oh, by the way, I am having issues.

Dr. Sassy Weinstein: 48:46

Right. Yeah. So I think, I think having the time to talk to them really helps. And it depends if they're coming in with an acute issue, like if somebody's coming in specifically for the hip, then obviously we're gonna talk about that and ask all the standard questions. But I also really want to always make sure that I know what is somebody, is there something that they're being limited by that they can't necessarily do? Right. And that might be something. In their day-to-day life, that might be something workout related, right? They might say, my shoulders actually always bother me and I feel like I actually can't do a pushup, or I can't do a plank, or I can't do an overhead press because it just has always bothered me, but I just chalked it up to getting older and, but it's something that clearly has limited them or they, they, if their shoulders hurt or something like that and they say, I, it's hard for me to walk up and down the stairs with, my baby. Or it's like a grandparent, right? And they say, I wanna be able to sit down on the floor and play with my grandkids. Right? There's, you always have to ask people what it is that they wanna be doing. What is their ideal life look like and what is stopping them? And because sometimes people who have been in pain for a really long time. They just live with it and they don't realize that they don't have to be in pain and that they can live differently. And it's, and I see that so much now with my practice because it's these people who haven't necessarily gotten answers from, the traditional system or from other providers and they just learn to live with it. And. When you actually start to figure things out and talk to, a physician or a provider who asks the right questions, who does the right things, you're like, oh my gosh, there's hope. Right? And that, that to me is bringing that hope back to people's lives and being like, I don't have to live like this, or I can, I can get out of this pain, I think is one of the most rewarding things. And I have a patient that comes to top of mind and she is really active, like an avid runner works out all the time. She's young, she's super fit, and, but she had pain, in her whole body for so long that we just started targeting little by little, just talking about everything else going on. And I just, she left me a voicemail the other day just almost in tears, just saying, I, I can't even begin where to start. Like, I don't even know where to start because I can't remember ever feeling like this in, in such a long time. And so. I think just listening and also just seeing what's missing out of people's lives, right? What do they want to be doing? What are their goals? What do they love doing for fun? And asking these things so you can see what are the limitations and what might you be missing.

Maryal Concepcion, MD: 51:36

Love that. And very different than I gotta ask you if you wear your seatbelt today, I can't listen, can't touch you. But you know, I gotta ask you if you wear your seatbelt today. Yeah. Because that's covered. Yeah. Done. So, th thank you. That is an amazing answer. And I, I'm just, I'm totally going to listen to your interview and incorporate what you said also, and just the way, like four plus years into our practice. I, I kept thinking about like, how did I miss this with a patient? And we all miss stuff, but I love what you said and I'm gonna incorporate what, the, the questioning that you just mentioned into our practice. I love it. So thank you for that. When it comes to people opening who want to do pocus, who want to do, sports, medicine related procedures and even lifestyle medicine. What are your tips for opening a clinic with, because like you have your ultrasound, but I don't know, like, how did you come to get your ultrasound if you had connections? But, I, I was talking with somebody yesterday who's there is this doctor wanting to sell an ophthalmology machine and it's$28,000. And I'm like, dude, a person opens a practice with less than$28,000. So how is someone going to afford a, a machine like that? So what are your tips on things to have when you're opening a clinic like yours?

Dr. Sassy Weinstein: 52:46

Yeah, and I think I learned from, a lot of the lecturers, the podcast, the people that I talked to, I was trying to keep it as slim as possible. And there's so many people that will say, don't overbuy in the beginning, right? Just get what you definitely need and work with that. And then you'll see kind of what else comes along. And so for me. Ultrasound's a big part of my practice. Obviously I do every single injection under ultrasound. I do a lot of, looking diagnostically to see what's going on. And so I knew I needed an ultrasound and equipment wise, that was, there was, there's other things that I want for sure, and I've now gotten some of them. And I just, purchased another, but I was trying to keep things as streamlined and, slim, I didn't have any other staff for eight months nine months. And so I think that piece of advice was really important is just think about what you absolutely need. And for me it was an ultrasound. And so then I started looking into different ultrasound machines, right? There were the ones that I had worked on at the past two places. And I had gotten, actually, I had gotten used to talking to reps and things like that when I was at my second job, because that was, there was no one else that was going to do that. And I only, I had knew the questions to ask and I had to be the one to demo all of these things out. And so. I was just looking at a lot of different products, talked to a lot of different reps, talked to a lot of different people, posted in different groups. And ultimately I ended up going with an ultrasound, a portable like wireless ultrasound that I absolutely love. Is it going to be the last ultrasound I have, probably not, but for me, at the price point that it was at, and actually at the resolution that I get on it, it's probably better than what I was working with at my past two jobs, which were using, 12, 15 old machines. And even though it was like probably better quality back then, now what I'm using is, is so much better and I can accomplish really everything that I'm doing. Is it the most high definition, amazing ultrasound. No, but I knew that this is, I could get by with this. And for the price point I was like, I'm, I'm doing this. I'm gonna try it out. And it's been, it's been great. And so I kind of went into it like that. I've now since purchased a shockwave unit, which has also been amazing. Much more expensive. But again, you just have to kind of think about how you're going to use it. Is it going to be, worth it in the beginning or is it just going to, look pretty while it's sitting there? And so I think you just have to think about what you really want, what you really need to operate and try to try to keep it as little as possible. Try to keep the overhead as low as possible. And I think that's, I mean, that's really how I started. And I felt like that was helpful because I wasn't stressing myself out, trying to, do and buy all this fancy stuff. And I was just like, let's just start, right? You just, you have to start somewhere and, and you'll grow and you'll learn different things and you'll see different stuff comes out and you'll develop different programs and, but you just take it day by day. And so that's, that's kinda how I started.

Maryal Concepcion, MD: 55:51

I love it. And I just think about as you're speaking there, that you had the autonomy to make these decisions and figure out what was gonna work for you to reach that goal of keeping your overhead low and then, adding things on, adding stuff on as you went forward. So here I think about. When you talk to people about lifestyle medicine, telling a person all of the things is really intimidating. And so, helping people just take one, to do one thing to start, you can't eat an elephant all in one bite. You got it to eat them. Yeah. Hopefully you're not actually eating elephants, but you know, the, the metaphor one bite at a time. For the listeners out there who are especially wanting to open up their own direct primary care, direct specialty care practice, what are some small bites of information that you would leave them with in terms of, if you're thinking about opening your own practice, these are the things to definitely think about or do when you're starting out.

Dr. Sassy Weinstein: 56:48

Yeah, so I mean, I think some of the biggest things are talk to as many people as possible listen to podcasts, read books. Just really reach out to your community to people who are doing the same thing. Um, There were some really great resources I know through like the private practice playbook by Somi docs. That to me was so helpful in starting my practice because they, when they brought on all these like different speakers, it was physicians, it was accountant, it was lawyers, and it was all of these things that you have to think about it. And it almost gave me a to-do list of what I needed to do and brought to my attention all of these things that I would've otherwise not thought about. So I think that was really important. Um, And I think just even picking one or two of these resources gives you a place to start, but not getting so overwhelmed, right? Don't listen to every single podcast that's out there, but while you're still in the thought of opening, do try to get as much information as you can to think about what you might need, right? Like I reached out to other sports docs who started their own practice and I'm like, what supplies do I need? And it's such an amazing community of people wanting to help each other, who are going out on their own. And she was like. I'll just send you our supplies list. And I was like, you don't even know how helpful these little things are. And so I feel like when other docs were thinking about doing the same thing, reach out to me. I'm like, of course I wanna help you. Right? Because I was in your shoes. And if there's anything I can do to make it more helpful for you, I just had another doc reach out last week who was like, I'm thinking about opening my own practice. I'm pm and r would love to just chat with you. And I think just having that conversation with people is like, okay, I'm not alone. I can do this. And like kind of then establishing your network, you can always go back to those people. Right. So I think really just reaching out to community members and even joining some of these Facebook groups although looking at every post I think is really overwhelming. So. I think even just like a few of these resources, like pick, one to three of them and just kind of get after it. Right? And, and then it, try start establishing a network of people that you can reach out to for, questions here and there.'cause I, I certainly still lean on and reach out to all the people that, it helped me get here.

Maryal Concepcion, MD: 59:12

The last thing I wanted to ask is about your ability to be a doctor, be a mom, and also do fitness classes. So tell us about how that even started, because it is so, I've heard another podcast how that's really your, your core audience of who you want to, your core avatar of who you want to have, join your practice as well. And it's so, it's so different and so awesome that people who know you as the person who's like helping them correct their form in class is also the person who can like, inject their knee if they need it. Yeah.

Dr. Sassy Weinstein: 59:42

Yeah, it's awesome. It is, it is so fun. It started because I was out marketing and my, again, the people I wanna be marketing to are the people who are kind of going to these local gyms who are invested in their health, but obviously might get injured, might have other stuff going on. So I was just going out marketing and I, would always offer to these places, can I do a talk? Can I do something like this? And this one owner of a gym in, in downtown Princeton we started talking and then I ended up moving offices and I was like, is, do you have any like space that I could rent that I could work out of? And this place is literally an old garage and he is like, literally we don't have any space. He is like, but on the offhand, do you have any interest in teaching group classes? And I was like, I do. I was like, I don't really have any experience. I was like, that being said, it has always been a dream of mine to. Teach a fitness class on this side of being a physician. Because when I was in med school I was living in Philly, the gym I went to, one of my favorite classes was a physician who worked at Penn. And I was like, how cool is this? Right? You get to be in this atmosphere, like doing what you love and being also around all these other people. And I was like, alright man, what do I need to do? He is like, just, just start. And he is like, you, most importantly, you just need say if you fit in with the vibe. And that was really it. I mean, I, and I just started since then, so once a week I teach a class. It's now on Friday morning, so it was right before this. And it is awesome. I mean, this, this community, I mean they, some of them have become such good friends, A lot have become patients. But again, just being around them in this different setting is. So much fun where we're just like listening to music and working out and sweating and it's just, it is so fun. It's so rewarding. It's like everything I, you know, I love, I'm just so passionate about working out and talking about that. What better way than just to be out in the community doing it and meeting all these incredible people.

Maryal Concepcion, MD: 1:01:46

Amazing.

Dr. Sassy Weinstein: 1:01:46

Thank you so much Dr. Weinstein for joining us

Maryal Concepcion, MD: 1:01:48

today.

Dr. Sassy Weinstein: 1:01:49

Yeah, thank you

Maryal Concepcion, MD: 1:01:50

so much for having me on. 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.