Filling the Void: DPC Response to Clinic Closures and Community Needs in New Orleans

Today Dr. Emily Holt, a Direct Primary Care (DPC) physician based in New Orleans, shares her inspiring journey from working in federally qualified health centers (FQHCs) and university clinics to opening her own DPC practice amidst a rapidly changing healthcare landscape. The discussion dives deep into the effects of the "one big beautiful bill," the challenges facing marginalized communities following recent legislative changes, and innovative ways DPC physicians in Louisiana are collaborating to fill healthcare gaps. The episode also highlights the power of community-driven solutions, nonprofit partnerships, and coalition-building among DPC practitioners to improve access to affordable, relationship-based care. Whether you’re a physician, patient, or healthcare advocate, this episode offers firsthand insight into DPC, healthcare advocacy, and the current realities for patients and providers in New Orleans and beyond. Recorded July 2025.

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Transcript

Dr. Maryal Concepcion: 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. Emily Holt is joining me today and she opened in October and it is so exciting to be here in New Orleans. This is like one of the things that is the highlight of today to be able to meet you and talk with you, but also in this town where you have. Lived and worked for many years in different roles. I would love if you could share with the audience. Especially because we are at a time now where they quote, big, beautiful Bill has passed and it is now affecting communities like this lovely community that you live in and you work in. So can you tell us a little bit about what roles have you been in throughout the years that you've been in

Dr. Emily Holt: 2:22

New Orleans? Sure. Well, first of all. Thank you for reaching out to me. I'm totally fangirling over here. And it it, if it wasn't for things like your podcast, I would not have my own clinic. So thank you for what you've done for the movement. So yeah, I started in, I, when I graduated my residency in New York City, I moved to New Orleans with my two sons at the time, and my husband and I started working for a fairly qualified health center. And I fell in love with that population, honestly, that that population of people who were very hardworking and needed healthcare and that clinic was their safety net. Really?

Dr. Maryal Concepcion: 3:04

Yeah.

Dr. Emily Holt: 3:05

And I knew that I wanted to be that doctor for people for the rest of my life. When I had my third baby, I actually left that FQHC while I was on maternity leave. Wow. Because. I could just tell that there's, you know, before I, I quit, I was waking up at 4:00 AM to, to finish charting and, you know, after having been up several times, breastfeeding the other, one of the other ones. And at night I just, it was not sustainable. Mm-hmm. Um, And I was probably seeing between 22 and 26 patients a day at the FQHC. I really enjoyed the patients, but New Orleans is a pretty poor city in the, in, in socioeconomic status. And so a lot of patients were coming from backgrounds of very, very meager means. And as many people who work at FQHCs can I probably identify with I would spend a lot of my 15 to 20 minutes with a patient Googling or looking on Walmart's.$4 list mm-hmm. To help them figure out which two of their six medications they were gonna purchase that month. Yeah. And so it felt a lot, like I wasn't helping many people, but at the same time I knew how important it was to be there. Mm-hmm. And have places like that, FQHC. So, it really hurt to leave, but I also knew that. I could not, it was not sustainable for me, my family, my mental health, my physical health. And so I, and I left to go to a job that had a much better work life balance. I was at the Tulane University Campus Health Center for six years and. I really enjoyed that job. I really enjoyed the patient population there. Mm-hmm. It, I, I realized that if I hadn't even known what adolescent medicine was, I might have decided to do a fellowship at some point. It was, it was just a fun population to work with especially as a mom. Mm-hmm. I felt like all those students, those kids, those young adults were my kids. Yeah. And, and I really enjoyed. Having a little bit more time to spend with them. Mm-hmm. And it, it occurred to me that so many students who came to college actually had very little education about them themselves, their bodies, their health. And so this felt like a really fun opportunity to spend the time with them and educate them. So. Yeah, that's, that's what it, and then I, I left to start my practice, so after that, so that's pretty much, that's pretty much it. As a doctor, it, as prior to medical school, when I, I went to me, I went to undergrad at Tulane University and I did a master's in public health. There. I worked in between those two edu educations as an emergency medical technician for the city of New Orleans full-time. I chose night shifts because you were guaranteed at least one gunshot wound per night.

Dr. Maryal Concepcion: 6:16

Oh my gosh. And

Dr. Emily Holt: 6:17

I loved those adrenaline rushes. Wow. I actually thought I wanted to be an emergency room doctor and you know, I, growing up I didn't know any doctors. Yeah. There's nobody in my family is really in medicine, and so that's why I became an EMT. I wanted to know what it was like. Sure. And I thought for sure I was gonna go into er'cause it was just way too fun. All the trauma, not knowing what was, what you were gonna get called to next. This was back when we treated CHF exacerbations with IV pushes of lasik. Oh man. And I, I just seem to remember, I mean, I wasn't a paramedic, I was the emergency medical technician, so I didn't have the same skill level, but. I, I remember we, when we coded patients, the back then the paramedics would push drugs through the endotracheal tube. And you know, I learned so much and it was fun. Talk about dopamine rushes. But actually I happened to be working full time when Hurricane Katrina hit the city of New Orleans and that experience. You know, I could talk for an hour about it, but the nutshell was I was stranded with my patients. They split, there were about 86 of us working for the city's new Orleans EMS, which at the time was called New Orleans Health Department. And they gathered us together the day of the storm and they said, okay, this is it. This is the big one. This is the storm we've all been expecting. It's gonna be a direct hit, a category, four or five, a direct hit on the city, and we expect the city to be destroyed, and we expect communication towers to go down and it's too late for people to evacuate. Yeah. And the Superdome, which is normally used as a, a oh, what's it called, A shelter. Last resort is not going to be used as a shelter. So people will have nowhere to go. And so we know they're gonna need help. So we're splitting you up into small groups and we're posting you throughout the city Wow. So that you can provide medical care. And I wound up at the Superdome. And so long story short, this, we got to the dome with all of our equipment as the, after the levees broke and as the water started to rise. We were stranded there with six feet of water surrounding the dome with the thousands of people who had come to the dome because they expected it to be a shelter. Wow. And it took three days for fema, the government to show up with helicopters. And in that time, I had no choice but to get to know my patients. Yeah. All we did was triage. I mean, we. We, we took patients, the ones who needed to go first, and we didn't know what was coming.'cause it's true, all communications were down. Geez. So we didn't know. We didn't know if we should expect a boat or a helicopter. But we took the patients who we knew needed to go out first and put'em in a, essentially a pile. We tagged dead patients. We, we separated the ones who could hang on a little longer. And I, I mean. Being in such an environment of just desperate humanity and I was in it with my patients. Yeah. I didn't have any food or water either. Yeah. Made me realize how important relationships were with the people I cared for. Yeah. And how much I wanted to know what had happened to them. Yeah. What was happening to them. And so those long-term relationships were something I had never considered and it made me completely changed my trajectory in medicine. And I, I, from then on, I decided I wanna be a primary care doctor. I wanna get to know these people. And I want to live my life with them alongside them. Yeah. I don't wanna treat'em and treat'em is how he would call it in the emergency room.

Dr. Maryal Concepcion: 10:23

Totally.

Dr. Emily Holt: 10:23

And that is.

Dr. Maryal Concepcion: 10:25

For the listeners, that is literally a pervasive term or a phrase, and that is so realistic, but it also absolutely speaks to the person you are that you know, you are so mission driven to even become a physician, a primary care physician versus an ER physician, or you know, somebody who is going to take care of people only in the acute stage. Here we are now. Fast forwarding to 2025, this quote unquote, big, beautiful bill has passed. And like I mentioned in the beginning, we're already to see, we're already seeing the, the fallout of what happens when healthcare is not a human right. When human rights are not a human right. Depending on the color of your skin, your orientation, your, you know, whatever it is. There's so much divisiveness right now. It's really, really a challenging time. And earlier we had a conversation about what happens when a clinic that is. Taking care of the patients who you, you know, the, the, the avatar of the patient who you used to care for. The person who goes to the FQHC clinic when their care is being threatened because of funding, because of government funding can no longer be used for fill in the blank, you know, ism right now that is going on. What. What are you hearing from people in the community who are also with that same mission that you had choosing primary care? What are they asking you in order to help these patients? The same as you wanted to help your patients when you became a doctor?

Dr. Emily Holt: 12:38

Yeah, I mean, you know, I think it's a difficult time right now in medicine because. Politics seems to have creeped in, in such a way that I've never seen it before. Hmm. You know, literally today a federal judge blocked the Trump administration's. It, I don't remember if it was an executive order or I think it was or it was, maybe it was a part of the big beautiful bill that said that planned Parenthood could not take Medicaid funding. You know, that's been a really big issue in the deep South because it's very hard for women in Louisiana to get good healthcare. Full stop. I think we have one of the highest maternal mortality rates in the United States, and I think Mississippi might be number one on that list, and we're number two, but. And then to break it down further black maternal mortality is by far the worst, and it's e extremely divided. It's, it's, it's a much bigger jump in terms of how bad it is mm-hmm. Than it is for other, for white women. So when it comes to like, it, it kind of depends on what you're talking about. Mm-hmm. Because it feels like there's. Different interests. Mm-hmm. And physicians, they aren't necessarily all aligned. Yeah, sure. I mean, I'll just be totally honest with you. I'm a member of the Louisiana Academy of Family Physicians a proud member of the Louisiana Academy of Family Physicians. We really don't, and I'm on the legislative advocacy committee and we really don't talk about the bills that. Are impacting women's health.

Dr. Maryal Concepcion: 14:26

Yeah.

Dr. Emily Holt: 14:26

We didn't even discuss the fact that Louisiana made Mery stone and misoprostol controlled substances in October of 2024. We were the first state to do it. That's not even something that Louisiana Academy of Family Physicians is. Is vocal about. And frankly it's because they, I'm sure it's because, I don't know.'cause no one tells me specifically, but they don't feel they have the support. Wow. And so it's, when you ask a question like that, it's honestly hard to answer.'cause some physicians are out there saying, you know, how can we support the patients who are. No longer gonna qualify for federally qualified health centers because they're undocumented. Yeah. Because of the big, beautiful bill that was specifically put in there to try to stop undocumented patients from getting healthcare. Mm-hmm. How are we gonna serve those patients? Federally qualified health centers locally are very concerned about that. Mm-hmm. They are going to lose funding and they can't make up the gap. Also gender affirming care. They, there is one federally qualified health center that is still providing it and everyone's kind of got their eyes on them and wondering Sure. Are they gonna be able to continue? Yeah. Because there are even whole university systems in other states that have stopped their gender affirming care programs. Mm-hmm. So it's a very fluid situation and large. Populations of people's healthcare

Dr. Maryal Concepcion: 16:03

are at risk. Absolutely. And you know, I, I think about how there are probably listeners who are saying things that I definitely hear in California, like, oh, but that's not gonna affect me and. That's absolutely not true, because as we see, you know, if, if people are no longer working at jobs, it affects the, you know, the supply chain. If people are no longer with access to healthcare, where are they gonna go to the emergency room? And so when you actually have an emergency, you might be one of how many if that hospital remains open. Because if the Medicaid and Medi-Cal reimbursements are enough that they will stay open. Who knows? So. The complacency and the, you know, the thoughts of like, that's not going to happen to me. When you, when you see that happening, but you also see people in the community who are trying to look to the future and look with, with that, with those types of situations happening, how to prepare to offer an an, a pathway for people to, to access. Care, access, healthcare, not insurance. What are the conversations that are going on in Louisiana?

Dr. Emily Holt: 17:17

Well, if you, you're not gonna have the government funding like we were used to having, and that's pretty clear that that's going away. Who can fill the gaps and how? And so just today we, I had a conversation with an FQHC locally about you know. Should we look for grants? Should we look for benefactors? Should we, and, and you and I were talking about, you know, should we, should I make a program for some people who are able to, to pay more, almost like that Robinhood mm-hmm. Model that you mentioned so that other people who can't afford it can pick it up. I have lots of service industry workers. Mm-hmm. And who are members of my d, my DPC. Just today I had to join and they, they told me they each make six, about$16 an hour. They applied for Medicaid and they were told they don't qualify. They don't, they don't, they make too much, but they would have to pay$400 a month if they wanted a marketplace plan. And they certainly can't afford that. Yeah. And so, you know, the struggle is where, where am I gonna spend my time? Mm-hmm. How, how am I gonna defend, divide my time? And while also trying to grow and run a business and reminding myself that I can't, I can't save everybody. Yep. And it's, it sounds so trite, but it's something that I've struggled with from since I was an emergency medical technician. Yeah. And so protecting myself is also part of this equation. Mm-hmm. My practice isn't even really. Profitable right now. I'm, and so, you're asking the million dollar question. Mm-hmm. And a lot of people are putting their heads together to try to figure out how can we fill this gap. I am a little scared that I know we're not gonna fill it for everybody. Mm-hmm. And there's gonna be a lot of suffering. Yeah. Yeah.

Dr. Maryal Concepcion: 19:17

And all of what you are saying is so true and it's so. Painful at the same time because it is so true. And in my opinion, it is totally avoidable because especially physicians like you and myself have been saying, you know, we have to uncouple insurance from primary care for a very long time. There are thousands of doctors saying that, but yet at levels of bureaucracy that are at, you know, in different organizations, different levels of the state, government, et cetera, that is not the default you know, thought process of how do you do any healthcare without insurance is not it's not the default. It is definitely being more familiar because people are having to be creative. But I think that yes, it is the million dollar question because if we could fix everything tomorrow that would be fantastic. Unfortunately, too long, in my opinion, we have left this pipeline of medical students and residents to the, the wolves of corporate medicine. And like I was there in terms of, I was an employee, I didn't know how to do anything else. But when those are the only things that are presented to you, you, you're only taught codes in residency and you're only taught the insurance system. It leaves, it, it's almost like a, a learned helplessness and. When people like you and I are coming to the table to have conversations to try to fix things definitely you've, you've even taken a big, you've taken already a big step in being a part of a safety net. Tell us about your affiliation with Bija Clinic.

Dr. Emily Holt: 20:54

Yes, I'm really excited about this. So, Dr. Byron Jasper, who is a DPC physician in Baton Rouge, and he somehow figured out how to also start a nonprofit Baja. And he brought me on literally as recently as a couple weeks ago as an affiliate to his DPC. And what, what I understand and what I, the MOU that I signed said is that I, as an affiliate can benefit from programs that are accessible to his nonprofit. Mm-hmm. Like for example, i'm now connected with the public health department, so I now have rapid point of care, h, hiv mm-hmm. Syphilis and Hepatitis C tests that I've, I can make available to anybody. And I also have access to his is it three 40 B pharmacy? Mm-hmm. Pricing. Now the FQHCs in town also use this pharmacy. It's called Aveda. And as I understand it, the larger the pot or the larger the nonprofit, the lower the prices get Sure. For the three 40 B pharmacy. And so if currently I actually don't know if, if Dr. Jasper has other affiliates. I think he does. I think he has three other affiliates. Okay. But you know, as long as all of us are still quite young in our businesses and we don't have. Thousands of patients like the, these FQHCs do. The, the three 40 B pricing isn't gonna look exactly like it would for an FQHC, but the more we grow together, the better the prices get, essentially for our patients at the pharmacy. And the more we're able to help other patients mm-hmm. Who are in need. Yeah. And so that's one of certainly Baja is mission driven. Absolutely. And, I really respect that and it's what I, what was, what I was drawn to when Dr. Jasper was talking to me about it. And so one of the things that he can do with Baja is any sort of donations to Baja or the the money that comes from the three 40 B pharmacy can be used and distributed to affiliates for things like paying for memberships for patients who can't afford the, the, the membership fee. Which is really exciting. Yeah.

Dr. Maryal Concepcion: 23:19

And I, I think it's, I, I love that we're talking about this. I love that we're together just brainstorming as a movement, how to fill in these gaps, because they're gonna get larger and larger, especially for the communities who are in the most need. And that doesn't matter what your, what state you're in, it's literally going to happen to every community, urban, rural, et cetera. So I'm wondering in terms of when you were mentioning, you talked with an FQHC, what are, do they understand what DPC is or what is the conversation in terms of you educating them about what DPC is? Because I think this is helpful for people who are. We're on one side of the, the community. We're always talking DPC, and there's clearly other people in the, you know, and not the DBC community yet who are speaking, but we only know how to do insurance. So how are you speaking and how are you educating people who are not always in the DPC space, like yourself and myself? Sure. Well, I

Dr. Emily Holt: 24:21

first they feel out what they do know. Mm-hmm. Because it's really. I guess it's not astonishing because this was me maybe four or five years ago. I didn't know what DPC was. I didn't have a clue that was even something that could be possible. Sure. And then with the FQHC, it's clear that they know very little about the model. And they're so entrenched in the, you know, of course,'cause they have to be, how to pay for healthcare using government funding. And obviously also commercial health plans. And so they are very entrenched in the mechanics of using insurance and government plans to pay for healthcare. Yeah. So, you know, as my husband noted, there were 12 people at the table in our Zoom call and probably 11 of them did not practice patient clinical medicine. Yeah. They were administrators and that, and that's not a. Knock on them at all. Like that's the system that they had to set up in order to service thousands and thousands of patients. And thank goodness for them. Yeah. Because otherwise those patients wouldn't get any care.

Dr. Maryal Concepcion: 25:31

Yeah.

Dr. Emily Holt: 25:31

But it's a very, very different model mm-hmm. Than DPC. And so they, you know, they start asking out just extremely basic questions like how do you even get patients? How do you market to them? How do they know you exist? You know, what do they do? What do you do after hours? And it's like exactly the same questions that I asked. Yeah. When I started mulling this over in my head and I'm like, wait, what is this beast?

Dr. Maryal Concepcion: 25:58

I've never seen this before. Yeah, it totally, and you know, it, it's so interesting'cause that's exactly what I was thinking when you were saying that just now is like, wow, where did those questions sound? Where do they, how come It sounds familiar. And I have also have been in this place of like, oh, like. This is a real thing. I remember going to my first summit only because somebody told me to, and I had zero idea what DVC actually was. And so this is fascinating. And I I, it, it's exciting too that more people are, it's unfortunate that they're being forced to look into another way, but it's like, what a time to be innovative. And going back to how you mentioned creative ways to offer. Your DPC offerings to different people in the community. I'm wondering, are you guys coming together as you know, the region within Louisiana to have more of these conversations? Louisiana's a state. Where are you guys in terms of who in the DPC community in Louisiana is coming to the table to try and brainstorm with people who are not yet in the DPC space?

Dr. Emily Holt: 27:04

Yes. So that's actually also been a really exciting. Sort of recent movement in, in Louisiana, there's a handful of DPCs, many of whom have been open for over, I would say six or eight years mm-hmm. Who are coming together and forming a coalition.

Dr. Maryal Concepcion: 27:22

Mm-hmm.

Dr. Emily Holt: 27:23

We've already kind of all met for dinner together and had a good time in Baton Rouge and met each other in person. I don't necessarily know that everybody wants to be part of a coalition. Sure. Everyone's in different places in their practice and their lives right now, but there's definitely a handful of people who are, are looking to start a Louisiana coalition. Mm-hmm. And getting that movement going with the networking. I met a handful, you know, the DPC summit 2025 was in New Orleans this past weekend. Yeah. And, and I, and I met a couple doc private practice doctors who were from Metairie, who was a sub, that's a suburb of New Orleans. And they were dp, DPC, curious. And so we're sort of enveloping them Yeah. Under our wing at the same time. And I don't really, I don't know where it's going, but just having. The fellowship in the first place has been really, really fantastic. I've learned so much from the Louisiana doctors who came before me, and it has been such a privilege to, to speak to them and work with them and learn from them. And I just, it makes me want to pay it forward. Yeah. That's awesome. And I

28:32

think

Dr. Maryal Concepcion: 28:32

that that is, that is literally getting at, you know, what we enjoy with our patients, having a relationship with them when we have a relationship amongst our own community. That's so powerful because then, you know, even just by talking out about something like, you know, oh man, I'm really struggling with accessing lidocaine or whatever it is, you don't know. Just same as as when I talk on the podcast and then somebody randomly will say like, oh, I heard that and it made me move to this different state and open a DBC. Like, we never know who we're gonna meet or talk to, but when it comes to. Working together with all of our different experiences, I think that there is always going to be power in community and coming together to move forward together for the community. So I think that's fantastic that you guys are, you know, even looking at how do we work together. And I I will say that this is something that J Keith said the DBC coalition echoed this weekend is that even though now the HSA legislation has passed the Primary Care Enhancement Act, this is where the work really happens because as more people are going to be impacted by losing healthcare, as more physicians are going to be replaced by non-physician providers, as more access points physically are going to close, and more people are going to look into DPC because of whatever reason, including necessity. This is where we have to speak up, in my opinion to make sure we do not rebuild a system that we are have just left.

Dr. Emily Holt: 30:04

Mm-hmm. Yes, absolutely. And then to speak a little bit more to that in terms of the physician empowerment and leadership. Being as important as it is in this day and age, I am one of the they're called cluster leaders of the reproductive health access projects. So I'm one of the colu leaders in Louisiana. Given that it's a, a very restrictive state for women's rights, it's actually quite a propo to call us a cluster. But we, we are currently in the process of setting up. A group. Mm-hmm. Sort of, I don't wanna call it a project, but a meet and greet almost with the emergency medicine, reproductive health access project. Because as physicians in different specialties and people who care about, in this particular circumstance, it's gonna be women's health or human rights when it comes to those who menstruate. Or bear children. Mm-hmm. You know, we have got to reach out to whoever we can to help each other. Mm-hmm. And that's not something I've ever seen before. And I am, I consider myself somebody who's really been in the advocacy space for a long time. And so maybe that's a, a silver lining. You know, family medicines and emergency family medicine doctors and emergency medicine doctors coming together to strategize. Absolutely.'cause we need all hands on deck right

Dr. Maryal Concepcion: 31:36

now.

Dr. Emily Holt: 31:36

Yep,

Dr. Maryal Concepcion: 31:36

a hundred percent. And I will say here that if advocating for our profession, advocating for our patients, advocating for human rights, access to healthcare, all of the things, if that. If that, you know, really makes you fired up as you're hearing this, I definitely would say talk to your, you know, your colleague in DPC. See how, if they've advocated, where have they gone? Local Chamber of Commerce, city council, state, federal where, because I will say that in general, whether it be local or whether it be federal, I, I will say that one of the things to keep in mind is that. DPC has always been bipartisan and it remains so in this. Time of extreme divisiveness and where we can advocate is literally telling about how we're delivering care to patients, not how we're delivering care with religious beliefs or political affiliation, but literally this is the access and quality of care that I can deliver to my patient that I have a relationship with over time. And that is. Quite powerful. And so I say that because even before we started recording, that was a concern that I was hearing is that how do you advocate if, you know, medically we don't all agree, we're not talking about how we can come together, put our heads together to. Ensure ways of people accessing healthcare and not health insurance. thank you so much. It, It's so wonderful and just fulfilling to know that there is a doctor out there like you who has literally followed her work and her mission and making sure that they tie together at all times. So thank you so much for what you do and I'm so excited for everyone to hear this. Thank you. Thank you. You as well. I really appreciate you.

33:31

Thanks for tuning in to My DPC Story. If this episode inspired you, please leave a five star review on Apple Podcasts. It helps more physicians find these stories when they need them the most. If you're new to DPC, you're just beginning your journey. Head to the Start Here age@mydpcstory.com. I've put together a practical startup guide and highlighted the episodes I think are essential for beginners. Got a question or a challenge you want to hear addressed on the show? Go to the Contact Page mydpcstory.com and leave me a voice message. And be sure to check out our my DPC story, Patreon. As a member of our Patreon, you'll find commercial free episodes and extended versions of the regular episodes. There's something for everyone with both free content and a paid tier that helps support the show. Follow us on socials@mydpcstory and check us out online at mydpcstory.com. Until next time, this is Maryal Concepcion.