Resources, Resilience, and the Road Ahead for Direct Primary Care

In today's episode of the My DPC Story Podcast, host Dr. Maryal Concepcion and guest Dr. Amber Beckenhauer reflect on the transformative landscape of Direct Primary Care (DPC) as 2025 ends and 2026 approaches. They discuss critical updates like HR1 and HSA regulations, sharing insights on how legislative changes, practice resources, and evolving patient needs are shaping the future of DPC clinics. Both physicians explore topics like staff restructuring, inflation impacts, and the importance of autonomy and creativity for entrepreneurial doctors. Dr. Amber Beckenhauer highlights her work in physician education, while Dr. Concepcion previews new resources and conferences available for DPC practices nationwide. The episode provides actionable tips for navigating open enrollment, building resilient teams, and adapting to changes in healthcare. Ideal for physicians, healthcare entrepreneurs, and those curious about DPC best practices, this episode inspires listeners to embrace innovation and sustainable growth in primary care. Find the DPC Magazine The Toolkit for more on HSAs and the IRS recommendations about HR1, visit mydpcstory.com/magazine. 

Connect with Dr. Beckenhauer and inquire about her upcoming courses HERE.

For those looking for the Medicare Survival Kit, you can find it HERE.

Get the FREE workbook to go along with our January RESET series HERE.

Learn how Zion HealthShare can pair with DPC to protect patients and physicians without returning to traditional insurance. Read more in the Toolkit, our DPC magazine, today. 

If hiring feels like one of the most intimidating parts of growing your DPC practice, read the Winter issue of The Toolkit, our DPC Magazine that includes an educational, step-by-step hiring guide from the Cooperative of American Physicians designed to replace guesswork with clarity.

Leave Maryal a voicemail @ https://mydpcstory.com/contact

Transcript

Maryal Concepcion: 1:18

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.

2:06

well this is the end of season five. Super excited to chat with you today. We have to make being in the same, per in the same place to record. This happen next year because it didn't happen this year. 2025 just flew by. Agreed. I had told Marielle last year, just to give people a little insight of what she's speaking of is, Hey, wouldn't it be fun if we were sitting in a little cabin by a fireplace, doing this DPC podcast in person instead of always doing it by phone? Although that did not happen because the world happens and kids happen. I can tell you God wanted to kind of reenact that for us in his own way because it was a snowstorm this weekend here in Nebraska. So we get to at least have a little bit of snow, and I sat by a fireplace. Did you? So no snow in Arnold, but we've had the, the fire in our fireplace going for maybe a week and a half now. Mm. Love it. And there's nowhere else in the world that I want to be except for in front of a fire. I mean, I, I, I lean into that and I live by it so much that I have melted pants in front of the fire because it felt so good. I love being that kind. Mm-hmm. Yeah. But yes, we have a, a wood burning fire and just an FYI. This is a fun thing going into the new year. At our Ace hardware, we found rainbow sprinkles, basically that turn your wood fires like rainbow colors. And I'm like, oh my God, we're doing this for New Year's. So random. That's really cool. Yeah. That's really cool. And the kids would love that. Oh yeah. Absolutely. My husband has a fireplace guy. I do not think he would love that. And he would tell me no. I'm sure. Sorry, Jeremy, I had to throw you out on that one, but True. But it's always awesome to, to catch up and connect. And I think that this year especially, our clinics have gone on like they do every year, but at the same time, the world around us has, has changed and there's so many changes coming. So it's it's gonna be a fun conversation today for sure. Mm-hmm. Yeah, I mean, I, I totally agree that there's just a lot of things moving in so many directions, but a lot of different messages that we heard from different positions that not only like the DPC conference, you've heard at multiple conferences and even talks that you've been through with a lot of the different positions. So I am excited to kind of hear some of those messages you've received and the emotional changes and ups and downs. But I mean, I really feel like a lot of doctors are being kind of pushed to the edge this year and having to make some changes for 26. And I know we felt that as well. But honestly, my take on it is really, and I tell my staff this often, and even my husband sometimes when I come home,'cause it's been such a busy last six months, is that I feel like every year we push out from COVID, there's different things happening may that be patients are finally receiving care that they didn't receive in the traditional system before. And we saw patients through the whole thing. But I feel like we have definitely had that dump on of, oh, okay, I didn't do any of this, maybe. I switched from traditional care and now I'm bringing it all to you, or whatever may be. Or we have, I mean, we have a very large wellness and preventative care population since we do a lot of functional medicine, integrative health from an osteopathic standpoint and beyond. And so people are looking into that more, and that's made us a lot busier. But I also feel like the big thing is, is people now, so 23, 20 23 is when people kind of woke up from COVID, and now two years later, it's almost like they're waking up, making life changes and decisions and. That's changed what people are doing from picking DPC as their choice to, getting rid of insurance, to starting to be very proactive in their care. Quitting jobs, doing life, life changes. I mean, it's just been a very big year from anything from patients to staff to, to business owning. So, yeah, I feel that it doesn't matter if you're a medicine or you're a fireplace guy or you're, a retail business owner, whatever it may be. I sit in those exam rooms and those patients are. They're overwhelmed. They don't know what to do. And I feel like it used to just be me as a doctor and my colleagues, right? But now, like the whole world is just kind of grasping, right? So hopefully this episode can bring people some resources and even direction because I think we're all just looking for some sort of path, right? To put it all together. I completely agree. And I think about when you say direction, I think that there's so many pathways that are wanting direction right now. There's people who are in residency and who, have the foresight to say i'm not doing the fee for service thing, I'm already planning on DPC. You have the people who are unfortunately experiencing being let go from their positions because their position doesn't exist anymore, or they're being fired because they're being replaced by non-physician models. I will say that until the day I die because it's so irritating that that happened to my husband and continues to happen to other people. And those of you who have listened to the podcast have definitely heard that verbiage from my mouth before. But, I think about the people who are also just done with the system and we, we see a lot of specialists. Even we are saying like, this is ridiculous. I can't mm-hmm. Just keep keeping work to the bone and we're like, over here in primary care land, we completely feel you.'cause it's, it's ridiculous how it doesn't actually matter what. Your degree is, or what your training is, or what your capabilities or specialties are. It's that we are coders in the system. And I have seen this year, these different groups of people traveling down these pretty, unique paths. But then also I think together as a movement, we are also going down a, a path together differently because of the recent passing of HR one and people being able to fund their HSAs as well as pay for DBC. And I think that, especially here in California where we have so many HMOs, we're really seeing people, people start asking questions like what you're talking about, like what does healthcare actually cost? Can I get healthcare if I don't have. An employer giving my me, giving me my healthcare. It, can I get healthcare that's better than what I'm getting right now. And so these questions are absolutely what I'm seeing and what I'm hearing. Mm-hmm. On my end as well. For sure. That's kinda crazy. You say that. And we have an Ashland Clinic, Blair Clinic, and we just had somebody come by and sign up their employees and the employee. So the employer came by, signed them up, the employee came by, signed all the contracts, and he was there like the Tuesday before Thanksgiving week'cause they're making all their decisions. And as he walked out, he looked at me and he's am I missing something? Because I had connected him with one of the insurance advisors in the area that we're using and working with from the Fremont. Or Fremont, sorry. That's a town nearby. F Market Medical Association. And so I was like, Hey, told the employer, call him, have him help you along with whoever you know you've been talking to, just so you can hear about health shares, things like that too. So he, he called him and he worked with his employee and their employee family now is going to use Health Share. And so this employee's looking at me as he walks out and he's am I missing something? He's we signed up for Health Share. And the rep and your insurance advisor like, made that way too easy. Now I signed this contract and I, know what I'm paying. And, and their employer had been using us for years, so he was already aware, but he's Ugh. Why is, why is not everybody doing this? Like why, why, why am I doing this now? I should have done it sooner, but why isn't the world doing this right? And I just, just like we tell everybody and walk through it with people is that, we're just all so used to what we do day in, day out. It takes a lot of time for change, but I do think that change is going to happen. Sooner than later. Mm-hmm. And I think that's where some of the resources and the magazines and the podcasts you have are going to be more fruitful and helpful more than they ever have been because there's so many people going to be going to DPC and that is what we all have wanted, right. To have the world understand there's choices and there's freedom and there's different things. But it's really hard having that happen right now, coming off the backs of COVID and so many system inefficiencies because we had to pour so many things so quickly into change that a lot of us DPC physicians didn't even wanna do.'cause we weren't utilizing paperwork and the system and Right. So that's changed. A lot over the last five years and I just got done telling some of my staff this last week at looking forward into 26. Just even from a entrepreneurial like financial side and like business side. This is the first time we've made it almost six to 12 months, I'm gonna say six to nine months, where there hasn't been some sort of ancillary service we use that has had a price increase. Wow. And so that has been one of our hardest things too, is that. Trying to decide what to do on memberships, because from 2020 until now, up until like halfway through 25, there has been just constant change of our own supplies, ancillary services, everything that have went up in cost. Mm-hmm. And we've tried to stay the same for so much of our original panel because they, just came with us along this journey. Right. But Oh wow. The inflation and the change has been incredible in four years. Yeah. And I, I will lean into how you're mentioning freedom like that, that is a really big thing that I keep hearing about. In terms of what is really fueling people to make the leap into DPC, the autonomy that one finds in running their practice or being a part of an independent practice, specifically a direct primary care practice independent of insurance. That's a lot of what drives people to, to listen to your, your words and my words in this podcast in general, but also I think it's so helpful that, you put in your own 2 cents just there about like price increase and the cost of goods and the things that, we have to go through as business owners. Because this is, it's on one hand saying this is not easy, but also. I keep at it because it's still so worth it at the end of the day. So I think that, this is a great episode for the end of the year, end of the season going into next year because there's so many, like you're talking about there's so many new resources out there. Definitely my DPC story is leaning into resources, like you mentioned the magazine. Our, our magazine just came out for December. And just really being really listening to our listeners especially, and just people who contact me through, my clinic work. And so it's yeah, I, I just, I say that in the sense that there's so many ways to craft your autonomy, craft your freedom going into next year, despite what policy is or is not going on in your state or your locale. So in our location right now the Free Market Medical Association has, are always been going on, right. But I feel like just with some of the change this summer with the HSAs and DPC and then also just the growth overall across the United States, that free market side, from an Omaha kind of perspective and, and surrounding is really pushing forward, trying to get a lot of change. And I know that there's. I mean, we've always had the cash pay surgical side that I had helped incorporate years ago in like the 2019 timeframe, but they're pushing to try and get, a bigger location and space and, and work with bigger groups in general. So yes, I mean, I think overall, like depending on where you are in the United States, finding out what is blossoming and growing and who's thinking about things and who can you connect with. Because even things that in groups that have been around, like the whole time I've been open, I might have to ebb and flow through those depending on my schedule. But they've also themselves changed like who's going or maybe what they're speaking of or what's transitioned. So like you said, residents and some of these other owners. Like looking around too and finding out like what's local. And I know a lot of your resources also help kind of guide people as well, but just the amount of people even that you've interviewed, going back and looking at places that, hey, I live close to them, let's listen to that podcast or whatever may be. So that's helpful. Totally. Yeah. And that's why one of the things I'm really excited about is leaning into more state conferences. So mm-hmm. We're looking to help Illinois but I do think that, especially now, that's something that has really been asked for and people, have their own little regional DPC groups, but at the same time, there's not, state DPC focused content in every state. And nor is there a conference in every state. Ohio has their Unum, California, we set one up in California last year, and it was fantastic. We've already had. Over 50% of the tickets reserved for next year. Yeah. But yeah, I mean, it's, it's so important to stay up on what's going on in your locale because it's gonna be very different on the national level and the national message because it's not, we not everybody lives in the nation state of California. Not everybody lives in, right. A place where home deliveries is illegal, like in Nebraska. So I do think that it is really important to know who's, who's in your state. But you know, speaking about like these different locations and just different physicians and businesses, I mean, what do you feel like stood out when you talked to all these different physician entrepreneurs over the last year versus even a couple years ago? Like I said, 2023. I really felt like things started changing when people started coming outta the woodwork after COVID. And I mean, how do you feel like energy wise and everything is in their practices? I know there's some that have closed, some that have opened. How are you feeling? Everybody's overall emotions and energy is in their business when you're interviewing. I definitely would say that, just as you called out before, during the pandemic was a great example of how DPC thrived where other clinics weren't open. Mm-hmm. I think that, that that energy of we are autonomous, we can do what we need to, to take care of our patients, who we work for directly. I think that the energy is more about hope and possibility because every clinic can be unique and every clinic is unique because none of us are the same, even if we're working in a practice where there's multiple DPCs within that, clinic mm-hmm. Name or brand, every one of us is different and our patients want us as their doctors. And so I think that, i, I hear a lot of people talking about that hope and possibility, but also in a realistic and educated sense also, because there are so many resources, people are mindful about financing a direct primary care. What do you need to open a direct primary care? What are the legal things you have to do? What are the business things that you have to do? Generally these things, they're so, easily found online. It's not so much of a like, oh, I could never do that mentality because. There's a lot of survival mode out there right now and sadly. Mm-hmm. And it's we're tough people. We went to medical school, so it's like we've been in survival mode before. We've, we've studied for renal before. We've studied for hemo before, and that stuff is not easy. Doing 24 hour calls on OB is not easy. But, I think that we have all of these experiences under our belts, and we're like, as a, as a collective, physician, entrepreneur group. I, I think that the energy is very much positive going into the future and reclaiming, reclaiming medicine for physicians and for patients. And I honestly think the DPC community is the way to do it and the ones to do it because one thing that I enjoy seeing when I'm at the DPC conferences online on Facebook per se, but really like when I hear your podcasts and just the years that I even put into it and watched the growth is, I mean, creativity is like the biggest word I can think of anytime I think of the DPC community because if it hasn't been created yet, oh by golly, you better believe it's gonna be because, I mean, these physicians are so stinking smart and there's this artsy or artistic side of us, a lot of the DPC physicians that I think were wanting to be used, but we didn't know that that was possible out of a little. Box, in a hospital or a pod because we are in medicine, so black and white. But I do think there are some things that even COVID allowed, all of our brains to grow and be creative because we were able to step out of boxes and say, Hey, we can try and work with our patient panel and do things this way, or create a clinic that looks like this. I mean, some of the time we were forced to be creative and think of new ideas. But I mean, leave it up to the DPC community. They're going to be creative and, and build something for the future. And I see that every day when I talk to them, see them. I think the hardest part in all of DPC though truly is just as a physician, you are trying to keep things structured. And that's obviously even in our decision making that we're trained to do and all of these things. Yes, we live in chaos. We thrive in ccra chaos. They teach us to do that so the balls don't drop. But it's like when you go into the entrepreneurial side now, yes, you are used to thriving in chaos by you trying not to make it chaos like you're trying to provide structure. And I don't know, I feel like it was, it was doable until we got to COVID and then it was like, gosh, I was really trying to make this environment structured and, and do the best I can and then you're just throwing your hands up to get through every day. So, some of the biggest things that we're working on in 26 and we have literally worked on for the last 90 to 120 days is redefining our structure and what the healthy human is now in 20, going into 26. Some of that we needed to do regardless because like I said, like a lot of the payment structures or inflations or things like that are kind of coming to an end and stabilizing a little bit. But there's been the change with HSAs and then we lost one of our longest running staff in August right after school started. And anybody that's had that happen, you realize, gosh, there's a lot of your business that you've done. Together with somebody that you know, has been there a long time. And so a lot of your daily efficiency, or even maybe lack thereof, was because of a relationship with, someone that you've worked with for so long. So we had to restructure everything and, and has been great'cause. Have a lot of, okay, this, this, not this, this, not this. And it's helped our patients, which is game for everybody. But that's, that's a lot of work going into the holidays or right after school has started. So, we tried to wrap up the end of our year with a lot more structured time off for our employees or our staff. Or even setting time aside, like we just did a Thanksgiving dinner on Wednesday for, we blocked out an hour and a half. Everybody brought food, did kinda like a little buffet style, just trying to focus on things that we did back when we were open in 2018, going backwards in time to, some of those things. So we don't lose that. And so, I mean, I think that's one of my biggest recommendations for people, the physician entrepreneurs and their practices, no matter what they look like going to 26, maybe this is the year that you. Go back if you've been open as long as I have and say, okay, what was I doing back then? Did we lose with growth? Or did it change with growth? Do we wanna bring it back? Do we not? Do we want it to look different?'Cause we've really tried to do that and figure out like what suits us, what, what works for us?'cause again, at the end of the day, we get to make those decisions, right? So, so we've really focused on that with the loss of that employee. And then the other big thing is trying to decide really what 26 might be. If say our patient panel was all the same, like what is our. Our big focus, and for me a big driver is education. Educating our own panel, but also going back to doing some training sessions for physicians. And some of the things that I get constantly asked about at the conferences that I really haven't made a priority because I was trying to focus on how do I manage our growth and our construction and everything with our buildings. And so now that all of that has come to an end in 25, it's time for us to really redefine like what our clinic looks like and even what my goals are. And going back to, I love to teach, that. And I feel like when you're at a conference, you are talking to 15 people at one time and, and that happens, to you too with the podcast. So. Being able to focus on a couple people, maybe physicians, or even when I think about like my community and my patient panel and those outside of like group education and, and utilizing our space here on Main Street, that's three stories. So we can use that for more of a community type event. So 26 will look a little different for us for sure. Yeah. And I think that, that, that difference is, is not necessarily a bad thing. Like you're talking about, there's, there's the opportunity where we don't even necessarily have that opportunity in, in an employed model, in a corporate employed model where we can look back to see like. what did we do? Did that work before? Should we do it again? How could we do it better? How could we do it different? Or, those, those types of decisions aren't even our own when we're in a corporate model. And so, you know mm-hmm. When you also, I, I wanna say here too, when you talk about when you talk about what. What's one thing that could be a difference in 2026 for me? Having a person in person would be lovely at big trees of the I, we have talked about this, but for the audience I literally went through, so I have a, an HR company that's helping me go through the hiring process, meaning I'm learning so much about HR that I had not known before in terms of structure and in terms of, making a job description and all of these things that I've, I, that's, that's, HR is not my strong suit. I can, I can make a magazine any day, but ask me to hire someone. Ooh, that's painful. And so, i, I, I had a, I've had a really great experience doing that working with a, a pro HR team. But then the person that we, that I had hired she quit like 10 days after she started. And I was completely floored by that. I mean, I was just like, I got so excited. I got my hopes up for oh my gosh. I, I, I graduated the Goldman Sachs 2000 Small Businesses program in May, and my growth opportunity is very much around having the clinic have more community focus and people focus in terms of like in-person blood draws and in-person things that for our, for members and non-members. And so when I found out that, she was not going to work at the clinic, I was, I was really bummed. And then went through the hiring process again and then. At the last moment, the person who, the next person who I was like, okay, like I think this next person's gonna be a good fit too, dah, dah. And then she declined the offer even though we offered her the position. And it's I don't mean to, be Nick a and Nancy, but we are in rural America and it's not the easiest thing to find, like people who the, the pool of people is just going to be less in rural America. And so I'm still on the so both my husband and I are still on this, hiring journey and hiring somebody in person is something we're really passionate about. Because. We need to have somebody to help us do these things that we can't do virtually. So I, I am excited about it, but sure as heck I mean, it's just, it's almost like dating, like it literally is that I was really hoping that that date would go well and it didn't. And then, you, you go through all these emotions and it's I know that there's people out there who are like, oh my God, I can completely relate to that because of staffing or because of dating and or both. And so I just, I, I do I, I'm excited to leave 20, 25 behind. But I, I am really hoping that 2026 is for our clinic especially going to be much more streamlined in terms of. My husband and I really focusing on the physician things and not necessarily doing all the hat wearing things of everything that is like patient messaging and sending of referrals and such.'cause that just does not bring me joy cleaning the toilets. I got you, man. Taking out the trash. No problem. But setting a referral, please. Anything else I will do. I will even, why? Why is that? That is so weird because I'm not, same way too. I don't understand, but I think it's just, we were born to, I mean, hard work is not something we shy from, so I don't know. I don't know. It's weird, but yes. Yeah. So tell me about your, because you mentioned HSAs, but we had a webinar with Jake Keas from the DPC Coalition. Come on to the podcast just a couple weeks ago talking about the implications of HR one and now that you can fund your HSA. As well as pay for DPC membership. A ton of employers are looking at DPC differently. A ton of people are looking at DPC differently. And just a point of clarification here, I will say. That the DPC coalition, for those of you who aren't aware in terms of there's so many organizations out there. The DPC coalition in particular is all about advocating for DPC and policy. DPC Alliance is not in their bylaws. They are not lobbying for one thing or the other. So if you are interested in getting into policy, I definitely would say check out the DPC coalition, DP care.org.'cause that is where you're going to focus on speaking your mind, speaking your story, and Im, and impacting policy as we go forward. And I do I haven't even asked my question to you, but it's like I do encourage people if you have the desire to help shape policies so that we don't recreate a fee for service system and we don't lose our autonomy, this is the time to start sharing your stories and the coalition can help. You create a, a, a strategy to do that, whether you're local or national. But just in, in terms of the health of human, how has, how has HR one impacted your practice and your patients, even conversation wise? As well as membership wise? I don't think we're gonna see that change maybe here locally necessarily until 2026. Like we had to get through like open enrollment and some of these insurance contracts that people are with, with employers and as an employee and et cetera. And what I mean by that is, is, I don't know, maybe I just have a large amount of people in Blair and Ashland that think like I do like, almost okay, I'm thinking ahead proactively, but right now I just need to get through what's going on. Meaning November's open enrollment. Thinking how that's gonna affect us. So I mean, we've seen some people that are reaching out to enroll now, like I said, some of these employers, et cetera. But I feel like we're gonna see the impact of that more like as we hit January 26, we're even maybe in 2026 when people realize like all the different changes, even in insurance premiums and everything DPC in this area is getting to be more well known. So I feel like we've drove some of that and and I feel like people here we're almost making a decision on if they like DPC. With or without, if HSA was included or not, it's either they value medicine and they like the thought of it. I don't know that that was the big driver. If it's more, Hey, this is gonna be a big perk, not so much a big driver. So I'm, I could be wrong. We'll see what 26 looks like, but I haven't seen a big change per se from summer until now, other than, Hey, that's great. We're excited. We see DPC Compass moving. But I feel like for the community around here, and even like Nebraska where I'm at, it's more of, like I said, it's a perk. Not necessarily the driver. Yeah. And I think that it's very, I, I think that's relatable in a lot of geographic places right now, especially because we don't have necessarily, the, the regulatory guidelines from the IRS on HR one as of the, the date of this recording. But I will say that mm-hmm. As you talk about creativity, I think that this is where people are going to get very creative, especially employers as to on the recording we did there was talk about, could employers fund HRA as well as, fund an HSA. It's a very interesting time. And I will say also that. You're totally spot on. It's not everybody pays with an HSA. And I will say that that is probably one thing as a, take home for everybody is if you did one thing about HR one and preparation for next year find out like, what, what is your patient population in terms of who has an HSA, who wants to fund their HSA, who is funding their HSA, who's paying with HSAs because yes we are, as Dr. Lesky has said, like we are not the tax person. But knowing more information about your patients, it definitely gives you a little bit more of a solid footing as regulations come out. So that would be my one. My one tip there, and I will say also that there was a lot of confusion because when I put out our open enrollment toolkit and now the first period of open enrollment for 20 25, 20 26 has passed, but now there's gonna be open enrollment again in January. But I will say that this is exactly why we put out our open enrollment survival kit because, for our patients we have a ton of Medicare patients who are eligible by age. And knowing that these changes were going to be coming down the pipeline, especially cost of medications, cost of premiums, all of these things we specifically. Developed this toolkit, the survival kit, to basically like figure out who to screen amongst your patients to have an open enrollment conversation about the value of DBC and open enrollment. It, it gives a lot of scripts that you can use in your clinic, but also just copy and paste things in email for emails and even your, patient portals. And so I, I think that something to think about is if you do have the bandwidth and you're, just, just figuring out next year and your plans for next year this is the time when we're not actively in like crazy, crazy open enrollment to think about, like, how can you set your practice up for the next open enrollment period? And so you're like, when you talk about, what you guys have been doing and experiencing for multiple months at a time, this, this is a big thing in terms of what we're doing at Big Tre MD is really looking to like, what is the next quarter? Our first issue of the magazine had, this whole. This whole article about this, but it is so important so that, you're prepared going forward. And it might change, but at least like getting some footing on what is the goal for next quarter and how do we actively achieve that. Those are really helpful things to just stay, stay on pause. Yeah. And, and what, what you did with that, kind of q and a and almost scripted or guidance, especially for a lot of people that are new to the DPC those are things that are just so foundational. That'll be to get or be with you or for someone to use, for at least a couple years if things don't change. But that is very time consuming work. To know that a trusted resource like you can go there, look at that, like that will be huge to many people. As we know, Medicare is like one of the most confusing things. So, I, I thank you for just a lot of the time you've put into those magazines and everything, and I know you said like for you, you can do that with your eyes closed versus hr and we all really do have our strong suits. But. It is wild. Just like how some things that seem so complicated to so many people, like a lot of us just can, oh, what do you mean? That's, that's easy and, and I love it. And I, and I'm passionate about it, which is why, we all kind of have, again, our own little creative journey through all of this DPC that we've navigated because we've kind of picked apart things that we do well or we really enjoy. Or maybe people come to us and ask our guidance. But some of those, some of those foundational items and and resources have just been huge. Mary Ellen and people well, I applaud you'cause I know how much time it can take you, especially with little kids, running around, but like you said, with HR and, and staffing issues and difficulty over the last five years I, I'm just really excited of. I hate to say this, but almost like wrapping up the last five years of this uncertainty and craziness.'cause I really do feel like, I don't know, maybe'cause it's an, an even year, maybe 26 is better than an odd year. I don't know. But well, don't, don't say anything because I said the same thing about 2020. I was like, I'm so excited. It's the Barbara Walters here. It's, it's even, oh my God. Oh my gosh. Oh, and then look, we had babies. But no, I, I, I am really, I'm really hopeful for this coming year I do wanna call out here also that with creativity on the table, you have also been working on, going beyond the talking to people at conferences specifically about, when it comes to women and hormones in general. This is something that you are so passionate about and also that's something, it's also something that so many people look to you for guidance on, and I know that that's something that I wanted to make sure the audience knows about. Over the last five years where it's already time to sit and redefine. What does practice look like? What does, career passions look like? I think it actually even made me realize like how much I miss even teaching and training my own. Colleagues and, and talking to them. And, at conferences, I feel like when I go there, I am focused on trying to help people and answer their questions on OB and, and like I said, regenerative hormones, those things. But there's never enough time to do that. And because I really do practice very uniquely when it comes to hormones.'cause I'm a very, risk averse person. Like we're, we're thinking through like, why are we doing this? Who is it for? What's the right option? I really don't do anything in life where I'm just like, oh, we're just gonna do this and haven't thought analytically through everything. And what's best based on their medical history because we really are trained to have a low complication, low side effect profile. So I do just take a lot of time for hormones and replacement and autoimmune disease and all the women's and men's health so when you talk about classes and, training, that's the part that probably would drive people crazy about me is that I, I like to gear it based off, who's coming, who's educating with me, what do they want from the program? I can teach and train a lot and. There's just never enough time in the day. So focusing on what people want is and going to be beneficial to their practice. May that be if we do one, two, or three individuals at a session versus, have it be more like six. I don't really like to have more than five or six. Even when we had our Mastermind, it was pretty big and we were jumping all over, but there were other physicians here and even reps helping, but trying to do a little bit more one-on-one and focusing on what they want versus maybe a class that's. Has the same likes, dislikes, sometimes even friends that have already been talking, so they already know what they want. But I mean, we can do anything from training them in aesthetics to, like I said, P-R-P-P-R-F. We really love to do hormone management and I love to redo labs and kinda walk through why I pick certain things for certain people. So a lot of clinical teaching, like literally from step one to a consult, lab review, et cetera, to why we pick what we pick and, these are our, this is our paperwork process, et cetera, but it really does help to have them here. And if we don't have them here, Marielle's gonna kind of help us figure out how to do that the best way possible from an online or video standpoint. But even that would take some time just because again, I feel like it's a lot of hands-on learning, especially if we are doing. Hormone replacement therapy, like training in the session because we would wanna be injecting people, et cetera. From A-P-R-P-P-R-F, so just for an example, in the past when we'd done PRP for women's health, so we did a lot a vaginal training for a little, a little timeframe and had people come down in their groups or what they wanted to learn. And we typically will set up patients from our panel and then have them be the ones that were injecting and, and obviously we're asking for consent and getting everybody lined up ahead of time. But it is nice to have you come in and have that hands-on training, not just hearing me. Talk through everything. I want people to feel confident about the, what they're doing.'cause this is not something that I take lightly, which is why when I stand up on stage at the D-P-C-A-F-P conferences to do hormones which have, no one likes to do because it's a very controversial topic. But I do it because I believe in it. I, I see it every day, how much it changes my patient's lives. And I think it's going to go a lot further, 2026 and beyond because of the new changes with the hormone replacement discussions and the black labels and all the, old studies that are kind of getting washed away.'cause people are like, maybe we aren't hurting everyone after all. And so I think 26 is gonna be a big year for hormones and people really opening their eyes and changing women's and men's lives completely. I mean, honestly, I think people are ready to hear it now. We just need to make sure the right people know how to practice it. So definitely check out healthy human dpc.com for more. Where to find Dr. Becker's training for physicians as it comes out. So I'm super excited about that. I will, I will definitely sign up for, for training with Dr. Becker. Any chance I can get. I will say, also, I, I love that you are you, I just, I love this time of year because it really, just having this conversation every year is really a great chance to, to say we achieved a lot. Despite 2025 being what it was. And I, I, I'm really looking forward to having. A good team at Bigtree MD and being able to really robustly serve the community in even more ways than we have been up to this point. So I'm super excited about that. And then for the podcast, I definitely will say, thank you to everybody who's listening. I'm so honored to be able to interview people within our community who are sharing their stories, and to have their stories be out there for more physicians to find. I just got elected to the chair of the a FP Direct Primary Care Member Interest Group. So if you are not member of the mig and you are a and you are an A FP member, please join because I have so many ideas for that mig. And then also just for the podcast itself what we're working on for 2026 is really exciting in terms of really helping people where they're at. People listen to the podcast as they're planning and as they're opening, and then also people who have listened to my DBC story and they're coming back because they, want more help on, strategies for marketing, strategies on, fine tuning their clinic in whatever they way, in whatever way they want to, going into the future. So, super excited about both fronts, the clinic as well as the podcast. But I hope you have a wonderful holiday and that's already white in Nebraska. I gotta play my Nebraska Christmas playlist soon, but I, that's right, Callie, Nebraska. Absolutely. But I can't wait to see you in 2026. Same here. Get some sleep. Okay, will too. Okay. Take care. Love you. Talk to you later. Love you too. Bye. Bye. 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.