She Didn't Start a DPC Practice. She Bought One.

Dr. Feneisha Franklin spent a decade in corporate medicine before finding her door: a Direct Primary Care practice seven minutes from her house, owned by a retiring physician ready to pass the torch. She left her employer on a Friday. She owned Living Well Family Medicine on Monday.

In this episode, Dr. Franklin breaks down what it actually takes to purchase an existing DPC practice: profit and loss statements, Medicare opt-out windows, non-compete clauses, legacy pricing, quarterly taxes, and the financial advisory team she credits with keeping her afloat in year one.

This is one of the most practical financial conversations we have had on this podcast.

What we cover:

• Evaluating a practice before you buy
• The Medicare opt-out problem nobody warned her about
• Building a financial team before you think you need one
• Pricing for legacy vs. new patients
• Growing sustainably without burning out your staff
• What physician joy actually looks like on the other side

Dr. Feneisha Franklin is the owner of Living Well Family Medicine in Lexington, South Carolina. She is currently accepting new patients.

Learn more at mydpcstory.com.

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Transcript

1:00

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. I feel like many people are unaware of just the fact that they're existing, but there's so much more that they can have and not realizing how the stressors in our life can cause us to project on the people that we love the most, and that there is a way to be better. There is a way to live more, love more, and just enjoy life to the fullest. I am Dr. Feneisha Franklin of Living Well Family Medicine. And this is my DPC story. What if you could skip the tear of starting from scratch and instead walk into an established DPC practice? Staff already in place. Patients already bought in a torch being passed by a physician who chose you to carry her legacy forward. That's exactly what this week's guest did. Dr. Feneisha Franklin is the owner of Living Well Family Medicine in Lexington, South Carolina. After a decade of corporate medicine and the constant pull between being a physician and being a present mom to three kids under 10, she found a door seven minutes from her house and bought the practice behind it. This month we're talking all about financial sustainability, and Dr. Franklin's story is one of the most instructive we've had on this podcast. Buying a practice means p and ls, non-competes Medicare, opt-out windows, legacy pricing, quarterly taxes, and a staffing transition. She navigated all of it. Welcome to the podcast, Dr. Franklin. Thank you so much for having me. We just are on the heels of Dr. Victoria lasu but still staying in the Carolinas. Dr. Franklin, I am so excited to have you share your story in this month where we're talking about financial sustainability because your journey has been very different than Dr. Hitchcock and Dr. Lata Shu, who shared you have entered the DPC world by purchasing clinic. And it's more of an option because yes, people continue to want to leave their private practices, but there's a sense of I really don't want to sell to Optum. So if there's an another way to do it, will anybody who's a physician buy my practice to take care of my patients in the same way that I've taken care of them for years. So let's talk about the, the world that you were in before living Well, family medicine, because I, I just wonder what was your exposure to private practice and to DPC as a model before you opened your DPC? No, that's a good, I think it's a good question because that's kind of, it's kind of unraveled over the years. So like my background obviously family medicine before that I did, I went to medical school at the University of Louisville, Kentucky. I am a military brat. My dad served 26 years in the Marine Corps, so we traveled abroad quite a, quite a bit. And so my, my desire to learn more about medicine started at a very young age. I have family members that are physicians but didn't, not necessarily, owning their own practice. And. So when I was in medical school, I remember one of my family medicine rotations where I was shadowing an old country doc, and that's what I'll refer to him as where he was doing a lot of co cosmetic procedures and he had this relationship with his patients. They knew him, they trusted his advice, then they came to him regularly. And so that was my dream. But then it kind of slowly, kind of dis disintegrated after I got through residency. So I came to university of South Carolina for residency. Now it's Palmetto Health or Prisma Family Medicine. And, I kind of was under the impression that there were no doctors really, or very few doctors still practicing independently. That was the story that I was told. And honestly I guess it was maybe in 2022, a good friend of mine told me about DPC. We went to residency and our fellowship together and I thought it was a unicorn. I'm like, who actually does this? And is it real? And got a few books to read about and I was like, Hmm, if this could happen, then yeah, I kind of stumbled upon dpc. Well, I think, I, I'm looking forward to reading your book about buying a practice and that experience, because I think that again, this is just, it's such a an important. Take on how to enter the DPC space. So I'm wondering, when you were doing your research, when you were, thinking about huh, this isn't a unicorn, this is actually something I could do what was the roadmap in your head and your actions when it comes to reading about it and then, eventually talking with Dr. Carter about living, well, family medicine, right. So I practice in corporate, what I refer to as corporate medicine for about 10 years. Three different institutions kind of in the search for that patient, doctor, patient relationship that I just couldn't seem to establish because I felt like my role as a mother, a wife, a physician, were like, I'm constantly pulling and regardless of what I did, I was sacrificing on one end or the other. And it really came to like 2023. I was just depressed, to be very honest, because I knew that I could be a better physician. I knew that I could, I was given the best care that I could possibly give to my patients, but it never, I didn't feel like I was being fulfilled in every area of my life. And so I, as a Christian, I started praying. I was like, God, look, I'm at this point in my life where either A, I'm going to leave medicine altogether, or B, there has to be something new, something different. And I, my friend, like I said, who told me about DPC, I then kind of googled who's doing this? Where can I get a mentor? And that's how I found Dr. Carter. Her practice was literally seven minutes from my residence, and I was like, okay, that's convenient. Let me just ask her, Hey, I, I plan on starting a practice. How do I do it? That's how it began for me. And I just I I just think that this is so fascinating that, and it's, it's very family medicine also to be inquisitive and asking like, Hey, like I would love to learn more about it is very family, it's very physician, but very family medicine especially because we're always asking like all the random questions, right. But I, I wonder like. When you asked Dr. Carter, Hey, I'd love to know about opening a practice. Mm-hmm. Did you like have a moment after that where you're like, I can't believe I asked this, or like, hell yeah. I asked this. What was your mindset when you were like, those words just left my mouth. Yes. Honestly, I just was, I was proud of myself. I was so proud. I was like, I did that. I'm advocating for me. And was what was so amazing. She, she was just so calm and collected and cr and crazy enough for, for me, I was like, all right, Dr. Carter, I have to be very transparent. I have three kids under the age of 10. Can I do this with three kids? And her response was like, absolutely. Oh, that's so real. That's so real. And there was a piece, tell us about those conversations, because it's one thing to say like, how do I do this on my own? And it's a different conversation to say, would you like to buy my practice or would you like to be the doctor here?'cause I'm on my exit path. When I called, I left a voicemail and her office manager, who is still office manager for me now she reached out to me and was like, Dr. Franklin, Dr. Carter would love to, reach out to you. Can you, I'll give her your cell phone number and she'll call you, what time are new available? And so I told her my availability and she invited me to come by and see the practice. That was the next step. So I came here, not under any notion that, hey, I'm gonna own this, but just, I'm like, I'm getting a mentor. That was, that was what I knew. I'm getting a mentor and I was thrilled at that. I was like, that was enough for me. So I came here she had Michelle and Sonya that've been with her basically since the beginning. And I'm like, man, I love these ladies. And I, and I was like. The, and then the other thought to me was like, man, she's one of the happiest looking doctors I've ever met. I want that. I want that. Wow. And in terms of Dr. Carter's, when she's said, oh yeah, you can totally do this with three kids under 10. I'm just wondering what, what did you pick up on specifically, or that that made you think to yourself like, she's really happy and I want that. What was the vat that you were picking up on or sensing or learning about? It was simple, it was joy. I wanted to be happy. I loved medicine. Like I said, from an early age, my mother would tell me that it was, I was two. I think that for me, it really happened around the age of 11, but I've always loved medicine and I felt like over the years it was just kind of being robbed because of the constant demands for metrics and numbers. And so when I saw her, it was just a relief. As you saw the joy that she had as you aspired to have a practice where you could have joy also and love medicine again. I'm wondering. How soon when you guys, from like, when you guys met to this, this conversations dialogue about you taking over, how soon was that from day one to day, whatever? Right. It was actual like a week or two. That's awesome. Because she was really in this mindset. Like Dr. Carter had been wanting to retire for about five years prior to my arrival. So she kind of was, decreasing her patient panel. But she was trying to hold on'cause the ladies that she had who had committed these years to her, wanted to continue to work. The patients were begging her to stay and so she was holding on and it was kind of like, so when can you start? Was that when, can you start as my partner discussion or when can you start as. Hey, I have the lease ready to go. It's been collecting dust for five years. What, where were you guys it was more the dusty, the dusty part. I love it. Oh my goodness. Hey, that's, that's real also. I love it. So tell us about the practice. The office manager who was with Dr. Carter is still your office manager now. Mm-hmm. And I think that's lovely because it really talks about the culture, that this is really for the patients and that's who they are staying with while having a physician come on board. Right. But tell us about the, the, the practice itself. Like where is it located and who are the patients? Yeah, so we're located two 14 old Chapin Road in Lexington, South Carolina. We're accepting patients um, but the patients are really kind of within the Lexington area, but we do have some that have kind of moved away, interestingly in enough in other states and still stay here and just travel back for their physicals. The staff, it really is a, a, a, a powerhouse of women. I have Sonya and Michelle Sonya's, my LPN. She is phenomenal. And I couldn't have asked for a better team to work with.'cause, you know, that was part of my apprehension is my goodness, they don't know me. I don't know, know them. Like, how is this gonna match? I didn't, we didn't choose each other, but it kind of flowed. And I, and I tell'em this all the time, I was like, I feel like I've always been here. So I love that it's been that way. And the nice thing is because of their, their, them staying here with me, patients had that stability and continuity of care, which was imperative because DPC is all about the relationships. In maintaining their roles at the clinic how did that work financially in terms of you are taking over a practice, there's an investment there, but then also there's already an established population, right? Like you said, they stayed. So how was it to go from not owning a practice, wanting to have the joy to being like, I also have patience and employees now? Yeah, that was a whirlwind, because you, you quickly learn about E-Verify, you've got a couple days that you need to get these employees rehired. And I was like, what? I think I probably did that at some point. One of these institutions that I've worked for and literally like for me, my transitionary period, I left my previous employer on a Friday and started BPC on that Monday. Wow, that's amazing. And because you were at three different institutions before you opened DPC, did you ever have any issues with practicing in the same locale, non-competes, anything like that? You better believe it. I would love to dive deeper, but you know how those things work, you can't share as much. But yeah, that was definitely a part of it. Wow. And I'm, I'm glad you mentioned that. Definitely we don't have to get into the details, but I just think it's important to note that this is. Something that restricts patient access. Mm-hmm. Period. Mm-hmm. So that's know, it's a, it's definitely something to think about, especially if you're, thinking about DPC out there and you're like, what does my contract mm-hmm. Actually say because what are the repercu need know, just there's a little side note there. Do you have any tips on, navigating for your future in terms of being smart about contracts and signing and looking for clauses that are not your favorite in, in, like when you look back on your journey? Yeah, so I had a healthcare attorney since I started residency when at our program they actually connected us with a number of different disciplines like a financial advisor. And I just so happened to luck out with exceptional ones. So he has been with me for the duration of my medical career and, I couldn't have done this without him. Even, between my transition period between three institutions to going into D pc, the only reason why I'm able to do, it's because of his hard work. And when it comes around contracts, I don't, I know we are brilliant individuals because we have our MDs behind our name, but we are not attorneys. And the jargon doesn't make sense. So you need to make sure you have a healthcare attorney that can explain it to you every single page. Every single line. And if you don't understand, ask the question because you don't wanna get yourself in a bind. So important to hear. And. I, I think that that is also fantastic. I don't think anyone shared that on the podcast having an attorney while they were in residency. So that is a massive pro tip, and I think that it's super doable, especially, there's lawyers who focus on DPC now these days. Mm-hmm. The dpc directory.com is definitely where you can find testimonials from DPC doctors who are using lawyers out there. But I definitely would say that, this is, is a massive thing, especially if you're earlier on in your career and you haven't even graduated residency, right? You can still have the legal boundaries and guidance in place even then. So that, that's a fantastic pro tip. Okay. So going back to living well that you, you mentioned how patients will still they moved out of the area, but they'll still travel to see you. I'm wondering if you can tell us here about the demographics of the practice when you purchased it, because I think that given that you're, you, we know your address now, we know where to find you and that you're accepting your patients. Absolutely love it. Always be selling. Fantastic. Absolutely. I, I wonder. What is your makeup so that listeners can hear? Oh, yeah, that's pretty similar to like my community. Yes. So we have a, a very diverse patient panel. We have a number of business owners who have multimillion dollar businesses versus like smaller businesses where tattoo owner, tattoo shop owners. Just, it's, it's a, it's a whole host of different options and I have patients that are uninsured. I do have patients that have Medicare. I have patients that have other major health insurance, and they have decided that yes, I have this, but what I know is that my insurance doesn't buy me this type of access. It doesn't buy me this type of care and communicate with my provider. And so we have a. And just because we're recording this in early 2026, I'm wondering, has that demographic or the insured insurance status of those people, who are your patients, has it been impacted or changed since we started January of 2026 to now? That's a good question. I know that I started obtaining some additional patients who were uninsured because of the fact that they still need care. They still need care. And unfortunately with the subsidies, having now been since removed, insurance is not affordable. And as an entrepreneur and my husband also being self-employed, we have learned having insurance. It is extremely expensive. You said so many things there that are so relatable to us as physicians who are. Becoming entrepreneurs forced to become entrepreneurs in some cases. Mm-hmm. And then patients who are forced to, find access that does not mean health insurance, but find access. what are the, the differences that you're seeing from people who are your new patients who might not have had access because they had previously only done health insurance covered care, versus the patients that you and Dr. Carter have taken care of now, because I suspect that there's a difference between what a person comes in with versus a person who's been established as a DPC patient right. And so I think the, the best way to even kind of, explain it would be even my transition from the working for an institution to being A DPC.'cause I had a number of my patients leave with me and they found me on their own. But basically it was, I, I ran into this situation repeatedly as an employed physician where there were acute concerns that patients would send in the EMR. Hey, I have a UTI, or I have this problem and I'm sorry I can't see you for six weeks. Go to your urgent care. You spend 300 versus DPC now where they simply text Hey, Dr. Franklin, I'm having, painful urination. It's urinary frequency, it's all these things. And not to mention at Walgreens there's a little test strip. I can go and dip my urine and get it. It shows that I have bacteria. No brainer. It doesn't take that, practicing medicine shouldn't be that difficult. And so the patients that we see now more so if they haven't been established with us, it's a complexity of issues or things that, and I don't want to shame the physicians that are employed because you're doing the best that you can with what you have and the time. And you're very limited in the amount of services you can offer. But because patients don't have that time there are a lot of things that kind of get postponed or dismissed or pushed off for a later date. And now I'm seeing those individuals where I'm like, gosh, if we had addressed this a little bit sooner, maybe we wouldn't be in this situation. Yeah. And I think about their. I, I have patients who are like, that, that experience is very similar to patients who are newer to the practice. We still have the remember you could have asked us for a cash pay lab instead of paying$200 for that test that you just decided to buy on Quest. But I, I feel that this is. Why the word of mouth marketing that we experience is so powerful. Yes. Because patients understand immediately whether they're young and healthy, quote unquote, whether they're older and with more chronic problems. This is the type of thing that the patients understand immediately with the, with picturing people like themselves, right. Being able to benefit from DPC because of things like this. Mm-hmm. So that's amazing. Mm-hmm. Now going back to your husband and you are entrepreneurs and you have three kids, I, I'm wondering what was the financial like I think about Kevin and home alone's, Kevin's master plan, like what was, what was your, adult version of your master plan to then financially purchase the clinic along with the finances of your family that you have to manage? Right. And so I knew coming into the practice that Dr. Dr. Carter had kind of decreased the patient panel. So, it was taking care of all the costs. Now, my husband, thankfully, because of savings and honestly some fi family support we were able to continue our current level of care, but we have also learned the, the difference between our needs and our wants. And so have our children, and they're like, no, I don't need this stuffed animal. And it's no, we don't, we don't need to go out to eat this often. So we have been better stewards of our finances because no, my salary is not, I, I wouldn't even really call it a salary at this point, but we are growing. And I think that initially I was under the impression that, oh my gosh, okay, I'm gonna get in there and everybody's gonna know I'm here. And sign up. And that was not the case. It was a, a rather slower transition because where, where I am, I'm in Lexington, I, I, I am the only DPC in Lexington. So educating patients and trying to get the word out there at different conferences because a number of individuals are like, oh, I didn't even know that existed despite the fact that DPC has been out for, 15 years or so or more. So, with the finances. We have a financial advisor. We actually have two. So I had one from residency again. They sent out a message and I was like, good. I don't know much about money. I've been having all this debt and loans. So I connected with one that was good with student loans and we had another one that we had had acquired before. We purchased this practice and he has been able to show, okay, these are what your investments are, this is how you're doing. And we meet with them monthly. when you meet monthly, what are the things that are like, this is a non-negotiable that we have to discuss every month. Yeah. So obviously just knowing what our balance is in regards to our investment accounts and just our savings and knowing the projection of, okay, if we, if we wouldn't have to take another cent, this is how we would do by the time I'm 60 years old. I also have like a business consultant that I work with who meets with me regularly. We, and she is good with finances and not a CPA, but I have a CPA, but she is good with finances where we sit down and we look at the projections. We sit down and go through, okay, this is what all of your expense have been this month. This is how much the medications have costed you, this is how many patients have enrolled. And kind of like, if we continue on this path, this is what you can anticipate will be in your account and slowly adjusting, okay, this is what I'm paying myself. But then I think another thing to also be mindful of is. So not everything should be your personal expense. It's actually a business expense because you're your business and having more of a tax strategist is imperative as well. Awesome. And how, because I know that there are definitely diads out there where the DPC owner is, the DPC physician and owner is one business and the other business is owned by the other partner. How do you guys address okay, we're one family though, so no matter where the income is coming in, this is how we strategically look at two businesses going forward for ourselves yeah. I think we had to learn this earlier on, like we kind of established roles especially in regards to finances. And so my husband having his business is it's completely separate entity and we kind of know it is one pot because it's still one family. We are supporting the kids if they, they continue, if they won't stop growing. So we gotta do, shoes and clothes and it's kind of like, it's one pot. And my husband, I am thankful for him because, it depends on who you're married to. Mine is very supportive and, he has known that I am more concerned about numbers. And so when it comes to details and the paperwork, I tend to carry a more, more of that. But in regards to networking and CRE and kind of funneling in more business for both of us, he is more outgoing in that regard and really the better public speaker. So we're working on each other's strengths and weaknesses, but we really kind of divvy up like everything for that makes our family run. We, and we go and we go out on dates weekly just to kind of, well, for our marriage, but then also for the business. And we sit down and discuss, alright, this is, these are the expenses that are coming up. The kids are going, they have, be re-enrolled in school. And just going through, okay, these are all of our expenses. What can we give, what do we, what is imperative at this time? And what are things that maybe we can push off a little bit later. He's had to cut more grass lately. Those types of things. But it's kind of been us taking a strategy and knowing what our weaknesses are and our strengths are. And my husband says we staff our weaknesses. Amazing. I love that. And I think that that is going to be so helpful for the listeners. Also just on a the kids, they just don't stop growing. Note, like this is a random mom note that I'm gonna drop in here, but I, getting over the, the target drama that happened last year. I will say that I take advantage of the cat and Jack returnable in 365 days policy. Yes, 100%. If we buy shoes, we have set alarms on our phones to be like, the shoes will expire at on this day, and if they are holy, if they are, whatever. Mm-hmm. I have absolutely taken advantage of the policy that is stated to Returnly patent and Jack things in 365 days. So if you are, were not aware of that. Also, the lifetime return of vacuums at Costco. Those are the two things that I'm like, as a mom, I think everybody should know. Yeah. We need to know we're people. Hundred percent. Hundred percent. So when you. Have come into buying a practice with already legal and financial support. So Awesome. I'm like so impressed by that. And I'm also like, dang, that was, I should have done that. But when it comes to looking at the practice and evaluating it, what tips do you have for people to say these are the things you need to look at in terms of evaluating a practice mm-hmm. To see if it's going to be something that is worth buying versus starting your own. Right. What tips do you have for for that process? Yeah. So, I think one of the most important things is looking at p and Ls, your profit and loss statements. I didn't know what that was before becoming a business owner, but I have since learned and not just like for that year, but for the previous three years to see exactly how the business had been doing. Also understanding what equipment is, plan the previous doctor plans on leaving in the office and are you able to utilize that? Will that be another source of income or, and how much has it depreciated? In regards to other finances, financial concerns, I would also. Make sure, I have an insurance broker. And so knowing, okay, well I have to have malpractice insurance, cybersecurity worker's comp, property insurance, and knowing how much all of these things are going to cost you, because it may have costed, it may have been a certain expense for Dr. Carter or your previous owner, but it's gonna be different for you when it get, when you're quoted. And so knowing these numbers and then also looking at what are all of the bills and organizing it because. Are you gonna keep that same phone service or is there a better, a cheaper, a more affordable option for you? These are things that you'll want to end up knowing and then deciding on whether or not that's impaired. That's something that you need. And the other thing was like Dr. Cord was, Dr. Carter was very forthcoming because a number of the equipment that was in office had been here when she started. So she was like, Hey, heads up you're gonna need new computers. So here I go, best Buy and trying to price match, okay, this is what, these are what these different things are going to cost me. And then also if you're leaving an institution, attorney fees because can rack up rather so in. And at least as, as informed, as much informed as you possibly can be. Absolutely. And just with the idea of that being informed as, as much as you could be can you tell us anything if, if, if there was anything that was like, oh boy, I didn't even see that one coming until after you had purchased the clinic. Because I, I think about it's like there's things in our house that I'm like, oh, that's fun. I wish I would've known about that during negotiations. Yes. So, I think, I think one of the, like when we switched over, because like I said, I started, it was a weekend that passed before I became a business owner. It, one of the biggest things was opting out. Yes, yes, yes. Oh my goodness. And this is state dependent, in regards to when it's enacted. So some, because I, and I looked, through a number of d PC docs and on Facebook, some of the Facebook groups like that, Hey, if I opt out of medi, when I opted outta Medicare, it took place in X amount of weeks, right? So for us here in South Carolina it takes three months. And again, I transitioned over a weekend, so I couldn't opt outta Medicare because, and. I couldn't bill my patients who, or charged my patients who had Medicare when I joined the DPC. Mm-hmm. And at least that, that was how I understood it. So, for the three months, I wasn't gonna dismiss. I'm a my heart is in geriatrics. I did my fellowship in geriatrics. I'm not gonna dismiss my 65 and plus because I can't charge you. They received all their care for free. For three months. Awesome. And I, I did the same thing while I was waiting. My two months I gave carefree for my patients who were Medicare re beneficiaries. Mm-hmm. So that is awesome and totally doable. And it's something to financially think about. If you have so many people in a practice that you're looking at and they have Medicare and you're not opted out, like how are you going to get that income made up? So that's how, that's a fantastic Yeah. It was a loss. It was a loss at that point. Yeah. When it comes to things that you had to do with your financial advisors quickly, were there certain adjustments in your KPIs and things that you were checking in monthly on that were like, oh, now we have to look at this? Just because like last week I wasn't a business center and now I am. No, it was a, it was a lot. And so I think that one of the things I had to get over was, as physicians and especially employed physicians, you're kind of told what to do. You are told what to do constantly. And there was no checklist. Like I, I read the, the different books for DPC, but my case was very different and so, I was trying to figure, I didn't ask the question, so I had a ton of penalties because I just didn't seek the information. At least everything for me was more fixated on acquisition. Like how, how am I acquiring the business as opposed to, all right, now I'm a business owner. Make sure you are up to date for all your taxes, the state and federal, and the fact that some of those are quarterly, and I didn't know, I didn't know, I didn't know the questions to ask, and I kind of just, when I, when I acquired the practice, I was, so, I was really trying to figure out how to just manage patients. Now how do I get my name on all of the accounts that I didn't, I kind of ignored the numbers. I, and that's the truth. I the numbers up until maybe. The January, like before taxes were due, but it was like three months of just trying to stay afloat. So, and when I, even when I tried to look at this, I was looking at my journals to figure out like, what was I doing? I was just, I was trying to survive. This is why I think that you, that those are such pro tips, have advisors before you even do DPC if you can. Mm-hmm. Because you have somebody who you already trust, who you know how to talk with, who knows, you know your mindset and who absolutely is aware about your business decisions from pre-business owning. Mm-hmm. And I think also, in terms of the, you, we are just surviving. If you're out there listening and you're feeling like that, give yourself grace because oh my God, even after you open, there's days where you're like, oh my God, I dunno the numbers. And that is a total normal feeling. But that's also why we have community. And this is also like the things that you like, we were talking about this before we started recording, but like you have your little trio. Dr. Eshu is one of those. And Dr. Boylan is the other who Dr. Eshu mentioned in her interview, but it's this is the importance of building community even locally, so that you can, talk to each other about your journeys. It's fantastic that your husband is an entrepreneur. So you can talk about your jour, your journeys on your weekly dates also. Mm-hmm. I think that, this is something where, it's one of those things where it's if you're feeling like you don't know your numbers, it's okay. Yes, learn your numbers. That is always a suggestion for being, being a business owner. But if you don't feel like you're confident in your numbers in this moment, you're not a bad business owner. Right. Right. And I think the other two thing too is like when I first started, I had a different group that was helping me with the finances, but it wasn't working out. And so I had to transition and shift and it really changed it. It just rocked my world because I was sitting there oh my gosh. And thankfully, like I said, I have all, I didn't even realize the wealth of knowledge of individuals who had already been in my life. And so when I made that transition, I was like, okay, now I need to find X, Y, and z. I was able to reach out to, family members and friends who were like, Hey, this is who I use. I trust them, and I could quickly pivot because. Like I said, I started, I don't know if I said this, but I started, I took ownership September 1st, 2024, but I was still held responsible for the previous months and where, I had my CPA that I trusted and Dr. Carter was willing to work with me, but I, I wanted to just keep the one that I had. Okay. Because again, it's just, I've, I've known her since I was. In undergrad. So it was a lot of them communicating and trying to get paperwork together in regards to making sure, like my staff, they got their W twos on time. I never had to worry about W twos and doing bonuses because I'm like, these women are fantastic, so I wanna make sure I continue to show'em appreciation and how do I file all these taxes and what information do you need from me? And then even okay, I need a, I need a, it was funny, I was calling our utilities department and they asked me, Hey, have you gotten, have you registered for your business license? I was like, huh, no I haven't. How do I do that? And she was like, not a problem. I'll give you their contact information because I'm like, who tells you that you need a business license? yes. I, that's that is my one word answer to all of the thoughts that I have about that process. And I've mentioned on the podcast before, but like in my county, there's a county license and then there's the state license. Mm-hmm. And for the county license, one of the pony Express requirements is that you have to be published in the physical newspaper for four weeks before you can open your business. And I'm like, are you serious? There's literally hardly any, places to put your quarters into to buy a newspaper anymore. And where, what, there's even newspapers in print. Are you kidding me? So, yeah. Amen. That is absolutely real. And again, this is why I wanna buy your book when you write it, because this is Come soon. Come soon. Oh, amen. I love it. I love it. So after you, got your business license, you're, in the next week as a business owner what was the, the first thing you did to become part of the team? Because the staff stayed on. Mm-hmm. As well as the patients. Right. So Dr. Carter and I scheduled a meet and greet, which was kind of like hailing her legacy and giving patients an opportunity to at least come by and say hello, bring gifts. And I was, it was also there for them to at least be able to meet me for all those that were interested. With Sonya and Michelle, we kind of, I, I took them out. We had lunch, we had our business meetings and eating lunch and just trying to get to know each other because I am kind of a very open and transparent individual, so I kind of was like, Hey, here's my family. They met my children. They were, they were also present at the meet and greet of my husband. But it was kind of like a handing a passing of the torch When you were in the meet and greets with the patients, what were some of the things that you heard from the patients? Because, I think about, this is absolutely not the same case, but I think about when I was with Dr. Blakey in Superior Nebraska and as a medical student, and I would go in and as, meet these patients to do their question about their, ear infection or whatever. And they had the understanding that like we at this clinic in Superior see people who work with Dr. Blakey. But this is an an example of where like you are going to be the new doctor, Dr. Carter is leaving. So what are the things that you heard from the patients during this meet and greet? Honestly it was, I think the vast majority of patients kept reiterating their gratitude for me coming on because they did not want to return to what we all have referred to as the system. They love the care and they're like, Hey, is Sonya Michelle staying? And I'm like, yes, they are. And for them it was, it was gratitude and they really embraced me and my family. And so it was. It was refreshing because I was nervous about how I would be embraced, because again, I'm like many of the, some of them, like they were born and established with Dr. Carter and have, and that's the only doctor they've ever known. And so I was able, they were, there was an opportunity for me not being the doctor on the stool, but rather just, Hey, I'm, I'm, I am a human being. I am here to take care of you, but I also want you to know me as a person. And I just think about you going to your friends and family for who would you use for dah, dah, dah. Dr. Carter's. Quote unquote seal of approval, like I'm sure that that has so much mm-hmm. Weight with patients when they're seeing the doctor who they're knowing is going to be exiting, and the doctor who is coming on board that there's a trust handoff almost. Mm-hmm. When it comes to you guys being present in the same room. Same room. Right, right. And it was that and that, and that's what it is. If you're good, if Dr. Carter's good with you, I'm good with you. That's amazing. And I, I haven't asked this, but when it comes to the patients transitioning to your practice did you was Dr. Carter doing DPC before you or was she billing insurance for the patient's care she was doing? So, Dr. Carter first, her very first practice was through, she was employed an employed physician. Then she did fee for service, and then she transitioned her practice to DPC. Got it. So how long were the patients already DPC members versus fee for service members before you guys made that transition? If I'm not mistaken, I think it was about 12, 13 years. Wow. Wow. So it was well known. Yeah. I think about the, yes, there's been some movement of people, but they've come back to see you. They've maintained their patient relationship with you as the new doctor. But it, it's interesting because I'm wondering, I just think about when you talk about Lexington and you're the only DPC in Lexington what do you think is the reason that there are not more patients banging down your door or more physicians asking you like, how did you do it? Or Can I join you? They don't know DPC exists. They really don't understand it. They don't understand the model. And I've even for some of my colleagues, again, I really didn't know about DPC until 22. So it's not, I'm trying to advertise for, and, and really what I want is part of my legacy will be where DPC is a household name in Lex, in Lexington. Yeah. What a, what an amazing goal and something so achievable. Yeah. So that's, that's fantastic. When it comes to the, the act of seeing patients for the first time. As your patients, I'm wondering, did you did you emulate some of the workflows that Michelle and Sonia had? Did you talk together about like, how do we create a new workflow starting over with the way I like to do medicine? Because I think that that's definitely something to think about when a patient might be used to like, oh, well they always do this, and you're like, but that, that's not me anymore. That's mm-hmm. I'm a different doctor. Right. And so what I did with Sonya and Michelle was I came by the office one day just to sit down and talk to them. It just so happened Dr. Carter was actually out that day. And so I sat down and was like, Hey, what do you enjoy? What has really worked for the practice? What would you like to see differently? And they asked me the same and I told'em, I was like, one of the, one of the hardest things when I first started was. I needed to transition my mindset outta grinding because DPC was much slower. So I initially had this ridiculous goal of getting every single patient in the practice their first physical within the first year. And I didn't want Sonya or Michelle to leave me, but we were going down a path because it was, it was insane and it was unnecessary. Sure, it was unnecessary, but I was like, I gotta, I need to, touch hand, touch each individual, make sure they know me, make sure they see me, make sure all these things. And I'm like, it was, it, it, it was all unnecessary. It's unnecessary stress that I placed on myself. But I asked them, Hey, time off. How are we gonna work that out? Because if I'm here, like we're, we all need kind of self care days and just working that out with the patients and and what had worked in the past also, I was thinking about, okay, I, I love these two ladies and in my mindset is, alright, I wanna be able to just, pay more. Yeah, absolutely. And just different things. Yeah. Awesome. And when we think about sustainability spec, specifically financial sustainability, I'm wondering what does it mean to you, in your words, to make a DPC genuinely, genuinely sustainable versus just surviving. Yeah, so I think you have to know your numbers. I know you hear that, with, in regards to labs all the time. But you need to know your numbers as pc. What, how much does it cost for your family to survive? What level or how, how do you want to function as a family? How much do you need to bring in between you and your spouse for your family to survive? And then looking at the practice, okay, so like with Dr. Harder, another thing that I did with the patients is I didn't feel like it would've been all right for me to switch her fee schedule with the patients. I wanted to honor that. Because to me, in exchange, they were staying with me. Now I had a different panel or fee schedule for anyone that was new. And so I based all of my numbers off of my fee schedule. So any patients that I acquired, I would need X amount of patience in order to give me this salary so that I can maintain my house and then, some extra, and, and that's what I'm working towards. But also you have to give yourself grace because you can expect to, or I guess it depends on everyone's situation, but I didn't. It's a party of three here. We can't handle that. We can't handle that. So I understand that it was gonna be a gradual growth and, and, and helped me to also transition here. That was one of the things I wanted to ask in terms of like, how did you do your pricing for existing patients versus new patients? And I, I, again, I think that you're dropping so many tips as to how to look at your numbers. And yes, know your numbers. It's like what Goldman Sachs teaches you on day one is know your numbers and it's one of those things where you'll hear it so many times and then one day you'll be like, oh, I have checked that box. There are physicians who have a lot of, oh my gosh, anxiety second guessing about changing pricing even for new members or upping pricing for existing members. What thoughts and what discussions have you had when it comes to pricing in general? Because I feel that this is something that. Goes along with the I'm not, I'm, I am, I only know the employee life. I don't know how to set my own numbers. Mm-hmm. I agree with that. So what I did was, again, I have Melissa and Tori, so I looked at what their pricing schedules were. And I was like, okay, can the, how many, how many patients would I need to see in order to make what I need? And I kind of sat in the middle between the two of them. And I, and that's where I placed my numbers. So like for an individual patient, it's$85. And then for a couple, I think I did it as one 60. And then for a family with two children or less, it's$200 or more. Now granted, I'm in South Carolina, so the cost of living is, significantly cheaper than in California, which I used to live too at one point in my life. So the cost of living is substantially cheaper or lower. And, the other part for me was that I, I, I, being a military rat I wanted to make sure that I gave a discount for my vets. Like veterans will always have a place in my heart because that's a number, another reason why I'm able to do what, what, what we're all able to do. And so I, I did a discounted rate for them and I did opt to add an enrollment fee because it takes time. And I wanted to make sure that patients were serious when they signed up with us. And if you weren't, don't do it. Yeah. I, putting skin in the game absolutely is, is a thing. And you can do it so many ways you can. You can have that to buffer, if you're not opted out of Medicare. That's the way that I got my Medicare patients to still put skin in the game, to reserve their spot, so to speak as when I, for when I was opted out. But yeah, it definitely takes time to onboard a patient. And yes, like we have tools and AI and all this stuff, but at the same time, like when you're building a relationship with someone you really like knowing, like their details. You talked about days off with your team, what other things do you or do you want to have for your team? Like 4 0 1 Ks or insurance for them? How do you are there other benefits that you have or that you're looking to have for your employees? So I'm looking to have those, I again, again, I was gifted with Sonya and Michelle because their husbands have all the benefits that they were really happy and satisfied with it and they didn't necessarily pressure me to have it, but because of, for just who I am, I want to be in a position to be able to offer that to them in the future. But, four oh ones and like health insurance, although they don't need it and it's a nice place to be if you don't need it. Yeah, absolutely. And I mean it's this, when I talk about people who are physicians who are like unexpectedly looking into ENT entrepreneurship because they were forced to from things like losing their jobs. This is definitely something that I'm seeing at our practice where people are like, good thing I have a DPC doctor,'cause my spouse just lost their insurance, which we were previously on. So that's definitely real on the patient side of things. And when it comes to balancing the number of patients you. Want to have the financial picture that you have as your goal, but also not taking on infinity number of patients. How do you work those numbers to be able to say like, I am willing to grow this many per week or this many per month. Mm-hmm. So I don't get overwhelmed. The team doesn't get overwhelmed, but also we don't, we don't change access to care of our existing patients. Right. Right. And so for me, it's kind of been a touch and go with this, because initially I had said, I. I had worked in places where I had 1200 patients assigned to me and others where I had a thousand, or, upper hundreds. So I was like, well, I could take 500, 600 patients, no problem. That's, that was what I thought. Now, coming into DPC, I started off with almost 300 and, I think that I'm, I'm constantly balancing that out regarding, in regards to how much time do I need to, I need to have available for my current panel, and how many patients can I add on at a time. So I think that you have, you can't lose sight of the ones who have already bought into the idea and who have already invested and are dedicated to what you do, but when you realistically have to grow, just working that into the schedule. And Simon and Michelle have helped me really with that because I'll look at how are we doing, ladies, is, is this too much? And if so, like we'll pull back. It's okay to have a waiting list. It's all right to, take your time so that you are not stressed out because you're not just a practicing physician anymore, you're a business owner and you need to ensure that your staff is happy. Happy, happy staff equals a happy business. You wanna make sure your patients wanna continue to refer their friends to you and feel like, Hey, I haven't lost this doc. I got this. Because you don't want anyone saying negative things about you. We just got this new doctor who joined us and she has no time to do with X, Y, and Z. So there is a balance, and I've had to learn that over the, the year and a half that I've been practicing and in this role. And so I feel a couple of patients a week. Like it's not, it's, it's doable. It's doable. I, I just go back to your statement about I had the goal of everybody coming in there for their physical, for their first year, and I inherited 300 patients. I'm like, bless your heart. Oh my goodness. That that is, that is true. Family medicine doctor right there. Oh my God. 65 days. I love it. Minus the three kids and their activities oh my God, but legit, this is, that is so real. Like that is, that is completely achievable goal when you're like, your, your family practice blinders around. You're like, I couldn't do this easy. Oh my God. I love it. One of the things that we've done intentionally, because I'm like, I don't want a a, like a, a fire hose of patients. Mm-hmm. And nor does my husband, we have perpetually join our waiting list on our website. So it's always there's a little bit of FOMO there for people who are checking out the website, but also when we. Do a meet and great, my husband does them because he's the one accepting new patients now, but when he does them, he'll say the soonest we can onboard you on is, and he'll decide the date based on what crazy we have with the kids schedules or whatever. So I think that there's so much creativity that you can have to make sure that you honor, like for you, if two a week is okay, this is cool, along with other patients, like amen, feel that out and figure out what, what's right for you and your team if you have one. Mm-hmm. That's fantastic. Yeah. Right, right. No, I agree. I agree with that. Awesome. And in terms of growing your practice, I want to ask here, do you work with employers or are you looking to work with employers? Who. Whose employees would then see you versus people who are individual members joining your practice? Mm-hmm. So I'm open to employers. I've actually I joined the Chamber of Commerce locally in order to meet other businesses because truly it's a benefit to those business owners as well. And so I have done a number of conferences and different meetings to just try to kind of let them know about what we're doing. We have a handful of employers currently that work with us and they've been satisfied and continue to send more patients. But I definitely am open to working, working with a few more. What have you found is helpful for your community, especially when you're talking to business owners at your chamber of Commerce? Because I feel that yes, there's always some, some commonalities between all small businesses, but I'm wondering, especially in the Lexington area, what have you found really like piques the interest of your local business owners? Well, I think everyone's always shocked to see me because they're like, you're a doctor what are you doing at a meeting? Wow. You don't typically see physicians. And like I said, I'm the only one here in Lexington that has my, or at least the only DPC for a while. I think there might be one individual that may have opened one or has kind of like a hybrid model. But what I have tried to do with the, the chamber of Commerce is talk to'em about what DPC is, the prices and the fact that if your, if your employees have a doctor that they can readily access, then they're less likely to have to call out for so many sick days. They can get their medications from our practice. They can. Have their physical schedule, they can do virtual visits on their lunch breaks. So it's more time with you, with you having a healthier employee. And I've been in invited to come to some of their offices and just kind of present what we do as well, which has been nice and a lot of practice because that was something that I had not been accustomed to doing before. Totally. And what are some of the things that they're asking you, especially when you go on site, because you are not in a concentrated environment, what are the things that employers and employees are asking you about DBC yeah, so they're asking about how is it different than going to a traditional physician. And like how often, how, how available am I? Can they text me all at any time? Like seriously, we can text you at any point. They also ask about the prices of the medications because they're always shocked about how low they are. I'm like, it's pennies in comparison to what you would pay for gonna another p a pharmacy, like any other pharmacy. The other thing that they often ask me about, because I, I tell them, if you have an acute concern, we can get you in the same day or the next day. So those are usually the highlights. Mm-hmm. For all of the business, the businesses and business owners or the, their employees as well. What have you seen when one of those employees or employers then joins on? Because it's one thing, again, like it's one thing to hear something and it's another thing to actually experience it and understand it. So, it's, it's, this is similar to my question of like the people who were not DPC members, what has their experience been like compared to the existing members? Mm-hmm. Because I think that as you talk about growing the practice, this is. Very helpful for employers to understand as well. Mm-hmm. No, it's kind of like Christmas, like they, they have this box and they're like, oh my goodness, it's a new toy. Let me text and see if this is going to really work. Is she gonna respond to me? And I like, yes, we're here to address any of your concerns. Or the very first time we're kind of hopefully getting out of like our flu season and everything, and they're texting like, Hey, my, my kid just tested positive for the flu. We were in the er, er last night. And the child obviously is not established with me, but they were in the ER last night. Hey, I, I'm concerned about being exposed because I'm gonna be at work. Can you send me a prescription? I'm like, not a problem. And it works. It works. I, that is, that is totally a Dr. Franklin original. DPC is like Christmas. Amen. That is awesome. Love it. So when, when we think about people like Dr. Carter who are wanting to have an exit strategy, it's definitely something that we're seeing now that DPCs have been in practice for 10 plus years. Mm-hmm. At this point, at the time that we're recording, and there are other doctors who are thinking about their exit strategy. If you were to have a doctor approach you to say like, Hey, I'm wondering if I could be the next physician at Living Well, family Medicine, why is it important for you to think about. Selling to somebody who is a physician versus vc, and what are the things that you would tell that physician or you would want them to know based on your transition experience? Yep. So that is something that I, that's part of my dream as well. I want to be able to hire physicians as I, once I expand enough, because I have known a number of exceptional physicians over the years that are just drowning in the system that really. Cannot support us in the way that we need them to. And so what I would love to do is, what family medicine is awesome at is mentoring, bringing someone under your wing earlier on, like a resident or, a newly, a new grad. And just trying to show them like that if you don't have to be employed. There are other options now in regards to the VC and all of that. To me, the, the issue will always remain that if someone else is holding the purse strings, they are going to dictate care. And they're not in the wor they're not working day to day, they don't have the relationship, they don't have the same investment that we do with our patients. So I don't see myself selling the practice to any of those entities because. That's the whole purpose of DPC is being physician owned. A physician ran beautiful. And this is, this is how we continue to stand out when it comes to what patients are looking for and what their understanding is different. They're like, oh, this is, this is a small business. Meaning it is a personal business. It is a, the person is actually in a relationship with me and not having somebody who doesn't care about my healthcare and my access, determining the rules here at this place. Mm-hmm. Yeah. That's beautiful. Mm-hmm. That's beautiful. When you think about the exercise of like you selling to another physician, what are the things that you would. You would idealize would be like the, the perfect transition for another doctor to buy your practice mm-hmm. Separate from the physicians joining your practice? Yeah. So if they wanted to buy the practice, I think that I would have, what I'm trying to work on now is like a binder of, here are the next steps, because that was something that I desperately wanted during this process. So it's kind of like, for instance I kept the EIN for the business. Because I loved the name Living Well, so I didn't wanna reinvent it. The, the different relationships that Dr. Carter had already established here like they recognized Living, well, family medicine, and to me it made more sense to keep it that way, but that also caused some, some confusion because then I needed to, register and become the, and you're selling the ownership or your shares and transferring that 100% to me. And then knowing that Dr. Carter, because she was primary on all of the accounts, what are all of those accounts? She started them 20 years ago, 13 years ago. And so it was kind of like, oops. Yep. We never did transition, the, the telephone or the lawn or whatever to my name. And so to make that a smoother process, I would definitely have that. Kind of like, when you buy a home and they give you your list of, Hey, here's this number for your electric company, the trash company, the, to get your, you need to call this number to get your trash bins. I think that's what we need a to-do list like that in DPC when you're talking about transitioning a practice, because it will help to guide the next steps in thinking like, am I gonna use QuickBooks? How much does that cost? What components of QuickBooks do I need? How do I even figure out how QuickBooks work? Like doing these online tutorials so that it may not all be applicable, but you have a reference book. Absolutely. Yeah. So fancy but, so doable. These, these days. Yes, an app would be amazing and I, I definitely would say, again, this is. This is this is so important for people to think about because having an exit strategy is something that we all deserve because mm-hmm. Yes. If you wanna be a physician for the rest of your life, fantastic. But if you do not want to be a physician the rest of your life clinically seeing patients, that's okay too. What would you experience or say if somebody were to call you, like you called Dr. Carter and say Hey, I'd like to open my own practice. Can you, can we meet and tell me about that? What would go on in your head if that happened today? I honestly embrace it because I feel like we need to support one another. It's not a competition. There is enough, there are enough patients to go around. And I would really want to just kind of, I think one of the first things, one thing that I had to think about the other day, and I'm like, I dunno if everybody will relate to it, but I think of DPC as kind of like starting a family, in the sense that, you don't know what it's gonna be like when you have a child. Pregnancy is different for every single one of them, despite the fact that it's the same gene pool. Yes, the basics don't change. Like they need to be fed, they need to be changed, they need sleep. DPC is like that. So with anybody that is trying to, either take ownership of another practice or inherit one, understand that your story will not be mine. But the framework and what you need is similar. It's just basic things like having that network of advisors that you can call on and having a doctor that is willing to work with you. So important. And for those who've had that experience of it's discharge day from the hospital and you're, they're handing you this child that you've made and you're like. No, no, no, no. You're supposed to take them back to the nursery. Like I just feed them every three hours. Like what are, what are you actually talking about taking the baby home? Oh, I like, and even if you're a doctor, that is a real experience. Mm-hmm. So when you're talking about this is a family member, that relationship is something like every child is born with their independent personality of their sibling. Yeah. It's that is so real. And I think that that is important because there's a lot of comparisons out there, like mm-hmm. Oh, I must be not succeeding if I am experiencing this and the doctor next door is not. Yeah. That's not true. And so I, I love that you're highlighting that your journey is your journey and your DPC is your DPC, and it's not gonna be the same as everybody else's. Right. Right. Living well, family medicine was built on a question, are you living or are you living well? So what does living well mean to you right now in this chapter of life? I really didn't know that I was just living for much of my career. I felt like I was existing physically present, but emotionally, mentally, spiritually absent because I was. Constantly on the go and trying to figure out how to make things work. So after joining the DPC movement I realized that there is this whole other way of life where it has strengthened my family life, my work life. I have the autonomy to do good when I take care of patients. And with my personal statement, like so many others, I wrote that I just want to help people. And not only am I helping other people, but I'm helping myself at the same time because I am really walking out what I feel is my ministry, my calling. And what it means to live well is when. Your personal and professional goals can kind of intersect. Thank you so much Dr. Franklin for sharing your story today. Thank you again for taking the time Thanks for being here for this episode of my DPC story. Whether you stumbled across DPC for the first time today, or you've been in practice for years, these stories are here for you, wherever you are in your DPC journey. And that's exactly, have a start here. page@mydpcstory.com is built now. It meets you where you are new to DPC and learning the fundamentals. There's a path for that already practicing or in the planning stages and looking for practical tools. There's a path for that too. Ready to go deeper. That's covered. Head to the start herePage@mydpcstory.com and find your starting point. If you have a question or challenge you want to hear addressed on the show, go to the contactPage@mydpcstory.com and leave me a voice message. And if this episode moved you, please leave a five star review on Apple Podcasts. It's one of the best ways to help other physicians find these stories when they need them the most. For commercial free episodes and extended conversations, check out our Patreon. There's a free tier and a paid tier, and both help keep the show going. Follow us. On socials at my DPC story and find everything from episodes free resources, the DPC Toolkit Magazine, and more@mydpcstory.com. My DPC story is created and hosted by me Maryal Concepcion. A huge thank you to the team that makes this show possible. Chief Growth Officer, Keira Hanselman, head of Marketing and Strategy, Nathalia Highland and Chief Operational Officer Alexander Gobble. We are all in your corner. Until next time, this is Maryal Concepcion.