Sustainability in Direct Primary Care: Building a Medical Career That Actually Lasts

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When most physicians hear the word sustainability, they think about keeping the doors open. But after a weekend with more than 80 doctors at the California DPC Summit, our host Dr. Maryal Concepcion came away certain it means so much more. In this episode of My DPC Story, five voices from the Direct Primary Care community share what makes a medical career, a practice, and a life sustainable.

The throughline is simple. Healthcare becomes sustainable when the people providing the care are allowed to thrive.

You will hear from:

Dr. Deepti Mundkur, My Happy Doctor, nearly six years into DPC, on how continuity and deep patient relationships became her real measure of sustainability, including watching patients need less medication over time.

Dr. Shannon Connolly of Open Arms Direct Primary Care on how community and physician innovation build confidence, and why scaling DPC looks nothing like the venture-backed version.

Dr. Dedra Beckles on knowing your worth, protecting your energy, and why boundaries are not optional if you want to keep showing up with joy.

Dr. Grace Hassell on authenticity, presence, and a powerful highlining metaphor for becoming the doctor she wrote about in her personal statement.

Noreen Gutierrez, RN, on building sustainable teams through head, heart, and hands, and her five Rs for clinic culture.

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Keywords: direct primary care, DPC, DPC physician, physician burnout, sustainable medical practice, California DPC Summit, Illinois DPC Summit, membership medicine, family medicine, My DPC Story

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Transcript

0:05

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, Maryal Concepcion, 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. Welcome back to My DPC Story. This month's theme is one that means something a little different to everyone you'll hear from today: sustainability. When most people hear that word, they think about business. They think about keeping the doors open or making the numbers work. But after spending a weekend surrounded by more than 80 physicians at the California State DPC Summit, I realized sustainability is so much more than that. Throughout this episode, whenever you hear us refer to the summit, we're talking about the California DPC Summit, which took place in the beginning of June. What struck me most wasn't simply that people were learning how to build successful practices. They were learning how to build sustainable careers, sustainable relationships, sustainable teams, and ultimately sustainable lives. Again and again, I heard conversations, especially in our small group breakouts, about rediscovering joy in medicine, about creating space for authentic patient relationships and supporting one another as physicians, and also remembering why we chose this profession in the first place. Every guest you're about to hear approaches sustainability from a different perspective. One talks about sustainability through long-term patient relationships, another through physician innovation and community, through knowing your worth and protecting your energy, another through authenticity and staying true to who you are. And finally, you'll hear from Someone who reminds us that sustainability isn't just a physician conversation. It's something every member of our DPC team helps create. Together these conversations tell one story however. Healthcare becomes sustainable when the people providing the care are allowed to thrive. If today's episode leaves you wishing you had a community like this around you, I hope you'll join us. Registration is now open for the Illinois DPC Summit, and I'm excited to share the, My DPC Story team is already working on the next state summit Tennessee So with that, let's get to the episode our first guest is Dr. Dipti Mankur, known to many as my happy doctor. Nearly six years into her direct primary care journey, Dr. Mankur reflects on what sustainability really looks like after building deep relationships with patients over time. Her story reminds us that success isn't measured by how fast we grow. It's measured by how deeply we're able to care Dr. Moncur, it's so good to see you again, my birthday twin. This is live time debriefing, but I would love to hear about your experience as a person who's been in DPC, going on six years. We've just come from the second annual, of which you've participated both years so far California DPC Summit. So tell us about, the importance of this conference, especially because we're talking about the state that you and I practice in. And I think that this is... The reason I wanna talk about this especially is because every state is different, and I think that, that, that this is why I'm so passionate about bringing these educational options to all the different states thank you for having me there, Maryal. And this has been amazing for, on many fronts for me. Number one, I was... every practice goes through ups and downs in terms of new patients joining, some patients, leaving. And so this was something I was looking forward to no matter what happened to my, practice and how it, how it worked. I was, I was just looking forward to meeting all the DPC doctors and just being, in a place where I, I can find like-minded people and I can, I can share the goods and the bads that happen with the practice and, and feel like I, I'm heard. But what was very interesting to me both times, but this time a lot more, was there was so much energy at the conference. It was palpable. There was nonstop just kind of, everyone's face is lit up about different talks that we're having or all those cute bags you made for everyone with things that they can write in it and amazing, amazing energy. I have been to conferences before, and mostly they're very kind of dry and generally very, very what do you call it? There has to be a word for it. But ma- mostly something that you just kind of go through for the CME or, just, just kind of, listen to and almost like lectures. But there was passion. All these doctors were so passionate about l- you know, trying to find a better way to care for patients and, and so excited to see other doctors who have already done it and learn from them. I definitely think it was, like, 50% better than the last one, so I can only imagine the next ones get, even better over time. 100%. We had our debrief meeting and plan for next year. And I will say, one, if you're in California if you go to calidpc.mydpcstory.com, you can actually get your ticket, and they're on sale at early bird prices for next year. But also if you're out there and you're like, "I would love something in my state," go to the contact page at mydpcstory.com and just send us an email and we we're in the talks to have different state summits into next year. So, so definitely consider that. And I will say, you're touching on this, but I think one of the big things is that palpable energy, I think was very much rooted in hope that a medical career and one's person are both sustainable going forward. Yeah. And I'm wondering, what, what did you see in the thread of people, starting out on Friday and then leaving on Sunday? 'Cause I thought it was like a very different weight. You could feel the weight on Friday, and it was much lighter on Sunday. Yeah. Yeah. No, absolutely. I think coming from a place where they show up in the clinic and there's all these office managers and other staff just pushing you through one crisis so after the other, and one crisis after the other, there's nobody you can actually count on because you really, you are the person they count on all the time. I think here coming in, they were probably skeptical about whether this is actually gonna help them or not, right? First day, 'cause how many years have they spent in the system and not had anything this hopeful to look forward to? And so I could see everyone had super serious faces and like, they brought the serious energy. I'm talking about those other conferences, right? That serious energy was in there. And then you s- you did this amazing thing of starting the small stations in the beginning, and so everyone kind of opened up. Opened up about how certain programs promote DPC, how certain programs look down upon DPC, and I had never heard of that before, right? I, I was very, very shocked in that moment that there were doctors who were having a membership model who came and spoke at the programs and somehow- No, no one at the program and other peers were not excited like this one person who attended this conference. So it was very interesting that we kind of touched on all these s- core things that people have w- worried about over the years, and now you, you are at the station right at the beginning of the conference, where you're pouring, all those things out on the table for everyone to kind of discuss. I think that made, that made the, the segue into the next few days, which really was amazing, where everyone just was like, "Okay, I know, I know you all have heard us." And the first day was more like hearing them and just not giving solutions right away, and just kind of listening and empathizing with how they're dealing with this. And so the next two days, it just... it was all, they were all ears. And, and some of the people who pulled me aside after, in between the, the talks were, s- attendees were just so excited about the fact that I said, "Every day feels like vacation." I mean, that was mind-boggling to them, because I'm not, I'm not paying for a vacation every day. But I'm actually experiencing just taking my own sweet time, like on a vacation day, where I can read a book and be somewhere, cozy, while still taking care of patients. And I think that that was finally the, Saturday and Sunday really got people to have that momentum to move forward. So they had this idea, they wondered if it was going to be okay, and then, and the second and third day really pushed it. I love that. And yeah, I definitely will say w- the way that, and, you know the way that our conference in California is built out, I, I... it was very much around this is your community in the state. Right. This is... if you are like, "I don't know what I'm doing," know that there's other people around you who are also either currently or- Yeah repeatedly or in the past have been like, "I also don't know what I'm doing." And I think that y- I, I do... that was one of the big changes we made this year, was that having the Friday session where we basically were, like, having cr- creating and reinforcing that safe space. Mm-hmm. And I do think that, that it made a difference in the way that people were interacting in the rest of the weekend, like you're saying. Yeah. Yeah. I wanna add, though, that one of the, one of the big things I noticed during the conference was, Everyone, everyone felt safe enough to ask all these questions because of the first day and how everything was kind of like small station, small groups so people could open up. Even though larger sessions were happening on the second and third day, they felt, pretty comfortable because they had already done that in previous day. And, and, and I say this because it's so, it's, it's such a different type of conference where we are empowering physicians to be not having shame about having a practice where you have to charge fees instead of a salaried position having to have talks with patients about your fees. And all of these things, somehow I felt like the sh- there was some sort of grooming that has happened over these years where people have been, especially, doctors, I shouldn't say people. Doctors have been groomed to not have to talk about money, not have to... when all we do is talk about how insurance doesn't pay anything. So, so it was very-- I think the, I think the takeaway from this conference for me was every- they have all the tools, and you gave them so many tools during the conference, but I feel like there was a, a sense of do, am I ready for this? Should I? When do I launch? What, what is a launch day? Would I be ready on that launch day? And I, I think the one message, if I didn't get a chance to say it enough during the c- during the actual conference, is m- kind of saying that all of us are still figuring it out Still figuring out how this process works 100%. And I think that also, to me, that's why, yes, we have a stage, quote-unquote, but at the same time, when we start out where we're all sitting in the living room, and thank you so much to Dr. Emily Scott and Dr. James Gore for letting us use their amazingly beautiful house. Absolutely. But, when, when you realize that yeah, Dr. Moncur may have opened a couple years, five years plus before you, but she's still human, and she still has frustrations- Yes and she still has wins. Yes. So here's a question, because in June we're focusing on sustainability, and absolutely people were asking you about sustainability. But i- in your practice, I'm wondering now that you're looking back, and we're gonna do your, your six reunion coming up, I'm so excited about that In a few months. Oh, it's so, it's awesome. Yes. But I'm wondering in terms of sustainability what were the things that people were asking you about sustainability that, you know or you're still figuring out today that you, you kept hearing over and over and over? Because I'm sure with the listeners, there's people out there, even if they're open, that are asking just sustainability related questions. Yes, absolutely. I think the, the biggest one with any business, right, is to make it to the third year mark, and then you know you're kind of... I mean, it's just kind of like an approximation of how businesses can be predicted to be successful or at least be sustainable. So I feel like up until then, up until the three-year mark, you're still adding more patients on. You're having all these meet and greets. You don't know if they're a good fit. You're trying to figure it out. At this stage in six years in- Like literally my conversation today was with a patient which would have been so different when they first joined in 2022 versus now. When I bring up this really sensitive topic and something that they, you know, they, they don't feel comfortable talking to doctors about, and I, I tell them that, "You've been with me this long, and I feel like I can talk about this." And, and this patient goes, "Yes, Doc, five years of being with you," or whatever, "this long that I've been with you, four years, you've, you absolutely had my back, and you've told me all the things. So I don't know why you would-- why, your recommendation now would be any different. I would still absolutely agree with what you, you have planned for me." And I think that is huge because now I'm starting s- I'm starting to see within six years, I don't know if I told you this, Dr. Concepcion, but literally the last three years of effort on patients, working on their lifestyle, their health, their well-being. Some of them retired from toxic corporate jobs because they made enough, but they were giving too much of their soul and themselves and having too much, stress levels that obviously we know have downstream bad effects to your health. And so these people are now needing less medication. Less medication. I mean, I have never in my life, throughout the training ever had to reduce medications for patients. And that, to me, I don't think there's anything else that e-explains sustainability more than that, right? If you're seeing results where p-people are actually getting healthier, less ER visits th-this doesn't h- become a statistic anymore. I'm actually seeing it happen. And it didn't take a lot of effort. It was just continuity, which is lacking so terribly in the system. So continuity, access, but there were a few, there were a few at this point in six years where I feel like there were a few patients that just wanted to be using me as a sounding board and really not taking up any of the recommendations, and I had to let go of some in a very gentle way, tell them, "Hey, I don't know if this is working. You probably would need a doctor you would trust better." And do I say that's poor for my business to let somebody go, let my fee, one paying member go away? The whole s- her whole practice is designed around the patient being first. So if they're not improving, and I don't see them improving last three or four years because something about my relationship with them is not al- allowing that trust to build, I have to let go of them while still sustaining my practice. And so it's amazing that I can still do that and, and be able to keep the practice going, and I feel like that is a blessing, and I'm so grateful for that moment where I've reached this stage. And I know that all these doctors who are trying to start out, it may seem surreal that, oh, you- you're actually telling a patient that it's not working out. But it, but it's crazy that you can do it I get, uh, shivers in my spine when you, when you are talking there because, when we, when we think about sustainability, number one, people think financial sustainability. But I love how you've painted that sustainability is building a practice that is, built around you the doctor, you the person, who is the caregiver in the situation, and the person who, you know... It- it's the relationship that is- Yes the answer to sustainability. It is just like you said, the access, the, the continuity. And it's not This is why I- I'm, I'm so grateful that you're saying this because it, it pushes people's thoughts beyond financial sustainability. I have to be financially sustainable. Yeah. Yeah, because I, I think the money would come in anyway f- especially with my design of practice being lean. But the l- leanness allows me that comfort to be able to onl- you know, kind of keep the churn low because I'm picking the, the patients who are a good fit. If someone says, "Why do I need you if, if I have insurance?" That's not a meet and greet I wanna even s- engage in because they are, they don't even know what DPC is. I'll probably explain it and leave it at that. And every meet and greet ends with no pressure, only if you think this works for you. And I think that is helping downstream now. Because if I had just given discounts over discounts and people just felt "Ah, this, I should lock in this discount and join with this doctor," and they don't have a good fit with me, it was just because they thought it was financially a smart move whe- when they can't trust me with the rest of my, recommendations and stuff. I think it made the core principles of the practice from the beginning, even though they were very tight and a lot of ma- many DPC doctors might have thought, "I don't know if she's gonna do well if she's so lean, not taking m- many, not marketing, not doing much." Just keeping my identity on social media, keeping my personal brand growing gently in the background, like my Happy Doctor T-shirts and this and that, and I think that has driven, that has driven the sustainability, not so much anything else that I can think of. I got so tickled every time somebody said to me, "I cannot believe that my Happy Doctor's here and I got to meet her." And I loved it so much because they see my Happy Doctor playing pickleball. They see my Happy Doctor, having her own Rub- Red Bubble store and having amazing watercolors. I, I think that that the, throughout time, I mean, e- even if you just go back to the Facebook posts around when you opened your posts are not all about DPC. Your posts are about DPC- Talk about it sure, but they're about Dr. Mankur. Thank you. That means a lot to me, and it's super humbling because- I mean, I've portrayed My Happy Doctor as all the, all the stuff that I want to be, and this is the idea of me and my practice that people have that, that's making them so excited. I don't know if everyone who knows me f- all through my life would be as excited, right? But what I mean to say is this, this experience where I'm, I'm kind of putting myself out there is very hard for people. Some people are introverts. They don't wanna, kind of put themselves out there. But it can be something very freeing to just figure yourself out. I feel like the whole journey through My Happy Doctor was less about my practice and more about figuring out who I am and what I want to do with the time that I have. Like literally today there's this chronic pancreatitis patient that I'm, helping, and I could see that he, he, he lost his wife a long time ago, and it was very hard for him. And now that he's in pain, he would lift 250 pounds or something at, in, in his late, late 70s. So he's a very fit guy, and he's trying to, he's trying to live a happy life, and now suddenly this disease is hitting him. And so we're trying to navigate that, and while doing that, I can see, I can see the way he communicates now with a little more sadness and a little more... And so when I met him, I told him about this book I'm reading, and I was like, "I think you should read this." And, it's, it's got this energy. I don't know if you've heard of this book. It's The Dragon Rider by Taran Matharu, and it, it, it's got this, It's got all these sci-fi, fantasy, historical fiction ideas of soul breathing, and your soul bound to this creature, which is, it's kind of like a mix of Harry Potter and Game of Thrones or whatever. But this, this patient is suffering from a situation where he, he's, he lives alone, and he, his family is busy, and he, he, he may not have a lot happening right now because he's physically not able to due to the condition. He heard the whole audiobook, and he's, he's finished the second book. I haven't even started the second book. So it's like he gives me updates about his health, and then he adds, this, this soul breathing thing sounds very hard, but I'm, like, totally, into it, and I finished the second book." And I think that is, that, that to me is something beyond what I would have ever been able to do in the insurance model. And six years of this, this feels almost normal now. This feels like a normal thing to have a conversation about with your patients. One of the themes you'll hear throughout today's episode is that none of us build sustainability alone. It grows through community. Our next guest has experienced exactly that. Joining us next is Dr. Shannon Connolly, co-founder of Open Arms Direct Primary Care in Southern California. Dr. Connolly shares how surrounding yourself with like-minded physicians creates confidence, sparks innovation, and reminds us that we don't have to reinvent healthcare by ourselves Dr. Connolly, not only were you present with us, like Dr. Amunkora had mentioned, at our Cali DPC Summit, but also, you were in the audience geographically close to where you practice. And I absolutely loved saying, Who has a DPC doctor in this room, and why are you not all seeing Dr. Shannon Connolly?" Because if I were in Southern California, I would as well. Uh, and I'm just wondering looking at the sustainability of your practice, the thoughts that you and Shane and Amy have had, the discussions where you guys talk about things as a team, how was your sustainability, h- how was your DPC can be sustainable because changed, morphed, impacted by being around other doctors who are just as passionate as you are and as passionate about spreading DPC to as many people in this country as possible? First of all, I really appreciate the shout-out at the summit. It was lovely to have that kind of support. But also it was lovely to be in a community of other DPC doctors who are from my community. The great thing about DPC is that everybody is so supportive of everyone else, and there's never this sense of competition. There's always a sense of, like, a rising tide lifts all boats and that is something that's so rare in medicine. I think that there's something uniquely great about being with other people who are practicing direct primary care in my community or in my state because there's a lot of i- kind of unique idiosyncrasies to the laws and regulations of California, and also just the, landscape, the insurance landscape that exists in my community, which is very HMO driven. And so there's a lot of kind of very specific considerations when you think about, marketing to patients or just explaining our value proposition to patients. So it was really helpful to be there and see um, what people who are more, you know, further along down the line developmentally than I am kind of how they were approaching those types of conversations. And even just seeing the language that they were using, like they were modeling "Here's how I discuss this with my patients," and I was like, "Oh, that's really helpful." I was writing notes a mile a minute um, just to make sure that I was capturing all of this like, wisdom that was getting dropped left and right. So, it was really very uplifting, and it really helped me feel a lot more confident in the long-term sustainability of practice because I could see people who were being successful at it in the room, and I thought, "Well, I can do that, too." And I love that because I do think that, just throughout the history of My DPC Story for me, for sure, it was a way that by talking with other people, it was wind in my sails. Mm-hmm. And I definitely get that feedback from many people that the stories help because you can relate to the people who are talking, who sound like you, practice in a place like you- Mm et cetera, et cetera. But I do think about when it, comes to hearing people talk about how they talk versus feeling less gun-shy about this model is gonna work, I'm wondering what in addition to they've been open X amount of years, months, et cetera, what was like, "Oh my gosh, I feel so much more rooted in that Open Arms is going to kick ass in Southern California and beyond"? I think some of it was getting access to the actual nitty-gritty logistics. So like- Deepthi, the, the Happy MD, like she literally gave us out of a piece of paper that was like, "Here's my budget. This is when I hit breakeven. This is what I charge per patient. This is how many patients I had." And being able to see something like that on paper and be like, "All right, this was this person's plan, and it worked out really, really well for her. Can I now recreate that?" That was really helpful. A lot of people shared information about, like what they're paying for their EMR and how they decided on, their, membership fee and whether or not they charge a registration or enrollment fee. And so when you're able to speak to people who have tried all these things and maybe, shifted course from what they've learned, but they're all very willing and very generous to share their, knowledge, that was really, really helpful. And so, everything from pricing to who you selected for your malpractice carrier to, how much money did you spend renovating your space before you moved in or, you know, I, think just hearing people's real-life experiences because you, can sort of imagine it all and even make a million spreadsheets and, try to create it, but like until you're actually doing it, there are so many things that that you just wouldn't either think of or just might not just even on- be on your radar. But having someone say "Hey, this little bit tripped me up in the beginning, and so I had to shift course here. And so here's this information that now you don't have to get tripped up on the same spot," that was really helpful to hear. And, and that kind of practical information was very valuable, especially in the context of the same market that I'm working in And you have two partners who are with you at Open Arms. There's always the you as the, individual are receiving information, and then you as the individual then sharing it with one or both of your partners. How did conversations get impacted after the summit when you talked with your partners about, the sustainability of Open Arms going into the future because you had examples, conversations, all of these things that you had been in, the, throes of during the weekend? Yeah. Well, it's funny, first of all, 'cause, because I have partners, I felt like it was so important when I was at the summit to take really good notes 'cause I was like, "I'm going to have to tell my partners all these things that I've learned." So I did take a lot of notes. And when we got back We meet regularly. Once a week we just have a meeting about kind of what's going on with the practice, and so I felt like I had a lot of things to share. For us in particular, we are very interested in exploring setting up a nonprofit. And so I, spoke to other people who have started nonprofits and I tried to share kind of what I learned, not just about, how it can be a really great model, but also some of the challenges of it and how expensive it is and what the legal fees are, you know, are involved. And so that kind of opened up a lot of conversations for us. But yeah, I think that- it's like these little pearls of wisdom that somebody just handed to me and was like, "Here's some pearls. Hold onto these." And then I got to bring them home and be like, "Hey, guys, look at these pearls I found at the summit." And, you know, to be able to share that with my colleagues has, really, I think, uplifted all of us and given us this kinda new jolt of energy and we already had a fire lit under us, but it kind of, built that fire even stronger because we're like, we can do this. All these other people are doing it, and doing it successfully, and they're not that different from us, and we also can make that happen." So. I'm wondering in terms of going into the future you already mentioned how you as a team meet regularly. I'm wondering other connections that you made at, the summit, whether they be in California southern, northern, doesn't matter, just in the state in general, people who think like you, inspire you. There were people who were there from out of state who- Mm-hmm we brought in specifically because of the model of their practice, like Dr. Esther Katibi has a nonprofit that she is excited to work with Physicians doing DBC all over the nation. I'm just wondering, like, how do you go into the future beyond your team at Open Arms to, uh, know and feel grounded in that you have community around you? Because I do think that that is, to your point of DBC can be a siloing experience. Mm-hmm. How do you look at- How you have created community, engaged with community, and built a network that you can go into the future you know, with. Because I- I think about for those doctors who they're not doing DPC because they don't want to be alone, I think that to me, the intentionality around that no matter what your thought is, in my opinion, I'm like, "Well, we've just burst that bubble." But I'm wondering, how do you look at community going forward? Because that also contributes to our mental, emotional especially, sustainability in addition to financial. Mm-hmm. During the summit I got so many phone numbers of so many other doctors, and we have been corresponding since then. And y- I mean, I'm always just floored at how kind and supportive the DPC community is. They're like, "How can I help you? What do I have? What knowledge do I have that I can give to you?" And that is just something that is so unique that you will not see anywhere else in medicine. Just this morning somebody who was at the summit texted me and was like, "Hey, I wanna talk to you about your EMR. Can we hop on the phone sometime?" I was like, "Yeah, no problem. No problem at all." At the dinner that we had I was talking with a couple of other DPC doctors from Southern California, and we realized that we really needed to have a more formal connection. And so right there at that dinner we created a WhatsApp group, and it has been super active since then. And I mean, like yesterday somebody was posting that they were selling an InBody scanner, and then last week somebody else was like, "Hey, does anybody know of a great psychiatrist in the area?" And so we've been, like, sharing our resources, sharing our referral lists, And now we're like, "Oh, hey, let's do a get-together. Let's just have everybody come together for you know, drinks and we'll hang out." And it's half social but also half professional, you know? and so it, it's- really nice to see that there's a willingness there. There's really a hunger to engage with each other. and Only good things can happen from that, right? We're all helping each other. Something that I wanna ask you in particular because you and I are active and aware of this HMO heavy community. Mm-hmm. And not all states are like that, fine. But I do think that when it comes to policy, when it comes to ways that we can prove sustainability as a movement to others, I know you were very uh, actively involved because somebody uh, sitting next to you was like, "Oh, my gosh, who is that? Shannon is so lovely. She asks great questions." But the group where Jay Kees, Mm-hmm of the DPC Coalition, and also Dr. Feleskyu- Yeah um, were talking about, this model going into the future, and I'm wondering, what, do you want people to think about when the things come up about, "Oh, well, DPC is not sustainable because it is for rich people. DPC is not sustainable because you know, not everybody has an HSA." I'm wondering, what were your takeaways that you either discovered or had reemphasized about that this model as a whole is sustainable? Even at my nascent stage, I already have this little chip in my shoulder that is that like, we have to push out a narrative into the community that DPC is for everybody. And if we are unable to be successful at, making that narrative, we will always have a perception problem, right? And so I'm always interested in engaging with people who are into thinking creatively about "How do we make this happen?" And I was really excited to talk to Jay and Phil about things like public-private partnerships. What would a demonstration project look like? Where is there a community that would be a good proof of concept for this? And, who would we need to engage? How do we bring in, elements of organized medicine? And I know organized medicine, a lot of us are like, "Oh, we've just walked away from organized medicine." We're gonna have to learn to play nice with some of these entities so that we can demonstrate our value because We can save the healthcare industry so much money by providing high-quality primary care. But the source of that money may or may not be able to come from our patients, right? And so if we are able to capture other programs, other public-private partnerships-- I mean, kind of like what you're doing, Maryal, you, like at where you are. Like, you're, you're doing it. We have to have more and more projects like that where we're saying like, you know, a, DPC is taking care of, all of these people who wouldn't otherwise get care in a maternity desert because they've, contracted with the local, health department or, whatever it is. Like, We need to push forward more and more things like that so that we have a leg to stand on. You know, When we go into policy spaces and say like, "DPC has to be covered," we have to be able to say, "Well, look in this community where a DPC has filled the gap that Medicaid couldn't fill because, we were able to deliver care in this particular model." So I get really excited when I get into rooms full of people who are interested in that. I mean, I'm also really excited when I go into rooms full of people that are just like, "I just wanna, take care of me and my 300 patients here." That's also really awesome. But, when we start thinking about scaling and how do we scale like, I don't think we're gonna scale like one DPC practice at a time. We're gonna have to find sort of systems-level ways of scaling. And so I get really excited when people wanna talk about that it's so painful. Somebody just asked me like, "When are your patient stories coming out?" I'm like, "This... We're working on it," but it's like I do think that absolutely, like the scaling is not the traditional way that we talk about scaling in terms of- building something that VC's gonna buy. The scale is the more people who have the ability to deliver this model of care, and the number of people who get access to this care. It's beautiful. Yeah. And, um, to your point, and, uh, thank you for saying that, if, you are new to the podcast, um The thing that we're doing in Calaveras County, which we are super excited about, is that I basically went to my public health department and was like, we can do care for people. How could we, fill in this gap of people, especially if they're uninsured, completely uninsured, or if they are in a, acute situation where they need somebody to write a prescription for Biktarvy?" That's the example I gave, during the summit. And so, It's random. in Calaveras County, we have a very forward-thinking, progressive, open to ideas team at public health. Not necessarily leadership at public health, but the team who's actually doing the work. I will say that they were so helpful in getting a grant to basically make it such that if somebody doesn't have the, funds to have insurance or they've lost insurance, whatever their issue is that's causing an acute issue that they need care for, public health basically sends their information to us. We call them, and we're able to help people, truly standing by that we do not discriminate based on what insurance a person does or does not have. And so by looking at scale as how many people can access this so that it just becomes primary care, I think that that's what is always fueling my sails with the idea of how is this a sustainable model? Yeah. Totally. Yeah. So, you, Dr. Poulin, Dr. Tressin are all talking at the statewide summit for California this fall. And I'm so excited. One, I will say, because I was like um, I sit on the education committee intentionally 'cause I was like, "Where's the representation of direct primary care? I'd like to ask that," or any independent practice. And then you guys are now having a very intentional placement in the program. I'm wondering, because you are going to be in front of people a lot of whom are still in training- what do you think are the most important things for a person who is, at a, corporate or VC-funded potentially, or even community model. What do you think is important to share with these people in training so that we can change perception earlier on in those individuals? My hope for the DPC movement is that the, types of doctors we attract are the innovators, the kinds of doctors that are like, "I wanna try something new. This system is not working. let's turn it on its head and try something completely, different." Physician innovators I think flock to DPC because- At a, small scale, you can try out a lot of different ideas. I think of DPCs as think tanks or like, incubators for ideas of like, "Well, how do we do it differently? is there a way to do this better?" And those are things that are really difficult to do at large organizations. If you work for a health system that employs, 10,000 people and takes care of millions of people trying to implement a new program, you might go through literally years of bureaucracy to be able to do your tiny little pilot project. Whereas in a DPC practice I can decide on a Friday, "I think on Monday I'm gonna start doing something different," and then just do it. I mean, obviously thoughtfully and carefully and, you know, with appropriate planning, but the types of barriers that exist to innovation just don't exist in DPC. And so I hope we're able to attract the brightest brains, the people who are, a little bit countercultural, the people who are like, I'm willing to start my career by saying this entire system is just messed up and isn't gonna work for our society," and like, the people who wanna immediately work on those problems. And so that's what I'm, hoping. I hope that there is a resident out there somewhere that's gonna hear our story and be like, "Oh, wow, there's a totally different way to practice medicine, and maybe that's more consistent with my value system, and so maybe that's something that I'll try." I know it's hard. The entry into DPC is a big scary like, jumping off of a cliff. But for those who wanna fly that's the way to do it. And so I really hope that we will be able to put forth that idea while, telling our own story. This isn't just a story about burnt-out doctors needing a different job. This is a story about like, physician innovation and I would like to see that the future of healthcare changes as a result of the DPC movement, and not just for DPC doctors, but for everybody. I think of DPC doctors as the, sort of independently thinking people who, kinda stand up in protest and walk out of the room and say "I'm not doing this anymore because it's not sustainable. It's not ethical. It's not consistent with my value system as a physician." And, I just wanna provide awareness of this other possibility that, is gonna be great for some people. I realize DPC isn't for everybody, but for the right person, DPC is like-- liberation in medicine thank you so much, Dr. Connolly, for sharing this little update, tidbit of an update even compared to when you guys opened. This is awesome. Thank you. Thank you. Yeah, it's been such a pleasure, and thank you for all of your support and kind of role modeling what is possible, and also getting our POP session, thank you for that too. Community gives us courage, but courage also requires something else, believing that we are worthy of building a different kind of life. Our next guest speaks beautifully about that journey. I'm excited to introduce Dr. Deidre Beckles. Dr. Beckles brings incredible energy to every conversation, but underneath that energy is an important reminder. Sustainability begins by valuing ourselves just as much as we value our patients. She shares what it means to create boundaries, protect your purpose, and build a career that allows you to keep showing up with joy. You've been open 18 plus months now and I'm wondering, when you look at the practice that you have built, the patients who you take care of one of the things that you and I have talked about before is that DPC can sometimes be isolating and it can feel like you're in a silo. And I'm wondering, how do you address sustainability when sometimes those feelings can pop up? For the first few months, I was, like, waiting for the shoe to drop. I was like, "When is the shoe gonna drop? All the patients who have joined will certainly cancel. Next month is the month they're gonna cancel. Yep, they're all out of here." And didn't happen that month, and I'm like, "Well, nobody else is coming. Nobody is coming here." And so I think the thought of like, sustainability had to begin with me. It was like, "Deidre, you have always given so much value to your patients." Those who know that value are the ones who stayed immediately, right? That, that first 100 patients were just patients who stayed from my private practice and were like, "Not going anywhere. Need to get in before your panel closes." And then there were those who went out and saw how ghetto healthcare was out there on those healthcare streets, and they came right back. And my whole... I would tell them all the time, "Honey, the porch lights will be on for you because you will go and you will see, and you will come back." But it definitely had to start with me being like, "You give value." And whether you start with 50 and end with 300 in six years, or you start with, 20 and you make it to 300 in a month, you will still keep giving the value that you give. And while you give that value, honey child, get your value back. So if you don't have patients tomorrow, you sure as heck better go to the beach and do the yoga. You better go and have an ice cream date with your husband. Because sustainability is... I- it's so many things. It's right, yeah, I need to be able to afford life. I need to be able to... This practice, the doors have to stay open. But also, what I started to feel in the regular medicine space was this was not sustainable for my life, for my mental health. And I'm in medicine for the long game. I love healing. I love medicine. I love my patients. So sustainability has to come in both ways. I have to be able to keep this business open, and I have to be able to keep my life healthy, whole, free, et cetera. And when I started looking at it like that and placing value on my own sustainability, it just necessarily fed into the fact that, yeah, the patients are gonna come. The healing will happen, right? Heal 100 until you heal 300. Actually, now I'm like, "Maybe you just wanna heal 200. Close that panel at 200, girl, 'cause you like these days. You like the sustainability of self," right? And so using opportunities to be like, it's okay that you're so siloed off in your office, because guess what? You get to have one, two, three days a week off, and then go find your people. Be with your family, right? And then go to the big DPC, you know, summits and meet your cousins. Listen, do the things because it doesn't just have to be medicine anymore, right? DPC has made it so that it doesn't just have to be medicine and clinic days. You're gonna get all of the things in the outside world, 'cause now you have time and space and opportunity to do that. So that's what I love. That's what I love I love, just the mention of time and space and opportunity when it's so tied to sustainability because you're recognizing, honoring, leaning into and you're not ignoring or you're not feeling guilty 'cause you can't honor those things anymore. And I think that it reminds me of, the glass is half full versus the glass is half empty. But I think that, this leads me to my next question, because it, was so wonderful to see you in Newport Beach at our California DPC summit. When it comes to, you having community now physically around you, you had people who are co-residents in the space with you talking and learning and doing all the things. But then you also have this, statewide set of cousins that is just expanding, and I'm wondering, did you discover or find yourself sharing over and over certain pieces of sustainability that either you hadn't thought of before or inspired your thoughts on sustainability or that you were like, "I can't say this enough because this is what sustains me, and you didn't think about that- For sure but now I'm telling you"? the, like, little nuggets and the pearls that I got and that I gave were... what I gave To everybody. And I, I would pray before I came "God, just whatever it is that you want me to do and be in this space let me be that. Let me not just come and be a consumer," right? And so what I found myself giving a lot to people that I just felt was really valuable is um, I became a mom at 15. I don't know if I've talked to you about that. But I'm like, "Deidre, you have always started before you were ready. You, were ready before you were ready always," right? Before your time, ma'am. and so that was in me. I found myself saying that to people a lot. You don't feel ready, but you will not even know the readiness that you have until you start. So launch, so pivot, so jump, so do the things. And so the cousins that I've stayed in touch with, I'm texting them. I'm like, "So what'd you do this week to get ready? Tell me how you've launched this week." And I found myself just trying to encourage people that this life, you can't even envision the beauty and the space and what the space is gonna mean to you and your patients and your family and all the things until you jump and get in it. So don't spend so much time trying to get ready. Know that you're ready, make the leap, and then, the rest will follow. And find the things that you need to find along the way, and they will continue to come. So that is what I continue to tell people. And then I feel like on the other end of it, what I got a lot that I needed is, you know, from being a mom at 15, I mother everybody. I don't care if you're 100 years old and you're my patient, I am your mom. Come here. Come here. Let, let Mama hold you, and then we're gonna talk about your blood pressure, right? So I mother so much and I pour so much, and sometimes the boundary between mothering and doctoring, it gets blurred a little bit. And what I found was that there are pieces of me that has a really hard time setting boundaries. Like, I can call a thing a thing and, I can be a straight shooter, but where it comes to boundaries, and Cousin Julie said this best. I might call her Auntie, actually, at this point, because she gave some auntie wisdom. You know, I was like, "How do I get out of the room? Now that I'm giving them an hour, they want an hour and a half." She was like, "But do you value yourself? How do you value yourself? And what do you tell yourself as it relates to the value that you're giving? Do you tell yourself it needs to be an hour and a half, or do you tell yourself you're giving good stuff and they get an hour?" And so for me, I would not be able to be sustainable as a DPC doc. I started getting weary and burdened like month three in, right? Because people were like, "Oh, you said we can get an hour. I want an hour. Maybe I want an hour and a half or two hours," right? And they don't say it with their mouths, but they say it with their posture. And then I allow it by not setting the boundary, and so it becomes a is this then gonna be sustainable, right? I knew that corporate medicine wasn't sustainable and I knew 3,000 patients wasn't sustainable, but, ew, is 150 even sustainable if this is the way that I'm gonna pour? So what I got from that and, when I would talk to people is like, really your sustainability of yourself in the space is not going to be there unless you put the appropriate boundaries in place. So girl, I went on Amazon, I ordered me some clocks for my rooms. And I sent Jennifer, you know, the clocks, the links that I ordered. Jennifer sent me back a text and said ordered the same clock. She sent me a picture of her clock in her room. And I think just pouring into each other in that way and validating that we all feel this, right? We are the docs who pour love, who pour all the things into the space, and we can pour to emptiness whether it's 3,000 patients or 150 patients if we don't check ourselves and continue to recognize the value that is in us. So yeah, those were the things. Those were the things. Thank you so much, Dr. Beckles, for sharing today about sustainability- You're welcome from your perspective. You're welcome. Thank you for having me. I loved this. This was so great. Once we begin valuing ourselves, another question naturally flows. Can we truly bring our whole selves into medicine? For our next guest, the answer is yes. Next, you'll hear from Dr. Grace Hassall. Dr. Hassall has another unique perspective you'll hear today. From both medicine and her passion for highlining, she shares a powerful metaphor for finding balance, embracing authenticity, and becoming the physician she dreamed about long before medical school. It's a conversation about sustainability, not just in practice, but in life. One of the things that I really was excited to ask you about, especially because you shared this with me when we were in California but when we're talking about sustainability, there's definitely ways to be sustainable in your DPC. But I'm wondering if you can talk to us about the sustainability of medicine as a future career. Because what we were talking about was heartbreaking, but also knowing that that was a past experience and how you got into this DPC space was so moving and so heartbreaking at the same time. So I'm just wondering if you can talk to us about sustainability of medicine as a career based on your experience and how that brought you into the world of DPC. Oh, yeah, absolutely. And I, I'm pretty sure on the little cards that you gave out that we had to write the words, I think one of my words was sustainability for what I was hoping to get just out of DPC and the conference and just because of, kind of the journey I went through in medical school. And yeah, I feel like for me it was pretty early on starting clinical training in medical school, and it was during COVID too like a big safety net hospital in Miami. And I had started medical school so excited and so idealistic, of course. And then it was, like, this creeping feeling that kept coming up the further I got in my education and training that was really crushing like, this feeling of, "Oh, I don't know if this is going to be sustainable for my soul. Like, I don't know if I can have this lifelong career taking care of patients in this way that I pictured and was so excited about." And a lot of it was just, I think just seeing how our medical system was failing so many patients that I really cared about. And as I learned more medicine, I was also learning wow, there's all these ways the system makes it so hard to do like the one thing we're here to do, which is take care of our patients, have good relationships with them, empower people to take care of their health. And so it felt like this sinking in my heart, like day to day, these little things, like I remember the first time I read or heard about moral injury, I was like, "Oh my gosh, that's what I'm feeling." Like just in all of these ways every day, and it was just this feeling of as I'm learning to be more efficient or like how this works, I feel like I can't both be myself and take care of patients and work within the system, like follow these rules without totally losing, myself. And I had already invested so much time and energy, and I was... just really scared every day, looking for something like, How am I gonna figure this out and make this work?" Because I knew I really wanted to do it. I just wasn't, seeing that in the hospital. I wasn't really seeing it with the doctors I worked with. A lot of the doctors I worked with that were kind of giving the kind of time to their patients that I wanted to give they were also like really burnt out and Not able to have good, I think balance and alignment in their personal life and with their values. I don't know if that makes sense, but It totally does. And I think that as we're talking you're outside of Winslow, Arizona on this outdoors trip, and you're doing, something that you want to do, and I, love that you have the time and space for it. I will say that it really hits home when you talk about you you invest so much money absolutely, but time and effort and, sheer energy into the field of medicine because that's what all of us have come to this world, in whatever way or form we came to medicine. There's a lot that goes into that journey. And so, when you talk about that, you were starting to notice this, In my head I think about how smart you are of a person to even pay attention to yourself because I don't think I paid attention to myself when I was in residency or in medical school. I was just paying attention to who I had to get through on my census. And so, when you shared that with me, I thought that was so amazing. It makes me think of also when my dad had his stroke in my third year of medical school. I was like, I don't know what's gonna happen. I don't know if I can take time off. I don't know what's gonna happen at graduation or Match. But I don't care 'cause I have to go take care of my dad." And I ended up, matriculating with the next class for residency, graduated remotely seven months late. But it's like at the end of the day, it was that moment of I don't even care. I just can't do anything but focus on my dad. And so this idea of like,. You cannot take care of others until you take care of yourself is so true. So well said, and wow, that's so powerful to hear. I'm so sorry that you went through that during, medical school too. Yeah. I mean, that's one thing you can count on is that life will throw you all these curve balls, but man, as we have just come from our California summit, it's like, when I'm losing my mind over, nitpicky things in the system of healthcare that we have dominantly in this country I'm very grateful that whenever crap happens, I'm always like, Who can I talk to who might know the answer as to, like, how to brainstorm through this?" Because even older people, older patients talk to me now about their child has passed away who's 65 I'm able to empathize with them in a very different way. Totally, never asked for that learning lesson of how to gain that empathy, but it sure as heck helps me slow down sometimes and think about like, there's more important things in life than money Yeah, It's like our humanity and finding that in everything, including like our roles in medicine too because we're taking care of humans, and we are humans. And I just definitely know what you're talking about when you're... Yeah, how it was in third year. I went through a similar thing, and I was I had a really unexpected loss and death in my family and was grieving, and I felt like my first reaction was almost annoyance or this feeling like I can't take time to slow down. I can't check in with myself. I just have to keep going. And then of course we're human, and we realize, like you said, life happens. And I think being able to check in with ourselves and take care of ourselves, connect with other people is at the end of the day what keeps us all going. And having that lesson, I can't imagine how that impacted you, early on in your training. Because yeah, for me being forced to slow down like that and think about myself it was, hard. Like I felt really guilty. Like you're just not supposed to do that. That doesn't help you get through. It's easier if you don't check in with yourself and you just don't even have time to think about how you're doing or how you really feel about things and, or notice those things. But once I did, I think it just, it really helped me because around that point I think during third year after I had tried pushing through, pushing forward and then I just realized you can only do that so much. And it was like I just have to check in with things and what I really want and it was, I think, at the conference, I forget who said it, but he was saying he, Don D. P. Sir went into to we all wanna be like the doctor we wrote about in our personal statement. And yeah, I just thought about who that doctor was, and I envisioned, someone that takes care of themselves too and that's how they take care of their patients is a reflection of that and I think I, in my free time, I am a highliner in my personal life. I do I don't know if you know what that is. I don't. I don't. so it's kind of like a tightrope, but it's like the have you seen a slackline before? Yeah. So it's that, but like really high up and across huge canyons and mountains and stuff usually. Or- So, the person who traversed the Twin Towers with a I think it was in the '70s, this person was not supposed to, but he like, threw a line between the two buildings and then had a pole to help him balance. But he walked across the Is, is that is that like highlining? It's really similar, except instead, I think that was, a tightrope, so a more static rope. And with a highline, it's a more dynamic piece of webbing. So you're, like, bouncing a little more, and instead of a pole, you use your hands- Wow and your own body to keep you up. But I just sent a picture in the chat to maybe give like- I'm checking right now. So where I was going with that, I think I wrote about that in my personal statement, I think for residency. Like, I had this idea of balance in medicine and wanting these Even before I knew what specialty I wanted to do, I always just knew the kind of patients I wanted to work with and the relationships I wanted to have with them. And, you know, I wanted to be able to just be with someone on their journey through all these different stages of their life and their health. And in my head, that was really similar to just what my personal experience highlining is like, just being really present and being able to be there and be focused. And I think that was what I had written about in my personal statement so long ago. And along the way, I kind of just lost that. I was like, "Oh, this isn't really how medicine is." You can only have 10 minutes and only see your patients every four months or, however long it takes. And it's just not quite what I imagined. And after the summit, from so much that I took away from it, I was so inspired that on Sunday after the last day I had my white coat and stuff in the car with me, and I was going out to High Line in Malibu, and I ended up wearing my white coat and my scrubs on the High Line. Because I just felt so inspired I feel like it healed this part of me that gave up on that and was like, "I can be the doctor I wrote about in my personal statement," and this can be, the type of presence I have with my patients and the way I'm, like, there with them on their journey and overcoming fears and challenges and just, I just felt so inspired after being in the room with you and all of these other doctors that were, like, doing things the way that... they probably envisioned when they first started out on their medical journeys. And Sorry, I don't have good words to even articulate, how much it meant to me. But It did inspire me to go out on the High Line like that, and I took these pictures. I was like, "I'm gonna use these pictures for my website for my DTC practice when I open up," because it was so cool to just hear you say that people want you-- in this model people want you to be their doctor because of who you are, not what insurance you take or whatever. And that was, like, almost By this point in my training, such a foreign concept to me that like, oh, I can be authentically myself in medicine, and that will actually like, help me. I was always just having to compartmentalize different parts of myself and for me, DPC really reflects this balance almost of getting to be myself and be aligned with my values and what I think is important in health and be able to like, bring that to the table for my patients When you clarified what highlining was my feet started feeling the tingles- because I am not a heights person, but how appropriate and how perfect of a, metaphor for alignment in your life is highlining. I can just imagine when you talk about you have to be in the moment, absolutely, because you're, most likely outdoors. I mean, I'm sure you've practiced inside, but just, being part of nature in a way that you can feel the wind I'm sure, like under your feet. And just feeling that, parts of you or a part was healed that needed healing in a thing that you love doing where you feel so present. I think that is absolutely like a breathtaking image that is just going through my head. I'm still waiting for your picture to come through the chat. I'm like, "Come on, I want to see this so bad." Oh, man. I'm- But I love, that you are gonna use on your website, 'cause when you said your white coat, I was like, "Website. Website. Oh my God. Yes." Yeah. It was like the last conversation I had at the conference. I was telling someone like, "Oh," like, I'm just, doing this thing," after they're asking about the rest of my day. And they were like, "I bet your patients would love that," or they just thought it was cool, and it's something I like, never talk about, you know- in the realm of medicine or in everything. And when they said that, I just, in my head I had this shift where I was like, Today's the day I decide to just combine those parts of me." That isn't a part of me I want to make small or separate from how I show up as a doctor. was like, "Oh, she's right." That's when I'm really brave, when I'm really present and resilient, and that is the type of attitude that I bring and aspire to always bring to every interaction I have in the room with a patient. And I had just never thought of it that way before. It never seemed like something that could be that related. The last time I thought of it like that was, you know, when I wrote my personal statement. But definitely coming to the summit made me realize just, how like these other parts of who we are outside of the job and just, how we sustain ourselves and our soul from whatever fuels us and whatever we love, I think that gets tossed around a lot, and a lot of stuff about wellness. But I feel like I was truly in a room with people who really value that and found this balance in their personal and professional lives, because they're just being the same person that they are. In outside of their jobs and in their jobs 'cause they're in this model where that is actually possible, which is just not possible, I think, in the traditional model, or really, really hard at least I think that this is one of the biggest things that I really appreciate having a smaller focused summit that is really heavily focused on networking and meeting each other in community rather than presentations- Yeah. Yeah of lectures. And that's just my own, bias, but I do feel that when, just like you're sharing, the whole do one, see one, teach one, we've done all of the doing in medical school, in residency. When you get to see one and teach another about you as a person and how you matter in medicine and how that story stays with a person, it stays with our patients for sure. I will say that, as you continue on your DPC path, I, I guarantee you that you will be reaffirmed on that your patients are finding you because they want you. I cannot say that enough. I mean, my patients remember every time well, not every time, but like yesterday I had a patient who was asking me about, I'm really scared to take new medicines because I had a really bad experience taking medicine. Maybe, you know, seeing an- another specialist, maybe they'll be able to convince me. I, I don't know." And I said to the patient, I hear you in that you're afraid of taking a new medicine. I completely think that that is a normal thing, and I'm really glad that you're sharing these concerns. I will say that, as you go and see your next specialist, you may feel so reassured and take the medicine because another doctor has said so. But know that no matter where you're at, if you have any questions, you can always call us. You know you can always leave a message." And this patient's been with me for, I don't know, 10 plus years and so, it's really wonderful to, even when you have a patient who they know that you left the system and you coulda chosen to stay but you couldn't do that anymore 'cause you really cared about your patients, it's really wonderful to even just continue to like reassure. And it's not 'cause you're doing it just so that they do what you say, they're their own person, but just the conversation of reassurance. For me, I find that is sustainable just because it's like, how you said, in four months. I can't... If you don't do this today, you're definitely not gonna do it in four months, and I can't tell you in four months to do this thing You need to do it now. And it's like when you don't have that stress of, if we're not gonna move the needle with cardiovascular health today, that's cool. Maybe we'll try again next time. But there's, less of a pressure to do it in such a rapid time. There's less of a complacency 'cause you can actually make a difference. There's less of a, "Oh, God, we're not at the 7.1 A1C yet. I'm not good enough." the administrators tell me everyone has to have an A1C of 7.1. All of that goes away. And it's just to be in this community and to be reaffirmed of those things is so important for all of us. I mean, even myself going forward, because there are people who've opened before me, there are people who have opened not yet who inspire me as well. So I'm so glad to hear that, you had this further exposure as to what DPC is and can be Yeah, It's like the best exposure I could've asked for. And I think exactly what you just described it was just kind of this gnawing feeling I had in my head, and especially since I first found your podcast in, during my year off in medical school, and I was like, "Oh, wait, there really might be a way," but I still didn't know a lot about it and I hadn't talked to anyone. Having these conversations with people telling me things like what you just said, how like, you're actually able to reassure your patients in that way and say i'm here for you. You can call me if you are scared of this or if we don't know, we'll figure it out together. We're here." You have this really collaborative relationship with your patients that I think just hearing you talk about that and just seeing that other people were doing that it felt like every late night, every struggle, every uncertainty I had just so far in the path, all the 24-hour shifts, I was like, "They're all worth it if I can just have that and be able to reassure my patients like that and show up for them in that way and actually mean it and not be like, 'Well, I don't know in four months we'll see,' or whatever." That just was never good enough for me. I'm so excited for you because as I think about, you on your Highline, I think about Adam Schulte in Yorba Linda, he was like, "I opened my DPC in a CrossFit because I wanna take care of people who do CrossFit." And I'm like, that's freaking amazing. And Dr. Gillian Klauke, who, does wilderness medicine in Sandpoint, Idaho a patient is going to find you because of your Highline picture on your website To me, it's like that breaks through all of the corporate marketing that goes on. You don't need a Super Bowl ad. You just need to be yourself. And so I'm so glad that you are on this journey. And, I wonder especially the people who, no matter where they are in their medical career, pre-med, medical student, resident, attending, Do you have something that you, go to as your, phrase of reminding yourself how valuable you are as a human being, how valuable you are as a physician, how valuable the way you deliver medicine is? I'm wondering if you have, your own sustainability mantra that grounds you if there's a little bit more wind kicking up suddenly on the Highline, or if you're just dealing with a really, really tough day on top of no sleep. I'm wondering what do you say to yourself to remind yourself to help you remain sustainable? little mantra routine that I do like, couple hundred feet in the air like, on the shaky line in the wind when I need to ground myself is the same practice I do just in between patient rooms basically and I usually slow down and take some deep breaths and just say that I'm here now and I'm me, I'm Grace, and Just to kind of ground myself in the present moment, and I guess who I am, like this idea of presence and authenticity. I don't know if it has good words, but for me that's just my little practice, my reminder of you're here to show up as the person that you are, as Grace, right now in this moment, and just be here. Whether it's standing up on this high line or just being here with this patient and sitting with whatever they have to tell me. And that's, kind of my little reset. But I think a lot of it is just really grounded in this idea of just realizing how important authenticity and presence is to sustainability, at least for me. I think those were the two things that I realized I would need to be able to like move forward in life and in my career in medicine. truly being able to feel present in these moments with my patients and feel like I'm being true to myself and the things that I value. and I probably never really had good ways to articulate that and, still not great, but the summit and hearing you speak again, it was like this permission that I was waiting for or validation of yes being authentically ourselves is very important can actually help us be better doctors and just be better humans Absolutely. And I think being better humans together also is so good 'cause I told this to Dr. Shannon Connolly the other day. I was like, "I love talking to DPC people 'cause it's like I'm actually talking to sane people." I realize that that's a lot of judgment passed in that sentence, but also I'm just like, I love people who don't look at me like an alien when I'm talking about sustainability in medicine, and that's not a lecture that I had to attend to get CME credit for. It's like- Yeah no, I wanna know about you the person. do you as a person survive in your career, not how do you make your money? Thank you so much, Dr. Hassell, for sharing today. I am so excited for your next highline, and I'm so excited for your DPC journey ahead. And I can't wait to see you next time in person. the summit Just absolutely changed my life and what I could imagine was possible. And specifically with the sustainability. I think it was, this first spark of like, this can be sustainable if you do it a different way. So thank you so much. Thanks for having this conversation with me. And I hope I texted you the pictures, so hopefully you see them. But thank you for inspiring that too. Throughout today's conversations, we've talked about physicians, but sustainable healthcare is not built by physicians alone. Thriving direct primary care practices Depend on community, and that can include an incredible team. Our final guest reminds us exactly why that matters. I'm excited to introduce Noreen Gutierrez, a registered nurse noreen brings a unique perspective, combining her background in nursing with her passion for business and operations. She shares her philosophy of head, heart, and hands along with the five Rs for creating sustainable teams, ideas that extend far beyond direct primary care and into every part of healthcare. Now I am excited to uh, introduce to the audience Noreen Gutierrez who's not only a, a nurse, but she is the person who I'm like, "Where were you four years ago?" Ever since uh, I got my first job I, got interested in knowing more about business. while I was working, I could also envision a business side of things, like how operations work from, billing the patients for their supplies and all that, and how system works when it comes to leadership. And so when I got my actual job from the actual course I took, which is nursing, it was definitely a good experience as well. But at the same time, I never look on this business side of things until this time I got this job, and I was like, "Oh, after all this time," like future been foreshadowing me about what I'm gonna be, where I am at right now. sustainability of practice It's not always just about passion. back in high school uh, um, we have these three things You don't only give yourself because you're passionate, you don't only just use your hands to provide services. You have to keep it in balance. So I would say sustainability comes with the head, heart, and your hands. having all these things would definitely turns out to have a sustainability not just in practice of DPC, not just in practice of business but in life. I'm wondering how you view, culture at different places that you've worked at. What do you think is helpful for culture in a DPC clinic to be sustainable as a team? When it comes to culture, we're all different, this is something that the sustainable practice we need to implement is to, select and deselect, and adapt and not to adapt. So this is gonna be applying five Rs, Refuse, reduce, reuse, repurpose, and recycle. Refuse the things that you know if it's gonna harm you or harm others or the team, or harm the company And reduce something unusual with the workflow of the team. Raise suggestions pitch a deck of proposed these things we have implemented this stuff so far in our clinic and I'm very proud that everything is working as a team There are some things coming from your past experience that you could, use of. You learn from your past, you can grab those things that you can apply. Sometimes we need to get back to our previous working procedures sometimes go back from where we've started. Maybe that way is more effective I think about how these five Rs could also be applied to the healthcare system in general. When I hear you say recycling, I think about my own body and person who chose this career of medicine, being recycled and put in a new use purpose Reducing, absolutely, we do that in DPC. And in a purpose- Mm-hmm in a place where like, I could actually be more of myself and more appreciated to be myself and not be, like- Yes the person who was just on the back of the person's insurance card. I will say DPC really hit hard to me even though it's not practiced here in the Philippines, it struck me of how amazing this model is. Having the w- opportunity to be part of this and know more about this had taught me of how we have to sustain the practice. I didn't know that we're already doing it, being a virtual assistant had taught me of this doesn't stop you from doing what you would want to do. And or rather say as a nurse, this didn't stop me of what I wanted to do for my patients. And that's what the DPC had taught me, and I'm really glad that I'm being part of the DPC team. It's so nice to hear from our patients Thank you for your quick response." That's what I like. Back in the hospital it was quite hard to sustain that load of work. At DPC, the, passion, it's still flowing. it's on fire, it retain your energy. It recycles you. You bring out the better version of you. And I will say that Noreen she's going to be taking her NCLEX in August so, if you feel so moved please call our podcast voicemail. Um, You can find it on the contact page and wish her good luck on her NCLEX, 'cause she's gonna do amazing. So excited. I, shared with Noreen that like, take your NCLEX. I was being, dragon mom by saying these things. I was like, "You gotta take, you gotta, gotta focus on school, pumpkin." That's what my dad would always say. And I will drop this in because I mentioned earlier in this episode that I took off some time from medical school when my dad had a stroke. he didn't even know I was flying to the Philippines. I show up in the hospital in his room and the first thing he says to me after he's had a stroke, he's "You're supposed to be at school." So it's like, with all the love that I know that my parents have they do care about me but they represent that through "You're supposed to be in school." I am like, yay, getting the completing all of the things that you want to complete but then also Taking that and doing what you want with it. It does not have to be only one way. It's just if you've seen one DPC you've seen one DPC. If you've seen one Noreen Gutierrez there's only one Noreen Gutierrez and Noreen Gutierrez before and after NCLEX is an amazing person no matter what and this is a reminder to everybody that your degrees do not make you. But definitely when you have your degrees you do not have to do the typical job description that your degree holds. For nurses. I'm addressing this for our nurses, particularly in the Philippines, because we have the stigma of "You're a nurse. You better be working at a hospital." But no. In our generation, it's been evolving, and I get to prove that, becoming a nurse leads you to any type of opportunities. Doctors work in hospital, and you guys have DPC? That's amazing. Doctors, deserve the same respect as everyone else. I would say every health professional deserves equal rights, equal respects. And that serves everyone in having a sustainable life, not only in our practice, but also in our health. Thank you so much, Noreen, for sharing today. Thank you so much, Duxi. so as you've heard throughout this episode, sustainability means something different to each of our guests. For some, it's community. For others, it's authenticity. For others, it's boundaries, innovation, teamwork, or rediscovering joy in medicine. But every one of these conversations points to the same truth: we cannot create sustainable healthcare without creating sustainable lives for the people providing the care. Thank you so much for joining us Again, I'd love to invite you to our next state summit, the Illinois DBC Summit Which is happening in October in the Chicagoland area And you're already planning for 2027 And you really want a quality small group experience all about DPC Registration is also open for California's third annual DPC Summit next year For the links to both of the events, head on over to mydbcstory.com and check out the Events page 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 I can't wait to see you at the AAFP co-sponsored DPC Summit in New Orleans. Make sure you come by and say hi, get a copy of the latest edition of our magazine all about DPC, and I'll be there with live mics so you can share your story. No matter where you are in that journey, there's a place for you at My DPC Story. If you're 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 mydpstory.com and find your starting point. And I'm excited to say it's all backed by a growing library of tools my team and I have built for the DPC physician at any stage. From a free copy of a BAA you can use in your clinic to our free ninety-day startup checklist to the physician owner's planner I created to help you get the business side more organized. It's there to meet you wherever you are and help you move forward. And here's something I'd love for you to do. Go to mydpstory.com/contact and leave me a voicemail. I want to hear your voice on this show. Tell me your question, your challenge, the thing you're stuck on or the win you're proud of, like if you've recently opened, and you might just hear it answered or featured in a future episode. Don't overthink it. Just hit record and talk to me. 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. You'll also find our state-by-state with Dr. Phil Eskew episodes there coming soon. 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, Kira Hanselmann, Head of Marketing and Strategy, Natalia Hyland, audio editing by Felipe Martins, and Chief Organizational Officer, Noreen Gutierrez. We are all in your corner. Until next time, this is Maryal Concepcion.