Facing Burnout, Cancer & Closing His DPC — Dr. Timothy Blain’s Story | Direct Primary Care

When Dr. Timothy Blain opened his direct primary care practice in the middle of COVID, he finally felt like a “real doctor” again — after two decades of employed medicine, five-year burnout cycles, and the constant ache of knowing he could help patients but never had the time.

In this honest and moving episode, Dr. Blain shares his full journey: graduating in 2000 as hospitals bought up practices, surviving non-Hodgkin lymphoma at 38, then weathering COVID pneumonia, a heart attack, and adult-onset Still’s disease — all while continuing to care for his patients. He opens up about how DPC helped save his marriage, why empathy is the first thing burnout takes from physicians, and what it truly means to be the patient when you’re also the doctor.

Dr. Concepcion and Dr. Blain dig into:

•The 5-year burnout curve, and why “just take a half day” never works

•Building patient loyalty so deep that almost no one left, even through his hospitalizations

•Practical steps for leaving employed medicine for DPC (including the prepay discount that funded his startup)

•Why DPC doctors may be best positioned to use AI in medicine

•Supplements, home visits, ultrasound, and staying curious as a physician

•How and why he chose to close his practice — the taxes, timing, and grief involved

•Redefining “failure” and finding peace in a one-year sabbatical

Whether you’re burned out and dreaming of a way out, a few years into your own DPC, or simply wondering what a fulfilling end to a medical career can look like, this conversation is a breath of fresh air.

“Failure is in the eye of the beholder.”

 — Dr. Timothy Blain

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Transcript

1:25

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. patients are sitting, here, the painting is right next to them. that Norman Rockwell, the one where he's looking at the diploma, and the doctor is getting the shot ready. In the meet and greets, I will tell the patients "Look at that picture there. That's the kind of doctor I wanna be. I wanna be able to do everything for you, the way, doctors did, in the past," because I think that, it works. and I have two other things in there that I, a lot of times point out. I have this plaque, it's the Latin for first do no harm, that is right above where people come in, to the reception area. And then I have a little magnet. one of the things that I did was, my wife kind of made fun of me, when we opened the practice I got a Craftsman toolbox to put meds and, she's like, "What are you getting that for?" I'm like, "Well, I want it," And I have a magnet from the Apollo mission that says, "Failure is not an option." and, I just look at that and I say, one person's failure. is not another person's failure. You know? It, it's, you know, In the eye of the beholder, I think this is different for different people, but, just retirement in general, I think a lot of doctors, their entire identity is tied, and that's why they don't retire. My entire identity is not. I mean, I love it, but I have lots of other interests, I don't feel bad about that. It's a privilege to be, to be able to be a doctor know, it has been a privilege. I'm Dr. Timothy Blaine and this is my DPC story. welcome to the podcast, Dr. Blaine. Hi, great to be here. As we're in July talking about growth and burnout I think that your story is very pertinent to the fabric of direct primary care in this country, because like we were talking about before we recorded, people are listening to your episode on the day it, releases, and people will be listening, you know, years from now. And I think that this is why I love when people who are, one more year into their DPC, they'll text me or they'll email me and say, you know, I listened to this episode and it landed differently for me because of..." And I think that your story in particular is really addressing happens if you decide to not do DPC on the everyday basis going forward. happens to you as a person? And I think that I say that as a little dramatic, but I say that because online, you know, I take pause when people say, look at the reason why they failed. Look at the reason" And I'm like, failure is in the eyes of the beholder. And I would say I'm talking to a fellow physician. I'm talking to somebody who's dealt with, kids and adults and over decades of a career. And to me in my eyes, even though we're meeting live time right now, you will never be a failure. Thank you. Yeah. So My journey started off, I graduated in the year 2000, and, that was right around the time when all the hospitals were starting to buy out practices, physicians started to be employed. And, I was starting a family and, I did look into starting my own practice, but, I think our first child was born the first year that I got out and I went to be employed. I actually had a public health scholarship, and so I had to go to an underserved area. I'm from a rural area originally. so I went there and it was interesting because it was a, hospital that was moving into an area that they didn't have a foothold. So they built this beautiful clinic and they hired three doctors. Okay. Well, it was... really ironic because I can remember, because they were new, we didn't have that many patients. And I can remember one day, one of my partners, we were standing in the hallway and, at that time we were seeing six patients a day or something like that. And I think I took one day a week off, so I worked four days a week. And we were just commenting, I said, "This is like a dream job." And the interesting thing is that's how I ended my practice and I look back at that and I'd say, that's the way I wanted to practice medicine. And then 2002, we had a premature daughter. She was born at 24 weeks, one and a half pounds. She's, what is she? 24 now. And, but miracle, she did great. She just graduated UF. But that created stress, so we ended up moving back near home and near family. And I think if you look at the, curve of when do you start to burn out I would say it's around five years. By that time, your practice should be about fall. You've seen the patients, you've kind of got to know them. And I think you burn out mainly bec- reason I did is, you obviously the time, but the other thing is, you you see the patient and they have problems that you know you can fix, you know you're capable, but you just don't have time. And interesting thing is, in 2000, I felt pretty confident that I could send them to a specialist and they would take care of them. That's not true anymore. Now the specialists don't have any more time than I do. And so I'm like, "Okay, well, if I send them there a lot of times they come back and, they didn't help them, and then it's back onto me." And then that, just created increased stress 'cause you didn't have time to, take care of them, and then it just became like a vicious circle. And then I would say EMRs came along and I'm real techy. I was really into it. know, It was Epic was the first one. I think it was in 2000, and I can't remember exactly the date, but 2007. And I was really good at it, and I was able to take some time to help train other doctors. And, gets you out of the office to kind of relieve a little bit of the stress. So I kind of gravitated towards that because, being in the office five days a week, that pace was just demoralizing. And then in 2008, I was 38, I can remember I was laying in bed and I was scratching my neck, and I felt a supraclavicular node. And I remember, being in pediatric on calls and they said, "Those are never normal." And I went to see my doctor, he couldn't feel it. I said, "There's something wrong." And they did it, and I had non-Hodgkin lymphoma. It was low grade, it was not aggressive, and actually at the time I chose not to be treated because the outcomes were no different 'cause I wasn't symptomatic. I just, felt it. And then, we ended up moving closer to family, and again, 'cause my wife's parents, they retired down to Florida. My wife's been down there and I'm thinking, "Okay, I got lymphoma. If we need help, I'd like to be, near family." So we moved to Florida. So I started another practice employed. And same thing, five years you start to burn out. Then I got, really, into EMR and I even did some Advisory work with athenahealth and did stuff with our, corporate office, which was, I think, multi-state. It was CHS. Not a good company, but it was a good experience. then I eventually needed treatment for the lymphoma. I think I woke up one day and I had severe hip pain. And so 2013 to 2015, and at the time, I was worried about, chemo. So standard chemo, and I kinda pushed my oncologist. I'm like, "Is there something other than standard chemo that we can use?" there was. It was immunotherapy was just, you starting. It was like 2013. it wasn't standard protocol, but I used just Rituxan. And I was on a maintenance for a couple of years. It's gone. I'm doing great. And then, as time went on, I got more and more into the EMR until I was about to take a position as a CMIO, assistant CMIO with the company. And, relationships start to suffer and things were not going well with the marriage at that point. And I was gonna do that, but then I was gonna have to travel a lot 'cause they wanted me to go up to Tennessee, and I didn't wanna move away, but they said, "Well, we'll fly you." And my wife said, "No, I don't think you should do that." So then I had to go back into practice full time. Before that, I was doing like a couple of days a week, and then I would leave for, several days to, to do EMR stuff, so that was kinda like that release valve that allowed me to, still continue on. So and then that's when things started to get really bad is when I was in the... and it was five days a week, and it was back to that grind and, So then I, started to burn out. And I know my partner did DPC first. And as soon as she told me about it, I'm like, "Okay, I wanna do this." But unfortunately, sign-- our, both our daughters were about ready to go to college. My wife's the financier of the family and she's very risk-averse, and she's "No, we're not doing that." And so, I see how, that scenario in which you feel trapped. your home life's suffering, your work life sucks, and you feel like there's just no way out. And, you get depressed and all of that. What I finally did, and this is what I recommend people do if you are getting burned out and, you're thinking about DPC, What I did is I just started taking the amount of time that I needed with the patient. And what happened was I got no lunch, and I went late, but, here's the but, the but is there's nothing they could do about it. They couldn't put more patients because they didn't wanna pay overtime to staff, right? So, so then they start to realize that, oh, okay, he's, not gonna, do whatever. So eventually, what happened was they said they were consolidating, and they... The company wasn't doing well, and I kinda thought that something was gonna happen anyway. They were gonna move my practice because they had employed me in a city that was, like, 10 or 15 minutes away, but they had other stuff, and I wasn't referring enough patients to that hospital. And they said, "We're gonna move your practice." And I'd been there for like, 10 years in that, city. I said, "No, I'm not gonna do that." And that's when my wife says, "Well, you guess you have no choice." And she said, "We'll do it." And so that's how, ended up in, starting the DPC. Started in 2000, right kinda in the middle of COVID. I think one piece of advice I would give people if they're coming from that type of situation where you're burned out, everything's, crumbling around you, and you're going to DPC try to fix your relationship before you do that, if you can. So, because I think First year was pretty rough because, if your relationship isn't solid with your spouse, it's gonna eventually catch up. And it eventually did, and we actually separated for a couple of months. But we got counseling, and we've never been closer in our marriage. DPC, I kind of, credit that to saving our marriage. Because, reflecting on it, I realize that- what was missing with my, our relationship was empathy because, it was all gone at work. There was nothing left when I got home. It just, there wasn't, looking back on it, I can remember saying, "Well, I'm doing all this stuff. I'm trying to be a good husband, doing this, this, and this." And it turned out it was just simple stuff like maybe she asked me to do something and I just saw it as something on a list, not like something that's important to them, and that I'm listening to them and I'm being empathetic that this is important, to them. But I think, the silver lining is eventually my wife i- ended up just the two of us in the practice. We did start off with employees, and she just worked a little bit. But, she got to see me in a workplace, the Dr. Blaine person's know, and I got to see her, too. us both kind of experiencing we're both good people. We just, couldn't see it because of all of the turmoil. But so I went from about 1,500 patients, and I got about 180 patients and that's why if you're thinking about leaving, you need to spend quality time with those patients for a year, so that when you leave, it's like, He listens to me," "He helped me. I'm gonna, go," because, you might not get that opportunity. And so I had the solid base, the other thing that I recommend people do is if you do have that opportunity to get a good chunk of patients from your previous, what we did is we offered a 5% discount if you paid the whole year in advance, okay? So we probably about half of them paid the whole year, half of them didn't. What that did is it gave me capital. was able to buy all the stuff that I needed to start the practice, and then I was able to kinda spread it out, the rest of the year. That, however, becomes complicated when you close your practice 'cause you gotta pay those people back the practice, I think, went, very well at first. As far as employees It's tough, and really what's tough about it, we had good employees, but most of them only lasted a year, and they, didn't leave because they were unhappy. It's, life happens, one of them, the whole family moved away. The other one, the, child needed special help, and the mother decided to stay home. The other one, the spouse that they were gonna get married, and financially she couldn't keep that job, and she was actually overqualified for the job anyway, so I'm like, "Okay, well, I guess you gotta..." And then I... A- and it came to the point where like I just asked my wife, I was like, we could take fewer patients if you worked," and that's what we ended up doing. And, I think the most important thing in your DPC practice is that one person up front. I mean, if they're not dependable and if you can't trust them that they're gonna do it, it increases your stress exponentially. The great thing about having a spouse is I knew it was gonna get done. I mean, I didn't even think about it. So if I said, "Hey, can you do this?" I didn't have to worry that it wasn't gonna get done. So it just was out of my mind, now, I had one employee that left, I trusted that person. That person was like, if I could've kept her I would've been okay. But I think the tricky part is, you hire somebody, maybe they're okay, but, what do you do, right? That's... i'm not just gonna fire you 'cause you're not perfect for the job, I mean, unless you're, really, bad. so- Then I would say, COVID came. I was doing okay. And then in 2022, I, I got COVID for the first time. I think I got it at the end of August, had the fever, the usual. And then about six weeks later, I just developed sudden onset shortness of breath, chest pain, and I had COVID again. And then I was hospitalized. I had COVID pneumonia. I wasn't on a ventilator, but, they did the whole, routine. I was in the hospital for five days. And interestingly, when you have DPC, you can still take care of your patients. So, There were other DPC doctors that I could have asked, to help, Actually, I was bored 'cause I wasn't critically ill, so I'm taking care of patients doing phone calls and all that. Actually, it was very distracting And it was a good thing, I thought. But then I got out, and I, just wasn't getting better, and I was still on oxygen, and I was seeing a pulmonologist, and they weren't helping. And I think that went on from end of October until February, and I was still on oxygen, and I just wasn't getting better, and I really wasn't seeing patients at the office. The only thing I would do is I would go in for procedures, so if somebody needed an injection, I would go in for that. But I did everything, remotely. And, interestingly, through all this, we hardly lost any patients. It just amazed me. The loyalty that your DPC patients, once you build that relationship, I just... It's I-- To me, that is the hardest, when you leave. You're like, "Okay, this person stood, with me, and, I'm leaving." And they understood when we get to that, but... So- I thought I was gonna have to close my practice at that point. And honestly, if I was employed, I probably would've been on disability. There's no way I could have practiced. No way. So I went to my oncologist and I had an immunologist... No, no, I didn't have an immunologist yet. So I went to some of my doctors my pulmonologist and my oncologist. I said, you gotta figure out what's wrong." So they didn't really have any ideas. So, Dr. Tim, took it upon himself to order my own labs. I had ordered antibodies and I was severely low on all my antibodies. And I got antibody infusion, and I was improved within a week. And, I eve- eventually, got the immunologist. But what ended up happening is my Rituxan worked too good. I have zero B-cells now. I do have some antibodies 'cause, technically you have plasma cells that stay in your marrow for, a long time. But, no B-cells at all. And so I got on the immunoglobulin, and I was like, "Okay, I'm back." took me probably a year to just recover, from fully from that. And like I said... But then after that, I was like, okay, that's when we decided, you know what? I'm not gonna get to the full whatever, three to 600 patients. At that point I'm like, I'm just lucky to be alive, i'm just gonna enjoy my practice and, we'll be fine. so things were going pretty well. Had the normal turnover. Our practice was probably around 280 most of the time. Now, 62 perc- We live in a retirement community, and so 62% were Medicare, so most of them were complex patients and, the higher rate. So it was fine. And then things were going pretty good, and then in 2024 I got COVID again and had the high fever. And I did recover, but then about six weeks later I had a heart attack. the crushing chest pain woke me up from sleep. Went in, got a stent. And then I got a stent. It's really tough being a patient as a doctor, as you cause the doctor, they come in and they put me on all this medicine. I'm like, "I don't have high blood..." I'm trying to explain to them, I was fairly healthy. I didn't have, even have high blood pressure before that. So they put me on all this medicine, and, my blood pressure was low. And I was being discharged from the hospital, and I felt great 'cause the night, the day before I was walking around, no problem. But then the day of discharge, I didn't do any walking 'cause I didn't wanna miss the doctors, but they had put me on all this medicine the day before. And so we get discharged and my wife says, "Are you gonna get the car?" I was like, "No, that's fine. I can walk to the car." So I walked to the car, and by the time I got to the car, I got chest pain. Okay? And I told my wife, I'm like, "I'm not going back to the hospital. We'll go home." And I just think it's 'cause my blood pressure's too low, all this medicine. And turns out I, I waited another two or three days. I'm doing EKGs on myself at home. so then I called the cardiologist and I said, "I think something's wrong." He's "Oh, we gotta take you back to cath lab." We went back and then there was an area that was, 50% that was actually more than it... So I got another stent, and then I was fine. And then about six to eight weeks later, I start getting these weird rashes over my bruise, 'cause you're on dual platelet therapy. And then I start getting flu-like symptoms, and I started getting these weird fevers. And so I'm going to my immunologist, and he's "Well, something allergic." You So then I'm on prednisone. And I'm on prednisone for- High dose, like 30 to 40 for about, four months. And actually, I went to Costa Rica during all this, 'cause it was really important to my wife. And so we, when I can remember on that trip, I, just, I was so weak. You oh, prednisone is so awful. I mean, I felt like I was 80, literally. I can remember running from one room to the next to answer the phone. I went to make a right turn, and I couldn't stop. It's "Oh my God, this is what it's like, when you're 80." And the immunologist couldn't figure it out. He put me on all his stuff. I'm getting worse, and I'm getting really worried. And then finally, and here is the bad thing about being a doctor. You know when something's wrong, and you kinda know what needs to be done. And so you don't wanna be sick, right? And unfortunately, you just have to suck it up, get really sick, and then go to the hospital, 'cause that's what I had to do. I just waited. I got a fever of 103, and then I went to the hospital and they did the whole workup. I saw infectious disease, and they said, "It's not infectious. Go see a rheumatologist." And then eventually I saw the rheumatologist. They diagnosed me with adult-onset Still's disease. I got treated for that, and so I'm missing work all this. Now that time, I did still go into the office, but I mean, he, the patients could see. I mean, I looked awful and at that point, I think we told the patients, "I'm just not gonna see people that are, have respiratory symptoms if you're, have something contagious." And even then, I only had one person that left the practice because of that, and, people are still, sticking with me And so I got that taken care of, and it's probably been a year, took me a year, and I, I'm feeling pretty good right now. But then I'm thinking of I just don't wanna go through this again." It's so hard to work and be that sick. It really is. If it weren't for the patients and how grateful the patients are, the satisfaction that you get from helping them when you're sick just keeps you kind of, elevated. And, so, if you can continue working, I encourage you to, because, it really is helpful, and your patients will be much more understanding than you can ever imagine. they will. And when I decided to, end the practice because I just, decided just I think I'm gonna have a long-term disability policy. I think I'm gonna apply and see if I get it. If I do, great. If I don't, my patients are like, 'Well, we'll just do telehealth with you.'" You don't even ha- I mean, it's just... Oh, man. "Yeah, we'll just do consults," and, that is really a difficult thing to do. And so we gave the patients three months notice. Now, just for people that are ending their practice for whatever reason cause we tried probably about three or four months to see if we could, get somebody to buy the practice and, So we get three months notice, and you just have to expect that some people are just gonna drop you the first month, so then you're losing the income. you're walking a, tightrope 'cause you don't want everybody to leave 'cause you still got bills to pay. You still got your lease and all of that. but I think overall it went pretty good. Did we lose money? I'm sure we did. I was able to sell a lot of the high dollar equipment. And I was able to sell most of the stuff. Most of the stuff I have left is just supplies. that stuff's kinda hard to sell. And then if you have any medicine And that was tricky. You had annual payment. You really gotta think about taxes. So, I was gonna... My lease actually isn't up until October, but what we figured out is because of my medicine my immunoglobulin therapy's like 5,500 a month. And then I got-- I didn't tell you, but I also... The before I went to the Costa Rica, I'd gotten out of the hospital and I fell on the stair and hit my back. And at the time, my, back started hurting, but I was on such high dose prednisone that I didn't really have the symptoms. But I actually had a compression fracture in my thoracic that I didn't know about, and, but the prednisone was kind of masking that. So, but we still went to Costa Rica, and then eventually I found out I had a compression fracture. And then when I went off that prednisone, I felt that. And I've never taken Vicodin before, but I did take it for that for a short period of time to sleep. but it would have cost I wanna say if it was just me, our health expenses were gonna be $35,000 a year. And if my wife got sick, it'd be 40,000. And we did the math and we only make poverty limit for the year, my entire expenses for the whole year is 5,500. So I saved $30,000. That was less than I had left on my lease. So you know, when you do end your practice and you really think, gotta think about taxes and, what are you gonna do about health insurance. Honestly, if I didn't have these conditions, I had a health share before. It was awesome. I loved it. But you know, obviously when you need medicine that's thousands of dollars a month, you have to get regular insurance. And it's o- it's okay. I mean, I... You a lot of people, say, "Well, insurance is, horrible." Well, it is if you don't need it. You know what I mean? But if you're a person like me and, you need it, I mean, it's, it's a lifesaver. What I really appreciate is that you're talking about you and your life especially when it comes to health, as, the career of medicine is going. And of the things that I was thinking this entire time is that, when you talk about this doctor, this, doctor in the Norman Rockwell painting who, can do everything and be everything I'm wondering when you also mentioned, that empathy was not there at times where it could've been helpful, looking back on the buildup of this expectation, especially as a GP like yourself and myself where do you think we can check ourselves as we're going into our careers? Because I think that that's something that general physicians, definitely wear on their shoulders a lot. But I also think that when it comes to people who are doing DPC, it's an even more pronounced expectation that nobody puts on you. Because, I experienced this definitely my first year of you have to be everything for everybody. And, I really love- Mm how you shared that even when you were like, Man, I cannot see you in the office today," I am the patient today that expectation can also come with regret, grief, disappointment, all of these things because of these expectations that, it's borders between countries. They're not actually there. People just put them on a map. Yeah, I think, you just have to realize that, if you do connect with your patients they will give empathy back to you. And I think that's where, you see yourself as more of a paternal figure to the patients, and you think you have to do everything for them, just you you do your children. But, understanding that, your children can do things on their own, and they can step up and they can take care of mom and dad. And, when I got sick I was concerned about. I will admit to you that when I was employed, I didn't really tell very many people I had it because, I was afraid, people would just leave. Here's this young guy, he's got cancer, maybe we better go see." But at that time, you weren't able to connect as closely to the patients, in that type of situation versus in a DPC, you when you can connect with the patients. And you'll know if you're connected to your patients or not. You know which ones you are and which ones you aren't, and I think that developing that relationship is just so important. And it isn't just you. I mean, it's everybody in the office. But don't be afraid to- call on the patients because you know what? Well, here's what's gonna happen. When you do that, you're gonna be left with all the patients you really want, right? So if the one or two people that I had left, I'm like, I don't miss you." and not in a negative way, not in a a vindictive, but I'm like this is probably... and so no, regrets, and I think that's the way you kinda have to look. But I mean, obviously, if you're losing a lot of patients then you're like, "Okay, wait a minute. Maybe I'm doing something wrong." Versus if you, lose the occasional difficult patient that, you're not hitting it off with so don't be afraid to share things with your patients. W- I mean, really because they will step up for you. I believe that. But as far as do you need to do everything, when you start, okay? You need to do everything that you want to do, okay? Myself, everything interests me, okay? The only thing I didn't do in my practice is the accounting. I'm not like a numbers guy, so we had an accountant to do that, but I'm real techy. I did all the IT in my office. And I think one key to building that bond and the relationship with the patient is figuring out how to engage them, and I'm sure you had a lot of people on here talking about that. And, there's the usual things, do a monthly newsletter. People really love that. My wife... I didn't even do it. My wife did it. I think she used ChatG- PT or something. and they love hearing about you and your family. You really kinda have to think of your practice as an extended family, and I really think of most of my patients as extended family to some extent. And, they love to hear about you. It just connects, and that's really the key to DPC is, getting that connection. Other things that I found very helpful to help connect, keep that connection going is, I don't know, do you do supplements in your office? We do. We always have the discussion with our patients, "What are you taking?" They'll ask questions about supplements. If they are not sure if something's safe, we'll talk to them about pros and cons. But absolutely, I think that for us, we're more of the evidence-based, but, if there's no evidence that's showing that it's gonna hurt you, it, like- Right If you try it, that's completely reasonable I encourage doctors to really become educated on them. And, we did... When we did the supplements, I mean, I'd always wanted to use supplement, but I'm like you, it's evidence-based, I don't really know what I'm doing. But I started doing vitamin testing. I would check people's vitamin C level I'd read stuff, articles, and figuring out, okay, what's this? And then I tried, I know we would use vitamin D, vitamin C, and then we'd check levels. And then after a while, it was interesting, vitamin C, I could predict what it was gonna be without even doing the level after I did it on enough people. but it was really enlightening because I was able to determine, okay, this supplement doesn't work, just throw it in the trash. This one does, this is the one we're gonna use. And, patients appreciate that. I don't wanna just give them a supplement. And then one of the things we did try to do is Pure Encapsulations, really love that brand tried to use some of their multivitamins that have extra vitamin D and to try to reduce the supplements, but what I found is it didn't work as well. The individual supplements, I don't know, they just worked better. Some of the levels we ended up having to supplement, and so I kinda got away from that. But, that is that learning process That you should just do, because it gets you engaged and them engaged. And what I like about the supplements and the medicine is every time they come in for... They have to come to the office, and that's what you're doing, right? You're getting to come in, they chat with the person up front. "Hey, how's things going?" And yet they just love... in our office it's a little different 'cause they're older, and for a lot of the elderly, I mean, this is their night out, this is their day out. They love coming in. They'll just come in, even have a coffee or, whatever, finding ways to, engage them, connect with them. I think the other thing is, patients come in, tell you stuff all the time, "What about this? What about that?" I mean, I think I focused most of my effort on learning about diseases that we don't have good treatments for, and what alternative things are out there that might help. Like with irritable bowel, I really got into the whole microbiome thing. I really went down that rabbit hole 'cause I, with my common variable immune deficiency, I have all kinds of GI issues, okay? And what I started to realize is most of IBS, I mean, there's some that's psych, but, most of it is all microbiome disruption. I got into the testing and learning about that. And before you don't have time to do that, but and patients love that because they say, "You're going the extra mile for me. you care. You're not just gonna give me the same whatever." And they can see when you're making effort, and sometimes they don't even see and they're like, "Oh my God, why is my doctor emailing me?" And you're like, Cause I think about you when you're not in the room across from me." Yeah. "I also think about you when I see something that is pertinent to your health." think some of us are more curious than others. So I think if you're a doctor and you're just, you're not a curious person, you need somebody that, like that in the office to say, "Hey, what about this? Let's do this. Let's do that." For me, I, I did everything from, I think we had one gentleman who had COVID and, you have some people that are on different ends of that whole thing. But the ones that are like, "I'm not going to the hospital. I'm not doing anything." We had one gentleman, he had I'm sure he had COPD. his O2 sat was low. I mean, he wasn't in like major distress, but he was a little distressed. And actually, he wouldn't go to the hospital, refused. And I actually, I had an oxygen concentrator because I had used oxygen, and I met him at our front gate or something and I loaned it to him. And then from then on, we, have oxygen concentrators, and occasionally we will loan those out. I have one gentleman where his oxygen concentrator was on the fritz. I was like, "Here, just take it, you can use it." I think I made telehealth kits. Made it myself with one of the, like the Echo Duo. I got them really cheap and the ear camera and... 'Cause we had... one of the things I like about where we live is we have like super wealthy people. They got homes all over. And we have, we even have some people on Medicaid. And I love that contrast between the haves and the have-nots, and everybody's the same, and everybody gets treated the same, a lot of times when we would have that wealthy person come in, one of the things you do wanna be sure that you make clear to them is, that- We are not concierge medicine. We are gonna provide the best care for you. And we are not gonna provide on-demand care. And I think differentiating this is not on-demand care, this is the best care, and even for people that aren't super wealthy, I think making that distinction very clear helps so much. The patients know. "Oh, okay, we get it. That knee pain that I've had for six months, yeah, maybe it could wait three days or, whatever, because you, can't get me in, today to do it." But one of the things that we did, of course, we did the Holter monitors. And I love doing things that, are out of your comfort zone but you know you can do. I had one gentleman, he came in and he didn't have insurance, and he had this big growth on his shin. It was right over the tibia. And I'm like, "Man, that's pretty big. I don't know if I can get the scale." He's "No, I trust you. You go ahead and do it." I did it, and it all turned out fine, but I was sweating bullets. But home care, certainly I think if you have elderly people, you really need to do that if they need it, not just because they want it. Because again, I always loved doing home care. Even when I was in employee practice when my, girls were little, I would take them with me on house calls. and mostly the patients that had dementia, severe dementia they just love that, the patients. So if you have small kids take them with you. Your elderly patients will love that. It's a good experience with your, children, to do that. I didn't really do nursing homes. I don't know. I, I tried. It's just too much hassle. At least it was, for me. I did one, but, they don't even recognize, "Oh, what, you're here? What are you doing here?" I was reminiscing with one of my 90-plus-year-old patients how when, I think maybe Nolan was four I brought him to a home visit for this particular patient. And then I remember I was talking with our patient, and it was just me, him, and the patient, and he just made himself at home, took off his shoes, started eating cashews from the coffee table. And I'm like, Dude, you gotta ask before you start eating cashews, man." Yeah. But that was... But, but they, Our patient was laughing, and she absolutely loved that and was like, "Are you gonna bring him next time?" So They totally do love that. Oh, I will give one tip. I'm real big on gadgets, okay? So I had, I had a lot of equipment. Most of it was not new. If you wanna get equipment, I got almost a majority of... Although there's some risks to it. There's medical auctions uh, so med.com. I got some incredible deals but, occasionally you get screwed. you get something that's "Oh, man, why'd I get that?" But I mean, you can get some incredible deals on some things, and so I got m- I mean, other than the, usual stuff that you get at the beginning, I didn't do that. But and then I... So basically I just gradually accumulated stuff over probably a six-year period. You, allocate a certain amount of your budget to okay, what am I gonna add to the practice? I think I did wa- I did One of the things I wish I could have gotten into more was the, the butterfly. I did get a butterfly ultrasound, but I didn't learn it as much as I could. I mostly use it for urinary stuff, post residual. And I started to do, I don't know. Do you have a butterfly or- Since 2018, yep. Yeah. So the, the AI has become incredible. Now you don't have to be a technician. I think I did the one for the DVT. The ThinkSano. it worked really well at teaching you. But that I think is people should do it more. And then the other tool that I wish I would've had when I started practice 26 years ago was AI. Okay? 'Cause I wanted to talk a little bit about AI. Because I don't know, do you use the Doximity Scribe? I use a different scribe. But I absolutely cannot live life without a scribe. Yeah. I mean, the Doximity, if people don't use one, it's free. It is incredible. And I've used lots of them over the years. I can remember even in 2000 I was big in computers and I bought this little clamshell computer and I was gonna do my charting on there. Of course that didn't work. But having the AI- That was the source of most of my stress is documentation. I have a little ADD, okay? And so I was always stressed. Did I get everything? What did they say? They come... You don't wanna look stupid when they come back. "Well, don't you remember?" It's like, "No, I didn't write it down." And it was so like, that was so much stress. I probably, if I hadn't had my concerns about infectious risk, I probably would've stayed longer as a DPC because of that AI being there. And actually, when I was really sick and I was on the high-dose prednisone, you know, prednisone affects you cognitively it was a lifesaver. And that's, actually I got worried 'cause I would go back after and look at what AI, I'm like, "I don't remember them telling me that." And that kinda scared me a little bit. But AI, you know- I think DPC doctors are best positioned for AI to be successful because, I done a little research. If you look at, subspecialists, okay? If you go back to 1980, the ratio of primary care to specialists completely flipped. I, I believe, and I could be wrong, that that needs to flip, okay? Because if you get rid of all of the specialists, except for the procedural specialists, of course, I mean, we still need them. But most of your internal medicine subspecialists, endocrinology and, pulmonology and all those specialists and get them more in procedural 'cause that's all they like to do anyway that AI can make that happen, because I don't know if you've done this before with... what I like about the Doximity Scribe is it is HIPAA compliant, and you can take the entire hospitalization notes, upload it, and then query it. I, I mean, I, 'cause I had a, couple patients where I didn't agree with the specialist management, and I kinda, queried it and, I think it can help you because you have more time to diagnose a patient. You have time to use the AI. The problem with AI in an insurance-based model, it's not gonna be as successful because, the hardest part, as we know in DPC, is getting the information, not analyzing it, right? So, that's what it's all... And you get that currently through your relationship with the patient, reading the patient, knowing the patient. They come in and you take one look at them, you know them. "Oh, something's really wrong with you." Versus the other one that looks hysterical like they're dying, and you're like, "Okay, you're fine." And until AI gets more empathy, I'm sure it'll probably happen, at some point. But I really see AI as So good for medicine because, being in the medical system as a patient, it is awful. Awful. when you get sick, honestly wish that most doctors could get sick with a serious illness because it does change you. It does make you more empathetic. But I will say this, that is a double-edged sword, though. Because as you become more empathetic, you get more transference from your patients, and that's stressful. You can only take so much of that. So that's one of the reasons I kinda decreased the number of patients because, you wanna fix them, right? Because you know when you're sick, if nobody's listening to you and they can't fix you, you feel that urgency that the patient feels. Whereas if you've never really experienced something like that, you, just don't quite experience it quite the same. And, that does make it stressful, One of my reflections on, how do you know if you're a good doctor was like, "Well, if you don't worry, I, question how good of a doctor you are." Because if you don't worry a little bit, I don't mean to the point of obsession about your patients- Well, you don't know everything, right? You know you don't know everything, so you should be a little bit worried. You should question, what you do. And I think the key is, obviously managing it, to where it doesn't become, something that's detrimental to your health. Just looking back at your journey in different types of practices in different, reimbursement types of practices on days where you felt good or days that you felt like you couldn't go to clinic I'm wondering, would you have built your DPC in a different way at all on any level to have made the journey even, more able to just, ebb and flow with, the life outside of being a doctor? There's not many things that I didn't enjoy about the journey because, immediately when you become a DPC doctor you're like, Okay, I feel like a real doctor now." I hate to say it, but the only other time I felt like a real doctor was when I was in residency, right? Because you're learning, you're figuring it out and, that ability to do that, is just so satisfying. I mean, I think things that maybe I'd do differently that I ended up doing differently is learning how to, relegate Cause I know when we, sold medicine, we did the prescription, we did the supplements, I just wanna give everything away, right? And my wife's "No, you can't do that." cause I would check the price and I'll, "That's too much." And then finally my wife, and actually we had another staff member, was like, "You just need to not look at it." And I did. I just didn't look at it anymore. Because I was stressing myself out, I was worrying about it. I'm like, you know what? They know better about that. I think knowing your weaknesses, I think is one of the keys to managing your, your stress, in your practices and, because the fact is you can be just as busy in your DPC as you were, in your employed, no doubt. You're just doing different things like, I'm counting pills or I'm doing, whatever, whatever it is you- you're doing that you didn't have to do before. most stressful things that took me probably a couple of years is the ordering of the medicine, figuring out inventory. Do I have it? Somebody comes in, I gotta order it. You need so much for free shipping. That was stressful, but it was a learning curve. But, after a while, you figure it out. But that is definitely time commitment, work, stress in order to learn it. But I don't think I would've not done it if I had to do it over again because it's such a good thing for patients. I mean, I don't know if you've experienced this, but- I'm really big on where it's made. Sure, sure. Sh- because we've had people, specifically Norvasc for some reason, where I had a patient where he's tracking it regularly and he called me one day, he's "Man, my blood pressure suddenly went up. I don't know why." And then I asked him, I said, "Well, did your pill change?" He's "Well, you know what? It did." We switched them and it was back. And I had somebody with a rash from a thyroid pill and, picking up on things like that or things that happened when you were in private practice and you can explain, like, why is this patient not taking their meds? Well, maybe they are, and patients love it when you talk about that stuff because they're like, "Hey, this is a different doctor." and that is one thing about DPC. You have to figure out how you can separate yourself, from every other doctor. Not necessarily other DPC doctors per se but you- just your regular doctor. The other advice is if you don't know where you wanna practice, let's say you are gonna do cold, you're not gonna transfer a practice find a community where there's a monopoly, where people don't have a choice, because that's where I was at. There's really just one huge primary care group. They refer to every specialist, they order tons of tests and, you experience that well, I don't wanna go there, so getting that I think is helpful. I know it was, funny because when I first started my DPC practice, I know my partner who had did it, I think I did it two years after she did. She was, she was kind of a little threatened. I told her, I said, "What are you worried about? There's plenty of patients." And there was. I mean, she, her practice has been full forever. But try not to be, worried about your fellow DPC people. I think, you shouldn't worry about that because, there is enough. If you do what you want and they do what they want, and some people are gonna like you better than they're gonna like the other person, and that's fine. And, I think worrying about patients that leave- And say, "Well, what could I have done better?" I think you do wanna look at that, but you don't wanna overstress. And I think most of the time people-- have a sense on your connection with the patient. And when they leave, you're like, "Hmm, I'm not surprised." Occasionally, you're surprised. But most of the time you're not, and you shouldn't worry about it. I mean, you are gonna have churn, and that's... I think we look back, total we probably had 650 patients, with the churn and, all of that. So you do have that. I mean, especially in an elderly population, moving and death and all of that. But yeah. When it comes to not necessarily would you change anything, but in terms of being mindful about how one develops their practice to make sure that they have time for themselves is there anything that you would recommend in terms of, like, how to schedule out the day, how to schedule out the week how to schedule out the quarter so that you're making sure to build you time in for, yourself, spending time with family just to intentionally build in some non-medical time into your practice? So one of the things that I recommend is, a lot of people won't agree with me on this, but you need to take a day off, a whole day. I'm sorry, but you know, I went through this, "Well, let's take a half a day." Half a day is never a half a day. Come on, because what... Here's what I did with that day off. If I wanted to do a procedure that I knew I was, not great at, it was gonna take me a long time and I didn't wanna be rushed, I would go in on Friday to do that. I would do my home visits on Friday, and then obviously we'd have days where you didn't have anything to do on Friday or you wanna take a long weekend or whatever. I mean, that one day is huge. I, And patients don't have a problem as long as you're willing to take care of them from home, and that's what I would tell patients, "I'm not in the office, but I'm always available." And people would call and I would take care of stuff over the phone. I mean, and occasionally, I was really very resistant about coming in on Friday for an appointment. I rarely did it, but most of the time I would say no, just because once you get down that slippery slope but occasionally I would. Having that day to do whatever you need to do, order or whatever, because that is where you are going to get that time. The other thing I did, again, people may not like it, but I think my last appointment was at like, And usually we try to keep the 4:00 open. and I think you have to determine, okay, what time you wanna get out, and you need to get out, and you need to make that happen. I mean, I think, we're gone. I mean, usually before that. And I think if... And the great thing is you schedule for yourself. You have control. I think that's one of the hard things to understand. When you go to a deep C's, you actually have control. You can do what you want, and don't worry. Like I said, if you have the good relationship with the patient, you take care of them. Even though you're not physically there, they know they can get ahold of you at any time. They're usually fine with it, as far as scheduling- I think scheduling is very individual and I really wouldn't tell people how to do that. having that defined time and staying fairly, rigid to that. And I think the other thing you need to do, which I know some of my fellow DPC in the area have not done, is you need to take vacation. you'll be fine. People are, "Oh, well, I need to have somebody cover." No. When we went on vacation, we just told the patients, "Once a day we are gonna check the messages. If there's anything urgent, we will take care of it." And we almost never had an issue. We went out of the country, on trips and, again, you, get into that because that's really the number one complaint from patient, is, "I can't get a hold of my doctor. I need something now." That's all they care about. They just want it taken care of, right? You take care of it for me, I don't care how you do it. You do it over the phone, you do it in person, you do it in my house, and that's kind of what I tell my patients, "I'm gonna take care of you however it makes sense. Whenever, wherever." And, most patients are like, "Okay, that's great. I can work with that." just a few other things on closing the practice, it's a lot of work. It really is. If you're not... If you don't have somebody just take it over, you really kind of have to prepare yourself for that. it's funny because my lease isn't up until October, and so I go in once a week to get the mail and I work for a couple of hours, packing stuff and doing stuff. And I thought, "Oh, I'm kind of glad I have that time," because I'm like, "Oh my God, what do I do with all this stuff? I'd get a rental storage. I don't wanna do that." and Yeah, the patients, they... Some of them take it well, but I felt pretty good the way I left because there was a good reason. Everybody understood. Most people were sympathetic and, it was more bittersweet, than bitter, And going forward, because, I'm so enjoying this conversation, I'm wondering, what else is on the docket that you are looking forward to because your future is not focused on clinical medicine at, what's running your days. Here's what I told my patients. I'm going to take a one-year sabbatical. So I'm gonna take one year off with no plans. You have lots of stuff you wanna do, around the house. My kids are out of the house now, and, organizing and doing projects. I'm really big into home improvement. And so there's a lot of stuff I wanna do. And but I know I will do something. I just don't know what. One of the other things that I will say, which may sound bad, but I feel like I accomplished everything I wanted to in medicine. I did everything I wanted to, I hate to say it but, once you, you feel that, you're like, "Okay, it's just not as great as it was." It's kinda like more of a job and it's just not as exciting, and I think, when that happens for you, when you're like, "Ah, it's just..." You don't have that excitement and it's more... I mean, I still had the satisfaction. I wanna kinda clarify that. I still had extreme satisfaction with the job but, the what ifs aren't quite, what they were. I mean, they're... 'Cause, before you go and do your DPC there's all these... I mean, I had all these ideas, these things I wanna do, and I did it, and I'm like, "Okay, well I did this, this and this. I wanted to have my own practice. I wanted, to do home visits. I wanted to..." I just thought about everything I wanted to do and, I did it. And, you feel pretty comfortable with your clinical skills And then obviously having illness, it makes you look at your life and like, "You know what? Maybe there's something else I wanna do." I mean, I'm always gonna be a doctor. I'm always gonna keep up on medical stuff. And it was so funny because my father-in-law. He's "Oh, are you still keeping up on the medicine?" And, I've only been retired for two or three months. I'm like, Well, yeah, for personal reasons I'm keeping up." something goes wrong with me, I kinda wanna know. Oh, that's awesome. Well, this has been a fantastic conversation, and I, really... to me it's a breath of fresh air in terms of as you were talking I'm like, what are you not gonna do?" And I love that, you feel so accomplished and like,, that's not a thing of shame to say like, "Yeah, I'm done with this part of my career. I'm moving on to the next thing." I mean, I think that's so real, and I think that It really feeds into the heart of who chooses to be a DPC doctor, is a person who wants to maintain themselves as they're going forward no matter what the future holds. Well, thank you so much, Dr. Blaine, for sharing today. I greatly appreciate you coming onto the podcast. All right. Thank you for having me. 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, Kiera Hanselmann, Head of Marketing and Strategy, Nathalia Hyland, audio editing by Filipe Martens, and Chief Organizational Officer, Noreen Gutierrez. We are all in your corner. Until next time, this is Maryal Concepcion.