The DPC NP
The DPC NP Podcast is a biweekly audio program that offers valuable insights and firsthand experiences pertaining to the management of a Direct Primary Care clinic owned by nurse practitioners and physician assistants. Esteemed guests will articulate and elucidate their individual journeys in navigating the complexities inherent in establishing and operating a Direct Primary Care practice.
Feel free to email me with any questions you might have about DPC!
aprice@faithfamilymedical.com
The DPC NP
Healing Through Horticulture: A Unique Healthcare Model with Terri Pinder, APRN
Terri Pinder, a nurse practitioner with over two decades of experience, joins us for an enlightening episode exploring how she combines her passion for horticulture with healthcare through the innovative Direct Primary Care (DPC) model. Discover how her unique practice, "Intentionally Well," emphasizes not only functional medicine but also the importance of community engagement and education in health.
Throughout her journey, Terri shares valuable insights on overcoming challenges and the critical need for autonomy in healthcare, highlighting the importance of nurturing meaningful relationships with patients. She offers a glimpse of her approach, which focuses on holistic wellness, promoting not just the physical health of her patients but encouraging them to adopt healthier lifestyles through workshops on gardening and wellness.
This episode challenges conventional wisdom surrounding medical practice, diving into how entrepreneurship can foster innovation in healthcare delivery. With her extraordinary experience and wisdom, Terri inspires both current and aspiring practitioners to explore their paths in healthcare and redefine success beyond numbers and productivity. Join us for this inspiring discussion, and discover the myriad ways you can also cultivate health and wellness in your communities. Don’t forget to subscribe and share your thoughts!
Thank you for joining us today!
Be sure to follow and share, and leave a review!
If you have questions, comments or want to be part of our community, follow us on Facebook at The DPC NP!
Welcome to Season 2 of the DPCNP Podcast. I'm Amanda Price and I'm thrilled to be back, bringing you even more insights, strategies and success stories from nurse practitioners and physician assistants leading the way in direct primary care. This season we'll dive deeper into real-world experiences, innovative practice models and the latest updates in the DPC movement. Whether you're just exploring DPC or already running your own practice, this podcast is here to support and inspire you. Let's get started. Hey everybody, welcome to the DPCNP. I have a wonderful guest for us today. Meet Terry Pender. She's a nurse practitioner from Port St Lucie, florida. She owns two businesses. Her DPC clinic is called Intentionally Well, and she owns another business that we will get into and talk about called Direct Care Clinical Coworking Terry welcome to the show.
Speaker 2:Well, thank you, amanda. It's my honor to be here. I have listened to many of the other previous podcasts and I feel like I'm among you know, the giants, the goats.
Speaker 1:Well, you are a goat. Anybody that is willing to be transparent and just tell their story and get it out there you are going to be helping so many people, hundreds of people maybe, that are going to listen and relate to what you're saying. So I'm just appreciative that you're willing to share your story. So tell me, how did you become a nurse practitioner?
Speaker 2:Well, I've been a nurse practitioner for kind of a long time, I feel like since 1997. So that makes it what? Like 27 years ish. It's kind of a long time. Honestly, when I think about it I can't even. Sometimes I don't feel like I've been alive that long, and I guess I once heard somebody say it like this like you know, it's time for you to go to nurse practitioner school. When you're standing in a room with a physician and you're thinking, all you keep thinking to yourself is I could be doing this a lot better and I could be really making a difference for this human being. Really is what you know, and I've heard that story, we've heard that story so many times, not just for why people chose to be nurse practitioners, but also what drives us to want to be direct primary care providers as well. So you know, that was kind of it. I had worked in many different places.
Speaker 2:Honestly, my first gig out of nursing school with my associate degree was oncology, because I had told my professor, my teacher, I wanted to work the psych ward, because I wanted to do the psychological support. I was so young and naive. What did I know? And she said you don't really want that what you want is oncology. So you know, this is in 1983 when, like, we kept patients in overnight for their chemo. There were no infusion centers, you know, and so it was a lot of emotional support for people, and so I knew that was something that mattered to me. But quickly, within a year, I realized, wow, these people are dying and nobody in administration cares. You know, I care and I'm tired of being the only one who's like carrying this burden and I don't know how to figure this out. And I was, honestly, after a year in nursing, thinking about leaving completely, but I instead chose to go back to school. You know, just kept always looking for the next job, the next gig. Going back to school, the next layer probably should have left, I don't know. The only thing that really saved me, honestly, was I graduated with my associate degree in 83.
Speaker 2:In November of 1984, I married my husband, my husband Marvin, who is a nurseryman, and together have grown his garden center. And well, actually it started out as a wholesale nursery where he just grew flowers. I actually opened the garden center in 2005. So, like most of my career, I've had one foot in medicine and one foot in horticulture and it's really opened my eyes to a lot of things. You know, beginning of that first year when I was working oncology, my mother-in-law was actually dying of cancer and she died about a month after we married, so before the end of the year, and she had not done any of the bookkeeping for the nursery for the whole year and my husband was kind of desperate to get the taxes done and he said, well, you please get my books caught up.
Speaker 2:So I was like, and these are in the old ledger pencil, ledger days, I mean it's a long time ago and I was handwriting these invoices and I came across this invoice from a place called Diamond R Supply and they're an agricultural supply place that provides my husband with pesticides. He grows ornamental plants, monoculture. I mean we're very responsible with pesticide use but it is a reality of our workplace there. I was like, wow, what is this really expensive thousand dollar chemical that you were buying? And I looked at the packing list and I could see the name of the manufacturer, for the pesticide was a company you may recall or recognize called Novartis. And I knew Novartis as the manufacturer of Nebsyn, a very potent, potent antibiotic that we use for our oncology patients when we wiped out their white blood cells and they came in near sepsis. I was like Marvin, what the heck are you buying from Novartis? They're a pharmaceutical company. He's like, no, they're not, they're a pesticide company. And that was the beginning of sort of the peeling back of the layers of my understanding that you know these companies, they're working sort of both angles here, right, and so that was 40 years ago. My, really my career has really been a lot of that understanding, you know, in a lot of different ways because of that interconnectedness.
Speaker 2:Another big turning point for me was, you know, we were at that point my husband was in mid 40s, peaking in his career. That you're due, you know, as business was growing, we were achieving a certain degree of financial security and I was like, can I leave nursing now? You know, can I get out of this gig? Because I hate it? Because Florida was not. We had no autonomy, there was no hope of autonomy. I mean, and I knew because of my business background that by the time I paid a supervising physician and met all the requirements, I couldn't make a business model work. You know, I'd rather grow flowers and nobody dies on a weekend when you're growing flowers. So you know it was much better lifestyle lifestyle especially when I was raising my kids.
Speaker 2:And then we had a year of hurricanes here in Florida that devastated our business and required ornamental horticulture business wholesale business at that time and required us to pivot. And I also suffered a lot of damage at my home which was under, was being remodeled, and we weren't dried in. And then you know so it was a really difficult time I had really truly, I recognize now I was suffering some PTSD and I had very little control over anything. I ended up planting some flowers on the walkway, the entryway to my home, because it couldn't do anything about the rotting drywall inside or any of the other mess that was going on. And I quickly realized that coming and going past those flowers every day shifted something fundamentally in me. I was healing in a way that I, you know, I was hopeful again. I could look forward to the day. I could look forward to coming home. If I didn't want to go inside, I could stand out there with a glass of wine and a hose in my hand or whatever it took, and I felt this tremendous call to make this available to people. So I encouraged my husband to allow me to dabble with opening a retail garden center at our farm. And so that was in 2005, 2006. And by 2010, we were really quite successful, 2012, really quite successful in that garden center endeavor.
Speaker 2:But with three kids two kids in college at once and another one graduating and heading off to college soon it was like we probably need some additional income. It was getting scary because we were taking more and more risks with that business and somebody had to have like steady income. And that was always sort of my job in the years. You know this as an employed person, a self-employed person, how freeing it can be to have a partner with a steady income, right. And so in the first part of our marriage I really gave my husband that freedom where I would go back and forth to work and then work for him and put his business before anything that I did. And then we opened that garden center and it was quite successful financially. And then it was time, like I said, for us. You know, even though it was successful, it was still growing and not a short thing, and we had two kids in college again trying to pay for it as we go, because no scholarships or anything like that, and we didn't want to burden our kids with a lot of loans. So we really tried to make it work.
Speaker 2:It was time for me to go back to nursing. But the problem was I had been self-employed and I was forever ruined as a nurse practitioner. You know, my previous gigs as a nurse practitioner were like employee health clinic, which weren't too bad, you know. They were really sort of like a model of direct primary care. They were like an onsite clinic, right, and I had years of occupational health nursing experience. I managed a clinic like that as I was in my NP training. So I brought that employer knowledge with me and then, being a small business owner, I had employer knowledge and honestly, it was seeing those employer-based models that I was like I want an onsite clinic from Pinders Nursery, I want that for our staff, but I couldn't find one. You know that I obviously couldn't afford to fund a whole clinic and couldn't be the provider to my own employees. So that was sort of a stumbling point.
Speaker 2:So, that's really. That's how I became a nurse practitioner. I really and by the time I became a nurse practitioner I was an RN for 15 years with very diverse background from that oncology to nephrology. You know, those are good chronic diseases to get your hand around how the body works, you know and then.
Speaker 2:I worked community health. I worked at prenatal clinic, an S, an STD clinic back when they were called VD clinic. So I and well, child, so all of that really and I opened an improved pregnancy outcome clinic or an IPO clinic. So I had a lot of that family preventive background from those experiences.
Speaker 1:You just said you opened up a clinic for women. Is that right? Yeah, for the public health department.
Speaker 2:I opened a clinic. Yes, I was employed so, like I have, I opened a clinic for Minute Clinic. I opened two of their locations for them, did all the set up, the clinic set up, the policies went, did the inspection. So I did that. I opened a clinic in a continuing care community where you know you go from independent living all the way through to nursing home and ALF and dementia care and they had a nurse practitioner run clinic there I worked. I didn't open the clinic, but I worked in independent mobile clinic for the local visiting nurses association. So I worked a lot of jobs where there was no doctor around, where you were on your own. I mean we had somebody on paper. But there were many gigs I had where I never even booked the supervising physician.
Speaker 1:So how did you get into direct primary care from there?
Speaker 2:It's really funny because probably that it was a very circuitous route. It was a torturous route Because I was looking for direct primary care. I wanted direct primary care for my employees at my husband's business. We have 30 employees there and I was looking for a healthcare solution for them. Back around 2010 when that Affordable Care Act passed and even though we're under 50 employees, I felt like this was going to create opportunities for different kinds of delivery systems. Right, and it did. It just didn't come to where we are in Florida. It was pretty delayed direct primary care and getting here. So I had learned about it, as I say, from the employer standpoint and, again being in Florida, we did not have a very viable economic model until 2020.
Speaker 2:When the pandemic hit Governor DeSantis, we had already folded up our lobbyists. They were coming home from Tallahassee. We had given up on that year in March at the end of our state legislative session for getting any kind of more freedom in our practice, and we had gotten the email from them saying, hey, sorry, we didn't get it this year. And then the next day President Trump declared the national emergency because of the SARS-CoV-2 pandemic or epidemic at that point, and when that happened, our lobbyists went right back to Tallahassee and went to go see the governor and said you need to sign off on this bill. It's gotten through over and over. You're going to need more primary care providers. And at that point it was just a day old, right. Everybody was you know. At the very beginning nobody knew what we were in for and the governor signed off on autonomous practice in the state of Florida for nurse practitioners, which is different than full practice authority. It requires three years of supervised practice. It requires 45 continuing ed credits or 15 college, university, master's level, graduate level credit in diagnostic reasoning and treatment and management plans and pharmacology within five years of your application for autonomous practice and three years of supervision under a physician's supervision. So once you have the educational requirements and the three years of supervision, you could apply for autonomous practice.
Speaker 2:Well, I had many years 20 years of supervision when this bill got passed. I was, fortunate enough, many people my age did not have the credit hours that were required, but because I was attending Institute for Functional Medicine for my IFM CP certification and because that school of function I had chosen that school of functional medicine, because they're one of the only ones that offer continuing ed and their continuing ed was approved by the American Board of Internal Medicine at the time. All of my hours for that. I was able to immediately apply for my autonomous licensure and it was a good thing because my then supervising doc was like all right, I heard they got it passed. How long do I have you? Because I'm sure you're out the door so? And he was ready to be done paying for me on his malpractice. So it worked out really well. I was one of the first 75 autonomously licensed practitioners in the state of Florida.
Speaker 1:So you're still autonomous. Now I am, yes, I am. That's great.
Speaker 2:Yes, and up until then my practice was really a consultative practice.
Speaker 2:Up until then, the way my scope was and the way my collaborative agreement was, it actually worked out better for me to not do primary care, to market myself as a consultative practice, only in functional medicine. But once this autonomous licensure passed, it does limit, which is another reason why it's not full practice authority. It limits our autonomy to the practice of primary care. So then it became evident to me that DPC was the perfect model for what I was doing, because I wanna do functional medicine, because that's what I've been doing since 2014. I wanna do it autonomously, I don't wanna have to pay a collaborator, and so for me to do that, I have to do it as part of a primary care program, and so my patients may have another primary care doctor or they may have insurance, because I don't take any insurance and I'm not Medicare enrolled. So they may be, you know, may have that somewhere else, but I am still offering them a primary care relationship. And now, for that reason, it actually helps me be compliant with the Florida autonomous scope of practice rules and regs.
Speaker 1:And how many patients do you have currently, and are they all just functional medicine patients, or do you have patients that are just typical family practice patients?
Speaker 2:So I have about 100 patients. I only ever want 150. Of those 100 patients, probably 30 of them are functional medicine that are actively like active.
Speaker 2:And then another 20 are patients who are, in my foundational plan, not functional, but it's not like I can take off my functional hat. That's when I'm recognizing that really everybody ends up getting a functional membership. So after our DPC Launchpad meeting, I came back so well informed and inspired and really empowered to get paid what I'm worth you know. So I am like blowing up my whole system right now and going to be changing it up honestly, because I don't feel like I'm getting paid fairly and I attend the annual international conference for the Institute for Functional Medicine. It's like a great gift I give myself. It was one of the things that was written into my plan for how I'm going to live successfully. I will attend every conference I choose to attend, and so this is one I love to go to.
Speaker 2:I'm a big Mark Hyman groupie and I actually paid 50 bucks to have a private only 50 of us in a room with him to ask questions. So we were in this room and he was talking about how your practice should be and he recommended that we all fall in love with our patient and I'm like that's really what I want to do, because as a functional practitioner, when you fall in love with your patient, you can really see things from their perspective and you can really do the detective work on that deep level that it takes to really get at the root cause, so often like it's something that's not even physiologic, right, you know, I mean, I think a lot of us who've been practicing for a while know that. You know so and have added even spiritual healing practices to our practice. I haven't done that, but I do really think that it's important to fall in love with your patient, really want the best for them, and the regular system, as we all know it, just didn't allow for that.
Speaker 1:So that just goes to show what kind of compassion you have for people and their health, not just from a medical perspective and not from the perspective of how much money you're going to make, but, like you, genuinely want these people to have a better quality of life, and I think that is what is at the heart of anybody that is in functional or integrative medicine is that they're not just trying to push this band-aid treatment on you and hopes that you'll come back another day and they'll make more money. That's the insurance way about things is quantity of patients is what drives those kinds of clinics, but when you are genuinely trying to help someone get better so that they don't need you anymore, that shows sacrifice on your part as a provider, because you're trying to heal this person so they don't need to come back.
Speaker 2:Absolutely. It's one of the it's one of the most joyful things is when you get a person to that place. You know, and actually what's happened for me recently, like when I first started in functional medicine. This is another thing that I wanted to talk to people about because, like, one thing is define success. However you define success, like my conferences are paid for, all of my personal supplements are paid for. I have a little bit of income because of my supplement sales. That's ongoing. I mean those other 50 patients. They just still keep reordering supplements. They may not be members because I only actually opened the DPC part of my practice six months in June of 2024. So it's about eight months ago now.
Speaker 2:Up until then I was a cash-based practice and the reason I ended up opening a DPC is because I'm successful in running and opening this garden center and it's created financial security for my family. But it's my husband's business, it's not my legacy, and I felt incomplete. I felt there was still more work for me to do and I was volunteering. I've always been very active with our local nurse practitioner group and I was volunteering with our first conference that we were putting on and I was working a booth and this young woman came up to the booth and said I am looking for a person named Terry Pinder and I said oh, that's me. And she said I have been looking for you, I need to talk to you, I want you to be my mentor. I'm about to sit my exam as a functional IFMCP and there's nobody else doing functional medicine around here and I want you to be my mentor. And that ended up being Emily Gabel, who you met also was with me at the DPC Launchpad, and I said okay, I have been waiting for you.
Speaker 2:I came to this conference knowing I was going to meet the person who was going to help me figure out what my legacy is and, honestly, I'm too old. I'm 63. My husband's 68. He wants to retire. We already have our little teardrop camper that we take for six weeks out west and I go off grid. I want that. That is how I define fast. But I still want to make a difference and I still want to have my little 150 chosen patients right.
Speaker 2:And so, for me, education's always been a big thing. Advocacy has always big thing. I've been a nursing instructor, I've been a mentor to other business women in garden world and other places, and so I wanted to create a way number one for Emily to launch her DPC so she could be the direct primary care provider to my company and employees right, which she is now for a year we're coming up on a year of her serving our company Number two so that I could build a space for people who wanted to check out of the massive industrialized healthcare complex. You know, locally we have Cleveland Clinic has bought up our little memorial hospitals and what's not been bought up by Cleveland has been bought up by HCA and now tenants moving in and everything is consolidating.
Speaker 2:You can't get a primary care If you're a new patient. You know, this time of year, because we're Florida and we're seasonal and it's winter, you might wait nine months to get a new patient visit. It's really horrible. If you're sick they might. You could see the NP and they always play that off as if it's some compromise you're making. You know within three weeks maybe, but there's no such thing as being seen when you're sick, you know, unless you go to urgent care or the ER.
Speaker 2:So I really wanted to be somebody who helped practitioners, who saw that was not the way to have a launchpad, really a place, an incubator that was compliant because I had opened clinics before I had been through the credentialing process. I had done it over and over again. I know it's complex. I wanted to be able to do that. I'll get the biohazardous waste permit. I'll get the CLIA waiver. I'll get all of those things.
Speaker 2:If you want to bill insurance, you can do it.
Speaker 2:You have your own EMR, you have your own LLC, which doesn't muddy the water about whether you're an employee or a 1099, and you lease from me and you join a co-op, I'll buy. You know I have the McKesson account so I get the strep test, 12 at a time and you pay me for them as you use them. So I have right now I have about six clinicians in this co-op who pay $79 a month. It's set up the same way. I use HIN to bill it, just like I bill my DPC membership, and I use my EMR to manage the booking of the room. And I have a suite that one, two, three wet exam rooms, one dry exam room, one mental health room, a classroom, a consultation room and then a front office reception area. You know, in a back dirty utility, biohazardous waste, you know centrifuge kind of area, and that space is then available to people to sublet by the four hour block of time, however they need it. So and then? $79 a month includes their first four hours and then they go down.
Speaker 1:Yeah, I was going to ask you about your rates. So how did you come up with the rates that you charge and be a little bit more specific with us about what you charge first for what things?
Speaker 2:Okay for the direct care clinical co working. Start with intentionally well.
Speaker 1:Okay, and then once you have told us that, then tell us what you charge for the direct care clinical.
Speaker 2:So for Intentionally Well, my direct primary care, what I charge, I set it up based on listening to Penny Vachon years ago, which has proven to be a mistake we're only charging 99. Emily and I have similar models 99 for foundational and 169 for the functional. And that's the part that's killing us, that 169 a month for the functional and that the part that's killing us, that 169 a month for the functional. $100 registration fee.
Speaker 2:Employers are 79 in groups of five or more are an employer group. There's children. We see two and up. I'm actually more comfortable I will seeing them at one and off. But we advertise two and up mostly because by two they're past all those important milestones for a cognitive development. Wise, you know.
Speaker 2:But I do get moms who are reaching out to me because their child's having indigestion and the doctor wants them on, or constipation, and they're one year old and the doctor's putting them on Miralax. So you know they they want some natural solutions. So for children anyway it's, with an adult it's 59. And I think it caps out at three kids. After that there's like a flat rate for one adult and three kids. But I don't have any families that large so I don't know. I mostly right now are doing adult women who are a lot of autoimmunity people, a lot of people who come to me wanting bioidentical hormone replacement therapy. You know sexual reproductive hormone replacement therapy and I don't ever start there. You know, as a functional practitioner we like to look at that HPA access first and thyroid and then, when we got all that tweaked, if they still need hormones for it, then we look at that.
Speaker 2:So that's sort of but when somebody comes to me and we do their initial intake. We figure out whether they're going to be a foundational patient or a functional patient. But, honestly, everybody who finds me really finds me because they're done seeing conventional and they want functional. You know that. You were saying that. I think everybody was why we ended up getting found. So I have to cap it I don't because I do other things in my life. I'm a grandma.
Speaker 2:I still am involved in my husband's business. I have my clinical co-working startup thing that I'm doing, so I really and I like my time and space for my own self-care, so I limit my visit to Tuesday. Wednesdays, thursdays and Fridays are generally like an administrative day, and Mondays whatever I want to fill in there Usually. You know I'm caring for my 90 something year old parents, so I have those responsibilities. So it's exactly the success I want right now for me.
Speaker 2:And you know I worked a lot of different places. The experience was great. But when I was trying to start up my practice, my cash-based practice, and I was paying for like marketing advice and stuff, they were like define your avatar, define your ideal client, think of all your best patients and I had the hardest time with that. And then I realized, like my avatar, my ideal client is gardeners. People who understand that the closer to the earth you are, the more in line you are and the healthier you're going to be. And people who understand that in line you are and the healthier you're going to be. And people who understand that you plant a seed today but you're not going to eat that watermelon for 120 days, you know. And in that meantime you're going to weed, you're going to feed, you're going to you know tend that you're going to build a permaculture, you're going to do these things.
Speaker 2:And for a decade, when I was running that garden center on the day-to-day, I was teaching people all of that, what I called grandmother knowledge, the wisdom of our grandmothers about the garden. And guess what they all knew? I was a nurse practitioner working in my husband's business. So when I was ready to go back to being a nurse practitioner, I had a mailing list of an email list of over 9,000 names of people who were really eager to hear my community lecture on the garden, in your gut, the 101 on the human microbiome. So, being always sensitive to the fact that they gave me permission to talk to them about the garden and not about their health. I periodically send out a little information about the link between the garden and your health and invite them to come over to my email list, and that has worked for me in building my email list to about a thousand fifteen hundred I guess I'm somewhere in there so and it's been growing since I opened the DPC because I've been putting myself out there.
Speaker 2:But, honestly, after our little meeting, that DPC launch was so pivotal for me because all of the discussion around my why I really had to get back to like what is my why and my why in doing this you know, 14 in 2014, 10 years ago, 11 years ago starting my practice was one thing. You know my why today is completely different, because my why today is more about building a legacy, being a leg up for the next generation, because I'm not going to build a 500 patient practice, but I could create a space where five other practitioners get their start for the first year, keep their expenses down, maybe two years until they hit their halfway on their panel. That's the agreement I have with Emily. She's got this one nurse practitioner I brought in. I gave her a discounted rental rate until she gets to 50% of her DPC panel and then we will go to the full rate. And that's the way the lease was written and that's how we did it.
Speaker 1:Yes, so what are they renting space from you? I know you mentioned this earlier, but I don't remember what you said about it. So the other nurse practitioners and medical professionals are renting space from you and you're providing all of, like you said, your clinic is CLIA wavered, so you're letting them use that and you buy medical supplies and stuff and you let them use that and you charge them for every medical supply. Or does that fall under the monthly membership that they pay? How does that work?
Speaker 2:So the way that works that's my other business, which is really what I consider my legacy is the direct care clinical coworking. So that is where these clinicians join a membership for $79 a month and with that membership they get two Zoom meetings a month where we're doing accountability, coaching and masterminding and hot seating and discovering our why and defining our all of that kind of stuff and really walking them through the depths of business ownership because of my experience in business. And so that's what they get for the $79 a month. Plus they get their first four hours of room space for that $79. So I have a lot of mobile practitioners, for example, who see patients in ALFs and they bill Medicare and they've been having a hard time getting credentialed with some of the commercial carriers because they were using PO boxes or UPS locations and now they have a fully Google verified mailing address, physical place where somebody can receive packages and get their mail and forward it for them.
Speaker 2:And then they can participate in those weekly or biweekly meetings if they want to or not, though I have like three clinicians like that who've been doing this for a long time and so they really just needed the physical address and mailing address. And then I have about four clinicians who are in startup phase, who are actually looking to get the guidance on how to get started, and so they attend the meetings regularly. One of the women who travels and does travel nursing a lot also does a botox clinic. So for her $79 a month, she uses my office, she uses it on the weekend, she does a little Botox party with a bunch of people that she has, and that's all. She gets that for $79 a month, plus the mail forwarding and everything else. So people are like, well, are you really making money on that? And probably not at this point.
Speaker 2:But my goal is to get enough people signed up for it and have this or that particular clinician she just sent her son who is on the autism spectrum. He just started college and so she wants her to be available to support her son. So that's what I want to do. I want to give clinicians the freedom to practice the way they want to practice and take away that concern for the overhead, and right now I'm able to pull it off and now it's growing Like I've been six months and I've got six clinicians signed up Tonight. My overhead for that isn't any more than it was for me to have this space that I'm practicing in. How big a space do you have? It's 1,700 square feet, so it's a fairly small waiting room. There's only I think I got like four chairs in there, three regular and one oversized but nobody's ever in our waiting room. You know how that is in a DPC Nobody's ever waiting.
Speaker 2:And then I've got, like I said, three wet exam rooms and they're very large rooms. They're 12 by 10 at a minimum, some are 12 by 12. And then I've got a 12 by 16 room that is set up for mental health professionals and I have two mental health professionals who are using that at different times. So different people are using different rooms at different times. So different people are using different rooms at different times.
Speaker 2:And right now I'm also open to somebody who wants to come in and say I want that exam room for myself and I want a lock and I don't want anybody using it other than me, and so that will be a different rate that we negotiate based on Actually, there's a formula for that that the OIG puts out to make sure that you're not in violation of anti-kickback or anti-stark laws.
Speaker 2:So I paid a lot of money to a healthcare attorney to write all of those agreements for me.
Speaker 2:So all of the clinicians have to have oh, I think it's called a BLA agreement for to be in compliance with HIPAA, and I have an IT company that understands healthcare practices, so they give me the support on how to make sure that we keep things secure and all of that regulatory stuff is addressed when the clinician first comes in and then over the course of the year they can be or two, I figure people be there a year or two and then they go out and get their own space.
Speaker 2:You know, over that time they can learn the ins and outs if they want to go the route of Leah, if they're going to take insurance, Because honestly, you know, if you're GPC and you're straight cash pay, you don't really have to comply with any of them, Right? I wanted the space to be compliant for those people who for anybody to rent. It is the bottom line. Ultimately, I hope it to be my passive income and I just have rental income and I can travel and move on to retirement and come back and see patients, you know, whenever I feel like it.
Speaker 1:Yeah, I wanted to talk about your retirement because I'm interested to know what the future looks like for you. As far as you know, you have both of these companies, and people are relying on the education that you have gotten. I mean, you have some certifications that not too many people have. I don't know about your area, but what does it look like to retire or to sell this business or to make it go without you physically being there?
Speaker 2:Well, what that would look like is renting out all those suites and having it, you know, having an occupancy there of at least 50%. That's what I wrote it for. Break even, carry the place completely and have a little cushion. Honestly, I'm not looking to make hundreds of thousands of dollars I have on that business. I suppose ultimately the real estate should be a decent investment. There's not a lot of medical office space. It took me two years to actually get that place approved as medical office space. So I think that has value added.
Speaker 2:You know, the real estate itself in Florida has been well. It had been appreciating greatly, but right now that is not the case. So it's a long-term real estate investment for us as well, for my husband and I, because we own that property and then at least by direct care, clinical co-working from my husband and I. So it becomes like I don't want to. It's sort of like a company paying another company, kind of thing. But it keeps everything separated for us so that our liability, because we own all these businesses and then we own several rental properties like vacation rental properties we have to keep things siloed for liability reasons. So it ends up it ends up being more complicated than it needs to be, but it allows me the freedom then to provide this space for other clinicians. The other thing that we do there at Direct Care, clinical Coworking to add value, because you know, when I said I was looking for a direct primary care, I was a patient of a direct primary care and I was paying crazy money I mean a lot of money to this doctor.
Speaker 2:And I remember going to her and saying you know, I got this little wart. You know, can you get this off? And she was like, oh, I'll send you to a dermatologist. I mean, really, you can't burn that off for me, you know? So like that kind of stuff. She never did anything for me and she just took my mind. So I was like I am going to add value.
Speaker 2:Honestly, when I went to go see her we spent I spent a 45 minute visit, but 30 minutes of it was me giving her garden advice you know about her plan and then 15 minutes of her giving me some other referrals, sending me somewhere else for my medical needs. So I'm like I'm going to do something that really adds value for people when we do a DPC, and so I modeled it a lot after my garden center where I built a community, a lot of garden activities and things for the people, and so that's what we're doing with our direct care, clinical co-working. The clinicians who come and join there can share their event with everybody and we create sort of this community of health seeking individuals. That's kind of what we're hoping for. So different providers there offer different classes for free to get people in and we market it to everybody's clientele. Good for everybody that way, mostly the patient, because they're meeting other people who are also seeking help, which you know you become most like the five people you spend the most time with trying to build that community again.
Speaker 1:Man, that's awesome. I don't even know how to follow that up with anything.
Speaker 2:I know I feel like I just yacked the whole time, oh no, that's so.
Speaker 1:that's so interesting Just the way that you can collaborate your husband's horticulture business with medicine and you interlink it. So I'm curious to know does he grow herbs and things that you use and do you, do you make your own tinctures and things like that to give to your patients?
Speaker 2:Tell us all about that. We do that, yes. So I told you one of the free classes that I give for the community is the garden in your gut, the one on one on the human microbiome. So for every community lecture we also offer a workshop. So the workshop that goes with that one is how to make sauerkraut. So we just have a bunch of people come it's a make and take so they pay low, like 20 bucks, and they leave with like a quart of sauerkraut that we make together and I coach them. Then there's like a automation and email automation. I use constant contact for my CRM and email automations that follows them up after that, that reminds them to check and keep it airtight and make sure there's no mold growing and all this stuff you have to do to finish up a sauerkraut.
Speaker 2:We grow herbs. We teach people how to grow herbs. During the pandemic I did a whole series of herbal monographs. I walked people through the how to grow them, how to use them culinary, and then I never got to how to use them medicinally because I was going to charge for that part and I never built that class out, but I instead what I've done is we do another class on herbs for calm, clarity and happiness, and so I talk about the different herbs that support that, how to grow them, how to complete what's called an herbal monograph that you can build your own materia medica with. And then we I talk about the benefits of the various herbs, and then I have people make their own mixes and I teach them how to make a tea blend, and so the workshop that accompanies that class the free class is a workshop on how to blend your own teas, or we do that one for heart health. So you know, I have Hawthorne berry and Kizandra berry and rose hip, and then we have Hawthorne leaf and I like for women, I like raspberry leaf, so, and then we just talk about the have like 20 different things for them pick from, and then they blend their own tea and we talk about the energy of plants and how they speak to you. So that's the other one that I do. So we have lots of workshops like that. Absolutely, we blend them together.
Speaker 2:I use a lot of botanical remedies. I make tinctures. There is, yeah, there's a class that I do for how to make tinctures and glycerite, yeah, so we do a lot of that. We do a lot of that kind of education in the community. Our community, like our garden community, expects us to teach them about health. We grow vegetables, so we teach people how to garden and grow their own food and how to use that, which is really hard for people the first time they're growing their own vegetables. Like what do I do with this Swiss chard? I don't even know what to do with it, so we totally do chard. I don't even know what to do with it, so we totally do that. I don't have a big role in that anymore.
Speaker 1:A lot of that education comes out through my daughter and my son, who are now taking over our nursery bizzo are the workshops only available to people that can physically come there and do your workshops, or are you able to do workshops for people that want to learn? Because people are going to listen to this podcast and they're going to be so interested in your workshops then they're going to reach out and they're going to want to know how can I listen in on Terry's workshops. So is that possible Is are you working?
Speaker 2:on that you can. I do have some Facebook live still on my Facebook page for intentionally well, I do have some Facebook lives still on my Facebook page for Intentionally Well, you'll find all the how to create an herbal monograph and then all the information about how to grow the herbs and they're commonly easy to grow herbs and then how to incorporate them into your diet, because, honestly, that's where the magic is like using those things every day, so that all is available for free. On my Facebook live you can listen to that, and one of the things that's also there is a downloadable PDF or the little form that's called the herbal monograph, which is how you keep your own notes. Every time you learn something more about rose, let's say, you go back to that page and you add to it. It's kind of like, you know, when I went to nurse practitioner school, we didn't have smartphones, so we kept a little index card, a flip file of index cards, with all our normals and our regular dosages and our protocols, right, and that was in our pocket. So it's sort of like that's what your herbal monograph is how to identify it in the wild, how to grow it, how to harvest it, all that. So those are available on my Facebook page.
Speaker 2:My other classes we have again. When we returned from our workshop, our DPC launchpad, emily and I said it's time for us to hire somebody because we have all these big plans and we can't get them off the ground. And so one of the plans I have a platform called Rizuku and it's like a lot of the other platforms, where you can load an auto piloted coursework where you do unit one and any PDFs are attached there and any other links are there and audio file, video file, all of that there, so a person could do a self-paced course that way. We have some that are available on our nursery website for like, how to grow herbs and how to grow food in Florida. I have not gotten those things launched for the garden in your gut class. I have them on zoom and I do share them with people who register. I can give them to you that way, but they're long and it's just me talking and you know I'm verbose, I talk too much.
Speaker 1:So you know, you're so full of information that I never want to interrupt you because I'm like she's still giving us all these good seeds. No pun intended. Good seeds, that's right.
Speaker 1:Oh man, it's been so interesting just listening to you talk about your different businesses, because it's unique. Just listening to you talk about your different businesses because you're it's unique. You have a special gift for multiple things not just taking care of patients, but being able to correlate their health care and everything with you know plant life around them and how they can utilize plants and the herbs and stuff to make them well. You know. God put those on the planet for us to use and you have figured out how to use them.
Speaker 2:It's been an awesome ride, honestly, like you said, like weaving my nursing career in with my husband's business is really, I feel, informed me. And the thing is, you know, when we went to DPC Launchpad, you hear all these highly successful people with hundreds of members in their panel and really rocking it and I say kudos to them. But I want everybody to hear that there are many ways to define success. And, coming back from that and really getting back in touch with my values, I realized you know, no, I've spent six months sort of chasing new memberships and that's really not what I wanted. I really want to build Emily's DPC so she can start paying me rent more rent, rather and I can travel and I can do things from afar, work on those classes and do those things, so that you know when I'm off grid or out of this realm.
Speaker 2:Ultimately, because we're in that stage of our life and a lot of the work that I've done throughout my life and the people who are attracted to me tend to be women at transition points in their life, and there are three archetypes for women throughout life the maid, the mother and the crone.
Speaker 2:And the maid is that bright eyed young oncology nurse who believed we were curing cancer nurse, who believed we were curing cancer, you know, and that the administrators really cared. And then I became the mother who was pushing for things to be different for the whole world. When you're a mother and you care so much for that next generation, you want to rock the world and change it. And that was more headbanging right. But now I'm the crone and I've gathered lots of experience over the years. From the garden, from my grandmothers, from my all the grandmothers I cared for over the years. I've learned that there's lots of ways to define success stay in touch with your values and find your happiness, find your joy and fall in love with what you are doing. Like Mark Hyman says, fall in love with your patients. That's the only way that you're going to really make that difference.
Speaker 1:That is great words of wisdom right there. So everybody go to intentionally well the Facebook page or go to Terry Pender's Facebook page. She's happy to share whatever she has on those two social media outlets for information and hopefully people that are out there that are looking for a different type of DPC clinic will see what you've got going on and maybe come down to Florida and check it out. I'm sure it is something worth seeing.
Speaker 2:Oh, it's beautiful place to come, visit, love to have you.
Speaker 1:Well, thank you so much, Terry, for meeting with me today. Thank you, wonderful podcast. I'm just so so much, terry, for meeting with me today. Thank you, wonderful podcast. I'm just so looking forward to getting this out there and seeing how many people are going to just benefit from your words. You are precious.
Speaker 2:Thank you, Amanda, you are as well. Thank you so much for the good work you're doing and inspiring folks and truly I'm honored to be among the members of your cast. Thank you so much. Thank you, Terry.
Speaker 1:You have a great day, you too, amanda. Bye, bye, bye, bye. Thank you so much for joining us today on the DPCNP. We hope you found our conversation insightful and informational. If you enjoyed today's episode, please consider subscribing to our podcast so that you do not miss an update, and don't forget to leave us a review. Your feedback means the world to us and it helps others discover our show. We love hearing from our listeners. Feel free to connect on our social media, share your thoughts, your suggestions and even topic ideas for future episodes. As we wrap up today, we are so grateful that you chose to spend a part of your life with us. Until next time, take care. This is Amanda Price signing off. See you on the next episode, thank you.