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
Beyond the Exam Room: Building a Thriving DPC with Dr. John Rothwell, APRN
John Rothwell's journey from Army medevac paramedic to owner of a thriving Direct Primary Care practice offers a blueprint for healthcare entrepreneurs seeking both clinical and business success. With over 1,000 patients and three nurse practitioners at Island Direct Primary Care in Florida, Rothwell demonstrates how values-based healthcare can create sustainable, profitable practices.
The foundation of Rothwell's approach rests on two core pillars: "God, family, and community" paired with a commitment to being "loving, encouraging, and empowering." This philosophy shapes everything from patient interactions to business decisions, creating a practice that stands out in a crowded healthcare marketplace.
After experiencing traditional healthcare's frustrations firsthand, Rothwell leveraged his diverse background in emergency medicine and technology sales to reimagine primary care delivery. Starting as the first DPC in his county five years ago, he built his practice through initial word-of-mouth referrals, strategic partnerships, and eventually hiring a dedicated marketing professional. This methodical growth approach has yielded remarkable results despite charging premium prices ($99/month for adults, $49/month for children) – 25-40% higher than local competitors.
What truly distinguishes Rothwell's model is his investment in people. Rather than following the typical lean DPC approach, he prioritizes quality staffing, offering nurse practitioners 28-hour workweeks, uncapped PTO, and a clear salary progression from $100,000 to $150,000 plus profit-sharing. This focus on practitioner wellbeing translates directly to patient experience, with providers having the time and energy to deliver exceptional care.
Rothwell's strategic innovations extend beyond staffing to include free medications for patients, specialized functional medicine programs at premium pricing ($4,800-5,500 for six months), and carefully designed technology systems. Now planning his third and fourth clinic locations, including out-of-state expansion, he offers aspiring DPC owners crucial advice: "Don't go at it alone," and "If you're not ready to make less and live more, then being an entrepreneur early on in DPC is probably not for you."
Ready to transform your healthcare practice or start your own DPC journey? Connect with like-minded practitioners, find mentors who've walked this path, and remember that sustainable success comes from putting values before profits. Your patients—and your quality of life—will thank you.
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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.
Speaker 2:Hey everybody, welcome to another episode of the DPCNP. I am excited to bring you today John Rothwell. I've been trying to interview him for almost a year now to bring you today John Rothwell. I've been trying to interview him for almost a year now. I finally get to interview John Rothwell. I know that it is going to be a blessing to everybody. He comes with tons of experience and knowledge. So let's welcome Dr DNP John Rothwell of Island Direct Primary Care in Merritt Island, florida. John, welcome to the show Finally.
Speaker 3:Finally, hey, amanda, thanks for having me. I guess, since you cornered me up in Charleston, we had to make this work right.
Speaker 2:Yes, I had to go all the way to Charleston to see you in person, to be like you are doing this interview, you know.
Speaker 3:I love it and I love doing them, and one of the beautiful things about direct primary care is we have the flexibility to care for our patients the way we want to, and so I do. One of the bad things that I think entrepreneurs and nurses who are involved in direct primary care because we're traditionally trained in caring I put all my patients before me and I really need to work on that. I need to work on that self-care and those kinds of things, and so I finally said, hey, you know what I'm going to make time, because I love doing this kind of stuff and I love helping other nurse practitioners and I think your story is super cool and the fact that you want to share it with everybody makes it even more cool.
Speaker 2:Yes, I mean, if we can all help each other out. That is the goal. I think that was the goal for the conference and I feel like that's the goal for this podcast is just listen to other people's individual stories and learn from their successes and their mistakes, and then your clinic will be the best that it will be Right.
Speaker 3:So take us back.
Speaker 2:What's that?
Speaker 3:It'll be yours, your clinic.
Speaker 2:That's right, exactly, and that is the important thing Be an entrepreneur. So take us back to, I guess, nursing school. Where did you go and how long were you a nurse and what field were you in? And then what led you to go back to be a nurse practitioner?
Speaker 3:Yeah, I'll try to make that story quick because it really started with the United States Army. As an EMT paramedic I flew search and rescue medevac when the Apache helicopters first started coming out. So I was in the second Apache helicopter unit and I got stationed in the Middle East, really kind of fell in love with the emergency medicine and caring for our soldiers, and so when I got back to reality, in other words when we got back out of the combat field, I decided to apply for college.
Speaker 3:So I got into University of Central Florida realized that you had to take more school than just nursing stuff. You actually had to take English and math and history. And so I you know the fraternity and the rugby party was more important than that. So I kind of went back in the national guard so I can stay in medicine. And then, fortunately for me, I met my wife and her little daughter, zoe, who now works with us, by the way. So she was one and a half years old. And my wife's like what are you going to do with your life Now? You have a girlfriend with a kid and she goes in the rugby party is not going to cut it. And so I said well, I want to be a nurse. And she goes, then go be a nurse.
Speaker 3:And so went to nursing school at Florida Community College was at the time where now it's Florida State College all the colleges in the state of Florida kind of become four-year public schools now and I got my nursing degree there. So it was a two-year RN, started in CVICU, ccu and transitioned into trauma and emergency medicine. Drgs started coming out in patient care where the insurance companies were now dictating admissions and discharges, and so I got pissed off so I left. So I moved up to New England and started working at a hospital there Guess what the system's broken up there too. I got pissed off again, and so, after a number of instances where the insurance companies were dictating how long my patients should be admitted in the hospital, when they should be discharged basically they were dictating the care of the nurse and the physicians I left and I got into technology, and so I did that for 10 years, and so I think one of the most interesting interviews I had was with a global telecommunications company, and the CEO, after an eight hour interview with other guys, goes John, you're a nurse, how does this help you in technology and sales and marketing?
Speaker 3:And I said it sets me up perfectly. And he goes well. What do you mean? I go well. The first thing we have to do is establish trust, and the second thing we need to do is build a relationship, and the third thing is is we have to let people know that we care, and if we do that along the sales process, you'll be one of the top sales guys. And so I did that for 10 years.
Speaker 3:Lucky enough for me. In 2008, the market crashed and I went bankrupt. I was 39 years old and we lost everything, and so I had an idea of opening up my own practice. But I was going to be the money man. But now I had no money so I went back to college. So at 39, I went back to college for seven years, so I went back to the ER, went to University of Central Florida again and got my bachelor's, master's and my doctorate, because I knew that once I stopped, I was never going back.
Speaker 3:And that's kind of like where the nurse practitioner journey began. I knew that being a nurse in itself wasn't going to be enough, because I wanted to do more. So as a nurse practitioner, while I was getting my DNP, I did emergency medicine and urgent care, and the day I graduated with my DNP was the day that I started writing my business plan, and it looked very concierge medicine-like. In reality, there was these small little practices, maybe micro practices across the country there's just over a thousand of them and they were called direct primary care practices. I'm like, oh, that's cool, and I was all about working with the underserved and uninsured communities and so finding DPC that really kind of focused on accessibility to care, and accessible, affordable care was really interesting to me. So I pivoted my business plan, wrote it, towards direct primary care, and that was just over five years ago. And so now we're three practitioners and over a thousand patients into it.
Speaker 2:Yeah, and I definitely want to get into how you were able to grow your practice so successfully. Want to get into how you were able to grow your practice so successfully. Let's go back to how did you even hear about direct primary care? I mean, I know you had created this business plan that looked concierge, but did you seriously create it in your mind and it was already existing? Or did you happen to see other clinics in your area that were already doing that model and you were trying to jump on their bandwagon? What does that look like?
Speaker 3:So, brevard County is 70 miles long. We're just under 70 miles long. We have about 660,000 people in the population. I was the first direct primary care practice in Brevard County.
Speaker 1:Okay, so I'm the pioneer. Now there's five.
Speaker 3:I've mentored three of them, and so there was a television show that my wife liked to watch, and so he would go to people's homes and take care of them. And my wife and I used to laugh about living in the islands and taking care of people for chicken and lobster and so traveling around on a boat to these little remote islands and taking care of those needed not doing it for money but just doing it for just out of sustainable goodness kind of thing. I saw that television show. It was a concierge medicine thing. So that idea didn't pop into my head when I did my business plan. You know, being a DNP, research is a big part of that and there's a clinical component too.
Speaker 3:But my technology background allowed me to realize that not everybody's the inventor. Many people are the innovators. So you take an idea, you make it yours, you make it better and you build on it and improve it, and that's okay. It's okay not to be the first. I worked for a technology company that was the first, and in five years the private equity firm shut us down and we all lost our jobs. And then there was a company called Cisco Systems. They were not the first and they actually did a lot of acquisitions and they would buy up other companies, put their label on it, so branding and marketing call it their own, even though they weren't the inventor, and so I'm like you know what.
Speaker 1:I don't have to be the inventor.
Speaker 3:What I need to do is take this really cool idea accessible, affordable healthcare and make it my own. And so I'm like well, how am I going to do that? So I do it built on two pillars. For me it's God, family and community. So nowhere in there is Island Direct Primary Care. I also own Main Street Direct Primary Care. I actually have a company that focuses on federal government acquisitions and stuff like that, because I'm a service-connected disabled veteran and so everything was God, family and community.
Speaker 3:And then we were going to practice as a leader within my business and in the community. We're going to be loving, encouraging and empowering, and I think if we focused on those six elements then we would have a successful business. And so that hasn't changed from day one. So day one started with me 200 patients. Later I hired one of my students who I was precepting, and so precepting, I think, is huge to growth and it's kind of like a six month interview. At the same time, nurse practitioners are already changing the way they think, and so you put them in a business model that thinks differently. Now you're actually creating something new and different for your community.
Speaker 2:How did you grow your panel, what was your marketing technique and how long did it take you to get to that 200?
Speaker 3:Yeah, so year one was just me, me stumbling over social media. Don't like it, not a fan. I think it's a necessary evil. Most of it is, you know, imposter syndrome and I just didn't feel self-confident on video and in my creative voice if you will, but I did it anyways. So the first year I had 94 patients. Then I did a referral program and started incentivizing my patients to leave reviews, which I didn't follow up with that. So that didn't work, but I get a few referrals, so kind of everything kind of organically started to grow. And then, midway through my second year, next, terra, which is a national DPC now, was looking for an affiliate practice in Florida because one of their customers acquired a company in Melbourne. And so they said hey look, john, we have 20 employees that work for this company that's part of a bigger group. Will you take care of them for us? And so I went ahead and I'm like yeah sure, it reduced my margin by almost 30%.
Speaker 3:So it was a lot, but when I looked at my customer acquisition costs, it was zero. And so I'm like you know what you know, let me go ahead and give this a shot. That was about 20, you know 20 patients there. Everything else was organic word of mouth until I hit 200 and I hired Nola. So now that's Nola DNP, so she's a nurse practitioner with a doctor as well.
Speaker 3:And then I needed to do something different. So I actually hired a marketing person who had a degree in marketing and she wanted to do business development and sales, and so I brought her on for 20 hours a week and let her do my social media, let her do those things based off of my vision and my voice. And so I invested heavily in people and so I'm very top heavy. So, whereas most people look at direct primary care and working lean, I have a very high overhead because I want to enjoy coming to work every day. I don't want to be stressed about the amount of volume and I'm in the long game, not the short game. You know, when I bought my last house, you know my mortgage was a thousand bucks, so it's not like I needed to make a lot of money and add a 1997 Jeep Wrangler.
Speaker 2:So that's awesome that you are very low maintenance in perspective of it all. How many patients does Nola have?
Speaker 3:So Nola has about 330 right now.
Speaker 2:So would you say that hiring the marketer paid off Like that got you more patients than you did when you were trying to grow it organically by yourself.
Speaker 3:So I think the first year and a half I spent training her and teaching her direct primary care and using my sales and marketing background of massaging her education and giving her a sense of urgency. I think that's one thing that's very difficult. You can't teach that If it's not their company. Having that sense of urgency is tough. I've been extremely blessed with my team has a sense of urgency for caring for people. And then when it comes to different strategies and techniques for example the marketing piece she had the autonomy to kind of do the things that she wanted to do and I would give her ideas.
Speaker 3:Danny has a degree in marketing. I hired her for 20 hours a week. It was already taking me 10 to 15 hours a week to do my social media and all that stuff. If I think of myself being worth, you know, a hundred $200 an hour, and I hired a marketing person for 25, fresh out of school, let her work from home, get her an $85 a month, health share right, you know, zion, she has it made and she can kind of work when she wants and all that stuff. So she has lots of flexibility. But it's taken at least two years for that really start to pay off, to give an example.
Speaker 3:So I hired my third nurse practitioner. She brought her on in September to the first while she was studying for boards. So September or October she just kind of shadowed us and learned the processes front office, back office. She did her doctorate work here, so she was familiar. Again another preceptor so she did her doctorate work here, so she was familiar with what our goals were. November 1st was her day one seeing patients as an MP and she has about 120 patients already.
Speaker 2:Wow, that is incredible. I'm trying to grow my nurse practitioners panel and I'm trying to do it by myself and, just like you, grow it organically, but it's kind of slow. So your tips and tricks will set me back a little bit financially, but it's probably, like you said, the necessary evil to really make it catapult, because I really need her to have more like 300, 400 patients, not 70 patients.
Speaker 3:Yeah, and so I start paying myself back when they get to 200. So the first 200 is out of my pocket, and then about after 200, they're kind of carrying.
Speaker 2:What is your pay scale for your nurse practitioners? Do you pay them a salary or do you pay them a percentage of each?
Speaker 3:membership. I pay them a salary. Full-time for me is 28 hours a week. Yeah.
Speaker 2:I remember you saying that at the conference.
Speaker 3:Work-life balance is super important. So you figure, you know they may. Their starting salary is less than what they would get if they went to work 40 hours a week for someone else. But as they grow their panel they actually have the opportunity to make more. And so roughly at 400 patients is, I'm capping between four and 500. When I cap them I'm capping their patient panel, not the money. So at 400, they're making basically 100,000 base and then I'm paying for everything.
Speaker 3:So continuing education, malpractice. They have unlimited PTO, so they have unlimited paid time off and those kinds of things. And then they get a $10,000 a year raise every year for five years. So basically, within five to seven years they go from their starting salary whatever that's negotiated at to about 150,000. And then they're capped at 150. And then I start profit sharing with them. And the whole point of profit sharing is it encourages them to grow the next nurse practitioner. So if they grow the next nurse practitioner in the practice so now I have three nurse practitioners sharing the same office staff my profit margin goes up, which means their profit share goes up.
Speaker 3:So, if they are eating their young, like you know, they say, right, then they don't grow the other person's practice, then it affects them financially too. So that's kind of like how it's set up, so salary unlimited, pto they get work, family life balance and then they're incentivized by growth.
Speaker 2:And what other employees are in?
Speaker 3:your office. I have my marketing manager, I have a operations manager Now she was my office manager and I have now so operations in office and then I have a registered nurse who is finishing up her functional medicine training and she's also a health coach. So those are my, those are my W-2s. And then I have a pharmacist on 1099 who's also a health coach and does specialty programs with me, and I also have another DNP who does 1099 and she does specialty programs with me, and I also have another DNP who does 1099 and she does specialty programs with me. So we have some functional medicine stuff that we do outside of DPC under my brand, and we also do some longevity and health spans up there. So those are programs, six month programs that are above and beyond direct primary care.
Speaker 2:Do you have any other add-ons other than the functional medicine that you do, like IV hydration or hormone replacement therapy or Botox or anything it's?
Speaker 3:a great question. So, being a integrative healthcare practitioner and you know Penny loves the word functional medicine, so we'll call it foundational medicine- no, she does not. I'm being facetious, right.
Speaker 2:Yeah.
Speaker 3:Sheates that term right and so, being an integrated healthcare practitioner and really focusing on anti-inflammation or focusing on people's inflammation, I'm not a fan of Botox, so I will never have Botox in my practice.
Speaker 2:So you're on an island in Florida. What do you?
Speaker 3:mean that's right. So right now we're researching and doing some groundwork on things like PRP and other things that may cause a natural inflammatory response to help those things from an aesthetic perspective. Obviously, collagen, hormone replacement and all that's part of what we do. I believe hormone replacement is part of primary care. I don't believe it's separate, so it's not an add-on for me. It's what we do, and so when people come in talking about fatigue and talking about insomnia and talking about constipation and these kinds of things, I'm looking immediately at hormones, whether it's thyroid hormones, sex hormones, insulin hormone. That's where we're going and then we're showing them how we look at it differently and that's how we're creating our value. I give away medications, so my CPA doesn't like me. We're compromising going into March, where I will have a free medication list and then have some graduating pricing for some things. So the only thing I've been charging for is Cialis and Viagra.
Speaker 2:Well, that's wonderful that you can include that as part of the services that you provide for your membership prices, which we'll talk about in a second. But the fact that you're offering free medication to patients is probably another selling point. And if you can afford to do it and like if you order medications from a wholesale distributor, the medications some of them are so cheap that I mean, what are you losing? $15 for 1000 pills or $20 for 1000 pills? Yet you are gaining a positive review that somebody is going to go tell their friend or they're going to put it up there on Facebook or other social media platforms to be like I got my medicine for free and you're just like, yeah, and I paid $15 for a thousand of those pills.
Speaker 3:So exactly, it's a marketing expense for me. We had 369 patients and over a 12 month period, you know, we ended up having another 300 patients. So that year I spent $7,288 on medicine and then we went from that mid 600s all the way up to 850. And I spent the exact same amount of money, plus or minus a hundred bucks. Right, I mean, at the end of the day that means I have that many more patients, but I'm spending the same amount of money as I'm not increasing prescribing, I'm reducing prescribing, and that's my goal is to help patients get off their meds.
Speaker 3:So my commitment to them is if I can help you get off them, I no longer have to buy them. You know when you're doing I don't prescribe statins, but I'm gonna use that as an example. A hundred, 100 tablets is a couple bucks. It's costing you 33 cents or, you know, 75 cents a month for a three month, look. But they tell their friends that they went to their primary care provider and they had everything right there. They didn't have to go another trip and all that kind of stuff, and so that brings a lot of value.
Speaker 2:Yes, okay, so let's talk about your membership rates. Now you're in central Florida.
Speaker 3:Orlando I'm due east Cocoa Beach, where the cruise ships come.
Speaker 2:Okay, well, I'm sure that the cost of living is probably higher than Memphis, tennessee or other places in the region or of the country. What are your membership prices and how did you come up with your fee structure? That's a great question.
Speaker 3:So I started off with Atlas. So I use a lot of the tools that Atlas provided at no cost and I've read just about every DPC book out there. I did the layered model 20, 40, 60, 80, 100 when I first started and that became a pain in the butt to manage because you know the families were just like well, my kids only this age, and you know when, I'm gonna bring them in at the same time and it just became a hassle. I'm gonna go. You know what, when it comes to pricing, psychology plays a big part in pricing. Psychology plays a big part in selling, presenting the value add to your business. So $99, right? And so I came up with 99, 49. So I can provide healthcare for you for less than a hundred dollars. Pretty cool, right? When you're carrying on that conversation and you tell someone I'm offering healthcare unlimited for under a hundred bucks, so don't tell me you can't make any money, because I'm making money, I'm not making millions. Will I make a million? I absolutely will, but it's not going to be doing it in the first year or the second year. You know, over time, as the business owner, as the entrepreneur, you know it starts to add up. Last year we grew revenue by a quarter million dollars. This year we're already on track to grow revenue by a quarter million dollars. That's kind of how that works. So 99, 49, it was just as much psychological as it was how many members I wanted in my panel.
Speaker 3:I found that 300 is a good stopping point for a new nurse practitioner who doesn't have a lot of experience, especially if you brought them straight from school to you. So we had a stopping point, so around 200,. I put Nola on a hold I would take more patients and then, until she kind of made sure onboarding was good and got comfortable, and then we did it at 250 and we did it at 300. And so we were very cognizant of the patient experience and so that's extremely important to us. So we have these sort of like Nola right now seeing patients again, but she's taking onesies and twosies based off of need, whereas Ashley is a newer nurse practitioner so she's kind of taking the bulk. And then I'm getting the specialized, specialized patients or the patients who are more low maintenance, like males who just coming on for hormone therapy or something like that friends and family maintenance like males who just coming on for hormone therapy or something like that, friends and family, and how long do you think that you'll maintain that membership pricing before you'll do an increase?
Speaker 2:And what does it look like to change prices on a patient? That's a kind of a fear that I have because I've had the same pricing since I started, which is two years ago now. So I'm scared to change the prices because I don't want to lose any patients over $5 or $10 or whatever it is.
Speaker 3:That is should be the logical decision there, sure, so I love the 99 49 model because it allows me to give it a pretty aggressive employer pricing that I do there. Michael Manchetta, have you have you interviewed? Yeah, so Michael and I go way back and Monica, so we kind of started. You know, michael started before me, I started before Monica. We've been in some masterminds together, we've done some things together, and so Michael had the same question and I'm like, dude, you just cut the cord and just increase pricing and he'd lost hardly anybody. He's in Poe Dunk, texas, right.
Speaker 2:Is that because? Did he not lose anybody because of the verbiage that went with the price increase, or people just genuinely didn't really bulk?
Speaker 3:at it. People genuinely felt the value was there and they wanted to continue seeing him in his company and his practitioners because of the value.
Speaker 2:This is where imposter syndrome comes in, because how do I know that people think I'm valuable enough to warrant paying a little bit more?
Speaker 3:If you really want to know what I believe that answer is girl. You know, it's in that little black book I'm sure you have on your dining room table or next to your nightstand. Okay, this is a you issue, not a them issue. You know, I think as nurse practitioners, nurses, as people, mindset plays a huge, huge part of our lifestyle, and so that's a change of mindset for you. You bring value. If you didn't bring value, you wouldn't be where you're at right now. So how someone else values you, you can't control. You can only control of what you present to them and what you give them, and so how they receive what you give them is a little different. And so we had a patient two weeks ago basically say I was expecting X, I didn't get X and I didn't get Y, so I'm gonna go find another practitioner. And we said be blessed, right. And so, and they're in now my practitioner.
Speaker 3:She took that really hard and I and I said, listen, he wanted to come in and do labs tomorrow at a specific time. That weren't, it wasn't urgent, it wasn't emergent, we were trying to work with him. He wanted to do hormone labs as well as check his magnesium, because he read something on the internet, and so I told him. I said, if you want an accurate hormone lab, we need to do this before 10 o'clock in the morning. Well, I've never heard of that before. Well, if you want an accurate reading, that's when we need to do it. And so he in turn sent that message back.
Speaker 3:I'm like it happens For me.
Speaker 3:I have been between 25 and 40% more, so I cost 25 to 40% more than all the other direct primary care practices in my county, except for the newest one, and the newest one matched me and then made an increase, and so she's a physician, she does integrative and functional health and she's doing it for $125, I think for her functional piece.
Speaker 3:My functional medicine practice is about $750 a month. So now this is new. We just kicked it off this year, but we already have four clients and so we charge a flat rate for for six month program and there's functional wellness and then functional plus DPC, because when I'm doing functional medicine I don't want to take care of all their acute care needs, and so they become part of someone's panel and I just do the functional medicine stuff, because if you're doing both, you're not going to get any rest or sleep and rest is probably the most important thing that you, as a nurse practitioner, can do, especially in your early years. If you're not getting the rest that you need, you'll burn out, even though you're working by yourself.
Speaker 2:So you've got a whole separate panel of patients that are only paying for six months worth of care and in that six month period they just pay a flat 750. And is that including their mycotox testing, their hormone testing, their Lyme testing, like whatever it is you're coming up with?
Speaker 3:So that's a great question so last year. So we've been just doing DPC and what was happening was people found out that we're integrative and we were getting your root cause or your functional medicine, people finding us for $99 a month and then they were coming here expecting that. And once you have that kind of background, it's your thinking doesn't change. I mean, you're you're all thinking is always changing. But my point being your approach to care is you're always looking through an integrative lens, so you may be looking down the traditional model, some you might be looking outside the traditional, some of the integrative and alternative models and so you're always looking through that lens based off your training, right, so we're judged at our highest level of training and so if you have all this training, you're going to look at everybody that way. And we were having a group of individuals coming on wanting that functional medicine. I cringe every time. I say that because of Penny after after, I think and one because I have an issue with how functional medicine is, because you mentioned all the testing does include all these testings, and so I'll get to that in a minute.
Speaker 3:We did an off to on point program last year, so we're focusing on women who were feeling off and they didn't know why, and so in many cases it's hormones and thyroid. And so this was our perimenopausal and early menopause clients and so me and my pharmacist we kind of put that program together. It was a three month program and we found out that people were willing to pay it and we really didn't have to market it a whole lot, especially since my pharmacist is a compound pharmacist, which means clients are actually looking for something and talking to her about it. And so going into this year was like well, what can we do more for that group without having being taken advantage of in the $99 DPC market and in full transparency? My nurse practitioner friend who has her doctor she's like John, I don't want to do primary care, I just want to do the functional medicine piece and I need her help in her experience. We've been doing business together, started at the same time and all that. So we decided to put together a separate program. So that separate program is $5,500 for six months or $4,800.
Speaker 3:If you pay up front it includes only one test, because I don't believe that you have to do all that testing in functional medicine. I think that you need to do a good intake and a good physical assessment and look at good foundation first and then let that direct your testings. If you do certain things and you understand okay, you know what this person needs a GI map we're going to just do the GI map. We're not going to charge them for it. If they need Lyme testing, we're going to go down the Lyme testing. You know, if we've got to go down the Sears route or mycotoxin or whatever the case may be, we'll do that In many cases. Just in my basic biomarkers in normal labs, I can see a lot of what I need to at least get started, get people feeling better as we try to find the root cause right.
Speaker 3:The buzzword of everything and I think everything there's a triad, so I think it's all interconnected. I think that's probably my most favorite word when you go to any of the functional medicine trainings out, there is the interconnectedness and so with that part I can agree. I just don't agree with all the testing and all the supplements for everything. I think a pill is a pill is a pill. You can eat better.
Speaker 2:Is there some conference or webinars or something that someone listening to the podcast wanting to get into integrative medicine that you recommend that they start with and listen to, that you think would be invaluable information for people who are trying to get into that, that are recognizing that there's more to medicine than just passing a pill?
Speaker 3:Sure, I'm a big book reader, and so I prefer books than sitting there listening to a podcast. I did School of Applied Functional Medicine is the one that I did more because it was more application layer than biochemical layer. So I think IFM, you know, provides that A4M has a little bit more, you know, anti-aging spin on these kinds of things. I think all three of them are fairly good, depending on what you want to do. Most of my longevity and health span training is self-taught, through self-study, reading, research. I'm doing a lot of genetic stuff right now, a lot of epigenetic stuff, and so that's kind of where my passion lies. So those three, four schools would be okay. You know, I think one of my big takeaways from DPC Launchpad was when Kat said hey look, if you're certified, that's, if you ever have to go in front of a jury or in front of a judge they're going to hold you accountable to your highest level of education. And so if you're certified, even though there is no technical certification, but everybody wants a piece of paper saying that they went to that school, you know I'd be careful with that.
Speaker 3:And so for me, I was studying, you know, I was studying this way of care and I was ready to start working. I'm like you know what I'm gonna start doing this now. And I was ready to start working. I'm like you know what I'm gonna start doing this now. I'm not gonna wait three years before I start diving into thyroid because my wife was Hashimoto's. The system missed it for 20 something years. I want my wife to start feeling better now. So what can I do? So I started working on gut health, started looking at the right labs. When it comes to that, I'm like, oh wow. And then you start putting those pieces together. Winner, winner, chicken dinner. Now her thyroid's normal. We focused on her sex hormones her sex hormones are normal. Got her off all the antidepressants and all the stuff, yeah, and now she, she fills herself again. It's a long winded answer for your question.
Speaker 2:I apologize, but yeah, I love that. I mean, and I know people are going to be able to hear the passion and to go back. For those of you that did not come to the DPC Launchpad Conference, kat Nickel is an attorney that came to speak at our conference and so that's who he's referring to. She gave us a wealth of information on how the legal aspects of owning your own DPC clinic are important to consider and not to just use fly-by-night contracts when you are an entrepreneur or you might get into trouble. And just like you said about the certifications is, they're all well and good. They look really pretty hanging on your wall. You know you have all these degrees and these certifications for all these unique, different platforms that you're passionate about, but at the end of the day, those certificates can make you more susceptible to lawsuits because you should be an expert in said field. So you have the certification, so you just have to be careful about getting too many certifications, thinking that that's benefiting you when, from a legal aspect, is it really?
Speaker 2:You can still get the information that you need to care for a patient without having to pay thousands of dollars to have the piece of paper on your wall.
Speaker 3:Thousands and thousands of dollars. Yes, but you and.
Speaker 2:I have learned that a little too late. I've learned that a little too late. So we're protecting all of you newbies out there that are just about to click. Send on your payment to ILM. Maybe you should just pause that, yeah, and I think and look at things.
Speaker 3:So, look, dpc Launchpad and I don't know if you know, as a group we're going to continue that name, you know, throughout. But either way, it's a nice vehicle for DPCs and PAs to start focusing on delivering direct primary care and, within that model, because we're traditionally trained in caring, we're looking outside of traditional healthcare and I think what was really cool at the DPC Launchpad was, I would guess, that about 80 plus percent were integrated practitioners and that was super cool. And so, as we do our second one and hopefully I get to be a part of that one too we get to start having sessions, if you will, on these different care delivery models as we continue to grow the information that we're providing people to start their own DPC and grow their own DPC, I mean by that time. So right now I'm working on clinic three and four, and so I'm building clinic two and then I'm looking at my first out-of-state location. There's a lot of moving parts on how people want to do what they want to do as an entrepreneur.
Speaker 3:Some people say you know what, give me my 400 patients. I want to make $250,000 a year and spend time with my family. Cool, it's awesome, I can help you do that. Then there's someone else who says you know what? I want a system, I want to help my community, I want to do these things, and so I'm that guy. Right, my kids are all grown. My youngest is 25 years old. He lives in Chicago. My oldest is 31 and working here, and so for me, I'm passionate about growing the model, and so I'll grow it and help people who are already doing it. But if there's not someone there, so I have a presence in 39 cities and if I find a main street that has a good market analysis, then I'm going to drop a clinic in and I'm going to find a good nurse practitioner or PA to put there More likely a nurse practitioner, just because initially we're going to see similar way.
Speaker 2:I wish I could get into the whole dynamics of how you accomplish that, but we're kind of wrapping up our interview so I can't get into that. I want to know what's that.
Speaker 3:It's a secret.
Speaker 2:Oh, it's a secret. Okay, so maybe to be continued, maybe you'll let your guard down in a year or two and then I can circle back around and ask you how'd you do that so real quick? What EMR do you use?
Speaker 3:You mentioned you were on Atlas. Does that mean you are no longer on Atlas driven guy, and so I like to be able to look at all the care that I provide across the lifespan and find out what's working and what's not. So think of the population health. You know that we do, or we kind of talk about health promotions and stuff like that, and as an MP, and then from health promotions you look at population health.
Speaker 3:I want something that will help us truly measure what we're doing in our communities from a population health perspective, traditional and non-traditional and we are so far from that from a EMR platform. So I don't like any of them, so I do elation for all of us. I just recently upgraded to the AI platform for that, because it's allowing my team not to take work home with them. So the only work they take home with them is spruce. So if they need to do a virtual call that's urgent, they can, but they also have boundaries that I set there, so they look it's not urgent, they tag it and answer the next day, so I don't want them taking work home with them.
Speaker 2:Why did you leave Atlas MD specifically?
Speaker 3:So it provided all the things that I wanted, just not the way that I wanted. It was a little bougie they're macros and it was very proprietary, very web-based, and I did want some reporting and at that time it had no reporting. Elation kind of told me it had more reporting than what it really had. So they didn't really tell me the truth either. Elation worked with Hint and I needed a little bit more financial management control over what I was doing and so I felt membership management platform. Hint gave me that Atlas didn't give me at the time. Right Again, you know this is five plus years ago. So I really kind of moved because I really liked the Hint membership management platform. I may actually move to Hint all in one eventually, but they're not even close yet for me to do that.
Speaker 2:So yeah, they all have their own special tweaks. I just figured out this week how to use the AI tool in Atlas MD and, oh my gosh, my charts have never looked so pretty in all their lives, so I'm excited about that. I feel like that will cut down on some of my work, but our main problem is the managing of the memberships that my office manager has to deal with. She is still constantly making Excel spreadsheets of all my patients to make sure that they're caught up with their payments, which I thought that the membership management tool within the EMR would have done that, but there's obviously some gaps in there, because people can easily fall under the radar and go months without paying if some person is not on top of it.
Speaker 3:Exactly.
Speaker 3:And then you're chasing them for four months. They think it's automatically coming out. It's not. You didn't see it and you know you charge. Now that's 400. In my book it's 400 bucks. And now you're asking them to give you a $400 check and they haven't budgeted for $400 check. They were budgeting $100 a month and to them they thought they were already paying it. So then you're working out some kind of payment model or payment plan, because we love people and we care.
Speaker 3:We've run into some of that too, and even with Hint I wasn't able to keep up with it with a thousand members. My operations person does that with my office manager, and so they stay on top of things to make sure that we're getting paid within that 30 day window, or at least we're aware. Charging labs right away. If you're not charging labs the day you're drawing labs, you're losing money somewhere. I've lost thousands and thousands and thousands of dollars because I didn't charge them because I was too busy, and then kind of come back and then and then I had to check it with the lab core statement or the quest statement or whatever to make sure it was right, and then by that went back. Now the customer's like where's this $200? You know why do you want me to pay $200? I just paid my membership and it's just like. Well, this is from three months ago, right? I'm just getting caught up. Well, that's not their fault, right?
Speaker 2:Right.
Speaker 3:So now we're charging that day.
Speaker 2:Yeah, I've gotten in the habit of doing that as well. I think the only time that I really feel lose money is when I get labs back and I see something is abnormal and it prompts me to add another additional lab to it. Then I'm probably losing money on that, because it's hard to go back and tell a patient well, I need to add this hepatitis panel because your liver enzymes are elevated.
Speaker 3:So that's going to be an additional blah, blah, blah, blah, blah, and I think it's valid though, like you're being proactively in their care and finding out exactly what it is, so I don't think you know they're there versus you were talking about something. You told them that you would do something, you would order it. You gave them a quote, they paid for it, and then you're like, oh crap, you know what I forgot to do a reverse T3 and an iodine on this thyroid patient. That's on you, right. But in a case where you see someone who has risk factors for hepatitis and they have elevated AST or LT or something like that, and you're like, oh wow, you know what we should do this. You call them up. But now you've got to answer the questions about the rest of the labs. That's right, but you can.
Speaker 2:So we've talked about what your future looks like a little bit, that you are growing to a third and fourth clinic. Is there anything else that we have not discussed that you feel like is something that you need to let our listeners know? That would be wisdom and advice coming from you. Here's what I know.
Speaker 3:Everybody who was strong enough to become a nurse practitioner or a PA is strong enough to work within the DPC environment. They may or may not have the desire to be an entrepreneur, but if they do, then they're strong enough to do it, no matter where you sit in the faith world or not. It's a step right. You had to take the first step in order for it to happen. There are direct primary care practices that don't make it. Most of them don't make it because they went at it alone. Don't go at it alone. Find an organization like what you know.
Speaker 3:We put the CPC Launchpad that you and Penny have really focused on and that was really you talking to the whole group right. The MPCPA is like we should do our own conference, right, and so get involved there so that's from an entrepreneur perspective and then just do it. If you think you're going to make the money you made when you were working for somebody else, you need to rethink that. If you're not ready to make less and live more, understand that. If you're not ready to make less and live more, then being an entrepreneur early on in DPC is probably not for you. So then I would encourage you to go find a DPC like you, like me, like Penny, and go work with them, because we know the importance of quality of life and that's why we're growing the systems that we're growing.
Speaker 2:That's good word. Good word, my friend. Well, it has been a pleasure. Thank you for getting together and being willing to be interviewed today, and I think that everybody is going to learn from you and I think it'll be very interactive for people. Is there any way that people could reach out to you if they have a question? Would you allow that to happen? Sure.
Speaker 3:I had a few DPCs that I mentored. Then I told them about DPC Launchpad and they showed up, and so that was really cool. So, john at islanddpccom so we're always on Island Times john at islanddpccom is my email address Island Direct Primary Care or Island DPC on Facebook, so they can reach out anywhere on there and send me an email I'm happy to at least you know provide some guidance and direction. I think the work is in the doing right, and so I don't think it's your responsibility or mine or Penny's or Michael's or Monica's to do the work for people who are looking to become startups and to give them all the IP, so to speak, but it's to help, guide and love on people so that they can be successful. But the learning is in the doing too, and in order for them to learn to do it and learn to be good entrepreneurs, I think we can provide them some guidance, get them to go out and do the work, and that'd be good.
Speaker 2:Perfect. Thank you so much, John. It's been fun.
Speaker 3:I had a great time in Charleston with you and talking to your wonderful husband, mark, and the mission that you guys are doing. I'm super excited about continuing that conversation with Mark and watching what you're doing here. So thank you so much. You know, and if some topic comes up and we're just trying to figure it out and we want to talk about it, reach out to me and awesome, have a great one.
Speaker 2:All right, john, you take care. Thank you so much, 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.