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
Building Papaya Primary Care: A New DPC Journey with Katlyn Agosta, APRN
Imagine trading the stress of seven-minute patient visits and two hours of nightly charting for a practice where you can truly connect with patients in a space that smells like apples instead of alcohol. That's exactly what Katlyn Agosta did when she founded Papaya Primary Care in Valrico, Florida—a journey she shares with remarkable candor in this captivating episode.
As a type 1 diabetic since age 15, Katlyn brings unique expertise and passion to her work with patients facing metabolic challenges. Her path from inpatient diabetes educator to burnt-out corporate healthcare provider to DPC owner offers a blueprint for nurse practitioners contemplating similar transitions. With refreshing honesty, she reveals the practical realities of starting from scratch—from finding affordable equipment on Facebook Marketplace to the emotional rollercoaster of building a patient panel that currently stands at 17 members.
What makes this conversation particularly valuable is that we're catching Katlyn at the beginning of her DPC journey, when every detail of getting started remains fresh. She shares specific pricing strategies ($75/month with a focus on metabolic syndrome patients), marketing approaches that actually work (local Facebook groups outperforming paid advertising), and practical considerations like EMR selection (she chose Hint) and finding clinical space (she rents 125 square feet within an aesthetics practice).
Beyond the business aspects, Katlyn's story illuminates the profound personal transformation possible through DPC. "I'm just now in a space in time where I can create connections," she reflects, describing how she's finally able to chaperone her son's field trip and pursue interests beyond medicine. Her vibrant clinic with its eye-catching mural represents not just a business but a philosophy—healthcare that feels welcoming rather than clinical.
Whether you're a seasoned DPC provider, considering opening your own practice, or simply interested in healthcare alternatives, this conversation offers invaluable insights into creating a practice built on connection, autonomy, and balance. Ready to reimagine what your professional life could be? Listen now and join Katlyn on her journey from burnout to breakthrough.
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Welcome to season two 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 back to the show. We have a wonderful guest this week. It is Caitlin. Back to the show. We have a wonderful guest this week. It is Caitlin Augusta from Valrico, florida. She owns Papaya Primary Care. Caitlin, I am so thankful that you are willing to share your story on the podcast, because meeting you at the DPC Launchpad was such a blessing and I know that you have a story to tell. So welcome to the podcast.
Speaker 3:Thank you, amanda, so much. I have to say I have listened to 100% of the episodes. These people that you've interviewed have influenced me and how my practice is going, and they don't even know it. I'm excited to share my story.
Speaker 2:Great. Well, why don't you take us all the way back to the beginning, how you became a nurse practitioner, or tell us what your nursing journey was like, and let's just go from there? Perfect.
Speaker 3:Yeah, so I grew up in a military family. Both my parents were in the army and that's how they met. My dad did six years and my mom retired after 20. So we moved around a lot growing up. The pathway to becoming a nurse. Really pivotal moment was when I turned 15. So at age 14, I was in San Antonio, which is a huge Air Force community, and the high school that I was going to had a junior ROTC program. So I loved it. I was in my uniform, I got extra points for shiny shoes, I was going to join the Air Force.
Speaker 3:Well, fast forward to the summer, between 14 and 15, I was diagnosed with type 1 diabetes and now I'm medically disqualified and needed a new pathway. So I didn't know what to do. My mom actually suggested that I look into or consider nursing, and boy was she right. So growing up, I'm actually from a huge family. I'm the third of eight kids. I have like older sister brother, and then I have one younger brother and then five total sisters, so there's a lot of estrogen in the household. But growing up I was like a secondary mom. I was their caregiver when my parents were working because they had to afford a family of 10, right, that's insane. Because of that upbringing I'm a very independent, strong-willed person and if I set my mind to it it's getting done, I'm going to do it. So that's kind of the pathway that I took.
Speaker 3:I started college with a nursing major at George Mason University in Virginia and then I started working. I kind of had like a stair step career in nursing as an RN, did the health department but was quickly very bored because I wanted to do more. I even was in charge of like a car seat distribution program. I organized the whole thing and like I just wanted to do more with the time that I had and I knew that I had a lot to offer. I did medical surgical nursing because that's what they say you're supposed to do, right, get in the hospital and do med surge, because it's a great foundation and that's true. But I really loved labor and delivery or the concept of that. So I had a fellowship it's all about who you know. I was working at a vet clinic and one of the clients there was a nurse and she gave me the in to getting in this labor and delivery residency program for RNs and I did that for three years.
Speaker 3:Then I decided to go back to school and I got my master's in basically leadership and education. But through that journey realized I don't want to be a leader in the sense of in the. I know you're laughing, but it's kind of ironic. The healthcare system that I was used to was all hospital based, right, and so you felt like a cog in the wheel half the time. I didn't want to be a manager of that kind of environment. So like I have this master's degree, but what am I going to do with it?
Speaker 3:Ironically, went to teaching, landed a job in as an inpatient diabetes educator. That's really what I want to do, and my passion for diabetes stems from my personal experience. I turned my diabetes diagnosis into a positive for me. I have been a contracted insulin pump trainer. I'm using the latest insulin pump CGM technology, which has come leaps and bounds from what it used to be when I started on NPH and regular insulin twice a day. That was horrible, and so I really am a diabetes expert and I own that, and that is the turning point why I became a nurse practitioner.
Speaker 3:I did almost five years inpatient diabetes education and got my certification in that. But the people that I was seeing A I usually saw them once and then I didn't know the influence that I had, because they just disappeared. If I saw them again, that means they're back in the ICU and DKA or now their kidneys have failed. And time and time again I saw so many people didn't know that they even had pre-diabetes leading up to their type 2 diabetes diagnosis and now their A1C is 12 or 14. I was frustrated for them and I knew I could do better in primary care, so I went back to school again. I honestly think my husband is the one who kind of pushed me as well. He told me he was going to go back to school, which meant I couldn't. So I was like no, no, no, I'll go. So I did another third time's charm, charm right Postmaster's certificate program and graduated February 2020.
Speaker 3:Our family, for my husband's job, moved to Austin, texas, and my kids were in school for two days before the pandemic shut everything down and including the testing centers shut down, so I couldn't test and get certified to practice until June of 2020.
Speaker 3:So from there, the only nurse practitioner position that I was offered was in as a preoperative optimization clinic provider. So I saw people before having surgeries, but I optimized their health conditions. So that included diabetes blood pressure. Some surgeons required smoking cessation with proof on a urine test that they had stopped BMI less than 40. So I was kind of dabbling in primary care for two years and then, since then, I've been working as a primary care provider. My first primary care position was at a in Cedar Park, texas, working in a private practice, and so I chose to move our family here to Valrico, florida, to be closer to my sister, and now we live five houses apart from each other. You know, kids are hanging out and she has been a great positive influence on me because she's also an entrepreneur and so if she can do it, I absolutely can do it, and so here I am.
Speaker 2:I did Wow, and I go back to what you said about how when you graduated with a master's degree in that leadership and that you never wanted to really be a leader you don't know how many business owners I've talked to and not just nurse practitioner business owners, any business owner it's crossed the board. None of us meant to be the leaders. We just wanted things done our way. So we open up these businesses and then we find that we're having to manage people and employees and all these things and do these leadership things that we didn't really anticipate would be part of the deal, but it is. And then I think that is really what makes some people not want to own their own business anymore, Because if you open up a business for something that you love doing, it should be successful right. But what ends up making it not successful is the managerial part of it, right.
Speaker 3:True, so true, yes. Well, here's the thing. I had to really rack my brain and think back like how did I even learn about direct primary care in the first place? And it was in 2018, when I was in my nurse practitioner program. Well, it was on Facebook or YouTube. It was a podcast or a video I saw from ZDoggMD and he was talking about his health 2.0, health 3.0. And I was like, wow, this makes a lot of sense and I would love to work at a place like that, but never did I dream I'd be creating one for myself.
Speaker 3:But really, the pivotal point is the job that I moved to Florida for was a corporate, big hospital based system, and I knew what I was getting into, but I didn't realize it was going to be as bad as it was. And what I mean by that is I really value the connections that I make with my patients and going on the journey with them, and also I value time and listening and teaching. Education is just ingrained in me because if you understand the why behind something, you're much more likely to actually move forward with whatever the plan of care is, and I let my patients choose that. But to make a choice, you have to be given the options and the big corporate systems don't give you time. We all know that you're lucky if you get that seven minutes FaceTime with them. So I quickly was burnt out. I worked in the system for a year. I was bringing home probably two hours worth of charting a night. I also worked 45 minutes to an hour, sometimes more of a commute from Valrico, and so like it just.
Speaker 3:The work-life balance was horrible. And I have two kids currently 11 and my son turns nine in two weeks and I was spending less and less time with my family and more and more time with my computer. And so I kind of developed a mantra of what is it that I'm living for? And right now it's work. And I like in the most unhealthy place I've ever been in my life because I'm not exercising, I'm stressed out, I just sleep, go to work, eat if I'm lucky, and that's not how I want to live.
Speaker 3:So I was frustrated. I literally went home one day on the drive home, crying in the car, and I thought I should quit nursing. I was going to go walk dogs, because you know why not. So I'm glad I changed my mind and instead I focused on obtaining my autonomous licensure. So in Florida you have to meet certain requirements to earn that autonomy, which actually was spoken about in your most recent podcast. So I'll let Terry just discuss that with you guys. I don't know, I still felt like maybe I should get it, but what if I don't? And so like I got the email that says, like you're autonomous. And so again my husband is like okay, we'll break out the computer, we're starting your LLC. And he's like here we go, we're just typing in the card number now and like here you got an LLC. I guess.
Speaker 2:I had to come up with the name first. Yes, and I am very curious how you came up with your name, because it's so cute and unique. Yeah.
Speaker 3:So I get this question a lot too.
Speaker 3:Why papaya and I mean when, I thought about it, like when I came up with this name, I just kept circling back to it and I knew it was the right one. And my oldest sister is a graphic designer and she's the one that did my logo for me and she did a great job. I asked her one day I was like hey, what do you think of papaya primary care? And she hesitated. She's like well, I don't hate it, Like it's, it's okay, but why? And really it came down to, I want it to be different, I want it to be memorable. It had to be easy to spell and I don't know.
Speaker 3:I like the alliteration of something with a P, so it could go with primary care, Cause I knew I wanted to have that in the name because of the rules and regulations in Florida. It's primary care that I have my autonomy in, so I didn't want there to be confusion and also that's what I want to do. So it's very clear as to what it is that I'm bringing to the table for people. But really, when I thought of papaya yes, it's cute, but also the colors, the vibrancy, the brightness, the when you think of a papaya, you don't think of anything but healthy and fiber and it's very Florida, and so it embodies the energy of my clinic. And so that's why and I love orange is teal and it goes really well with orange too.
Speaker 2:I love that, and I also want to give you a moment to talk about the mural that's on the back of your office wall. It's beautiful. It encompasses the whole wall, so tell us how like what is that? Yes, so you'll have to describe it, because nobody's going to be able to see it.
Speaker 3:That's right. Well, you can see it if you go on my website, papayaprimarycarecom. There is a video tour of the clinic, and so, basically, the mural happened by accident. So I'm renting a room in an aesthetics and wellness practice, so the square footage is about 125 square feet and the space is perfect. It actually has a portable sink in there, which I didn't even know was an option. So if you don't have a clinic that has a sink or plumbing, that's something that you can look into to bring water to the area. But it had this big blank white wall and I'm allowed to paint it as long as I paint it back Whenever I move.
Speaker 3:I'm part of a bunch of different Facebook groups on different communities, and so this one, the Buy Nothing group, is national, and so, basically it's the concept is you give things or ask for things that other people don't need. And then this person, this local mural artist, wanted to boost her portfolio and, like, get into doing more murals. So she posted a mural that she had done and was gifting a mural. So she said, hey, tell me what your ideas are, I'll pick one. And so I put that picture of this big blank wall in this super modern space as a teaser of come paint me.
Speaker 3:And she did, and she incorporated all the colors on my logo. So what's on the wall? It's two monstera leaves and just flowing lines of just kind of geometric shapes and it's very modern. And that is the first thing that you see when you walk in the clinic and everybody comments on it. It doesn't feel like you're at a health clinic, you feel like you're at a living room, people are more relaxed and I'm getting excellent blood pressures for all the people that say they have white coat effect because they feel comfortable here.
Speaker 2:Wow, I love that. I love the fact that even the aesthetic of your office space is giving people that peace that you're trying to promote in the first place. That is wonderful. So what kinds of services do you offer at your primary care clinic?
Speaker 3:Well, and I'll back up to you. I'm brand new. I moved into the space in December of 2024, and doors opened to seeing patients on January 1st 2025. The service that I'm offering is pure, direct primary care. I did a lot of research on the other practices in my area, what it was that they were offering, as well as their pricing. I did a deep dive and then I looked outside of that, even at other states, other places. Monica McKittrick is my inspiration and I even messaged her. I was like, oh my gosh, if I had known you existed when I was working in Cedar Park, texas, she was there. I just didn't know she was there.
Speaker 3:What somebody gets when they sign up with Papaya Primary Care, it's, first of all, $75 a month, so 75 times 12, that's $900 for the year that. I do have an enrollment fee and I went back and forth on that, but really it's the easiest thing. If you're going to give an incentive for someone to sign up, you can reduce the cost or waive the enrollment fee without taking away their monthly membership, and I actually did that for January. I had free enrollment for that month to try to get people in the door because in order to be successful, we all know it word of mouth, and so I need patients to get the word of mouth going and my Google reviews. That was my goal. But for $75, you have obviously the unlimited access for appointments. I am not advertising that I'm 24, seven, because I am not. I work Monday through Friday, eight to four, 30. And I have Tuesdays reserved for virtual only so that I have more flexibility if I don't necessarily have to be physically in the clinic on a Tuesday. I use Tuesdays a lot for networking opportunities as well.
Speaker 3:I have a pharmacy program that's built for direct primary care and I actually learned about that from Brian Fretwell. So basically I enroll my patients in this pharmacy program for a set amount per month and they receive their generic medications via mail order direct to their door. And it's hundreds of meds, the majority of the things I'm already prescribing, like their levothyroxine, their lisinopril, if they're on a cholesterol medication, like it's got a lot of stuff. It even has test strips on there which a lot of people like it's buried in this list of like eight pages of fine print of all the things that are included. So it's 150 test strips in a 90 days period are free. It has also, I mean ibuprofen and Zyrtec are on this list as mail order meds.
Speaker 3:Vitamin D is on there, so it's a lot of value and I wanted to offer that because the person that I love caring for is the person with diabetes and metabolic conditions. Right, they are going to be on chronic meds, so I needed to tailor my service to that. I also love the fact that it has they call it an urgent care formulary. So your antibiotics, fluconazole, there's albuterol, sumatriptan, like steroid pack, that kind of stuff you can get with this membership for $0 at your local pharmacy. That's participating and it just makes sense. So member also receives four lab tests per year that I'm covering.
Speaker 3:So that's a CBC, cmp, a1c, of course, and a lipid panel, and if they want to add more stuff on, then I've got the discounted rates through LabCorp. I have a group purchasing organization that I signed up with called Healthcare Procurement Solutions HPS and for the provider it's free. You just do an application, you get the group rate and I mean the cost for the labs is. It just makes sense. If you take out all the things that I'm paying for versus the membership fee, my take-home amount is probably $10 less than the membership per month.
Speaker 2:So let me go back to this organization that you joined. I know that LabCorp because I also use LabCorp and I know a CBC. I think it's like $2.75. But by joining that other organization is it even cheaper than that.
Speaker 3:I think the CBC is $2.60. Here let's see. Okay, you have to compare it's pennies. You have to have that because even your Access Labs and your Rupa if you have a LabCorp nearby, like it makes sense and I have been very fortunate the LabCorp rep. He came to my office and walked me through how to use the provider portal to make sure I knew how to order the right supplies, and has been super supportive.
Speaker 2:That's good, and so your patients charge them anything above their labs. How much do you charge? I know I have a flat like 50 cent markup and that just really covers the credit card transaction fee really, but there's some people that do a 10% markup of the actual lab. So how do you do yours?
Speaker 3:A lot of different ways to slice it, and so it kind of depends. I've heard of other providers say that they give it to the patient at cost because they figured out the price of their membership and kind of have it offset the cost of the lab. So I have an a la carte. If you want to add on a testosterone or thyroid testing, I price it out for the patient and I have a price point for everything. But for a CVC, if you wanted to get another one, it's $6. And the reason for that is by scent.
Speaker 3:I don't draw labs in the clinic because I don't have space to house supplies. I'm in 125 square feet, right, so I have to be very mindful of what I put into the clinic. Physical space is a commodity and I don't have enough supply space for a bunch of lab tubes and a centrifuge and all that stuff. The cost for me for sending someone to have their blood drawn at lab core I get charged $3 as a venipuncture fee. So by marking up the labs a little bit, it's to cover the cost of the credit card transaction as well as the venipuncture fee, so that I'm not losing money on labs. I'm also not getting much, but, and the thing is, it's still way cheaper than using insurance.
Speaker 2:Yes, and you know, I love the fact that I'm interviewing you in the beginning stages of your clinic, because everything will be fresh on your mind and I know that there are a lot of nurse practitioners that are getting ready to open up their DPC clinic, or they also just got started, and so just hearing the things that you've done that worked, and maybe some things that did not work, that would be so helpful. So can we talk about your marketing, since you know? I find it interesting that you're? How long have you lived in Florida?
Speaker 3:So a little over a year.
Speaker 2:Okay, so you're basically you're not a known person in your community, you're brand new and you just decided to open up this business and it opened two months ago, basically. So let's first talk about and all of the anxiety of just opening up a business. How is the marketing going? I know that I totally agree with you that word of mouth is what is going to actually seriously grow your panel of patients. But what did you do to get your name out there for people to start signing up? And then what did you do? That maybe did not work and you feel like, hey, don't waste your time on this effort because I wasted money and time and it didn't work.
Speaker 3:Waste your time on this effort because I wasted money and time and it didn't work. Yeah, absolutely Well, so I worked. I want to say it was like at least 30, 35 miles away in Apollo Beach, if you look on the map to Valrico, and I did not have a non-compete or like a radius of like any contract saying that I couldn't do this. First of all, and when I knew I was going to leave, I made sure that my patients, if they they chose to, could find me Meaning. I have a LinkedIn profile that says where I'm at, and so you Google my name. That's one of the first things that comes up is where am I so that they know how to contact me? And I mean, I really don't have a lot of people that are willing to travel from Apollo Beach to Valrico. There's maybe two or three that have done that, and so when I opened on January 1st, I had three members and they were people that I had been caring for previously. So they already knew me and my practice style and my patients love me because I make them laugh and I actually listen, and that's really what people want. They want to be listened to and to help feel like they're a part of the plan. So if you're doing that, you're doing it right.
Speaker 3:So from there I have joined my local chamber of commerce and I'm lucky that A we share a wall. They're literally next door to me. The chamber that I'm in is very active, so this particular one has four recurring events monthly. One of them is every single Wednesday. So I go to those because you have to build a know, like and trust factor. No one's going to just send you a patient because they know you care for them. They have to know you as a human so that they can connect the right person to you. So the Chamber of Commerce and I will talk to anybody. I'm very outgoing, so I have set up one-to-one meetings, even if it doesn't seem like it might lead to something like a financial planner, if you think about it, part of financially planning is knowing what the cost of health care is, so that they can connect people to you and just get creative with it.
Speaker 3:But the other things that I'm doing, I have a Facebook page and an Instagram and I put content out there and it's a combination of educational things as well as, as I guess you could call them, advertising. But the biggest way that I found that I'm getting patients so far is through the local Facebook groups, like your mom's groups and your community what's in my community kind of groups. But I also just started working out with a group. On Fridays I work out what's called Fia Fishhawk. So I drive 25 minutes in the morning to go work out with this group of women because I think they're going to be my clients. But hey, I need to take care of me and now I am being held accountable. Also, I'm getting to know other avenues in my community, different places. I've learned so much about Valrico and the local, like the different towns around me, and different services that I didn't even know existed because I'm putting myself out there. So the health department, for example, has a diabetes prevention program and an exercise program. All their stuff that's free to the community. They just need to know about it. There's an organization that's called Hope for Her that I really want to connect with so that I can help these women that are getting back on their feet with things like pap smears, different cancer screenings. So I'm building that connection and you don't know about it if you don't ask about it or network with other people. I've been a guest at BNI, which you know is other a networking group.
Speaker 3:But the thing that's holding me back from this is time. There's a time commitment with everything that you're doing and you as a provider are the only one that can provide the care if you're a solopreneur. So time is a huge commodity. And the other thing that I've recently as like a new you know, I just opened person I realized I need to have more focus, to have more time efficiency, and what I mean by that is my ideal avatar. I have like a general idea of who my ideal patient is, but they're not fleshed out enough. Shane Grindle had a one-on-one recently and he kind of helped me dig down one of my avatars and came up with what is the problem, right?
Speaker 3:So if I have this person with type 2 diabetes who is in my mind, I think of it as the male A lot of time. The metabolic condition like is primarily man, with that android obesity. He's married, he's very busy, he's not really taking care of himself, but ultimately his problem is he has erectile dysfunction because he's not sleeping he's probably asleep apnea and his wife's nagging on him, but that's what he cares about. So I can't. I, with his help, came up with a post that has a like an eggplant right To bring about, like the, without saying it and I use chat GPT to help me out I literally told it like hey, I'm marketing on Facebook to this age group and I want to use emojis specifically and give infuse a little humor into it, and it popped out something that was perfect and it took me like two minutes to do, but the focus was there, and so what I found is that I'm spending a bunch of time in different areas but not really going anywhere if I don't have that focus first.
Speaker 2:Yeah, I love that answer. That'll be so helpful for sure. You were talking about BNI and I just recently hired a new nurse practitioner and she's not well known in our community so I'm trying to grow her panel for her and so I joined our local B&I chapter because I had done another interview earlier with Lisa McGarry said oh, b&i is the way to go. Well, it is like you said, if you have time, if you've just opened up your practice, it probably is not a great avenue for marketing, because you don't just have to go to the weekly meetings. You then have to do one-to-one lunches or coffees or breakfast or something with the members of your chapter to get to know them, and then it's reciprocal.
Speaker 2:It's giver's gain is what they call it. They'll help you, but you have to help them too. So you're always having to think in your mind, like if someone is looking to buy a house, like you need to refer this realtor because they're in your chapter. If someone needs to paint their house, you need to refer this painter. If someone needs an electrician or a plumber or whatever all these people that are in your chapter you're constantly expected to give references and then you have to log it into your BNI app, which, don't get me wrong. It is an excellent way to get to know other business owners and to be able to get patients, and I have gotten patients from BNI. But it is a huge responsibility and if you don't have the time to be able to dedicate to multiple hours a week, then it's not a good fit.
Speaker 3:Have you done? Oh, go ahead. Yeah, so, and that's kind of the conclusion that I came to as well. But also this year BNI increased their fees, so it's $1,500 for the year and if you don't meet all the little check boxes, you're kicked out. Well, this actually reminds me of the insurance based world, so I get an icky feeling about it.
Speaker 3:I have learned throughout the couple of months that I've been doing this I need to trust my gut, because it's always right, my little spidey senses are telling me something for a reason. I mean I don't think I told you yet I have 17 clients that are signed up and so I'm clearly doing something right and they like the service. So one of the things I just literally launched yesterday is a referral program, and so we'll see how it works. But to kind of give a little bit of an incentive to my current members who are already experiencing the DPC model and who love what I'm offering, to have them talk more, promote that word of mouth and get something in return. So if a new person signs up and then refer, like lit names them as their referral source, which is one of the questions on my like intake questionnaire then both parties get $30 credit on their account. Oh yeah, that's good and we'll see how that works.
Speaker 3:But 25 didn't seem like enough and 40 sounded like it was too much and I don't know. I'm still taking the enrollment fee, which is 75. I get a little bit of something still for like skin in the game is what that enrollment fee is for. What I'm trying to attract, which is motivated and engaged patients.
Speaker 2:Did you say that your monthly membership fee was $65 a month?
Speaker 3:So 75, if I did my calculations right, with credit card transactions and like the things that I'm sponsoring and all that, I totaled it and then divided by 12. So if somebody stays for a whole year, ultimately my take home is about 65 ish $64 a month. So to break even, I calculated my overhead for rent and my EMR and all that kind of stuff is roughly 25 patients and I'm at 17. So I'm still not profitable or even, as my husband says, working for free. But I love what I'm doing and the freedom is I can't even describe it.
Speaker 2:How did you find that small space that you're staying in right now that you've set up your clinic in, and how long do you anticipate that you'll be there before you've got to go find more space?
Speaker 3:I mean, that's a great question. So, first of all, I don't know how long I'm going to be here, because it depends on how quickly I grow. I anticipate maybe somewhere around a year or more. My personal goal is to reach 60 members by the end of the year, because I think that's achievable. Maybe I'll exceed it, I don't know. I won't be in the red anymore. You know I have a consistent growth. One of the things that I took away from the launch ad conference was if you're bringing in about five or more members a month, that's sustainable. Obviously you want more than that, but on the flip side, if you have 30 new people to onboard, that's a lot, and so you've got to grow at a steady pace as well.
Speaker 3:I found the clinic to answer your question through, actually, my sister. So my sister is a mental health therapist and I came with her to tour a room that she found through Facebook on one of her like therapy groups. She was connected with the owner of this clinic or the person that is leasing it, and so she subleases to three other people, so myself, my sister, and then someone who's a lash artist, and then the person. It's an aesthetic and wellness space, so she does Botox and fillers and compounded weight loss and IV therapy and those are not things that I offer. So we're not competing against each other.
Speaker 2:So your goal is to have 60 by the end of the year. What is your goal overall? As far as how big do you want your final panel of patients to be?
Speaker 3:So, this is very unique to every person's like what do you want your work-life balance to be? That's really what drives that number, as well as, obviously, the patients themselves, I think, and we'll see how that actually turns out. My ultimate goal is around 300, but it might be 150. So we'll see. And I know that somewhere in there I'm going to have to hire on and I don't know what that looks like yet. In this space I would not be able to bring on a physical human. I would have to be a virtual assistant because I don't have any place for them to be. So if I was going to hire on another provider, I can't be in the space that I'm in.
Speaker 3:The one thing that really sold me about this clinic in particular is a, the physical location, the space itself. It is very cohesive and so many people comment on the lobby and like the vibe and the feel. I can't take credit for that. That's, that's her clinic, not mine, but I get credit for it and it smells great when you walk in. So my clinic has a little plug in. It smells like apples, like it doesn't smell like alcohol and it's got that bright mural on the wall. So people feel different when they're here because it is different.
Speaker 2:I totally agree with you that that is all going to be a personal decision. What one DPC clinic owner's goals are is going to be completely different than anybody else's. But I have a nurse and an office manager in my office because I only want to have to do the health care. I don't want to have to deal with the memberships and asking my patients to give me their money. I don't want to have to remind them if their credit card didn't process that they still owe me money Like that is super awkward to me, but I know that there are plenty of providers out there that don't mind having those conversations, so I have to see more patients.
Speaker 2:Oh, and to go back, I also have my nurse. She does all my PAs, she does all the referrals, she draws the blood, she runs the strep test and the COVID test and the flu test and the pregnancy test and the urinalysis. She does the EKGs. I don't want to do those things, so I have to keep a higher patient panel so that I can afford these two people in my practice, whereas if I did it all myself I probably could manage with just two or 300 patients, like you said. But I don't want to work that hard.
Speaker 3:Exactly Well, and the other thing, like you have to, as the provider and owner, ask yourself what is your life going to look like? Are you working full time? Because if you're not, then your panel is going to be smaller versus because you got to have the slots and you also have to be able to provide what it is you're promising. One of the things that I don't have fleshed out yet is what happens if I'm sick or if I'm going to go on vacation on a cruise ship next year for the conference. What does that look like for my patients? So I have time to figure that out, but that's where networking with your local like-minded individuals makes a lot of sense. So there's a Tampa-based NP entrepreneur group that I joined. The majority of these providers they're in Tampa, but on the west side of Tampa, so they meet usually once a month in person to have dinner together, which I think is fantastic, and I've gone to two of them now, but it's about a 45 minute drive or more for me to get there, but for me it's worth it because, again, networking, getting my name out there and building my support network, and they're awesome people and they've been at it longer than me and so they're definitely somebody that I can ask a question to and more often than not, if they don't know the answer, they're going to get me connected with someone who does, because I want to make sure that we include this for the new people the different stuff that I've uncovered.
Speaker 3:You mentioned EKGs. So, having someone as my ideal client with metabolic syndrome, right, ekgs are super important for me and I know how to read them because I did it for two years in a pre-op setting. Everybody got an EKG. I would say that if you're looking to learn how to really understand and read an EKG, dr G, the NP, is who I learned from and she is amazing. She's another nurse practitioner entrepreneur who is just the way she explains things that sticks in your mind, and she's an awesome human. So I just got to give a shout out. Her name is Trenise Goodloe and she offers CEs now too, so you can put it in your budget. But the EKG itself I struggled to find one that was in my my budget, so I'm self-funded. I didn't say that either, so I've self-funded the clinic, meaning I'm in a place financially with my family that I had enough of a savings that I could afford to literally quit my job in November. That was my last month working, and from December 24 forward I am self-employed, so I'm not bringing a paycheck in. I rely heavily on my husband then to have a steady income and planned out what that amount that I'm going to initially invest into the clinic as well.
Speaker 3:So this EKG machine I found on Facebook marketplace and it was a retired doctor was selling it and it's nothing like no bells and whistles and it was 600 bucks and it came with the EKG paper and a little electrodes and I drove all the way into Tampa to get it and I was trying to make sure that it worked and so it would turn on. I was able to enter all the information, but he didn't know how to use it either, and so we couldn't get it to print the tracing right. I actually I'm standing in his garage and I'm reaching under my shirt I attached myself to the ZKG machine and I couldn't get the print button to work, and so I took a chance and I brought it home with me. Look at the brand. Watch a video on how to operate it before you go to pick it up. That's my tip for you, and it kind of works, but one of the leads I think it's V3, is just a black box. There's no tracing there, and so I was trying to troubleshoot it. And I also know like in the hospital system you just call biomed and they come and they take care of it and make sure that your equipment is working and they put the sticker on it. Well, there is no biomed in the real world.
Speaker 3:So I called the company to ask like, hey, is there a local place that I can bring this to that can service it for me? And the answer was no, I would have to mail it to California. We were able to discover. I don't even know how old this thing is, because the electrodes he gave me literally had expired 10 years previous. So this thing is not new and it does work. But I couldn't rely on it and every time I tried to, like I put it on my son, put it on my lash artist neighbor here I was like hey, you busy, can I try the ZKG on you? And it wasn't working.
Speaker 3:So I went back to the drawing board. I was going to buy one new and I was looking at the price. It's going to be around $1,800, which is that's the most expensive thing in this room that I have is this EKG at this point. And then I found SmartHeart. So SmartHeart is a Bluetooth enabled EKG system that has no sticky electrodes. They actually have a rate for DPC providers. It's $99 a month to like basically lease this machine and it's like a little box that goes on the patient's chest and it has four metal bumps behind it. Those are the electrodes like a little box that goes on the patient's chest and it has four metal bumps behind it. Those are the electrodes and then a rubber strap that goes around that has the bumps as well. So, and then there's three like limb leads that are metal. They're different shapes, one goes under each armpit and then one in the waistband of your patient and you activate it with water between the electrodes and the skin. So it's very easy to use.
Speaker 3:And then what you get is there's an app on your phone. It looks just like the same EKG that you get on paper, but now you have a digital version so it integrates. I have to upload it as a file but like I have it in my EMR and it just looks much nicer. And the kicker for me that sold me on it is A to just buy it outright and pay for a year of the service was $1,500. Well, I was looking at an EKG with the stickies for 1800 anyway, and then one now that I own the machine next year. It's $250 for the entire year of the app and if I have a question about an EKG I can push it to a cardiologist to read it for $25 and you get unlimited use.
Speaker 3:So the other thing that I discovered two things. For imaging, radiologyassistcom is free. You can type in the study whatever you're looking for and it spits out for your local zip code, cash pricing for imaging. It doesn't have everything. So I kind of compare between that and green imaging. I set up an account with them. They're also tailored towards DPC providers and I compare both to see what's the most economical way for my patient to get their thyroid ultrasound. So one is $125. The other one's a hundred bucks, so that $25 for someone in this case he does not have insurance is a big deal.
Speaker 2:What EMR did you choose to go with and walk us through that process.
Speaker 3:Sure, I knew I wanted an all-in-one system, because I've worked in hospital systems that have it segmented and it gets clunky. I chose to use Hint all-in-one. I'm happy with it. I know a lot of people like Atlas. I haven't seen Atlas before like in the real world. But one of the things Hint does not do that I believe Atlas does is ICD-10 codes. So if you're looking to print a like a super bill for your patient to then take and get reimbursed later, you have to do it manually in Hint and what Hint gives you is a blank text box. You have to create your own templates, which is not hard to do. But if you're not super tech savvy, atlas has my understanding, is like a library of templates that you can kind of already pull from, and I don't like the fact that to do my review of systems or my physical exam documentation. It's free texting, so I have to build templates for that and you can't select radio buttons or whatever. Athena, I really liked the way that theirs was set up but that's not affordable.
Speaker 3:Whatever Athena, I really liked the way that theirs was set up, but that's not affordable. One of the things when I signed on with Kent, that also was why I went with them they had I signed on, I want to say, in September, but I didn't have to pay anything until my doors opened. So from September to January I had access to the program and could go in and set up what it was going to look like before paying any dollars, and the first month also was waived. So really my first payment to Hint came out in February. The other thing that they just started is they're calling it the Hint DPC launch bootcamp, but basically what that is.
Speaker 3:It's cohorts of people that are using the Hint platform and it could be either just the billing or the Hint all in one together, and then it's weekly webinars. They have a speaker like an expert in whatever the topic is of that week to with the goal of going from hey, I would like to start my DPC to my doors are open and everything in between. So they talk about marketing, creating your avatar, the legal aspects, so a lot of what the DPC Launchpad Conference was looking to do. The cohorts were there Now, I was in the first cohort and some of it was a little clunky, but I suggested two specific things that they literally implemented the next week. So I love the fact that Hint is listening and really their values align with mine.
Speaker 2:That's great. Yeah, I would say most people in our DPC world are either using Hint, elation or Atlas MD. I chose Atlas MD because I also wanted an all-in-one. I didn't want to have to worry about having another program to communicate with my patients, having another program to keep up with the memberships and all that. I wanted it all to be all encompassing and I just liked my onboarding experience with Atlas MD. I just feel like they're the most down to earth guys. I feel like it's just gigantic big umber family that just owns Atlas MD, because every time I talking to anybody from Atlas MD they're like so-and-so umber, so-and-so umber. I'm like this family has taken over, which is fine. I love it. I get good customer service. I know Penny has said that Josh is not a big, huge nurse, practitioner, entrepreneur fan, but I feel like we'll change that, like we just need to give him some time to recognize just how special we really are.
Speaker 3:Hint has like three different tiers. I picked the one that has the AI transcription. At this point, I really am not impressed with it. So I actually choose to use Heidi, the free version, when I'm with my patients, because what the final product? I liked better with Heidi. I know there's a lot on the market now, but I am very particular in what my documentation looks like right now. Hint doesn't provide what I'm looking for and it also created basically a second note that was like an after visit summary, which sounds like it's great, but it was too wordy and too complicated. No patient's going to look at that and know what to do.
Speaker 2:Yes, I just discovered, and I've had my DPC clinic now for two years almost, and I finally figured out how to use the AI tool in Atlas MD. Oh, it's been a game changer. It doesn't lay out the notes how I am used to laying them out, but it actually is better than what I was even doing. I was using this template that I created because you also get a blank text box with Atlas MD and you got to fill in everything and so everything is a hashtag. So you're like you hashtag now if you want the date in there and you hashtag note and then it pulls up your template. My template was scant, to say the least. It was pitiful.
Speaker 2:But now that I can record my entire conversation with my patient and then I email that recording to some cloud in Atlas and then I can hit create soap note from the recording and it creates everything I would never have remembered from talking to my patient, and now I don't even walk into my patient's room with a computer or anything, I just walk in and they have my undivided attention, because I don't have to sit there in my brain and try to remember like oh, they said this, I need to make sure I mentioned that and they said this, and they said that I got to make sure that I chart that when I go back in, or sometimes if I'm seeing a patient for a physical or a complicated problem, I would bring the computer in the room and I'm typing while they're talking, just so I'll remember everything they say. Now it's just all eyes on you and I can pay attention to what you're saying and if I've missed something, then the recording is picking it up and it'll lay it out. And then, once it lays it out, you have a button option to be able to edit it, because it doesn't put any of the diagnoses in there. So I have to always hit the edit button anyway because I need, I have to put in the vital signs that were taken and I have to put in the diagnosis.
Speaker 2:But what I like about Atlas is it'll even suggest diagnosis for you. You just hit hashtag, hashtag and then it'll be like oh, do you want us to suggest diagnosis based on the note? And I'm like yes, and sometimes it's obnoxious, there's like 20 different diagnosis and I'm like no, no, no, but I just go through and I delete all the ones. But there have been ones that I've kept that I'm like I didn't realize that was a diagnosis that was available.
Speaker 3:Yeah, I didn't know that was an option. Oh my gosh, all these years I've been a nurse practitioner and I could have been diagnosing that. One tip I would say, especially when you're transitioning from the insurance-based world to DPC, is who are you charting for? Because you're trained to chart for the insurance company, right, and so now you actually have the luxury of creating the note the way that you want it to be.
Speaker 3:But one of the things that my original mentor in nurse practitioner school, like I, took from her is that you got to look at your note and be able to pick up from where you left off, so you can put things in there. Like, if this fails, here's my next idea to jog your memory on what you were thinking, because I know, you know it's. The worst thing is to see someone else's note and have no clue what to do because there's not enough in there. But you can also be on the flip side and over document, and not that you know, from a litigation standpoint, sure, but your time is the most valuable commodity, remember. So who are you charging for? And if it's for you, then it's got to match what your style looks like.
Speaker 2:Yeah, I completely agree with that and I'm so thankful that I'm out of the insurance world so that I don't have to be so specific and make sure I have this many points under this review of systems and this many points under my physical exam and all that kind of stuff an outline laid out, because there are times where you're going to refer your patient to a specialist and that always has to accompany a note and so you don't want to look like you're halfway doing something with your patients.
Speaker 3:Right. Like again, they have to be able to understand where you're coming from and what to do next, and your note has to reflect.
Speaker 3:You know one of the things that I'm super excited about is that my son, he's going on a field trip next month and he's has to reflect. You know, one of the things that I'm super excited about is that my son he's going on a field trip next month and he's about to turn nine. This is the first time I'm going to be a chaperone, because I can, and he's so excited I'm excited. I mean, that's what I'm in it for is a more appropriate work-life balance, to be able to fill my cup doing what I love, which is primary care, listening to people, and I'm kind of like an interesting blend. I'm not 100% Western. The more I learn about integrative or functional medicine, the more I realize that there's so much to know. I'm kind of in the middle, and so I meet people where they are and give them options, but I'm also making connections to experienced functional providers in my community. I have three people today that I could send them to if they're looking for that four, actually, because I just made another connection this week.
Speaker 2:Well, as we end this podcast, is there anything that is on your heart that you just want to put out there for the listeners before we say goodbye?
Speaker 3:That's a good question. I would say that you have to believe in yourself, because if you don't, you're not going to be successful. You've got to believe in you and surround yourself with the people who are going to help level you up and not be the people that are taking away your energy or bringing down your ideas. You've got to find those people, you know. I actually did a little workshop today and the first question was who are the five people you are surrounding yourself with right now? Like the most of your time is spent with these five people, and I struggled to come up with five.
Speaker 2:I meet everybody I talked to so what I'm hearing is you do not have nine kids yourself.
Speaker 3:No, I have two, and they were on the list, and my husband and my sister. And then I was like well, I guess her husband too, because I don't know, I'm a homebody, because my husband doesn't like going out, I'm mimicking him. But I recognize that I need to branch out and make friends.
Speaker 2:Well now, you have time to do that. Now you can pour into relationships from the personal side of you, because when you're seeing 20, 30, 40 patients, you only have time, like you said, to see the patients and go home and then chart on them and maybe spend an hour with your own family and now you can invest some of yourself into deeper, meaningful relationships with other women.
Speaker 3:And the way that this happened. I know exactly why I moved here from Texas. I worked, and I would have worked until I died if I allowed it to happen and so I'm just now in a space in time where I can create those connections, and that's what I'm doing, one of the things that I am doing is a.
Speaker 3:Facebook group for women and I actually put myself out there. I make pinatas and I hosted a pinata making class so that other people like just to get to know people. I actually have a whole Facebook album on the pinatas that I've made for my kids. That's why I started doing it but you've got to find something that you like to do and remember that you are important and that you need to fill up your cup. In order to do that, you've got to put yourself out there and try new things.
Speaker 2:I love that. That is a great way to end this podcast. You're so full of positivity. I wish you all the best with papaya primary care. I think it's going to be great. I would love to do a follow-up interview with you, like in a year, and just see how it has come full circle 2026. But I will see you on a cruise ship this summer.
Speaker 3:I'm going.
Speaker 2:I am so excited for you and your business and it is beautiful. Y'all I do these Zoom interviews where I can see behind and the pictures are beautiful. So if you get a chance, yeah, go on her website, take a look at what she's going. Maybe it will spark some ideas of how y'all can decorate your clinic. If you're just now opening it, and hopefully some of the information that Caitlin shared today will help you have the best practice that you can have. So thank you so much, Caitlin.
Speaker 3:Thank you. I really enjoyed our time and 100%. We will see you next year and I'd love to do a follow-up podcast, Perfect.
Speaker 2:Okay, we certainly will do that. I'll talk to you later. 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.