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.
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aprice@faithfamilymedical.com
The DPC NP
From IV Hydration to Whole-Person Care: Stephanie Miles’ Journey to DPC
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Being the first direct primary care clinic in your city sounds exciting until you realize you also have to teach your entire community what DPC is and why a monthly membership can beat insurance-based primary care. We sit down with Stephanie Miles, nurse practitioner and owner of Smith’s Primary Care and Wellness in Winston-Salem, North Carolina, to share what it really took to grow a thriving cash-based practice with a clear patient cap and a plan to scale.
Stephanie walks us through her story from nine years in a Level 1 trauma ER to becoming an adult primary care NP who wanted continuity, outcomes, and relationships. We talk about why she launched an IV hydration business first, how that experience prepared her for practice ownership, and what changed when she discovered direct primary care while researching a traditional clinic model. If you’re searching “how to start a DPC practice” or “direct primary care for nurse practitioners,” you’ll hear practical, specific decisions you can copy.
We also dig into the day-to-day mechanics that make membership medicine work: how she set pricing, what she includes for members, when she charges small supply fees for procedures, and why she offers a one-time visit option for non-members. Stephanie shares what’s actually driving growth (hint: word of mouth and Google), what marketing spend didn’t pay off, and how she keeps operations simple with an all-in-one EMR like Atlas MD. On the business side, we cover collaborating physician agreements, lowering overhead through smart real estate moves, hiring her first medical assistant, and the tough contractor lesson that taught her to keep personal and business separate.
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Season Three Kickoff
SPEAKER_01Welcome to season three of the DPCNP Podcast. I'm your host, Amanda Price, nurse practitioner, clinic owner, and someone who believes there's a better way to care for patients. This season we're diving deeper into the real stories, challenges, and breakthroughs behind direct primary care. Whether you're just curious or ready to take that leap, you're in the right place. Let's get started. Hey everybody, welcome back to the DPCNP. I have a special guest today, Stephanie Miles, who owns Smith's Primary Care and Wellness. Stephanie, welcome to the show. I'm so glad you're here. Thanks for having me. Yes, it's been a long time coming. I've been wanting to interview you, I think for about two years now. So here we are.
SPEAKER_00Yes, we made it.
SPEAKER_01We did. We're busy women people. I just want you to know we're both busy, and so it's really hard to lay down some times, but I'm so glad that y'all are gonna get to hear from Stephanie and all the positive things that she has going on because she has really a good clinic. So Stephanie, I like to go back in the very beginning to when you became a nurse and then how you transitioned to be a nurse practitioner and kind of what is your background that led you up to owning your own clinic.
SPEAKER_00Okay. So
From Calling To Nursing Career
SPEAKER_00nursing was definitely a calling for me. My father, um, growing up, he had a lot of different illnesses. He had seizures, he had type 1 diabetes, many things. And so he started calling me his nurse back when I was in high school, well before I really knew that nursing was on the radar. Graduated, got into college, went straight to the nursing program, and then it's just been that way ever since. My cap and gown, my cap had his nurse painted on it when I graduated from Winston-Salem State with my BSN. So my career was in the emergency room. I was in the level one trauma center for nine years. I thought that's, you know, I was running that thing. I from charge nurse to behavioral health to triage to sexual assault nurse examiner. I did everything in that ER. But after being there for a while, you get your regulars, you get your frequent flyers, as we call them. And, you know, they end up becoming like family. So that's what I was missing. I was missing the what happened to this person, or what's the outcome of these interventions? So I started wanting more. I started getting to a place where I wanted to walk in the room and I recognize you, and you recognize me, and we keep going. So that's where I decided to go back to school and get my nurse practitioner degree. I was very specific. I did not want critical care, I wanted primary care. So my degree is adult general primary care nurse practitioner because I knew 13 enough, I didn't want to deal with the kids. But I can handle the adolescents, I can handle the teenagers and up. So I was very specific in my degree, and that's what I went for.
SPEAKER_01So, how long have you been a nurse practitioner then?
SPEAKER_00I've been a nurse practitioner for seven years.
SPEAKER_01Okay. So, did you go straight from graduating to just owning your own practice, or did you work somewhere first?
ER Skills To Practice Ownership
SPEAKER_00So I graduated nurse practitioner school in 2019, and I started working in a private practice, but it was an internal medicine/slash pain management clinic. So there I was doing primary care, but then I was also doing pain management, which I will never do that again. That's the one thing I do not offer in my practice now. But I also got to do procedures, so joint injections and abscess drainage and skin tag removals, and that's stuff that you don't really do in traditional primary care settings. So I was there for two and a half years, but definitely learned a lot. Throughout my school and throughout my career, I knew that I had a goal of owning my own practice. And so after two and a half years there, I've never, you know, we didn't go to business school. I've never owned a business before, but being an ER nurse, I knew I could start some IVs in my sleep. So what I did was I opened up an IV hydration business in 2021. That was just to get my feet wet in the business world. I said, I'm gonna give myself six months, take 3,000 out of my savings, and just go for it. And I did, and it wasn't very popular in my area, so that took off, and I was able to end up leaving my full-time MP job and then pursuing the IV business. But of course, that's a nursing role. So I started missing the diagnosing, the prescribing, the MP role. So that's when I started doing my research. And I was gonna open up a traditional primary care practice. But while I was researching and Googling and joining Facebook groups, I discovered direct primary care, and that was a game changer.
SPEAKER_01Lucky you that you found it before you went down that horrible rabbit hole of insurance-based medicine. Oh my gosh, the Lord is shining down on you.
SPEAKER_00For sure. Because I there was none in my city. I I'm the first direct primary care practice in Winston-Salem, North Carolina. So I jumped out there, you know, trying to introduce something that people are looking at me sideways and saying it's too good to be true. So I really have to put in work to grow this practice.
SPEAKER_01Yeah, let's talk about that for a minute because I can relate with that so much because I was the first one in Memphis also, but I just opened mine a few years ago. So you've been open for a while. So, what are the things that you had to do to educate your community about DPC? And how did you start convincing because you were a brand new clinic, and really the only people that knew you were the ones that were coming in for just IV hydration? So nobody had experience with you on how well you would take care of their acute and chronic needs. So, how did you gain the momentum that you needed to start getting all of your patients?
SPEAKER_00So I
Introducing DPC To A New City
SPEAKER_00opened up the DPC in 2022, so a year after opening up the IV clinic. And honestly, I am born and raised in Winston-Salem. So when I say I can't go anywhere without somebody recognizing me and knowing me, that was a big plus. Even though I was opening up something non-traditional and stuff someone has never heard of before, they did know who Stephanie Miles was. And so when they found out I was doing it, it took a lot of posting. I had to post on my personal social media. I did build, of course, my business pages and business website, but in the beginning, I had to put everything on my personal pages because that's where my followers were. That's people know me. So it was a lot of posting all the time, educating. People do not read, so you know, even when I'm putting all the information out there, I realize they don't listen and they don't read. She's not wrong. I did a lot of community events, and honestly, it's because of just who I am. So being an ER nurse for nine years, the people know my level of care and my compassion. Working at the private practice for two and a half years. Now, a lot of my patients didn't follow me because, of course, they had insurance, they were about, you know, 30, 40 minutes away, so they didn't want to travel and they wanted to use their insurance. So I didn't have many follow me, but filtering people through the Ivy business and they're learning about it, and then just simply word of mouth. A lot of my patients, and not even patients, friends, family, associates, former colleagues, people are always dropping my name out there in rooms I'm not in. And so a lot of it really became word of mouth.
SPEAKER_01Did you have to join your chamber of commerce or a BI group or anything like that?
SPEAKER_00So I attended a few BI groups. I did not join them because I couldn't being a sole provider and running this all by myself, there's no way I could commit to those required, you know, meetings that you have to attend for the BI groups. But I did go to two different ones where I could at least introduce myself and my services. I did join the chamber of commerce. Where that has helped me at, though, is through the different programs and grants that they offer. Being a member of the chamber has gotten me where I have run two grants presented or by them. So joining the chamber, I have met people in other businesses. I have not really gotten patience from being a member, but what I've gotten is grant money. And I'm talking like 17,000, and I'm talking about a good amount.
SPEAKER_01Hold up just one cotton pick and minute, honey. Yeah. Does every chamber of commerce offer grants? And how do we get said grants?
SPEAKER_00That now that now that I'm not sure, but here in um Winston-Salem, you know, our chamber, they're really big on small businesses. And, you know, this is the city of innovation. So they're really supportive when it comes to bringing businesses to Winston-Salem and supporting them. So through different companies putting their money together, they've been running these, it's like um small business grants. Some of them are women or minority-owned grants, but they I want to say it ran for strong five years of them issuing out these grants to various businesses. And so we won two years in a row. Okay, everybody.
SPEAKER_01Listen to what Stephanie's saying. Check with your own individual chamber of commerces to see if they're offering grants because we can always use some money for something. Yes, right?
SPEAKER_00Sure. Mm-hmm. The IV business won Small Business of the Year Award that was a part of being with the chamber. So sometimes it's just about the right people recognizing the your name and what you're doing in your community.
SPEAKER_01I love that. So what happened was you started your IV clinic first, then you then a year later you added the DPC. And
Wellness Model With Counseling Included
SPEAKER_01then I also noticed on your website that you have counseling, which I love. I want to talk about that a minute, but I love the fact that you do offer that because a lot of people that I have actually interviewed do have IV hydration services, but most of the added services that they offer are more aesthetics and things like that. So the fact that your clinic just kind of represents this holistic approach, I think that's really something that I want you to speak to everybody about and how that came about and how it's going and things like that.
SPEAKER_00Yeah. So, you know, so many times we like to hear stuff being a trend. Oh, the IV business is a trend, it's here now, be gone tomorrow, that type thing. And when I opened up in 2021, it wasn't popular, but now, fast forward to now, it is quite popular and it's, you know, in many cities, many states. So what I wanted to do is set myself apart because I noticed that many IV businesses transition to med spas. They're offering Botox, they're offering fillers. I know how to do those things, but I don't, I'm not passionate about it. So what I did was avoid that altogether. I want mine to really be more holistic, more health and wellness, not really so focused on beauty. So what I did was paired the Ivy hydration with the primary care. And then my sister got in school to be um getting her master's in mental health counseling. So there's always been, we're super close, it's like my best friend. So there's always been the dream as well as having you know a business together, and that is why the business is called Smith's Primary Care and Wellness. It's our maiden name.
SPEAKER_01Ah, I was gonna ask that because your last name didn't seem to be Smith.
SPEAKER_00Okay, it is the one name, and honestly, a lot of people have where the Ivy Hydration is a or aesthetics or whatever it may be is an add-on to their DPC. I have two separate LLCs. So you have Ivy Smiles Hydration is an LLC, Smith's Primary Care and Wellness is a LLC separate, and I like doing that because depending on where we're going and the community, I like having them separate. They're two separate businesses, but they're all together. So with my sister, there's Smith's Counseling and Wellness, which is a part of course Smith's primary care and wellness. But being her therapist, she also has her own LLC that is umbrellaed in with the Smith's primary care wellness, you know, so she can build for her services. So it's truly a one-stop shop. And of course, when you're dealing with physical, there's always a mental component, or when you're dealing with mental, there's a physical component. So we wanted a safe space, a place very open, very welcoming that you really can just benefit from all services, whether it's the mind, the body, or just even, you know, health and wellness with hydration.
SPEAKER_01So does she, since she is under your umbrella and your main thing is not taking insurance, does she also not take insurance?
SPEAKER_00She doesn't. She charges a hundred dollars a session. And then you and so a lot of times, like you know, my patients see me for primary care, they see her for uh therapy, and she's right upstairs on the third level. So they'll come for their primary care visit and they'll go right on upstairs and then have their mental health appointment or session as well. But yeah, all the services are cash-based, which we find to be a lot easier. We're not having to jump through so many hurdles, we're not waiting for reimbursements, getting paid, not getting paid, you know, that's kind of out the door. And $100 a session is actually cheap. Like, you know, I have a therapist and she doesn't take my insurance, so mine is at least $150 a session, which that's a discount. So most folks are having to pay more than that if they're paying cash, pay for therapy. So even the therapy portion, it's it's affordable, just like DPC is.
SPEAKER_01That's great. I love that. So take me back to your DPC clinic for a minute because we want to know specifically how many patients do you have and how did you work out your membership schedule?
SPEAKER_00Okay. So
Membership Pricing And Patient Cap
SPEAKER_00I am up to 376 patients now, and my cap is 400. So I am almost there. Almost there. So, of course, the next plan is to hire another provider, let them start their panel, and I'll just kind of form a waiting list. As far as like, you mean like the pricing of my DPC?
SPEAKER_01Yeah, I saw on your website that you charge $75 for like an individual membership, and you have some discounts for couples membership and family membership. How did you how did you come up with those prices?
SPEAKER_00Honestly, I just did my research. So I looked at what was the comp because it wasn't anyone around here to compare to. So I looked at what some other DPCs were charging. I was, you know, following the groups and kind of seeing that. I saw 75 being like a good starting or stand-up price that I saw. There's a physician in Greensboro, which is like maybe 30, 40 minutes from where I am, and he has a DPC as well. He's completely full, he's been full for a while. I think a lot of his patients followed him when he transitioned into that, and so my prices are like right up under his as well, as far as how much we charge a month. You know, I started this in 2022 and my prices have not changed. So I was going to talk about that because it's time, it's time, it's been time. So I'm thinking that's gonna be my 2027 change. I think I must, especially because by then, you know, I'll be in my capacity, I'll have my waiting list. So the price is going to go up in 2027. I feel like I've, you know, I've dedicated the time. My patients are getting a they are spoiled, they are spoiled rotten. So I know the service and what all I do and provide is worth it. But you know, starting out with no one else really doing it, you know, you kind of sometimes you're afraid to just jump out there and hit people with a high number, especially when they weren't familiar with the type of business that we're running. But now, you know, four years in the game, it's time.
SPEAKER_01I agree. And so, you know, I'd hired Dan Luna, my new bookkeeper, who told me it's time. I've been open now for three years. So come February, we'll be in our fourth year. And so he told us we needed to increase our prices by $10 a month, which sounds so reasonable. I mean, you're only talking about $10. But this statistic is gonna blow your mind. So I have almost 400 patients, and that's pretty much my max because I have another nurse practitioner that I had brought in in February, and I'm trying to get her to like $450, which is her goal. My goal isn't more than $400, but I have functional medicine patients that have a higher acuity, so I just want less patients. But he said that it's time to increase my prices by $10 a month. But even if I lost 85 patients, I would still be in the positive. So I'm just over here thinking, well, if 84 people quit because of the $10 increase, I'm still in the positive and I have less responsibility. So I feel like it's a gamble worth taking.
SPEAKER_00I think so. I'm glad you shared that because I'm about to do the same thing.
SPEAKER_01Well, it's nerve-wracking. Like I can completely, and I'm sure anybody listening to this podcast that already has a DPC clinic, you're just so nervous about any kind of change because you don't know how people are gonna react. How loyal are they really to us? Yeah, you know, and are they all just like right here on the line and you just do one little thing and you've lost them. Yeah, you know, yeah. I'd like to think that that's not the case, but it is. But you never know.
SPEAKER_00You never know. But I mean, the way that healthcare is going, the way that insurance is quite unaffordable, even us going up ten dollars, it's still saving people so much time and money, like for sure. You still can't beat that.
SPEAKER_01So I'm looking at all these things, services that you say you are doing, like not so much the labs and stuff, because I'm sure you're charging for the labs. Yeah, we got those great prices with lab core and stuff, like skin tag removals and INDs and cryotherapy for wart removal and stuff. Are you charging extra for that? Are you on the process?
SPEAKER_00I'm charging ten dollars. I charge ten dollars, and that's more so them paying for the supply. So I'm not charging them for the procedure, like a joint injection costs this, but they are paying ten dollars each time that I do one of these procedures to just cover the supplies I'm using.
SPEAKER_01Do you charge for your strep test or flu test or like uh new sinus cocktails or B12 shots or anything?
SPEAKER_00Yes and no. So strep tests and COVID tests and all that stuff. If it's a member, a DPC member, they don't pay extra for those. But I do offer those to like the outside public. So they, if you know, if I swap someone who's not a member, then they pay for that service. Now, when it comes to what was other things, oh B12 shots, B12 shots, IV hydration, any of that stuff, that's a part of the Ivy Smiles business. So they do pay for those services, they get a 10% discount being a DPC patient, but they have to pay for those services and injections.
SPEAKER_01I give them a discount as well for my IV hydration, but my DPC patients pay for any test labs or anything extra, but I think it's a reasonable fee. I don't gouge them by any means, of course. I mean it's reasonable, but uh, you said something that interested me.
One-Time Visits And Extra Services
SPEAKER_01You said that you charge people that are not members. So am I hearing you say that you let people walk in and be seen that are not DPC?
SPEAKER_00They call. So we I offer a one-time visit. So people are able to schedule a one-time visit, whether that's a physical, their lab work, you know, whatever it is, or if it's something simple as you know, a strep test, they can come in and do a one-time visit, but they're paying $195 for that one-time visit.
SPEAKER_01What kind of activity do you have?
SPEAKER_00Do you have a lot of people that are doing it's not a lot of people, it's just kind of hit or miss. You have some of those ones who really just don't go to the doctor at all and they don't want to commit to monthly because it's just that, you know, one and done type thing. I just need my labs just for this year. I may come back next year. It's those type of folks. So they'll come in and or I think I did maybe one procedure, it might have been like a mole or a big skin tag or a mole removal. They'll pay the $195 and I'll do the service, and then that's it. Not a lot of folks coming in, but there's a handful, and then sometimes those convert into actual monthly patients. So it gives people a little bit of access to me who's still maybe on the fence about joining the membership or not.
SPEAKER_01What is the percentage, would you say, that transitions over to DPC?
SPEAKER_00Well, you know, it's probably only 5% actually taking on the one-time visit offer. So that's kind of hard to answer. I think the majority I don't see anymore, but I'm not doing a lot of one-time visits.
SPEAKER_01Well, if they're willing to pay $195 for one visit, you've pretty much covered almost three months of a DPC person.
SPEAKER_00That's what it is. Yep, that's what it is. Three months left.
SPEAKER_01Yeah, I think that might be something that would work really well for people that are trying to grow their membership panel because they haven't quite made it to their goal yet. And that's so that's a really good idea. So, what EMR did you choose, and why did you choose that one?
Atlas MD Workflow And Collaboration
SPEAKER_00So I chose Atlas MD, and I chose it because you know me, as you know, I like this one-stop shop type things. So with Atlas MD, it's everything in one from the billing to the communication to the lab results to the prescribing to the making appointments. I am a creature of habit and I am a person who likes things, I don't like to overcomplicate things. I don't want to have to have a bunch of different programs to run a practice. So honestly, I didn't try. I think I maybe trialed maybe one other EMR, but Atlas, oh, when I first started, there was a DPC in um it's a place called North Wilkesboro. It's about an hour from where I am, and I know the lady that started it. So when I first started, because I didn't have anyone in the area to go to, I called her and just kind of asked her about things, and she uses Atlas MD. So she's the one who told me about it, and then of course I tried it out, and I mean it's just too convenient. And then once I like something, I'm stuck with it.
SPEAKER_01I don't like changes. I have changed EMRs about four or five times, and so I also have Atlas MD, and I feel like I finally found the easiest EMR ever. Now I know that you know there's there are some limitations it has. I recognize that. I think they all have their pros and cons, but there are so many more pros to Atlas MD. I I can't imagine having to have subscriptions to all these other entities to make my practice run when I really just want the one thing. Let's keep it simple. Yes, you know, the more bills that I'm having to pay, the more stressed out I am. So if we can keep it, we can keep it to just like rent and utilities and Wi-Fi and my EMR. That I'll be happy.
SPEAKER_00Yes, for sure.
SPEAKER_01Do you have to have a collaborating physician in North Carolina?
SPEAKER_00We do.
SPEAKER_01So was it difficult to find a collaborating physician to support you through DPC?
SPEAKER_00Okay, it was not. So, you know, being in the hospital for nine years, we were in a I was in a teaching facility. So, you know, we got the new residents coming through, we got our attendings. So when I first started this journey, I went to some of the attendings I was close to, and of course they didn't know what I was doing. So, and and they're busy, so they were like, uh, I don't know, not knowing that they don't have to really do much. But so I was like, let me stop asking all the attendants and let me go to some of these residents that's about to become an attendant. So that's what I did. My collaborator, his uh Dr. Nicholas Pettit, he is the best, he is down for all of my shenanigans. When I have an idea, we get together, I pitch it to them, I tell them what I want to do, you know, I give them like my plan. And with him, it was literally like I think we met at Panair Bread. I gave him exactly what I wanted to do. I told him, I'm gonna pay you $250 a month for the first six months. Pending business is successful, we continue a maximum of $500 a month. So that's what I did. $250 for six months. After that, we went up to $500 and we've been $500 a month ever since. No increase. I made that the maximum. We do mm-hmm, and he had no issues with that. Like it's funny. He jokes and says, I make his truck payment, and I'm like, You're welcome. Enjoy that truck.
SPEAKER_01But does he? I mean, if he collaborates with some other nurse practitioners, he can make pretty good money.
SPEAKER_00Oh, yes, and he does. So I was his first one, but another nurse that I used to work with, she went back to school, got her MP, but she's into the aesthetic world, so she's pretty much left primary care, and she's running a successful med spa in a little town, probably like 30 minutes from where I am, and he's her collaborator. And so he he has me, her, and uh another MP that I taught the IV business. She has started her own IV business in med spa. So he has three MPs, that's probably all he'll get. He don't want too many. I know he always wants nurse practitioners, but he's super supportive. So, you know, we come in, we do our chart reviews. If I need to discuss anything or if I need him for anything, he's there. But honestly, I don't bother the man. We just do our chart reviews and you know, he just gets his money. But he's very supportive though. So I was I was lucky to be around physicians and people that I knew and who knows me and know my work ethic and you know believes in me. So it was no struggle at all. I didn't pay a service, or you know, there's these companies out that provide collaborating physicians for a fee. I didn't have to do any of that.
SPEAKER_01That's good. Is there anything that you could offer to anybody listening that's considering opening up a DPC?
Marketing That Actually Works
SPEAKER_01Something that maybe along the journey of you opening up and up to today, something that you would have redone if you could, or something you regretted doing that you could maybe help somebody prevent from doing.
SPEAKER_00I guess when it comes to advertising, don't like fall for all the traps because you get so many phone calls about your business being featured in the on the golf markers and the sports schedules and things like that. And you know, you're so big now. Do you need a good marketing budget? Yes, that does help. I have a marketing team that does all my posting for me, so you'll get there with time. I would be cautious about all those different avenues of advertising because it really doesn't equate to people coming in. I found that the biggest benefit has been really your patience, like your word of mouth and Google searches. And you know, a lot of that is free, so just don't fall for all of the phone calls that you get of people trying to promote your business or get you to display certain places. I don't feel like the and I've done it all. I've done radio, I've done commercials, I've done magazines, you know, I've done every type of marketing you can think of. But honestly, Google and word of mouth is the key. Keep on posting, keep on being consistent. People will watch you for a year and then decide to come to you. So if you don't continue to put yourself out there and put information out, you're gonna get forgotten about. So do remember that people are always watching, and it just takes people a different time frame before they finally come in and join. But they're definitely watching, and you're not gonna have all the answers and have it all together when you start. So just take the first step of just getting out there and going, and as you practice and as you go, things will fall into place, and you'll realize, oh, I need this. I did not have everything when I first started, and Facebook Marketplace was my friend. So my EKG machine, my exam table, some of those expensive things I got off of Facebook Marketplace. So I did not take a loan out, I took 3,000 out of my savings for the IV business. I took 5,000 out of my savings. Well, the IV business helped $5,000 to start the direct primary care. So don't try to just jump out there and have all the bells and whistles in the beginning. I just started paying myself from my direct primary care business. I want to say it's either this year or last year. I want to say this year, but of course, that's me running two different businesses. Everyone doesn't have that setup, but it took me a long time to start paying myself from my businesses, and that helped it grow and helped that account boost up.
SPEAKER_01Do you have a pretty high overhead or something?
SPEAKER_00Not
Keeping Overhead Low With Real Estate
SPEAKER_00really. So I own my buildings that I'm in, and so when I first started out, I was renting a suite kind of where I am now, and I believe my rent was $1,200 a month for that, and that's where the Ivy and the primary care was in it together. So the Ivy was going, I was building the primary care. Then they try to go up on rent on me a lot, like almost a two that from $1,200 to $2,000 a month. And I said, That's a heck of a jump. Yeah. So at that time, I saw that there was a suite that had been vacant for three years, belonged to a retired chiropractor. I called him on the phone. We hash it out on the phone. I got my attorney and I bought it from him. So going from paying $1,200 a month in rent, quoted $2,000, end up purchasing my suite, and my mortgage is a thousand, less than a thousand dollars. Nice. Yes, for the first suite. So so no, I would say the overhead is not bad. I just own, so I'm not, you know, and now I expanded because on the first suite, that's the IV business, my primary care, and the therapy was all in one suite. Well, as I'm growing, we need more room. I want a future provider. So the opportunity came to buy the suite below. So I own 8B. I bought a 8A, I bought 8B last year. I the time times is flying. But um, I I just moved in. I just moved into my this suite for my primary care the end of May. And so then I got a better this unit was actually I paid less for it than I paid for upstairs. And I'm talking like for this to be commercial suites, my suites are like 145,000, and then this one was like 134,000, which is kind of unheard of for commercial property. So I, you know, so I I got good spaces and good deals, and so my mortgage is low.
SPEAKER_01That's wonderful. Uh, so your future of your clinic looks like you're wanting to hire another provider. Do
Staffing Plans And Paying Providers
SPEAKER_01you have a medical assistant or a nurse that does your vital signs and all that?
SPEAKER_00I've been using students. So I have um I just the I just had two nurse practitioner students finish their rotation. One of them is going to start back up soon. I got another one coming at the end of August. So I've been avoiding hiring a medical assistant by utilizing MP students, PA students, students needing clinical hours before they apply to PA school. So that's worked well until now. Actually, it's funny you asked that today. I made a post today with a flyer. I'm finally hiring a medical assistant. So after all these years, so I actually have some interviews lined up. I'm gonna be interviewing for two weeks in August with their plan start date in September. And that's one of my students that's on a gap year before applying to PA school. She finishes up with me at the end of August. So by the time she's finishing, I'll have my hired one train, and then I'll finally have a medical assistant. But I have been winging it and doing it myself here lately.
SPEAKER_01That's a lot with 300-something patients. Yes. I see how my other nurse practitioner is with the 290 that she has, and she's about to pull her hair out because she's having to do everything for herself. But we're also interviewing for an MA. And I can I just encourage you to make sure that you hire someone that is exactly who you want and don't settle because being a DPC MA is a pretty sweet gig. Yeah. Because most of these MAs have to work their butt off in a family practice clinic where their provider may see 30 to 40 patients. Right. They might see 20. Let's give them the benefit of the doubt. They may see 20, but they are doing so many PAs, so many referrals, uh, I mean, just phone messages. I they are working to death. And so if they're potentially getting a job at a DPC clinic where there's so much downtime that they can watch Netflix, you make sure you hire somebody that you feel like is going to appreciate this job because it's a sweet gig. So as I'm interviewing MAs, if they say one thing that I'm like, you're not worthy, they're out of here.
SPEAKER_00And I will do the same thing because that's what that's what's taking me so long. You know, I have employees in the Ivy business and everything. I've never had to put a job posting out, I've never had to look for anyone. All of my staff that I have so far have fallen into my lap or I knew them from previously working with them, and they reached out to me, like Stephanie, if you ever need some help, I'm here. So I've been so, so blessed to have an amazing staff, you know, on the IV side. And so that's why I've been dragging my feet hiring an MA because I was like, Lord, can you just let the MA drop in my lap like every, like everyone else has? But I know, you know, with the numbers increasing, with me getting close to my 400 mark, with me wanting getting ready to prepare to figure out how to even hire another provider, I know it's time. And I can just feel it, you know, from having to check my email and the lab reviewing and answering the phone and returning the, you know, well, I got an assistant that answers the phone, but returning phone calls, all of these tasks that are now just getting to be too much for me. And I'm feeling it. Like, and I'm like, I just I know now I need to be able to delegate, and I need to be able to push some of this off of me onto someone else. So I think having these students helping me out really kind of opened my eyes, like, okay, Stephanie, and but they're temporary. I can't have the students forever. They, you know, have their goals and other places and other sites to go to. So it's to the point now where it's finally time. So I officially did it. I started coming up with interview questions and kind of putting my little flyer together. I posted on LinkedIn, and now I have a post that just went out a couple hours ago that my marketing marketing team did for me. So I've got four people lined up so far. I really want bilingual. I've been praying for bilingual. That will be a game changer if I can have Spanish speaking MA in this building.
SPEAKER_01Yeah, because that could be a lot of memberships that would come in if they felt like someone would understand.
SPEAKER_00Because especially in that population, you know, when they are happy, they bring the whole family. One of my old colleagues, she does uh IVs for me on the weekends just for extra cash. She's a neuro MP right now, specialized in migraines. But she would like to come and be a part of this practice, but she gotta keep making, you know, the money she makes, six figures. I can't afford that right now to pay her. So, like, I'm trying to figure out this whole hiring process, probably like part-time. Her go get like a PRN or part-time job and then work here and build. I don't know. That's the thing.
SPEAKER_01Yeah, I was gonna I was gonna ask you how you were going to pay a new nurse practitioner.
SPEAKER_00I don't know. I've been I've been, you know, perusing our group, kind of like seeing when people ask that question. I know some people have a base pay and then they get a percentage of their enrollment. Some people got a flat fee. Like, I really don't know what to do on that.
SPEAKER_01Um well, you know, part of why I started this podcast is to get advice from all these people that I'm interviewing, right? Yes.
SPEAKER_00Now I'm asking for advice.
SPEAKER_01Yeah, yeah. So I'm gonna give it to you. I've done both when I interviewed Monica um originally, she had a pay structure for her nurse practitioners where she was paying them a percentage of their memberships. So it started with a base salary, and my base salary was 40,000. I think hers was uh 30 or 35, I can't remember, but I started at 40,000. And then once she had patience to where 50% of the money coming in from her memberships equaled 40,000. Then after that, she started making 50% of every membership after that. So her paycheck was always changing. What I discovered in that situation though is it was a nightmare for my office manager to keep up with it because once she got to that number of patients, that number didn't stay there. So she might get two or three patients, but then somebody's turned in their notice and they're dropping, and so we're going back. And so she's having to count all the patients. And then my pediatric patients pay less than my adult patients. So we have to take that into perspective as well. So it really was a logistics nightmare doing it that way. And she never got to a decent income that she was happy with. If she had grown very quickly, she would be making $200,000 and she would have been doing great. So when she left to go work in the ER, and I hired my next nurse practitioner, I wanted to make sure that I had a good quality nurse practitioner that had the same ideals of health care that I have. You know, I'm kind of a little bit granola, you know, uh a little bit hippie. So I I want to find somebody that isn't going to just pill push all my patients because that's just not what I do. Right. So I needed someone that was like that, and I knew I wasn't gonna be able to just start that person off at $40,000, you know. Right. And so I took a huge gamble and I started her pay at $94,000 because I didn't quite want to go all the way to $100. She asked for $100, and actually I wanted to start her off at $75,000, but you know, because she wouldn't be working very much because she didn't have the only she only she was only going to be getting 120 patients. So I'm like, you're not gonna work hard yet. I'm gonna give you $75,000. But she talked me into 94, which was fine. It made me tight for a while, but she was the right person because she helped me advertise for herself. She was always willing to create in her spare time. She was willing to create her own Facebook marketing things, and so she grew very quickly. Like I said, she's only been with me since February, and now she has almost 300 patients. That's awesome. It's so awesome. And so I'm gonna be able to give her at least the raise to a hundred thousand and hire an MA because of the amount of money she's bringing in now. Yeah, it's not so taxing on me financially. So, but it was it was a little stressful, you know, paying someone that much money when I knew that they weren't gonna be working hard. But they have to be someone that is willing to do the things to help you help them. Because I recognize I've I've interviewed enough people that I recognize that it's not your nurse practitioner's job to get patients because they don't own the business. You own the business. So it's your job to get her patients. But if you hire somebody that is team oriented, then the pressure doesn't fall on you because you've got your 300 and something patients, 380 patients or whatever, you're busy. The last thing you have time to do is try to promote somebody that's just sitting around twiddling their thumbs. Yeah. So if you find somebody that has been established in the community like you are, and you find someone that is outgoing so that they never meet a stranger, and so people flock to them because their personality is contagious, yeah, then I feel like they're gonna grow. If you hire a quiet, shy person that just moved here from Alaska, then it'll be a little bit more difficult.
SPEAKER_00Yeah, for sure. No, that's good. That's good advice.
SPEAKER_01Yeah. Well, do you have a good bookkeeper that can lay out a plan for you?
SPEAKER_00Yes, and no. So, like, I have a bookkeeper for the first business. Because I wasn't paying myself and a lot of stuff wasn't going out for the primary for my DPC, I was just kind of doing it myself. But now I'm at a point, now that I'm on payroll, I do need to get the bookkeeping services for the primary care too. And I know that will help because then somebody could be looking at those numbers and saying, all right, you can afford this, you may want to hold off on that. So it needs to be in the work.
SPEAKER_01All right. Well, before before I let you go, Stephanie, is there is there anything else that you can think of that you just want to offer advice to for anybody out there? Did you do something that you wish you hadn't? I mean, anything. Just you got the last say on whatever you have to say, okay? So go for it.
SPEAKER_00I
Contractor Loss And Hard Boundaries
SPEAKER_00guess I'll share my, I guess, biggest boss business owner, entrepreneurial mistake. So when I got to um when I purchased my suite for the primary care practice, you know, it it I needed some renovations, I needed some changes, I needed some closets, I wanted, I added some stairs to combine. The suites, and so I used a contractor who I had used before. He did my first unit, he did an awesome job, and you know, he became a patient, he became my DPC patient, he became like family for sure, like we treated him like family, and so it was a no-brainer when it got time to renovate the next place. That's who I used. And I thought I was saving myself money and making stuff easy. Instead of doing what I should do, which is pay half up front and the other half at completion, I was writing like small $5,000 checks. Because in my mind, I'm like, oh, it's only $5,000 coming at account at the time. You know, that's more time for the account to keep building up. And so I thought I was doing myself a favor and of course doing him a favor. Long story short, $26,000 out of my pocket and an uncompleted job. I end up having to fire him. Yes. Oh no. The biggest mistake I could have made. And you know, you have to remember, and I shared it. I actually shared it on my social media when I calmed down. It took a while. When I calmed down and I looked at it as a lesson learned, it was definitely a tough lesson to learn. But you know, you can't mix personal and business, even if you are close to the person, even if they've done great work for you, if you, you know, know them for many, many years. Being entrepreneurs and starting our own businesses and making all these grown-up decisions, purchasing property and leasing and things like that, my biggest advice is just to make sure that you keep it business and protect yourself. The job was done horribly. So, like even when I fired him, the new contractor had to go back and correct things. The wall was crooked in the bathroom, even left an open pipe inside the wall of the bathroom. So if we would have not caught that, now you're talking about black mold, you know, not even knowing that that was forming behind the wall if we wouldn't have caught it. So I hate I had to learn that lesson. The blessing is that the contractor after him corrected all of the mistakes and finished the job, and it was $10,000. And I knew, you know, and it should have been more than that. I know it should have. So I did find a really great guy who just felt awful and felt felt bad for me. But that is the biggest mistake and lesson learned so far in my entrepreneurial journey is just, you know, losing that money by I guess mixing the personal and business together.
SPEAKER_01Shame on that guy for taking all that money. Yes, yes, man. Well, thank you for that advice because somebody somewhere is about to build out their space. Yes, and they they needed to hear that. So that's very helpful. What do you think, real quick? I know I said that was the last thing, but that that made me think of something else. You know, sometimes I think about should I be hiring patients to do things like an example is I've got a guy that does my lawn care. He's no longer a patient. He was my patient when I had an insurance-based clinic, and when I switched to DPC, he left me and went to another clinic, but I'm still paying him to do my lawn care. Now, to my defense, I don't know any patient currently that has a lawn care business. But what are your thoughts on would you hire patients to do those kinds of things just as a I think it's like a thank you for trusting me with your health care. And so therefore, I trust my grass with you, or I trust my pest control with you, or whatever. Like, would you do that?
SPEAKER_00I would because you know, the patients are support. Well, how I look at it is the patients are supporting us. A lot of them are supporting us, they're sharing our posts, they're telling their friends and their family, they're spreading the good news. So if I'm able to hire one of them for something, for some type of service, it's to me is showing my appreciation and then returning the support. Now, we gotta do it right, learning from my mistake. Of course, make sure it's strictly business, make sure you know you're they're being paid, you're charging correctly, that type thing. But I think it's uh it's a good thing. I think it helps with the overall morale and just how they feel about you as their provider. And of course, even if they do leave and go somewhere else, I mean it's still business. So, you know, you never I would never take it personal, but um, I had a community event like an uh open house when I moved to the new suite. I found out that one of my patients started a jollipop soda business. So I was like, oh, you should bring your business out here, and you know, and I think I paid for the first 50 soda pops were on me, and then anything after that, the people that would came would pay for it themselves. But it was a way for and they were good. I supported her business as she has always supported mine. Met her, met her sister and family and other folks, and then she was able to promote her business at my open house event. So I'm I'm all about that. It's always collaboration, you know, over competition, it's all about networking, and so a lot of my patients finding out what they do, it can help. Like a lot, some of them are contractors. Even when I was looking to buy in my first property, I looked at it and was like, this looks a mess. But I brought some patients up and some clients up who was in the business unanimously. All of them was like, Oh no, this is a good deal, you should do it. So I actually use the opinion of people in the business in the field to help make my decision on buying my first office suite. So I'm all about using them if necessary.
SPEAKER_01Well, good. I feel the same way because honestly, I treat my patients like their family. And so supporting them and them supporting me. I mean, that's just I think that's what DPC is all about, is just building that personal relationship all the way around. Well, Stephanie, thank you so much for your time today and just everything that you shared. I'm just so inspired by you, and I wish you all the best going forward, finding a new MA and a new nurse practitioner eventually. Thanks. Thanks. We're in this together. We sure are. It's exciting times for sure. But well, you take care. Um, are you coming to the DPC Launchpad? I am. I'm Austin. I'm VIP status. No, all right. Well,
Launchpad Invite And Closing
SPEAKER_01everybody, if you have not signed up for DPC Launchpad now, we only have so many tickets. So you need to go ahead and sign up. It's in Austin, Texas, February 17th through the 19th, something like that. It's it's over there. So you'll want to come and hang out with us. We're so fun.
SPEAKER_00We are good times ahead.
SPEAKER_01Yes. All right, Stephanie. Well, you take care and I'll talk to you soon, okay?
SPEAKER_00All right, you too. All right.
SPEAKER_01Thank 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.