Through the Door: The Insider's Perspective on Running a Business

Healthcare vs. Sick Care

• Nevada State Bank • Episode 22

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What if healthcare worked more like a membership service than an insurance claim? Megan Comfort, Director of Business Banking at Nevada State Bank, sits down with Dr. Ati Hakimi, founder, CEO and physician at Vegas Direct Primary Care, to explore a model that is challenging conventional healthcare. Hakimi discusses why she left corporate medicine, how direct primary care is helping patients access affordable and personalized care, and why she believes Nevada has an opportunity to rethink its healthcare future. From physician shortages and rising costs to entrepreneurship and advocacy, this episode offers a fresh perspective on one of the most important issues facing Nevada families and businesses today.

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SPEAKER_01

Welcome to Through the Door: The Insider's Perspective on Running a Business. I'm Megan Comfort, Director of Business Banking at Nevada State Bank, and this is a podcast where we interview business owners, serial entrepreneurs, and business and community leaders, and we get to learn from their stories and experiences, running companies, and making big decisions that impact our communities. If you like listening to podcasts, then please subscribe anywhere you listen to podcasts. Or if you'd like to see a recorded video version of this interview, you can actually go to Nevada State Bank's YouTube and watch us there. So today I actually have Dr. Ati Hakimi here. She's the owner of Vegas Direct Primary Care. I love it because it's explained as a practice that is the equivalent of Netflix of healthcare, basically, a low and affordable flat monthly fee which gives her members all access to a physician, something that is desperately needed here in the state of Nevada. She's a Northwestern University graduate and has been practicing medicine for over 20 years. She ended up in Las Vegas in 2016, and she's also a graduate of Leadership Las Vegas, class of 2018. And this is where she kind of understood some of the inner workings of the city and really where Nevada falls as far as ranking in the nation for healthcare, which kind of you know moved her into the direction of starting Vegas Direct Primary Care. So thank you so much, Doctor, for being here. Thank you, Megan. It's a pleasure. So we love to start these off with talking a little bit about your origin story. So tell me, like, how did you decide to go into the field of medicine and then move to Vegas and then you know venture into entrepreneurship?

SPEAKER_00

Yeah, so we're going way back. Okay. So basically, um, I am actually of Iranian American descent. Um and my parents came here for vacation and decided never to go back because it was a land of opportunity. So I've been taught from very early on about business. And I was the little girl that was playing with her Barbies, but I would bandage them up instead of, you know, changing their clothes and their hair and things like that. You're triaging them. Exactly.

unknown

Yes.

SPEAKER_00

Exactly. So that was kind of my calling from the beginning was to take care of people. Um, and even in a restaurant setting, I was always taking care of people. Um, but it translated to health care and becoming a physician, which was my passion, I guess, since I was a little girl. So a funny story is that my last name is Hakimi. Um, so it's not a Persian last name, it's actually an Arabic last name. Um, and it means doctor. So my name literally means doctor doctor.

SPEAKER_01

Whoa, that's crazy. You really were destined to be in this field. Correct, yes. So where what made you decide like kind of your schooling, and then ultimately, why did you end up in Las Vegas?

SPEAKER_00

Okay, so that story is basically I'm actually from California myself. And I decided to do family medicine when I was doing my schooling because I felt like that was the true doctors. No offense to anybody else, but you know, family doctors are trained to take care of people from beginning of life to end of life. And we kind of know a little bit about everything. So that's why it's so important to have relationships with our people, is because that's how we were trained. And so that was my calling because I'm also a very social person, as you can see. I love to talk. So I didn't want people to be asleep when I wanted to take care of them, and so family medicine was my calling. Um I actually started with uh seeing people in the VA because I actually did a fellowship in geriatrics. Seniors were my jam. So um I started with the VA and decided that wasn't a good fit for me, and that was still in California, then went out to the Department of Defense, and it wasn't a good fit for me either, even though I love taking care of our vets, God bless America, and all of it. But it wasn't a good fit for me. And somewhere along that line, I actually got an MBA. Uh so I got an executive healthcare MBA at UC Irvine because medicine had already started to change, to become a business. And I wanted to be able to speak the language. Wow, that was really smart on your part. Yes, yeah, yeah. It was already changing. So um how I ended up in Las Vegas is that the MBA school that I went to, the president of, I believe, healthcare partners was a colleague in my MBA school. So he reached out and he was like, we need doctors. We need doctors. And it was a time in my life where I felt like, yeah, I think I'm ready for change. And so uh I moved out here from California to work with a very, very large organization. Um, and I was very excited because it was so big. I didn't know anybody out here, so I was like, great, I'll meet friends and people, and it'll be just great. Um so because I'm a family doctor, like I said, I'm social. So I actually had a Halloween party that first year, and um that corporation had a large amount of clinicians. Um, so I invited everybody, and about five people showed up. Whoa. That's crazy. Did they get the memo? Yeah. So I think that that was the first indication that there was not a good fit for me because people didn't like where they were working.

SPEAKER_01

Yeah, the culturality or community aspect of just working within a company. Yeah.

SPEAKER_00

Yeah. They didn't really want to even have anything to do with anything work-related on their own social time. So that was my my first clue that this might also not be a good fit for me. Um so that was quite a while back, but at some point um I also decided that I wanted to make friends. So that's how Leadership Las Vegas happened. Um, and I met some amazing human beings, as you know, uh, because you're also going through it's so fantastic. Um, and these people became my tribe. That's the word. And the tribe is the people that allowed me to feel like, yeah, I can do this because I left that institution. It started to become very toxic once the corporatization of medicine started happening. And, you know, no fault of anyone, but that's just how our field is becoming. And I didn't feel like that I could make a difference by doing that, right? So seeing somebody for 10 minutes when I went to school for 12 years doesn't translate. Um, and the reason why that happens is because there's literally 2,000 of you waiting to see us. Um that's humanly impossible. Yeah, volume versus quality of care of capacity. I can see how that would be a very difficult balancing act. Correct. So I decided that wasn't for me, so I actually quit. And that's when I started to do the program. So I was pretty lucky because I took that year off to kind of figure out what was my next step. But what I was also doing was I was volunteering with Volunteers in Medicine Southern Nevada, and there what I was doing was I was taking care of people. There was no billing, there was no coding, there were no metrics, right? I was just taking care of people. And I realized I'm a pretty good gosh darn good doctor, so I can't just walk away from this, right? But I couldn't figure out where I fit, where I fit. Um yeah, because at that time, what year was that when you were volunteer? It was like 2018 around that time. I actually started volunteering with volunteers in medicine like right when I came out here in like 2015 or so, um, because I just love that. It fed my soul to be able to help people in that situation as well. Um I'm actually trilingual, so I speak Spanish fluently too. So I was able to take care of their um Latino uh seniors. That was kind of what what um I was doing for volunteers in medicine as well. So it just fed my soul, right? So I've been doing that, um, but just to be able to do that exclusively was pretty amazing as well. And the other best part of that was they had a scribe. So I didn't even have to write anything, you know, it was just it was just a perfect world. So trying to figure out how I can do this perfect world as a career, right? Um, I didn't think that I was employable anymore. I didn't want a job, I wanted a career. So I was in a place in my life where I felt like I was comfortable enough to take chances, to take risks. And I was doing some research online and I came across direct primary care. And so what I did immediately was I tried to find someone in Las Vegas that was actually practicing direct primary care because I couldn't believe it. There was no way this actually worked, right? So I found somebody and I'm happy to call out his name because he is absolutely the person that mentored me. His name is Dr. Jimmy Hawks, fantastic human being. He had a practice already where he had about four or five hundred people in his practice, right? So the way he found everybody, um yeah. Wow. Yeah. Because he actually was a hospitalist. So a hospitalist is the persons that take care of you in the hospital setting. Um, medicine has changed. When I was training as a family doc, we took care of you in the hospital, we took care of you in the inpatient, outpatient, everywhere. But now that has been, you know, changed. So there's doctors now that just see you in the hospital setting, and then you follow up with your primary on the outside. Oh, okay.

SPEAKER_01

So that's interesting, actually. Let's so I love that you actually talk about you had a corporate job, right? And a lot of doctors probably see like big corporate, strong, financially sound, you know, job to kind of so many career opportunities and places to take it. And then you also saw like actual care where there wasn't the stress of a bottom line, and you just did what made sense and what was right for your patient, correct. And were able to take the time. And then you did this research because you're like, these are two wildly different sides of the spectrum. Correct. And so how do I find what makes sense and fits for me as a physician? And then you come across Dr. Hawkes? Correct. And he was practicing direct primary care. Yeah. And so how did that look as far as because it sounds like that was a very foreign concept here in Nevada? I hear concierge doctor more frequently now, but tell us a little bit, yeah, about kind of what he showed you and taught you that's something that you know you kind of found as like, okay, this is something that I want to actually do too.

SPEAKER_00

Yeah. So the difference between concierge and direct primary care. So concierge, uh, the concept came about because people were having a hard time accessing, right? Us. So the concept was access to your clinician, because I do think um other people besides physicians are practicing concierge. So uh it's like a flat fee up front. So it's about four to five thousand dollars up front, they still bill your insurance. So it's almost like a double dip. Oh wow. So there's concierge and you know, things like that are like MD VIP, things like that. Those are all concierge practices. So it's a little bit of a double dip, um, but direct primary care is literally Netflix. It's a flat monthly fee. Um so because it's more like a membership plan, there are perks to joining a direct primary care. So some of the perks that I have for my members is that if they want to go through me to do things like their labs, what happens is that I take the onus of paying the lab the fees for whatever they charge the lab. When I do that, the lab gives me prices that are pennies on the dollar. Okay. Pennies on the dollar. And that's because the lab doesn't have to worry about running after your copays, your deductibles, all of your own. The wait time, the receivable chasing. All of that, correct. So getting rid of a middleman, right? And so I can do an entire panel, fancy stuff, vitamins, inflammatory markers, all of it for about 120 bucks.

SPEAKER_01

Yeah, I'm always I don't ever understand the insurance health bills that I get sometimes where it's like, here's what you owe, but here's all the charges, and and then all the marked. And I'm like, I don't, this looks like foreign to me, and I'm just gonna trust because I'm not gonna call these places and validate anything. So I'm like, I'm like, but I have insurance, why do I keep getting charged for things? I'm so confused.

SPEAKER_00

And so so am I, right? And so that's why I couldn't do that system anymore, because you're as confused as I am. We don't even know what's going on most of the time either. And unfortunately, what's happened is that it's gotten so convoluted that this country thinks that insurance takes care of you. Insurance doesn't take care of you, we take care of you. So that message we have to rewrite 100%, right? So that's what direct primary care allows us to do is to have that direct relationship again and to personalize medicine again, and to for there to be a relationship again. That's what I was trained to do, is to be a part of your family, because I'm a family doc, right? I should know your dog's name, I should know your husband's name, now I do. So there is that direct relationship again. So that membership has a lot of perks. Um that's one aspect. The other aspect is we use the local imaging uh centers in town when we want to get imaging, right? I can do an X-ray, 50 bucks, I can do a CAT scan, maybe four, four hundred dollars, actually three hundred dollars, MRIs maybe five hundred dollars, depending on your body parts, right? No co-pays, no deductibles, no pre-authorizations. That is the bane of our society right now. Explain the pre-hysicians.

SPEAKER_01

Explain that a little bit, the pre-authorization piece. Because I do think for anyone like me, I don't ever really have to go to the doctor. So I don't some of these concepts are a little bit foreign to me, but as my parents get older, yes, and I start talking to them about their health care and their doctor's visits and all this stuff, and them saying, Hey, well, I have to wait because I'm my doctor's waiting for a pre-auth. I'm like, what is that? What is that?

SPEAKER_00

Tell me a little bit about a pre-authorization and I would love to try to explain it to you the best I can because it is something that has been decided by these companies. Um I don't know why they were created, but basically the concept is that we have to ask permission of these companies, the healthcare insurance companies, if it's okay for us to order something and they make us justify it. So it could be your medications, it could be labs, it could be um, you know, different tests or or any of these things.

SPEAKER_01

Aaron Powell But if it's coming from a doctor that obviously went to school for many years, residency, all those things, they're cle you're clearly rationalizing why you the patient or person needs that care. Correct. So I guess is there are situations where they're like, no, we don't believe you, or no, you can't?

SPEAKER_00

Aaron Powell So there's a lot of problems with the pre-authorization world. And I think that it initiated because at some point, you know, there was a lot of cost incurred, and you know, there were there were different ways that people were, you know, abusing the system and and things of that avail. So that it might have had a purpose at that time.

SPEAKER_01

Okay, so there was like controls maybe because of some type of major fraud or something that might have abusing the system.

SPEAKER_00

Maybe at one time, but I think that it has been overused at this time too. So um I'll give you an example of what I deal with as a primary care with the pre-authorization world. So right now we have some amazing medicines that help people with their blood sugars and with weight control. And unfortunately, they are very expensive in our country. Now, the reason why our drugs are very expensive in our country is because we do all the research and development. So the companies that make these drugs want to kind of make back the costs of that research and development. Because I also do clinical trials, so I know what's going on in that world, but it's pretty exorbitant, honestly. So, anyway, some of our drugs are very expensive, especially when they're still patented. Um, and these injections that we're doing right now for diabetes and weight loss have been some of the drugs that are revolutionary, amazing drugs. Um but nobody wants to pay for them. Right? So this is my struggle specifically. So I had an incident where I actually was trying to get this medication. So here's the thing with direct primary care. I'm gonna go back a little bit, is that if you have insurance, great, we can use it. We're still doctors, we can still do all of the things. We can still use the insurance to, you know, get your labs, your imaging, your medications, any of those things. But if they play nice. If they don't play nice, then that's okay. We don't need them. Because I'm just a primary care doctor. You know, that world of insurance is important, but it was made for catastrophes. Listen, you don't use your car insurance to go put paint on it or to do your transmission check or things like that, right? You don't use your homeowner's insurance to get a new gas stove or something, right? So that's kind of where we had initiated insurance for. But we got too busy taking care of you guys, and here we are. So, you know, I got tired of complaining. This isn't a complaint. This is basically saying that this is my way of trying to make a difference in this world before I leave it. Because that's why I chose to be a doctor.

SPEAKER_01

Well, is to make a difference. So that brings me to how do you let me tell you my story about that pre-authorization real quick.

SPEAKER_00

Okay, yes. So, my my experience with that pre-authorization was basically um I wanted to give this medication, so the process is I will order the medication, it goes to the pharmacy, the pharmacy will kick it back, and they will say that insurance A does not accept this. You have to do a pre-authorization. They will give me a number that I have to put into a platform, and then I have to answer various questions, correct? Digital. Umline. Okay. Yep. So when I do that, sometimes that's not good enough for them. They'll kick it back. And then sometimes they'll do something called a peer-to-peer authorization. This is where it gets really fun because my last peer was who do you think?

SPEAKER_01

I don't know.

SPEAKER_00

Call out some type of a clinician that you think should be my peer. I mean, I would think anyone who practices family medicine. Correct. You would think another physician. Yeah. My peer was a pharmacy technician. That was employed by this insurance company or consulted. Correct. So that's how convoluted the system is. I don't understand how someone that has been trained for maybe a few months is equivocal to someone that's been trained for 12 years. So that's just my story as a family doc. But we've got surgeons and all kinds of, you know, super specialists that have to basically beg to do life saving measures because they're not being, you know, approved ahead of time. And sometimes it gets so nasty that, you know, they'll already have the procedure done, and then the insurance companies will come back after them and say, no, we really didn't mean to approve it. So that's the system has uh gotten out of hand. Right? It's really gotten out of hand with the way that we have decided to take care of people. But like I said, once again, I'm just a family doctor, and so my onus is prevention, making sure that people don't get disease. And I can't do that in 10 minutes. So now with this type of concept, I get to make it what I want it to be. So I literally will spend an hour with you. So I like the fact that you said, I never get sick so I don't see my doctor. That's wrong. Why is that wrong?

SPEAKER_01

Well, because I'm not preventing anything from happening. That's what it's wrong. It's my naivete. No, it's not.

SPEAKER_00

It's it's what we've all been told. That's the story we've all been told.

SPEAKER_01

When you're sick is what Well, because historically, you've always been told, and I mean I've seen it like healthcare is so expensive, right? So I love that you bring up the insurance analogy on like you don't go to your insurance company if you want to paint your car or like there's a tiny dent, right? You fix it and you just figure it out. Same with homeowners insurance. Like you don't, for some needs, it doesn't make sense to utilize insurance. I agree that the concept of that in healthcare just doesn't seem, I don't know, like it exists or that people have an understanding of that. And maybe it's because the nor the consumer has been has to has had to take on the responsibility of so many additional costs. Correct. Rather than the thing that they have to pay that's almost required for just living in general, right? Health insurance. Insurance, car insurance, like all those things, like so.

SPEAKER_00

Once upon a time we were mandated we had to have health insurance, right? And so there was, you know, penalties and things of that avail to kind of push that story forward. So the only people that won at that game were the insurance companies, once again. We didn't win. Because they also negotiate what we are worth, right? That's the other problem. Um so once again, direct primary care, I don't have to deal with any of that. I literally will just have that personal relationship with each of my people. I literally charge about as much as two drinks on a strip. I charge 150 bucks a month, and that's it. And I think that's very fair. Now, so some people will say, well, then now you are picking and choosing people who have money, things of that sort. Listen, 150 bucks in this day and age is unfortunately is not a lot of money. But I do volunteer volunteers in medicine, I do other things in terms of giving back to my community, but I have everybody in my panel. I have the Uber drivers, I have the immigrants, I have the CEOs, I have the CFOs, I have everybody, and I treat everybody equally. So I don't I don't pick and choose. People find me that really want to have good health care. And so my job is preventing you from getting disease. So I spend an hour with you every time because I need to know what you are doing in terms of your sleep, your hydration, your physical activity, your nutrition, your base and foundation of healing is what we are taught as physicians, especially family docs. I can't do that in 10 minutes. And the reason why you will get a goodie bag when you leave, so people say, Well, you guys are always just prescribing and things like this. Guess what? If I don't give you something, there is something called these surveys now that they they put out when when we're employed, these metrics that are put out. And when people turn around and say, Well, my doctor didn't do anything for me, because the perception is if I don't give you something in terms of a prescription, I didn't even do anything for you. So that's how toxic the system has gotten.

SPEAKER_01

Yeah. And well, I think that's also a misconception because I actually really appreciate when I go to a doctor, like I just got a blood panel done, you know, a couple weeks ago, and they were like, you are the picture of health. And I was like, dang, I was really hoping you could just give me a magical pill and like make me have more energy. Right. Whatever the case may be. But they're like, no, you actually everything's in line. And I'm like, okay, that's actually great news, especially, you know, me being a parent, having young kids. Like I am more conscious, my husband and I, of going at least once a year to do something with the doctor. I don't even know what that is exactly. I feel like a lot of people are like that. They're like, I just know I should be going at least once a year to be talking to someone. So I love that you talk about you found this niche, right? That is it meets kind of that reciprocal type of relationship that you want to have with your clients where you're able to provide that level of care to them and you're able to do it where they can actually afford it, and it cuts out all the extra politics or nuances that are associated with any major industry that is extremely vital. So I guess my question is how do you kind of find, like, how did you grow that practice, but make sure that you grew it to where you could provide that level of attention and care and you didn't, you know, overdo it with not being able to, like taking on so many patients that you can't like see all of them, right?

SPEAKER_00

So remember, um, we are used to taking care of about 2,000 of you at a time, correct? That's what we've tr we've been trained to do. So when you start to practice with direct primary care, you will realize that um you can make it whatever you want it to be. So physicians that are out there that are thinking this is it for the rest of my life need to know that they also have options. Not just you guys having options, but we have options too. So my colleagues can have as many as, you know, um Dr. Hawks had four or five hundred people. My practice is like a boutique micro practice because it is just me. So I like to have that continuity. So you call, it's me, you text, it's me, you email, it's me, you see me, it's me. I like to have that continuity. Because listen, I don't bill, I don't code. I don't need someone doing that. I don't need anyone bringing you back. I do that. I know how to take your blood pressure. I was trained to do that. So it can just be as simple as that. So a lot of these physicians out there practicing primary care need to know that this is an option too. But for you guys, you have access to us now too. And I think that's that's the most important part of this story, especially in our city, there's just not enough of us. I think the stats in uh Nevada right now is about for every one of us, there's a thousand of you. So I'm talking about physicians, right? So physicians is what we're talking about. Um, so we couldn't do better. And I know how to get physicians here now. I promise you. If we figure out a system where our legislators work with us to bring more physicians in by allowing them to practice on their own, just like I am and my colleagues are, then I promise you we can bring more physicians to this state. So there's a lot of amazing physicians right now in our state. Um, the problem is that we are not being nurtured, we are not being mentored, we're not being given options, we're not being heard. That's my other concern. So that conversation and and that world, I would like to also change, and I think that's a really important part of um what we can all do together, um, especially with your team.

SPEAKER_01

Yeah, I would agree. I mean, I think it's very interesting that you talk about I can get physicians here, right?

SPEAKER_02

Yeah.

SPEAKER_01

But they need, there's hurdles for them to actually come here and practice and what that looks like. So, from a, I guess from your vantage point, outside of maybe just the awareness and education piece of letting people know, like, hey, there's absolutely a need, you can make a good living, you can kind of scale this how you would like to scale it. Absolutely. Um, and it's absolutely possible. What do you think are some of the other hurdles that are keeping physicians from considering this maybe as an option to kind of open up this segment of the industry that might be so small today?

SPEAKER_00

So, first of all, we're talking about primary care, right? Um so my specialist colleagues are um possibly limited, especially those that have to do procedures because you know it's more costly. So that's where they have to actually work with the insurance world. But there's a lot of specialists that are looking to direct specialty care where they might charge more of like that concierge practice where they'll charge that flat fee up front so you can have more direct access to the specialists as well. I mean, I don't know if you guys know this, but the struggle we have in this state as physicians is that we are paid 30% less than all other states uh if you do take insurance. And I don't know why. That's what I'm still trying to figure out. Why. That's not going to attract anybody.

SPEAKER_01

If this were the a same patient doctor in a different state needing the same type of level of care procedures done, that doctor is paid more just because they're in a different state than in the state of Nevada? Correct. Yeah, that's very interesting. I have no idea. I wonder what type of data or analyst is looking at information and deciding.

SPEAKER_00

Correct. So I mean, the way that we also get paid predominantly is Medicare. So Medicare has all of these metrics that they also have and base it on your locality when they pay you, but they pay us 30 percent lower in the state of Nevada. So I don't know. Those are the conversations that we need to start having with our legislators and things of that avail as to why that's happening. So that's one of the major struggles, I think, with bringing physicians to our state. Um the other one is obviously the corporatization of healthcare. We don't want it. We don't want it. We want to still be able to practice the art of medicine. We went to school, we have hundreds of thousands of dollars in debt. You're in a bank, I'm sure you've seen it. But that does not translate to why we became physicians. We became physicians because we were taught to be autonomous, to make life-saving decisions at the last minute. But we were not taught to bring on thousands of people and give you a 10-minute visit. Now I'm talking once again about primary care. My colleagues in surgery and things have their own stories they would love to share with you, but that's not what we want. We want to be uh autonomous again. But um our numbers and stats, I think if we go back to looking at them prior to the 80s, I'm sure people were happier with their doctors at that time. I'm sure they had relationships with their doctors. This is the word that I am missing the most right now, is us having that relationship with you guys. We miss that. We want that. That's what we were trained to do. But we're not able to do that currently with the model of care that we have in our country. But Nevada specifically, we do have these hurdles. And it's kind of frustrating when you hear some of the answers that people outside of our industry are coming up with that we know is not going to work. I just would like for us to be more at the tables when these conversations are had. That's kind of the goal that I would like to have. Um, like I said, I have a female physician group that I've kind of brought together, and there's probably at least 70 of us now that are in all fields. So we're inpatient, we're outpatient, we're CEOs, we are, you know, surgeons, we're in the state of Nevada or across the just happened organically. It was just a matter of, you know, I met a few women, I was like, hey, do you guys want to get together? So it's about once again that tribe that I've developed. Um unfortunately, leadership was 2018. You'll see, it gets it changes year by year. I still have a core of, you know, amazing friends that are still my people, but my new tribe is actually being with other physicians, and we are coming together to help each other in terms of um not only uh as friends, but also as colleagues, trying to make sure that my listen, we have one pediatric neurosurgeon in this entire state. This is a problem. So we are trying to keep our people here, right? And so we want people, especially unfortunately I can only get to the females so far, but we want people in the in the medical industry to know that they have a tribe as well to get them through whatever they gotta get through. Um it's very important for me for this nourishment of this of us.

SPEAKER_01

Um well, and the community that you're creating among like-minded individuals in the same field, because then that's really where the power comes, because you have a collective of individuals. We talked about this a little bit earlier, but talking about the importance of engaging with your legislators and talking to them about certain things that are impacting, you know, our state and the people in our communities, and how we could maybe do a better job about it, and how we automatically sometimes make the assumption that somebody is doing it, somebody's talking to them, and somebody is figuring this out and providing a solution because ultimately we're all very busy and we all assume that these things are happening, but then you start to realize as you really peel back the onion, like, why is it this way? You start to understand, oh, wait a minute, there really isn't maybe all the right people at the table talking about some of these challenges, maybe providing some solutions, orchestrating a group of people to really figure out how to provide a level of care at every different level. Because the direct primary care model, I mean, that sounds like such a great model for even the growing population of senior citizens that are here. So that kind of brings me to another question about that, because we are in a state that has a very large older population that obviously has care. Not only that, there's also growing families in the state, too. Yes. Which is, you know, really cool and fun. I'm one of them. Um, but it makes you start to pay attention to healthcare, to, you know, the the topics that we've always heard have always been of top concern for our state. So if you had an individual, like an elderly individual that was on Medicare, and then also maybe looking for a supplement type of insurance, because I've heard of that too. I have older parents, so they tell me all the craziness behind, you know, the algorithms and things that they're trying to figure out with insurance because it's very foreign. Yeah, what would you say to that person when you're educating them? Like, yes, there's this fee that I have, but does it is there something that gets removed because some of these individuals are on fixed income? And so, you know, the concerns of inflationary impacts with like rising prices and just having one more thing that comes out of their overall maybe income, even fixed income that's coming in. Would that be a good fit?

SPEAKER_00

Yeah. So um first of all, tell your parents do not do anything but straight Medicare. Right? That's very important, straight Medicare. We'll talk later. My dad's a veteran. Perfect. And thank you for thank him for doing that. Um I think that direct primary care would be an absolutely amazing addition to senior care. So I'm a geriatrician, like I said, so seniors are my jam. I've done the whole gamut of, you know, going into the nursing homes and the post-acutes and and all of that, and even homes. So I used to do house calls once upon a time, but I stopped because our legislature also removed our medical malpractice cap. That's another reason doctors aren't coming here. So yeah. Expensive to get insured. Our insurance, yeah, has significantly gone up because of that. My insurer personally left the state, period. So I had to scramble to find someone else. That's how impactful it was. So that's another hurdle that we need to help when we bring doctors in to allow them to be able to practice good medicine. So I think for seniors, direct primary care would be an amazing addition. And I think that if you do have a parent that is on a fixed income, that's where the kids need to step up. With all due respect. This is the time you step up and you pay for that direct primary care because what we do once again is prevent things from happening and we're accessible. So for seniors, I think the scary thing is that when there's something that's different, blood pressure changes, medication changes, these are, you know, big, big things that happen to our seniors and there's no access, and then they've got too many specialists. Listen, I don't think you guys know that we were the gatekeepers. We were everything once upon a time. The reason why everybody's getting sent out to all these specialists is I can't even do my job, right? I can't do what I'm trained to do. Well, it takes three months to get to a special time. And that's the other problem. But not with direct primary care, because remember, so direct primary care, the other aspect of it is that because I have, you know, this alliance with a lot of physicians now too, I can bypass all of that. Um they literally are on my phone. So I can, you know, reach out to colleagues and friends and be like, hey, you know, this this rash, I'm not quite understanding. What do you think? I just saved you a visit, I just saved you a cost, I just saved you three months of your life waiting for an answer, right? So that's the other aspect of direct primary care. You literally get direct answers too, and so you don't have to have any worries when it comes to things like that. But for seniors, I think it's invaluable because that access is important, and then you guys, in terms of, you know, the family members of the moms, dads, the grandmas, know that you have a doctor, know that it's gonna be the same doctor. That's the other problem. Continuity is non-existent anymore, and that's so dangerous for seniors because then too many hands in that pot and changing things, and they're so seniors are like kiddos. It's like that circle of life, right? So you're kiddos, you know, uh, I don't want to say the analogy, but anyway, so you know, we come into this world a certain way, we live, we leave this world a certain way, but it's very similar. So they're very, very precious, and they're very, very, we have to be careful. Um, I don't think our seniors get enough attention and love and things of that avail. And that's just not in our state, that's in our entire country. So we need to do a better job overall taking care of our seniors. Um, but I was trained to do that. So my practice isn't just about seniors, but I do have seniors in my practice, and I prevent them from hitting that ER proudly, because I'm there for them when their medicines change or they go to their specialist, they didn't understand something, I can explain it to them because I'm that family doc. That's what that's we were supposed to be, you know.

SPEAKER_01

Um, so well, and it probably helps you like that. You talk about that continuity of care. Yes. Is you have that storyline with that individual, so you're not having to relearn or oh, let me look at this person's chart and what was it, and where have they been, and piecing things together very rapidly to your point, because you don't have a lot of time with these individuals to try and figure out.

SPEAKER_00

It's impossible. There's no way I can walk into that room and I know you guys get frustrated, but guess what? We're just as frustrated. We're just as frustrated, right? I mean, can you imagine being in a field where you have like no control over a lot of things, and that's not how we were trained. We were we were trained to take care of lives, you know. So it's just as frustrating for us as it is for you guys. So please don't think that it is purposeful, that you know, we don't care. That's the worst thing we we want people to feel is that we don't care. We absolutely care. We're just practicing we're practicing health care in a sick care world. It's not allowing us to practice what we were what we were taught to practice. So I I always say that, right? So I practice health care. Um I don't practice sick care. My my job is to prevent disease from happening, especially as a primary. So what I do is I actually do check in with you once a month. Megan. You're selling me on this whole class. I do check on you once a month because listen, if these parts of your base and your foundation start to sway, listen, your mental health. Family docs, we do that. We do that as well. And there's not enough mental health clinicians anyway.

SPEAKER_01

Yeah. It's the purgatory, I think, for a lot of people. Like I hear that a lot with if you have to go in to see a doctor or even do something and you're like, I don't know. Or the I hate when the doctor says like someone will call you like only if something is wrong. I'm like, don't say that. Just call me, period, so that I know, like, either way that everything's all good or or things are wrong. And so I really like that you're kind of shedding some light on just the other side of the equation that maybe a lot of people don't understand. It honestly begs the question of why aren't there more direct primary care physicians? Like, there's obviously, like, we talked about malpractice and some other hurdles, but you were able to build up a clientele. You met a mentor that had a significantly larger level of clientele. So I guess what were some key learnings there when you started your own practice that really helped you know like this is possible, I can do this, I can I can have a level of patience and income coming in where I'm doing the type of medicine that I want to do and I know that I'm making a difference, and I'm able to make a living too. Correct.

SPEAKER_00

So I think that um so I know we were gonna do this at the end, but I'm gonna tell you what my dad said. He always told me that um success is on the other side of fear. You've got to get over the fear of not succeeding. That's the first thing, especially as physicians that have been in the environment where we have pretty much been employed all our lives. I started my life over again at 46. 46. Because I, like I said, I was not employable, but I knew I was a good doctor and I wanted to make a difference. So that's why direct primary care was absolutely the right option for me. Um for my colleagues and the young doctors and things of that avail. I think that they need to find one of us, is what I tell people. You guys don't know about us because this concept is not necessarily new, but it's not advertised, right? So our younger doctors are out there on social media. Media now trying to do their best to get the word out. But for me, my practice was organic. It's literally been word of mouth. And it's been enough for me. I'd like 50 more people if possible. But you know, that's the only thing.

SPEAKER_01

I can think of at least four.

SPEAKER_00

But but the it it's not advertised because we are not insurance. So that's the most important thing. We're not insurance. We're not claiming to be insurance. That's not what we do. We're just doctors trying to make a difference in people's lives, and we've found a way to do it. Now getting that message out is a little bit of a struggle, but people like me are not giving up. We're not giving up. We're making sure that we're trying to get to the right people so that they can hear, especially to our young doctors. And for me, like I have a plan. I literally have a plan to bring doctors in and for them to realize that they can be independent. I just need for the state to be in on it because it's going to require money and I don't have money. So, but just like other organizations have brought in different professionals into our state, this is absolutely doable. My overhead is nothing. This is the problem that a lot of people think that, oh, you have an MBA too, by the way. Yeah, great. I have an MBA, but you don't need an MBA to start your own business. As you know, you guys, you know, work with all kinds of businesses.

SPEAKER_01

I think we're all different types of successful business owners from all varying levels of calculation.

SPEAKER_00

And it's totally possible. I think the biggest factor for me when I tell people about direct primary care, especially other clinicians, is that you need to start out with the basics, which is how much you want to make. Um, because we don't even know what that number looks like anymore because we're my my colleagues that are in primary care that are using the insurance model usually get paid about $30 or $40 a visit. So that's kind of what they're used to. But they need to figure out their finances first, work backwards, know that your overhead can be very low. It doesn't have to be this huge, beautiful office right away. You can start off, you know, very slow. But I think the most important thing is that you want to make a difference. You want to have that relationship, and we all want to do that, right? I think we're all pretty much tired of not being able to practice the art that we've been taught. Medical school was rough, residency was rough. We missed out on about 14 years of opportunity cost. The monies that we could have put into savings accounts and you know, things of that avail. People say that, well, you know, doctors make so much money. That story is dead. That story is so dead. I think the CEOs of these various companies come home with, you know, 30 million at a time. We're not nowhere near that. And we're the ones that are actually taking care of you. I mean, I don't think anybody else ever has to tell someone they they have cancer. I've got to do that, right? So it's it's a it's a career that we wanted to go into and we love and we're passionate about. I didn't like the way it was being run. So, like I said, for me, this was the right option. I think it's important for us to give others a choice, not only um, you know, people like you need to know about it, but people like me need to know about it as well. We all need to have that conversation of bringing back doctors that want to have their own private practices. And this is a sustainable model that we can that we can have for all of us to to get that relationship back, to know your doctor. I mean, I had at least my dad's funeral, at least 10 of my members were were at his funeral. I mean, that's the relationship we should have. I'm a family doc. I should be a part of your family. That's what I signed up for.

SPEAKER_01

Yeah. I've never had a family doc. I was a military brat, but I I completely agree with you. I think anyone that has a family or has had that experience, that's how they envision it, and that's obviously what they would seek. It's just nobody knows that it still exists today and in at what level. And I also think to your point, the conversation of insurance probably does need to change and people need to be a little bit more educated. And it's such a complicated environment to navigate through. And historically, we've always been told get a job that gives you healthcare, right? Because healthcare is so expensive and you should have healthcare. If you are an entrepreneur, the stress of wanting to provide healthcare for your employees, and how do you make that affordable and what does that look like? Understanding the options that exist is, you know, something that I think is really hard in today's environment, which is odd because we're we're able to actually do that so much better now through podcasts and social media and different things like that. Is that what what do you think about that as a business owner and how you kind of get the message out? You talked about word of mouth, which we're in the perfect city for that. Correct. Because you're two degrees of separation from everyone in this entire town, even being you know, 2.4 or 2.6 million deep. But what are some of the other things? Because you have to wear so many hats, even with being the physician, and that's your actual work, but then you know, CFO and marketer and you know, business administration and everything else, how do you manage through that?

SPEAKER_00

Uh so my younger colleagues are doing a fantastic job of that because they're very comfortable in front of the camera and telling the stories and things like that. So I do lean on them a little bit more. I'll occasionally go online. You know, I do have my own Instagram account and uh Facebook for the older crowd and things of that avail, but I do the best I can. I think for me, um, my way of making a difference is having these organic conversations and bringing that to the table and actually attending events and things of that avail and telling people directly about this option. Um but it is difficult to get the word out because I mean, even when I first heard about it, I was kind of dumbfounded and sad because healthcare is not expensive. It is just too many hands in the pot. That's the problem. Um and as far as business owners, uh direct primary care is an amazing option for business owners. And I'll tell you why, because when you have someone that is your point person for taking care of your people, that gives you so much peace of mind, right? So that you know who's taking care of your people, what they can and can't do, and what they have to offer. And it's a flat fee. Um, so direct primary care is affordable, it's quality, and it's transparent. There are no hidden fees or any. You'll actually understand your bill. Right. And like if in a even with those labs, like if you ask me, hey, you know, doc, can you also order, you know, this inflammatory panel or something else that I saw online, we'll have the conversation, and then I will tell you it's gonna cost you 20 bucks, right? That's how much labs cost. Everything else is not true. I'm gonna tell you right now. My prices have not changed in the six years that I've been practicing. Why is everything going up? The other thing that I can do in the state of Nevada is actually physicians are allowed to um dispense medications. So uh for those of us that do that, we do have a license with the pharmacy board, and we basically can order medications directly from the manufacturer. So I can get three months worth of blood pressure pills for probably about 10 bucks. Right. Much cheaper than that. So we get rid of the middleman there too, because those are very convoluted right now, and you know, the actual pharmacy owns the company, and that's a whole nother podcast. A whole nother podcast.

SPEAKER_01

Did you have to build up that network of you know, basically your supply chain, if you will, for like labs and you know, different panels and CT scans and x-rays. Nope. It's all there. You just anyway.

SPEAKER_00

I just followed everything what Dr. Hawks taught me. Wow. And I can do that for anybody else that wants to do it. And I'm 100% trying to be an advocate for it. So I I'm trying to get into our I have pre-meds that come to my office and they shadow me. Um both of them are actually two or three of them that I've shadowed actually are in med school now, so they're looking to go into primary care because they saw what I did. Right? So I'm very proud of that. That's three doctors, and I'm trying to get them to come back to the state because, you know, that's the other conversation, is we don't have enough residencies right now. Um, but I need more doctors here in order to get more residencies. So that's that's the plan is to get more of us here before we build more residencies. But at least, you know, I got three doctors in that will practice primary care because we're starting to become dinosaurs. Um, but they saw what I did and they were inspired. And so they're like, I like doing that. And and it was kind of sad because one of them literally said, Wow, doc, you actually care.

SPEAKER_01

We all care. Yeah. I agree. I mean, it's I every doctor that I've met, I've always thought the world, I've I've been very fortunate in the state of Nevada to have like a great, you know, doctor to help me through my pregnancies. And I mean, just you know, any time I've ever had to see like our pediatrician or something like that. But I do agree that I think the volume and capacity constraints and just the the business side of the corporate healthcare structure seems to have caused somewhat of a strain, and the people that kind of have the hardest time navigating through it are literally the people that have to work within it and that need the care. And those are us. Correct. You and me. Um so correct. If someone was listening to this podcast, what are some of the things that you would tell them to consider if they were trying to rethink their health care options?

SPEAKER_00

Yeah. So I think that if you are not employed, um, direct primary care is fantastic. If you are employed, direct primary care is fantastic. The reason being is that the one story of being employed is the fact that you will know your doctor. Um, you're not going to pick somebody on a list that you've never met. I also in network versus out of network. Correct. That drama. I do a meet and greet because I like to get to know my people before they join so they know how I work in terms of my um philosophy of healthcare. Because it's not always a good fit for everybody. But you know, that eny meeny miny mo system doesn't work either. I mean, literally, when I was in residency, so my name is Atihakimi, right? So I had this beautiful Japanese lady come in and she looked at me when I walked in and was like, oh, you're not Japanese. And I'm like, no, I'm Persian, but you know, if you want someone else, she's like, no, no, it's okay. Because she thought I was Japanese. So, you know, that system doesn't work. So when you actually get to talk to your doctor, know your doctor, um, you're able to get that, you know, quality care from someone. I think that's important when you're in that um employed system world. Um, but that way you don't have to worry about your primary care leaving or or being a new person or um any of those things, right? So it's important to have that continuity and the access, right? The access is very important. People text me all the time. That's really a majority of my practice because of the busy world we live in, and I respond. And I respond. The access is everything. Yeah.

SPEAKER_01

Especially if you've lived here in Nevada and ever been frustrated with a referral trying to schedule an appointment. And having an appointment, it's like two months away, and then you sit in a waiting room for about three hours, not knowing or understanding you are going. Yeah, my husband has, he's like, I'm done seeing the doctor. This is ridiculous. And so the access, I think, is huge. And it is just a narrative, it's an awareness thing. It's how great is it that this does exist and it's something that you can explore and you can see if it's a good fit for you, for your family, for your business.

SPEAKER_00

So if you are unemployed, or I mean sorry, if you're not in a employed setting, you're a private business owner or you're a student or anything like that. The ideal healthcare model, I think, this is what I do, is that you join a direct primary care practice because our job is prevention, taking care of you, making sure nothing happens to you. And if there is a catastrophe, what we recommend is called a health share plan. Have you ever heard of a health share plan? Health share plans were created by the Christian faith once upon a time where people put money in a pot, dipped into it when there was an emergency. That concept is now a business. You don't have to be of any faith base. There are several health share plans that are out there that people can join, and they charge a small monthly fee as well, much less than you know what you would probably pay in the other system. Um, and that's it. You've got everything. You've got your primary care, you've got your catastrophic care, and that's it. You're covered. So that's the other story that needs to be told. It doesn't have to be the way it is right now. Um I've saved people thousands of dollars by doing this method as well. Um it was astounding to me the amount of money that people are spending on a monthly basis for their health care when it's uh sometimes a challenge to even use it when we need it for catastrophes, as you have been hearing stories and things of that avail, and we experience it too. It's like I have something that I pay for on a monthly basis, and when I need it, it's still hard to use. Why do we even do that anymore? So it's just a different option. Um, if people feel comfortable, they need to know that they have choices. But it's kind of scary, right? It's like starting your own business, starting a new type of health care for yourself.

SPEAKER_01

But as long as people know, but I feel like it's more exciting than anything that there's an option that exists, and it really is we're we have access to so much information and to be able to self-educate in so many different ways. And this is the first time that I'm truly understanding what direct primary care means and how affordable it actually is, how quick and accessible it is. And I agree that it's it's one of those things that maybe is just a best kept secret in the industry. And hopefully more people will listen to this and it will spark some ideas and some inspiration and have, you know, the curiosity level to see if this is a healthcare plan that would work for them or their families or people that they know. Because our state is still ranked very low in healthcare and having multiple options, having you know, private enterprise come in and just change the game on providing service that's absolutely needed should happen. There should be varying levels of care that fit every different demographic. Right now, I feel like it's just two sides of the spectrum, maybe, or like the ultra, ultra wealthy get this, you know, direct concierge type of you know, medical care. But really, there's so many different levels in between that people just honestly don't know about. Correct. Yeah.

SPEAKER_00

So that's our jobs, all of us that are doing direct primary care. We hope to, you know, try to get the word out as much as possible in any way possible. I'm very passionate about it, um, but I'm also very passionate about bringing more doctors to our state. I know how to do it, we know how to do it. Those of us that are in practice, uh, we just want the you know, the legislation and and people such as yourselves to to tell our stories, um, that it's time for our state to be physician-led again when it comes to health care. Uh, we want to be a part of this conversation. Direct primary care is an amazing option, especially for everyone as far as I'm concerned. But to know that quality health care is absolutely affordable, I would like to say. Transparent, that's the other key, is the transparency in DPC was unbelievable to me. There are no games, there are no, you know, different little, you know, bills in the mail and things of that sort. So I actually went to the ER recently. Uh it's my own story, but I went to the emergency room and um I actually had let my, you know, health insurance and health share lapse, so I had to go cash pay. My bill for the emergency room when I walked in uh for migraine is what it was. I just wanted to get some IV medications because the pills weren't working. And I did my own CAT scan even. So I did the the imaging, made sure that something horrific wasn't happening to me because I was in so much pain. Um the CAT scan cost me how much, Megan? 500. $123. Wow. Yes, $123. Uh got my CAT scan done, and that's not just because I'm a doctor, that's because that's how much that imaging center charges for cash pay. That's all. Had nothing to do with me being a doctor. Um so I got my CAT scan done, but it wasn't cutting it, so I had to go to the ER, and when all else was done, I basically walked into the ER, wonderful emergency room, great service. Told the ER doc what I needed. There was no labs done, there was no imaging done. It was literally an IV, put in my arm, four medications in, a bag of IV fluids. How much is a bag of IV fluids, Megan? I would hope pennies on the dollar. How much do you think it is? Just give me a big one. At a hospital?

SPEAKER_01

Thousands.

SPEAKER_00

Yeah, so a bag of IV fluids is a dollar fifty. Uh I think I got charged about $500 for that. To make a long story short, I walked out with an $8,000 bill. This is the story that needs to be told. This is not what we need to do. It doesn't make sense. With all due respect to everybody that was involved in that situation, that is not the right story to be told. That's not that's not what should have happened. So I am, you know, trying to work with them because I'm cash pay. So, you know, things have been dropping a little bit at a time, a little bit at a time, but the overinflation of healthcare, it's just mind-boggling for us. Mind-boggling. And we're not a part of that conversation, by the way. I don't even know what what happens to that money or where it goes or what happens. But that's another thing that we need to probably do better with when it comes to health care, is just the exorbitant cost that I don't even I have no idea where they get these numbers. Because like I said, I order my stuff directly and I see these numbers that that I'm getting from the manufacturers or the labs or what have you. Where do these numbers come from? And I understand we all want to make money in the end. But why so much? Why are there so many hands in this pot?

SPEAKER_01

Yeah, it would be interesting to get basically every facet of the healthcare industry in a room to better understand maybe where or why, you know, the pricing is where it is and why it is so vastly different among different carriers and different places and uh different businesses. That that would be pretty fascinating. It's difficult to do, and that's probably why it hasn't been done before. Because trying to navigate through the layers and that world and actually everyone being open-minded to actually share and have a discussion about how do we solve this problem, right? We're all in this together, so how do we figure it out? Um I hope I'm hopeful that it will happen and that you know the state of Nevada will start to improve in the healthcare front. I know that it's a topic that everybody talks about and that is important. I'm so thankful that you actually organized an entire network and are really pushing the agenda to be involved in these conversations because we'll probably start seeing some positive changes there. Because that's what's so cool about our state is that accessibility to these individuals to make an impact and a difference, and everyone truly wanting a solution that works for all levels of the population here, so that we have better healthcare, we have a better story as a state, and we have great people that live here. Um I'm just I know that it will be good.

SPEAKER_00

Oh, 100%. And like I tell I'm telling you, that we do have amazing physicians. I know this. My colleagues are all amazing. Every physician I've met has been amazing. We just need to do better with having us at the table at these conversations. Um, I know there's a lot of physician leaders in this state that are doing the best they can. Uh, I would like for more of us to be in alignment with them as well, uh, especially those of us that are not employed, that are private practice. I think our stories need to be told as well. Uh the concierge docs, the DPC docs, um, the direct specialty docs, we all need to be a part of that conversation that is had because it's more than just the hospitals and the insurance groups and you know all of that. We need to also be a part of that conversation because it's not I'm not complaining. I'm saying there's answers. We have solutions. And there's a lot of smart minds that want to figure out. Right, exactly. That's the good exactly, yes, exactly. So not only are we taking care of you guys, we can actually answer some of the problems that we have. Because I think in the past it's always been don't bother the doctors because they're there's, you know, there's not enough of them and they have to see patients and all. Yeah, we can do that, but some of us actually listen with direct primary care. My quality of life, also, by the way, is 100%. That's the other thing. Quality of life for us, I think, is just as important as quality of life for you, because now my quality of life is good. I give you that quality of life as well, too. But my quality of life is so good that I actually have time now to try to help and make things better. So that's the that's the other conversation is that don't assume that we're all just wanting to see patients all the time. Yes, a lot of us do, but with different types of practices like direct primary care, we actually do have the time to be more involved. Yeah.

SPEAKER_01

Yeah, no, that's exciting. Yeah. Well, thank you so much, Dr. Hikimi, for actually being here and talking about your business. Vegas direct primary care, such a cool concept. And I hope that we see more information about these popping up and then sharing this story and just making sure that people educate themselves on the options that exist here. Because it sounds like there are a lot of different options. It just takes a little bit of digging and understanding to figure it out.

SPEAKER_00

Absolutely. Yeah, and if your listeners ever want any, you know, advice or navigation or anything, they can they can reach out to me as well. This honestly, my onus in this life, I said, is about making a difference. It's not really about making money. I'm blessed and grateful to be where I am. So and you can find me online, Vegas Direct Primary Care. That's literally my phone number. And everybody thinks I'm crazy, but no, when people have peace of mind, they have their doctor's number in their phones. They're very respectful. So I'm happy to help. That's great.

SPEAKER_01

Thank you so much. And thank you for tuning in today on Through the Door, the Insider's Perspective on Running a Business. I hope you enjoyed the show.