Shadow Me Next!

7 - How Direct Primary Care is Changing the Face of Medicine, an interview with a Family Medicine Nurse Practitioner | Leah White, APRN

• Ashley Love • Season 1 • Episode 7

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In this engaging episode, I sit down with Leah White, a dedicated family medicine nurse practitioner at Celebrate Primary Care in Gainesville, Florida. Leah walks us through her fascinating journey in healthcare, sharing how her initial dreams of becoming a doctor were reshaped after an encounter with the formidable challenge of organic chemistry. Rather than deterred, Leah found her path in nursing, where she embraced roles as a health educator and critical care nurse. Her story is one of resilience and adaptability, guided by insightful mentors and a passion for the transformative direct primary care (DPC) model.

Leah opens up about the delicate balancing act of pursuing advanced nursing education while managing the demands of work and family life. She offers a unique perspective on the flexibility of nurse practitioner programs and the importance of blending theoretical learning with hands-on experience, particularly in critical care settings. As we explore the financial and organizational aspects of further education, Leah provides valuable advice for those navigating similar challenges, sharing her thoughts on managing costs and commitments without losing sight of one's goals.

In a model that emphasizes personalized patient care, Leah's role in direct primary care allows her to build lasting relationships with her patients. Her experiences highlight how DPC empowers practitioners to offer tailored health care through flexible scheduling and attentive communication. From hour-long appointments to weekend accessibility, Leah's approach ensures comprehensive care that resonates with her patients and builds trust. Tune in to discover how passion and dedication drive Leah’s work, and how the DPC model is reshaping the future of healthcare for both providers and patients alike.

To learn more about Leah and Celebrate Primary Care, a direct primary care medical practice serving businesses and individuals in Gainesville, Florida, visit their website: https://www.celebrateprimarycare.com/

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Ashley:

Hello and welcome to Shadow Me Next, a podcast where I take you into and behind the scenes of the medical world to provide you with a deeper understanding of the human side of medicine. I'm Ashley, a physician assistant and the creator of Shadow Me Next. It's my goal to introduce you to incredible members of the healthcare field and uncover their unique stories, the joys and challenges they face and what drives them in their careers. It's access you want and stories you need, whether you're a pre-med student or simply curious about the healthcare field. I invite you to join me as we take a conversational and personal look into the lives and minds of leaders in medicine. I don't want you to miss a single one of these conversations, so make sure that you subscribe to this podcast, which will automatically notify you when new episodes are dropped, and follow us on Instagram and Facebook at Shadow Me Next, where I'll give you sneak previews of our upcoming guests.

Ashley:

Welcome back to this episode of Shadow Me Next. Today we talk to Leah White, a family medicine nurse practitioner at Celebrate Primary Care in Gainesville, florida. Leah dives into the direct primary care model, explaining its benefits over traditional primary care and the deep, lasting relationships she builds with her patients. She shares her journey into healthcare, the challenges she faced and the fulfillment she finds in her role. This episode is packed with great insights into the DPC model. Hi Leah, thank you so much for joining me on Shadow Me Next. How are you doing today? I'm great Thanks for having me Fantastic. So, before we get started, would you mind giving us a little introduction to yourself? Where do you work? What is your job? What's your profession? Could you mind giving us a little introduction to yourself.

Leah:

Where do you work? What is your job? What's your profession? All right, I am a family nurse practitioner with Celebrate Primary Care in Gainesville, Florida. We are a direct primary care practice which is a very different model than traditional primary care and I think we'll probably get into that. I've been with the practice.

Ashley:

In January It'll be six years and then, before that, I was a nurse at UF Health, also in Gainesville. That's great. I am so excited to talk to you about direct primary care. It has such amazing qualities that people might not be very familiar with, something that I definitely see becoming more and more popular in the coming years in medicine. So thank you so much for joining us and being on the show with us. Can you tell me a little bit about your journey into healthcare? What initially inspired you to pursue a career in nursing?

Leah:

All right. Well, it's kind of a long journey. So when I started at UF in 2004, after I graduated from school in Gainesville, I was pre-med, as were many of my other IB you know students that were. They went to school with me and I decided when I took 16 credit hours of organic chemistry plus other classes, that I would did not want to pass organic chemistry because I didn't think that I could, and so I dropped that class and I said what else can I do in healthcare that would also be fulfilling with not becoming a doctor? So then I thought about physical therapy, because I had torn both my ACLs playing sports and I knew a lot about physical therapy. I ended college with a degree in health education, knowing that I would really like that, with the idea of going on to graduate school and doing potentially physical therapy. I took all enough classes to have all of the kind of pre-coursework for whatever would come next.

Leah:

I worked as a health educator in Daytona at the health department and I met a nurse who said you should become a nurse and I said I think I should become a nurse. So I went to nursing school. I went to UCF in Daytona, I loved it and I figured I would use my health education background. I'd have an RN behind my name and I would be a health educator that had a lot more credentials. And I became a real glorified nurse. I was in critical care doing all of the nursing things.

Leah:

I had my son and I was talking to him from France in P school and they said you should go into P school. So I decided to become a nurse practitioner. Once I made my mind up, I talked to my family about it and decided to find a program that would start within the next six months or so. So I did all of the background that I needed and I got into a program. I worked and went to any P school. After that I got lucky and found this awesome job and it's all come into place. I always wanted to work in healthcare because I can remember as a little kid saying, oh, I want to be a doctor when I grow up. It was helping people, it was using my brain, it was communicating. It was all of the things that I liked to do, continuing to research and grow in a profession, and so to me as a little person, that was a doctor. And then now I see kind of like what you're talking about on your podcast, but it could be so many different things in this space.

Ashley:

Absolutely, and I'm so grateful that you were just so honest about your approach into medicine, because I think oftentimes when we see our providers we think they must have known they wanted to be a blank from the very beginning and often the people I've spoken with I've realized that's not the case. We have this journey. We all end up going on somehow, and sometimes the journey is shaped by our own realization 16 credit hours of a class that we might not want to do, thinking about how extensive medical school residency, et cetera, is Some of those things we can make for ourselves, some of those decisions. But I think a lot of times we do end up finding accidental mentors throughout the process. For example, as a health educator, we see a nurse in action and we say you know what that does sound like, something I want to do. So I thank you for sharing that story and about how, when things shift or when things might not look exactly like what you expected, it is absolutely not the end of the road. It's just perhaps a different direction, and there are many directions in medicine, as you've pointed out. Health educator, now that's a really interesting job.

Ashley:

I think you specialized in HIV and STD education. Is that correct. Yes. How did that experience shape your perspective on patient care? Do you employ some of those things in your practice currently?

Leah:

So in talking about HIV and STDs, I was doing presentations in the community. I would do them at a high school, I would do them at a nursing program, I would do them at, like, an assisted living facility. I'm talking to all kinds of people about very personal subjects teaching people how to put condoms on bananas. It was really funny and fun and I'm good at it. I didn't get nervous to talk to people about like very vulnerable topics and I think that having been able to talk with people about that job made me so much more comfortable. I'll have someone come in and they're nervous to talk about. Well, I think I need to be tested. I have heard it all, I have seen it all. You don't have to feel worried about what you're going to say to me. That has provided me a lot of opportunity to have like deeper, more vulnerable conversations with patients that maybe someone who didn't have that experience would be a little more nervous to have.

Leah:

And then the health education side. It was the Lennon-Avery Foundation because kind of a big part of health education is prevention. The idea with prevention is you put all of your you know eggs into that basket. Help with long-term you know benefits for patients, and I find that the mirroring of that and primary care makes perfect sense. In primary care, we focus a lot on prevention. That's always the goal. Care makes perfect sense. In primary care, we focus a lot on prevention. That's always the goal. And we also have to do a lot of educating the patients. I spend a big part of my time summarizing things for people. They'll go to the ER, get discharged and they're like they told me to do this, but I don't know why I'm able to sit down with them and say here's what they think you have, here's why we need to see the specialist and how we're going to go about doing that. I can navigate systems, because I'm much more familiar with that, explaining how things work and why things work from a more education standpoint.

Ashley:

Being able to have those conversations with patients both ways is incredible and I think those vulnerable conversations, those really deep, vulnerable conversations, having those conversations comes with experience, getting comfortable having those conversations. It all comes from experience. I don't know many people that haven't experienced having a conversation about STDs, cancer, mental health or organic brain disease. I don't know many people that can just step into the room and have that conversation comfortably and be incredibly empathetic at the same time. You know so. I think that an experience that you've had in health education really, really helped with that and then that goes both ways right. So when patients can be vulnerable with you about their concerns, they're willing to accept the conversations that you have with them about patient education right, and I think that's really where that information highway really takes off.

Leah:

Yeah, I think so much of our background, whether it's professional or personal, really impacts our ability to have that interaction.

Leah:

So many people get into medicine or health care because they have a family history right, you know they might have.

Leah:

They've had someone who's gone through something like with me thinking I wanted to be a PT because I've done a lot of physical therapy so that I could go back and play soccer when I was in high school my dad died of dementia that I could go back and play soccer. When I was in high school my dad died of dementia, so I wouldn't want to work in that field because it is too like. I mean, I have patients and I can do it, but it wouldn't be the only thing I would want to do because it hits so close to home and I think that you learn that as you're in school, as you have mentors, as you experience life that's outside of work as well as like in work to really see, like, what you're good at as well as what you might say I don't. I don't want to do that. I don't think I would want to do hospice because I've been there with my dad and that's okay, because there are other people who are amazing at it.

Ashley:

I think that's so true. I think that we are shaped by our experiences and experiences period good experiences, bad experiences, neutral experiences. It is what makes us fantastic providers and I would imagine it also allows you to step into that empathetic role when you have a patient struggling with a family member who's having a similar experience that you had. I think that is such a strength we have as providers and it's one of the reasons why I firmly believe that we need to maintain our identity as people and allow that to support us as practitioners, as providers. I think that's so important. Shifting gears a little Leah, let's talk about your experience in nursing school. Sometimes this brings a lot of poor memories back for people, a little bit of PTSD, but for you, what was the most challenging part of nursing school? Whether it was getting your RN or when you became a nurse practitioner?

Leah:

So my nursing school experience as well as my nurse practitioner school experience were very different than undergrad. Undergrad was classic undergrad. We won four national championships. It was all about friends and enjoying all of that.

Leah:

By the time I was in nursing school to become a nurse, I was in my mid-20s and married and living in a different town, and so school was my focus. It was absolutely what I was saying. I was going to get good grades, but I also knew that if I'm going to learn this, I'm going to have to know it forever. This isn't something that you just cram for a test and then it goes away, because I knew that knowing the impacts of high potassium could be something I have to know to help save someone down the road. So that was a lot different than going to undergrad courses that you just take and pass or do decently well on. For me, that was the challenge finding the way to make sure that I was prioritizing it, I was learning it and I really took it very seriously, which I thought was good because I did. I would talk when I was a nurse like, oh yeah, I remember learning this. They're like you remember that from nursing school? Like, yeah, I learned it. I really wanted to make sure that I had that experience. And then within P-School I was using it at the same time, so that was neat. So and then with NP school, I was using it at the same time, so that was neat.

Leah:

So I was working as a nurse in critical care, so like more of like medicine side, and then I was a nurse in the PACU, which is more surgical side. So everything I was learning I was able to contextualize while I was working, which I thought was neat, because in nursing school you learn it, but you don't see it until you do clinical. But once you're already a nurse and you're in nursing school, you learn it, but you don't see it until you do clinicals. But once you're already a nurse and you're in NP school, you've seen it. But then you're getting even deeper into the understanding and I could say, oh, so this person is having this type of surgery. This is where they started and this is how they're here. I understand this step-by-step process. What got them to this place? It was hard because I had a kid. I got pregnant with my second.

Ashley:

I had a family.

Leah:

I was working full time so I was really pushing through. But it was a different kind of challenge than undergrad versus nursing school versus NP school. But overall I had an amazing experience. I think the clinical experiences, because it really showed me what it was to be in this role, and the same thing with my nursing experience. I was in a smaller program so we got to be in the ICU for a month. We got to do all of this really cool nursing that wasn't as typical with students in a town that has more people.

Ashley:

Thanks for breaking all of that down and for really comparing everything because I think comparisons is so important. Really comparing everything because I think comparisons is so important.

Leah:

So when you were in in peace school, you were able to continue working as a nurse as well. They coincided, yes, so I was working as a nurse. I was doing three, 12 that I did part-time in people. I don't remember my timeline. I don't remember if I went to part-time, all I did clinicals or not. That was something that I could do in addition, you know, and it could be as fast or as slow as I needed it to be, which was really helpful. Instead of completely taking off and being a hundred percent a student, I was able to find that balance of working, studying and doing clinicals.

Ashley:

Do you think that is a similar story to all the other nurse practitioners in the world, or have you found that the road to nurse practitioners varied?

Leah:

I think it's varied. A lot of people switch to part-time once they're in their clinical experience so they can have more availability. Because you want to go to a preceptor and say I'm here whenever you will have me. But if you say I work Monday, tuesday, wednesday, I have to come on Thursday and Friday. That might not be something that goes over well. So I do think there's a lot of switching to either a weekend schedule or having a PRN job or your schedule based on your availability, instead of having something set by your management. I see that with a lot of students that I take as well.

Ashley:

Very cool. I think that will appeal to many people the flexibility of that education. I'm really glad you shared that.

Leah:

Thank you, I think the big reason why that is is just the cost of school. If I could have gone to school and not worked and afforded my life, great. I think it ends up being a symptom of the extensive cost of paying for higher education, but that's a whole different podcast.

Ashley:

Oh my gosh, you're so right, that could be a whole different podcast itself. The cost of education has to be considered and I think some people forget that. Thank you for bringing that up. That's a big deal. That's a perfect segue to our quality questions. This is a segment where I asked if you have ever heard of a question, an interview question, whether you ask it or it has been asked of you. That has really just stuck out in your memory. Do you have one of those?

Leah:

Yes, I do, so what? I like to ask people that we're hiring specifically, like a nurse, practitioner or an MD that we're bringing on, I like to ask them if I were to look at their computer right now, how many tabs would they have open on their browser? What?

Ashley:

a great question.

Leah:

You know it shows us about multitasking. It shows us about how different types of personalities, as well as different brains kind of work.

Ashley:

I'm trying to count the number of tabs I have open right now on my screen and there's so little and close together. I can't do it. I mean I can't do it. So if that tells you anything, what a great question. I might have to swipe that one from you. That's a, or how many in my case. How many windows do you have open on your phone in your internet browser, right, good grief? So, leah, let's jump into a day in your life. We've talked about how you got to where you are now as a practicing nurse practitioner.

Leah:

What, does Now as a practicing nurse practitioner, what does a typical day look like for you at Celebrate Primary Care? Celebrate Primary Care, we do family medicine. We have newborns all the way to 99 plus. We are what's called a direct primary care and that's like people call it a DTC, and what that means is my patients have direct access to me as their provider 24-7. Obviously, I sleep. I tell them 2 am is an emergency, not necessarily a primary care concern, but they really do have access, and so my day in the office does start at 8 or 9, kind of depending on the schedule, but my day can be varied. We have in-person appointments and then we also are answering text messages and reviewing labs, looking at orders and things throughout the day. So in DPC and our practice, celebrate, we typically have hour-long appointments for our patients. We're able to get to know them, we're able to really spend that quality time.

Leah:

For, like those vulnerable conversations I hear so often in the primary care space, there's an importance on how many you see in order to like make enough money to function. You get like one or two problems With mine. We can talk about whatever they need, and are there times where I see an ear and it takes five minutes. Sure, are there times where it's supposed to just be a sore ankle and we end up talking about their mental health Absolutely, and so I think that that's what varies a little bit about what we do. But in primary care, we cover all the things you know, anything that you can think of we cover, and then I potentially end up referring to specialists or imaging throughout my day.

Ashley:

I'm so excited that we have finally gotten to this part of this podcast, because this is what I've been waiting for. It's such an incredible idea that is now an incredible practice in medicine. I am sure that your patients are so grateful for it. Can you describe the relationships that you build with your patients using this DPC model as compared to, maybe, what somebody else might have in a non-DPC model?

Leah:

Yeah. So patients pay a low monthly membership and that means they get direct access to me. They either sign up online or we have a lot of small businesses that offer us as a benefit to their employees. We do what's called the established care appointment. It's like an hour-long appointment where I find out their medical history. If they have any concerns that they want to go over, we get caught up on like when were your last labs? Who have you had as a primary? Do you have any specialists that you see? And we really get that like overall kind of picture.

Leah:

I also, at that patient appointment, have the opportunity to talk about, like how's your diet, how's your sleep, do you exercise, do you smoke? What does this look like? I provide them all my information and then we slowly check off the boxes. If someone says I need to get caught up on my colonoscopy and mammogram, we'll prioritize what comes next. The way that we build this relationship is I'm then available. You know, if they have a follow-up question, they can text me. If they get the sniffles the next day or their ear hurts, or they have a follow-up question, they can text me If they get the sniffles the next day or their ear hurts or they have a history of asthma and all of a sudden they're having exacerbation.

Leah:

They text me directly. They don't call the office, make an appointment, get in the room and then go over what's happening. They just go straight to me and if I need to see them same day, next day, I do. If I can do something remotely. I also do A lot of opportunity for answering questions that otherwise they would wait. As well as providing that reassurance that someone is there, because so often people feel lost and scared, I try to say hey, text me if you have a question, I'm here for it. That's what you pay me for, and people are receptive to it. They feel confident that they know that in a couple of hours, sometimes in a couple of minutes, they're going to get a response from a trusted medical professional, not just going on Google and thinking, okay, it's doomsday, I have this thing that I've decided is way bigger than it actually is.

Ashley:

Accessibility is huge. I mean, that's what that's this whole podcast as well right, and I think to have that kind of accessibility to your healthcare provider is something that most patients think is unrealistic. They think it's a dream, a pretend idea, and it's your everyday life.

Leah:

Right, I always joke. I say my favorite thing about my job is like a UTI on a Saturday and it sounds so silly. But I can really make someone's life so much better by just saying, okay, let's handle this, let's get you taken care of.

Ashley:

You absolutely can make somebody stay better on a Saturday who has a UTI? How do you define success in this role, under this model? What does a successful day look like to you?

Leah:

Well, it's getting everything done, which doesn't always happen because there's a lot of moving pieces between seeing patients in person, making sure I'm responding to all of the messages I receive, accomplishing all of the tasks that are sent to me through the front office. So that's going to be reviewing labs, filling medications, sometimes following up with patients who have reached out to the front office instead of directly. That's a successful day. But for me personally, when do I feel fulfilled? Is when maybe I get a diagnosis thought on easily and someone's going to get better, like strep throat. I'm like I love it. Look at me, you have this, we can fix it, problem solved. That's what fulfills me.

Leah:

But then I also get messages where people say thank you so much, I didn't know that this was possible, or I appreciate you being here. I sometimes forget what I do and I talk to my colleagues about this. Healthcare is hard and you are there for, like, the deepest, darkest for people, and to have those little sweet messages sometimes it's enough to go okay, we can do this again tomorrow. It can be a lot to be somebody's person all the time.

Ashley:

It can be a lot, and I'm sure that there are times when it probably feels overwhelming to you. How do you stay motivated and inspired in those moments when perhaps you didn't get everything done throughout the day? Or maybe someone presents with a very complicated problem and they're cranky about it because they're scared or hurt?

Leah:

Yeah, and I was thinking about this. You know, as far as you'd ask kind of the why and how you don't get burned out, because that's a big common theme in healthcare right now. And I think, besides the fact that patients have that access to me, I think one of the benefits of direct primary care for the provider is that we have balance. And so, say, my kid has a play, I can block my schedule. Will I get a text during it? Maybe If it's important, will I text them back Absolutely, but it gives me this flexibility that I have learned to find that balance. Will I get a text during it? Maybe, if it's important, will I text them back Absolutely, but it gives me this flexibility that I have learned to find that balance. So I have answered people when I'm at Disney World with my kids, there are times where it's like well, that's kind of intrusive, I'm like what I get to be here? I can easily find this balance between the two and I think that really helps me personally not feel that burnout as far as what to do when we have complex things.

Leah:

I have built a relationship with a lot of people. I've been doing this long enough that my colleagues make fun of me because I'll meet someone in a specialty and I'll be like, hey, can I save you a number? I mean I've done it with you. I'm like, okay, durham person Got it, good to know I can text. This is what I'm thinking. Can I refer them to you? Do you have space for it? And we can make that connection when people are so busy and traditional practices that they can take the time to get people where they need to go. And that's been something that I find so fulfilling, because I've got a cardiologist that I can get them to, or an ENT or urgent MRIs, so that we know they're going to get where they need to go without saying, oh sorry, go to the ER, even though this isn't an emergency.

Ashley:

We always talk about how medicine is a network, always a collaborative environment, etc. And I think that the DPC model really highlights that in the best way possible. You have formed your own network of people that you trust will answer you quickly with good medical knowledge. That's the network we're talking about.

Leah:

I know they're going to take good care of my people because I provide a good service and I want to know that I'm referring them somewhere, that they're not going to just be a number, they're going to be a person and someone who is going through something.

Ashley:

Leah for our final question. What advice would you give to someone who is going through something? Leah for our final question. What advice would you give to someone who is considering a career in medicine? Run?

Leah:

No, I'm just kidding. So honestly, for me I think it's just been kind of let things kind of take you in the right direction. I don't think necessarily you can be completely handoff and just expect the universe to move you, but don't be stuck in an idea that you don't see everything else is going along. I could still be doing what I was doing 10 plus years ago if I wouldn't have said let's see how this goes, let's see where this can take me. People have to remember to prioritize what's important. In healthcare. We can get stuck in a space of work and work we have to do better for ourselves. We saw that during COVID so much burnout, so many people who didn't feel like they were appreciated for what they were doing in our country. I think that it really highlighted this is a hard job, this is a hard profession to be in when it comes to healthcare and we need to look out for each other.

Ashley:

Absolutely. That's such great advice, leah. Thank you so much for joining me today on Shadow Me. Next, I am so glad that we were able to talk about the DPC model. It's incredible, I'm so hopeful for it and I'm so glad that we were able to talk about the DPC model. It's incredible, I'm so hopeful for it and I'm so glad that you broke it down for us.

Leah:

Yeah, absolutely. I'm so glad I was able to come on here. I look forward to listening for your other guests. I think it's such a cool thing for people to just hear, like, what do you do? What does it look like? Because I mean, to be honest, I didn't know what the real nurse did until I was in nursing school.

Ashley:

It's amazing the inner workings of all of these professions. It's been so fun to talk to people who do it every single day, all day, and people who are passionate about it. You know, I'm still waiting for the interview that we have to do anonymously because that medical provider is disenchanted with what they do. Maybe we'll be doing this three years from now and I'll still be waiting, but most people are so proud of their role in medicine and it shows. I love your work. I love what you do. Thank you so very much for listening to this episode of Shadow Me Next. If you liked this episode or if you think it could be useful for a friend, please subscribe and invite them to join us next Monday, as always. If you have any questions, let me know on Facebook or Instagram Access. You want stories you need? You're always invited to shadow me next.

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Ashley Love

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