How Direct Primary Care Changed the Way I Practice Medicine

In this episode of Patients Win, Dr. Jonathan Bushman sits down with longtime friend, colleague, and next-door clinic neighbor Dr. Charles Jantzen for an honest conversation about resilience, burnout, and rediscovering joy in medicine. The two reflect on their journeys from the early days of medical school and rural residency in Enid, Oklahoma, through the challenges of changing healthcare systems, administrative frustrations, and personal struggles that led both to question their place in the profession.

From the camaraderie and hands-on learning of rural medicine, to the painful closure of their residency program and the impact of corporate changes on their daily work, Dr. Jantzen and Dr. Bushman share candidly about what led them to the brink of leaving medicine and what brought them back. Together, they explore the difficult emotions around quitting, the importance of peer support, and how finding new models like direct primary care has helped them reclaim satisfaction and patient connection in their work.

Whether you’re a physician feeling the weight of burnout or a patient curious about what your doctor faces behind the scenes, this episode is a powerful reminder that taking care of ourselves is often the first step to making sure that patients win.

Timestamps:

00:00 Early days in medical school

09:40 Reflecting on a mountain hike

13:21 Residency program closure frustration

18:20 Leaving the Hospital for the Clinic

24:06 Challenges with medical scheduling

28:40 Discussion on Physician Economic Impact

36:19 Clinic relocation and budget concerns

40:00 Leaving the job and notifying patients

47:53 Changes in medical clinic culture

53:36 Joining Owasso Urgent Care Team

58:58 Reflecting on a breakthrough moment

01:03:24 Finding joy in medicine again

Show Website - https://thepatientswin.com/

Primed Healthcare - https://primedhealthcare.com/

Troy Reichert - Show Host - LinkedIn - https://www.linkedin.com/in/troy-reichert-67606b5/

Dr. Jonathan Bushman - Show Host - LinkedIn - https://www.linkedin.com/in/jonathan-bushman-do-106821191

Media Partner - TopHealth - https://tophealth.care/

“Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”

Transcript

SPEAKER_03 0:00

We're the only two rats left on the ship and I ain't gonna make it. Then I turned my notice in and started telling patients I wasn't gonna be there any longer. So I went from several months of breaking down in the parking lot when you pull up in the morning because you don't want to go in, to breaking down in the room with patients for three months. The hardest part of quitting was telling everybody I was quitting.

SPEAKER_00 0:18

You didn't fail medicine. Medicine failed you. You made the boldest step you ever could to step away from something that was breaking you and finding your joy again in the profession that you love. I'm Jonathan Bushman, physician, DPC physician and benefits broker. And today is a special opportunity that I have to uh host a good friend, a longtime colleague, and um literally next door neighbor in the clinic, Dr. Chuck Jansen. Dr. Jansen, thanks for joining us today. Yeah.

unknown 1:09

You're welcome, man.

SPEAKER_00 1:10

Been a long time coming. It's been a really long time coming. And I was actually uh thinking about some of our first times to have met. Uh I believe I was a senior resident when you were a fourth-year medical student, um, three years behind me in medical school, but you were rotating uh in Enid, Oklahoma at the residency that I was a part of. And and uh you're a fourth-year medical student. And you know, we we laugh about it now, but really those first uh few experiences you had with me, I I promise I haven't changed. But uh my favorite thing to do was to say something a little bit odd or awkward in the middle of a visit just to see if you picked up on it and see if I could get you to crack, see if I can make you smile.

SPEAKER_03 1:54

And you were very good at it. You could tell you had been practicing for a while.

SPEAKER_00 1:58

There's just certain uh there's certain opportunities you don't want to miss. And uh training medical students and residents, uh uh I've had I've had some of those opportunities and they're they're wonderful. But uh yeah, I think I did I broke you a couple times. It was good.

SPEAKER_03 2:12

Yeah, there's a couple really good ones in there.

SPEAKER_00 2:16

It's very good. Well, Chuck, tell me, um, and I know it's Charles, but we all calls you we all call you Chuck and and and I know it's doctor and doctor, but for the sake of Charles on the scrub, it's Chuck in real life. That's right. That's right. And obviously, um, you know, I'm John to you, and you're Chuck to me, and and that's just the way we work, and and I love that. Um, but I want to I want to go back a little bit um to a time before I had met you. Um tell me a little bit about you know who you are, where you grew up, and and what kind of led you to this world of medicine that you found yourself in.

SPEAKER_03 2:53

Yeah. So I was actually born here in Enid. Um, but my mom's family was uh from around Ada in southeast Oklahoma. So when I was real little, like six months old, we moved down there. So my grandparents um on my mom's side were alive and they helped a lot. So grew up in Lula, America, went to Latta High School, ended up going to OU for one semester. I was actually pursuing electrical engineering at the time. I was supposed to be joining the Air Force and going into remote sensing and geophysics, and um through what many would call an act of God and act of government, I actually got out of that before it started, as the tech school was uh hit by a hurricane. Um, and the government was 25,000 men over the limit. Um, so they let me out before I even started. And so then I had left college. I was back in ADA. Um, I ended up going back to classes there at East Central, and I kind of started back in physics and and everything that I that's really what I enjoyed was the physics part and the math stuff. And over time I ended up switching to more of a dual major in chemistry and biology. Um, and I had zero intentions of ever going to medical school from a summer experience. Um when I was in high school, I did an internship at OU and Pediatrics Genetics and didn't have the best experience. And part of that was my use and um bad decisions, and um and then part of it was just kind of where we were at in that research. And um, some of those academic places are very competitive, the opposite of what I ended up finding at OSU for the medical school. But it was actually um, I don't remember his name right now, it was my histology professor. He was a retired Marine. Um, and I was in his office one day, and he said, Mr. Jansen, you'll be much happier with your life when you decide you're gonna be a doctor. And I literally looked right at him and said, I don't want to be a doctor. Um, and kind of gave him the background on the experiences. And he said, Well don't you go look at the osteopathic school in Tulsa? And I was like, Well, what's that? And then he used a couple choice words of calling me an idiot, um, that my own pediatrician was a DO and that I didn't know what that was. But he handed me a flyer for the Med Extravaganza and ended up traveling to that. It was about a month after that sit-down, and had a wonderful experience there. Um, you know, the whole tour was led by medical students. It was very inviting, accepting, kind of the opposite I had gotten from some of my previous academic um experiences. And I don't tell this story a lot, but I actually had kind of hurt my back. Um literally mopping the floor of a drive-thru convenience store. And they, we were in the OMT lab, and the guy said, I'm looking for volunteers, and I said, I'll do it. And just with me sitting there, he came up behind me, put his finger in my back, and said, I bet you hurt right here. And I said, Whatever this black magic is, I'm in. And that's literally the moment I was like, you know, I'd just from that experience and um decided that I would go ahead and apply. Um, I didn't initially plan to apply the year I did, and it was actually the intervention of another um college professor that made me go ahead and apply. So I got in a year earlier than I thought. Um thoroughly enjoyed Tulsa and uh the medical school. I was one of the first rule track students. Um they had the original rule tract, which was you know, basically just extra rotations out, and we did uh rule core, and so I literally only did three months of actual medical school rotations in Tulsa, and everything else was Bristow and Durant and ADA, and obviously ended up coming here to Enid, um, which had its own set of events that had to happen. Uh we laugh all the time about the EMRs. It was actually the doctor I was supposed to be with in an ADA uh for my rural rotation. Uh he was getting put on a new EMR and he told me he didn't want me to come. And so last minute, Dr. Jones here in Enid was the one that could make it happen. So that's how I ended up here for the first rotation. And obviously, after meeting all the residents here and um hanging out with Dr. Jones, it was it was about a weekend. I was like, yeah, this is probably where I want to end up. So I mean, pre-med school, I wanted to be a radiologist and because it was the physics background stuff. Um, but then I realized you sit in a dark room a lot. Um, and with the ADD, family practice worked out very well. Um, something different in every room. And um, so that's kind of how I ended up in medicine. A lot of very important people made very specific statements along the way to get me there. Um, so I've been very fortunate to this point and very happy with where we're at now.

SPEAKER_00 8:12

Yeah. Yeah, that's gosh, we've known each other for over a decade. You just told me things I haven't heard before. So that's great. Um and you know, I I I recall um when you did your audition rotation with Dr. Jones. I even remember at the time, um, number one, we had fun. Uh we we were having fun all the time in residency, but um but I but I remember you being just extremely um excited, um invigorated with the learning experience. You were um, and I still call you this to this day, but you're you're you're a digger, you know. It's like uh you're like a dog with a bone, you're gonna figure it out, you know? And I and I love that about you, and that's something I saw as a fourth year medical student. I think it became very clear to us, or particularly me as a senior resident, we're looking to see who's gonna fill this next class. I'm like, this is the kind of student that we want. You show up early, stay late, you're always looking for the answers, um, you're having fun, and and you can see the joy of learning. And and that's honestly, that's what it takes. I mean, you have to have hard work and the joy of learning. I mean, that's really what it is, right? And um, and what you what you said about these multiple people and multiple instances in your past that um helped all lead to this place, you you look back, and sometimes it takes five, ten, fifteen years to recognize how influential one single conversation or one lunch actually was with an individual to get you where you are that day. And it's um it's a it's a great exercise in gratitude, but it's also just that um the recognition of where you've been. And uh I had the opportunity last week to hike a 14er, and uh, you know, yes, I was out of breath, and no, I wasn't in my best shape. Uh, but I did it with my son, and you know, um we've we've we've climbed the figurative mountain together over the years, and to sit on top of a literal mountain together and realize you look back. And now granted, this is only like you know, two hours, but you look back at that track that got you to where you are and like, wow, that's incredible. Look at the view from here. And uh I love that story of of of the various different people and nuances of things that had to happen. Um tell me a little bit about so so you made the you made the move to Enid. Um and tell me a little bit about your residency experience and um and either th the either the fulfillment that it brought to you or the or the recognition that you had about medicine during residency.

SPEAKER_03 10:47

Yeah, residency was very interesting because you know, back then in Enid with our health system, I mean, we had everything. Cardiothoracics, we were doing, we could do valves, we'd do lots of hard stuff, we had multiple neurosurgeons, I mean the pulmonologist. Um one of the big influences of coming to Enid was if you're gonna do a rural residency and you're gonna learn how to do that, and what the choices I had, we we had the most services. Plus, you know, meshing with um the residents and Dr. Jones and Dr. Glen Dinning and and all those things. And um so the beginning of residency was very was very fun, um, spending time with Dr. Shaw um in my very first couple months, and you got to do a lot. I mean a lot. And that was always the idea with the rural residency is when you're on a service, you're it. When you're on ortho, you're the guy. Um even as a medical student into residency, there's not many places you could see somebody in the ER. They would let you go upstairs with them to surgery and then end up seeing them after surgery, um, just passing by, and then later establish them as a patient when you started residency. And I actually um I still have one of those that's uh followed me to this point. Um and I I love the residency. Um everybody knows I did. Um, and things were growing, um, and it was awesome, and we had awesome residents, and um you know, most people know that the residency here ended up getting closed, and I was in the final group that um graduated. And you know that one of the things that I know that part of this whole thing is things that lead to grinding you down. And I think the first thing that started grinding me down was when when the residency got closed. Um it was very ominous to to be in a room um with everybody and told the same day, hey, we all got this meeting, and there's people from Oklahoma City coming, and I'll never forget Dr. Patskowski walking in the room, and he just he had his head just tucked down, like just beaten. And I pushed my chair back a little bit and I said, We're done. This whole place is done. And everybody just kind of looked at me, and sure enough, that's when they came in and told us that um they'd be closing the residency. Um and then, you know, I was really upset, not only because of that, because of how it affects our whole region, but it's like your residency mates, you know, everybody that wasn't a third year had to find a new place to go. We had just matched a whole we just went through the match. We had, I think it was five people coming in. And I can't imagine being those those people coming in and going, oh, great, I just got called at that residency that, you know, I picked in this match process to be ranked wherever it was, they're gone. So now you're you're scrambling. And it was very frustrating because five out of the I think it was five out of the last seven uh people that graduate ended up working for the um the institution that closed the residency. And so it never really made sense to me. Um but that was the first thing that really really got me frustrated with um corporate dynamics and and different things. That was a wild time. You know, we we had all these different things going. We had just done we went to Epic like a few months before that. ICD 10 came out at like the same time. Residency closes, started new practice. It was just it was a very, very wild time. Um as far as the residency goes, I I'm still bitter, and I I am. I just I just see the things that have happened sequentially after that that could have been very different as far as serving our area. Um and I would have loved for some of those people that ended up leaving to find a new place to still be here with us in town because the potential for some of them to have started practice and so I I don't think about it as much as I did, but you know, it has been a while. It's been 10 years since I happened. So um, but still not fun.

SPEAKER_00 15:17

Yeah. Man, uh you know, I hadn't even really necessarily put the pieces together like you did, just there for me. Uh, but that era of time, uh even on my personal level, uh once you mentioned what you just did, it reminded me. December 2015, we went to Epic. February of 2016, both my nurses went out on maternity leave. Don't get any bad ideas, audience. Okay, that's totally both my nurses went out on maternity leave within nine days, and I had Phil in help. I move in to a new house in mid-March that'd been working on for a year, and two months later my divorce begins. And uh, you know, this this show and this conversation, it that's not what this is for, me going into that. But I think it I would be amiss to personally, but also for you during that time frame to understand what was going on, both in our professional and personal lives. Uh, it was a lot. There was a lot going on. And then you had already signed to join the same practice that I was in, yeah, along with one of your resident cohorts. And so, you know, here we are, mid-March, the close of the residency, and you've got a report to duty for your, you know, next several years with the same institution. And quite frankly, I was excited to have you, but you know, on the on the brink of what had just happened with the residency, it was like this just poor taste in your mouth, you know. And uh meanwhile, while I should be that senior resident mentor or friend that's down the hall, that's got everything to give to help you make that transition. I'm sitting here in my own my own sense of grief and uh and uh gosh, what a what a mess. And yeah, 10 years ago, this is just crazy. But let's go through um, you know, we were each going through our own battles, again, both professionally and personally. And um, you know, take me through those first, you know, two or three years in practice, you know, um, I've I've mentioned this to students all the time. Every every time I have a student, I mention to them, you know, if you go into family medicine or primary care specialty, you're minimum seven years into constant change, right? And specifically the last five years, you've changed every single month. Your schedule, the people you're working with, the people you're seeing, the type of work that you're doing, it changes constantly. And then you commit to a three or four-year plan of being in the same same office with the same people and seeing the same panel of patients doing the same sorts of things. It's a massive change anyway. But tell me a little bit about those first couple years and what what kind of struck you as the biggest difference getting out of the training.

SPEAKER_03 18:09

So for me, the biggest change was, you know, we we all just did clinic. You know, we didn't do hospital anymore. Um I personally always struggled with leaving the hospital at the hospital.

SPEAKER_01 18:20

Uh-huh.

SPEAKER_03 18:20

So even when I wasn't there, I'd spent way too much time Stockton labs and thinking in what did I miss and what did I do? And um even Dr. Shaw during residency when I went through my divorce, um, she called me out one day and said, You you can't hide from life in the hospital because I was there at like four on the afternoon for no reason. Um But no, it was very it was hard to give up the hospital. Um coming into the clinic there, you know, uh Dr. Gibson came and I came and and Dwayne retired at the same time. Um that was way harder than I thought it was gonna be. Um I I had a lot of patients that some jokingly and some not so jokingly, um said that they only stayed to be with me because I was a Dr. Jansen, even though it's spelled different, so they didn't have to learn a new name. Um, and I I heard a lot of, well, Dr. Jansen didn't do it that way, Dr. Jansen didn't do it that way. Um so I think I spent the first six months to a year um trying um to continue to be myself and the way that I looked at things and you know, when you assume patients, you don't when you you you also don't want to change everything for them or say, hey, I don't agree with what we're doing, as um Dwayne was a great physician, and you know as generations pass and training's different. I mean, we we all just do stuff different. I mean, even me and you being a couple years different. I mean, things are different, and then we see the students coming through. And so you're trying to balance a this new life, clinic only, new hospital, um, tons of new people, um, changes in life, but overall it was great. I mean, what there was like fourteen of us in the clinic between the front staff and the back staff and everything, I think there was fourteen.

SPEAKER_01 20:17

Mm-hmm.

SPEAKER_03 20:17

But it was hectic and it was it was kind of wild. And then the other things that fed off of that was the um exodus of others. As you know, I I sat in the office of a previous administrator and I had said that, you know, if things don't change, there's gonna be a mass exodus, and he actually laughed at me. Um and all that came true. Um and so there was a mass exodus kind of with the residency. I mean, think about it, you've you've how many physicians we lost just right there. Um and then a few other people left town, and so I kept not only Dwayne's patients, but it was like, now this doctor left, and it's how many of those can you get in, and this doctor left, and how many of those can you get in? And so those first couple years were were hard. Um and then obviously we get into the um the compensation things and the the time period where um our previous employer started changing a lot of things. And what started is I always like to explain our when I got out of residency and we all started is it it felt like we basically made all the decisions, like who worked up front, how things worked, um, what the flows were, what schedules were, and I mean you were probably the most productive one in the system. And um then this things keep changing, and you know, we we both know certain administrative things that that happened that that led to those changes and those decisions weren't made by us. And you know, by the time by the time I left um there to take my little hiatus from medicine for a while, I didn't even get the Know who was applying or interviewing for front desk positions. And so you just look at how different that got. You know, the patient care part got easier. You get to know people. Um, they don't compare you to their previous person as much. Um, you get more comfortable with people. Um, and that was that part was always not easy, but that was that part was okay because that you see results from that when you when you spend time and effort and brain cells to figure out things and and help with people, and then just slowly as administrative things change to where it makes all those things harder.

SPEAKER_01 22:42

Yeah.

SPEAKER_03 22:43

Can you keep the right staff and you make pay changes and pay scale changes and then certain people leave and you know, you the staff, as we both know well, the staff makes or breaks you 100%. Right. Um and then I don't know. So it was just you know, and then heck, we got into COVID, you know. And you know, you ended up starting this journey for both of us on your own.

SPEAKER_01 23:10

Um about a year out of that, yeah. Yeah.

SPEAKER_03 23:14

But it was inter interesting that you started that and it it wasn't the right time with me because little man was hopefully on the way pretty soon, and then COVID happened, and I mean we've just had a series of events um that have that have really shaped things.

SPEAKER_01 23:30

Mm-hmm.

SPEAKER_00 23:31

Yeah, and before you jump too far ahead, I want to go back a little bit. Um, and I appreciate the how would I say it? Um I appreciate the fact you're not calling out names and and things like that. And and honestly, that's not where our our hearts or minds lie anyway. Like I just know, and and that's a that's a good thing. That means we're in a good place. But do do help me understand, like, give me an example or two of specific changes that were made administratively that changed the dynamic of the way that you looked at your job or or took care of your patients.

SPEAKER_03 24:06

Yeah. Well, one of the biggest first ones was, you know, we did this central scheduling thing. And I was even in residency. And where all these rural patients are used to calling the office and getting one specific person and they know more about them. Are they complicated? Are they, you know, do they call all the time or do they never call? Are they the farmer with the chest pain that's actually willing to come in? Actually, what was funny is I actually had a patient in residency that they scheduled with the residency in Oklahoma City and and told them that I actually didn't practice an Enid. And I don't know if they actually ended up driving to the city to try to see me. But that was frustrating. Um, we had the whole, you know, changes with radiology scheduling, and um one of the biggest ones um just over time was who was in administrative spots that took care of the clinics and made decisions or did things that are not to mention specific scenarios, but it just made really hard to keep good people and keep those good people happy because there were so many pressures, you know, quality metric this, and we gotta see this many people. Um if you don't see enough people, you're not gonna we're gonna have to pull staff or you know, we're floating staff all over the place. We you know, it's keeping those people. And so I I never once complained about my pay when I worked there. That was never a problem to me. Um it was the pressures on how many people to see, the loss of ancillary services that we had over time, whether that was the loss of the LTAC or changes at the hospital, changes with staffing, um, keeping the good people, and just general expectations of um and I didn't even get I can never say I was treated badly. I got upset about some things, and obviously, you know, one of the greatest um moments. Um, but most of it was like just what we did to staff and and scheduling and just making the clinic flow. You know, I'd I'd we just like things to be efficient. This is how you do it. And when you're on the clinical side and you see how things work, um some changes just don't make sense. And when they can't give you an answer of why it makes sense, you go because it doesn't. You don't. We've got people making decisions that don't do this. Um and that's not a local problem, that's a nationwide problem with medicine. But I think those were probably the things that made it the hardest. And just we never got any credit as the clinics. It's like, you know, you go to the National Health Association, they talk about how many dollars one rural family physician brings in or what changes that brings to a town. And we were never we got no credit, you know, um for what we for what we did.

SPEAKER_00 27:07

You know, you were mentioning uh, and I'll bring it up. I'll I'll bring up I'll bring up the specifics of what happened, but uh I'll never forget you and I were in this, I would say fairly small group meeting. And and this is the other thing, you know, we talk about well, let's think big picture here for for physicians and and physicians across the country, uh, and I and I hope many of you listening to this, you've had your own experiences, whether it's a a hospital-based system or a large group or independent group or whatever, whatever it may be, we've all had our experiences of what the doctor's lounge feels like, what that environment is and isn't. Um early in in our in our careers, in our trained careers, we had these phenomenal medical group meetings. I mean, like we were excited to go to medical group meetings. For one, as residents, to be included was kind of cool. Uh two, you know, we were meeting in a in a great place with great food and drinks, and this is our colleagues we get to hang out with for a few hours, and the conversations were generally pretty good. And we saw over the course of time that changed, and and this this particular instance I'm about to reference was actually in the basement or first floor of the hospital in like this like dungeon room. And there's at this point, instead of like 50 or 60 physicians, we have like, I don't know, the 10 that were required to be there. And we literally that night, I don't know if you remember the content that night, but we had a billing specialist come in and describe to us these new codes that we could be using for like transitional care management or something. I something along those lines. But it wasn't even a month before that there was this economic local economic development discussion amongst our found like a foundation meeting about the economic impact, like what you were referencing, where a family physician can bring anywhere from two, three, four million dollars into the gross uh economic you know revenue to a community. And at the end of that meeting, um just so happens that uh there's like three of us physicians standing around at the end speaking to the to the administrator, and and and I don't know how the conversation led to what it did, but I definitely recall when the administrator said, you know, we lose an average of about $150,000 a year per physician that we employ. Now, for the sake of your reputation in the audience, I won't suggest explicitly what you said to her. But it was it was spot on. It was so spot on. Something like, well, you know, you could save a half a million dollars if you just fired the three of us. Something of that nature. Yeah. With a few X3D versions, yeah. Syllables. Uh so and I'm like, you know, she looks at me when you leave and she's like, what was that? And I said, well, very diplomatically, I said, well, I'm just thinking there's a better way to express how valued a physician is to this organization than what you just did by telling us that we were supposed supposedly a financial burden to you. Um but yeah, those those those events, those, those happenings, those conversations, the changes that occur, whether it's and I would agree with you, I was never dissatisfied with my pay. I mean, like that, that was never it wasn't it wasn't that. Now, maybe the method of the way they paid, what they incentivized us in order to get paid, bothered me, but the actual what I took home didn't bother me. My my kind of um, I don't know what you call the event, but like like that that moment in time where I guess you could call it the straw that broke the camel's back for me was when the payment model changed. And it wasn't the dollar that I was concerned about because from a dollar perspective, we're talking a few percentage points. But what happened at the end of that conversation was an administrator recalculated from what they had just presented to me, instead of a bonus, it was going to be a depreciation on my income. Again, not the problem. The problem was about five minutes after that, they had done some little napkin math and said, you know, it looks like if you would see about four more patients per week, just per week, four more patients, um, you'd basically have the same pay. And I remember that was on a phone call. I remember looking up at the local administrator and and I mouthed to him, I said, I'm done. And he just hung his head. He was like, Oh my goodness, I cannot believe that was just said. But I was done because at that point I realized this isn't what I'm here for. I knew that, but then to hear it and feel it and be like, this is not what I'm here for. This is not what I'm here for. And um, that conversation actually came within that same year of everything we were discussing earlier. So it's like, yeah, you know, no wonder you take um one of your highest producers in the system who's like wearing the badge saying, I will do anything I can for this organization to um, I don't believe in this anymore. And once you start not believing in it, you start peeling back the layers of but what is it that I'm I'm not okay with? And if I were gonna make something different, what would it look like? And that's really for me what led me eventually to DPC. I I I think I I spent maybe 30 minutes in a DPC clinic and I said, hmm, okay, it's not a matter about uh of if but when. How am I gonna make this work?

SPEAKER_03 32:28

To feed into what you to feed into what you were just talking about. I mean, as as far as events and timing and things that happen, you know, once you left um to start reliant. Um obviously that was a big change for the clinic, and um but we made it, and it was, you know, for me and everybody there at the time, it was we just that's what we had, and that's what we did. Um when the when Dr. Gibson left, that was the one that really got me because um two top administrators from Ocoma City showed up the next day um asking me what was wrong and you know, not so much what can they do. Um but by the end of the conversation, their response to me was if I'm not happy with the way things are, I should be on more committees. And that was the moment that I knew that I was done. I just didn't know what time frame that was gonna be. And it ended up being way too long, which is part of the issues of getting burnt out and and quitting from a while, was um I was done. And I I knew they did not have our best interest. And so that when you look at the moment like you talked about, that was the moment I knew I was done. But it was it was it was several years later before I was done done. Um just you know, COVID and life and and different things.

SPEAKER_00 33:51

So well, and I'm gonna I'm gonna reference something I don't I haven't brought up to you in a really long time, but to me it's um it's a fundamental piece of of your history, at least my history with you, is um uh probably 2018. This is within the last year of of being in that practice with you. Um I started personally observing certain behaviors or certain things that were done down the hall. Um that I'm like, man, gosh, he is struggling. He is really struggling. And then I had um a patient and friend come to me and say, Hey, uh, you know, I see, I see Dr. Jansen, but um, is he okay? Like, what's going on with him? And I remember taking you aside and and saying, Hey, I just as a friend and colleague, like, like this matters to me. And if somebody's talking about this, if it's beyond just my observation, like there's something to this. Tell me, you know, what can I do? Like what what is it I can do? And um, are you aware of this? And I remember your response to me quite clearly, which is I don't even like who I am anymore. Yeah, and I had already lived that. I had already I knew exactly what you meant when you said I don't even like who I've become. And um I had lived that years before that, and hadn't completely come around uh even myself to going like, man, you know, I'm I'm proud of who I've become, or I'm proud of the kind of work I'm doing on a daily basis. And I mean it kind of rocked me uh as a friend of yours to to to to see that, to hear it, and kind of feel I don't know if I'd say helpless, but um I wasn't sure what to do, even though I'd been through it, because at the same time we were still both kind of within the the midst of that uh kind of live life that we were living, right? I I escaped, you know. I we we we talked and then I and I'm like, hey man, I I I've got to do this and I'm gonna do it on my own. And if somebody follows me, you know, so be it. But if it's only ever me, then I I've got to do this. Um but take me back, so you you said the transition after I was after I was gone. What what led up to and and how did you and when did you finally say, you know what, I I I not only am I done done here, but I'm like, hmm, see you guys. Yeah. Yeah.

SPEAKER_03 36:18

About I don't remember the dates anymore. Um when we moved clinics and we went into the the old hospital. One of the things that that really got me is, you know, we moved out of that previous place to save whatever it was, eleven or twelve thousand dollars a month on rent. They were renovating some old um basically LTAC rooms, um, which was fine, but we we could never get anything. It was like bartering for used furniture and carpet for the new offices. It was like if we just moved to save eleven thousand dollars a month or whatever, where'd that go? And they're like, oh yeah, that's already that's allocated somewhere else. And it's like we couldn't have kept a little bit. And just ever since pretty much immediately after we made that that move to where the clinic ended up in the pavilion, it it's just one thing after another, one change, one administrative thing, this person leaves, that person leaves. Ideas I had that you don't implement unless you become the squeaky wheel, which I was pretty good at becoming the squeaky wheel. Um but I've specifically remember we had some issues, and I don't even at this point remember all what all it was because there were so many different ones, but everybody that worked in that office was just not happy. The nurse practitioner that was with me, the front staff, everybody's just miserable of trying to do all these things and make it work and take care of people. And um, you know, I joked all the time. I said, I can I can take care of people, I can do the insurance crap and a bunch of other things. But then when you add also the employer stuff and everybody, I can't do all those things. Something's gotta give. I I can't, you know, and then that starts affecting home. Um and it affects you. And that's what happened to me is um I let it affect me and and it eventually got to how I treated people. And I remember one of the nurses coming in and basically calling me out on being not so nice to somebody on the phone. Um, and they were 100% right. And I told them that I was very sorry and actually called that person and apologized and told them I was going through a lot. I kind of made that moment the moment that I wrote down a list of things that had to change for me to stay. And I became the squeaky wheel, and one of those administrators came up and we reviewed the list, and only one of those things on that list involved me. Everything else was about staff. I mean, there was even things about the ER and how they treated, you know, staff stuff at the ER because that affects your patients when they end up there. And, you know, just the whole flow of all of patient care. And we knew it so well because we'd been here. We trained here, we knew how good it could work. And I remember that list being on the desk, and we were going to have every two-week meetings for a while, and that happened for about a month. And then after the next month, those meetings kind of stopped, and less than 15% of the things on the list ever changed. I just I don't I don't even remember what the moment was that it was like, okay, I'm done, done. But it was like, okay, what day am I, what day am I quitting? And when I mean quitting, I mean quitting, quitting because I was done. Um I didn't know if I was ever going to practice again. I wanted out. I didn't want anything to do with it. I strategically didn't turn my notice in right then because I wanted all the staff to find other jobs, and we did a pretty good job of that. Um I don't think from the original 14, I think there was one left by the time I left. I remember actually it was Carol. I remember when I told Carol that I was gonna be turning my notice in, I um went up front, I said, Do you remember how many of us there were? And we got to talking about numbers, and that's kind of how I remember the numbers. And I said, We're the only two rats left on the ship, and I and I ain't got and I ain't gonna make it. But, you know, then I turned my notice in and um started telling patients that um I wasn't gonna be there any longer. Um, and then of course their jerk reaction is, well, where are you going? Are you are you going across town? Are you doing your own thing? I think one of the hardest things besides making that decision to be done um was telling all those people that I was done. So I went from several months of sometimes breaking down in the parking lot when you pull up in the morning because you don't want to go in, to to breaking down um in the room with patients for three months, um filling meds for a year because I'm not gonna be here. Hard patients trying to find them somewhere to go when we already lost so many physicians in town. And um I still have days where I see people in public and it's really hard. You know, they're still mad. I mean, I'm obviously in a much better place now, and this is the right thing for me. Um, but that was probably the hardest part of quitting was telling everybody I was quitting. And then I remember that final day, you got your box and you head out for the the last time and just went home and went, wow, this is uh first time I haven't had charts to do or phone to answer in in a while. So that was fun for like two weeks, and then you know, we get bored. But I you know, I would as you know, I had done really well in some crypto things at that time, and I had I had um I saved up money. I mean, I knew this was coming for a while, so I mean I had put money back so we weren't in a financial strain. And you know, I figured I had a good six months to a year before I needed to really do anything. So I enjoyed it, played lots of golf, and you know, I always joke with people. My last day at previous employer was um 222 22 on a Tuesday. And I just thought that was funny. It's easy to remember. But yeah, that was just you know, you you spend all that time, you go to college, you go to medical school, you do residency, you practice, you do all those things, and then one day when you're not doing it, I mean, even though I did not want to be there, I didn't want to be there at all. Um, and I was glad to be away from some things, you you automatically miss people. Um, obviously during that time frame, going out in public was hard because there's everywhere, is everywhere you went, where are you going? I heard you you know, especially the people that didn't make it through in that three months of you know, turning in a notice, um, you know, still refilled things for them, of having those conversations of you know, why did you go? Um, why are you not practicing? When are you when are you gonna do something? Um, I remember, you know, I know we kind of have this on our thing of you know, I think you're basically the only person that really reached out consistently after me leaving. Um I did make that comment one time in a meeting. Um I do remember one other person that called like within the first month, but that was kind of the only follow-up. And honestly, I I don't know if I can really blame other people for for not reaching out because I probably didn't want to be reached out to. That's how that's how done I was and how much I felt like I'd you know let myself down and let people down. I still want to talk about it. It's really hard.

SPEAKER_01 43:37

Yeah.

SPEAKER_00 43:38

No, it is. And um I remember that comment you made to me, like just that it still breaks my heart thinking about like you know, we have our stories are two of probably thousands. And there's not a place for physicians to go to talk about that. You can't talk about it amongst other employed physicians because you're afraid things will get back, and you're afraid to bring it up. Because, you know, does it mean there's something wrong with me? Am I the broken one that like, yeah, you know, um, you know, and and then just this, just this theme of honestly, specifically for men, but all of us, um, is just the fear of failure. And it's like you're putting yourself out there in public as I've failed, you know, like, um, and even though you know innately that's not true, that's what the it's what it feels like. And that's why going out into public and facing people and even talking about it, it's like, um, you know, what's wrong with you? What's wrong with you? And then there's also fear, not saying I didn't feel it, but I kind of knew where you were coming from a little bit. There's fear of reaching out. Like, am I prepared for what I'm gonna hear from my colleague? And if they share their heart, am I gonna be able to handle it? Or is it gonna create this cognitive dissonance for myself, knowing that I full well appreciate and feel everything that they're feeling, but yet I'm willing to accept it and accept the terms of it. And then there's part on your end where you're like, well, I don't really want to talk too much about it because I don't want you all, if you're currently happy with your situation, I'm not trying to make you unhappy with it. Yeah, you know, you don't need to be like in my unhappiness or dissatisfaction, also, but it's sort of and and I think the hardest thing, Chuck, is with patience. Like, I know I know our exits were different. I mean, I had my plan, I knew what I was doing, but uh the reasons weren't all that different. But man, that's I and I've told anyone who ever transitions to a different practice, particularly particularly if you're staying in the same community, like those last 90 days, once the notice goes out, like probably the hardest time you'll ever go through. Because uh two things. One is almost all family physicians are are empaths, and we've dedicated ourselves to the profession, we've dedicated ourselves to these patients, and you've gotten to know them, and the biggest thing is the the trust. You know, they've entrusted you and they've depended on you, and now all of a sudden, maybe the trust isn't broken, but now they can't depend on you. And um that it does, it just feels like it feels like you're failing them, and uh man, I I I hear you. That the the those 90 days are are excruciating. Yeah, and I remember that meeting. I I I couldn't hold myself together when you were telling me like I was the only one that really stayed in touch with you, and and I I sometimes go back to that and I wonder if is it because I had experienced it previously and then I watched you experience it, and I knew personally, no one reached out to me necessarily either. And this roller coaster of emotions for me particularly was like I'd go into one room and I'd have a patient go, Yes. This is awesome. I love this for you, you know? Yeah, I'm so happy for you. And the next one is just in tears, like, what am I gonna do? I've been I you know it's taken me 30 years to finally find a physician that listens to me and trusts me, and like and then you start to wonder how many, because you know you now know you've been in this world for the last three years anyway, in direct care. You start realizing that like there's certain personalities within direct care. We all we have this, I don't I don't know how to describe it, but um we have a common blend that it was probably our personalities in the first place, and what we demanded and desired so much of our profession that led us to that place. Yeah. Not that we were broken, but that we were so inclined to do everything we could. Yeah. That when we couldn't do it, when the agency was there and the autonomy wasn't, it just broke us.

unknown 47:52

Yeah.

SPEAKER_03 47:54

And I I've talked to several people since then and you know, earlier in the past, and I'm like, well, that's kind of the way clinics always been for us. I'm like, yeah, we we were fortunate to be at the end where we we got to see the way things were when we got here in town. And I think that was part of the hardest part of how different it was from showing up here as a fourth year med student for that first month and all the specialists and the big meetings and you know, all those things to what it was there at the end, you know. And then COVID didn't help with isolation and canceling in-person meetings and a lot of things that were already dwindling down as far as seeing people and running into people went down. So um yeah, I just what I want to say real quick, I I 100% agree with you on the on the personality type of maybe why we get certain people get more burnout or emotionally damaged or whatever words we want to use for broken. Um maybe we do take too much on. We can see other people's struggles and try to do more for them, or see what the staff's struggling with and trying to do more for them. And then maybe we did put too much on our own plate, and that made the plate get too heavy. Um and but at the same time, those same characteristics make for great physician-patient relationships and specifically in direct care. I mean, it's just it's great to think third level about things. It's not just, oh, you need an MRI, go. Here's your slip, go figure it out. It's well, do you have insurance? Do you have coverage? What's your deductible? Where can we get it done? What's this med cost? What you know, there's there's so many different levels we think about in direct care to try to be bring great value, but do good care more lean, you know, and so I think that personality type obviously um does well with that because we think second, third level, and how can things be more efficient, better for you know, there's lots of decisions we make. It's like it might not necessarily be the best decision for me, but maybe it's better for staff or better for the patients, or just better for the flow of everything in general. So yeah, I I like what you said there. I hadn't really thought about it that way before.

SPEAKER_00 50:35

Yeah, and I want to be clear too that um to to to look at a satisfied, happy, you know, energetic physician working in a traditional practice, that that doesn't mean the opposite is true. It doesn't mean that they don't have great relationships, it doesn't mean any of that. Yeah, exactly. Um but there is, it's like this just it's just this drive for wanting more for your patients and wanting more for the practice. And and and then when certain incentives enter your head while you're trying to do that, and it really and you realize that those are distracting you, like they're actually trying to drive you into a different direction than just specifically for the for the patient. That that was that's where I think the term moral injury actually fits, where it's like I I can't serve two masters, and the way I get paid is one master, but the master is really the the person that's getting paid for, and that's the patient. So who am I serving here? And and that was that was tough. And you had to like either you either had to give in or like ignore that part of your your your brain. That's hard to do. It's really hard to do. So August of 2023, like year and a half after you've you've left medicine. I I think I actually think it was aug it was summer of 22 that I told you, hey, I want you to understand you have zero pressure from me, but if you ever need a place to land or if you ever want to try this, you this sustaining invitation, the doors open to you anytime. And and that's about how I left it. Like, hey, it just and that's what it was.

SPEAKER_03 52:07

And I mean, I had no real intention. Um, and then you know, you reached out at one point because you were gonna be gone and Riley was gonna be gone, needed somebody to to sit at the clinic. That's right. Um, and and that week in general has been one of the biggest impacts of my life. Um, A, you got to see DPC. You got to see uh the coolest thing was the first time you saw somebody and you sent them out with antibiotic. I was like, why has it not been this way the whole time? Like it just I just loved it. You mean from the in-house pharmacy? Yeah, from the in-house pharmacy. I'm like, here, you don't have to go away somewhere. It's four dollars. Good job. You know, move on. Yeah, yeah. Um, that week was also very hard because that's the week that Gary Bull passed away. Um, and that's the week that we had his funeral. And it was actually the Thursday before his funeral. I was sitting at the desk where Dr. Oldham's at now, and I got a random call from somebody from Owasso, and I didn't know the number, and I totally ignored it. And I had this like three-minute voicemail from somebody in Owassa that owned urgent care. And um, Dr. Culvert had told him that I might be able to help them because I wasn't doing anything. It wasn't exactly the word that he used, but but they were in a bind, and um, you know, I ended up, you know, and loving the weeks that I spent here, the the time filling in. Um, obviously, Gary Bull's funeral. Um, but then that Sunday we went and saw Alwasso and saw the surgeon care, and they were they were looking for help of a one of the providers was really green um and just needed some some support um and some teaching. Um, and they needed help with workflow being a little more efficient, and their current supervising provider um was very sick, and so they were kind of in a bind. So I ended up starting to go over there basically a a day and a half per week for a while, and then that turned into two days a week, and then that turned into well, hey, we just ended up moving over there, and for better or worse, that was not the best move in the long run. For me and Amanda, I think that we proved pretty early on that being over there wasn't the right place for us, you know, between postal traffic and I'm going there and she's working and making calls and shifts and getting the boys to school and just not having anybody and have anybody to pick up a kid if they get sick. That pretty quickly we decided. I specifically remember one time where Amanda said, Well, we're going back, whether you come back with us or not. I was like, okay, well, I'll get 100% on board with that. And that's about the time you had reached out again and like, hey, no pressure. You know, we're getting busier, we're gonna be having some more corporate accounts, and you know, and it was, you know, we were making this decision to come back, and I was like, well, if we're gonna if it's ever gonna happen now, it's the time. Um, because obviously I wasn't going back, you know, I I got more comfortable with medicine again. You know, if you get back into it, you know, I ended up doing basically primary care at the urgent care. Um, and that comes with its own downfalls because then you spend too much time and the waiting room's full of people. Um But no, that was, and I I don't remember exactly what message it was. It was like you gave me some numbers and we talked about this thing, and it's like, okay, yeah, well, cool. Well, I'll start then. And, you know, we got moved back and and bought a house that needed remodeling to get to the right school for the year, and you know, we just kind of got started slowly. And but I don't know if we ever really had a moment was like 100%, yeah, we're like, let's do this. It was just kind of like, yeah, it's all makes sense. You know, you need help, I'm coming back.

SPEAKER_01 55:51

Mm-hmm.

SPEAKER_03 55:52

And I've told people that a couple of times, and like, what do you mean? You like it just I was like, it's just is the right thing. Obviously, the the week that I had been here before um before moving away for a while was awesome. And you'd been the one that keeps reaching out and no pressure, and so it just made sense. It's like the the the person that set out to do this and you know, supported me and not pushy. It's like that's that's the kind of people you want to work for, right? Well, I hope to be that, yeah. Yeah, exactly. And so that that's that's what we've had. And it's um, you know, we didn't do a lot of advertising up front, and we really didn't have to, and I didn't really want to be that busy, and you know, because all those new people, especially if they're people I hadn't seen in a while, they're all brand new again. It's been you know a couple years, and so that beginning of of being here and spending more time, obviously a much better beginning than residencies closing, doors, lights are turned off behind you, going into a busy clinic and absorbing a bunch of patients. But you know, I I love direct care. I love the flexibility it gives me to be here. I still do the urgent care supervision. Um, I get to go do stuff with the boys if needed. I get to go pick up stuff and take care of things. And so, I mean, it it's crazy when we sit and reflect on the whole thing.

SPEAKER_01 57:20

Yeah.

SPEAKER_03 57:20

And then, you know, like you said, it's it's it's hard to go, well, I'm here and I'm pretty happy and I'm content. And it's like, well, how many other people are in that in that mess somewhere?

SPEAKER_00 57:31

Well, yeah, absolutely. And to me, like, and you know this about me, but like one of my greatest privileges, um, you know, I don't I don't think of I don't think of myself as a boss or an employer. I just don't, it's just not my mentality. Um but you know, I brought you in, I said, hey, you know, you be as busy as you want to be, like you tell me when you're done, like do not recreate a monster, right? Yeah, like that's not what this is about. Um, I want you to have the schedule that's you know um that's got longevity. I want you to have the time to do what you need. And it's it's super gratifying for me, and and obviously there's several of us around here that are doing that, but like I practice that way, you practice that way, Riley practice that way, Sarah practice that way, Haley practice that. I mean, like we're all in that have that ability to just say, you know what, this is this is my degree, it's my career, and uh I'm taking control of what I can to make sure that I'm in the best place personally to provide the best care to anyone who who comes in front of me. And I'll tell you what, Chuck, I've been in this now seven and a half years. I don't see a lot of new patients anymore. I mean, I just I don't, just by the way of capacity. But I had just this morning, I haven't told you this, just this morning, 75 minute new patient appointment. 75 minutes I was able to spend and rehash the last 12 years with one of my patients. And by the about 60 minutes into that, I was able to put this whole picture together that I don't think I would have ever done that. I don't think I would have ever come to that. It took that long of asking all the questions, putting the pieces together, and time will tell, time will tell what happens in that relationship with that patient. But all the premonition that I have in this is like I think we just solved a problem that has spent a decade and probably a million dollars worth of health care for the wrong thing. Like the wrong thing by multiple people. And um yeah, it's just it's it's incredible. But I I do want to kind of end on a on a obviously a positive note is like how how things have changed for you as you if you as you got into direct care, but like I know we have colleagues that that might listen to this. I know that we have the patients that might be hearing it, but I'd like to know kind of you know what would your message be to our colleagues because quite frankly, I haven't been very vocal and purposefully I haven't been crazy vocal on a local level because I'm not I don't want my colleagues and friends to feel like um you know that they're trapped. Or I I don't want to give them language or feelings that they didn't already have. It's like, but I want I want our colleagues to know and what would you what would you say to them when they feel broken or trapped or feel like they've just completely lost themselves in what they're doing.

SPEAKER_03 1:00:41

Yeah, I mean I'd I'd you know we've talked about that a lot of what do you say to people, you know, if they're in the employed model, because you know, A, we don't want to seem like we're trying to poach people um or make somebody feel like they do things wrong. Right. You know, I'd I can I can tell you that a lot of my flaws from are just time limitations. You know, and so somebody that's in that employed model, they they still have the time, you know, issues that we luckily have more time, and it's it's much easier to do a good job when you have more time. And you know, I'd I never been the best at reaching out to other people, obviously. We already talked about that. Um, so I should really do a better job with that. Um you're not alone. Well, you're going through somebody's been through. We just proved that. Two guys sitting on podcasts, um, working in the same clinic a couple years apart, going through it. And so that's everywhere. Um I saw a TikTok or something a while back of and it was talking about taking care of yourself of you know, the airplane thing, you got to put the oxygen mask on yourself before you can take care of the kiddos and the other people. Um, and you know, we've always you know, you you hear things over time like, oh, if you don't take care of yourself, you can't take care of other people. It's like, well, I did really good for a long time taking care of other people, was out taking care of myself, and then it just went bad for everybody. So they probably are right that if you do feel like you're not who you want to be, or you know, i is there other options? Is there, you know, reach out to somebody, you know. Um you know, obviously when we if we did a better job of telling other people what we went through, then maybe they would be more comfortable with with reaching out. Um and again, that's been a a fine line to dance in a small town. Um but yeah, it's just I remember what I told my mom one time. I said, I just I'm not gonna live like this forever because she knew something was wrong. You know, I'm an only child. Um no, something's wrong, you know. Um it's just hard, you know. We we've when you we've been through training and it's take care of other people, take care of other people, do this, be busy, go, go, go. And then to step back and go, there is something wrong. I need to do something different, you know, that's hard. So my words for other people would be, we felt that we've been there, you're not alone. Um and hopefully as the years go by, and as a group of physicians, not only locally but across the country, hopefully we can all do a better job supporting each other.

SPEAKER_00 1:03:23

Mm-hmm. Ask for help for sure. Well, I know I've said it before, but you didn't fail medicine. Medicine failed you. When you understand that concept, you weren't the failure. You made the most, the boldest step you ever could to step away from something that was breaking you and um and and finding your joy again in the profession that you love, taking care of the people that you love. And it it brings me no greater joy than to have seen that whole journey for you firsthand. And I always think about going back to when I first met you as a fourth-year medical student, and I get to see you now however many years it's been like 17 years or something. Uh no, yeah, something like that. Uh that's really bad math. Yes. 13 years.

SPEAKER_03 1:04:11

13, yeah.

SPEAKER_00 1:04:12

13 years I get to look back and I go, man, Chuck reminds me of what he what he was when he was a fourth-year medical student. He's he's full of life, he's digging, he's enjoying it, he's having fun, and uh, that's the kind of person you want to surround yourself with. And um I'm privileged to have you as a partner and a friend, and um wish you the best in your continued career. Uh whether that's with me for a long time or if it takes you somewhere else, you know, you know me too, that I'll I'll always be supportive of of what you need and what's best for you. So um thanks again for joining us, Chuck. Thank you for telling your story. Um fact of the matter is, when we put ourselves in the place to make sure that patients win on a daily basis, uh, it's the most gratifying experience ever.

SPEAKER_03 1:04:57

Appreciate you having me on.

SPEAKER_00 1:04:59

Yeah, absolutely.

SPEAKER_03 1:05:00

I'll see you down, see you down the hall.

SPEAKER_00 1:05:02

All right.

SPEAKER_03 1:05:03

See you soon.