Real Doctor Speaks

Why Most Patients Don’t Actually Have Their Own Doctor Anymore

• Jim O'Leary • Episode 10

Share episode

Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.

0:00 | 50:13

Most people believe they have a doctor.

But the truth is… most don’t.

What they really have is a system. A system where doctors are rushed, appointments are short, and decisions are often controlled by insurance companies instead of the people sitting in the exam room.

I see this problem every day.

In this episode, I talk about a different model of medicine that quietly puts the relationship between doctor and patient back where it belongs. It changes how care is delivered, how doctors practice, and how patients experience healthcare.

But most people have never heard of it.

And once you understand how it works, you start to see why the current system feels so frustrating.

In this episode, you’ll learn:

  • Why the modern healthcare system often prevents doctors from truly helping patients
  • The surprising model of care that removes insurance from the middle of the doctor-patient relationship
  • Why some doctors say this approach completely changed the way they practice medicine

If you’ve ever felt rushed, unheard, or stuck inside the healthcare system… this conversation may completely change how you think about medical care.

Learn more about William Steelman:

Direct Primary Care (DPC) is a model in which patients pay a monthly subscription fee to a physician for unliminted primary care. This doesn't involve insurane, but you can use your insurance for any follow up services needed.


SPEAKER_00

The biggest issue face to today is they don't have their own doctor. In the old days, they had their own doctor, so they can do them, someone that they could trust. Now 80% of the patients are employed. And when you see an employee physician, they're not working for you. They're working for their employer. The other thing is they have to see as many patients as possible in a short period of time as possible. And then you think you want to stick with the same doctor, you call up and you find out you can't see that doctor. They're on a room of their schedule or they're allowed. And you see a rotation of different doctors or practitioners. And then you think, what am I going to do? Well, today we're going to tell you there's a great solution. It's called direct primary care. And I love direct primary care because it puts the patient and the doctor back together again. You pay a subscription once a month, and then what happens, the doctor works for you. And it works out fantastic. Now you have long visits, they know who you are, and you get the care you deserve. And today we've got a very innovative direct primary care physician, Dr. William Steelman, the Steelman Medical Group, and he's going to share with us all his great ideas. And this podcast is for educational purposes only. It's not medical advice, and you should always take the advice of a physician. I'm so excited to have you here today. And the other thing is, I feel like we've walked a lot of the same ground. You were born in Virginia Beach, Virginia from a Navy family, and I did a Navy internship at Portsmouth Naval Hospital. And I have three beautiful daughters just as you do. So well Yeah, that was uh thank you.

SPEAKER_01

Thank you. Thank you for having me. It's uh it's it's good to get our the message out about drug partner care, and uh, I love sharing it as a No that that's wonderful.

SPEAKER_00

And then uh you worked for about 12 years, it sounded like after your residency. And what type of work did you do? Were you employed at that time or were you self-employed?

SPEAKER_01

So immediately out of residency, I took jobs uh as 1099 uh locum tenants uh hospitalist. So trained uh traditional internal medicine and uh uh finished residency in 2012. So uh so immediately, you know, the next day I started working at the same hospital I trained at. So that was uh it was an easy transition.

SPEAKER_00

But the nice thing with that is you get a tremendous amount of experience as a hospitalist. You obviously feel very comfortable with complex medical situations. So I think that's a a good pathway. You know, if somebody's listening and they're in their second year of residency and they're like, I don't know what I'm gonna do. You know, that's I think it's great training. And what was that one moment where you're like, you know what? I need to go to a different model. I want to do the direct primary care.

SPEAKER_01

So so transitioning into direct primary care uh took a couple years. So um uh I was you know very flexible, and and when I initially started doing local tenants work, I wanted to get as much experience from different um hospital centers as I could. So one health system doesn't handle one problem the same way as every other place. And um and what I learned quickly was that there are uh very creative ways of doing the same thing. So uh so getting to do several um several rotations at major medical centers really uh made a big difference to me.

SPEAKER_00

You're right that every hospital does things a different way. And the funny thing is when you're in that one hospital, they act like that's the only way you can do it. And I always laugh. I'm like, well, you can actually do it a different way and it works, but you know, they're like, this is the way. It's like the Ten Commandments comes down, you know, so it uh what kind of drove you to say, you know what, I'm gonna take that leap? Because it's you know it's a big risk. I know a lot of docs are, you know, they they've never run a business and they're comfortable being employed. They don't like it necessarily, but you know, they don't have to make payroll and they don't have to find an office and and go through all the administrative issues with that. So what drove you to do direct primary care?

SPEAKER_01

Um at the at the end of the day, it it was uh it was a health decision. I I I was just too burned out um uh doing a a full um uh a full-time W-2 hospitalist job. Uh I I eventually settled, you know, when I met my wife, uh I I stopped uh moving around so much with the locums jobs, and and when I settled into my W-2, I stayed there about six years. Uh towards the end, this is uh end of COVID 2023 or so, um, I was starting to get sick. I was starting to to like physically break down. So they the the job literally was so hard uh psychologically, spiritually, mentally, you know, that I was breaking down and had to make a decision. I was either going to go back on the road and do uh work at a different center more part-time, or I was gonna try to make a transition. And and that's when I made the decision um initially to go to concierge medicine. Um and then about halfway through that process, we we hired a consultant group to uh to look at our uh our our environment to uh to help us plan out. And then about halfway through, I I started to look at the um uh the insurance uh uh landscape and decided that it just it wasn't worth the squeeze. Uh so direct primary care was the was the next obvious answer.

SPEAKER_00

Can you explain the difference for viewers between concierge medicine and direct primary care?

SPEAKER_01

Uh so direct primary care technically uh I you could think of it this way as a offshoot of concierge medicine. Concierge medicine in the common use uh means that you are paying a membership fee to join uh to join the practice, uh uh, which is allow allowing the physician to have a smaller panel and spend more time with each uh each patient. Uh traditionally these can be very high in cost. Um there's no real limit to what they can be. The highest I ever saw was like $20,000 a month, uh, which is a little bit exotic, but um most of them are three to five thousand a year on average, if you were to look around in different different areas of the country. Um and they also um still are a hybrid practice in that they uh they will do cash-based things, but they mostly uh turn around and also bill insurance. So concierge is still on insurance contracts. Um the direct primary care world is cash-based membership um that does not engage with insurance. So we are completely out of network. Um I like to think of it as uh free from insurance influence.

SPEAKER_00

Well, you've walked away from the system that's oppressing both patients and physicians. And the one thing I think is fascinating, I grew up in an era where people just paid cash for physician services. They're very inexpensive. My allergist, when I was young, had a nurse and a receptionist. That was it. And a doctor. I mean, you know, that was it was a very simple setup. And he was actually prepaid. This was a longties outside of Chicago. He was prepaid and you could see him whenever you needed to. And he was very relaxed and very nice guy. You know, he found out he wanted to be a physician, encouraged me in that. So I was probably 10 years old at that time. It was very close to him. And it was a great model. And then all of a sudden we were convinced by the insurance companies that, oh, it's too expensive to pay for a physician care, and you have to put this intermediate in there. So I love that you're going back to a pure pure system. And I kind of get tired of people saying, oh, it's so expensive. It's for the rich. And I mean, your prices start at $100 a month. And I'm thinking, what do you get for $100 a month nowadays? Not very much. I mean, everybody's paying more than that for cable, cell phone. I'm like, you know, what you have to prioritize your health. People need to stop saying, I'm gonna depend on my insurance company. It's the craziest thing. And it we talked about earlier, the HSAs can now pay for direct primary care, which is wonderful.

SPEAKER_01

That's right. And and that really transforms the practice into uh into a uniquely uh beneficial business opportunity for for small businesses. Um if you're getting a high deductible health plan uh with a HSA and a DPC, you you have the most cost-effective uh healthcare coverage that you can possibly get. And that's that's just a uh a free market solution that's popped up as a result of uh pressures from the uh the major pulling insured because so I would add that all your patients are gonna get that money back twice.

SPEAKER_00

First of all, they're using pre-tax dollars to subscribe if they use an HSA. So that's first off, that's a great way. Second way, you're offering them deeply discounted labs and drugs. And that's gonna pay for itself, you know. So, really, when you think of it, they're kind of seeing you for free. They're just smart enough to figure it out.

SPEAKER_01

It's it's it's not free, and nothing in medicine is free. And and anytime you stamp medical on it, uh uh the cost goes exponentially higher. So we do a lot of wholesale purchasing uh to make sure that we're doing that. And labs is one of those. We we use a direct primary care alliance uh uh GPO, uh the group purchasing organization, be able to buy labs cheaper. And it turns out that the biggest expense for the labs is actually the collections. So when you pay the labs directly, cash, the the price that they can offer you is so much lower. So we'll get our labs down to like $4 a piece, something like that.

SPEAKER_00

Great. So what would a CBC typically cost or a metabolic panel or a lipid panel?

SPEAKER_01

Uh I want it's I want to say it's around $4 as for a CBC, and the insurance price, if you run it through your your good insurance, is uh like $32 or more.

SPEAKER_00

No, it that's phenomenal. And there's so much variance, especially in the price of generic drugs as well. I know you can get really good deals with that.

SPEAKER_01

So state of Texas won't let us yet uh uh prescribe from the office. Um I I I haven't pushed it uh yet, but I I hear that we can offer 72 hours of uh of emergency uh medications we can give away. Um but I I try not to push the rules too much. But in 45 other states, uh direct primary care can actually uh uh prescribe from the office, white bagged, uh uh white labeled and and um at cost. So some of these pills bought wholesale um are a quarter of a penny apiece. So I mean 30 cents for a month of blood pressure pills is not unexpected.

SPEAKER_00

That's amazing. And and I have to say I I actually myself, my family go to a direct primary care physician, and we've gotten, and there's nothing better than when you're feeling bad and they just hand you the medication. You don't have to go wait at the pharmacy for an hour or two, and I mean it's such a great service to the patients.

SPEAKER_01

The turnaround time uh to be able to uh to engage with patients is phenomenally different in direct primary care. So uh being able to have access to your physician literally at your fingertips is it changes the game.

SPEAKER_00

And I love that on the weekends you also have coverage if people get sick on the weekends. If I get a bronchitis or strep throat that I could get through to this service.

SPEAKER_01

I imagine uh like uh uh I don't really know the show all that well because it's before my time, but the the old Marcus Welby style uh uh uh primary care, the community primary care. This is really, I act like my neighbor. So, you know, it it's uh it is intended to be that easy access, and and we have multiple ways that you can get through to me depending on how emergent the problem is, whether it's a text, uh uh uh a chat message, uh uh email, video, whatever.

SPEAKER_00

And how long are your standard appointments? If I'm a patient of yours and I call you up, and uh, you know, I'm coming in for a yearly exam?

SPEAKER_01

Uh so it it varies on what the patients need. The shortest, uh, you know, if you're coming in for a flu swap, we can get that in and out in maybe 10 minutes. Uh but the the the typical you know hour-long follow-up study is is about right for me. Um I'm I'm pretty long-winded. Uh so uh compared to other DPCs, you might get 30-minute to 60-minute visits, depending. Uh I I I actually forced my EMR company to uh extend my uh length of time we were we were able to do audio recordings uh that we that we use to generate our notes with AI uh to save time. But this is uh this is pretty typical with us uh for uh to do a 60-minute up to a 90-minute uh initial interview to get a really good history.

SPEAKER_00

I think it's fascinating with direct primary care. There's different models of it. I mean, some do more family care, you know, to take care of the whole family. And you do a lot with longevity and prevention of problems. Can you talk about how you do that? What makes you so unique?

SPEAKER_01

The initial concept was that I just was very unsatisfied with with the current uh reactionary uh sick care medical model, which is um uh we used to call uh uh Medicine 2.0. Uh uh now that we have imaging, now that we have uh advanced labs, uh we can diagnose things very, very accurately, but not until they reach a certain point. Okay, and and the the medical system's designed to pay out based on CPT codes that are illness codes. So essentially you mean nothing to an insurance-driven doctor until you're sick enough to meet that code. So pre-diabetes doesn't get a lot of attention. Alright? And and this is a big problem because things are reversible at that point. And and you can really you can walk back in a preventive sense uh from uh from a lot of pre-disease statuses that you can't get once you've already crossed the line. And our our intention in doing the services, I was just unsatisfied. I was like, I don't want you to wait until you actually have a heart attack, until you come in to see me. I want to see how much soft plaque you have uh in a coronary CT angiography with you know hard flow AI processing. I can find that out once a year and see if we're doing a good job.

SPEAKER_00

And I know you're using the continuous glucose monitors to also help out folks. And you employ then people who don't have actual diabetes diagnosed. And how do you do that? How do you incorporate that in your practice?

SPEAKER_01

So the the most of the continuous glucose monitors are now over the counter. Uh the the two big competitors, Abbott uh makes Lingo and Dexcom makes Stello. Uh those are both uh right around, they they they kind of compete against a little bit on price, but they're right around $59 a month. Um and uh it might be $59 per unit, I think actually I correct that. Uh but the the ability to get those and and have real-time feedback, there's about a two-hour delay between when you eat when you eat and when you see the blood sugar numbers. But we use it as a training tool when we're when we're doing food selection um and when we're when we're training folks how to how to transition from um eating a standard American diet, processed foods, over to eating real whole foods the way that um uh that lowers blood sugar directly. So this is uh game-changing in terms of uh risk stratification and and teaching you how to you know not continue to push down the line to get sicker and sicker.

SPEAKER_00

I love that. You know, I took care of a lot of gestational diabetics who are insulin dependent. And it's hard because you would have at most four, maybe six blood sugars a day to work with. Yeah, because it's difficult because these people never had diabetes, I had convinced them to check their blood sugars, which you know it's hard to do. And but you're really trying to run something that's complex because as the pregnancy uh advances, uh their needs are different. And then depending on their diets, there's a lot of moving pieces. And I would have loved to have continuous glucose monitoring to really model it and sit down and go through because what you just described is so common. Different cultures would come in. You know, we had people where if they're Hispanic, they might eat lots of rice and beans, and you're like, this is kind of a disaster with the rice, you know, and you had to go through that with them. So we have to get you in a different direction, at least during the pregnancy. But I I love the idea, and I did read a study that they're starting to look at local monitoring during uh the type two diabetics. I think that's great. I love that whole idea. And like you said, you know, if you could really prevent those folks from becoming a diabetic, and that's why I said that my type two my uh gestational diabetics, you know, we have to monitor you going forward because you're at a higher risk of this. We can't just say we're through the pregnancy, we're okay with that. And tell me about your longevity, you know, what you do for that and the peptides, because that sounds pretty exciting, and that's not traditional medicine, the peptides and longevity.

SPEAKER_01

This is something that that has popped up in in more recent years. Um, you know, we all know peptides, uh, we just didn't call them by that name uh through training. So uh insulin is a peptide, um uh ACTH uh all the way through uh uh GLP1s that became so popular. And so when we started to see the GLP ones, uh it kind of crept into the practice through some of my patients who were uh performance athletes, bodybuilders, uh uh just general we call them biohackers. Uh and and these are folks that are using uh short chain amino acid peptides uh as ways to improve their overall performance. And there are you know major categories of these um with just an unbelievable number of of uh unused and unknown ones that that are always coming out. So um it does it does border on the um uh uh the the Wild West uh end of medicine because uh a lot of these are not yet ready for for prime time, and so you you have to use a lot of discretion uh pouring through what data you have available. Um the the anti-aging game is actually accelerated now because we have we have several products out that that do things directly um to stimulate uh DNA repair. So we're looking at DNA methylation as a as a model of aging. This is uh David Sinclair's uh work out of uh Harvard, I believe it is. And uh the the primary one that he's always selling uh uh uh and talking about is uh uh NAD. Um I'm gonna I'm gonna butcher it, but nicotinamide amine DID nucleotide uh as a precursor for uh energy transfer. And you can take NAD in an oral form called uh NMN uh or an injectable uh IV or subcutaneous infusion uh uh as uh NAD plus. And these are these are easily accessible uh uh commercial products, they generally make them a compounding. Um these are that's not a peptide, it's a small molecule, but this feeds an actual mechanism, the sertuan pathway, that is uh designed to repair DNA. And they've got fantastic mouse studies that show um show some incredible uh uh output from you know older mice and things like this. But in human studies, it didn't translate um quite as profoundly, uh, but this is a uh this is an ongoing uh research topic. In in clinical practice, uh longevity uh treatments mostly are uh building muscle and and resilience against injury um and then using uh using peptides and small molecules like NAV uh to help you um uh to recover from an injury faster. And and we've got that down um uh to to quite a few options now.

SPEAKER_00

Do you do any VO2 max testing?

SPEAKER_01

Yes, actually, um we we do. VO2 Max is is a fantastic way of looking at uh at overall risk factors for uh for um uh for for mortality, but it's uh it's actually uh a really trackable way of looking at your physical performance. So cardiovascular uh performance and and the the VO2 max uh um are an easy assessment you can do every few months uh as a way to look at this. We get Iron Men competitors, uh Marathon Runners, things like that that will that will go and regularly get those.

SPEAKER_00

You'd share with me that you really have taken off very quickly. And when did you open your door right now and what percentage of your panel have you filled?

SPEAKER_01

So we're we're at about two years, uh just a little bit over two years uh open. Um I don't really count that first month where they're open because we didn't see our first patient. Until almost the 28th of January 24 when we uh after we had already opened. So it was a little scary. Uh big risk, you know, to do all this. But um but we will we will close our panel. My my panel uh we think will extend to 700. Um it depends on how well I can take care of those people. Um but somewhere around 700 patients uh will close our panel uh in in October. So it'll be about two and a half years, a little bit over months.

SPEAKER_00

It's phenomenal. And the interesting thing is when I when I talk to people about drug primary care, a lot of the people say, well, you have to have a long-standing primary care practice and then switch over to that. And you know, so you already have the space, but you didn't do that, and you didn't have that.

SPEAKER_01

We uh I I I was beat down to the point where uh uh it was life or death. So it it it it didn't matter how big the challenge was gonna be because I was going to do this. Uh this I was gonna make this happen. And uh and I was willing to to work locums and and and um you know pay the piper while I was building. Uh and so that made it uh that made it really possible. Uh the the practice themselves, uh direct primary care almost exclusively is word of mouth. So uh we share on Facebook, we share on social media, um, and that brings in a fair number of people. Uh but almost all of our patients uh know each other in the community. Uh they they will say, I heard from so-and-so and so-and-so. And that's actually uh that's actually a really nice uh way to grow uh by individuals. We also take employer contracts. Uh we serve several not-for-profit uh companies locally that uh uh that benefit quite a bit out of it.

SPEAKER_00

That's great. So you do kind of organic growth in the community, and that's how traditionally practices grew. And you know, I I came to a practice in 1995 in Wisconsin, a small town of Wisconsin, and that's exactly how my practice grew. And you know, just giving talks, businesses, getting your word out, and slowly people would mention, you know, you know, here's this new guy in town. And and but I love that. I mean, this is really turning the clock back to where medicine should be. The one thing I say, I I'm very excited about direct primary care. I'm probably the most excited for somebody who's not strictly primary care. I'm an OV, so that's kind of in between a little bit. But I love that it's because I've seen primary care just get decimated. I mean, it just it's terrible what's happened in primary care. So I love that you know they're coming back. The one thing I want to caution everybody out there who's listening is that we really need to keep direct primary care the way Dr. Shielman's done it. We have to have the doctors in charge. So it's great to bring in consultants, great to bring in MBA people that work for us. What we don't want to do is turn it over to the MBA's tri private equity, because then it's going to get ruined. So that's really important in my mind. What's your thoughts on that?

SPEAKER_01

So I I get fired up about this because um because it it was it's such an abusive system on the other end, uh, that that I get very passionate about uh protecting my docs who who are really struggling and and hurting uh in the current situation. This is this is something we underplay, but uh it it does get to a point where um where it becomes life or death uh to make a decision. You're either going to walk away from medicine uh the way it is right now in the insurance-driven world, or you're going to you're going to compromise some part of your values in in patient care. Um and and I couldn't do that. I I I basically just poured it on until I broke. Um and trying to save all the docs, you know, going forward is is really my next mission in life. Uh this this idea that um um that somehow I'm gonna get out here and then you know, uh benefits consultants and employers are gonna give me a contract that then feeds me back into some kind of you know alternate work RVU metric-driven world again. That's just it's not happening. So we we we are not giving up the ship here. It is not happening. Um I tell them all the time, like, you go ahead and ask a DPC doc. Um, you'll you'll get an answer real quick. It's not happening.

SPEAKER_00

The interesting thing is the number of intermediates, I was looking at there's a um a substack called measured scalpel. And I don't know if you've ever seen that, but there's a gentleman who did a report on there and wonderful. And one of the things that he talked about was the number of steps between a patient and a physician and a physician getting paid. And there's seven major steps. There's all these companies I didn't even know existed. And when you start looking at that, you realize why you can have a physician get paid directly by a company, and say 30 to 40 percent in the service is better. You understand why, and employers are suffering in this whole equation as well. The benefit consultants, and if you're a benefit consultant, I don't really care. You're not helping, for the most part, you're not helping the employer. You're not doing the right thing for them or the physicians. So, you know, I think we really need to cut them out. I mean, the employers need us, they don't need benefit consultants, they don't do anything.

SPEAKER_01

So I I met with uh uh some of the benefits consultants uh uh in in a previous podcast uh to invite them to talk to us because I do think it's an opportunity for these guys to transition uh to a to a new model for medicine, which we which we're we're putting forward. Uh the benefits consultants um do take commissions based on on sales, which is uh uh I think Dr. Bushman's uh article, uh the 5% problem, uh, was was really quite good uh describing how this is how this uh the money is really uh um not incentivized in patients uh favor and in medicine. And this is um this is a bigger question. So, how can benefits uh consultants work with employers and with DPC and find a way to be part of the solution here? And and I think I think the answer is that that they can play an active role in in generating the data that previously they had offloaded on the physicians and the clinical staff. Um and and this is um this is actually a natural part of what they do in in claims processing. But the problem is that the claims have always been um difficult to assess uh and and have been sometimes hidden behind contracts. So in the in the era of transparency, ultimately everything has sunshine on it. Uh and so we're gonna see all these claims and and everyone's gonna have to answer for them. Okay. Uh employers now are starting to say, hey, wait a second, you you've got a 60% increase in premiums uh coming my way for the same service as you did last year. Um I want to see what my claims are. And and we actually participate in uh in in that with employers that are interested in joining DPC to actually go through and review these line by line. Um this is this is not an easy task, it's a lot of work. Um, and so you can't really take clinical staff and pour them into that. I do it sort of you know on a mission, but uh but the uh I think that the benefits advisors uh really can uh play an active role there and not just be a commission to broker.

SPEAKER_00

And you're certain there are some great health benefit consultants who are doing that and they work with employers, they show all the data, and they actively try to get the cost down 30-40 percent. And I think that's wonderful. One of the things I love about DPC is you could really manage uh chronic medical conditions, and obviously you like to prevent them, but obviously lots of people in America have chronic medical conditions. And you can spend that time. I you know, I think of like a type two diabetic, if they've already crossed over, there's so much you can do for education, monitoring, lifestyle, exercise, eating. There's so many things that the average employed physician, you have 15 minutes, you can't do that. You want to do it, but you can't. So that that's the beauty. I that's I really love about DPC for people who have illnesses like that.

SPEAKER_01

Yeah, it's it's hard to put a metric in a in a uh an ENM code on on preventing a disease. Uh that's it's it's really hard to put those numbers in. The the recommendations we had in the past were to were to submit uh ghost TPA submissions and codes like that. I'm not really into doing more work at this point to to justify our return on investment uh like that. I I think that can go to the the guys who are selling the plans. I think that's just that that sounds appropriate to me. But um in terms of the impact that we can have on folks who have chronic diseases, I tell you that the greatest victory, the the the biggest like medicine win that I get, uh, and this is weekly now, is that I get to de-prescribe medications. And I not even once got to do that in the in the insurance-driven world because we just don't have time uh to do that. But I take people off of blood pressure pills because we've lost enough weight, we've gotten in such good shape, we've cleaned up our diet, we've completely transformed our lifestyle. Um and and you just don't need them anymore. They're like they're calling me up saying, hey, I'm feeling dizzy, and I'm like, what's your blood pressure? It's like 103, you know, over 50 on these blood pressure pills, nothing's changed. I'm like, well, that means you've you won. Uh, you know, we get to come off the meds now. Uh and that that actually happens. And and um, I I wouldn't have believed it. I wouldn't have been confident and saying that kind of stuff if if it didn't happen to me all the time.

SPEAKER_00

I that's wonderful. And I agree with you, you know, we when you're in the insurance world, you know, we certainly tell people about diet, exercise, but you don't have time to really explain it to them and go to the next level. So if I tell somebody who's obese, you need to lose weight, here's all the problems with that, and that's all the time I have, that really doesn't help them take that next step.

SPEAKER_01

Yeah, no, uh it takes uh it takes a long time. And and you have to understand that that a lot of people have a food addiction. They they they don't come to that easily, and and there's a lot of uh the coke that happens uh you know uh in the in the consult room. Uh this is this is part of the process. But um you you have to have a couple things, and CGMs are really pretty useful for this because you can see it, you know, the direct feedback. When you eat that that that healthy protein bar and you see your your blood sugar spike, you know that that oh that wasn't quite so healthy. Um maybe I should try something different, and then you you try uh you know uh a whole food recipe that that doesn't have any uh any added uh uh processed food uh products in it, no added sugar, you know, you made from scratch, and you see that it doesn't do that. You're like, okay, well that was pretty obvious. So there has to be the patient has to see it. Um the the docs have to be able to follow up um as often as needed, and sometimes that's a couple times, uh a couple times a week initially. Uh they'll send me pictures of their meals, we'll we'll do cooking skills, we'll talk about food selection, where we're actually going to pick out the food. So doing this lifestyle uh work is is is time intensive. Um okay. Biggest challenge. Biggest challenge is uh well, it's it's fear. Uh the the the just the fear of the unknown. You're almost in a panic for the first six months because no one's joining. You're you're you're all by yourself. There it's a very lonely job. Uh I wish that I had you know a dozen partners. I'm I'm I'm working as hard as I can to uh to pour the honey in uh in other you know internaceers to to have them come over and and join us, but um it's it's such a different thing and it's such a high-risk uh um proposition to hang a shingle these days that uh um that that's that's probably the the biggest barrier. Uh the the most surprising things about the practice are the business and aspects of it, because you just realize how much physicians have been cut out uh of any of the any of the financial gain in the in the um uh the business decision making. It's it's so ridiculous to think that you would uh that you would do that, but that's that's how the system was set up.

SPEAKER_00

And you also have what I'll call some fun parts to your business, like the sysy skincare. Can you talk about that? How how you came up with that and how that's working out?

SPEAKER_01

Sure. So that those those ideas are actually my my wife and uh and we have two teenage daughters, and um we we wanted them to learn some entrepreneurial skills while we were uh starting the practice because it became a big part of our lives. Um and so we said, you said, well, you're not getting um you're not gonna sit and and do nothing. You're gonna get a you're gonna get a summer job. And so we said, well, you're gonna do this, and and they came up with the idea to do uh medical grade skincare products. So we chased, we had them chase down um uh the chemists uh uh and the and the companies that that make these products overseas. Uh we have them made in in Canada right now and then and shipped down, and we're we're uh pursuing other other locations that make all these products at the same time. But they they came, they took all the top products from uh from the dermatologist's office that are very high dollar. I don't know if you ever bought any of these, but some of them are like $180 an ounce. So um they're pretty unaffordable uh in general. We found out that we can make these products um uh you know using a medical license and have them have them made just like pharmaceuticals, uh, and we can offer them in the office for at least half of that cost. So um we had them basically start this uh this project um and and build it into a business because we wanted to teach them how to how to start businesses. And I think that's sort of where the kids have to develop skills uh into the future, this is what I see for them.

SPEAKER_00

I love that. That's a great story. And it's uh I love that you got your best idea from your wife, because I always get my best ideas from my wife. So you know, like you said, we have a lot of similarities, and it I feel like you're my cousin. You know, there's there's so I I love your whole attitude with that. And I you know, I think that direct primary care can save primary care. I really do, for both doctors and patients.

SPEAKER_01

Yeah, it it absolutely saved my life. I I that's it's not hyperbole, it's not uh I'm not bragging that I did such a great job because if I can do this, literally anybody can do this. Uh I had a lot of help. There, there was a lot of resources, and a lot of docs volunteer their time uh to help save other docs and bring them over to the model. Uh but at the end of the day, uh it the the the alternative, the traditional insurance-driven, health system-driven, uh employed model, is is so bad that it makes it easy uh every day. I I say all the time, my my my worst day in BPC is better than my best day working in the hospital. It's there's no question. The patient satisfaction. I've never had a patient take a swing at me. Uh that was a regular occurrence in the hospital. This is uh that's that's an interesting one. Um everyone's happy. Um, I'm actually achieving higher metrics and better outcomes for my patients than I ever have in the in the alternative world. And this is um I've this there's no question that this is going to be the dominant force in primary care. Um, it also allows me to do a lot of care navigation. It allows me to do a lot of uh um uh steerage to give people high quality referrals so that they get to the uh the most effective, the most uh cost effective and and clinically effective uh uh referrals. So when I send people to a referral, they come with a full HP. They come with all of the imaging done, they come with all of the uh pre-op uh clearance and EKG, it's like wrapped in a bow. Um and it's the it's the easiest thing in the world. It's it's literally the way this was the whole thing was designed. So I I I just see it as this is the way medicine should be, and and I don't have any questions anymore.

SPEAKER_00

No, I I agree a hundred percent with that. And what do you do, you know, if someone needs a CAT scan? Because obviously you're not doing that at your center. Do you have a place that you send them to in town or a preferred place?

SPEAKER_01

So we use independent imaging centers because they can offer cash prices that are um a fraction, a tenth of what you would get through an insurance uh uh run-up. So a CT scan with insurance will run $2,500, maybe something like this. It depends on the contract. Uh but our cash price is around $200. So it there's no question that uh that a a non-emergent uh primary care office can get almost everything that they want. We can market stat, we'll get an answer within a day or so. But um, as long as it's non-emergent, uh, we can generally save people time and money.

SPEAKER_00

As Mark Cuban says, if you could shop, if you can schedule it, you can shop for it. And we have to get patients really in the mindset of shopping for care. And I don't think most people realize, even if they're using their insurance, which you know they think is gonna save them, that the insurance company's job isn't to get them the best price, it's to make the most amount of money on them and their backs. And the only way you can do that is charge more money and give less services. There's no other way.

SPEAKER_01

That's right. And what we say to people is if you have to ask, is insurance gonna cover it, the answer is no.

SPEAKER_00

Oh, you're that that is so true. And what's for what's in the future? What do you what's your plans for the next one, two, five years out for Steelman Medical Group?

SPEAKER_01

As we close my panel out, I will I will transition you know what what free time I have. Right now, um we onboard uh new patients about 50% of our time throughout the week. So as I'm no longer onboarding new patients, I'll start a wait list and and then start building another docs practice. Um I'd I I would love to uh to have uh a whole army of docs uh doing this uh locally because then we can start doing things that are more fun. Um we can buy a DEXA scan and start doing um you know zero dollar body composition scans. We can start doing, we can even um uh get our own imaging. Um there there are ways to uh to get access to CT scans and X-ray and all of this in the office. It's not um it's not super feasible for a small micropractice like like ours, but um, but as you get larger you can.

SPEAKER_00

I I don't know if you've ever talked with Andy Schoonover from CrowdHealth.

SPEAKER_01

Um I know of them. I haven't talked to CrowdHealth. Uh we are interested in them. They're one of the more popular uh health sharing uh uh vendors out there, so this is great.

SPEAKER_00

He's very supportive, and he's been on my pocket very supportive of drug patient care physicians, and he he loves supporting them, you know. So he'd be somebody I would say worthwhile to put a call in, you know, tell them that we talked to me phenomenal guy. He is so smart, he really understands the business, and he's putting humanity back into it, which exactly what you're doing. So I think that'd be a really nice mix for you to work with. And I and he keeps a database of physicians that are good for his patients. So I think you guys be a natural fit.

SPEAKER_01

Yeah, I love this idea of uh bringing sunshine and and and transparency to everything because you know the the value of what we do uh has been so wildly undervalued uh in in the medical community that once you realize what what we're actually capable of and and you take the reins off of uh primary care physicians, you realize that uh that we've been doing this all wrong. And and that we're driving uh the costs and and uh and the these exorbitant prices uh because we're making it possible. And if you if you just do it in a free market way, um the vendors compete against each other and bring their own prices down. This is this is true in any cash-based uh uh medical service like uh dermatology, plastic surgery, uh, ENT sometimes. Um the the any any non-insurance-based cash-based prices value goes up, prices go down, and and this is uh uh this is a classic uh uh business model.

SPEAKER_00

I think it's gonna save medicine and healthcare, it's gonna bring our costs down and really get our country healthier. And I really, like I said, I support direct primary care, and I'm I've been beating the drum. I'm gonna keep beating that drum. And next time I'm down in Texas, I would love to get a tour of your your clinic and have lunch with you.

SPEAKER_01

Yeah, that'd be that would be amazing. We uh we love showing off how um how advanced yet yet simple the the the projects really are. And we try to to go to the ends of the world to the end of the world to to find any new technology, um, things that we're that we're looking for. Um we've been a we've been a big adopter uh for AI assisted uh note-taking that really transforms the the practice uh as we're going. Um and and uh going into the future, uh adding things like AI agents that can help patients design uh uh workout programs and and function as nutritionists uh really opens up a lot of lanes.

SPEAKER_00

My prediction is that this is gonna be a tidal wave because I I know talking to the residents, they're very excited about this. And I think it's gonna start spreading to specialists because I think all of a sudden, you know, the orthopedic surgeons are saying, you know, why can't our group just work directly with employers and not deal with nonsensical things like prior authorizations and you know, why are we getting permission for a $200 CAT scan? I mean, the insanity of this whole system drives me crazy.

SPEAKER_01

So I think we actually see this now. We're we're we're actively participating in this. Um uh what happened after we were open and and successful uh a couple years in uh is we started getting contact from um uh from healthcare system uh specialists who wanted wanted to do this. They wanted to know how can a specialist do this. So now we've had uh we've had specialists from from most of the the uh the in-hospital healthcare systems that used to be independent, honestly. I remember back in the day when when every specialty practice, every surgical practice was independent, uh, they can be again and and uh direct specialty care uh through the direct specialty care alliance uh it shows the path. Uh there are many, many specialists that reach out to us and and uh and we we always book time to talk to them and and make it possible. Basically, um the bottleneck there is you have to have um a big enough funnel of direct primary care uh to be sending folks into um a cash marketplace direct specialty care um uh funnel. And that um that requires four or five um uh DPCs per specialty uh service, and and that's really not a big um not a big ask at this point.

SPEAKER_00

I think that's great. And they could also work, like I said, directly with employers too. I mean, I think Ortho is really uniquely set up for that. If they can go to a large employer and say we can take your muscle skeletal issues for your, you know, go in with physical therapist, and yeah, I think there's a lot of opportunity there. But you know what? I'm really excited. Thank you so much for sharing your time. I know you're super busy. And next time I'm down in Texas, we're gonna have to have that lunch. So I look forward to that. But but thank you. Do you have any closing remarks? Anything that I forgot to ask you about or anything you want to add?

SPEAKER_01

No, I what I would encourage people to do is to find the the DPC physician near them, um, the the most the most unifying uh group, and there's a lot of new websites that are that are cropping up uh for for finding DPC near you. But um mapper.dpcfrontier.com uh is is one of the one of the the bigger resources where people will list out uh direct primary care. Um on occasion you can look up concierge and make sure that they're designated as direct primary care, but uh this is uh uh this is where it's going. And and we we want people to reach out and and talk to DPCs. DPCs are much friendlier as a group uh than the traditional doctor's offices because we're not we're not hammered uh uh quite the same way. Um and so we we tend to be a happier uh group. Uh we are taking medical students to have them rotate through um and get them a good experience so that they they can get excited about medicine again and and that we make primary care a viable option uh as a career uh instead of just uh hoping to go work for a big health system or or in you know insurance contract. And it's just we we want to show people that that this is uh this is a real uh good option right now.

SPEAKER_00

So I love it. You you know it's funny when I was in medical school, the star of medicine back then in the 80s was the general internist. And then all of a sudden, they're just disappearing because they'd all say, Well, I don't want to do that, and they're gonna become a subspecialist. And I I love general internists. I mean, they're really helpful, and you know, they had that full breadth of their practice and they're smart folks and you know, always willing to help you out. And so I'm glad they're they're coming back and that there's a path back. So I'd love when you turn the clock back and we get back to where we should have been all along. But thanks for what you're doing. I really appreciate it.

SPEAKER_01

All right. Thank you, Jim. I appreciate the time. Um, and anyone can reach out to me if they uh if they want, we're at steelmanmedical group.com. And uh it's uh it's easy to take a look at our uh our website and see what this kind of thing is. Um also uh anyone, any residents, any students, other physicians, the direct uh primary care alliance uh is uh is a uh a major body uh uh has an annual conference for anyone who's uh DPC curious uh down in New Orleans uh coming up in July of 26. Uh and then uh the Direct Specialty Care Alliance Online uh has their own thing. So this is great.

SPEAKER_00

You know what? I'll put those links in the show notes for everybody, make it very easy. So, you know, because I love that that we always need that call to action at the end. And I'm actually gonna go to the Health Rosetta conference this year to check that out, and I'm going to kind of meet DPC docs and and talk with them and do that because I'm very excited about this. And we'll do is we're gonna close this out. And please like and follow for more. And please like and follow Dr. Steelman. He's got a great Instagram page, he's a great social media star, and he's always got something to do on there. I love watching. My wife loves watching the Instagrams as well. And then please like and follow for more. If you have any questions, please let us know. We're happy to answer those. And we'll see you at the next episode. Thank you for following. Thank you for listening. If you made it this far, thank you for listening. And thank you, Dr. Stielman, for giving us your time.