[INTRODUCTION]
Announcer
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[EPISODE]
Christopher Habig
Hi, everybody. Welcome to Healthcare Americana, the podcast where we explore the intricacies of healthcare, share inspiring stories and bring you insights from industry leaders. I am your host, Christopher Habig, the CEO of Freedom Healthworks. Today, we're diving, of course, a favorite topic back into the world of direct primary care with a focus on the choices physicians face when starting a DPC practice. Joining us is the fabulous Dr. Michelle Cooke of Sol Direct Primary Care, who has successfully navigated this path. Dr. Cooke, welcome to Healthcare Americana.
Dr. Michelle Cooke
Thank you, thank you so much, Chris. I'm excited to be here to talk about my favorite topic as well.
Christopher Habig
Well, I'm going to assume that is direct primary care. So let's, let's dive into it. Whenever I talk with a DPC physician, and of course within Freedom Healthworks, we get to day in day out talk to doctors who are making a difference and actually changing the way we do healthcare and making a difference in patients' lives. And it's, it's very rewarding for me and my team and I to be here. But I always love asking, you know, Doc, when you decided to do this, what was, you know, was there one thing where you're like, okay, this was the straw that broke the camel's back. This was my, aha watershed moment where I'm like I can't do it anymore in the in the previous way I'm gonna say the old-school way of practicing medicine and that insurance-based third-party payer. I gotta go out and do something else when was that moment for you what was the real motivation for getting out and doing something different?
Dr. Michelle Cooke
Excellent question, Chris. I really think there were so many things, but if I had to really pin it down to one moment, there was a moment where I tell people I work to travel, I love vacation, and vacation is very restorative for me. And I went on a vacation when I was still an employed physician, and it just all went wrong because despite asking them to block my schedule multiple times, I wouldn't have patience on the schedule while I was away. That was not done. When I returned, I had multiple patients on my schedule who wanted to be double and triple booked because they hadn't been removed from my schedule prior to the vacation.
And when I came back, I felt like I was being punished, you know, and all the benefits I got from that vacation were completely gone. And when I realized that vacation was not restorative anymore, that I just knew it wasn't going to get better. There's that moment you hit where you realize you can deal with a bad day, you can deal with a bad week. Sometimes you can even deal with a bad season, like flu season or something like that. But, the chaos just becomes business as usual and you're always overburdened. And when I realized it wasn't going to get better, I knew I had to make a change.
Christopher Habig
There's an old saying that you hear every once in a while that if you truly love what you're doing for a living, you don't go to work a single day. And I'm always saying like, you know, that sounds great. Of course, everything, every bumper sticker sounds great until you actually start thinking about it. But there's always, in my mind, there was always like a third component to that when it came to physicians. That, okay, this isn't a career, it's not a job for the vast majority of physicians out there. And I believe that most physicians enjoy taking care of people, but you know, and yet that saying just never ever rings true because there's this third component like you just talked about.
Like there's this one that's like boogie man in the room that says, even though you're doing what you want to, you're called to it, you're taking care of patients, there's like this pressure, there's this weight that's a third component of it. And so it's like, we got to change that bumper sticker to say, if you love what you're doing and you're able to actually do it, then you never work a day in your life.
Dr. Michelle Cooke
It's so true. And I think a lot of us go into medicine because we do love what we do. But what happens is we have this terrible loss of autonomy, especially when you're an employed physician. I think that's largely what I was suffering, that I had no control over my schedule. You know, like I knew I could see it coming. I could see there's patients on my schedules, but I literally did not have the power or the authority in the EHR to change my schedule. I had to get permission for every little thing.
If I wanted to be away from my son's teacher meeting, I could not do it. Like I had to always ask permission for me to live my life. And I think after you go to medical school, you know, you know, you, you, you suffer for a little bit, you know, you're willing to be a team member and you, you put some of your needs aside with the expectation that it will get better and you'll have more control over your time and the way that you practice. And that just did not end up being true. Where that got even more real for me was when I realized that that lack of control was putting my patients at risk. You know, it's not safe to see double and triple book patients.
It's not safe to see more patients a day than you're comfortable seeing. And I realized that the more I was doing that, the more I was putting my patients at risk. I didn't think that my institution would back me if I had a bad outcome. And so again, just those multiple things that kept coming up made me realize, nope, this can't keep working because when it hits the fan and it will, it's not if, but when there's a problem, I didn't have faith that I wouldn't be thrown under the bus. And so I just stepped away and said I had to do it differently.
Christopher Habig
Was there a moment where you thought, I'm not sure if I can be a doctor anymore?
Dr. Michelle Cooke
It did get to that at times. It did get to that at times. I still, I always tell people, I love what I do, but I hated the way I was doing it. And I don't want to say I ever thought I didn't want to be a doctor, and this is going to sound hard, but we're exiting mental health month. And I always tell people, I never thought I was suicidal, but it crossed my mind a lot more than I was comfortable with.
You know, there were times I hear about, luckily, none of my immediate colleagues, but you know, in Atlanta, we've lost a lot of physicians to suicide. And I just remember thinking, I get it. Like I get why people will just want a total way out of this. I get why they'd want to do that. And the thought crossed my mind so much. I'm like, are you suicidal, Michelle? Like I had to ask myself, and the fact that I had to ask myself that question so many times really, really bothered me. So I didn't really want to leave medicine, but I didn't want to do it that way. I'll tell you that, you know, I'm on a lot of physician forums, especially on Facebook and different groups.
And you would be amazed to see how many physicians will jokingly, but they're serious and gosh, it'd be nice to just kind of break my leg right now and have a reason to be out of work. Or oops, if I got an accidental pregnancy, gosh, maternity would look really good right now just because they want a break. And we feel like we can't make it or ask for it. So some catastrophic acts of God has to take us out of this. So I don't say I never wanted to be a doctor, but there were times where I just wanted it to stop. And the thoughts that were crossing my mind were more uncomfortable than I was okay with.
Christopher Habig
Yeah, it's almost like you heard that terminology when you look back and read about World War I soldiers in the trenches. They're like, well, if I just had an accident, I could get out of the front lines here. Or in Vietnam, like maybe I could get out of the jungle, I could get out here. And I'm drawing that comparison just as you're talking there, because if we're treating our physicians, and even through COVID, we're like, no, front lines, front lines. You can't be on the front lines always. Even soldiers are rotated in and out before, you know, they do something bad to themselves because that is very oppressive for any type of human being.
Now, when you were looking at this and you're saying, what is medicine going to become? I totally agree with you that there's so many physicians out there who either they get their spirit broken and they're saying, look, I don't really know what else to do.
This is what I, you know, I wanted to be a physician. I worked my entire life for this. I don't think there's another option out there. Obviously where you are now with your own DPC practice, you found that other option. So give us kind of a breakdown of those when you're saying, you know what? Here is kind of this light bulb moment that I have to find a different way to do something that I love to be a doctor. Was that looking at, all right, how do I become independent again?
Or is there a place that is better to their employees than my current place? Walk us through kind of your decision points along the way in those very early days when you decided that there needed to be a change.
Dr. Michelle Cooke
Absolutely. Well, I learned about DPC probably about five years ago by one of the great Dr. Julie Gunther, who's I consider one of the godmothers of DPC. She spoke at a Georgia Academy of Family Physicians meeting. And I remember listening to it and saying, this is how healthcare should be run. Like this is exactly why I wanted to be a doctor.
And my biggest fear was I didn't have a business acumen. You know, I didn't get an MBA, I don't know business. Like I'm terrified of business. You know, that was my background, but I just wanted to come in and be the doctor. I didn't want to worry about the business practice. I didn't want to worry about hiring or how the lights stay on. I just wanted to be the doctor. And so a lot of it was just fear, fear that I didn't know how to make it work. And I think as more physicians are employed, a lot of what we're exposed to now are these big machines of healthcare.
You have this huge system and all these departments, and it makes you think that you need all these components in order to make a practice work, and it can't be more far from the truth. But that's what we're exposed to. The physicians coming out right now really haven't seen the private practice model. It's been dying, so there's only 30% left, and they're struggling. So when you look at it and say, gosh, if this large healthcare system needs all these pieces to get running. How on earth can I do it on my own? So you get extremely intimidated.
And it took me hitting that point of realizing it wasn't going to get better to say, there are other doctors doing this. I got mentorship. You know, I got to touch some of these practices and go and visit other doctors who are doing this model. Like, wow, you know, seeing it is believing and seeing that can work. And these doctors were happier and they had more time with their patients. Like, I think we have to show physicians that there is a different way because you can get blindsided to thinking there really only one way to practice medicine that requires like this behemoth systems to make it work and that's so far from the truth.
Christopher Habig
So it sounds like you know, when you're in employment, you're like, okay, there's this thing called DPC over here. So you went like, all right, DPC first, then I'll figure out how to be a small business owner. Cause we talked to some people and they're like, I needed to go do my own thing. I thought I was going to spool up a big insurance practice. Turns out didn't even need to do that with the overhead and everything along those lines. So there's, my point is like, there's a lot of really personal paths into getting into independent practice. And I think that's where, that's where, you know, we, I'm a big fan of that saying, look, it's up to us to figure out, us as a society, to figure out how we get our most educated, our most intelligent, and our most empathetic people, our physicians, our caregivers, into a place where they are free from somebody else's agenda and they can actually go and care of us. What a novel concept there.
So, all right, so here's Dr. Cooke. She's like, all right, I'm out of here. See you guys. I'm going to go. What was that experience like when you told your employers, I'm out?
Dr. Michelle Cooke
I think in some ways, it's funny how everything happens for a reason, but in some ways I look back and I feel a little bit lucky, because in some ways I was pushed out. What ended up happening is that I worked for a large healthcare system in Atlanta, and the system covers more than just the city of Atlanta, but Atlanta was their market that was failing the most financially. The story is that they were losing so much money in the Atlanta market that they were going to close down their Atlanta practices. So we've actually closed two hospitals, which is insane to think about two hospitals in Metro Atlanta closing and all the primary care practices closing with it.
So I was given a termination for my position because they intended to close the practice. They're like, you know, we're leaving this market, you know, it's not working, you know, we're going to terminate this position. So it wasn't because of my performance, it wasn't because of anything I did wrong, but that termination was kind of my ticket to freedom. And it told me a couple of things. It told me like, Michelle, it's clearly time to go. You know, sometimes when you're not ready to leap yourself, like you get pushed. And so I was kind of pushed.
The second thing it told me is like, if this big system is crumbling here, then we clearly are doing it wrong. You know, most business models fail because there's, you know, lack of engagement, lack of customers. And that's so far from the truth in healthcare. Everybody needs care is looking for it. So how do we not make this model work when there's so many people who are dying and begging for care? So it was just more proof to me that this model is not sustainable. It's not appropriate and there's got to be a different way so I didn't have to, I would, I admire my, my colleagues who are brave enough to write that resignation letter internally. I can imagine how difficult that was. That was one thing I didn't have to do because it crumbled around me. And so it was kind of my freedom to walk away and say, you know what? It's now the time.
In the back of my mind, I was planning to do DPC. So I had my own little exit strategy, but it came a lot faster than I expected. So I was shoved into it much sooner than I expected.
Christopher Habig
I'm sitting here laughing because it's something I say like all the time is, how is healthcare with increasing demand, demand doesn't go away, right? How is your business model so broken where you cannot make things work? It just doesn't make sense to me. That's why I'm sitting here chuckling behind my microphone here. So, all right, so this hospital system says all these clinics are gone.
I'm going to kind of be a little facetious here and just assume that, okay, so we had a couple dozen DPC clinics spring up out of the ether, right, in Atlanta. All these doctors must have gone DPC, right, because why else wouldn't they?
Dr. Michelle Cooke
Well, of the doctors in my cohort who worked in the Atlanta market, I was the only one that went DPC. So I was the first in Southwest Atlanta to start a DPC practice. Some people had the option of staying on with the health system, but going to a different market, like going to a different area of the state to practice. There's some that left the system altogether and went to other healthcare systems. So a lot of people pivoted to different healthcare systems. It was pretty sudden. And of course you can imagine when a healthcare institution goes down, like the vultures come in.
So all the other hospital systems like, ooh, there's doctors available, let's go grab them. So they went and got a lot of my colleagues. However, most of those colleagues are calling me every day saying, it's just as bad over here. You know, what are you doing? We want to join. I just knew, I knew I wasn't gonna go play for another team. Like if the field was still the same, like it just, it didn't make any sense to me. And most of my colleagues who stayed on board or stayed with different health institutions are calling me now saying, you know, Michelle, this is not working. Like how can we do what you're doing? How do you get into DPC? So it was clear to me that I made the right decision.
Christopher Habig
That's why I had to stifle my laughter there. People accuse me of laughing at my own jokes every once in a while, which I'm like, yeah, I'm guilty. But I had a feeling, I had a sneaking suspicion that there were maybe one, you, or maybe another one out of all this stuff. And so it's almost, I called it a couple years ago, like Stockholm Syndrome, when doctors are on this and they're like, I hate this. I'm not looking forward to Monday. And then like you said, they are basically pushed and be like, okay, now you're out there in the wild. We’re closing these down. And what do they do? They run back to their captures.
And that I think is something that we need to solve. And again, I'm saying we as an industry, we need to solve that. Thinking about overcoming the challenges and overcoming, use the word fear earlier in this discussion, overcoming that, what do we need to do in direct primary care and even branching out into direct care to say, hey, doc, this isn't a leap of faith. There are choreographed sets. There are trailblazers who've done this from the DIY model. There's people out there that will give you books. There are people who have written kind of checklists.
There are full-service companies such as Freedom Healthworks who say, look, be able to invest in your practice all the way through. Point is, there are options out there that fit almost every single need, every budget, and every skill set, and fits everything that they want to do, yet we still aren't seeing this massive influx of doctors. It's growing, but it's not growing enough in my mind.
Dr. Michelle Cooke
Right, I agree. I think the first piece of education for our physicians, and what I'm going to say here is going to sound very harsh, but the further I get away from the system, the more I'm seeing this system is corrupt and unethical. And as physicians, I think we have felt for so long, this is the only option we have to practice. But the more we participate in the system, the more we're contributing to a system that truly hurts patients.
We have lack of price transparency. We have patients who are uninsured that can't access care. We have patients who are going into bankruptcy. We have patients who are not getting the time with the doctor that they need because we're limited to 15-minute appointments. And so the further I step away, the more I look at it and say, this is just wrong. It's just wrong. And so I really hope that can appeal for my physicians from an ethical standpoint. Like we stood up and said, we first want to do no harm. And every day we work under the structure we are doing harm.
And I can't state that enough. And I'm not trying to make physicians feel bad, but really question whether what they're doing is helping others or is it causing harm. And as I walked away, I realized I was truly, yes, I was helping sometimes. Yeah, you'd fix a cold, you'd lower some blood pressure, but overall, the medical bills my patients were stuck with, not being able to access me when they needed to, having to go to overuse the ER, referring internally to a system when it wasn't in the best price interest of my patients, like I was part of the machine that was hurting patients. And most of us are if we're employed physicians. And so I think getting the education out there that no, this is unethical and it's wrong. And I think that should be the biggest impetus to push us into different care models.
The second thing is giving a pathway to say that it's going to be okay. You know, we have to educate the rest of the community as well. We have to educate patients saying, you know what, you're probably just gonna save a lot more money and get much better care if you go the direct care route. People don't believe it until they taste it themselves or they hear the story. So that's why I do so much outreach and advocacy sharing the stories that I saved this person $1,000 a year just in medications alone, you know, with using direct care models. So we have to get that part of the story out there.
The other thing I think is we have to get industry involved to make it less risky. So one thing that's beautiful about direct primary care is that physicians can start small. Like I started with a micro practice. I was subleasing from another physician like a lot of people say that the joke is you just need a stethoscope and a tubal loop to get started.
So I love that joke and it's kind of true. That's really all you need. And I'd say an EHR, some type of organization system, but that's really all you need. Patients come to see you. They want, they want to get heard. We always are told that your history and physical are the most important part of medicine. And you don't need these bright, shiny institutions to do a history and physical. But my point of getting to that is that to start these practices, no, you don't have to be very debt heavy, but it's hard to find financial institutions that are willing to help support physicians in these new models.
So as doctors are looking for business loans and things to get started, they're like, you don't have insurance contracts? No, this is way too risky, way too risky. So finding capital is a big problem. Many of us who have graduated in the past 10, 15 years are super debt-laden. So I understand making this leap is really scary. You know, we have loads and loads of student debt. We do need a way to pay the bills.
Many of us bootstrap our practices, but some people do need support in the form of business loans and grants to help fuel this forward. So I think we need to shift where we're spending the money in medicine and help use that to back the physicians that want to start these type of practices.
Christopher Habig
From an institution standpoint, and again, I'm gonna assume that you know, when you say that it's going to be including universities, residencies all the way through and not just feeding it into, you mentioned capital specifically, so not just financial institutions, but that goes along with it because it's the education and the fact that there's so many banks out there, I guess, you know, just to kind of vent from my standpoint a lot, that we'll go talk to different types of banks and try to address the problems you just talked to right there, talked about right there. And so many banks are like, yeah, we got products for physicians, it's great. Like awesome.
Here's what the docs want to do. They want to start a new business and they kind of look at me funny like what do you mean? They want to use a proven framework that our team is helping them with. Here's all the past success that doctors in Freedom Healthworks have been using. Here's their three-year pro forma. We're really good at hitting these things and I go, well wait a minute, that's really cool. But no, our doctor products are to go out and buy a new boat or a new house and a new car. And so from an institution standpoint it's like they will loan but they want to drive home more just over and not even overhead it it's more oppressive…
Dr. Michelle Cooke
Lifestyle creep, right? You want that boat, so you have to pay for it, or you got the bigger mortgage and you pay for it. And it is nice. It's a nice perk as a physician to have access to those things. But I think what we really need is access to capital to start these businesses. It's funny that we're looked at as so risky, but the average DPC breaks even much faster than any other business model. So, you know, I'm not a business person. I tell people that all the time, because I think because I talk about this so much, people think I know business. I don't know business, but I'm learning as I go.
And my business broke even at 3 months, 3 months in. Why? Because I'm not taking insurance contracts and fighting for every dollar and revenue cycle management won't kick in until 4 or 5, 6 months down the line. From day one when people signed up, cash was coming in. So in some ways, words like some of the least risky businesses, if we had a little bit more of a bump, a little bit more capital to get started, I think we could grow even faster. So again, telling that story, getting these banks, because you really just need a couple of them to say, you know, to catch on and say, hey, I think there's something really going on here.
And it can be the primary bank for DPC startups. And they're going to be the strongest banks ever because they're the one bank that gets healthcare right. So I do think we need to tell that story and start to get more allies who are willing to invest time and capital to make this dream work.
Christopher Habig
Hear you loud and clear right there. So, well, we've got some ideas, I think, like that maybe a different a future topic. We'll have to dive deep into that one. Yeah. So it's like it's something that doesn't just load on the debt. Right. And just drive doctors deeper. We see that a lot like residencies. You get out and it's all sudden it's like, here's a boat. Here's a car. Here's a house. Boom, boom, boom. And then they become addicted to their salary in that they just can't survive the interruption. Right. We've talked to doctors who are like, I need 30K a year a month just to meet my bills.
I'm like, holy cow, why did you think this was sound financial? Well, because I'm a doctor, right? And everybody's telling me I can go out and do this. So there is some, like I said, institutional education's gotta go on from the business savvy part of it. And you mentioned, you're like, hey, I don't know a ton about business, but I'm learning. And I love that mindset because it drives me nuts when I hear a doctor be like, yeah, doctors are just bad at business. And I go, well, hold on.
Everybody's bad at business because it's hard these days from a regulatory standpoint. I go, I wouldn't go put a hot dog cart in downtown Indianapolis on the Circle unless I've talked to an attorney, I've talked to the right type of people for permits, I've talked to the right food vendors. It takes a team, it kind of takes a village for any business startup because we've built so many different type of potential pitfalls, I guess, in the business environment. So I tell docs all the time, like, cut yourself some slack. Take a deep breath. It's okay.
You know, there are resources out there to help you avoid being shut down or avoid very expensive mistakes. But at the same time, that small struggle is important because that's how you learn. And I think too many people are saying, well, I don't want that struggle. I just want the nice, you know, posh, I can go in, punch a time clock at 8am and I get to leave at 5pm. That doesn't exactly exist in medicine for most people. So going back to your experience there, you know, you've talked about being a very big advocate in your community for patients. We'll come back to the physician side of it, but from your patient side of it, you know, what are some of your tips when you walk out and say, look, look, it's when you talk to people, you've got to be comfortable having that message because nobody can sell this practice like the actual physician owner.
Dr. Michelle Cooke
Mm-hmm, this is true. Honestly, the idea really sells itself. I mean, one of the things we talk a lot about in selling our practices is go ask patients what their experience is like in healthcare. It is rare that I have somebody tell me that they have a wonderful experience, they can get in touch with their doctor and they get to ask all their questions and if they call their doctor, we'll call them back or they, like, it just doesn't exist.
So when patients call my office, you know, at first there's some hesitancy about, it's a monthly membership fee, don't take my insurance. I was like, well, tell me about your healthcare. Why did you call? There's a reason why you called. They're like, well, this happened just this week. I had a patient call who had been struggling to find a primary care doctor. Her doctor retired. She was referred to a new doctor and I actually know this doctor. She was referred to a new doctor, had scheduled her appointment in August, couldn't get her first appointment till December.
December, she meets the doctor only to find out that doctor's leaving the institution the next week. So she's waited all this time to get face to face with this doctor who's now gone. And so when I tell those patients, it's like, you know what, my patients here rarely wait longer than a week or two for an appointment. And the other thing is I'm a business owner. I'm not an employee, right? So it's going to take a lot for me to just up and walk away from this and leave you abandoned like that and not let you know what's going on from the front end. When we're employed, you know, we're kind of like LeBron James, we can take our talents to South Beach if we want.
We could just pick up and run if we want to. We're just as good as the contract is. So you do see doctors hopping around and it really hurts that primary care relationship. Now I don't blame those doctors for looking for greener pastures, but what happens is that we have these serial like interrupted relationships with patients and they get bounced around and every time they're seeing a new face and we know that that's not quality care. So when I tell them, yeah, you get to see me every single time.
When you call, I'll call you back. If you text message, I'll text message you. When you come, I schedule 30 to 60 minutes to sit with you. We're gonna get your answers met. And if you leave and you forgot something, just give me a message. Like it doesn't end here. You don't have to come in with like that list and that pressure part of like, my God, I got 12 questions asked. Let me get it out now. And they start speaking really fast because they know that they're gonna be kicked out so soon. So when patients get through the door and have the experience, the anxiety goes down. They're like, I don't know why I didn't do this sooner. Like my health is so worth it to be able to have a doctor who's gonna be in my corner.
And so again, just telling that story, letting the patients tell their story, having patients do reviews on your practice to tell the community what the experience is like, that's how we start to sell the story.
Christopher Habig
The brilliance in what you said, the big takeaway is that the key to sales is to ask questions. And I think so many doctors struggle with that and we see that from docs. We're like, well, yeah, I had a bunch of meet and greets or initial interviews, whatever you want to call it. We're like, great, what did you say? Well, I told them all the great benefits about this. Why were they there? Why were they sitting across the table from you? I'm not sure. Ah okay. So revisit that, you know, your pitch to say, why are you calling in here, right?
Because I love where you went there of once they realized that, okay, you know, paying a health insurance premium is not actually paying for healthcare. Paying Dr. Cooke's monthly membership is actually paying for healthcare. Then I think there's almost like a physical switch you can see in people's faces. We're like, wait a minute. This actually makes sense.
Dr. Michelle Cooke
Yep. Yeah. Cause everybody has different needs. Like that patient I talked about her, her need was access, which was really important. I've had at least two physicians join my practice who call, and these are physicians. You think we know how to navigate the healthcare landscape, but one of the physicians had a rough year in terms of some health issues that popped up and she's like, you know what, Michelle, I can't tolerate another surprise bill. I just can't. She was like, you know, all these issues happen. I know I need to seek care because I know how serious this issue can get.
And every time I popped in, there's always some bill coming $500, $350. I never knew when they were coming and when they were going to stop. She's like, so, you know, it seems a little unusual pay us monthly membership fee, but it's all upfront. So that's what was appealing to her. So you start to figure out what patients are looking for and you can speak to that.
Christopher Habig
Absolutely, absolutely. Going from patients into physicians, you mentioned that you get a lot of inbound of, hey, Dr. Cooke, how did you do this? What are you doing? What do you like? What are you saying about it? Is there a certain demographic of physician that is reaching out to you? And there's a reason why I asked, but I just want to hear your answer.
Dr. Michelle Cooke
Absolutely. I would say it's definitely the employed physicians and that's, and that's my background is too. I came from the employed space, but I'd say employed physicians who are at least five years out. You know, when you first get into your employed position, it's all great. You know, they've, they've courted you, you know, it's nice. Your patient panel isn't huge yet, but I think by the time you hit that five-year market really gets real. It's like, Whoa, I have way too many patients, not enough time. I thought I was going to have more time with my family or for hobbies. And all I'm doing is just.
I'm on this cycle where I just got to see see see patients and then do all this in basket and there's no relief, there's no help, like there's nothing there. So they get this point where like, I can't do this for the rest of my career. And if I'm going to stay a doctor, I have to do it differently. So it's certainly the employed physicians largely who are calling me. But there also has been a lot of interest from medical students and residents who I think are looking at the landscape. You know, we've seen the data saying that 25% of medical students don't even want to practice but they're looking at the landscape and saying, if I'm gonna do this, there had to be a different way.
So that population is starting to rise too. I do some education with the medical schools in my area to talk to students about the direct care model and I have them rotate with me so they can see the model themselves. So there's lots of people that are coming, but I would say definitely the employed physician, so I think really feel the lack of autonomy.
Christopher Habig
Totally agree with what you're saying there and totally corroborates with what we see. It's like doctors have to have that first hospital contract burn off and then they're like, okay, I can't keep doing this for the next 35 years going forward with it. And what surprised me really was that the majority of physicians that we work with at Freedom Healthworks are female physicians.
And we've been trying to think like, okay, so we hear all the time that healthcare is a male-dominated industry, and it is, but yet, DPC, there seems to be a significant number of female physicians leading the charge when it comes to direct primary care.
Dr. Michelle Cooke
Absolutely. I think we're seeing a tide shift across a lot of the academic industries. I think for the first time a couple of years ago, we hit 50-50 with men and women graduating, and I think women have now surpassed that. I also think in primary care, I don't know all the stats, but if I had to guess, if we're thinking about people who go into primary care, I think that's definitely more weighted towards women over men. A lot of my colleagues, when I was in medical school, went into specialty care that were males, and many of the women went into specialty as well, but I think more of us went into primary care.
Christopher Habig
I'm curious now switching into, all right, here's the people raising their hand and saying, yeah, I need a way out of employment. This direct primary care thing sounds really, really cool.
Do you, where do those conversations go? Because, you know, we consider you to be a DIYer and that's not a, that's not a knock or anything. Like I salute everybody who's able to do it. But there's this, there's this kind of, whenever I go to a conference, it's like, there's this fierce competitiveness over, or really, I don't even know if competitive is what I want, but there's like the stigma that it is not okay to ask for help. And again, I'm not just going to sit here and plug in Freedom Healthworks and say, Hey, this is what we do all day, every day.
But there's a lot of people on stage saying I did it this way and I mortgage two houses and you can do it too and that's what the sacrifice is about and I'm like that's just that just feels toxic. You don't have to buy our services. That's okay. But yet don't come out here and hit people over the head because you're just acting like a hospital admin when you're saying, it's not okay to ask for help.
Dr. Michelle Cooke
Right, right. I'm really glad you brought this up because I have a lot of thoughts about this topic. I think number one, when people call a lot of the conversations about mindset, you know, just getting over the idea that you can practice differently, like how does it work? How do you, you know, is it really real? Like people don't believe it's real that you can practice in a different way. And then the second part is, you know, do I have to do it all myself? And there's some people that want to do that. You know, I came in not wanting to be an entrepreneur, but I have some colleagues who are like, I've always wanted to start a business, and this is just my opportunity and they're just ready to go.
They've already had some side hustles and you know, they're ready to go and they want to just DIY it and that's totally cool. But there's some of us who are just so kind of crippled and need some hand holding just to make sure they have a guide to go into it. And it just, it's just that, that form of safety. And I think asking for help, as we say in medicine is one of the biggest signs of wisdom, like knowing what you don't know and making sure you find the resources to help get you there.
But what I think we have to be honest about is that we have been burned, especially if you're an employed physician. So we've had these administrators come to us, promise us these contracts. And so there is an inherent mistrust of industry. It's kind of like, okay, what do you want from me and how are you going to burn me? And so I think there's a lot of times where physicians don't want to engage with other people from industry because we're weary and I think we have every right to be so based on what's happened before.
And that's where that vetting process really comes through. So we have institutions like Docs for Patient Care. We have the Direct Primary Care Alliance who start to look at these partnerships and say, not to be so black and white, but like, who are the good guys and who are the not so good guys? You know, because sometimes we have a hard time seeing the difference because we thought that our employers were the good guys until they weren't. We thought the insurance companies were the good guys until they weren't. So now it's kind of like, I have to look at everybody with a side eye before I decide to join them, give them my resources.
And so I do think it's smart to have a bit of skepticism, but I think we're learning that there are people in industry who really do want to help and want better healthcare, not because they want to take advantage of physicians, but because they want to see a world where there's access to care. We all need great doctors. Their parents need great doctors. Their children need to have great doctors. And I think people like you with Freedom Healthworks, we see where this is going to go if we don't make a change like yesterday, you know, like it's crumbling before our eyes and like we are so behind the eight ball with being able to catch up with care.
And it's like, we need to get all hands on deck to help people. But I do think it's important for physicians to know it is okay to ask for help. It's okay to get as much help as you need. And sometimes you do have to pay for that help and that's okay. I share with people that one of the biggest investments I made when I started my business was to hire a business coach.
And I hired somebody who's adjacent to industry, but not quite in industry. Cause again, I had that level of mistrust. I don't want anybody in healthcare, but I hired somebody who was a small business owner and scaled his business and is doing really well in his business right now. Cause I was like, I need to know how do small business owners think? How do you navigate situations? How do you interact with vendors? And you know, at first I had some naysayers like, are you wasting your money on this? How do you know you're going to get a return? It's hard to compare where you would have been versus where you are now, but the comfort of knowing I have somebody I can bounce ideas off of and not go down rabbit holes and all of that is just worth its weight in goals.
And I do think I was more successful because I got help. When we look at the best performers, I referenced LeBron James earlier, but if we look at the best competitors, they have coaches. Michael Jordan had a Phil Jackson. We need people to help shine that light on us, show us where our faults are and help get us stronger. Are there people that do it on their own? Certainly, but that's not everybody, nor does it need to be everybody. So it's okay to ask for help.
Christopher Habig
Looking at your experience, and this will be one of my last questions here, looking at your experience, you talked about how important it is for people to vet those who they think about asking. What are some of your recommendations? What questions should people be asking if they're looking at asking for help from outside partners, us, anybody else that kind of play in that DPC space or adjacent industries like you just described? So, kind of a two-part question here to it, I'm getting to it, the anticipation, right?
What's your advice for somebody on how to vet potential partners? And then secondly, you know, through your experience looking back, are there any other places where you're like, this is where I should have raised my hand and I wish I did so?
Dr. Michelle Cooke
Good question. The first thing that comes to mind, one of my favorite questions is kind of what is your philosophy on healthcare and what do you think the biggest problems with healthcare are right now? And I think that can tell you a lot about, about whether this partnership is going to work. I remember I was speaking with, I can't even remember what this gentleman was offering me, but he was somebody that did like practice improvement. And he's like, yeah, we're going to boost your insurance contracts and make sure you're putting the right codes out there. And immediately I'm not doing that.
So there was nothing more he could say to me that was going to get me to come on board with him because I'm like, no, I'm done with the world of having to code for payment. And it just doesn't make any sense. So when you ask people, you know, what's their philosophy on care and what's and what do they think the biggest problems are healthcare? I think that tells you a lot. I think the second part is see your results. Who have you worked with before? You know, do you have references? Are there people who have worked with you in the past who can tell me about their story of working with you and see how aligned you are with those people? So those are probably the first two approaches I would take.
Making sure you're in alignment is so important. You know, it's not just about what they can promise you or the revenue that they can promise you, but making sure that you're in alignment. I think when you're moving in alignment, the rewards will come because you're moving in an ethical direction. And I think that's true for physicians that start their practices. And we didn't talk a lot about like all the different options for DPC, but it's cool if you want to be employed by a DPC practice. Maybe you really have no desire to be an entrepreneur and start a practice, but you don't want to practice the way that we're practicing. So find that practice that's in alignment with you.
Find that doctor that sees healthcare, you have the same vision for care. You want to see patients the same way, you have the same interests. And I think joining that is also incredible and that's okay too. So looking for alignment, I think is probably the most important thing.
Christopher Habig
And so the second part of that, looking through your own journey, was there any point where you're saying, you know, I should have asked for help here and vice versa that, you know, I actually could have gotten through certain points of this without asking for help.
Dr. Michelle Cooke
Good question. I think the further I'm in the journey, I think I've had more discernment. Because now my thought is, how much do I want to figure this out by myself? There is some benefit of just going through the process and showing your work, if you will. Right? Now I'm at a stage in my practice where I'm like, I'm going to waste a lot of time trying to figure this out if there's somebody out there who's an expert that knows how to do it.
So one thing that my DPC journey has brought me is just doing a lot more reading. So I'm doing a lot more reading about self-help and business and entrepreneurship. And one of the last book I read was “Who Not How” by Dr. Hardy. They have strategic coach, I believe is the company, but they did, you know, 10x Is Easier Than 2x” and “Who Not How”. And the premise of this book is don't always try to figure out how, look for a who, because there are who's out there, meaning a who like they just do nothing else and they're just so good at making a website or they're just so good at setting up a process or so good at whatever it may be.
And that's the person you want in your team. It's going to be worth your weight and goal just to pay them to do what they do. So with my website, I could have built it, but I'm terrible at website design. I would have had to Google all this stuff and it would have taken me hours and days and it would have been a subpar product versus could I hire somebody to do that?
They give me a stellar product. I'm ready to go. And the time that they spent doing that, I can get other things done. So I think as you go on your journey, you learn what your strengths are and you should be working in your strengths. If you can do it and do it the best, then do it. And the things that we do best is see patience, right? That's what we need to really be focusing our time on. And there are some business things that you shouldn't defer. Like you should be looking at, you know, your prof and law statements. Like there's certain things you need to be doing, but there's a lot of other things that we're actually going to be so much more effective if we hand it off to somebody who knows how to do it better.
And that's totally fine to do. In fact, you're going to get farther. They talk about if you want to go fast, go alone. But if you want to go far, go together. And so the importance of building your team and getting your support is, is it's, it's priceless. So that's what I've learned as I've gone forward. It's like, you don't have to do everything. And in fact, like, it's not a badge of honor to do everything if you're depleted by the end of the day. Get the help you need to go faster and go further.
Christopher Habig
It's this concept of opportunity cost and it comes up a lot, right? Like so many physicians, and I sympathize with this being raised by two physicians, that they thought they had to have all the answers all the time because when you're in an exam room, and somebody asks you a question or you get a bad diagnosis, what do I do next? You've got to be prepared. You are the one, you know, it's the old, the buck stops here.
But when you flip that in your physician and a business owner, the savvy business owners do exactly what you did. They find out where their best time and effort is spent and they go do that and they're able to delegate well on the other things that happen there in a smart manner too, right? It's like, don't hire 10 people if you only have five patients. Probably not a recipe for success. Might work for a few people, but not probably not the vast majority of us out there. So totally agree with what you're saying and that opportunity cost concept, it's something that we focus on a lot because, like you said, could you build your own website? Yeah, but why? Why are you doing that?
A lot of these things have commoditized. One thing that has not commoditized and any hospital insurance person might be shocked at this, but physicians have not been commoditized no matter how often and prevalent this mindset is that if you have a stethoscope and a white coat, you're all the same. That's just not true even though insurance company tries to make it that case.
Understand your value and know when you are best. Is it better to hire a lawn service to come cut your lawn or you're gonna do it yourself when you could be seeing patients or building up a business, right? There's there's little trade-offs throughout the day and the smart business owners are the ones who ready to identify that and say, you know what it is time to put this onto somebody who specializes like you just mentioned right there. Appreciate you sharing your insights.
Last question for you. And this will be more of a fun one. So I'm gonna make you the I used to ask this a lot on previous seasons of the podcast, but you are now the billboard empress of the United States. You own all the billboards out there and you get to put a message up there that drives that education point home like you talked about this need for education. And you can put this to any audience that you want to. What goes on your billboards across the US to help drive forward your mission?
Dr. Michelle Cooke
No pressure, right? Gosh, what goes on the billboard? I think if we're speaking specifically about healthcare, I would say bring it back to relationships, bring it back to the doctor and the patient. The more that we put in between there, the messier and nastier it gets, but we need to bring it back to the basics. So I think that's probably the thing I would say, bring it back to the basics. And if we can get to the basics, I think we're going to go so much further.
Christopher Habig
Dr. Michelle Cooke with Sol Direct Primary Care. Dr. Cooke, it has been an absolute pleasure. Thanks for joining us.
Dr. Michelle Cooke
Thank you.
Christopher Habig
And a big thank you to all of our listeners. Remember to like and share this episode on all of our socials. Visit our YouTube channel. Get to see Dr. Cooke and I here and live in color and live action, which is always fun and not just a voice behind your favorite podcast player. And again, to our listeners, we hope this episode has provided a deeper understanding of choices and the considerations involving starting a DPC practice and for patients for joining a DPC practice because informed decisions are the foundation of all successful healthcare.
Until next time, I'm Christopher Habig. Thanks for listening.
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