The Pep Talk Episode

If you've had or have any of the following thoughts and need a pep talk, this episode is for you:

This seems crazy.

I don’t know anything about business.

I don’t have any time to learn/plan/work on this.

How can I abandon n my patients?

Is this ethical?

What if I fail?

Will patients be willing to pay?

Can I really be “on” all the time?

Can I really do the job of all these other people?

What if they abuse their access to me?

What will my colleagues think? Will my colleagues think I sold out?

I’m overwhelmed.

I made a mistake.

Why aren’t more people signing up?

I miss having a salary.

I miss having a staff.

What if I change my mind?

If you're enjoying this pod, I would love to connect! Real human feedback is so deeply appreciated. Here are a few ways to reach me:

Connect with me on IG @soniasinghMD
Email me at sonia@micropracticemama.com
Learn more at www.micropracticemama.com

The Micropractice 101 E-Course is available NOW. Learn more or enroll here: https://micropracticemama.thinkific.com/courses/micropracticemama

And if you're not sick of my voice yet, check out my other podcast with Dr. Rebecca Berens: The Antisocial Doctors on Apple Podcasts or Spotify!

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Transcript

Sonia Singh MD 0:01

Hey doctors. You're listening to the Micropractice Mama Podcast, a podcast for women physicians who are striving to practice primary care sustainably and creatively with autonomy, authenticity, and joy. I'm your host, Sonya Singh, internist, PCP, and proud mother of two human babies, one for a baby, and one life-changing Micropractice. I wanna empower you to push past whatever is holding you back and make the leap to launching a practice that aligns with your values and priorities, and finally allows you to take care of your patients, your family, and yourself in the ways that you want and deserve. Are you ready to make the leap? Let's do it. Hi doctors. Today's episode is a special one, and I hope it becomes one that you listen to multiple times and you refer back to, and you come back to whenever you need it. It is called the pep Talk episode. I actually had a different episode plan for this week and I recorded it yesterday and I edited it yesterday. But after I finished editing it, I just felt eh, I don't know, this doesn't feel like a full episode. It feels like maybe a bonus episode. And I wanted to give you something else for this week. And so I am reserving that and I'm gonna release it as a bonus episode. And instead for this week, I am doing a different topic, which is a little. Pep talk. So what inspired this episode is that I find with a lot of the doctors that I've now mentored and with myself and with my friends everybody needs a pep talk sometimes. There are times when I'll speak to somebody for one-on-one consulting and they'll be so energized and excited and motivated, and then the next time I'll see them and they'll just feel bogged down and, they ran into some roadblock and they're just not sure how to get over it or something went wrong or didn't go as expected. Or they got some big bill for something that they weren't anticipating and they just look deflated and discouraged and they just need a little pick me up. And a lot of times we chat and we have our session and I can tell, that it's turned them around a little bit. And so I thought why don't I make an episode for those moments because I have those two. And I will tell you a few of those moments that I've had in the very re like literally in the last month. So one was, I had an older couple, generally I don't take patients over 65 and this couple was over 65 and they were in a very unique and terrible. Set of circumstances And they were asking me who they should see as a doctor, and I was trying to find a direct care practice that would take them. And I couldn't actually find anyone at that time. And I said, I'm not opted outta Medicare, so really I can't charge you, but I will just take you for free because I just feel for you and I want to take care of you and I'll, I'm happy to take you pro bono. Just come see me. And so I was taking care of this. Couple. And somehow in the signup, I did not realize this until almost a year into it I, I got a message one day from one of the people in the couple saying, Hey, we got this$300 charge on our credit card. We were under the impression that the membership was gonna be free for us. We just wanted to check with you about this. And I was like, oh my God, what happened? And so I went into Hint and I gave them a discount code or coupon code or I did something such that they would not be charged anything, but I needed them to go in and still sign all of the consents. So I had them still enroll in Hint, and it turned out that the coupon code like only applied to one of them and not the other one. So the other one had been being charged and I was like, oh my God. So I immediately refunded every single charge. I was like, two grand back in your bank account. I am. So I apologized profusely. I just felt so terrible. Like I just felt like the worst business owner. I was like, oh my God, I took these people on. I told them they weren't gonna have to pay anything. I've been taking money out of their account all of this time. I did not notice. Oh, okay. I had a total beat myself up moment, where I just, I mean I was thinking about it way too much for 24 hours. Yeah, but you know what they, They were not mad. They were like, oh, thank you so much. And I just, I gave them all the money back and that was the end of it. Could have gone a different way, but yeah they were honestly not that mad. Another time that I had this feeling was a couple months ago, I had a patient I was treating is actually a physician, and we were waiting for some labs to initiate a certain treatment. And the labs took a little longer than we thought to come back. And then we finally started the treatment. And then she felt so much better on the treatment and she gave me the feedback of I wish we had not waited. I wish we had just initiated this. We probably didn't need to wait and. It was very kind of her and generous of her to give me the feedback. But also it caused me to go into this spiral of oh man, did I do the wrong thing? Should I have, was I crazy to not to do that, to wait for those laugh? Did I make the wrong decision? Did I prolong this person's struggle because, I wanted this extra piece of data for myself. Was that just me, serving my own intellectual purposes, or was that really the right clinical decision or, I just I had this whole cloud of thoughts that was just what, hanging over me for several days. So that was a moment that I had that feeling where I was like, I think I need a pep talk right now. What else had, there was something, oh, just last week. I had two patients actually that had been on my, one of them was on my wait list. One of them had disappeared for a while and come back and they were both trying to join the practice and for one of them I was like, here's the link. And then I just didn't hear from her. And then the other one kept messaging me and saying, I'm trying to sign up and it's just giving me this error. And the error really didn't say anything. It just said Contact Juniper, modern Primary Care. And I didn't really know what, why that was happening. I just, I tried doing a test sign up myself and it worked. And so I was like, I just don't know, other people are, signing up and it seems to be working. So I don't really understand and. Finally after this, back and forth with her for probably over a week, three or four emails, I realized that she had actually technically signed up in the past but it was when I was not taking new patients and she had just had the link from a while ago. And then I didn't confirm the membership because I was not accepting new patients. So I saw her get added to my list and I didn't confirm it. And I told her, Hey, look, I'm not gonna confirm the membership because I'm not actually taking new patients. And that unconfirmed membership was still sitting there. So then when she tried to join, it was a duplicate and it was not letting her join. And then once I made that realization, the light bulb went off in my mind that the other patient that I had sent a message to was gonna have the same problem.'cause she had been in the practice previously, and this woman had messaged me multiple times and was like, oh, I'm going through such a bad period. And, I, my parents just passed away and I'm finally prioritizing my own health, like she needed to be seen, and then I didn't know why I didn't hear from her after that. And now I'm like, oh she couldn't join and she still hasn't contacted me back. And so now I have this horrible bad feeling that, this person needed to be seen. They were reaching out to me, they were trying to get signed up. She probably ran into the same technical glitch and tried a billion times and then just gave up. Anyway, so I've, I was feeling I, I needed a peptide. All of these things, I needed a pep talk. So I was like, let me make an episode for those times that we need a pep talk and I'm gonna cover a bunch of different. Things that may, prompt you to need a pep talk here. So let me go through the list of things I'm gonna cover. In my course I refer to this voice in our heads as negative Nancy, and she has a little icon and she shows up in the course from time to time. If you're in, the CBT world, you may think of these as intrusive thoughts. If you're in the coaching world, you may see them as limiting beliefs, but whatever you wanna call them, these are thoughts that I find pop up for me and pop up for a lot of the people that I mentor frequently. And it's normal. I think it's so normal for these thoughts to come up and they don't stop. At least for me. Maybe there's probably physicians out there who never have these thoughts and just are confident out of the womb. I am not one of those people. These thoughts are always gonna plague me and I'm always going to have to, grapple with them myself. I'm gonna share how I grapple with them and hopefully they, that helps you. So these are the ones I'm gonna go through. So I. This whole idea sounds crazy of starting a practice. I don't know anything about business. I don't have the time or energy to learn, plan, or work on a business. How could I abandon the patients that I have now and can't afford to come with me or won't join my practice? Is it even ethical to have a cash-based practice? What if my practice fails? What will patients even be willing to pay? Will they be willing to pay? Can I really be on all the time? Can I really do the job of all of these other staff and people that I currently work with? What if patients start abusing their access to me? Can I really give them access to my phone? What will my colleagues think? Will they look at me as a sellout? I'm overwhelmed. What if I made a mistake? Why aren't more people signing up? I miss having a salary. I miss having a staff. What if I change my mind and this isn't working? All right, so hopefully I have not triggered you too much. Those are like all the anxious thoughts that have, that's a good summary of the anxious thoughts that I have had in the course of starting and working on my practice. So let's start at the top. I think the first thought is man, quitting a salaried, stable, predictable, very safe, secure job and doing this crazy DPC thing seems really risky and a little insane. And. I do think it seems that way to a lot of people. And it does involve inherent risk, which I try to say all the time and not downplay there is inherent financial risk involved in this. I think anytime you are a pioneer or there's innovation happening in a field, the first wave of people that do it, do seem crazy and they are having to take a risk and they are having to make a little bit of a leap of faith. And what I always come back to is, yeah, this may seem like a risky move. You're taking the path less traveled here, but you know what the traditional path looks like. You most likely can look down the road and see very clearly what your current job looks like 10 years from now. And there's a good chance it looks about the same if your primary care doctor or harder, as your own patient's age, your own panel gets bigger. The demands of your own life change. So yes, it may seem crazy, but I would constantly remind yourself, this is a relatively new movement within medicine. Micro practice is an even newer movement in medicine. The first people to do any kind of, new model like this are going to seem a little crazy. But that's why the time is now I just spoke today with a colleague of mine here in Houston who has a mobile geriatrics practice. There is basically no other mobile geriatrics practice in Houston. She has essentially no competition. There's nobody else that is serving patients in exactly the same way that she is serving them. And in a way she can set her price and do what she wants and, design the practice exactly as she wants to without really thinking about, is there somebody else down the street doing exactly the same thing? Because nobody is. So this is really the time and people are doing this successfully. I always say this how in these big national physician groups, if somebody says anything about direct care, there's always a handful of people that just get on there to say, oh, that's not gonna work. No, who's gonna pay for that? And that's never gonna work. It's working. It's working in a lot of places for a lot of people. If you don't believe me, go look at my DPC story, the podcast with Mariel Conception, which is one of my favorite podcasts. That was one of the things that brought me into the DPC world. You will hear story after story of people in primary care, people in specialties, people in all different parts of the country. People in micro practices, people in multi physician practices, so many different flavors of direct care. And you will see that it's working and it can work in a million different ways. So it is not crazy, but it is okay and normal for it to seem a little crazy to you right now. Okay, next. I don't know anything about business. This is something I hear all the time. It's not just, I don't know anything about business. It's just I don't want to know anything about business. And that was me. That was abs like 100%. That was me. Never had the slightest interest in business finance. The inner workings of every aspect of medicine that was not clinical care did not interest me. I was interested in public health and epidemiology and that sort of thing. The dollars and cents were repulsive, not even uninterested, like I was repulsed by them. I think I've come a long way in how I think about business generally. I, before when I thought about business, I just thought about corporate greed. That was really my only reference point that I was thinking about. And now, I really view it more, business is essentially, or entrepreneurship is essentially seeing a need in the market and finding a way to serve that need in a way that's valuable to people. And it's just, it's problem solving. It's coming up with solutions to problems and, solving those problems well. And we as physicians are problem solvers. That's what we do. We diagnose pro, we collect data, we diagnose problems, we solve the problems. And that's, you can do that in business. And when people say to me I don't know it and I don't want to know it. What I try to remind them all the time is if you can manage DKA, like if you have gone through medical school and learned all these complex algorithms for diagnosis and treatment, you can definitely start a business. It's really not that hard. People with way less education, way less training, way less motivation and determination and discipline and so many of the qualities that we must have to even get to the point of practicing medicine. So many people without any of those things do start businesses and can be successful in them That happens all the time. So there is no reason to believe that you cannot do this. Oftentimes what's holding you back is these preconceived ideas about what business is and how hard it's going to be, and I think we in medicine are brainwashed to think that you have to be super over-prepared and overqualified to do. Anything.'cause we are forced to be so very prepared for our jobs. So to go and do this other thing without any sort of, training or apprenticeship or education or certificate or whatever, it feels like a big leap. The rest of the world doesn't operate like medicine and there's so many things that you can learn on the job, on the fly that really do not require any specialized training. If it's okay, if you don't know anything about business, I didn't, A lot of the other people who do DPC did not when they started, but you can learn it is a learnable thing, and it is not inherently evil or greedy. Okay, but I don't have any time. I don't have any time to learn about it. I can't plan it. I can't work on this. I am so burnt out and, burning the candle at both ends of my job I just cannot even fathom expending the time and energy to start a whole separate business. That's totally legit. That is a legit concern. I don't wanna gaslight you and make you think, no, you can do it. Everybody can do it. No you maybe can't do it if you don't have the time. But what I would ask yourself is, are you ever gonna have more time? Is that ever going to let up? Is that ever going to change? I think a lot of us have these delusional ideas. I have these delusional ideas too, of oh, maybe when my child is in school, oh, maybe when both of my children are in school, maybe when they're in high school and then, they get there and then they have activities, and then they have homework that they need help. Like it just it all just keeps adding up. And I think. Especially women in medicine, like we tend to have this there's always like a mythical future where everything's gonna be fine, and at a certain point, I think you have to accept that mythical future where everything suddenly becomes easier is not gonna happen for you naturally unless you make it happen. And take very conscious steps towards making it happen. And I think, at least for me in primary care, I could have gone more and more part-time, but. Doing that would have sacrificed really just salary for me. And I don't think the work administratively or clinically would've really been that different. I would've had less face-to-face clinic time and less pay. But I don't think the burden of the actual labor was going to ever go down because the panel was never gonna go down. It's not like they're like, oh, now you have 2000, but you're going part-time, so you know now we'll cap you at 1500. They're never gonna say that. I think if you're one of those people who's just I cannot even fathom doing anything else'cause I have no time and I'm stretched so thin, I would just ask yourself how long are you willing to live a life where you have no time? Where you feel like that, where there's literally no breathing room for anything else. Is that okay? Is that really the only option? And I'm not saying this is an option for everyone. Again, I don't wanna make it seem like anyone can do this. They cannot. You may be in a situation where truly you are stuck. But I think there's a lot of people out there who could actually. Have, three to six months where life is a little bit miserable'cause you're working a job and still planning your practice in the background. But, the long-term benefit of the flexibility, the autonomy, the control over your schedule and over your career is, invaluable. No employed position can compare to that. Okay, so how can I abandon my patients? How can I turn my back on the, maybe you've been at a place for a long time and you just feel if I leave these people now, they've trusted me, they've established a relationship with me. We have a rapport, we have a therapeutic connection. How can I just leave these people. This is a really hard thing. I'm not gonna pretend it's not hard. I cried as if I was breaking up with a thousand people every time I have left the job like this. Leaving a patient panel has always been like very hard on me. Like I, it, it really felt like just breaking up with people back to back for weeks. And so I get that. I totally get that. There will be people who will wanna come with you and who will be cheerleaders of yours and will be happy for you for making this change and will wanna come with you. And there will be people who will say, but how can you do that? I already spend so much on my health insurance and I spend so much on all these other things and now you're asking me to pay more just to see my PCP, who I've known for five years, 10 years, whatever. That hurts. That is like a dagger. I had a patient say something along those lines to me and I just wanted to burst into tears. But what I told her was the honest truth. If your heart is in the right place and you're doing this for the right reasons, and you're transparent about those, I honestly think most reasonable human beings can understand that. I told that patient, I was like, look, I hear you. I don't like this. I wish that. Traditional insurance-based healthcare supported me in a way that allowed me to take care of my patients the way I want to take care of them, and the way that I would feel good about. I, wish that this job allowed me the flexibility that I need to be a present mother. But there are other people out there that can be great PCPs for you. My son has one mom and I feel like I am missing his childhood. I can't go back and do this over this. This feels like the right decision and honestly the only decision for me at this time, and when you say that to people, I think, like I said, any reasonable person I think will. So that's what I would say when patients are like, can you abandon? Secondly, next, not, secondly, I don't know, this is like the sixth one. Is this eth ethical. So I think a lot of people really struggle with the ethics. There was just, somebody just asked this question and I think physician community or one of those Facebook groups where it's just like, how do you justify in your own mind, only taking care of patients who are willing to pay the, who can pay this cash price? News for you. If you work in an insurance-based clinic where there's any plans that are not accepted, you're already, doing the same thing. Like in insurance-based care, I don't know. I don't know about you guys, but when I was in, a regular, traditional primary care job, we had a list of insurance as we accepted, there were certain insurances we did not accept. Of course, we would take self-pay patients if they came out. Somebody off the street just wanted to come and be seen. They would have to pay a ridiculous amount to see me for 15 minutes. Even a 9, 9 2 1 3 was like, I don't know, 200 ish dollars. Yes, we would technically see those patients, but realistically, the access to my care was, not equitable or easy or fair or open to all. It wasn't, so I think you have to step back and think about what is the way we've structured the healthcare system, ethical or equitable is what you do now and the way you're compensated and the way your work is valued. Is that ethical? Do you get paid maternity leave? Do you get protected pumping time? Do you get compensated for all of the non face-to-face administrative work that you do? Are all the hours you spend on FMLA forms and documentation accounted for in your salary? I can almost guarantee you, especially if you are a female physician, that the answer to those questions is no. The system is not ethical for patients or doctors as it is. So the more we continue to participate in it and, basically shrink ourselves down to fit as cogs in this giant wheel. The more we perpetuate the same things and the less it's going to change, I would love for DPC to be a big enough movement that, academic institutions, big healthcare systems take notice and say, what are these guys doing what are they do getting right that perhaps we should be doing. Also, I don't know if that will ever happen. I, if you asked me to look in my crystal ball, I think the future of primary care is that it's gonna be NPS and PAs taking care of everyone for the most part, and MDs and dos, supervising a lot of them and you probably don't see your MD or do very often and care is going to be increasingly fragmented and. We're just we're moving to a different world, and I don't really like the direction that it's moving. And so to me, this question of ethics, it's like you can't consider DPC in a vacuum. Like you really have to look at these step back and look at the entire context, and if for you, the mission is really to serve the most underserved, then maybe DPC is not the right choice for you. DPC is not the right choice for everybody, and maybe you are better off working in an FQHC or like a place that serves the population that you are most passionate about serving, and that's fine, the other thing that you have to always remind yourself about DBC is that. You get to make the rules. And like I just said at the top of the episode, I just took a couple for free because like I just felt for them and I knew that they needed it and I just took them on, although it turned out to not be for free, but it is for free'cause I return the money back. But you know what I'm saying? Basically you can make the practice whatever you want. So you know, if you happen to be in a practice that is doing really well and you're charging a good amount and you feel well compensated for your time and you've got some extra bandwidth, take on a few patients for free, that, need it. And I will tell you, I take care of way more uninsured patients now than I ever took care of in traditional practice. I have a handful of patients that don't pay anything to see me, and those are patients that otherwise would have almost nothing. Like they are people who would have a hard time jumping through all the hoops to get, one of the low cost or free plans through the exchange. And then they would probably have a hard time navigating that system and getting to those clinics and, instead, they have me. I. The question of ethics, I think it's so much more nuanced. I think there's a lot of people who just think it's very black and white of oh, you're charging cash. Unethical, doesn't, doesn't jive with our, our calling and our dedication to, or serving patients and blah, blah, blah. And I just think that's a bunch of balogna. It's so much more complicated than that. And that's really ignoring the broader context that we live in. Okay, next. What if I fail? Okay, this is a common one. This is one that you're gonna have. I was worried about this up until the point that I was like, okay, I'm paying myself and honestly, my husband even still is just like, what if it goes up in flames? You can have this thought for a long time. Okay, what if I fail? What I tell myself about failure is you have not failed until you have decided you failed. Or I guess maybe if you just run outta money and you're like, okay, this is I have no resources to keep trying this. I have to go back to a regular job. If that happens, the good news is you have one of the, most valuable skillsets in one of the most secure jobs that exist. In America. You as a, especially if you are a primary care doctor, it will not be hard to find a job. Like you should be able to, there's a shortage, an ongoing worsening shortage of primary care doctors. So you, you have job security, you can always go back, even if you opt out of Medicare, the opt out time is two years, right? So you can go back after a good solid try at DPC if it really truly is not working. But what I think is, failure is such a subjective thing. My husband was saying the other day, oh I was doing this thing and I just, I feel like I failed. And I was just like, I was looking at it from the outside I don't think you've failed at that at all. I think it's going great. So let's just first acknowledge that failure is a subjective term. To me. Let's say you set up your DPC practice, you launch and it's just not picking up. As you thought, you have basically done an experiment. You've tried something that you thought was gonna work, it did not work. And now it's your job to look at the data, observe and figure out why it's not working, and make an adjustment. And I talked about this in one of my previous episodes. I think it was an episode about why I've been MIA for six weeks. But, this happened to me with Micropractice Mama, where I had all these grand plans. I worked on it so hard. I invested so much time and energy, when I was freshly postpartum, like on making this course and doing the content for this platform and my initial launch. Just, it was fine. I, I had some people enroll, but it just, it didn't go as I had hoped and didn't reach the benchmarks that I had set for myself. And I think a version of me, five, 10 years ago would've been like, oh, that was just a total flop and I would've been hiding under the covers and ashamed every time someone mentioned anything related to this again. When you come to realize that, again, like I said, failure is very subjective and it's really not failure. It's just you tried something, it didn't quite work the way you thought and now you have to figure out how to tweak it and try again. And I tried again and it. Totally took off in a way that I was not mentally or logistically prepared for. I just think you have to ask yourself what does failure really mean for me? And, if that does happen, what would my life look like? And in most cases, the worst part is just the feeling of oh I tried this thing, it didn't work out. I went back. But, I can tell you from experience, even before my practice was established or successful, or I paid myself, I just had so many colleagues be like, you're living the dream. I want to do this, but I'm too scared. So good for you for being out there and doing it. So honestly, I feel like even if I had come back two years later with my tail between my legs, I feel like a lot of people would've just patted me on the back and been like, man, it was worth a shot. I am so proud of you for just trying to get out of this hamster wheel, I, I just don't think for us. If you have enough financial cushion to take the financial risk I would say two to three years is a good timeframe to give yourself to to, build up to paying yourself a decent salary. And you should be able to ask yourself at that point, okay can I keep doing this? Or is it not making sense for me? Okay, next, but are patients gonna be willing to pay? I had a colleague, I mentioned her all the time, who quit at, around the same time I did. She went into insurance-based primary care solo. I went into direct care. When I was asking her, why are you doing that? I was like, that's insane. You should do what I'm doing. It's gonna work so much better. I'm gonna be so much easier for you. Her big thing was like, I'm just scared. I'm scared. Patients are not gonna be willing to pay. I don't know why they would be, I just can't imagine why they would be willing to pay. I think that is a symptom of. You yourself not being completely sold on the model and the value of the model. And that's why you're afraid that other people will not see the value of the model. Once you are fully convinced, then it's a little easier to understand. And honestly, also, once you do it or experience it as a patient, then it becomes, I think, crystal clear to you where the value is and why somebody would pay for it, and that people will absolutely pay for it. I feel like people in the general DPC community scoff at my prices, but there is a concierge clinic here in Houston that charges 20 grand per year. Per year, 20 grand per year per patient. Not per family. Per patient. And they have patients they have plenty of patients. There's always a population out there that's willing to pay. And if you're scared oh but it's just gonna be this top 1%. It's just gonna be these like super needy, super demanding, terrible patients. No, they're gonna go to the, those people are gonna go to the$20,000 a year clinic. Okay. They're not gonna come to my piddly little one 50 to$200 per month type of practice. And so really what, most of us in the DPC world are doing is surprisingly accessible to more people than I think a lot of people would assume. And I think also. When you have that assumption of oh, it's just gonna be the ultra wealthy, if you charge this cash price, you're making a lot of assumptions about what people of lower incomes would value. And that's not really fair.'Cause I, I'm sometimes I'll do a meet and greet. I'll be like, are you sure you wanna do this? I don't wanna cause you financial strain. I don't wanna make you feel stressed about paying this monthly fee. I've had, teachers and I had a a patient care assistant and just people that I'm like I know that this might feel like a stretch to you, but a lot of those people are really confident that they, that it's a valuable for them. They're like no, this means I'm not gonna have to miss work every time. I need to have a doctor's appointment. This means my, prescription is not gonna lapse.'cause I can't get into the doctor to be seen for my three month follow up. So I, I. I think a lot of that stuff goes out the window when you actually look at real DPC practices and when you actually, get out there and start practicing this. Okay, can I really be on all the time? This is a common question. If you're the only one and like you're doing all the phones and the messages and the faxes and how do you go on vacation? How do you do this? I have a whole episode about how I deal with vacations'cause it's such a common question. I, I'm not gonna lie, there is a certain amount of being on all the time that is just unavoidable when you are a business owner and especially a medical practice owner. You're caring for people, you're responsible for their medical care, and there is a certain amount of responsibility that you're gonna have on you at all times. So I'm not gonna lie about that. But what I will say is I felt on in my old practice all the time anyway. We did not share call. We would take our own call for our own patients. I was always on the hook for, they would have to call the clinic number and go through a phone tree and they would have to pick all the right options in order to get it to go to my phone, but they could get to me, and so I was already on all the time. And for instance, I usually, I tried to have good boundaries and not log into my EMR over the weekend unless there was something really specific I wanted to check. But I hated that feeling of walking in on Monday morning and having 80 messages and lab results in the inbox. That was a horrible feeling. And for me, the trickle of messages over the weekend, which honestly probably 80% of them I look at and I just am like, okay, I'll answer that on Monday morning. And then occasionally there's a couple that I will answer right away. Just having the freedom to do that triaging and, not have the Sunday scaries because Monday morning is so painful to me. Is worth it, it's worth being on all the time. And yeah, I do spend a little bit of time. On my vacations on a regular basis, just quickly checking my faxes and scanning my messages to make sure there's nothing urgent that I need to deal with. But for me, doing that is worth the flexibility of just having total control over my schedule. I start my day after I drop my son off to school. My younger, my baby. My baby is gonna start preschool on Tuesday. I'm very emotional about it. But his preschool is in our neighborhood and I plan to walk him there and walk back with my dog. And, I want that to be the routine and I'm just gonna carve out time for that. I don't, there's no asking anyone permission. There's no making some terrible change in the schedule and having to reschedule, three months worth of patience. I just, I can just do it. Yes, you'll be on all the time, but you'll also be in control of every single thing. Alright, next. Can I really do the job of all of these people? You're just sitting there in your clinic with all of the staff and you're just thinking, can I do a practice where none of these people are here? I'm gonna tell you right now, yes, you can. You can. A lot of that machinery is because of the insurance based reimbursement system, like all of the coding and the billing and making sure these specific questions are answered and making sure these specific things get documented. A lot of that is just bloat that has been created by our, ridiculous, payment system. In medicine, when all of that stuff goes out the window and the patients are just paying you this flat monthly fee, you're not counting any minutes. You're not trying to meet any specific metrics, you're not trying to do two review of systems. You're not trying to do three elements of an exam. You're not doing any of that stuff. You're just doing what makes sense for the patient. A lot of the things that are delegated and outsourced in traditional practice have to be delegated and outsourced because the volume of patients is so much that there's no way you would be able to do that stuff on your own. But, the volume in micro practice at least is like one 10th, what you're gonna see in traditional practice. And so it's a lot more manageable. And I say this all the time, but there's a learned helplessness that happens when you've never done those tasks and they've always been done by somebody else, and it makes you believe that they're complicated. These things are not complicated, like sending an imaging order, a mammogram order, sending a referral, request requesting records, like none of that is complicated. PAs are not complicated. None of it is complicated. You can definitely do it. Again, if you can manage DKA, you can do your own PAs, you can send a referral, you can send an order. You can do all of these things and I bet you that there actually a lot. Easier than you think. They're okay. What if patients abuse their access to me? Can I really give them access directly to me without any filter or, nurse or ma or somebody between us? I say this all the time. My doctor friends are always just shocked at how I don't get hammer texted constantly. I think there's a few things when, first of all, the volume is like a one 10th of what, again, what you, my volume is like one 10th of what I had before. So that already cuts down on 90% of the messages and calls that you may be getting. The other thing is you're spending so much more time with them, each visit is there's no rushing. You can spend as much time as you need, you can answer all of their questions. I, at the end of every, towards the end of every visit am. The way I'm ending those visits is, what else is there to talk about? I literally keep opening the door for them to say more things until they run out of things and they cannot say anything else. So when you've had a visit like that where you've really covered all your bases and you've gone through everything, the loose ends are just not as many. They just don't have as many follow up questions and you've already told them, what are the red flags to look out for? You've already told them what to expect in terms of the medication side effects. You've already told them you know what the return precautions are. So they have a good game plan and they usually don't have to call you that much. Plus when they have the ability to text you and they know you're gonna respond, they're not doing this panic, call, text, email, you show up there, they're not doing that'cause they feel comfortable that you are gonna respond when you message them. Third, I think when you're in this type of, especially with a micro practice where. They really have an understanding that you are the entire practice. You are the whole business. You're the person who's answering all the messages. They get that. So I think when I worked in a traditional practice, people would be like, oh, I don't know. There's probably a doctor on call, and that's the person who's answering my 11:00 PM urgent message that I'm sending. No, it was me all the time. So there, there were nights when somebody woke me up at 2:00 AM and I was panicking about some reaction to a medication and I was still showing up at work at seven 30. And I don't think a lot of them realized that, I think they assume that we have some sort of shift stuff and we, are they, I don't think they realize that you're on 24 7, but they in micro practice. I think they all know that very well. The other thing is, I think you know that not every practice, not every DPC practice does, not even every micro practices, but I did is, I have been very open with my patients about my life outside of medicine, on my social media. I'll be like, this is what I'm having for dinner and like this's what my family is doing. This way I don't do it anymore'cause I'm off social media for my mental health. But. I generally had been just sharing that I'm a mom of young kids and this is what's happening in my life. And I really think that helped humanize me to a lot of my patient panels. So they understand that I have other things to do. Sometimes I'm busy, like I even get messages, a lot of times I'll get messages at 7 58 and they'll be like, I know you're probably at drop off, but can I come in at, and I think when they have that human connection with you and they see you as human, they're much more likely to be considerate of your time and respect your boundaries and think first before they start messaging. It's not this faceless portal. It's oh, I'm actually texting her cell phone. Like she's gonna get this ping right now. In my experience, I feel actually a lot less. Abused and exploited in micropractice than I did in traditional practice. And if somebody truly is abusing you, you have the right in micropractice to be like, this is not a good fit. You're abusing your access to me. You're using this messaging for inappropriate reasons. And all again, all of it is under your control. You're the boss. You get to decide okay, what will my colleagues think? What if they think I sold out? This was a, like a loud thought for me. And, I interviewed Shane a couple weeks ago and she was just like, I don't give a toss. I, the people follow all different areas on this of the spectrum, on how they, process how other people are perceiving what they're doing. I, I think initially there were a lot of colleagues that could just had this oh yeah, she's gone concierge, like she sold out. And that really irked me and got under my skin. But I would say that the vast majority of those people now, four years later, if they've stayed on board and followed what I'm doing are like, oh, I get it now. I get it, And then there was like a bunch of colleagues that, again, like I said, they were just like, I'm too scared to do this, but good for you. I'm glad you're trying it.'cause this what we're doing is not working and does not feel sustainable. So good for you. And now at this point I have so many colleagues that are like, can you tell me how you did this? And I wanna do I wanna do this too. Even people who were totally just didn't understand what I was doing at all. Have now completely flipped to how can I do the same? Alright, i'm overwhelmed. Now. We're kinda shifting into thoughts that you can have at any point in the journey. Okay, so what if you're just like, I'm just so overwhelmed. You're looking at the list of things. You're like, I gotta make these lab contracts and I gotta get these agreements and I gotta figure out my EMR and I gotta get a brand designer. I gotta, okay, what if you're overwhelmed? What I always tell people in my course is you just have to focus on the one step in front of you. And in those times when you're feeling like, oh my God, this is a lot. You wanna just, take a deep breath and like just zoom in on whatever the very next most important step is that you need to do. Focus on that and also look back at all the things you've already done. Because even if you're at zero and you're just thinking about starting a practice, like you gotta remind yourself you are a phys, like you're a doctor. You went through so many years of school, you've taken so many tests, you've taken so many standardized exams. You've been in osce. You know how weird it is the fact that we do these oskies where we do these mock exams with actors and all of that. You've probably worked 80 hours a week. You've probably slept in a hospital so many times. You've probably had so many conversations with people on their deathbeds. You have done so much hard shit, excuse my language. You have done so many hard things. And if you even just look at the statistics the. The acceptance rates into medical school, they're single digits in a lot of places. We, we are already, we have jumped through so many hoops in our lives. We are already exceptional. We have proven our work ethic, we've proven our, intellectual abilities. We've proven our ability to self-sacrifice. Just if you ever have that doubt, even like I said, if you've literally done nothing yet in terms of building a practice, just look back at all the things that you've done just by virtue of having that M-D-R-D-O in the, on the end of your name. Once you have gotten a little farther, like I had a lot of overwhelm when I was about to renovate my space. I was taking on this commercial lease and I was hiring a contractor and all of that was very foreign and new to me and scary. And I feel like my husband was getting anxious about it. Just looking at it from far away. And the thing that got me through that was just looking back and being like, in the last year I started a whole business. I started a practice. I'm taking care of actual humans. I am, getting their preventive care done. I'm taking care of their issues. I'm helping them navigate hospital like I am. I could never have imagined having done that a few years before. So if I can do that, I can do this. This is just another thing. I have access to Google. I know a lot of smart people. I can, I can figure this out. I can, everything is figureoutable as, what's her name? Maria Forleo would say. So you just have to keep focusing on the one step in front of you that you need to do. And, remind yourself of all the things you've already done. And remember that everything is figureoutable. Okay. What about, I made a mistake. So this applies to me on that day that I realized I had charged this person like$2,000 that I didn't intend to charge them. This is my biggest challenge'cause I make mistakes like everybody else and I am human. And I tend to do this whole self-flagellation for days when that happens and it's terrible and I get in a very dark place. I am still actively working on this, but the things that have helped me is to talk about it. Sometimes you tell a friend and they're just like, yeah, Sonia, that's not a big deal. I do that too. A lot of my DBC friends when I tell them something that's happened to me in, in the practice, they're just like, oh yeah, I did that. So talking about it really helps, I think just reminding myself I am human. Like these things are gonna happen. I'm one person, I have no one double checking my work. So yeah, some thing things are gonna happen. That's all par for the course. That's a part of business, that's a part of medicine. You are going to make mistakes. My five-year-old is very much, he's got that perfectionism gene and we're practicing saying. Mistakes mean you're learning. Mistakes mean you're learning. So I have to just remind myself all the time, and you have, I self-compassion is a very big challenge for me and I think it probably is for a lot of us, but. Hopefully me telling you all the mistakes I've made in the past month will make you feel a little bit better when you make your first big mistakes. I think you just have to remind yourself that mistakes are going to happen. That's the best, way to prepare is that just knowing that they are going to happen. And that, as long as you're looking at them constructively and deciding what can I learn from this and how can I make this not happen in the future, then I think that's the best you can do. Okay, so let's say you're already up and running and now you're having the feeling of. Why aren't more people signing up? So the thing I would say to somebody who's in that phase I was in that that happened to me a few months in, I had a little lull and I started to panic and think was this the right decision? Is this over now? Does nobody like me? I, was falling into that whole spiral. What I can tell you now, having mentored so many other physicians and zooming out and looking a little bit more at the whole landscape. So much of people's success has to do with factors that are not necessarily in your control or in their control. It has to do with what type of practice they were converting from. What was that patient population like? What is the local competition like? What's the landscape of primary care there? What type of doctor are they? What type of services are they offering? What are other people charging in there? There's. So many different factors that go into this. I've had multiple students now in my course or people that I've mentored that have just done better than me, right out of the gate, better than me at pre-enrollment, better than me at three months, better than me, at six months better than me at a year. And I would hope for that because I think that we all stand on each other's shoulders. And I hope that everything that I learned, building my practice, I can transfer and, other people don't have to learn on the go and they can just, apply that stuff immediately and be more successful. So that's not entirely shocking to me. But I also acknowledged that a lot of those people had other factors that were working in their favor and allowed them to be that successful. So I would just caution you against playing this game of comparison of oh, but this person's doing this. And should I be more like them? I think it's fine to look at what those people are doing and ask yourself would I benefit from, using a strategy like them, or are there things that I can learn from that person? But I think, the first year can look so different for different people and they can all, end up equally successful after a few years, or they can all reach a full capacity and be perfectly happy It's just not gonna look the same for everybody. And I really think in that beginning phase, you have to remember that most people are not gonna hear about your practice and just immediately jump in. They're just not, there's, I think there's research out there that shows that it's, some insane number of touchpoint, four or five, I can't even remember anymore. But a lot of touch points are needed where they're hearing about it from one person and then maybe they come across your social media and then maybe they see a sign and maybe you're at a health fair. And it takes a lot for. For people to give you their money. And and that's normal, and to entrust you with their health. And it's, especially if you're starting from scratch in a place where you're not converting a practice, you didn't have a panel already. I think it's so normal to have slow growth and I think you have to remind yourself that you're planting seeds and those seeds need time to grow. You're not gonna plant a seed and then the next day see a sprout. That's not how it works. I've expected that for a lot of my life and that's why I don't have a green thumb and I don't garden because I'm too impatient. But it's a good analogy because you need to plant the seed and you need to water it and give it sunlight and all of this stuff, and eventually it will reap rewards, do not be discouraged, especially in the first year if you're feeling like, oh, I don't know. Okay, next. I miss having a salary. For a while my husband couldn't let go of the fact that I had this period of lost income. The year that I didn't really pay myself very much, he was just like, oh my God, we took this huge financial hit. Now I think he's changed his tune because he sees how our life literally just would not work if I was trying to work this seven to five job four days a week, which is what I was doing. And, plus all of these administrative things that I was doing from home. So he gets it now, and now I make more than I did in that job with flexibility. So he's very much on board. But initially that was a big blow for us and it was hard for him to give up that certainty. And that's understandable. But, I think again, you have to decide what you value and what's most important to you. And I really think that for me and for a lot of my colleagues, it's not even money, it's time that has become the scarcest and most precious resource, like time and attention. And that's the thing that I wanna optimize for. You have to ask yourself in any kind of, I think business endeavor. Really anything, but you have to ask yourself like, what am I optimizing for in this situation? And especially for me in this stage of my life, I am trying to optimize my life, not for money, but for time. I have enough for the basic needs of our family and our household. Now, what I want is time for freedom. And that leads you to make very different decisions. So anyway, I would think about that. When you think about the lost security of a salary I miss having a staff, so I, that's the thought that I think comes up for a lot of DPC doctors. It still comes up for me. There are times when I just really wish I had another person in the office to bounce an idea off of or to talk through something with, or even to vent to. But, I have my DPC colleagues and they feel, very much kindred spirits and friends and people that I can, share anything with. And I treat them that way. And I, I just had coffee with one of my colleagues who, like I said, does Jerry in Houston. And it was just I was just I walked away from that thinking, oh I wanna see her more often. I think you still. Have opportunities to have meaningful connection with people. It just looks a little bit different and, it's not a traditional office staff environment, me being chatty, having staff around, even though, I did like it I was a lot less efficient. I don't waste time anymore chatting and gossiping with any of the staff, which is probably a good thing. And then, the other thing is, in micro practice, I mostly I'm mostly mentoring physicians who are trying to have a really lean practice with little to no staff, but you can get staff, if that's right for you and your practice, you can have staff. That's something that you can always adjust to, to suit yourself. Lastly, what if I change my mind or what if I get. Burned out doing this. I think it's definitely possible to get burned out doing DPC just as much as, it's, I think it's way less likely in DPC than it is in traditional practice, but it absolutely can happen and it does happen. I think people don't, probably don't talk about that a mu as much. I wish people talked about it more who are feeling that burnout because I think we can all learn from why is that? I guess my personal belief is if you are starting to have that burnout, feeling something is not right, something needs to be changed and it's hard to know what that is. For me outsourcing as much of my like household responsibilities as I could was really game changing. I felt like I was getting burnout from. Household management and some childcare type duties rather than really my clinical work or even administrative work. Outsourcing that really helped me. But, I know that's not possible for every single person. I think when you're feeling outsourced by your clinical worker or your administrative work, you have to ask yourself like, okay, is it just that the volume is too much? Like I, this is too many patients for me to be doing this administrative work? Is it that I hate this administrative work no matter what the volume is? Which in that case, maybe you need a virtual assistant. Is it that you just have too many patients or they're demanding too much of your time? I think if that's the case, you have to say, is my pricing appropriate? Is the size of my panel sustainable? And then if the size of your panel is not sustainable, and you have to make it smaller, you have to ask yourself, what is my pricing appropriate for the amount of work that I'm doing? And do I need to raise my pricing? Yes, it's possible to be burned out in DPC still, and DPC is not some like magical rainbows and unicorns kind of place, things can still go wrong. But the beauty of DPC is that you have total control. You can observe and decide where is that coming from, why is that happening, and how can I adjust this practice to make that less and you have the ability to do that and that's not something you can do in traditional practice. I felt in traditional practice, I was very quick to diagnose all the things that were causing me stress and burnout, but I had no control over changing any of those. And I felt this constant powerlessness of. Saying like this, I need more support. I need this, I need that. I need a longer appointment. I need, and just, like I've written about being gaslit and making, feeling as though I'm the only one that feels that way. And I'm crazy for saying that. And of course you can't have longer than 15 minutes, and of course you can't have a smaller panel. Just all of the things. That's that. And then lastly, oh, what if I changed my mind? So what if you do just decide I don't actually like running a practice. I don't like DPC, I just don't wanna do this anymore. I've decided I don't wanna do clinical. You get to decide that you can always change your mind. One of the physicians who did my beta class. Is someone who I really admire who's now tried out every different practice style. Like she's been in an academic center, she's taught, she's had a private practice, solo, private practice. She's been part of a private practice. She's, she's just run the gamut, and now she's gearing up to maybe do her own a specialty micro practice. And I don't look at her and think oh, this person's, flighty and non-committal. It's I look at her and I'm just like she doesn't give up. She's not settling for something that she thinks is less than what she deserves. She is not afraid to try things. She is, had experience in so many different settings. I bet she's learned so much from that. And she can take all of that experience into starting her own practice. Again, we have all these ideas about what it is to fail and what failure looks like and what that means and what that says about us. But, all of it is so subjective when you really step back and look at it. So anyway, I hope the take home message here is that you are awesome. You have done so much. I don't even have to know who you are or what your name is, but if you're listening to this, I can already guarantee you that you have accomplished so much already in your life and you are brilliant. You are capable, You are intelligent, you are caring. I just, I know so much about you, just by virtue of you being most likely a primary care physician. And you can do this thing and you're also human. So it's not gonna be perfect. And there's gonna be bumps in the road. And I think just reminding yourself over and hearing from others none of us are perfect. We have all made mistakes in this. They are to be expected. And when one happens to you, you can be like, oh, there it is. Knew it was coming, knew I was gonna do something wrong. And here it is. So do not despair. Do not let that get you down. Do not be discouraged. You're doing great. You are doing great. All right. So that's the pep talk. That's the end. I hope you come back to this when you need it, and I hope this is a good resource for you and I will talk to you guys next week. I have the webinar coming up. I will. Fix the link because I, it is come to my attention that it has been broken in the apple Podcasts show notes. So I will have a new link up there. I will also try to put a banner on my website with the link so you have another place to go. For some reason that's still not working. But the webinar is September 10th at HPM Central Time via Zoom. It's gonna be playing. It's one of the greatest hits, making the leap deciding if Micropractice is right for you. So it's a good introduction to Micropractice. It's a little sneak peek of the course. I go through my micro practice mama's secret sauce, like all the things that I emphasize in the course. And I think distinguish sort of the practices that I meant, my flavor of DPC. So de definitely try to come join for that if you are able. And otherwise, I will talk to you guys next week. Bye.