This episode is especially dedicated to our guest, Dr.

Jalen Pritchard of Thread Health in Spokane, Washington.

Jalen, I hope you enjoy listening to your Wise Self.

As much as I enjoyed finally meeting you in person, and for everyone tuning in, be sure to check out our brand new my DPC story, Substack, where you'll find an article on building a business rooted in values, along with Dr.

Pritchard's original episode.

Enjoy.

Direct Primary care is an innovative alternative path to insurance-driven healthcare.

Typically, a patient pays their doctor a low monthly membership and in return builds a lasting relationship with their doctor and has their doctor available at their fingertip.

Welcome to the My DPC Story podcast, where each week you will hear the ever so relatable stories shared by physicians who have chosen to practice medicine in their individual communities through the direct primary care model.

I'm your host, Marielle Conception.

Family, physician, DPC, owner, and former fee for service.

Doctor, I hope you enjoy today's episode and come away feeling inspired about the future of patient care direct primary care.

I'm so excited.

Hi.

Because I met you for the first time today.

Oh my gosh.

So Dr.

Jaylen er is almost at her two year 30 or three year anniversary three.

See, it just, oh my gosh.

What is time?

What is time?

I literally just took a picture of you and Dr.

Jade Norris because I absolutely love how.

You learned about DBC and then you deep dove so,

so deep, so

deep.

And one of the things that you have been able to do, because you are almost at year three, is that you have really been, you've been so intentional with all of your social media posts, with all of your posts on Facebook.

When I say social media, I meant Instagram, but.

With always taking a check at like where you are compared to where you've been.

Yeah.

And I really love that because I don't freaking remember what happened on week one.

Nope.

Zero.

Yeah.

And so I would love if you could bring us back to, the, the almost three years in.

One of the questions we got today was.

What are the biggest challenges and how have you come through them?

Yeah.

I think that there's, there's a number of things I can think of.

I would say I tend to be a classic over analyzer.

It's my, it's my superpower.

So I, I think it, it would've been a challenge if I wasn't an over analyzer, but I definitely have to see things on paper, on purpose in black and white before I'll make a decision.

So financially, fiscally.

Business decisions, like they have to make sense before I'll actually dive in.

I don't go by my gut.

And I think that's actually helped.

But it also is a challenge because there's things that I see other people doing in their practices that I won't do because I can't do them.

Yeah.

Because they don't make sense on paper.

Yeah.

I think another thing that has been a good challenge, but it still is emotionally draining as boundary setting.

I think that this model of practice attracts a.

Yeah, repertoire of different personalities.

And so boundary setting can be both very rewarding and very difficult, but patients are trainable.

And that's, I think, important to remember.

And then I, I think the last thing is, is maybe just like the constant perseveration, like I, I've realized I, I tend to be a very creative person.

I writing is very cathartic to me.

We, we really like to stay active in our family, and one of the things that has been a challenge, moving forward is detaching yourself.

This becomes your baby.

And it's, it is really hard.

I mean, it really is hard to mentally take a break and detach yourself and not be thinking about what's the next thing, what, what am I doing next?

How am I growing?

How am I numbers?

And not just patient numbers, but you know, financials and, and the whole kit and caboodle of operating a business.

So that's something I'm still working on.

My husband and kids would be like, mom, you're on your phone too much.

Or Mom, like, where are you?

Hello, you're here.

But you know, you're not mentally here.

But I, I think that those are probably the things that stand out.

And I, I do think after talking with people here, it's really interesting to me to see the different strengths that people have and that they bring to the table.

Because I think for me, a lot of the business decisions have been very seamless.

I think just the way that I think about things.

All the questions I've asked, we were telling someone earlier that I literally went on the Facebook group and read to the very first post.

Like I read almost every comment, almost every.

My screen time was embarrassing during that time.

But I, I do think that, I just, the way that I operate and for other people, for friends that I have that are, in this space, the business decisions are so agonizing because that's just not how their brain works.

So I do think we all bring different, sort of, features and strengths to the table when it comes to our own individual practices.

Absolutely.

And I think that this just echoes how important it is to point out that because everybody thinks about.

Medicine differently.

Mm-hmm.

Everyone thinks about entrepreneurship differently.

Yeah.

So then when you have physician entrepreneurship on the table, yeah.

You're going to experience it differently, talk about it differently, learn about it differently.

And so it's so important for people to hear that.

Yeah.

Because it's whatever gets you to be comfortable with your next step.

Yeah.

Or uncomfortable in your next step, but you know it's okay still.

Mm-hmm.

So this brings me to my next question, because I remember.

You had asked but how do I know it will work?

Because recently there was a DPC that closed around you.

Yeah.

And I'm wondering, if there was a, it was at 75% of me feeling comfortable that I was like, I'm just gonna try.

Yeah.

What, what was your experience with knowing that another person had closed A DBC around you and you were on the cusp of opening?

It was scary.

I mean, I, I, I think,

yeah, it was scary.

And I, I will say, I mean, I.

I think being here and seeing all of the DPC curious people, there's definitely features of personalities.

Mm-hmm.

Business plans, value sets that lend themselves more generously towards success.

And I think now, obviously hindsight's 2020, looking back, I can see that, that that person that failed didn't have a great business structure.

Their personality was like a dry sponge.

I feel like they, that the people that they were attracting, the niche that they sort of dove into wasn't, it didn't serve them very well in business.

And so I, I would say, it, it was super scary to be like, oh my gosh, what if I fail?

And my husband has been amazing.

He's like, what if you do?

What if you fail?

Tomorrow's a new day, tomorrow's day when you can start over and you can go back.

You can always go back.

So I, I think that, again, this is again, my personality, but going back to that, like when you start.

Solid and you've saved money and instead of taking out a loan when you don't make yourself you don't start from a position that you're strapped, failure becomes, it becomes a barricade and dis a disappointment, but it doesn't become a life altering.

I can never get over this event.

Yeah.

And so

important for people to hear that also because that is part of the imposter syndrome that is experienced by.

Most of us in this movement.

Yeah.

Yeah.

Is that like you, it's an all or nothing thing.

Mm-hmm.

And it's like we don't give ourselves enough credit for the things we are so capable of.

Yeah.

The fact that our jobs are literally, because you and I are family practice.

Yeah.

We literally have zero idea as to what our patients are going to say out of their mouths, and yet we can still communicate with them.

Yep.

That comes with a lot of.

Random experiences that comes with a lot of failed attempts at trying to not be awkward.

Mm-hmm.

That comes with so many things.

And when I remember speaking with Dr.

Gabrielle Williams and saying girl, I would work at, the bakery at a grocery store.

Yeah.

Because anything is better than fee for service.

Yeah.

And it might not be the same income, but it's is that life or death?

No.

Yeah.

But it is really hard when your value is so whittled down to what codes you are producing.

And so I really love that you point that out.

Yeah, yeah,

yeah.

Can I say two more things?

Absolutely.

Okay.

I I have two.

I have two.

I have two points more.

I was talking to a group of residents a couple weeks ago and I was like, I, no one told me this when I graduated, and I don't even think anyone told me this at the beginning of my journey, because I think when we're in this space and people are like, yay, DPC that's amazing.

There's also a dark side to it, right?

Like there, there's a whole nother side that we really don't talk about.

And I told this group of residents, I was like.

I'm giving you permission from now until forever more to take your life in five year increments and to change your mind.

It's okay, it's okay if you open and you decide five years in that it's too exhausting and you can't do it, and you close, like it's okay.

So that's the first thing.

And then the second thing, and I, I also wish that this was talked about Maria.

I'll give a talk next year, but I, I really would encourage people that are just opening to really.

Do some, I, I mentioned when you interviewed me the first time that I did some career coaching.

Mm-hmm.

Yep.

And that what it did for me is it pulled out what my values were.

Not only as a human, but also as a physician.

Like I realize now, and I can say so confidently, this is where my value set lies amazing.

I'm not talking about ethics.

I'm just talking about this is what fills my tank.

And when I don't have that value met, I feel X, Y, and z.

I feel trapped, I feel depressed.

I feel, you insert the link.

But I think that one of the things I would love to see more is like starting, starting your practice, starting your dream, starting your business with a set of values instead of a business plan.

Because truthfully, if you know your values, I was talking to John Sanders from Utah, and he was saying, one of my values is just really good patient care.

And he's like, I don't mind if I don't make a whole lot of money.

And that allows him to steer his business decisions accordingly.

My core value is autonomy.

And so as soon as I get enough patients where I start to feel trapped, I can steer my business decision accordingly.

But if you don't know your values and you're just working off a business plan, all of a sudden it's well, what do I do next?

And you have nothing to fall back on.

And so I sort of wish that like one of the very first, or sort of mastermind exercises that we did here was for all the new people to say, where are my values?

Where do I feel most free?

Where am I most fulfilled?

And you just said, right, that you love this podcast.

Like this brings you joy.

And so.

If you didn't have the freedom to practice and continue doing this, you may feel trapped.

So anyway, I, I guess the encouragement is like for all the people that are just starting out, or even just people who are still going.

Yeah.

To try to continue to redefine where those values are and then, plan your life and your business according to it.

Yeah.

When we talk

values, I'm wondering whether it's, from your discussions with your coach or just life in general, being a mom, et cetera, et cetera, how do you challenge people to.

Get in touch with their values, especially when it comes to not devaluing what they're capable of and they're not recognizing.

Mm-hmm.

I think, I don't know if I have a great answer for that, to be honest.

I mean, I, I think that part of it is understanding what you're feeling in the moment.

Mm-hmm.

So, I mean, I, I can use myself as an example.

I didn't quite, I couldn't put words to why I hated being employed.

I, I couldn't put words to why.

I hated, I would show up at the office at 7 45 for my first patient at eight, and then I couldn't go to the bank.

I couldn't go to the post office.

I couldn't pick a sick kid up from school.

I couldn't take my dog to the groomer.

And I, now that I have a word for it, I realize that I felt trapped, right?

I felt trapped at the office.

And that feeling, because I value my autonomy and my ability to make decisions on my own without someone breathing on my neck, questioning my judgment.

That, that value is so important to me.

So as you know, I have a side gig, right?

I work 0.5 FTE for a telehealth job that I actually love.

And the reason I love it is because I see a patient and clean a toilet and see a patient and switch the laundry and see a patient and pick a kid up from school.

And it allows me to maintain my autonomy.

And I, I think we're, maybe, I, I mean, at least this is a trend I've witnessed, is that we're sort of moving away from this, like purist DPC, this is the only thing you can do mentality.

And I think a lot of us as physicians are realizing.

That we need, we need multiple pots on the stove at one time to make us feel fulfilled in different ways.

A hundred percent.

And absolutely physician entrepreneurship does not mean you must be a clinician only at all times for the rest of your life until you dropped dead entrepreneurship.

Yeah, a hundred percent.

Yeah.

And absolutely the, I just talked with Dr.

Natalie Gentilly, you were there this morning, physically just not on camera.

And that is, that is so important for people to be okay with.

That like whatever brings you joy and value, even if that's not clinical medicine.

Yeah.

That doesn't make you less of a doctor, doesn't make you less, that doesn't degrade the fact that you went to school for all of these years.

Yeah.

And trained in residency and killed yourself.

Staying awake, eat when you can, pee, when you can, all of that is still part of you and goes with you no matter what the heck you do in the future.

Yeah, yeah.

Even if that's going to sit on a beach.

Right.

Yeah.

You can still empathize with the next person who you talk with Yeah.

Because of your experiences.

Yeah, totally.

So I love that.

Totally.

When it comes to values mm-hmm.

You have very much embraced your patients and their need for access to quality, obesity medicine.

Yeah.

And I'm wondering if you can tell us one about how you started incorporating that in your practice.

Mm-hmm.

And also your course.

Oh, yeah.

So I realized very early on in residency that we were giving patients terrible advice.

I tell this story, this there, I have a patient from residency, and I so distinctly remember this, that she was like grinning from ear to ear because she'd lost 20 pounds.

And my attending was like, what have you been eating?

And she was like, fruit Loops.

Like she'd replaced breakfast and lunch with Fruit Loops and was eating dinner and it was a calorie deficit and she lost weight.

And we were like, wow.

So great.

Her A1C was terrible, but that's another story.

So I I've been doing weight loss.

Weight management medicine since 2014 probably.

And then obviously as this space has just exploded I do think that having a niche, whether it's hormones, functional medicine, whatever sports medicine like you, you name it, is really helpful in business growth.

So I realized that I was saying the same things over and over again, and I also realized that my patients that were looking to lose weight, were needing a lot of direction.

Sure.

I am maybe a little unique in the, in the, obesity medicine space where I really think this is multifactorial, that this is not just about prescribing the right diet.

If diets worked, we wouldn't be here a

hundred percent.

I also think that there's a lot of behavioral component, there's a lot of psychology to this.

We have neuropsychology to prove it.

We have, behavioral psychology to prove it.

And we can't just prescribe medicines.

We know this.

We can't just prescribe.

Drugs or, or, diet plans because if those worked well, then we wouldn't be in the position we're in.

And so I essentially created a membership level that where patients pay a little bit more for a temporary period of time in order to have longer visits, more access.

And then, as an aside to that, I, I, because I didn't wanna say the same thing over and over again.

I created two resources, so one's a free, it's called a GLP Masterclass.

It's free online.

And then I created a 16 week like comprehensive online course where we go through the brain biology and behavior of weight management.

There's health coaching included in it once a week and it's mostly for accountability, but it's been a huge blessing to patients because I get to do my job in prescribing and, sort of counseling and redirecting.

And then the health coach does the job of accountability and coaching, and the program educates people so they know not only why, like what they're supposed to be doing, but then also why they're supposed to be doing those things.

So it's been I mean, it's still fairly new.

We did a beta group in August or September and then we've had three cohorts go through since then.

But it's a it's something I think a lot of maybe more established business owners can look into.

If you have a niche where.

You're saying the same thing over and over and over and over again, and it lends itself well to teaching.

Because I think patients are hungry to learn and they're hungry to learn from you because they trust you.

Yeah.

And just, the ability, again, this is like multiple pots on the stove, like creating resources that are useful for your patients, useful for the community, and also, fulfilling for you.

And the, the course is, it's an aside to my practice, but it, it still is an offering that anybody can ask this.

You don't have to be my patient.

But it.

It's a resource that, that I think is, is great and I would encourage people that are also in practice to like, create the resources.

Yeah.

We need to share.

I love that.

And I do agree completely that if you're gonna say things over and over especially when it comes to resources like you've built, that anybody in the community can use.

I just think about it as in this world of AI and this world of who actually knows if that Society of America is actually legit?

Or did somebody just go on Canva and make a logo?

Yeah.

Yeah.

It is really important to have the doctor who is the value proposition.

Yeah.

Who is valued in the community to also be talking to the community in ways that they are flat out an expert and, be an anchor in this chaos that we're living in right now.

And so I do think that especially being an Anthem major in undergrad, it's like.

We need connection.

No matter how much AI is out there, we are gonna need connection.

Yeah.

And when you actually have somebody that you can trust, especially in the healthcare space of helping you with your healthcare Yeah.

The level of stress goes down.

Yeah.

And absolutely holistically, stress is related to all the things.

Right?

All the things.

Yeah.

Yeah.

So just literally by being there for your patients, that is medicine without taking a pill.

Mm-hmm.

If pills and shots are needed, great.

But it's like that's not.

At all what we have to fit into an eight minute visit any longer.

Right, right.

And that's amazing.

Yeah.

I'm wondering what are some of the comments that you've heard from your patients?

Because you I think about how a lot of people, especially here, are working on their elevator pitches.

They're working on like, how do I sell to a patient?

Yeah.

And you have mentioned this, this separate like little pathway if someone's going to have more time specifically to focus on weight management, obesity, medicine.

Mm-hmm.

How do you, how do you talk to patients about that offering and what have you heard?

Because I'm sure the patients are like, Dr.

Prichard, you, you just, where do I sweat my card?

Yeah.

Because I don't care about what caused, I just need you to tell me how to get help.

Yeah.

No, I, I think that there, I, I think there's a, I guess I would say there's a delineation.

I think that, that I'm starting to see a very distinct pattern in people.

And I think if you're somebody that's offering multiple things at your clinic, you're gonna attract the type of people that are attracted to those things.

Yeah.

Logically.

And so I, I think I didn't wanna make my membership levels too complicated.

I didn't wanna offer packages because that's something I have to track and I wanna be as hands off as possible.

And so I think that, for the most part, if you can, if you can add value to what they're getting and they feel like they've got a coach and they've got check-ins and they've got guidance.

What's been the most fascinating is a psychology experiment that, you have essentially probably 40% of my patients that just sign up and they're like, just gimme drugs.

And then I put them on my body composition scale and I'm like, you can't have any more drugs because you've lost too much muscle mass.

Or, you're not responding well, or you, what are you eating?

And those are patients that are really hard to get through.

And I've, I, I don't wanna say that they're a lost cause.

I never believe that, but I do think that there's, there's a boundary that you have to set in saying, you can teach a man to fish, but you, you can't make him fish by himself.

And the, the other subset of patients is so hungry for information.

Mm-hmm.

And they're so willing to learn and, and follow.

That I, I think that they, they really appreciate more time that's built in.

They appreciate the number that, that they, they just sign up and, and I think part of it is because it's a fair value.

I haven't overpriced it.

I'm honest and transparent about what is being offered and the resources they have available.

And then if they don't use'em, that's on them.

It's not on me.

Yeah.

Did that answer your question?

It did, and I, I think that one, like to the point of like, how do you talk to patients about it, it's literally like you.

Are transparent, you're literally just saying what you're doing.

It's not like you're putting a glossy cover on it and just being like, hashtag I won't follow up and actually offer that after you sign up.

It's just a, just a, a funnel to get you in.

Yeah.

And definitely, when it comes to the 60 40 split, that is so true.

And I, I really feel that that's how I love my patient panel even more so than I did in fee for service.

Because they self-select.

They self-select, yes.

And it's we, we have to definitely deal with the 40 and the 60%.

Mm-hmm.

But this leads me to, in terms of like how you're dealing with boundaries, how have you shored up your boundaries over time?

And specifically, where were your boundaries pushed the most?

Oh my gosh, this is such a hard question to answer.

I, I think I still struggle with boundaries sometimes.

I, as you are probably in the same position, I think as women, we tend to attract medically traumatized, medically ousted or mystery patients more than other people.

And so it does, there's, there's just people that will push boundaries.

I think that, again, this is leaning into, because I know my core value is autonomy.

I, when I feel squeezed by them, I am either very transparent and I say.

I need a break from you.

You are welcome to message me on the portal.

You are not allowed to text for the next week, and if you do text, I will not answer you.

You can get on your computer and message me on the portal, and if they don't respect it, then we have to have a very frank conversation about what does the future look like for us.

There's other times where, I'll start to kind of feel like a vending machine.

And that doesn't feel good either.

That doesn't really support my core value.

I don't think it feels good to anybody regardless of what your core value is.

But you know, it also, it, it's very easy for me now to take a step back.

Again, this goes back to you have to know where your values are, because if you don't, I think those are the most unhappy people in DPC.

Like I, I absolutely think that, and maybe in clinical practice, to be honest, but DPC allows you the flexibility to say.

I'm not prescribing that medication.

Don't let the door hit you on the way out if you would like to leave.

Yeah, I think it's so true, and I think that the reason I really, really agree with that right off the bat is because even if your DBC is not where you want it to be, if you don't have it the whole time in alignment with your values, or if it's not tracking back to your values, it's a lot easier to give up.

Mm-hmm.

And again, if that's your journey, great.

But it's if you are in it with your values.

You, yes, it's a lot of work, but it still makes you happier than fee for service.

It does.

It still makes you so excited.

But like, know, you could make SNY remarks about oh my God, they literally sent me 45 messages.

But then you're like, but yes, I do recognize that.

Like I changed your life.

Yeah.

And like I'm a good doctor.

Yep.

But it just really is annoying sometimes.

Yeah.

And that's okay.

But it's also what.

What makes you so proud of what you do is absolutely tied to your values.

And if you don't have that pride and value tied, it is more challenging to just stick with it.

Mm-hmm.

So sticking with it is really tough sometimes for people when it comes to like, where's the money to pay the bills.

Yes.

And so I know this is like your jam.

Yeah.

And so I would love if you could talk to us about what your thoughts are when it comes to financing, especially for people who are.

Newer on.

Yep.

And they, they're in the first three years and they're like, but day,

get to my money.

That's a hard thing.

I, I will, I will preface this with, I think I've been very lucky.

Yeah.

I think that I landed at the right time, at the right place in the right niche.

I've been, hormones are all the rage right now, and I always have to laugh when people are like, oh my gosh, I'm taking this.

I'm like, oh, welcome to this world.

I mean, I've been, I think maybe I told you this, I got written up in residency Oh, I know.

For prescribing hormones.

I've mentioned that on a podcast.

And so, and I know exactly, I know exactly the attending that did it too.

So I I think that the financials are, they're hard, they're hard to talk about.

Especially in places like the DPC summit,'cause you can't talk numbers very, very freely.

But I do think that there's a few things that have helped, and I would say that, again, this goes back to your values.

So, I think everyone that opens, I don't think you need a business plan, but you need a pro forma so mm-hmm.

Get your Excel, get your Excel dance on, and plug in all of your expenses and all of your numbers and see if the numbers crunch.

It's gonna be hard to take home money if you have less than 60 to 80 patients, regardless of how high your overhead is or how low I guess your overhead is.

I think that we probably, if you're used to a fee for service clinic, you're gonna naturally overbuy.

I literally think the first like six to eight weeks, I used six band-aids, my stethoscope, maybe a tongue depressor, one piece of gauze and a exam table, like I think legitimately.

I could have had the, my cupboards completely empty and no one would've been any in a blood pressure cuff.

I guess I left that out, like no one would've been wiser.

Like they, they would've never known that I had empty cupboards.

And then I, I think we also get, I don't know why this happens.

I'm not naturally, I'm not an impulse buyer naturally.

And so I've also talked to a number of people that are like, I bought a laser.

I bought a facial machine.

I bought a TMS machine.

I bought, an InBody scale and you're buying them way too soon.

I, we, my husband and I are very very strong budgeters.

Like we run a zero based budget.

Yes you are.

You had raspberries

mentioned before.

Oh my God.

So we've relaxed a little bit since we're doing fine.

But I do think that if you can't manage your home finances, it is gonna be dang hard for you to manage business finances, particularly if you don't have some accountability.

And just having somebody say, Hey, you don't need that machine.

I think there's big dreams that get in the way, and again, this is why my process is that I have to see it on paper, on purpose in black and white, and the numbers have to make sense and be in the black before I will make, I broke Prior to coming, I broke two blood pressure cuffs before I came the whatever fgo.

And I'm like, well, shoot, I have to buy two more blood pressure cuffs.

And so I was on Excel today earlier like plugging in the numbers to make sure that I wasn't buying other supplies this month and that I, my inventory was good and I might have to buy one now and buy one in four months.

And it's a blood pressure cuff, it's not a laser machine.

So I think that that would be my advice is just, people's loans are terrible and.

We worked super hard to pay ours off like we did not, there was no, the loan forgiveness, nothing, which I understand not everybody can do.

But I, I just, I think that the biggest, the biggest concern that I have in talking to some people is if you can't manage your own money, you're not gonna be able to manage the businesses.

Yeah.

It's definitely like you're jumping into this pool of entrepreneurship and.

Knowing your numbers is so, so important.

So important.

Yeah.

I just finished the 10 Goldman Sachs 10,000 Small Businesses program.

Yeah, everybody should do it.

Everybody has to be in two years into business and then they can apply.

But everyone who's that including you should do it.

It's amazing.

That's awesome.

But that is like one of the core things is that you have to know your numbers.

Yeah.

I am not as organized as you, and I literally was like.

La la, la Fifi, blah, blah, blah.

Fifi, I cannot understand what you're saying.

I choose not to listen, and I've definitely gotten help.

But my question to you is, if somebody is ostrich head in the sand like myself, how do you then, get your head out of the sand?

Because I think that there's different ways forgiving yourself is one thing.

Yeah.

Starting wherever you're at, leaning on friends, but what suggestions do you have for people who are like, home finances?

Black or red?

Yeah.

Like What are we gonna do next month?

Dunno.

But it's, it is still black or red.

To be more granular because somebody like Dr.

Jeanne Rodham is very much like you.

She's like, oh no, I know.

To the Penn.

Yeah.

Like maybe within three pennies, how much am I owing for my business?

Yeah.

And getting from my business.

Yes.

Yeah.

I think that you have to have the bandwidth, right?

Like you have to have the bandwidth.

I think one of the biggest things is being able to tell yourself.

No, I mean, and I, I actually, this is a ridiculous story, but I bought a new like, travel cosmetic case.

Like ones that hang on the towel hook.

When I was pregnant with our second child, she just, she's 11.

Okay.

And I remember, so noticing I was very pregnant'cause I was like, I need something new to take to the hospital.

And I remember standing in the target aisle and I was like, this is$17.

Like I can't spend this money because we were mid loan repayment.

Like it was not, it was no on the zero base budget that I was gonna spend$17 and I just got rid of it.

Like I just got a new Wow.

A new cosmetic case.

And I think that just being able to tell yourself, you can't buy that.

You cannot afford that.

And I don't know, I come from a very like conservative traditional background where that was what I was taught.

And I don't know, every individual is different and where we're at, but like I literally, oh, I didn't eat it today.

Dang it.

I should have, I literally brought a foldable Tupperware container to take leftovers home from restaurants so I could eat them the following day for the this, this is extreme, Mariel, but I do think that for people who are just naive to it, like you just have to, even with personal finance, like you just have to start tracking what you're spending.

And I think it's so easy to put, to get the, put the cart before the horse, right?

And say, oh my gosh, I have this business and I'm gonna take out these loans.

I'm gonna take out a credit card, and I'm, gonna do all these things.

And it just.

It will bite you every time.

It will bite you.

Just speaking from my own experience, that is a huge thing to just start.

Mm-hmm.

It's okay if you know nothing about stuff.

'cause I went from, I remember very vividly every single month I would get my at t bill at medical school and my habit was to staple.

I like, ha oh, it was so beautiful.

Like 12 months in one packet and I stapled that stuff together.

It was so gratifying, so organized, so gratifying.

Yes.

Then I got married.

Yeah.

And I'm like.

I don't do money.

And then I'm like, oh God, now I have a business.

And so I was like, well, I just rested on my laurels of my husband will figure it out.

Yeah.

But then my husband is here writing on paper with a pen and I'm like, okay, there's something wrong with this situation who is not working?

No one can translate this.

And no one is vetting that this is right, that you, you charged my account the, the cost.

And that's a mutual purchase.

And I would argue that that's always a mutual purchase.

So.

Knowing that like you'd literally today, today is different than tomorrow.

Yeah.

Is so important.

Yeah.

But I, I do think that there's so many tools out there.

Yeah.

Especially when you talk about proforma.

Yes.

It's so important and I love that because the proforma is very different than making sure you know, every single charge.

Right?

Yes.

And it's much more, it's much more lenient for that person who's stressed about I don't.

I don't look at numbers, I just look at color.

Red or black.

Yeah.

Yeah.

It's hard.

I mean, I think, I think lots of people are super intimidated by it, and I, I think there's, is it Amy Otic, I think?

Yeah.

Yeah.

I connected with her really briefly, but I think they do like Dave Ramsey, Dave Ramsey, the bill, the,

the bell.

Yeah.

Yeah.

Yeah.

And I, I think if you, we made a commitment from the beginning, like we would run a debt-free business.

Mm-hmm.

And so I am very risk averse.

Like I, I will not take out debt.

And I understand that's a privileged place to be.

But I also think that we, we have a tendency because of what we see and what we train with, that we overestimate what we need and what's gonna happen and, what are we gonna be able to do.

I mean, even yesterday, this is a perfect example, is I was talking to somebody and they were like, I'm gonna draw labs.

And I was like, oh, great.

I mean, I love it when people draw labs.

Are you gonna have staff?

And she was like, well, no, it's gonna be me.

And I'm like, are you gonna show up at 7:00 AM for fasting AM insulin and cortisol levels?

I'm not doing that.

And so, I think just the practical aspect of being like, oh, I, I didn't really think about that aspect of that, and again, downfall, like it's, it's to a fault that I like, put something on the table and I'm like, oh, what does it look like from this angle and this angle and this angle, but.

I do think that it is incredibly helpful for financial decisions because there's, there's no question at the end if I'm gonna buy it, it's a good deal and I'm gonna buy it.

Yeah.

I love that.

When it comes to you mentioning these examples, which I love, I.

It, it warms my heart when you're like, oh, like I'm walking my dog and it's Sunday and I'm listening to my, I do every Sunday.

Every Sunday morning.

Yes, I know.

And I love it.

It makes my heart, I know that at least Dr.

Jalen Pritchard is listening True to the Mind DBC two podcast.

But I, I'm wondering in terms of like community, because you are a solo doc, you have a virtual assistant now.

Yeah.

But how, how important is community?

And I get everybody's different.

I get that.

Yeah.

But how important is community and how do you.

Maintain community.

Yeah.

Because this movement is growing.

It's, and there's always gonna be people who opened around the same time at the same year as you.

Yeah.

But there's always gonna be new people and there's always gonna be people who are going to be looking to retire.

Yeah.

Yeah.

I think on a professional level, we have a great community of DPC in Spokane.

There's probably seven.

I actually just got a text.

I think there's nine people on the thread.

Amazing.

I know.

So we're growing, we, I sort of organize meetings every quarter, every two to three months.

We give community updates where we're at in practices, how we can help each other renew resources.

We have a newly open sports medicine cash pay practice.

There's rheumatologist that's opening a cash pay practice.

So we're sort of trying to figure out what the next step is as far as making ourselves official.

And then I, I really have loved a lot of the specialists.

I talked to an ophthalmologist, I talked to gi and they're like, oh my gosh, I'm so glad you're doing this.

'cause they know they can get ahold of us, right?

Yeah.

And that community's growing I think from a.

A larger perspective.

It's, I, I'll be honest, being a business owner and it's probably the age that I'm at, but like every new female patient that comes in, I'm like, Ugh, I wanted to be your friend.

I would totally be your friend.

And so it's been, it's hard when you run a practice like this that, I, I would like to think has a good reputation.

And I have friends of friends of friends and friends that, that it is easy to feel.

Like you're on an island.

And I think for my husband and I, like we, we, we've always in the past prioritized community, but with the stages of our kids and the practice and my side gig and my husband works full time, we have five acres.

It's hard it's, it's hard to maintain the community.

And I mean, I would, I would love you to answer that question too, since you're like an energizer bunny.

Just constantly, your hands are in everything.

But I, I, I don't, I think especially from a business perspective, yeah.

You just have to be willing to ask questions.

Totally.

And I think the most successful people that aren't in these big communities are actually the ones that overanalyze everything.

I talked to a friend of mine who's about two and a half hours south of us, and I asked her before she opened, I was like, how did you do this?

She goes, well, we have a backup plan to the backup plan, to the backup plan.

And I was like, oh, that's my brain.

That is what I do.

But she's been incredibly successful because.

She's able to map things out without saying, oh my gosh, what are you doing?

So I don't totally,

I would say that my answer to community is, it's just like how you're talking about, you have your niche and you lean into it.

If it's something teachable that you can do, fantastic.

Just don't keep saying it.

Just put it down in something that is, accessible and shareable.

When I find those people who are like, you're really good at PRP, you're really good at aesthetics.

Yeah.

You're really good at I, I don't, it's I, I laugh because it's instead of Liam Neeson saying, I have skills, it's like I have people.

Yeah.

So it's like I know that I'm never, especially being rural.

Mm-hmm.

I have been very comfortable since medical school that like you are never alone.

Mm-hmm.

You might be alone in the office that day'cause there ain't anybody there.

'cause nobody waits in the waiting room.

Yeah.

Yeah.

But when it comes to, as you're talking about this rheumatologist and the sports medicine doctor, I know that those people are always there and, and this movement is growing so much that it's like there are more people that I can turn to.

Yeah.

For example.

A doctor colleague of ours in DPC needed a specialist for their kid.

Mm-hmm.

And I'm like, I don't know, but I know who to ask.

Yeah.

And sure as heck, yeah.

I got the name of the person that that person needs to take their kid to.

Yeah.

And this is, this is DPC.

Yeah.

And we literally get to be paid for this.

Yeah.

And yes, boundaries in terms of like, how much time are you spending on that?

But at the same time, it's to me, community is recognizing that I'm not alone in this.

Yeah.

Even if there's no one else who lives in Arnold, California.

Yeah.

Yeah.

But who should come be a new physician, Arnold,

California, and be my friend.

And you know what else I love about community is like I have a fairly physician heavy panel.

Yeah.

Like I take care of a lot of doctors and I got these results back.

I had a, a non-verbal child with autism who had a dental procedure.

So we're like, do everything, do vaccines, do labs right when he's under sedation.

And so I got these labs back and I was like.

Oh my gosh, they were so abnormal.

Wow.

And I, looking at them, I was like, I'm pretty sure he's just dehydrated.

Yeah.

So I texted mom and I'm like, Hey, how long had you eaten and drank it?

Whatever.

And she was like, what?

And I just could not sleep.

I couldn't sleep.

And so I have a patient that's a pediatric hematologist and I texted her and I was like, can I ask you a, can I ask you a question?

She's oh my gosh, yes.

I have a patient.

That is a, it's a radiologist, like a specialty radiologist.

And I text her all the time.

I'm like, Hey, I have a patient with a breast cyst.

Can you get them in?

And it just, it's such a gift because they appreciate you and they appreciate the care you provide, and they appreciate the referrals that you're sending them and they, they wanna repay you.

And that's their gift back.

It's just, it's like this puppy family.

Like

it's a lovely circle.

It totally is.

And I think that it also feeds into community.

Mm-hmm.

Because it's just when social media can be so.

Ugh.

Malignant and nasty and all this stuff.

Yeah.

When you see the opposite of that, the people are like, I don't know you, but like I overheard you and this might help you if I'm not being too invasive.

It's and when you know that, oh my god, there's amazing primary care doctors out there who are like actually following up and calling me and conversing with me about our mutual patient.

Yeah.

What I have found also is that in terms of growing community, these people are like.

C Can I do that?

Yeah.

As a specialist.

I'm like, yes you can.

Yes, yes you can.

You can.

Yeah.

Yeah.

So that's amazing.

Awesome.

So what is coming in year three, year four, year.

Once Don, you skip a few until you're done.

I know.

I don't know yet.

Actually that was, I kind of came here and I'm like, man, I'm really hoping to try to figure out the next step.

So actually just last night I was up until 1230 adjusting my website from in like schedule an inquiry call to join our wait list.

So that's one big step.

I think I'm gonna continue to promote the course.

It's called Lose Better.

You can lose-better.com.

I'm gonna continue to promote the course just'cause I think it's needed in this space.

Yes.

And then I need to decide if we're gonna grow.

Like I need to decide.

I really I love my va.

She's amazing.

I think that I don't have a great set of admin management skills for staff that need lots of hands-on touches.

So I need to figure out if I'm gonna hire.

Another physician.

Mm-hmm.

Or a nurse practitioner, whoever.

And then there's some community outreach stuff that I want to kind of start.

There's lots of confusion around the menopause space in the community.

There's a few people that have opened their doors and are sort of advertising some things that I don't necessarily agree with.

So I'm like, how do we face that head on?

And then, yeah, I think just continuing to grow.

It's really amazing to get to a spot where you're like, I'm good.

Like I'm.

I have my patience.

I'm good.

Is there gonna be attrition?

Of course there's gonna be attrition.

But you know, for the most part, I think if you really show up, you know your values, you align your business with your values, you provide really good care to people, and you're empathetic, people are not gonna leave you like they truly, truly won't.

Yeah,

it's, it's so true.

And I think it's gonna be even more.

A parent when in the next couple of years people will lose their healthcare somewhere another by people not accepting their Medi-Cal or Medicaid.

Yeah.

By people not having Medi-Cal or Medicaid.

Yeah.

Yeah.

And I literally have been telling my entire family like, you better get yourself a DPC doctor before we're all full.

We're, yeah.

Like literally that's just a black and white fact.

Yeah.

Yeah.

And I found someone here for my cousin in, in Arizona.

'cause I'm like, here, here's your GBC doctor.

Yeah.

You like pay now and argue with me later.

Yeah.

Because I, I think that that is so important for for us to recognize that so many people need and want what we're doing.

Yeah.

So I think that, as you put your website to wait list mm-hmm.

I like, I mean, you've always done what's right for you.

You've always worked until you find an answer that's comfortable for you.

So it's like I know that you'll know what, what is the next step for you?

Next step.

Yeah.

But I love that you're in community right now and I'm so excited to meet you in prison.

I know.

Because like literally, this is where if you are not sure what the heck to do, just like vomit on somebody else.

Not physically Yeah.

But like vomit all the ideas and then just like you have, you're like, you don't need a laser today.

Yeah, yeah, yeah.

And because we can't see past the end of our noses sometimes.

Yeah.

Yeah.

And that's okay.

It's okay.

It's okay.

Yeah.

Yeah.

Yeah.

Well, I am super excited for you, whatever the future brings.

Thank

you.

Yeah, it's a, it's such a gift that you've given this community to just keep asking good questions and hearing people's stories.

And I think the stories are like the best part of this, right?

Absolutely.

'cause everybody, you can, you can hold them up next to each other and go where, what, what fits me?

And you know, you say it all the time, like if you've seen one, you've seen one.

And there's no right or wrong.

I mean, there's plenty of wrong ways to do this, but there's no right way to do this.

And I think that it can work for.

Anyone, anywhere.

Again, as long as you align with your values, I'm gonna be preaching that until I'm 90.

That's your pitch next year for a talk.

That's my pitch.

There you go.

Let me know if people wanna hear it.

Keynote.

Keynote.

Hashtag

keynote.

I love that.

Well, thank you so much.

I look forward to Thank you.

What the future holds, and I'm so excited again to meet you in person.

Thank you.

Thank you for listening to another episode of my DBC story.

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