SPEAKER_00 0:00

This story starts at about 5 30 AM while I'm at the gym. I get a text from a patient. She says, Hey, so I got this eye problem. My eye's been really irritated, itchy, red, and it's really bothering me. Can I get in today? So between sets of strict press and deadlift, I said, Yeah, you want to come in at 9 a.m.? She said, sure. So that was the start of this story. And then so she shows up at 9 a.m. And I was hoping that this would be a good idea.

SPEAKER_02 0:33

Let's pause this story.

SPEAKER_00 0:35

Yes.

SPEAKER_02 0:36

Because this I'm I'm looking forward to kind of unpacking all this. But as we kind of fill out the full of this episode, I think it gives a really good uh I'm looking forward to get the context of how the experiences have been of concierge medicine versus your traditional experience in traditional insurance-based medicine. And so as we pause on that story, we'll come back to it. I would love to kind of get a two years into the practice now, this 30,000 foot lens of what it's been like when being in a concierge practice and what it's been like for being a nutritional insurance-based practice, especially around the ideas of like volume, expectations, patient experience. It's it's a quite high level, but now that we're two years into practice, you get to really have fun stories and experiences and see the different nuances. So kind of walk me back on the old practice. How many patients did you have?

SPEAKER_00 1:36

It was somewhere over three thousand.

SPEAKER_02 1:39

And you wonder why everyone feels like a number.

SPEAKER_00 1:42

I know. And the funny thing is, this isn't a I was a physician that at the time had a closed panel because when you get enough patients, you can close your panel because obviously you're one person and you can't see everybody. But the organization that I worked for, they made it so that if you were a patient with another provider in the same system, you could transfer to another provider that you wanted to see within that system. Okay. And you, as the physician, could not say no to that transfer. So you so it's an open system. So despite the fact that you had a closed panel, anybody could get to you because if they were already in the system, they would just switch to you.

SPEAKER_02 2:25

That's fascinating.

SPEAKER_00 2:26

So it was a rather silly setup, in my opinion. So there was over 3,000 patients on my panel there. And at this practice, Ken Series Medicine West Michigan, I am not going to see more than 300. So a tenth of the number.

SPEAKER_02 2:44

Go back to that experience back then.

SPEAKER_01 2:46

Yeah.

SPEAKER_02 2:47

Because you had 3,000 patients, how many patients were you seeing a day? How what was your average patient meeting time? Uh I'm asking a lot of questions. We'll start with those two.

SPEAKER_00 2:56

Yeah. So when I was at the other, my other job, I had a probably on average, dependent the days were slightly different lengths, but around 20 patients per day. Okay. And so that would be anywhere from seven to fifteen minutes with each patient, I would say. And I I honestly don't even think and I think not everybody realizes this, that it's not even just the patient number that you're seeing in the office that makes this challenging. It is now you have 20 people in person coming to see you, but you also have 3,000 other patients that have questions. And so they are calling, they're sending portal messages directly to me. They're asking about labs, they're asking for refills. All of that just compounds. So it's not just seeing 3,000 people in person in the office. It's all then the follow-up and all those other things that make this so challenging.

SPEAKER_02 3:57

So then, because I so then I kind of broke down how many patients you're seeing per day, minutes per visit. Any guesstimation on like inbox like inbox messages from your 3,000 patients on, let's say, a weekly average.

unknown 4:11

Right?

SPEAKER_02 4:12

No, we'll say we'll get a little bit more.

SPEAKER_00 4:12

Messages, you would say?

SPEAKER_02 4:13

Yeah, like out of your 3000 patients. That's a good question.

SPEAKER_00 4:16

If this was like me just having left my job, I probably would remember this better. But I mean, I would get 30 a day at least.

SPEAKER_02 4:27

So So not only the 20 patients you're physically seeing a day, and then you gotta prep for and be kind of understanding. You got 30 more online going, I need a refill, I need this. I got a rash, what do you think?

SPEAKER_00 4:41

And a lot, and you know, it'd be one thing. If people are asking really simple, reasonable things, hey, you prescribed this medication two days ago, I'm having this issue. Fantastic use of that messaging system. I think you'd already seen me, we'd had a conversation, you're having a problem. Awesome. But it was a lot of, hey, I have this symptom, these problems. Can you either tell me what to do, or can you just give me this say antibiotic that I want? And so it was a lot of that of, hey, I just want your time and your care without me having to come in to see you.

SPEAKER_02 5:16

Okay. Now, from that, realistically, how many fell through the cracks? Probably Well, okay.

SPEAKER_00 5:24

So and what do you mean by fall through the cracks? I would ask first.

SPEAKER_02 5:28

I guess I guess the angle is like they have so we're asking questions like, hey, I have this question on antibiotic or something.

SPEAKER_00 5:36

Yeah.

SPEAKER_02 5:37

You're just gonna what what what is your go-to? You gotta come in.

SPEAKER_00 5:40

Okay, so yes, in this scenario, in that my prior job, if patients asked a demanding question about something that I had not seen them for, I would, if it was a message to me, I would just directly tell the patient, please schedule an appointment. And if it was a message relayed through a nurse about a phone call, I would tell the nurse to call the patient back and schedule them. Because I don't have time to do that during my day. And it's challenging to appropriately treat people in medicine when you haven't seen them. And I think patients don't always like that because they think just give me this thing that will take care of it. And there's there could be so much nuance to the question that they're asking that how can I tell them what's wrong just based on a two-sentence message from them?

SPEAKER_02 6:28

Yeah, it's not great medicine. Well, and yeah, and the classic is like, well, is it a rash? Is it eczema? Is it this? Is it that? You gotta look at it.

SPEAKER_00 6:38

Well, and they would sometimes send a picture, but they're like, okay, I've had I have this rash, can you tell me what it is? What's the story behind this rash? Like, how long has it been present? Have you, you know, there's so many questions that I could ask them about this rash that would help me to know what it is. And just getting a picture of something is not always helpful.

SPEAKER_02 6:55

And then because obviously, obviously being in a larger practice, you actually had nurses and other stuff as well. How much does nurses take of this of that load?

SPEAKER_00 7:07

So the nurses were really helpful. The nurses that do this job at a primary care office, they are really great because they do actually try. The good ones are really trying to protect the physicians. They really care about the physicians. And so they are trying to get people scheduled. They have the ability to make that clinical decision of saying, hey, this needs to be seen so they can tell the patient it needs to be scheduled. Um, and they were really good about calling people back. So you didn't have to because you didn't have the time to do it. And so they were really helpful in that job. So shout out to all you nurses out there who are working in primary care offices. You are loved.

SPEAKER_02 7:42

Love that. Okay. So that kind of gave a perspective of how many patients you had to deal with, how much day-to-day seeing patients versus versus having interaction with the patients per day, the expectations of those patients with that type of volume, and you wonder why everyone feels like they're getting it's not your fault, but you're give you you only can give half half you only go halfway or even once the way because you just don't have the time resources in particular to spend the allotted because because then, okay, you set up a have them set up an appointment. What was your average booking in advance, unless it was like an extreme thing?

SPEAKER_00 8:26

Well, I mean, it would be probably weeks out unless people are lucky. And so a lot of times they'd be scheduled with, say, another provider in the office, or if it was something that they felt like they had to be seeing now, they'd get told go to urgent care. So there was a lot of that.

SPEAKER_02 8:41

Okay.

unknown 8:42

Yep.

SPEAKER_02 8:42

So now we kind of laid down the groundwork here. Um, go back to the story. So walk me through uh your current patient experience. So from my recollection, because I've actually heard half the story, but not the whole thing. You were at the gym getting a set in, working those delts, and then patient texts you saying, I have this problem in my eye. You check your schedule, you had a 9 a.m. available that same day. Yep. Well, okay, what happens next?

SPEAKER_00 9:09

So she she came in at nine, and I was hoping this would be. I mean, okay, there's a lot of people that have eye complaints. Like it's not an uncommon scenario in a primary care office. And a lot of times it's like you're like, it's probably a mild conjunctivitis, whether it be allergic or irritant or uh infectious. And so a lot of these things are really simple. It also could be, and I thought it maybe would be a corneal abrasion. And so she came in and her eyes really puffy, her, her, the her eyes injected where it's all red, and she's just tearing up. I mean, it's just like tearing while she's talking to me. And I looked at it, evaluated it, and I was hoping to just be able to send her out the door with some instructions and maybe an eye drop, but it just didn't feel right. And I was like, this and this is something that I think this is what really the practice of medicine is, where you can know all the things, you can know all the science, the physiology, the pathophysiology. But when you've practiced medicine for many years, you get a gut feeling of this is a problem versus, oh, this is no big deal.

SPEAKER_02 10:24

And I think this this will this will fix itself over time.

SPEAKER_00 10:27

Yeah. And sometimes you can't like tell a patient, well, I know this is gonna get better without any significant treatment based on these criteria. Like, you can't always tell people that. You just have had experience and you know. And I was like, this eye just doesn't look right. And so I was like asking her all the questions, hoping she'd say no to a lot of different things. And ultimately I was like, you know, I really think you need to have your eye doctor. She did have, she does have an eye doctor. So I was like, I really think we should get you to an eye doctor to look deeper into what's going on with this eye. And so I said, Who's your eye doctor? She told me. I walked out of the room, asked our front desk um staff to please call her eye doctor and get her an appointment. I told her what to say. This is what's going on. And so then I went back in the room and talked to the patient. And we continued to have a conversation. And she actually was like, Yeah, great, we got that story across. Can I ask you another thing going on? Can we talk about it? And in my prior practice, I would have been like, no, probably the appointment was already over. And at this practice, I was like, absolutely, what else is going on? And so we went on to move on to a completely different healthcare topic. We walked through that, came up with a plan for that. And then by the time we finished there, there was a knock on the door, and there was the appointment. She had an appointment set up in 20 minutes with her eye doctor. So she walked out of our office, drove to her eye doctor. And then I haven't talked to the patient since, but she did text me later that day saying that she had a serious eye infection and she needed to get on this antibiotic that day. But the pharmacy was out of the pharmacy was out, so she was kind of a little bit frantic about I need this eye drop today. So can you help me and work on getting it to a different pharmacy? Because I can't get a hold of the eye doctor's office. They're just it's slower to get through to the doctor there. So I helped her out with the with the eye drop and the pharmacy, and she's good to go. Nice. But that kind of there are certain eye problems that are emergencies, and this was one of them. And she got taken care of in from her message at 5 30 in the morning till 10 10 in the morning. It was taken care of. Nice.

SPEAKER_02 12:42

How many do you have any idea how many uh pharmacies you had to go through to find it?

SPEAKER_00 12:47

It was it didn't take that long. But it was it was just really nice to be able to help her out. That's the thing. A lot of times patients will have stuff done with specialists, and then they will message or text us and say, Hey, I know you didn't actually either prescribe this or do this, but I can't get a hold of that office, or they're not getting back to me fast enough. Can you help out? And often we can. Now, not always, but a lot of times it's something that we have the time to be able to do this a lot quicker. And so they don't have to wait for their specialists. They can just go through us.

SPEAKER_02 13:18

Okay. So now flip that story. Yes. This exact scenario happens. A patient of yours, 5 a.m. puts in the portal, or maybe calls first thing in the morning at when when the when did the practice open? 7 30, maybe. Yeah. So they called right at 7 30. They get a hold of uh the front desk, front desk gets a nurse.

SPEAKER_00 13:39

Uh huh.

SPEAKER_02 13:40

Tell the story of the nurse, what happens?

SPEAKER_00 13:42

So depending on what I guess, depending on how good the nurse was and how many questions they asked, they would have either gotten work to get this person an appointment with whoever was available, or sent him to urgent care, like I said. If that person had sent this through the portal, which is what a lot of people would do, I might not have even seen that message until 4 p.m. that day. Because by the time you get there, there's already how many things in my inbox I had to go through. And I can't, I don't know if that's an urgent message. I can't look through all of them at the beginning of the day sometimes. And so that could have been lost for 12 hours and never gotten taken care of that day. And so the experience would have been completely different. Yeah.

SPEAKER_02 14:26

And it would all and then like and delayed care. Delative care, which obviously then it's the concern of the what-ifs of someone, depending on someone's ability, get access to urgent care, get access to ER. You're like, okay, we want to take it serious, we're gonna go to the ER. And it's like, well, if you're going to the ER, you're waiting three, four hours, and you it's gonna and it's gonna be costly. And you sit there and do this whole process out, okay, cool. That logs down the system. No one wants to spend a half a day. So then they go, Well, I don't want to spend a half a day. So you kind of wait on it, hoping that it's a nothing burger.

SPEAKER_00 15:00

Right.

SPEAKER_02 15:01

And then it turns into something way worse. Yeah.

SPEAKER_00 15:05

So it was it was really fun to be able to respond at 5 30 in the morning. And even when this patient came in, she was like, I didn't expect you to s respond right away to my question about the appointment. She was just getting, you know, texting so that first thing, potentially when I got to the office, I'd be able to figure that out. But I'm like, hey, I'm between sets. I can schedule this. No big deal. Love it.

SPEAKER_02 15:31

Yep. Are there any other um going off of that whole kind of breakdown? Are there any other personal experiences over the last say two years where you have found that wow, when you have the time, focus, and ability, you made a problematic health pro like situation a lot more streamlined? Do you have any stories?

SPEAKER_00 15:54

There's a lot of them. I mean, there's the simple stuff like I got a tick bite or I have this wound that needs to be cleaned. There's that simple type of stuff. Um, but there's also, uh interestingly enough, the same day that we're talking about that, I saw this patient. I also had a new, I had a new patient. I'd seen him once before the week before. He had come in because he really, we were close, he wanted easy access, wanted to be able to get in when he needed to. And he had had an episode of AFib previously. And so he had texted me in the middle of the day and was like, hey, you know, his heart felt weird. He was feeling some like weird things. Can I come in for an EKG? And I was like, come in at three, and he said, perfect. And then uh, so we came in, we did an EKG, came up with a plan, and then when he left, he said, This is exactly why I signed up for this practice. I was like, fantastic.

SPEAKER_02 16:46

Yeah, because obviously you flip this back to the the previous experience, it would have been go to the ER.

SPEAKER_00 16:52

Unless somebody had to happen opening, anytime uh people are calling about chest-related complaints, most nurses were their job, they're supposed to send that person to the ER. Unless they talk to a physician. But then good luck finding the physician between patients.

SPEAKER_02 17:09

Yeah.

SPEAKER_00 17:10

That's always a challenge too.

SPEAKER_02 17:12

Well, very cool.

SPEAKER_00 17:13

Okay, so any other questions for me?

SPEAKER_02 17:15

Honestly, though the big one there is like kind of unpacking, I guess. You kind of gave out two stories. Is there anything else uh that kind of pops out? Because I came up with a couple of different scenarios.

SPEAKER_00 17:28

What do you got?

SPEAKER_02 17:30

All right, we'll go with this is always a fascinating one because we I want we were talking about doing a video on this for social media. The annual physical. Yes. All right, walk me through when you're at your previous practice, the process of an annual physical, how was it from your side of the table? How is this experience for the the patient on the other side of the table? Walk me through that.

SPEAKER_00 17:52

So the physical is something that my sister and I talk about a lot because patients have an expectation of what physical means, and physicians and health insurances and payers have an idea of what physicals mean.

SPEAKER_02 18:06

Mostly mostly from the experience of being on the seeing from behind the the veil is the physical is basically a checkbox of insurance boxes so that the doctors can actually get paid for something that the insurance will actually cover.

SPEAKER_00 18:21

Yeah, so physical is supposed to be healthcare maintenance. So it is checking out off the boxes of things that are approved to keep you healthy long-term preventative care measures. But by preventative care, they're not talking about make sure you make sure this person's due nutrition is good and they're exercising well and they're sleeping well. That is not what insurance is asking us to do. They're asking us to make sure this person has had the appropriate labs to have had their colonoscopy, their mammogram, their prostate cancer screening, their PAPS mirror, all these things up to date. It's making sure their medication list is appropriate. But it is not, from an insurance and healthcare system standpoint, it is not a visit for patients to come in and ask all their questions about all their problems that they have had come up over the past year.

SPEAKER_02 19:06

Yeah, because from from uh from the patient side, and I even thought this myself, like the your annual physical is your way to talk to your doctor about all your problems so we can start creating a plan.

SPEAKER_00 19:17

But from your side of the table, from the healthcare system side, that is not what it is. And this is why patients get so upset, and rightfully so, that they don't feel heard because they're going into this visit with an expectation and they come out very unsatisfied because either A, they were told they can't talk about their concerns and they have to schedule a new appointment, which is what a lot of people have been told more recently, is what I'm hearing. Or they do, their doctor is willing to listen to some of these concerns that they have. They work through it, and then they get a bill because it is no longer a physical. It is now that physical is a preventative screening. That's how insurance looks at it. An acute or chronic problem is not considered preventative, so it is billed differently. And patients get so mad. Now, some physicians will just not bill for those other things, but then they're not getting paid for half the work that they did. So, and some doctors will do that because they think I'm doing this for my patient, which is awesome if that's a physician's decision. But I also think it's okay to fit for physicians to say, I should be conservative for what I did.

SPEAKER_02 20:30

It's it's a weird concept that we've hold uh sometimes doctors this weird notion. It's like, well, because it's health, they they can't get compensated.

SPEAKER_00 20:39

Like you should just give out this advice for free. I don't know. I mean, and I I'm not saying I like this system, but that is how it's set up.

SPEAKER_02 20:45

And that's the whole thing. Like it's it's a battle between doctor and insurance, not between the patient, but the patient gets caught in the middle of it in these in these situations.

SPEAKER_00 21:09

Right. And I this is the thing, Jan and I always talk about that if you want to make sure someone has their all their screening tests up to date and their lab work is done, like why do you need a physician to have an appointment with a patient to make sure that's all done? That is very algorithmic. It's based on the recommendations by different organizations about time frames and follow-up. This is something that could be done probably by a computer system nowadays with AI or with a nurse. Like, this is something that's not really I just don't see the value of having a patient come in, sit with her physician, go through these things. The patient can't ask their questions and then they're done. I just don't understand what the value in that is. And I was always annoyed by that. And so I was always willing to talk to with people about their other concerns at this. That didn't bother me a ton because it just seems absolutely ridiculous to say you are not allowed to talk about this, which is what I know some healthcare systems in our area are telling their physicians to do. And I think patients get like letters or notifications that you cannot talk about these things at your visit. This is this is truth.

SPEAKER_02 22:19

That's fascinating. Okay. So so from your left, so obviously the experience of annual physicals obviously just as a whole is an issue. And then the experience of how that is uh explained to patients is a goofy one. Now, do you do some type of annual physical when it comes to what you're doing now?

SPEAKER_00 22:42

Yes. So we still do a physical, but it looks very different. And I will going back to how I did physicals before, part of that is supposed to be like healthcare screening or um recommendations through like nutrition and exercise. But let me just say, I think that's just so low on the totem pole for most clinicians because they don't have the time to actually dive into doing more of that discussion. And as bad as it sounds, they're not getting paid extra to do that. So the what we do at our physicals now is we run through all that stuff that we did at our at the physical in my prior job. Like that stuff is all really important stuff. I'm not saying it's not, but we do that, we get through it, and then we go through all the person's problems. We talk about any concerns that they have, we follow up on everything that they have questions on. And we do an extensive dive into their nutrition and their exercise and their sleep and their stress. And it is just so much more valuable to have the time to be able to really get the details on where they are in those pieces, because that foundation is so important for their health. Like you want to get your screening test done, absolutely. But you also, if you're not doing the right nutrition and exercise and you're not sleeping well, that is going to negatively impact your health. And why are we avoiding talking about those things in detail?

SPEAKER_02 24:05

Well, because like because I've in the last two years, what are some of the questions that you never really got to ask when you had 15 minutes or less and you had 3,000 patients to think about?

SPEAKER_00 24:18

Well, we really dive in, but we talk a lot about different macros for people, how much, you know, how much fiber should they be eating. We go into like the nitty-gritty of that, not just the superficial, hey, you should eat more fruits and vegetables. Because that's sometimes all I said at my prior job. Um, because that was like all I felt like I had time for and that we could really get out that we could get out in the time frame that we had. And so doing that and diving into that and giving them recommendations on where they should, like how to do effective weight training and really diving into how important that is for your overall health. Then we also do our in-body skills. So we want to look at body composition analysis, and that's a big piece for a lot of our patients and understanding their health in a bigger way outside of just their weight and their BMI. And that can be eye-opening for people and can really encourage people uh to make some of these changes, understanding the physiology internally a little bit more.

SPEAKER_02 25:12

That makes sense. Now, okay, on a on a new scenario, because this is a this one happens a lot, and I couldn't imagine what it's like with 3,000 patients.

SPEAKER_01 25:21

Yes.

SPEAKER_02 25:22

The lab result that comes back just a little off because this this this is the the the pros and cons of the new technological advancements of uh healthcare and stuff is let's be honest here, patients get their blood their lab results probably faster than you do.

SPEAKER_00 25:40

Okay, so it depends on the system. This is interesting. So in my prior job, how the hospital system had this set up is they had all lab results and imaging results pushed to the patient the instant they came through. So the instant everything was resulted, the patient got notified. Which means the patient's getting a ding on their phone, probably or in their email, that there's a lab result or an imaging result that's available. What are they gonna do? They're gonna instantly look at it, especially if they're waiting for it for a specific reason. Whereas me as the physician, I am seeing my 20 patients, I am not gonna look at those lab results probably till the end of the day. And so by the time the end of the day comes, the patient's already sent me a message about their labs when I haven't even had a chance to review them yet. So now you have to like go through the process of explaining what is this one factor that is off through a portal message when a patient's freak been freaking out about it for the last several hours. And the system's just screwed. Now, our system at our office is when our lab results come back, they are not pushed to the patient until I push them to the patient. And I find this a better way. And I think most patients are totally fine with that. We also respond to lab results within a very short time frame because we have the ability to do that. And so I don't have to have my patients waiting on those results either.

SPEAKER_02 27:05

Yeah. Cause like back in, I mean, I couldn't even imagine you get a a blood a lab result that again, the the the practice of medicine where just because the result is abnormal, like peep people have this idea that, okay, if it goes like so many things, it's gre it's most for so many lab results, it's green or red. Yep. And it's like, wait, wait, wait, wait, it's but but but the lab results red.

SPEAKER_00 27:33

Yeah, that's bad.

SPEAKER_02 27:34

That's bad.

SPEAKER_00 27:35

It's like, well, I mean I think people don't understand there is a difference between outside of the reference range and significantly abnormal. And just because something's red when something is red, that just means it's outside the reference range. And for some things, that is a big deal. There are certain results that if it is outside the reference range, that's a big problem. A lot of them, if it's outside the reference range, it means nothing. And so freaking out about a red result is not necessary. The I feel like the lab test that is most common.

SPEAKER_02 28:11

How many can finish what you're saying?

SPEAKER_00 28:13

The most common CBCs, there's so many factors on there that can be off just slightly out of the reference range, and it's not uncommon at all. I would it's like I'm almost shocked when a CBC is completely normal because there's so often something on there that's outside the reference range. And the vast majority of them are not a problem whatsoever, because usually you have to see a pattern of abnormalities or levels outside the reference range, and then that helps you to identify what's going on. If one or two even is outside the reference range, it's usually not anything.

SPEAKER_02 28:44

Because any idea when you look back at your five years of practicing traditional insurance-based medicine, your inquiries of messaging into the portal, how many of them were just talking patients off a cliff when they got an abnormal lab result? It was quite a few. Was it like 10%, 20%, 50%?

SPEAKER_00 29:08

I mean, there was a lot of messages.

SPEAKER_02 29:09

Yeah.

SPEAKER_00 29:10

So 20% maybe.

SPEAKER_02 29:12

Because again, I got that's just a hard like I couldn't even imagine you get this little reference range, someone freaks out and they're like, But what what am I gonna die am I gonna die? Like, was everything okay? And it's like I you Okay, it's okay.

SPEAKER_00 29:22

We'll get I will get back to you.

SPEAKER_02 29:24

I will let you know. Yeah, and then nowadays I know you've had a couple of I mean, I'm sure that has happened too, like it's kind of follow-up on that. And and I think it's important to know. I'm sh being a good physician, which you are obviously.

SPEAKER_00 29:40

Well, thank you.

SPEAKER_01 29:41

I'm glad you think so.

SPEAKER_02 29:42

I'm not biased, she's not I'm not married to her. Is okay. I know there's been experiences, and this is kind of off of this, and this is not like this is kind of off off kilter, but I'm curious where this is going. When you get the bad lab result that you know is bad.

SPEAKER_00 30:00

Yeah.

SPEAKER_02 30:00

And I know currently there's been a couple scenarios at the practice of like those really nasty phone calls you have to make that no one wants to make, how was that experience when you had 3,000 patients and five years of traditional insurance medicine versus concierge? How how has has it been similar? Because if you're good like Yeah, I mean it's a good question.

SPEAKER_00 30:20

I think when something is so bad that it some result is so bad, it's I mean, like, it doesn't matter which system cancer. Yeah. So interestingly enough, I have in the prior my prior system and in the current system, I had kind of the same thing happen where someone had some imaging done. Uh it was two females in my prior practice and current practice that went for imaging and incidentally found mediastinal masses. And so in my first practice, my old practice, I was actually across the hall from the radiology department. And the radiology tech that was doing this x-ray, she knew this was bad. Like she's she can't say anything to the patient because she's a tech and they're not allowed to do that. But she knew this was bad. And so she literally called over to our office and said, Can you come over here? The patient was still there. And so I had to go over there. She showed me what she's looking at, and I had to talk to the patient right then and there about this is what we're seeing. And then at the at our practice now, what happened was the person went in for a just a screening imaging of her chest and found a mediastinal mass, but the images were done through the hospital system. So she saw the results first and she freaked out and called the our office, understandably. So I happened to be on my honeymoon.

SPEAKER_02 31:44

That's right.

SPEAKER_00 31:45

And so my sister was able to talk to her on the phone right then and there, walk through a plan, do the follow-up, and get it done. So I think when stuff is that bad, it doesn't matter which system you're in. You have to drop everything you're doing and take care of it.

SPEAKER_02 32:03

Yeah. I mean, because because I can I mean there's certain levels where, let's be honest, it's the the the big system, the the big issue between tr the traditional insurance model where you have 3,000 patients and concierge or like a membership bottle where you could where you get to actually some breathing room with patients is not the big problems. Yeah. It's the compounding of small problems.

SPEAKER_00 32:26

Yeah. And I think in my when I was dealing with this in the old practice, now what the only negative of that experience was my time. Yeah. Because now I'm three patients behind because I had to go walk over and talk to a young female about her mediastinal mass. So now all my other patients are sitting and waiting. Whereas in the scenario here, Jan was able to talk to her. She's not behind. She had time to do that during her day because of how our practice is set up. So that would be the difference in that.

SPEAKER_02 33:00

That makes sense. I I I that was a follow-up. It was it was similar, but I just I didn't never knew how that kind of process would go. So yeah, I mean that I mean that's always fascinating. So, like kind of going back to it, this process now that it's been on for two two years, has this been a pretty consistent process of seeing the differences between it's huge.

SPEAKER_00 33:22

There's really no difference whatsoever. I mean, a huge difference in everything that we do, outside maybe those really emergency situations. I mean, just the the amount of time that we spend with patients. I have said this to a lot of people that I think patients are like, can I get out of here, please? I am so done with this visit. It's been so long. And they're almost pushing me out the door where that never once happened at our old practice. They're like grabbing you, stay in the room. I'm not done yet. And so the it's just like a night and day difference on that experience for both a patient and for me.

SPEAKER_02 33:58

Now, here's a question because I don't I'm sure I'm sure not everything was bad from the traditional side of insurance, traditional insurance side of medicine, 3,000 patients. Is there anything you miss?

SPEAKER_00 34:10

I miss my staff.

SPEAKER_02 34:11

Yeah.

SPEAKER_00 34:12

I had a lot more staff, but I also don't need as much staff here. But that is, it was you have a lot of people that do a lot of the staff, not the administration, but the staff you work with on a day-to-day basis in the traditional system is generally really awesome. And they really look out for each other, and we're all trying to do our best within the system that we have. So I would say that is something that I guess I don't miss in the sense that I don't need it right now here, but there is something really special about that.

SPEAKER_02 34:44

Well, yeah, and it and like, and as much as you love your sister, uh-huh, Janna, we love you. I'm sure having more than one physician around and having more nurses and more like there's I there's something valid, like fun about that and moving around and having more than there is some truth to that.

SPEAKER_00 35:03

I will say though, I worked in a fairly big office before, and you are head down senior patients. Yeah. I didn't really talk to my fellow providers all that much. Yeah. Because you are all so stinking busy. There's people on the other side of the office you never even talked to. Uh, there was a physician I worked with for like a year and a half that I probably talked to five times the whole time we were there. It was just like you don't have even the time and the ability to go talk to these people. The only time you ever sit down with each other is when you have staff meetings and then nobody wants to be there because you're all behind anyway, and you want to go finish up all the stuff you're supposed to be doing for your patients. So I would say there is some, there is a good though, support with how everybody's on the same page about a lot of the ways that we have to take care of patients in that system.

SPEAKER_02 35:54

So, biggest takeaways for you on 3,000 patients versus 300 patients, what has been some of the most enjoyable factors? What are the are there any of the factors that you're looking to expand upon?

SPEAKER_00 36:10

I mean, I super really enjoy getting to know my patients at a really deep level. And just knowing so much more about their lives, and which is something you can develop over time in the traditional system if you have patients that stick with you over years, but it doesn't take us that long here. And so being able to have those long-term relationships is a huge piece of primary care. And I think it's what people do value, but they've just never really experienced it truly. And so, um, unless you're someone that had a really old doctor that like treated you kind of in a cancerous way, which some people did have, most people are not getting this experience in the traditional traditional system. I also love that I have the time with patients to, outside of seeing them, to really dive into their problems. So I had people that bring me research that they've done on their problems and research they've done on their symptoms. And I have the ability to sit down and spend the time to dive into what the literature says about these things and see if there are new strategies, creative ways that we can try to either diagnose or manage specific things. And in my prior practice, I'd be like, your labs are fine, see ya. And that's what people experience, right? The labs are fine, and then they never care. Yeah, or you know, I don't know why you're having those weird sometimes. Everything looks good. Good luck. And so that isn't a very good way to treat patients, but there's just not a lot of good ways around that, at least I didn't feel, if you want to maintain an actual work-life balance.

SPEAKER_02 37:39

Well, yeah, and you sit there and go, like, you try even if you get even if you tried because of billing, because of time constraints, then you're getting ripped by your admins because they're like, hey, you're you're taking too long with this. Hey, you didn't build this right. Hey, how did you do and I mean it's it's doctors are put between a rock and a hard place.

SPEAKER_00 37:57

Well, and and I'm just speaking from my experience, thinking about one of my partners at my old practice, when we were talking about like the inbox and following up on their patient messages and their lab results, he had literally one over 1,000 patient messages that hadn't been looked at. So now I worked really hard to get through my patient messages. That was just not his priority, I guess. And how it worked, I guess, for him. But those critical messages where someone should be seen now haven't even been looked at three months later. And so that is the reality of some physicians.

SPEAKER_02 38:33

I'm sure some physicians like, if it's important, they'll call.

SPEAKER_00 38:35

Yeah, that's exactly it. It was like they didn't really a lot of times it was sometimes not always, because I think some of the younger physicians do this too, but the older physicians, especially, they didn't grow, they didn't grow their training, they didn't grow up in tech the tech with these patient messages. So like that wasn't their norm. And so I don't think they felt as much value in following up on that when there were so many other things to do. But I always thought that was insane.

SPEAKER_02 39:00

Yeah, because you can't do it all.

SPEAKER_00 39:01

Like you can't. Something has to give. Either it's your time as a physician, or it's gonna be the messages in your inbox. You know, some the you can't do it all. So what are you gonna give up or let go?

SPEAKER_02 39:14

Yeah. W when when you're when you're working with 3,000 patients, because that's how insurance bills, like what do you what do you do? It you do the best you can. It has nothing to do with the quality of the physician. It's just like there's a time and time constraint. You can't do it all. Makes sense. Well, this was a question. Yeah, same patient, two systems. I think it gives a good perspective on uh you spent multiple years inside of traditional health insurance model of medicine, three thousand patients, now two years in concierge medicine, three hundred patients. You can see how it doesn't necessarily mean you're like your educational knowledge between the two systems is not the change. It's time to spend with patients.

SPEAKER_00 40:00

It's uh time is so valuable. And I'm thankful that I have a lot more of it.

SPEAKER_02 40:06

Love it. Well, hopefully you guys got some good perspective on what traditional insurance based primary care looks like versus concierge concierge uh membership model. Uh hopefully you have a phenomenal day and we'll talk to you all later.

SPEAKER_00 40:18

Bye.