Embracing the Direct Primary Care Movement
Direct Primary Care Doctor
In the world of healthcare, the traditional fee-for-service model has faced increasing scrutiny and challenges over the years. However, in the midst of this, another approach has emerged – Direct Primary Care (DPC). DPC offers patients a refreshing alternative to insurance-driven healthcare, emphasizing personalized, accessible, and cost-effective medical services. In a recent episode of the My DPC Story Podcast, Dr. Maryal Concepcion invites Dr. Kissi Blackwell to share her inspiring journey into the DPC model, discussing the challenges, triumphs, and future plans for Clarity Direct Care in Wichita Falls, Texas.
Transition to DPC: A Journey of Purpose and Change
Dr. Blackwell's decision to transition from a fee-for-service practice to establishing Clarity Direct Care was not only a pivotal moment in her career but also a testament to her dedication to providing exceptional healthcare. Her unwavering belief in the DPC model, which fosters enduring doctor-patient relationships and streamlined access to care, beautifully aligns with the core principles of this innovative approach.
Navigating Challenges and Embracing Success
During her transition, Dr. Blackwell endured the steep learning curve often associated with change. The metaphorical "drinking from the fire hose" resonates with her experience, reflecting the intensity of transitioning to a novel practice model. Despite the hurdles, she adeptly adapted, curating strategies that propelled Clarity Direct Care to admirable success. From marketing through community outreach and word-of-mouth to developing a unique age-based pricing strategy, Dr. Blackwell's innovative approach reflects her commitment to amplifying patient awareness and access to DPC services.
The Human Touch Behind the Practice
Dr. Blackwell’s success is underpinned by the dedicated individuals who form the backbone of Clarity Direct Care. Jennifer, her invaluable team member, played a pivotal role in the practice's growth, leveraging her expertise to streamline operations and enhance member management. This exemplifies the collaborative effort and mutual trust that define the practice's ethos, underscoring the significance of camaraderie and shared purpose in achieving DPC excellence.
Navigating Patient Engagement and Retention
Central to the success of Clarity Direct Care is Dr. Blackwell’s unwavering commitment to patient satisfaction and empowerment. Her keen focus on setting strategic enrollment fees and implementing waitlists underscores her dedication to maintaining quality care and a manageable patient workload. These thoughtful decisions are exemplary of Dr. Blackwell’s dedication to creating a sustainable and patient-centric environment within her practice.
Shaping the Future of Healthcare through DPC Alliances
Dr. Blackwell's involvement as the secretary of the Direct Primary Care Alliance embodies her dedication not only to her personal practice but to the DPC movement at large. By uplifting and supporting fellow DPC practitioners, she exemplifies the collaborative spirit that drives positive change and innovation within the healthcare landscape. Through platforms like DPC University and mentorship events, the DPC Alliance continues to engineer an ecosystem that nurtures and empowers healthcare professionals to excel in the DPC model.
Conclusion: An Inspiring Journey of Dedication and Innovation
Reflecting on Dr. Blackwell's journey, we are reminded of the transformative power of dedication, innovation, and a steadfast commitment to patient-centered care. Her unwavering spirit and relentless pursuit of excellence have not only solidified Clarity Direct Care’s position as a vanguard in DPC but also spotlighted the profound impact of the DPC movement.
In closing, Dr. Kissi Blackwell’s narrative serves as a beacon of inspiration for aspiring DPC practitioners and underscores the immense potential of the DPC model. It is a testament to the transformative impact of forging enduring doctor-patient relationships and pioneering new frontiers in healthcare.
For more compelling stories and insights from the DPC landscape, tune in to the My DPC Story Podcast, and explore the evolving narrative of the healthcare revolution.
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With shared dedication and unwavering passion, we continue to illustrate the extraordinary potential of the DPC model, one story at a time.
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BIO
Dr. Kissi Blackwell graduated from the University of Texas Southwestern Medical School in Dallas, Texas in 2006 and from John Peter Smith Family Medicine Residency in 2009.
She practiced for 5 years in Fort Worth at John Peter Smith Hospital and moved back her hometown of Wichita Falls in 2014.
After almost 3 years of working with United Regional Physician Group, she ventured to open her own direct primary care practice and bring a new kind of healthcare to the Wichita Falls area.
She has been serving as the DPC Alliance secretary since Dec 2020.
She opened Clarity Direct Care in 2017!
In her interview she shares how she had 278 patients before she even opened her doors. She shares about how she made the transition to DPC and how she's been able to pivot on many issues; she has had to make lots of changes on her journey to DPC like selling her Escalade (only to buy yet another when she was in the black) and moving her clinic within 90 days to a new location!
Resources mentioned by Dr. Blackwell:
- For marketing, Alexa Torres, Kissi's Cousin, over at www.careid.us
- Start With Why: How Great Leaders Inspire Everyone To Take Action by Simon Sinek
- Sphenocaths for sphenopalatine ganglion blocks (point of clarification:
Dr. Blackwell notes in the interview she reuses sphenocaths only after they are cleaned but of
note, she only reuses a single sphenocath on the same patient.
- Point of care ultrasound (POCUS) classes she took:
CONTACT:
Listen To The Episode HERE:
Watch The Episode HERE:
TRANSCRIPT*
Dr. Maryal Concepcion:
A special note before today's episode. Lots is coming down the pipeline over here at myDPC story. So head on over to my dpcstory.com today to become a myDPC story insider and subscribe to our newsletter because that's where we'll be sending the word out about exclusive events, Exciting updates, resources, and much more. Now on to today's episode.
Dr. Maryal Concepcion:
Direct primary care is an innovative alternative path to insurance driven health care. Typically, patients pay their doctor a low monthly membership and in return, build a lasting relationship with their doctor, and have their doctor available at their fingertips.
Dr. Kissi Blackwell:
Direct primary care is what allows me the freedom and the privilege to build meaningful relationships with patients that both allow patients To receive attentive and personalized care and allows me as a physician to truly care about and to care for each patient in the way that they truly deserve. I am doctor Kissy Blackwell, and this is my DPC story.
Dr. Maryal Concepcion:
Doctor Kissy Blackwell graduated from the University of Texas Southwestern Medical School in Dallas, Texas in 2006 and from the John Peter Smith family medicine residency in 2009. She practiced for 5 years in Fort Worth at John Peter Smith Hospital and moved back to her hometown of Wichita Falls in 2014. After almost 3 years of working with United Regional Physician Group, She ventured to open her own direct primary care practice and bring a new kind of health care to the Wichita Falls area. She has been serving the DPC alliance as secretary since December of 2020, and she opened Clarity Direct Care in 2017. Welcome to the podcast, doctor Blackwell.
Dr. Kissi Blackwell:
Thank you for having me, Marielle.
Dr. Kissi Blackwell:
It's definitely my pleasure. I wanna start with Clarity. Clarity Direct Care being the name of your direct primary care practice. Can you share with the listeners about your name choice?
Dr. Kissi Blackwell:
Absolutely. I think I wanted to find 1 word that I kind of felt like embodied what health care should be and kind of what defined DPC for me. So I remember sitting down and writing down, like, A bazillion different words. And I kept thinking, well, people aren't gonna be able to spell that and that one's too long and that one just doesn't sound right. And Clarity, I mean, as soon as I kinda had that word, it was sort of a moment of clarity for me. So, that's Kinda how I chose it, and I and I always knew I wanted it to be something direct care. And so, once I came to Clarity, it was just Right in my head that that was what it should be.
Dr. Kissi Blackwell:
After you decided on Clarity Direct Care, did you go about designing your own logo, or did you have Someone design it for
Dr. Kissi Blackwell:
you. So, my cousin who is a graphic designer and does a lot of website building and things, she did all of my branding, and she created my website, and she actually now act has created, I believe it's about 6 different doctors, in DPC, and so I was her first. And she learned about DPC through me, and so now she's been able to do that for others. And, I really appreciate all her work because she did a beautiful job.
Dr. Kissi Blackwell:
Kisi, prior to opening your doors in DPC, you were with United Regional Physician Group. Can you share about your transition, and what was your practice like?
Dr. Kissi Blackwell:
So I actually would had I had been in fee for service practice for 8 years prior to opening my DPC. Originally, I had been, in Fort Worth at John Peter Smith Hospital, and I had stayed on after residency in in the, in the community clinic. And I knew that I I had actually heard about DPC during that time, and I really loved the idea of it. And, I knew that that's what I wanted to do, but I wasn't sure exactly how I was gonna do it. So when I finally decided to move to Wichita Falls, I decided I I probably needed to establish here first, before I opened a DPC practice, And so I decided to join United Regional Physician Group with the idea that at some point in time, I was probably going to open my own practice. And so for a little bit, I wasn't sure that I was gonna do that, but there was definitely a point in time where I felt like, okay. I'm really So burned out and I'm so tired and they're pushing me to do more and more and I was ready. So in 2016, I actually went To the Direct Primary Care Summit, the AAFP, summit with my dad, who is also a family medicine physician and Also a DPC doctor now, which is great and a different story.
Dr. Kissi Blackwell:
But, so my dad and I went to the summit, And as soon as we came back from the summit, I told my dad, this is it. This is what I wanna do and I'm gonna start now. And as soon as I got home, I actually, sat down and talked with my husband. The next day, we sold both of our cars and got Something that was much less expensive. We sat down and created a family budget, and I started planning what I was gonna do to make sure that I had enough money to do what I wanted to do.
Dr. Kissi Blackwell:
That's fantastic and such a unique story. At the 2019 summit in Cargo. I sat at a table with a resident, who was there with both of his parents. So that is fantastic that you and your dad went to The summit. I did not
Dr. Kissi Blackwell:
know that before. And, you know, and we can certainly talk about this later, but, I helped my parents transition 2 years ago into DPC, They're both family medicine as well, so I'm very proud of that.
Dr. Kissi Blackwell:
I did not know that at all. Yes.
Dr. Kissi Blackwell:
It was great. They were both actually private practice for 30 plus years and then ended up, they were having some trouble with just, you know, keeping up with all the regulations, and so they decided to join United Regional Physician Group, which actually just right after I joined them as well. And, you know, it was just a nightmare for them. They'd never Really been employed like that, and they finally decided they were either gonna have to retire or do something else. And I kept egging them on, like, Please don't retire. Like, let me help you transition to DPC. And sure enough, they, they love it now. They're doing really well, And and they haven't retired, so their patients still have them, which is great.
Dr. Kissi Blackwell:
That's what I was gonna ask. Are they now never going to retire because are they so happy with That's probably That's amazing.
Dr. Kissi Blackwell:
Because I think my dad is still looking forward to retirement, but not as soon as what they would have done before.
Dr. Kissi Blackwell:
Oh my gosh. That is so awesome. This is like I'm so excited about this because I mean, it's like taking getting people involved to the next level. I mean, you went Forwards instead of backwards. We're always talking about the pipeline and affecting medical students. Like, your freaking parents
Dr. Kissi Blackwell:
are doing TV It's great. That's probably one of the the best things I could have done through this Whole thing was to help my parents transition.
Dr. Kissi Blackwell:
When you opened your doors and when you transitioned from United Regional Physician Group, so you are famous for drinking from the fire hose. Can you tell us a little bit about what that means?
Dr. Kissi Blackwell:
Of course, no one ever knows when they start DPC exactly how many patients might Come with them or whether they're going to be able to, you know, afford to pay themselves during that time. And so I had actually had a friend that had just started DPC, and he kept telling me that I needed to save up at least $50,000 before I started. So I took an entire year, and I moonlighted every Saturday for an entire year until I built up 50 k. And because I'm the The main breadwinner of our family, I really wanted to make sure that I wasn't going to be starving at any point in time. So So, yeah, after a year of planning, I gave notice to United Regional in mid February, And I had to give them 4 months notice, so, that was when I was able to start marketing was during that period of time. But before that, I had my website ready. I had AtlasMD set up so that when patients went to the website, all they had to do was go in and sign up And put their credit card in and be all ready to go and just really started marketing everything right away. I was Lucky that and I actually had sort of planned this some because I knew when I signed the contract with United Regional that I probably would open my own practice.
Dr. Kissi Blackwell:
And so I made sure that I didn't have a noncompete and that I didn't have a non solicit. And so I was able to talk to my patients about where I was going and what I was doing, At least in a brief sense. And so I used every single patient encounter as a marketing opportunity. So I, had flyers printed up. I had my business cards ready, and so every patient that came in, got a 1 minute spiel about DPC and why I was doing this, and this is where I'm gonna be, and here's my business card. And, by the end of June before I started, I was starting at 278 patients that had signed up. And by the end of 1st week, I had 300 patients signed up. And by the 3 month mark, I was over 400 patients, so I was growing super fast at this point.
Dr. Kissi Blackwell:
And I'm kind of a stickler about, like, making sure that patients have At least their original visit in the office so I can see them face to face, so I can do an H and P. And so I literally had the entire month of July Full to the brim. You know, probably seeing 10, 15 patients a day doing, you know, initial interviews just because, you know, everybody paid for July, so I had to make sure everybody had their visit. So I did, at first, feel like, oh my god. I am I am drowning. I am working just as much as I did in fee for service. This isn't really what I wanted, but I kept going because I knew that this was the right thing to do. I could see that people really wanted this type of practice in Wichita Falls, and, I wanted to make sure that I could deliver everything that I was saying that I could deliver.
Dr. Kissi Blackwell:
And so, So, yeah, I worked really, really hard the 1st few months, in fact, the 1st, 10 months. By about 5 months, I was getting to the point where I was really overwhelmed, so I decided to implement a soft wait list, which meant that my patients would wait Somewhere between 2 3 weeks for an appointment. Then later on, it got out to, like, 4 to 6 weeks, and I wouldn't charge them, of course, until the month of their appointment. And so that soft wait list helped me a little bit in kind of cushioning myself, and I was full at 600 patients in 10 months. So very, very quick opening. There was probably only about 80 or so patients of that 278 patients that were the patients I was seeing at United Regional. So it's very interesting to note that it was really I I really think it was more of the legwork I was doing with my marketing to, you know, bring patients and and have other people understand what I was doing. I don't know.
Dr. Kissi Blackwell:
I'm not entirely sure if if It was the marketing. If it was that, some of it, I think, was that patients were telling family members about it. Like, oh, hey. And I remember patients telling me, oh, hey. I I don't I don't wanna do this, but I have a daughter who doesn't have any insurance and her family doesn't have insurance, and I'm gonna tell them about it. And so some of it, I think, was word-of-mouth in that sense that my patients may have given me some word-of-mouth marketing there. But, yeah, it wasn't really all of my patients. It was Really mostly community patients, which is very interesting.
Dr. Kissi Blackwell:
We have about a 130,000, I believe, in kind of the county area, and I definitely get patients from all around the county. So we're not a huge town, but we're certainly not super small either. So, but plenty of patients to go around.
Dr. Kissi Blackwell:
When you were deciding on your pricing, had you determined your pricing prior to handing in your your notice when you had already developed your website and when you were already signed up with Atlas, or did you develop your pricing strategy Through talking with patients when you were in that last bulk of time,
Dr. Kissi Blackwell:
I felt like it was really important To be transparent from the very beginning and not just say, hey. Here's this practice. Like, sign up, but I don't know how much it's gonna be. So, you know, patients wanted to know, like, well, how much is it gonna cost me, and what is this and what is that? So I did feel like it was important to have that already ready to go so that it was very clear to patients, hey. This is what I'm doing. This is why I'm doing it, and then this is how much it's gonna cost. So I developed my pricing really just based on, you know, speaking to some of the seasoned DPC doctors. A lot of them had age based pricing, and I liked the idea of that just because I felt like with age based pricing, I could potentially Attract more young families with small children because I do like to do pediatrics and that sort of thing.
Dr. Kissi Blackwell:
And so, and that's really what I do see in my practice Just now is that with the age based pricing, I have a lot of young families, you know, a lot of people that have their own small businesses and that sort of thing, and a lot of kiddos, about 20% of my practice is children. So, that's kind of what I wanted, and it's the reason that I Chose the pricing structure that I did because I knew I wanted to sort of have that type of demographic in my clinic.
Dr. Kissi Blackwell:
When you were talking with your patients and educating them about your DPC and DPC in general, What was your elevator speech?
Dr. Kissi Blackwell:
One of the things that I came across and read while I was kind of trying to figure out what I was gonna tell people was, the book by Simon Sinek, always start I think it's called start with why, And, it really it really struck a chord with me. And so always when I go to tell people what I do, I don't tell them, like, oh, well, this is how much I charge, and I charge a monthly membership. No. I always wanna start with why I'm doing this. And so I always say something like, I really wanted to bring back the doctor patient relationship and make sure that My patients and I had a good relationship and that there were no middlemen between, my patients and and myself. So this is the reason why I decided to open this type of practice. And so then I go on from there, and so I always wanna kinda tell patients why so that they kind of onboard, with my why before I even tell them how much it costs, and I still do that.
Dr. Kissi Blackwell:
You had mentioned having a soft enrollment wait list when the numbers in your practice were getting, to a point where you felt that was necessary. Did those patients do any preenrollment payment in, anticipation for their 1st visit? Once I decided to implement the wait list because I was kind of
Dr. Kissi Blackwell:
drowning in so many patient visits per month, I would charge the enrollment fee, But then I wouldn't charge them their 1st month's visit until the month of their appointment. So if I enrolled them in, January, they would Pay their $75 enrollment fee, but I didn't see them till February, then they wouldn't pay their 1st month until February.
Dr. Kissi Blackwell:
Gotcha. And With regards to your pricing, you have on your website that the enrollment fee is waived if a person signs up and pays an the annual rate. Was that something that you implemented early on?
Dr. Kissi Blackwell:
When I was doing my preenrollment during that 4 months that I was, still working for the hospital, I did actually waive the enrollment fee for patients that would sign up before the start date. So that, I think, was a good marketing tool as well, Just saying, hey. You know, sign up now. That way, you don't have to pay the enrollment fee. And then I did have the I I did do the Waiving of the enrollment fee with a year's payment from the very beginning, and I think that was just something that I had noted on. I believe it was probably Josh Umbers' website that they that they did something like that, and so Just gives them a little more incentive to do the yearly if they wanted to do that.
Dr. Kissi Blackwell:
Absolutely. And one of the things I miss about conferences is that During a conference, you were able to speak with so many people and hear so many different strategies. And I think that, you know, going into planning DPC, take it
Dr. Kissi Blackwell:
all in, and listen to what you're saying and what other people have, have thought about or done to tailor your practice for what you wanna make it. You know, it really just is a matter of what your preferences are with regards to what what you want your patient population to look like And just, you know, even different parts of the country have different ways of doing things. So definitely speaking with as many people as you can, people that are in Similar situations, people that are in similar sized towns, all that kind of thing is wonderful to be able to gather information.
Dr. Kissi Blackwell:
That said, Kizzy, after your initial experience with drinking from the fire hose, did you do community marketing like Town halls or presentations with local businesses
Dr. Kissi Blackwell:
to continue momentum. Most of the marketing that I did was in that 4 month period before I opened my practice, just because at at at that point, I felt like it was important to to make the push for preenrollment, And I had a a little bit more time at that point too. So I did a town hall probably about a month before I opened my practice. I didn't have a huge turnout. There were probably 30 people there, but I do think there was a lot of word-of-mouth that got out. I was able to use a local pharmacy. They have kind of a an educational area that they use for their own patients, and so they were they allowed me to use it for free, which was great. You know, I had food, and I had actually advertised for the town hall in the letter that they sent out Notifying patients that I was leaving United Regional.
Dr. Kissi Blackwell:
United Regional sent out a letter, but I also sent out my own letter because in says they actually have to give you the information for your own patients so that you don't abandon them. So They gave me a list of the patients and their addresses and things, and I was able to send out my own letter and inviting everyone who wanted to know about what I was doing to that town hall. My banker was actually part of the Rotary Club, and he was really excited for me to speak to the Rotary Club. So I was able to do that, and talk to a lot of business owners there about the benefits of having businesses join my practice. I also had a few companies after that that wanted me to come talk to their employees, And so I did speak to a few business employees. Some of them joined, some of them didn't, but I think, certainly, that just being out there and getting, your name across and people know what you're doing and who you are is important even if you don't get the sale necessarily. And then I was just super Gung ho about talking to everyone. I spoke with people, you know, at the coffee shop, at the local restaurant, at the salon, at the grocery store.
Dr. Kissi Blackwell:
I mean, anywhere you saw me, I'd probably start talking to you about DPC. So for a little while, I think I lived and breathed DPC.
Dr. Kissi Blackwell:
That's wonderful. Kizzy, now that times have changed with the pandemic, do you have any words of advice or ideas for those people who Might be wanting to to do DPC's planning in residency where they can't as easily talk to people in person.
Dr. Kissi Blackwell:
This is a really difficult time to do any kind of in person marketing, but I do still think it's it's mainly a word-of-mouth thing. So I think it's still important to try to get in front of people, and sometimes you still can. I mean, there's definitely some opportunity for that, but there's also opportunities We're not necessarily in person, but maybe Zoom calls or presentations and things that you can give online using social media like Facebook and Instagram to post videos and educational things And, certainly, mailing things out if they're and that was one of the things I think was a huge thing for me was being able to mail out letters to all my patients. It's a little more difficult. I definitely won't say that it's as easy as it as it was for me right now.
Dr. Kissi Blackwell:
And then also, you know, I love what you mentioned in terms of speaking with your patients about it after you had given your notice. Right? That if a doctor is still seeing patients and that's a strategy that they can employ,
Dr. Kissi Blackwell:
Especially with employed doctors, it's important to make sure that they know if they have a non solicitation because they may not be able to say something to their patients. But, you know, they may be able to just hand them a business card, and so that's why I think it's super important to make sure your website and your is really good before you go to start marketing the patients.
Dr. Kissi Blackwell:
Thinking about your initial onboarding of patients, Were there any patients who you felt were not a good fit?
Dr. Kissi Blackwell:
I I I've shied away and don't really like the idea of screening patients because I have had a lot of patients that seem to improve with, you know, giving them more time and actually being able to sit down and and really Have a more caring doctor patient relationship with them, so I I'd like to give people the benefit of the doubt. But certainly, there were patients that, you know, the 1st visit, they came in and they were really demanding this, that, or the other. And Most of the time, by the end of the 1st visit, we you know, I could sort of direct that patient into like, Hey. You know what? I think this is probably not the right practice for you. You know, we may wanna reconsider. I'd be glad to refund you everything. And so it was I I really had to do these things more face to face just because I really don't like doing screenings. But I know some doctors actually do Initial, sort of get to know you visits or I'm not exactly sure how they call them, meet and greet.
Dr. Kissi Blackwell:
I'm not a huge fan of the meet and greet, but I know that a lot of doctors do like to do that just so that they can say, hey. You know, I don't think you're gonna be a good fit for my practice or however exactly they wanna say that to them. But a lot of The times I would just let them go for a little while. And sometimes if they could see that I wasn't gonna Do what they wanted me to do, they would leave on their own. And so it wasn't really you know, maybe not exactly ideal, but it was really kind of the way I like to do things just because I don't like to rock the boat with people too much, and I didn't want people to say, oh, well, I went to this practice, and they told me I couldn't join. I didn't want the bad press on that either.
Dr. Kissi Blackwell:
And this especially with what you shared earlier about the population of Wichita Falls, I could
Dr. Kissi Blackwell:
say something here today and tomorrow. It would be all over town, so definitely goes both ways in the good and the bad. On that note, with websites like Yelp and vitals.com and Healthgrades, do you manage or monitor? So I had a patient that was unhappy with my care, and it was really not about the care. It was actually about So she came in and had a well visit, and she also ended up talking about anxiety. And so we build the well visit and we build for anxiety, and so she got very that she got billed for the anxiety part even though that's a very valid way of doing things. So she did go on to Healthgrades and gave me this horrible review, and I don't know how I came across it exactly, but I came crossed the review and I thought, oh my gosh. I really need to make sure that I'm managing these things. And so so I did claim my Healthgrades website.
Dr. Kissi Blackwell:
I claimed vitals. Com. I did I don't think I've done Zocdoc, but maybe something I need to look into. But, the other reason too was because I had a patient come in from She was using Yelp to try to find my practice, and she couldn't find me because I wasn't listed on there. And when I and my name listing actually was still attached to the hospital and I actually had to fight with Yelp to allow me to use my own name. It was really ridiculous. So, so, yes, I definitely encourage people to look themselves up on Google and just make sure that there's nothing out there that just looks weird or that should be claimed or that should be changed or fixed because you just never know where people are gonna end up when they Google stuff. And I also have my Google profile.
Dr. Kissi Blackwell:
So if you have a new review or if, they'll also send you kind of like Monthly, like, hey. This is how many people viewed your site. They do that on Google for sure, and sort of give you, like, some updates. So I don't do it very often, but I definitely go to look and, you know, probably review it. Once, somebody post a review and I get an alert about it. I'll go and kind of look at all those statistics and, you know, look at the review and all that kind of stuff. So And, of course, we've had to move twice in the last three and a half years, and so I've also had to go back and change my address. And That is that's just a pain in the rear to have to change your address with, like, everyone and especially having to have done it twice.
Dr. Kissi Blackwell:
But that That's a good way to just to go back and make sure that all of that stuff is is changed and fixed because otherwise, people can't find you.
Dr. Kissi Blackwell:
And I wanna segue into Your physical space. You mentioned that you knew because you were from Wichita Falls originally, you know, where generally you wanted to have your clinic. But how did you find your space?
Dr. Kissi Blackwell:
I do have a friend here in town who is a broke she's a commercial broker, and she has helped me multiple times now in finding a space, but I did go to her. She actually helped us find our home as well and say, hey. I need a space. I need you to help me, and she was very happy to do that. So the 1st space that I had, I actually didn't take right away. So after I had Called a local radiologist regarding, getting some cash pricing For radiology exams from them, they actually offered me a space in their building for free. He needed a doctor on-site to be able to do CT scans, which they had just acquired, a CT machine. And in order to do IV contrast, there has to be an MD or a DO on-site.
Dr. Kissi Blackwell:
And so he said, hey. If you'll come and do this for me, I'll give you a space in my office for free. And it was about 650 square feet, so it wasn't a lot, but it was free. And all of my utilities were free and Internet was free, And so there was, a 6 month period of time where that was, perfect. It was the perfect size, you know, obviously, the perfect price, but it allowed me to grow really quickly. It allowed me to pay myself really quickly. And, you know, being the The main breadwinner at home, it was it was really great for me not to have to worry about losing my home or anything like that. So, what happened with that one was that the radiology center closed down, and it was sort of an abrupt thing.
Dr. Kissi Blackwell:
They sort of just got up and left. And so I ended up just having to move in a hurry and had to leave my space pretty quickly. And Thank goodness the previous space that I had been looking at was actually still available, and so I was able to move into that space pretty quickly, which was great. And so this new space that I had was a 1,000 square feet. I had 1 giant, like, 20 by 14 room. And at first, I was like, oh my god. I don't know what I'm gonna do with this because I don't have time to do any kind of renovation or anything else, But it actually worked out great. We actually put everything in that room.
Dr. Kissi Blackwell:
We had some, locked toolboxes, The big, like, utility toolboxes that with, like, cabinets and things, that are all locked. And so, You know, we had everything in that 1 room. It was all locked up, but it was great because we had a couch in there and a place for the kids to play. And then then on the other side of the I was seeing mom and dad and, you know, family members could be in there. So it actually worked out great, and we really enjoyed having that really large space. And then we also had another little smaller exam room where we where my nurse did a lot of her stuff like drawing blood and testing for flu or whatever she may be doing on that side. We had a bathroom and then my office. So it was really tiny little space, but with a really big giant exam room, and we really loved it for a long time.
Dr. Kissi Blackwell:
And actually here recently, so in November, I came to find out that the space had been bought out by the home health company store, and they gave me 90 days to get out of my space. So it was a little bit frustrating, and, certainly, I wasn't expecting it. I'd I had thought before that I might, you know, move into a bigger space or, you know, expand or buy my own space, But I just never imagined that it would have to be this quickly. And thank goodness, it was it's really amazing. It was kind of like it like fate. There was a building that I had been looking at for a long time thinking, man, if that building ever went for sale, I would totally buy it. And sure enough, it was for sale. And so somehow, we ended up closing on this building within 4 week or I guess it was in 6 weeks of of doing all of this planning, and we just moved into the space about 2 weeks ago, So we are really excited about our new location, and now I own it so I don't have to worry about ever being Kicked out again, oh, which is great.
Dr. Kissi Blackwell:
So I'm excited to be able to own my own space now, and I do have a renter that I'm renting some of the space out to because our building is huge. So this new building is 34 100 square feet and excuse me, 39 100 square feet. And so I've rented her out one side of the building, and she's a doctor of audiology. So she's got her sound booth and all of her equipment there, and so that'll be a really nice addition, I think, even to be able to Send patients her way.
Dr. Kissi Blackwell:
How exciting, Kissy. That is fantastic.
Dr. Kissi Blackwell:
Yes.
Dr. Kissi Blackwell:
I wanna ask because you mentioned your nurse. When you opened your doors, did you have experience working with your nurse?
Dr. Kissi Blackwell:
Worked with me, in fee for service For 2 years before I decided to go into DPC, and she, I think, had the feeling that I was gonna leave at some point. And she said, if you ever leave, please take me with you. I just remember her saying that. And so as soon as I started doing this, I knew that I wanted her to come with me. And before I knew how many patients I was really going to onboard, I had told her that we would wait until I got to, like, a Certain number of patients, and I can't even remember what I told her now. And she was like, okay. Yeah. That's fine.
Dr. Kissi Blackwell:
I just have to give 2 weeks notice, so it's not a big deal. And then what had happened was actually the hospital was kind of pressuring her to tell them because I think they knew that I was probably gonna take her with me, And she didn't wanna tell them. She's like, I don't know. I I'm not sure. She just kept trying to, like, put them off because she didn't wanna, You know, she didn't want them to fire her or something along that line before I could pay her and, but, you know, things worked out and, you know, we I I I knew that I'd reached whatever point of patience that I thought I was gonna bring her on at. I reached that and then We surpassed it by the time our doors opened, and so I was like, nope. Jennifer, you're definitely coming with me. Just Go ahead and tell them that you're putting your notice and I'll start paying you right away.
Dr. Kissi Blackwell:
So the nice thing was that I hired her 2 weeks before we started, and so in that 2 weeks, She just worked for me answering the phone, scheduling patients, talking to patients about what DPC was. So that's how we ended up with so many patients at the end of the day too. Currently, we have 711 patients. I've added about 35 patients over the last 4 weeks just because I wanna make sure that I can Pay a bigger mortgage and that kind of thing, and so I wanted to be sure that I wasn't gonna have any income gap. And I asked her before. I said, Hey. Do you think you need me to hire somebody for you? Like, would you rather me just hire a front desk person? And she told me she said, I really don't feel like I'm that busy. So if, You know, I would rather you pay me a little bit more than for you to hire somebody else.
Dr. Kissi Blackwell:
And I was like, done. So I pay her well and, you know, she can't leave because I don't think she'll ever find that kind of salary anywhere else, But she and I work really well together. She anticipates all my needs. She's actually been a manager at a store in the past, and so She manages all of the member management stuff so well. She's very good with customer service. She knows DPC front and back Just like I do, I really feel like she and I opened this practice together, and I think that's what's been so great about it.
Dr. Kissi Blackwell:
That's wonderful. And It it definitely sounds like the dream person that if if a doctor in doing DPC was wanting to have a a partner, If
Dr. Kissi Blackwell:
you feel like you can onboard a person, right away, especially someone that you know well or that you know works well with you, that you trust. Those obviously are all important qualities and someone you wanna hire.
Dr. Kissi Blackwell:
And, Kizzy, does Jennifer get A four
Dr. Kissi Blackwell:
zero one k or health benefit. Husband actually carries health insurance for them through his job, And I haven't done a four zero one k just because I hadn't you know, I was still sort of in the starting phase and things, and so but I have actually been considering doing that here in the near future.
Dr. Kissi Blackwell:
With the value that you bring, having a direct primary care practice in Wichita Falls, I wanted to ask about medication dispensing because in Texas, doctors are restricted in terms of how they can dispense medicines to patients.
Dr. Kissi Blackwell:
You know, a lot of the talk between people that were starting DPC or or even the people that were already seasoned DPC, They talked a lot about medication dispensing and how much value that brought to the practice, so it was a little bit nerve wracking to think that I couldn't do that. I'll have to tell you that I don't think that it has really been a hindrance for me. You know, I I am Still able to dispense a few things out of my office just because Texas does allow you to dispense up to 3 days of medication, But I don't do a lot of that. I do I do Diflucan for patients that come in with yeast infection. I do Azithromycin For people that come in with chlamydia or people that have STD exposure, and I do Zofran for people that come in with nausea and vomiting. So so those are things I can definitely dispense in 3 day increments, and and it kinda works out. And, of course, I also do sampling, and, I've gotten very good at finding reps to come out and see me and bring me stuff, and, you know, I've got whole Binders full of cards for reps, which is great. We have a whole closet full of lots of different types of samples.
Dr. Kissi Blackwell:
So the nice thing about DPC is that because we don't have tons of patients, I may only have 1 or 2 patients for each type of medication that needs Each type of medication. So, you know, getting enough samples for them to kinda keep them going isn't really terribly difficult.
Dr. Kissi Blackwell:
That said, Kizzy, with you using Atlas, instead of using Atlas for an inventory of medicines that you self dispense, do you use the Inventory That
Dr. Kissi Blackwell:
are what? I'm sorry.
Dr. Kissi Blackwell:
That you have, that are samples?
Dr. Kissi Blackwell:
Samples. I don't actually use it for samples. It got really difficult because, in Atlas, it kind of has, like especially when you get samples, you get sort of different lot numbers, and you may have, like, You know, 6 different boxes of with different lot numbers on them, and so it would just get really, really bogged down, having, like, a bazillion lot numbers in there. Though I don't really like using it for that, I feel like it's not useful because if I go in there to dispense something and it's the wrong lot number, then I'm really not giving them any information anyway. So what we do is we actually just, We document in the patient's chart the lot number and the expiration, everything, and what was given to the patient. But then we we do use the inventory for our injectables because because we do still do injectable medications, and we do a little bit of DME as well, so, like, wrist splints, and Lately, it's been pulse oxes and things like that.
Dr. Kissi Blackwell:
You mentioned that your practice has now over 700 patients. And right now, your website lists Sign ups on the wait list, because you're not accepting new patients at this time. Can you talk can you touch on churn?
Dr. Kissi Blackwell:
We did have, a hard wait list where we only really took patients off the wait list when we kind of got down to, you know, where our churn was really getting too high. So for me, that number was about 6 150 at the time. So if I ever got to under 650 or getting close to 650, I would take a few patients off the waitlist. Because I was kind of hovering at 680 most of the time. So we had after COVID started, our wait list actually doubled. So we actually had about 90 patients on our wait list before I started taking people off, because of my building purchase. So we had quite a few people that were waiting, but we started taking patients off of the wait list in December, just in anticipation of patient of buying our new building. And my goal is to hopefully get up to, around 750.
Dr. Kissi Blackwell:
So we're not quite exactly where I wanna be just yet, but the the 90 patients off the wait list, I probably got about 40 of those. The rest of them had already found a PCP, and a lot of them have actually had actually been on the wait list for about a year. So it definitely was, You know, not something I was really taking people off too quickly before all this happened. And, actually, what's really interesting is that I felt like The attrition rate actually went way down during COVID. I think people were just like, oh, no. I'm keeping my doctor at that point. You know? Like So I really didn't have a lot of people leave, and I didn't have anybody leave because of financial reasons. So that was very interesting.
Dr. Kissi Blackwell:
I've actually had more people leave here in January just because, you know, how January goes, people start, oh, I got insurance and, oh, I I don't wanna pay for it anymore. I didn't use you or whatever. They wanna excuse it. So I've had more attrition in this month than I've actually had, but I I usually expect that in January.
Dr. Kissi Blackwell:
And if people decide to leave, do you Have them pay a reenrollment fee if they Yes.
Dr. Kissi Blackwell:
There is a $200 reenrollment fee. I've only had 2 patients that have actually paid to come back. I've had a couple of patients that, you know, it it was it was kind of not of through no fault of their own. And so If with those patients, certainly on a patient by patient, I won't charge the enrollment fee. So it really kinda depends. But, yes, we usually do charge the reenrollment fee if they decide to come back.
Dr. Kissi Blackwell:
Casey, addressing the quality and the value that you You bring to patients and you bring to your practice and, you know, the the reason why patients stick with you. Do you strategically Classify your patients in terms of, like, these patients have diabetes or these patients are are pediatric patients. In order to contact that group of patients,
Dr. Kissi Blackwell:
just don't find a lot of value in that. But I do sometimes go in and look at, you know, utilization, Jen, for instance, like, okay. Like, who's been the 1 person that's, like, calling me constantly? You know, what I do with that information, I you know, I don't always do anything with it, but, I do like to look at stats with regards to, like, how many pediatric patients I have, how many older patients. There's not a really great way for me to mine data with regards to, like, how many diabetic patients or how many hypertensive or how many with this or that. The Atlas doesn't have functionality very good for that type of mining, but, certainly, looking at demographics And, you know, the utilization and that sort of thing is is or, you know, when they joined, how long they've been with me, that kind of thing. Certainly interesting things to look at, but I don't think I necessarily use that information for anything in particular.
Dr. Kissi Blackwell:
Gotcha. Kasey, I want to touch on the fact that you offer a a wide range of treatments for your patients when it comes to procedures. And one of those examples is the sphenopalatine, ganglion blocks. Did you have experience in your training in doing?
Dr. Kissi Blackwell:
I thought I wanted to be a surgeon before I decided to do family practice, and so I think I kind of still have retained some of that, Need, and I love doing all kinds of procedures. I mean, I do anything from laceration repair, nerve blocks, Joint injections, TPI, cyst removal, skin biopsies, IUDs, Nexplanons, EMBs. So lots of different things that, I offer to patients, and most of these things were things that I learned in residency and in training, because, at John Peter Smith in Fort Worth, it was a very procedure oriented type of Residency program. And so anything I wanted to do, I really could do. So that that's part of it, but I certainly have added some things that I didn't do before for that. So the sphenopalatine block is a good example of that. I had a patient come in and tell me that she was getting these Nerve blocks from this nurse practitioner in Dallas, which is 2 hours from here, and she was seeing the neurologist, and I guess the neurologist nurse Tushar was doing these blocks for her, and so I started doing some research about what these blocks were and what she was actually getting there, and I realized that it was something so simple, Something that I could absolutely do. And so, I started, trying to talk to the company about using, the company I was looking at was, SphenoCath, and I spoke with them, and they actually sent me a few free ones.
Dr. Kissi Blackwell:
And then I realized I could reuse them. I could clean them and reuse them because we were just putting them up people's noses. It's not like we were, you know, doing anything that was really requiring sterility. And so we would clean them very well with alcohol and then we would reuse them. So I started doing that and had such wonderful results with people that had, just intractable migraine issues Then I just kept doing it, and then I started learning other types of blocks as well, like occipital blocks and super orbital blocks. And so lots of different things that we were doing For people with migraine headaches, which is great because migraines are always really difficult to deal with. And then I've also done a lot of TPI with trigger point injections for Patients, I didn't ever used to do that in fee for service, but it does really seem like I've had a lot of fibromyalgia patients and patients with a lot of Pain that really benefit from doing kinda regular trigger point injections. So I have several patients that'll come in every 2 weeks or every 4 weeks to do trigger points.
Dr. Kissi Blackwell:
And they really feel like it helps with their quality of life and they don't have to use pain medications and We keep them off the narcotics and so that's great too. But, with regards to learning new things, one of the newer things I've learned is actually, ultrasound unique, which has been really great. I never really did get to learn about that stuff during residency, and so It's definitely been a new thing for me. I've actually taken 2 courses for ultrasound, one out in South Carolina and one in California. And both were just amazing programs and both were kind of intros, but I think, the the one out in California, I probably got a little bit more in-depth, which was great because this was my second one. And, I've been able to find all kinds of crazy things. One of the more interesting things that I've been able to look for, I had a patient with potential myxedema coma, and he came in and his TSH was just insanely through the roof. And he was short of breath, and he was pale, and he just looked like he was dying.
Dr. Kissi Blackwell:
And, you know, I stuck the ultrasound on his chest, and sure enough, he had A huge pericardial effusion. And so I was able to get him to the ER and know exactly what was going on, and so it was really It was really nice to be able to have that tool and know exactly what was happening with him and to be able to follow him too because I'd bring him back and Look at it again, make sure it was getting smaller and he was getting better, and so it's a a very nice tool to have.
Dr. Kissi Blackwell:
With you describing That particular patient's case, how how life changing is that for you to be able to see him as often as you you guys needed to to monitor his his health. I can't imagine what he would have faced if he were waiting for a fee for service appointment to do follow ups and what quality he would have gotten, but that's wonderful that you were able to diagnose and treat.
Dr. Kissi Blackwell:
One of the other things I think that was really great that I Had been able to use it for was a a pretty big lady who had fallen and really hurt her knee. It was real swollen. She had terrible landmarks because her leg was just so large, and so I was able to stick the ultrasound on her and actually get a steroid injection into her knee. And she was singing my praises by the time she left the office because she felt so good, and there's no way I would have been able to do that injection without an ultrasound.
Dr. Kissi Blackwell:
That's wonderful. I want to shift the conversation because I feel it's really important to Address the fact that you are the current secretary of the DPC alliance. And so I wanted to ask you, Could you explain what is the DPC alliance?
Dr. Kissi Blackwell:
We wanted to create this alliance that helped With education and, advocacy for DPC, helping new doctors create their own practice and helping seasoned doctors continue their practice. And so it's been evolving over the years. Certainly, it started off more as new DPC doctors through, and we still definitely do that. But now we also are hoping and and, of course, With COVID, we were kind of unable to do some of the things that we wanted to do, but we do eventually want to make sure that the DPC summit Has things like procedure workshops so that docs that are wanting to learn new procedures and new things can actually learn some new techniques And, you know, even things like how do we do aesthetics and how do we add prolotherapy and how do we add, you know, just different types of things 2 growing practices as well. So we wanna be able to make sure that we take care of our growing practices as well as our new practices. So that being said, we're actually in the process of planning a lot of things for this new year. And one of the things we did last share. That was really great.
Dr. Kissi Blackwell:
We didn't get to do as many as we wanted, but we did get to do a few of our mastermind events, and those have just been so great. Actually, I've been to 2 mastermind events because I really kind of like to be there for mentorship. I went to the one in Portland as well as the one in Raleigh this year, And it's just amazing to be able to have sort of 1 on 1 with people that are, in the process of opening their practice We're potentially already in practice and just wanting a little bit more help, and it was very nice to be able to do those 1 on 1 things for people and really help them where they were. We had about oh, and I'm I'm not entirely sure exactly how many numbers, but I think we had about 10 People at the first one in Portland where I went, and then in Raleigh, I wanna say there were like 15. So there's definitely a small number, which is what we want, and we didn't want it to be too big. And, of course, with COVID this year, we really couldn't make it too big. Then we also had a much larger one in Kansas City just after the Raleigh one, and they just did a wonderful job in making sure that everybody was safe and that we had sort of, separate groups and so that we weren't in a big group, but there were quite a few people on that one too, which was wonderful. So I think we had a very good response from that.
Dr. Kissi Blackwell:
People were really excited about going. They felt like they learned something. They felt like they really got what they needed, And I think it was it kinda goes to what you were saying before with when you can actually interact with people in person and really discuss things and really talk things out and ask your own personal questions, what your own personal fears may be in Obstacles to getting to DPC, it's so much different than just reading things online or that sort of thing. So So, certainly, the in person events are great. The other thing I think that's really awesome about DPC Alliance is that we have something called DPC University. So this was actually created by a bunch of us that actually flew into Dallas 1 year, and we all started writing articles about Different topics in DPC, and we created several 100 articles that are now in the DPC University, and they are basically they're meant to kind of gear new new, DPC doctors into into their own practice, but we also want to continue to grow it so that we can also add topics for growing DPC practices, as well as educational type of things. And, so the well, and I'll come back to the educational part, but, so there's lots of different things in DPC University there that are really great for starting practices, and one of the main Ones that I kind of like to point people to is our DPC startup checklist. So we actually went through and just started thinking about what kinds of things new DPC practices needed to make sure they did, and so there's a nice little short checklist that, they can go through, and that's actually free.
Dr. Kissi Blackwell:
So in our first 3 sections are actually free for starting doctors, which is great. Certainly, if, they would join the DPC alliance, there's actually Quite a bit more in there. And then we also have things like sample patient contracts, sample employer contracts, sample employee contracts, Medicare waiver, HIPAA forms, all kinds of things in there that are really useful for starting doctors. The other thing that we've been doing is trying to implement more education, and, so we've actually had, doctor Thomas White, doing some DPC ground rounds, and those are actually located on the DPC Alliance Facebook group, which is actually Currently, just for alliance members, but we've had some really wonderful topics on the, DPC crown rounds, and, you know, I think that's hopefully something we can continue to grow too. I think that, there's definitely Advantages to being a member that actually end up paying for themselves at the end of the day. One of the nicer things is that we Actually, do offer a monthly payment so you can pay $48 a month, and that way you don't have to worry about paying that $500 up front. Certainly, in the spirit of DPC, we wanted to make sure that we offered a monthly option as well. So that's one way of doing things.
Dr. Kissi Blackwell:
The other is that we have So many discounts. We have so many things that we have negotiated for our members and, you know, just saving Money in Rubicon and allergy choices and these types of things actually pays for the membership in and of itself. We do have hardship memberships for people that are still in the beginning of their practice where they feel like they can't afford the membership right away. So we do ask that they email us at the alliance, and we can definitely, look into doing a hardship application for them.
Dr. Kissi Blackwell:
I wanted to bring us back to your practice and the fact that you now own your building, that you are practicing sing out of what do you see for Clarity Direct Care in the future?
Dr. Kissi Blackwell:
Now that I have a much bigger space, I think, hiring someone wouldn't be completely out of the question. I certainly have the room for it now. I would I wanna find somebody that really fits well with My practice and how I do things. Eventually, we do hope to have maybe a front desk person just to kind of give my nurse a little bit of relief too, And that certainly can come later on as well. So, yeah, I think that's part of the growth is maybe adding a new doctor, maybe adding some front desk stuff and certainly adding any more, procedural based things that I end up coming across later on.
Dr. Kissi Blackwell:
Wonderful. In terms of advice that you could share in addition to what you've shared already, what advice would you give doctors who might be fearful of transitioning To DPC or to those doctors who might feel isolated in a micro practice.
Dr. Kissi Blackwell:
As you can see and as we've talked about, there are so many groups and ways To connect with colleagues and to connect with people that are already doing DPC, DPC Alliance, DPC Docs on Facebook, DPC Summit, DPC Nuts and Bolts, so many different ways to connect with other DPC doctors, And it's really amazing how DPC is really a family. I mean, when you come across another DPC doctor, it's it's almost like you are Speaking the same language at that point. I usually tell those types of doctors that are sort of scared of jumping ship like that because they're they may be alone, that they really need to go to a conference. They need to to see how other doctors are Actually doing this because when we're in fee for service practice, we're almost in competition and you almost kinda feel like you're Isolated even though you're surrounded by people. It's always seems like a competition. It never really seems like it's Genuine, and so I think it's a very different culture in the DPC world. And if you if they'll just go to a conference and actually meet DPC doctors, I remember that that was the one thing that I I just couldn't believe when I was at the DPC summit in 2016 was I can't believe how these doctors really genuinely wanna help me and genuinely want to see me succeed. And I think that's a really for for, new doctors to feel.
Dr. Kissi Blackwell:
Thank you for sharing those wise words, and I I can't agree more. That's my when I met you for the 1st time when we all grouped together for an Airbnb for the the point of Carol Twist us. But, yeah, I I had never met you before, and It was such a wonderful experience talking with you and that idea of of of sharing this same language. That it's so true.
Dr. Maryal Concepcion:
Dr. Kissi Blackwell:
Thank you so much, doctor Blackwell, for joining us today.
Dr. Kissi Blackwell:
Thank you, Marielle. I really enjoyed being on here.
Dr. Maryal Concepcion:
Next week, as a special nod to mother's day, Look forward to hearing from doctor Blackwell's mom, doctora Rosa Torres, and her dad, doctor Oscar Torres. Yep. They're both DPC doctors as well. Don't forget to sign up to be a myDPC story insider to get our newsletter with exclusive insider offerings like events, updates, resources, and much more. If you like what you heard today, please leave a review and subscribe wherever you listen to your podcasts. Tell your friends too. For more information on this episode and much more, please visit my dpcstory.com. And for the latest in DPC news, check out dpcnews.com.
Dr. Maryal Concepcion:
Until next week, this is Marielle Conception.
*Generated by AI, so please excuse errors.
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