Direct Primary Care Doctor
For many physicians, the traditional fee-for-service model fosters a feeling of discontent due to its limitations on patient care and physician autonomy. Dr. Erinn Harris, an internal medicine physician with a specialty in functional medicine, realized that to find fulfillment in her medical career, she needed to transform her approach to patient care. It was this understanding that propelled her journey into the world of Direct Primary Care (DPC), a healthcare model that emphasizes personal relationships between patients and their physicians. In the latest episode of "My DPC Story Podcast," I had the pleasure of interviewing Dr. Harris about her transition to DPC, the challenges she faced, and the rewards it has brought to her professional and personal life.
Transforming the Medical Practice Model: Branding and Evolution of the Clinic
Dr. Harris ventured into DPC with an open mind, initially naming her practice 'Harris Internal Medicine'. Though she began with modest expectations, her practice underwent unexpected expansion after five years. The key to her success was two-fold: keeping overhead costs low and seizing the opportunity to relocate to Peachtree City, Georgia. Her practice connected intimately with the community, growing patient numbers significantly and carving a niche in the DPC space during the challenging pandemic period.
Operational Insights and After-Visit Care
With the expansion of her practice came the need for exceptional after-visit care. Dr. Harris highlighted the significance of systematizing processes, using practical tools like checklists and exit interviews to enhance patient outcomes. She also provided sage advice for budding DPC practitioners - start lean, spend wisely, and focus on quality patient care over extravagance.
Subheader: Lessons from the DPC Transition
Navigating Business Changes
The initial years of Dr. Harris’s DPC practice were marked by patient scarcity and financial hurdles. Yet, she found greater satisfaction in devoting more time to patients, which motivated her persistence in the DPC arena. Her practice underwent transitions in its legal structure, moving from a PC to an LLC for tax benefits. She underscored the continuity of the same EIN as critical during such transitions.
Team Building and Staffing Strategies
Initially a solo practitioner, Dr. Harris gradually built her team, keeping a close eye on finances to preclude the risk of future layoffs. She stressed the importance of medical experience for staff in DPC settings, a stark contrast to the fee-for-service model. Personnel changes are inevitable, and she shared her experience of parting ways amicably with a staff member while expanding her team to include independent contractors for health coaching and nutrition services – an innovative strategy in the DPC practice.
Navigating Legal and Pricing Strategies in DPC: Compliance with State Laws
Dr. Harris took care to ensure compliance with state laws regarding nutrition and medical advice when integrating functional medicine into her practice. Her proactive measures included seeking legal advice and implementing waivers, allowing her to practice freely without legal concerns.
Pricing in the DPC Environment
Setting the right price for her DPC membership was a challenge that required consultation with colleagues and adjusting to industry norms. Dr. Harris devised a flexible model to cater to patients' primary care and functional medicine needs, offering tiered pricing to reflect the different levels of service.
Personal Growth and Professional Rewards: Reimagining Healthcare and Life Balance
The DPC model has not only revolutionized Dr. Harris’s approach to healthcare but has also afforded her the luxury of time – time that she now spends with family and in the pursuit of passions. She shared her early inclinations towards bench science, but her fascination with the human body and the desire to work with patients directly led her to medicine and ultimately to embrace DPC after reaching a point of burnout in the traditional system.
Conclusion: A Beacon for Future DPC Practices
Dr. Erinn Harris's story, as eloquently shared on the "My DPC Story Podcast," is a beacon for doctors considering a shift to DPC. It portrays a genuine reconnection with the roots of medicine through personal patient relationships and the freedom to make healthcare decisions rooted in wellbeing rather than reimbursements. As our healthcare system evolves, Dr. Harris’s experience is a testament to the viability and fulfillment that Direct Primary Care can offer to physicians and patients alike. Join us to explore more DPC journeys and harness the wisdom shared by practitioners like Dr. Harris, who are reshaping the landscape of healthcare delivery.
BIO
Meet Dr. Erin Harris: Board-Certified Internal Medicine Physician and functional Medicine Specialist. With a BA in Biology from Earlham College and a Doctorate in Medicine from Indiana University School of Medicine, Dr. Harris has honed her expertise. Her journey includes internal medicine training at Emory University and specialized functional medicine training via the Institute of Functional Medicine.
Discover how the Direct Primary Care (DPC) model empowers Dr. Harris to prioritize family, homeschool her children, and embrace her passions while delivering comprehensive care.
Listen to the Episode Here:
Here's a glimpse of what you'll learn:
Dr. Erinn Harris's unexpected journey from a small practice to a rapidly expanding one in Peachtree City, Georgia.
The challenges and decisions Dr. Harris faced in managing her practice growth, including hiring and letting go of team members.
Her transition to Direct Primary Care (DPC) and the financial stability it provided for decision-making based on growth rates.
Insights into adding functional medicine to her practice and setting up membership-based pricing, including guidance on legal regulations and business practices.
Practical advice for doctors looking to start a DPC practice, including the importance of efficiency, patient care quality, and pricing strategy.
In this episode...
Dr. Erinn Harris shares the challenges she faced in growing her practice, making tough decisions, and embracing the transition from traditional fee-for-service models to DPC. Listeners will hear about Dr. Harris's experiences in managing her practice, setting up systems, and navigating the complexities of adding team members.
Join us as we delve into the practical advice and invaluable insights that Dr. Harris has to offer for those considering a career in DPC.
HARRIS INTERNATIONAL AND FUNCTIONAL MEDICINE:
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CONTACT:
Address: 4000 Shakerag Hill, Ste 100 Peachtree City GA 30269
Telephone Number: 770.954.5010
Email Adress: info@harrisinternalmed.com
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Transcript*
Direct primary care is an innovative, alternative path to insurance driven healthcare. Typically, a patient pays their doctor a low monthly membership and, in return, builds a lasting relationship with their doctor and has their doctor available at the time. their fingertips. Welcome to the My DPC Story podcast, where each week you will hear the ever so relatable stories shared by physicians who have chosen to practice medicine in their individual communities through the direct primary care model.
I'm your host, Marielle Concepcion, family physician, DPC owner, and former Fee for Service doctor. I hope you enjoy today's episode and come away feeling inspired about the future of patient care. Direct. Primary care.
Direct primary care helps me restore my faith and reinforce my call into the practice of medicine. I am Dr. Erin Harris of Harris Internal Medicine, and this is my DPC story.
Dr. Erin Harris is a board certified internal medicine physician with specialty training in functional medicine. She graduated from Earlham College with a BA in biology and from Indiana University School of Medicine with a doctorate in medicine. She completed internal medicine training at Emory University and functional medicine training through the Institute of Functional Medicine.
The DPC model has allowed her to spend more time with her husband, homeschool her children, and enjoy the things she loves.
Welcome to the podcast, Dr. Harris.
Thank you. Thank you for having me.
It's my pleasure. It's been a few months, but I was super excited to just walk down the hall from Dr. Krista Springsteen's grand reopening. And there you are with your own clinic, literally down the hallway. So it was so great to meet you in person.
And it's so great to even have a longer chat with you today. It's great to be here. So, you
know, going back to this idea of you guys are literally down the hall from each other. It really embodies the whole idea of if you've seen one DPC, you've seen one DPC. You guys are both internal medicine physicians.
You guys are both thriving and you have been thriving for years. And being an early pioneer, especially in the state of Georgia, I want to ask about your journey, a lot of the, the foundations of your journey, as well as what's going on now in your practice. So I wanted to start with your journey into medicine because, uh, you know, reading on your website, your journey about your own diagnosis with, with vitiligo and.
Just being a patient when you're training to become the person who takes care of the patients is very different and for those listeners who have a, you know, a chronic diagnosis of whatever sort, asthma, a dermatologic condition, mental health concern. It's very different when a physician becomes the patient versus when a non physician becomes the patient.
So what drew you into medicine specifically that was impacted by you becoming a patient?
Actually, I had this conversation with my father just Last night, he was like, you know, I never asked why you went into, went to medical school, why you went into medicine. And honestly, it wasn't always something that I thought that I would always do.
I knew that I would be in science in some type of way. I just didn't know if I was going to do bench science or people science. And so I decided to do actually research of the amoeba that causes encephalitis when you swim in pools. So my lab was right above the medical school admissions office, and so I realized I didn't like lab bench work, and I decided to go to medical school, and so I just didn't know which one I wanted to do, and I ended up basically just loving medicine, everything about the human body.
That's how I ended up in as a physician. There wasn't anything like pretty or, or sexy or anything like that. It was just like, I think that's what I want to do. That's pretty, you know, I, I go back to that time in my own mind about, you know, being an undergrad, being a pre med and then like looking at all the medical students, like, Oh my God, there's a medical student.
Like they're a celebrity, you know? And it's very interesting when you're on the other side of things and you're like, Dude, that was not even, like, there was no celebrity going on there whatsoever. We were, we were.
No celebrity. Yeah. So, I, I. We were funky, stinky, not having any showers, any of that. Nothing cute about it.
Oh my gosh.
Continuing to live in jammies. I remember I did that for the first two years, especially when it was book work and, and medicine. But I love that. You know, it's like, it doesn't have to be sexy. It doesn't have to be sensational. It's like. When, when somebody realizes that, you know, I'm going to do a lot better with my career if I'm around people versus if I'm around toys that I'm, you know, pipetting with and stuff, it's a, it's a different, it's a different world.
And I think it's important for, for people to hear that because there, there might be some people who. You know, I, I know a person in medical school in my husband's class who was pushed into going into medicine, um, by his family because everyone's a doctor and that was the, the culture. And for some people, like my family, nobody in my family, in my immediate family is a, is a physician.
So I think it's important to recognize. You know, whatever it is, it's in alignment with what we want to do. Amen. So when you were going down your route of becoming, you know, a physician, you're in medical school and residency, and you had shared in your bio on your website about how, you know, you were frustrated with the way that you were, you were being treated as a patient and the treatment you were not getting, you started being open to.
Other causes of vitiligo specifically and your website mentioned how I think it was, it was your husband found a video about copper supplementation that somebody was using to treat vitiligo and it worked and then I wanted to ask about that because I really saw parallels reading your story on your website to you being, you know, a trailblazer in Georgia and opening your own DPC.
And the reason I say that is because you didn't just, okay, this is my, this is what the doctor said. I'm just going to go along with it. You didn't say, okay, everybody else around me is going fee for service. I'm just going to do that. Is there any relation to the way that you took the reins of your own health determinants?
Does that relate at all to why you took the reins on your career and opened a DPC?
Absolutely. Absolutely. So just to kind of give you my backstory. For direct primary care and how I got into it. I don't know if you wanted to lead into that, but it, it was a continuous story. Honestly, it was, it was hard to really break up how I transition into functional medicine.
But back in 2012, I can really remember at that time. I decided I was burnt out. I was not and it was early. Into, you know, fee for service and, and insurance and documenting and Medicare and all of those things. And I knew at that time when it all started, I was like, I'm not going to be a part of this.
This is way too much. And so I was burning out and went to the VA and I was like, Oh, no, what did I just do? And walked into the VA and said, I have to do something else. And, um, really started looking at other practice models. I, I said there was concierge. Well, concierge didn't make much sense because why are you charging insurance?
And then you're charging an extra fee on top of that. And then I saw a video with Garrison Bliss and Erica Bliss. On YouTube. And I was like, this is it. And I think I, I was reading something in, I think, um, Medicine Today or one of those, you know, kind of business medicine magazines and saw this article. I think Garrison Bliss was in the article and I was like, this is it.
And it was nothing. I'm telling you nothing to go on except for what I was reading. And the only thing I could, I would read in articles or I would get online and hear, you know, forums, I'm speaking forums and that's it. And so I don't know what I was thinking about, but I knew in 2013 was very pivotal in my life because two people were diagnosed that were really close to me for breast cancer, my sister and my really good friend of mine, my friend passed away, my sister survived.
Um, she's passed away that year, but I was like, I'm wasting my life if I continue to do this. And continue to not be happy with what I'm doing. This is not profitable for me. And so I literally, and we had this thing in Atlanta called Snowmageddon and was all over the world where everything stopped. Do you guys remember that?
It was my, literally my dad was like, I was on a boat in St. Croix and I saw that you guys can't move anywhere on the highway. And I was like, and so I was literally in my house in 2000, January, 2014, trying to figure out what I was going to do in my life. Found DPC. And by April of 2014, I had my LLC, well, my PC at that time together and started a business and started practice.
What the heck was I thinking? I had zero patients. I didn't have anybody. I didn't know the model. I was just kind of piecing everything together and just going by what I saw. I started off per patient fees. And then when it's a membership and started off on one patient, literally one member, and then the next year I had five and the next year I think I had 15 what, how I transitioned is because I realize this is, I mean, I absolutely loved it.
I absolutely love the time I spend with my patients. I love the fact that I could determine. What I wanted to determine how I wanted to spend my day, what I wanted to do. And I still had to do a lot of moonlighting in order to, because I was the main breadwinner in the family at the time. And so I had to do a lot of moonlighting in order to support my, in a sense, my habit of DPC, but it allowed me to, to spend a lot of time with my patients.
And as I spent a lot of time on my patients, I saw that there were other things I couldn't address. I just didn't understand. Well, I didn't have the tools to understand what was going on with them. Why did they have anxiety and why did it improve with folic acid? And, um, why, what's going on with their gut and why did it, you know, how's this?
I know it's interrelated, interrelated some type of way. I just don't know how, but I had time to figure it out, you know, being able to spend time on my patients. I had time to figure it out and yeah, and then my husband said, Hey, you know what? You've been really looking into this vitiligo thing. You know, I saw this video on YouTube of a woman who.
And it literally took me down a, down my rabbit hole. And I think I was at the DPC conference either in, DC or Indianapolis. I couldn't remember one. And one of my colleagues was like, Hey, Aaron, he also transitioned into functional medicine at this time. You may want to look at estrogen metabolism and he was speaking like literally foreign language to me.
I was like, what did we really learn this in medical school or did I go somewhere else? And so, um, I spent the day in his practice and that was it for me. That's awesome. Let me go back. One of the things that you said that really piqued my, my interest here was when you talked about before you transitioned to DPC, as you had seen the video and you read the interview featuring the Blisses, I'm wondering about when you said the future wouldn't be profitable if you continued on your journey in fee for service.
When you say profit, what does profit mean to you? Because in, as we're finding by, you know, when I, when I speak to many people and who've chosen DPC, profit is not always dollar signs. So when you said, you know, to yourself, this is not going to be a profitable way for me to continue going forward, what did you see in your future, you know?
Imagining that crystal ball of like, you can see your future if you continue in fee for service, what were the, the absolute turn offs that said, that translated into, it wouldn't be profitable for you? My time and my freedom. I wasn't able to determine. How much time I spent with my patients. I wasn't able to determine how much time I spent with my family.
I wasn't free to make choices that I wanted to make for my patients that I felt like were necessary, and nor did I have freedom to make choices that. You know, with my family. Oh, I want to go here for vacation with my family. I need to spend some time. I need to actually cut this day short a little bit because I actually want to go to a game or I need to homeschool or, you know, there are a lot of things that I wanted to do that I wasn't able to do as.
A fee for service physician. So yeah, what I felt like was a value was not money. It was time and freedom. And as you chose DPC as your hobby, I love that, that that's, you know, you're referring to it in the first, in the starting out years noted that you had your moonlighting going on, but I want to ask you about how you mentioned you were initially opened as a PC and then now an LLC, so in the state of Georgia.
Were you able to function as a medical doctor with a PC or did you have to have a different type of corporation like an LLC to continue growing your DPC?
No, actually you could choose either one. You could be a PC or LLC in the state of Georgia. So some states you only can be a PC or a P. LLC or something like that.
But in Georgia, you can choose either one. I just decided I wanted to structure my business a little bit differently for tax purposes. And I chose to, and only in a PC, the only members could be individuals and not other entities or other LLCs or individuals, or, you know, other types of entities. And I just decided I wanted to structure a little, a little bit different.
So I, I switched. I think it was in 2020. Got it. And how was that switch? Cause I, I haven't actually heard anyone say on the podcast about that transition specifically. Did you, did it require much work or much legal fees to transition from one to the other? No, but I would tell you learning from my mistake, always keep your EIN number.
Cause I didn't realize that you, that was the, I mean, there are always mistakes in business, but. I was like, what, I was supposed to keep the same EIN number. I didn't know I could do that. And so once I closed the PC, I couldn't backtrack and change it. They were like, no, sorry. So that was the one mistake that I made as it's kind of like you had to start all over again with business credit.
Gotcha. Now, let me ask you, because at the time you opened, there were a lot, the number of resources were very different than the number of resources that there are out there now, including people listening to your story. Like, this is awesome that you were able to, to share, you know, with even more people in addition to your dad, like about why you went to medical school and opening your DPC.
But when you chose the name of your clinic, let me ask you there, because with us talking about legal transitions, did your company always maintain the same name or did you, or do you have your clinic as a DBA? Uh, yeah, I had it originally as, I had basically had no idea what I was doing and there wasn't a lot of.
There wasn't a lot of resources to tell us, you know, they have these really, you know, cute names like Plum and you know, , you know, fruit of Vine, you know, just like really , just like, and I was like, me Harris. So the, I just did Aaron Harris, MDPC, and I did a DBA as Harris internal Medicine. And when I think you had said something about, well, did you think about adding on, uh, partners or anybody at the time?
I was like, no, I honestly, I just originally thought it was just going to be me, me, myself and I, and that was it. And so I was just like, okay, I had no thoughts of becoming large. I just thought, oh, maybe 100, 150 patients, maybe 200, but that was it. And I never thought that. It would expand the way it did, especially the fact that I really didn't start expanding until five years in.
So I kept at it, you know, five patients, 15 patients the next year, 25 and then 50. And then it just explosion in 2020, it's crazy because you know, you're referencing a year that the world was very different, not as, not as a little bit more different even than snowmageddon, but when it comes to, you know, that magic number 50, it's very common for practices to hit that.
Well, there's 50 patients who are telling like you were telling. One person a day about your practice and how like, Oh, I'm so sorry you had to go to the ER. I just called Dr. Harris for my, you know, my acute issue that really isn't acute. And I think it's really important for people to hear that because there are practices, whether it be, you know, DPC doctors who are moving to a community where they hadn't practiced before or a person who is in their same community, but weren't really known as more than a part of a corporation.
And there are people who are. Asking the question like how come growth is not in the hundreds and for some people, like you pointed out, like the goal is not to reach a thousand patients for most people in independent DPCs. The goal is to focus on personalized, accessible, affordable care. So when you talk about or when you think back to this time where you are doing moonlighting as well as having, you know, one patient, five patients, 15 patients, and you just kept at it.
What were some of those things that you. Could share with us in terms of like self talk that you had about, you know, I got to keep this going. What am I doing? Anything that might be going on in other people's minds and other listeners minds as well as what was it that, you know, kept you at the end of the day, not choosing to go back to fee for service or not choosing to close your ractice and go to strictly moonlighting gigs.
Well, I did. I, to be honest with you, there were several times I was like, well, maybe I should just, you know, it's been five years, they said three years is when you should cut it off. I thought about maybe, you know, just decreasing my practice or just keeping the small amount of patient and just closing maybe at 20 and then doing just a moonlighting.
But every single time I made that decision, honestly, the phone would always ring. And I would be thinking, how did you get my information? How did, who, who, where did you come from? And it was always a sign to me, I just need to keep going. I just need to stay open. And as I did that, I just, it, more people just continue to come, but it was difficult during those times.
Um, when you thought, Oh, what am I doing wrong? I will go to DPC conferences and they would be like, Oh, I got a hundred patients in, in 30 days that I was like, and I don't know if you guys know Jeffrey gold, but he opened like right after I did, and I was always on his tail. He never knew it, but I told him during a, I told him during like a, um, conference one year.
I was like, Jeff, I'm always on your tail. Like I'm always following you. You know, I was like, well, if he can do it, I can do it. And I was like, obviously I had the mindset of it's not impossible if everybody else is doing it. And if, if it's meant for me to do, then I have to just stick in there. And maybe there's, there's a reason why.
I haven't grown. Maybe I have to develop my foundation. Maybe I have to work some kinks out. Maybe I need to improve my systems and processes. So when I do grow, my foundation is strong. So when I do grow, maybe I need, I need to have a strong foundation so it won't fall. And so there are a lot of things when I look back.
I got pregnant, you know, during my first two years. And so I had a small baby. So there were a lot of factors involved. So if I had grown really quickly, then I had a small baby yet. That's awesome.
And it's funny cause your, your small baby is, was, uh, watching some, I don't know, some kid's show with my son when, when I was in Atlanta and I was like, Hey there, like, I don't, I don't know who Asher like walks up with and they're like, can we watch a movie?
I'm like, sure. Like let's, it's hilarious. Your baby is still coming to the practice and seeing how awesome his mom is doing.
Love it. Talking about these first five years and you, you know, not growing in numbers like you had seen other practices doing and still persisting, I want to ask about your finances and how did you view your overhead because with knowing you, you know, you had one patient, five patients, 15 patients and those first five years, were you in the same space that you are today or did you change spaces as your practice grew in terms of patient numbers?
No, I was in a medium sized space, but the price per square foot was very cheap. I think it was 11 a square foot. And so, my overhead was very low. I always seemed to find a practice that was, I could just walk into. I didn't have to paint. Didn't have to buy furniture. Somehow, everything was there. And I probably had to buy, you know, a small amount of equipment.
I practiced next to a OBGYN. We, it was kind of like a shared space. She was on one side and I was on the other side and we shared the check in area. And so, um, leased from her, she owned the building and I leased from her, but it was way back and had to do a lot of marketing, um, because people just didn't, you know, it wasn't like out in front and then when, even when I just had 50 people or maybe a little bit less than that.
I had to take a leap of faith and say, I think it's time to move my practice because she moved to Minnesota, I was the only one back there, and it was kind of like back in a cul de sac in a city like right behind where I practice now. So I moved from a city called Tyrone, Georgia to Peachtree City, Georgia, and it really was a leap of faith because that's, that's when my practice boomed, it just took off.
It was literally like one month, 10 patients, next month, 15, the next month, 20, next month, 25, next month, 30. It was crazy and we, we were so glad that COVID hit because we were able to breathe because we were growing so fast.
I'm just like laughing over here because I'm like, where have I heard that story before going from Tyrone to Peachtree City?
Like that is so crazy that both you and Krista. Krista! Yeah, it's so crazy.
Oh my gosh, for different reasons, but that's so insane. Oh my gosh. So. Just, just a side note, if you haven't heard Dr. Krista Springsteen's story, definitely listen to hers. She had a, an issue with a non compete area, a geographical area.
So, um, definitely listen to, to why we're talking about that. But when you, so let me ask you, when you say we, did you open with any of your current staff members or did you have anybody virtually assist you in, in the beginning? No, no, my husband is, was awesome with systems and processes.
So I had me, myself, and I, it was just me and I was definitely a micro practice. I had Uma as a phone system. And so there was no one to, I had a front office or front desk, but there was no one sitting up there except for me when I would check in somebody. And then I would go back to the nurse's station and check in the patient and do this. And then I would go to the doctor's office and be the doctor.
And so he was like, okay, when somebody comes in, how are you going to know when they come in? And so he had me work out all the keys. As far as like, well, how are they going to know? Oh, well they can call. So what literally they would do is I had a, a sign out, call dial this number in order to, when you, in order to check in, I would come up front, check them in, take them back, and I had a whole system in place and when I was, uh, moonlighting.
Say I was at the hospital because I still, I didn't take Medicare patients because I was still doing hospital work. I have my phone and in my lab coat and I would be with the patient. Thank God it wasn't during a cold that somebody would call in and hello. Welcome to Harris internal medicine. I would run out the room when I was seeing a patient in hospital.
Thank you for calling Harris internal medicine. How may I help you today?
That's very DVC, but also very primary care. Like, uh, that, that's, that is dedication right there. I love it. I love it. Oh my gosh. So when you were moving into your new space and you, that's the space that you're in today, how did you then add on team members because you're saying that your husband was very good at systems and processes.
When, at what point did it go from being you wearing all the hats and him helping out on the admin side of things and then having a, an actual team member join your practice? When I feel like I could afford it, when I knew there was enough where I could pay a salary and I wouldn't, I wouldn't be like, oh, I have to lay you off when I, I'm pretty good at looking at numbers and forecasting and say, okay.
You know, I started off. I started Marley off part time and actually in the building. I was upstairs. So we weren't downstairs on that first floor at all. I had a 900 square foot space that opened up and two rooms. It was perfect. And Just enough space for me. So I didn't really necessarily change rent. I think I went down and ran a little bit.
Um, when I moved into that space, so Marley started off part time and then I was like, okay, you can do two days a week and then three days a week. And then I think, and then I said, okay, four. And I think the next year I said, okay, I'm ready to stop moonlighting. So it was a gradual process. Awesome.
And when you looked at your financial outlook and you had the, you know, the funds coming in to pay a salary, but also to say peace out to your moon landing gig, did you have any plans in place in terms of like.
Needed to make sure that you had six months of, you know, bill payment to be able to say bye to the moonlighting gig, or how did you set your benchmarks to be able to make that decision and leave, uh, moonlighting? Well, the thing about DPC is it's very consistent and. You can really determine what your growth rate is and just simply by looking at previous years and forecasting for that year to come and I said, okay, if I'm growing at this rate, then by next year or the next six months, I can afford to do X, Y and Z.
And so that was really not necessarily saying, okay, I'm going to stack six months back. It was mainly saying, okay, if I continue to grow at this rate, I'll be okay to actually stop moonlighting. That's awesome.
And it comes on the tails of somebody leaving a. a comment on our contact page about, you know, like, how do the finances work in DPC?
And it, it literally is like, is simple like that. You know, if you're doing a, a model where you have, and I shouldn't say simple because there's some, especially specialists who choose not to do memberships, but for those, especially who are doing memberships, it literally is this many members. equals this much amount coming in.
And then if you have one more member, they're paying that much more. Like it literally is, it's not like, okay, today's CMS is reimbursing me this amount of money. And so it's not, it's not like that anymore. Um, so I love that. Now, in, in addition to Marley, you have, you have Stephanie, Susan, and Kelly, and I'm not sure if you have any additional people, uh, running the front office or is that, is that your whole team today?
No, I had two people running the front office and I did have to let go of one.
So let's talk about teams because that's, that's a big thing is people are growing their practices just like you did, you know, you started out with you wearing all the hats, your husband is in, is in the, you know, background helping.
Essentially, you know, going from a micro practice to. Adding on team member and then multiple team members, and then, as you said, at least letting one person go, let's start with how did you find your teammates and how did you make sure that they were going to be a good fit for you, your practice and your practice culture?
I promise you every one of my teammates found me except for Marley. I worked with Marley when I was in fee for service, and I told her, just hang on, just hang on. And she was like, okay, it's been like five years. How long, how much longer do I, cause that, she was at my grand opening for, in 2014. And she was like, okay, how long?
What, where's it, where's it going? And so she was the only one I knew that I could work with because I worked with her as an MA and she was long gone from the practice where we worked together. So the other people found me, Stephanie, who's a nurse practitioner. She came in and said, Hey, I'm a nurse practitioner student.
I'm interested in doing, you know, some, I need some work to do, you know, she needs to be supervised. I was like, there's something about that girl and we, it just, and I said, well, if it works out as a student and she fits in the team, then we'll keep her on. And it did same with Susan and Kelly, who are a health coach and a nutritional consultant, basically, they found me though.
Chelsea is a new, she's a new person up front. She's actually Marley's niece and she worked out really well. And Anisha. She was up front. Um, I knew her as a long time friend. However, she was wonderful. Great. It was the hardest thing I have to do to let her go because she was so good, a customer service.
But as you even when you're growing in a business, you realize. Oh, wait a minute. I didn't even think about that. I was like, she doesn't have any medical experience. She's great at customer service, but you forget that you can't do what you do in fee for service. In fee for service, you can just have somebody up in the front answering phones with no medical background, and they just.
They may have a little bit, but they don't need to have MA training or anything like that. Can't do that in DPC. They have to have something. And I was like, wow, this sucks.
Cause she was great. She was great.
It just reminds me of when something changes in our practices, it's not. It's definitely an opportunity to learn from, to go past. And I am, I was reminded today eating a humble pie myself around like a financial decision in my practice that, you know, that, okay, like also remember that we are very fortunate in terms of like, we can say like, okay, we still have house and home.
We still have food to put on the, or money to put food on the table. And now we're going to pivot and make another decision. And so, but when it comes to having a conversation with someone, especially someone who you care so much about, you know, and you're very fond of who is doing amazing customer service in her case, any tips on how to have uncomfortable conversations, especially when it comes to letting go of a person.
That was hard. It was hard. I really had to, I went back and forth, back and forth, back and forth. It's going to work. No, it's not. It can't. It wasn't that she was doing a bad job. It wasn't that she was really making mistakes. It was the fact that I can't grow without I was so what I did. Okay, let me tell you what I did.
I have a mastermind group that I'm a part of. And ask them, I need help. This is what I need help with. And they gave me a lot of good ideas of what to do. And I took a lot of our ideas. So what I did was offer her a way to expand with the practice. You're awesome. I gave her your, your, your, the greatest customer service.
However, I know you haven't had any medical experience. Therefore, I really need somebody with medical experience. Are you willing to get medical experience? If we, if you, you know, I'll help you with that, or I'll aid you in that. And that's not what she wants to do. And I was like, well, unfortunately we can't continue.
It really ended on a great note. And she was like, I know that this is, I was here to help you when I needed to help you. And. You know, I was like, if you need any, anything, any help finding any positions or any references or anything at all. That's the way we ended. It was very positive. I
think it's so helpful for people to hear that, whether they're listening to this recording when it comes out or, you know, years later, because it is not something as DPC owners, we went to doctor school.
We didn't go to HR school. We didn't go to other schools. And it, and I think especially for physicians. Who do care about who comes into the clinic to work as part of the culture, you know, it's not a comfortable thing that, you know, we'll have people signing up to do, right? Like, that's not usually a doctor who would be the, the firer in a company.
So I appreciate you sharing that experience. And I, I think that for those people, I've talked to so many who are like. Well, you know, this person is the daughter of so and so in the town, or this person is like not doing their job or whatever, and there's different reasons to, you know, find that this is not going to be a good fit going forward, but hearing, you know, the, the little bit of agony there, like I should, I know I can't, like, that's normal, totally normal, but it also means you care, you care about the person and you care about the practice, so I think that, Take it, take it, take it, um, how you will, but take Dr. Harris's experience as this happened and she still ended on good terms, you know, so I think that that's, that's awesome. So let me ask you about when you brought people on and they, you know, you, you said how Kelly and Susan found you. Did they find you through functional medicine connections or word of mouth connections through functional medicine or internal medicine or both?
I think Kelly found me, I was doing, I spoke during COVID just about COVID in general, and I just felt like it wasn't like I was at that point and wanted to drum up more business. I just felt like the people in my community need to know about. They were, it was so many kind of things going out there that weren't untrue or answering questions.
And, and so she has started her own private, you know, health coaching business, and she wanted to partner with partner with me. And that's another thing. That's what I love about DPC is you can be creative of how you partner with people cause she's. I didn't hire her. She's just an independent contractor.
We worked out, um, something where, you know, if you see so many patients, you get this much money and the same goes for, um, Susan, same thing. And they compliment each other very, very well. One is stronger with nutrition. The other one's strong with health, health coaching. So it works really well for the practice.
And in terms of when they see patients who are also your patients, how does that work space wise? Do they see them virtually? Do they, do you guys come into the office at different times, or do you have space for everyone to have their own room when they need to see a patient? Yeah, it's really up to them.
Some patients want to meet in the office. Some patients, mainly virtually, they mainly meet virtually. Or they meet at Starbucks or just wherever they decide to meet. Gotcha.
And when it comes to you learning about functional medicine, deciding to, you know, add functional medicine as a component to your internal medicine practice, were there any issues legally adding functional medicine to your practice? in the state of Georgia? No, not in the state of Georgia. The one thing, there was a, um, podcast or a seminar on a patient who, not on a patient, on a, a physician who transitioned her, I think it was a fee for service into functional medicine, did a membership based functional medicine practice. And didn't know anything about her.
I was like, wow, she did exactly the same thing I did. I was like, we had like minds, but never knew each other. And I was like a very similar setup. So her husband is a lawyer. So he has a platform to help functional physicians practicing functional medicine, who are also doing a membership based model.
Very, very tight niche. And so I learned just some things from him and said, okay, I just need to tighten up here and tighten up there. Just making sure that people, because maybe functional medicine may not be. Okay, as the more that you learn about it, the more people learn about it. It is okay. It's just a practice of medicine.
I say on a biochemical level. That's that's how I see functional medicine. But you just have to make sure that you have a waiver there in place that. IFM or the Institute of Functional Medicine already provides for you. So they give you a lot of kind of help business wise to say, here's a waiver. You already have a waiver.
Here's a waiver for bioidentical hormones. Here's a waiver for functional medicine. Here's a, what to expect from functional medicine. And so we put a lot of those things in place, put a process in place where we do that digitally and it's done. Awesome. Yeah, it's, it's very important to know what's going on in your state legally when it comes to even things like nutrition.
I was reading how in California, anybody could be a nutritionist because there's no degree that comes with that versus a registered dietician. And so for someone to be giving medical advice, Whether it be nutrition or, you know, a Western medicine, like blood pressure medicine, definitely pay attention to what's going on in your state, but that's, that's awesome that you were able to get guidance and just a little bit more, not only from IFM, but just from talking and looking at your practice through a legal lens, how you were able to say like, this is what I'm doing.
I just need to protect how I'm doing it. I think that's awesome. So let me go back to your patients. You said like with the first few years that you were doing. And how has your pricing changed over time and any tips on how to set pricing so it is in alignment with the service that you're
providing? So this is very interesting story and I think you're going to like it.
So, so when I originally, when I originally set out to do memberships, I think I was probably just 3 months in and I was like, I had Rob Lambert, Bob Nelson, and we were the three, we were the trio in Georgia. And I had called Rob, I don't know Robert very well, I know Bob a little, Bob Nelson a little bit better.
But he was like, um, you know, we're doing this memberships thing. I said, I'm doing memberships, do you know how to, I'm doing it through QuickBooks, do you know? What's out there and he said, I heard about this thing called hit that crazy. That's like, I heard about the telephone, you know? And so, uh, he said, yeah, I heard about this thing called him.
It looks really promising. I think that's the way to go. And so I had, but in between there, in between that time of trying to figure out in, and how do I get into him? And who is this hint? I ran into a consultant. It's the same consultant that consulted with Jeffrey Gold all the way in And he was like, oh no because I started out I looked at everybody because I that's what I would do I would get on everybody's website.
I would get on atlas, you know, everybody quick reliance You know, the bliss is in C a typical charge. What was the average charge? Everybody was charging about up to about 75 a month, between 50, 45, 70, even back then, and I said, okay, well, that's where I'm going to set my prices. They came in as a consultant and said, oh no, no, you're charging, not charging enough, you need to be charging more 150 a month.
Don't you think that's a little steep? 125. And that's what's actually halted my growth. And so I became so upset because I, and I talked to Jeffrey later and he was like, yeah, yeah. Same thing happened to me. Same guy, same thing happened to me. And I was like, wow. So I went back to The baseline price where everyone is practicing.
So you really have to charge what the average charge is, because it's kind of like, you know, unless you're bonbons or like soup, like have diamonds in them and you crunch and you have, then you can charge, you know, you know, a hundred thousand dollars a bomb bomb. If it's a regular bomb bomb, just charge, you know, anyway, you got, you get it.
But I spoke with Josh. He was on it. It's such an awesome guy because my husband said, I'm going to call Josh. I said, you're calling who? Do you know who Josh is? Like this guy's been on Hannity. He's not going to talk to me. And so, and my husband called up Josh, it was the weekend of Thanksgiving, and he was driving to his family's home, and God bless Josh, I love him, because anytime, he'll be like, yeah, I'm walking into, hey Josh, are you available?
Yeah, I'm walking into like, the movies. It's like, but yeah, so he told me, yeah, your prices are too high. You need to go back to the foundation. And I started growing again. And so I really got kind of bitter because I was like. You know, I should have listened to my gut as whatever I knew I should have been charging those prices, but I learned a good lesson that that's, you know, you charge where kind of like where the baseline charges now to go up on charges.
I probably have increased my prices by 10 to 15 since I started. At the most for primary care. Now, of course, my functional medicine prices are in range with the rest of the nation, but, um, still have to be a little bit higher because I see less patients and I do more time. I give them two hours on their first visit.
And in terms of how you, if a, if a person is coming into your practice, I asked the same thing of Dr. Tammy Singh, who's doing functional medicine as a family medicine doctor, uh, down in Florida, how do patients find which pathway they're going to go down, whether it be a primary care under, under the internal medicine membership or functional medicine?
That's a really good question. That's a question we had to figure out because there were a lot of patients that we were seeing at the time that were really functional medicine patients. And I really haven't, I hadn't turned the switch on for functional medicine yet. And so we had to give them a choice and say, Hey, you know, this is what we're doing.
We're going to switch people who are really functional medicine over to this price point. And we have to make that determination patient by patient. There are some people who try to slide up on the radar and use. The nurse practitioner as, you know, for primary care, which is something else I thought I would never do as I, or a nurse practitioner, I was like, Oh no, no nurse practitioner is all positions, but she does a great job and I needed the help at the time, but that's another story for another day.
So we have to, she really communicates as far as like, I really think this person is functional medicine, but I really think they're trying to. you know, just slide up under the radar. But I, we have to be very stern with them and say, you know, she's not trained in functional medicine. I am, this is a functional medicine issue.
If you, this is the way you want to go, you really need to switch over.
And in terms of your patients, if they are both functional medicine patient, as well as person seeing you for, you know, Pap smears and just annual, uh, regular things that, that aren't necessarily needing the same time as a person who is seeing you for a functional medicine visit, how does that work out?
Do they maintain their membership and get a different price for doing functional medicine plus
membership? No. So everybody's a member. So you still pay the monthly membership. It's just a higher price point for functional medicine. However, I'm still your primary care doctor, which is, which I think a lot of.
I think it's a cool thing about direct primary care and the model is you can do anything you want to do. I still, they're like, you can still write my prescription for hyper. Yeah, I can still do that. I can still do your pap and I could still do your breast exam. I could still take that thing off. Let's just let's tip it off right now.
Why I say I could still do your biopsy, but I'm also your functional medicine doctor too.
Awesome. And in terms of your way of practicing, especially at the after visit, so, you know, given that functional medicine visits, any DPC visit, especially the new, the new patient visit, you're going to find more time is spent on that, on any visit in DPC, whether it be functional or not, just because we're DPC and we're not bombarded with number of PEDs seen per day, number of codes brought in per day.
So as a doctor who is having the time with patients, how do you go about the after visit? Because especially in functional medicine, you know, with different types of supplements, understanding where to go for, you know, information on, it's not fake news or whatever about supplements that you might be prescribing.
And also, Giving, setting up a patient for success if they have, shucks, I forgot what Dr. Harris said, because she said a lot during two hours and I'm not sure what she said, how do you set your patients up for success after your visit, whether it be functional or Western internal medicine? Yeah, that's a really good idea.
We just had a staff meeting about this last week is really still the importance of putting those systems systems and all those processes in place to make sure. That because that was we have somebody decides to leave the practice that we do an exit interview with them and fill out what could we have done better.
What was the reason why you're leaving? How can we improve? And one person said, well, you know, making sure that we have a list of things that we need to do or. That there's something that we can go by when, when we leave, because there's so much information we'll forget and I was like, wow. So we decided to do a form where we'll check off and it will have like a, a general form.
I will check off. You're going to do this, this, this, this test. This is how much it's going to cost, you know, and it's. Really just something that's really laid out. It's in the process of doing, but that's one of those things about great. You know, if you really love, if you're really an entrepreneur heart, that's one of the things that you love to do is like, oh, we could do this better.
Let's do it better.
That's awesome. And I think that that it speaks to the freedom that you chose when you decided to open up your own practice, because I just, I think about, you know, in 2014, just by happenstance, I mean, it's, it's like other doctors, like Dr. Emily Scott, like just by happenstance, you read this article or you saw this video.
It's like, It just things happen for a reason. It's like when you were like, I'm going to close somebody calls, you know, it's just so cool how things like that happen. But, you know, I think about how you've grown so much over time. And so I want to, I want to ask when you have other people who are clearly like in the Georgia area, there's, I'm so jealous because there's so many doctors like Dr.
Michelle Cook was at, um, Chris's grand opening. Are we grand opening? And, you know, Anand Mehta is down the, like, he's what, 45 minutes away. I mean, it's like super jealous of your guys location, but as other doctors are, you know, definitely reaching out, whether they be functional focused or whether they'd be just wanting to know about DPC, what big pearls, what bonbons filled with diamonds do you give them?
When they're, when they're saying, Hey, Dr. Harris, like you are a pioneer in Georgia and you're a pioneer in DPC. You know, what, what are, what are some of the big tools that you always pass on to others who might be asking about VPC?
What I would always tell people is. Start off slim, do not overspend, don't go big, don't do any of that, unless, until you're way into very stable ground, you know, get used things.
I still, even when I opened up the bigger practice, I still got used furniture. I didn't, you know, you still, it looks the same, nobody can tell the difference, it's not torn, great. But yeah, start slim. Don't go really just have a slim practice. That's very efficient. Don't hire more than you need to hire.
Don't have a front person up there. If you don't, if they're not being used for like five different things, you know, so it's just, you know, be very efficient and very effective at how you run your practice, I think is the best thing is a lot of people want to have marble in the front and they want to have.
The thing that looks the best on Instagram, and you could, I have one little area in my, that has some pillows and a chair, and that's the best part, and I always take that picture. It doesn't mean the rest of it looks horrible, but I'm just saying, I don't have a million dollar, dollar practice, and it's not important to have that if you're taking care of people.
People aren't really going to care if you have marble everywhere, if you treat them poorly. And if you're not going to be open in three months because you can't keep up with the bills. I love it. And as I was listening to you just say that, you know, it makes me think of Dr. Clota Ryan had dropped this gem of There is marble that is in the form of contact paper that you can stick on counters and people don't know the difference.
Um, but also, it's super true, but you called it out, you know, it's like patients aren't looking for a million dollar clinic. They're looking for a million dollar doctor. So with that, thank you so much Dr. Harris for sharing your story today.
You're welcome. Thank you for having me.
*Transcript generated by AI so please forgive errors.
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