Direct Primary Care Doctor
Dr. Philipp Olshausen has been an internal medicine physician since 2006 when he finished his residency at the Yale-affiliated Norwalk Hospital in Connecticut. His training began in his home country of Germany, in Berlin, where he attended the Charité at the Humboldt Universität, having lived in the U.S. for a few years as a teenager due to his father's job, there was something drawing him back and that led to his residency and chief residency in Connecticut. He has lived in beautiful Southern Oregon ever since.
He had a career practicing primary care medicine with different independent medical practices and one of his biggest professional achievements was opening his own Direct Primary Care practice in 2017.
Being able to step away from the third-party payers was amazing for his professional life in the way that he could provide care to patients and for the work-life balance it provided as well. He started also working in telemedicine jobs here and there, but since 2020 has made that a regular endeavor as well, and it has allowed him to experience the exciting world of telehealth and digital health with all it has to offer. It has been wonderful to be a part of that growing and expanding way to practice medicine and play another part in fixing the broken healthcare system by improving access to care, which he has found to be one of the biggest issues right up there with the unnecessarily exorbitant costs.
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Here's a glimpse of what you'll learn:
Dr. Philipp Olshausen shares their journey from traditional primary care to starting their own Direct Primary Care (DPC) practice, highlighting the motivations and advantages of this model.
The speaker discusses the challenges of transitioning to DPC, including financial considerations, concerns about patient retention, and the importance of attending conferences and hearing inspiring stories from other DPC practitioners.
Learn about the speaker's decision to close their DPC practice and their plans for the future, including transitioning to full-time telemedicine and exploring other opportunities in the healthcare field.
Get insights into the practical aspects of running a DPC practice, such as managing patient subscriptions, handling administrative tasks, and developing workflows organically without structured planning.
Discover the various ways in which Dr. Olshausen and the host advocate for the DPC model, emphasizing the benefits it offers to patients in terms of accessibility, personalized care, and a more meaningful doctor-patient relationship.
In this episode...
Dr. Philipp Olshausen, previously associated with Rogue Direct Primary Care in Medford, Oregon, shares an inspiring odyssey into the realm of Direct Primary Care (DPC). Unveiling a tapestry of experiences and hurdles, he offers a candid exploration of this transformative journey.
Our conversation delves deep into the essence of access within DPC—not merely centered on appointment availability but also emphasizing the significance of swift responses to patient queries through digital mediums like email and text. Dr. Olshausen illuminates the imperative need for broader education surrounding primary care capabilities, such as demystifying procedures like pap smears.
While facing the challenging decision to close his practice, Dr. Olshausen prioritized his well-being and demonstrated a profound sense of responsibility by preemptively notifying his patients through a heartfelt email. We venture into his future aspirations, as he navigates beyond DPC, seeking new horizons while balancing work-life harmony.
Our dialogue extends to the myriad concerns and considerations that accompany the transition to DPC—ranging from retirement planning to managing financial obligations. Dr. Olshausen shares how attending a pivotal conference assuaged his doubts and served as a catalyst, propelling his dedication to the DPC model.
Join us for an immersive journey into Dr. Olshausen's narrative—unraveling the organic evolution of his practice workflows, the expansion of his patient network, and the nuanced dynamics of running a solo DPC venture. Brace yourself for captivating insights, intimate anecdotes, and invaluable counsel tailored for physicians contemplating the profound shift to the DPC framework.
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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.
Hi, I'm Dr. Phillip Olthausen, formerly of Rogue Direct Primary Care in Southern Oregon, and this is my DPC story. I started DPC, or I started my DPC practice, six years ago in the summer of 2017. And my motivation was really getting more control for myself, my life, my work life, my personal life, and also offering something that was not just unique, but simply better for my patients.
This mainly revolved around access and having more access to me, having more personal care that I just wasn't able to provide before that. And from my perspective, having more control about how many hours I actually have off and to enjoy my personal life. Uh, but at the same time, also. Controlling the time that I can focus on my patients.
Dr. Philip Olshausen has been an internal medicine physician since 2006 when he finished residency at the Yale affiliated Norwalk Hospital in Connecticut. His training began in his home country of Germany, in Berlin, where he attended the Charité at the Humboldt Universität, having lived in the U. S. for a few years as a teenager due to his father's job.
There was something drawing him back and that led to his residency and chief residency in Connecticut. He has lived in beautiful Southern Oregon ever since. He had a career practicing primary care medicine with different independent medical practices and one of his biggest professional achievements Was opening his own direct primary care practice in 2017.
Being able to step away from the third party payers was amazing for his professional life in the way that he could provide care to patients and for the work-life balance it provided as well. He started also working in telemedicine jobs here and there, but since 2020 has made that a regular endeavor as well, and it has allowed him to experience the exciting world of telehealth.
and digital health with all it has to offer. It has been wonderful to be a part of that growing and expanding way to practice medicine and play another part in fixing the broken healthcare system by improving access to care, which he has found to be one of the biggest issues right up there with the unnecessarily exorbitant costs.
Welcome to the podcast, Dr. Olsasson. Thank you. This is such a treat to have you on. I know that we arranged this earlier on when you announced that you were going to be closing your DPC and doing other things with your life. And you know, we were talking about this a little bit before recording, but you know, there is unfortunately an air sometimes in the Facebook groups, especially about, Oh, if you close your DPC, you're a failure.
And I, I was saying, you know. I'm not a failure because I left fee for service medicine. And so the same thing for when we go, you know, into life as DPC doctors, and we are able to see what we are capable of achieving in life. It's very interesting because entrepreneurship is definitely a thing that people tend to love a lot in DPC.
Some people would definitely disagree with me on that one. But for me, the entrepreneurial brain has just made me so much happier than In fee for service and with entrepreneurship comes lots of things and the outlook that you have on life. I'm so excited for everybody to hear your story and also where you're going in the future because there's lots of future coming.
Absolutely. I'm happy to share. So I wanted to go back to 2017 when you opened Rogue Direct Primary Care. And as of this recording, the practice closed a little over a month ago. So, tell us about 2017. What was happening in your life that made you transition to DPC?
Sure. So, at that time, I had been in practice after residency for about 11 years.
And I had always been in independent practices. And I say that just because a lot of people that do transition to DPC were in, you know, working for big healthcare systems or big hospital systems. And I think that's a different ballgame even then. Working at independent physician practices that were physician owned and where things were actually a little more along the lines of what physicians wanted compared to some of these other examples.
So, in the grand scheme of fee for service, insurance based medicine, I probably had a relatively good professional life. You know, I didn't have to see. 2025 or more patients a day. I had to maybe see 16 to 18. So I wasn't burnt out. But I will preface all of this by saying I seem to be this personality that every few years kind of says, what else could I do?
Or how could I do this different? Or maybe I should change something or maybe I should just make a switch. So it's been pretty consistent. Every 5 to 6 years. I make some kind of. Major switch in my life. So people should probably know that because maybe that's not the norm for everybody. So at that point in time, I wasn't really unhappy with what I was doing, but I'd heard about D.P. C.
I'd heard about other practice models. I obviously heard about concierge medicine. So I just started looking into it. And there was actually a brief moment of time where I considered or talked to my colleagues. There were six colleagues All internal medicine and group practice to say, Hey, do you guys want to do something like this together?
But that quickly fizzled out because people were just looking at me like I was a little bit crazy. So I moved on and researched for myself. And I think I remember going to the, at that point it was in Kansas City. The DPC conference and that really sold me. I mean, before I was kind of thinking about it, maybe it could work, but that sold me.
I left that conference knowing that I was going to do this, you know, come hell or high water. So that's what happened. So just a note there, because this experience that you're describing of, you know, having a life changing moment because of a conference. The DPC summit, that is co-sponsored by the AAFP, the A-C-O-F-P-F-M-E-C, the Family Medic Medical Education Consortium, and the DPC Alliance is gonna be June, 2024.
So definitely look to DPC summit.org for updates there, as well as our uh, resources page on the my d DPC story.com website and there will be updates there as well. When you talk about that, you were talking to your fellow physicians internal medicine. Docs who were just like, I don't, I don't know about that.
Like, you know, be well, have fun. You do you, but we're going to stay here. What were those discussions like? Like, what exactly did they not latch onto the same way? Because yesterday, like this is just a. Side story. I drove to Walnut Creek for the second time to get a COVID vaccine for my family because it's not available in our county.
And so I was talking to the doctor there who's an independent doctor. This doctor has been working for John Muir and other, you know, Medi Cal clinics and then. You know, we were talking about DPC and the comment was initially that'll never work in the Bay Area. And I said, well, look at Dr. Nazia Sharif.
She's a pediatrician killing it over in Orinda. And she was like, what? And so it's so interesting to, you know, have these conversations. I feel it's so different when we talk to our fellow colleagues who have already graduated residency and who are in fee for service than it is a medical student or resident for the most part.
So what, what were those conversations like? And what did they get differently than you when you were thinking DPC? Um, it's a good question. Let me jog my memory. So I think one of the things was they wanted to take little baby steps. You know, they wanted to say, hmm, can we, you know, obviously everybody was struggling with how much they were making seeing Medicare patients, which automatically is a high percentage in the internal medicine practice.
They were thinking, can we charge some kind of an annual fee to provide services that are officially not Medicare covered, which, of course, immediately goes along with lots of legal, you know, you have to have somebody really write a good contract to make sure that's above board with Medicare, but they didn't want to take that real big step, which was essentially this practice is done the way I'm doing it, and I'm going to just jump in and try something completely new.
And I think there were different concerns. Some were close to retirement and just didn't want to go that route. Some were very young and just out of residency and still were struggling with, okay, how am I going to pay all that debt off? So there was just different life situations and everybody had their own worries.
I wouldn't call myself typically an entrepreneur. So I wasn't this person that always did these things. Just at the time that was just felt right to me. So I can't tell you why for me, it was less of an issue. But those were all the different worries. And, and I think one worry that I should also mention is that they said, well, a lot of patients will drop off, which is true, of course, and kind of have to because you can't have that same volume in your DPC practice.
And they were concerned about that, and they didn't really know where they would go, even though I'm in an area that I wouldn't necessarily call underserved. There, there's a bit of a difficulty getting in with a new primary care physician. So that was another worry. And it's interesting because that was in 2017, you know, I'm sure that that's much more impacted now.
And, you know, for those people who aren't aware, uh, where you're, you were practicing, you know, when you go to the website, it's, it's like the same website designed for, I think it's like four different practices as of today. And so, you know, there's lots of people who see adults in. That building that you were in, but it is definitely something to think about, especially for listeners going to move to rural or urban and I'm thinking about DPC.
Now, when you went to that conference, what was it that, you know, despite you not being like super entrepreneurial and super like, you know, Oh man, this is, uh, you know, I I'm going to do DPC before going to the conference. What was it that truly convinced you? Like, this is it.
Well, you hear a lot of inspiring stories, of course, from people that have done it.
And you're like, Oh, people actually can make this work. And I think in the end, though, the conference managed to take away some of my worry or fear or concern, which everybody has, you know, starting a new, new business, no matter what it is, no matter what industry it's in. So that was probably the biggest thing.
There were people there that were able to alleviate my concerns that were still, you know, roaming around in my head.
That's awesome, and that is definitely something that will happen at any conference that you go to when it comes to DPC, as well as if you watch, uh, former conferences that have taken place.
The recordings are definitely available on YouTube for free. And of course, listening to episodes of my DPC story, gonna totally put in a plug there. So when you were transitioning, let me ask you about that because how we mentioned you were, your practice was already in a building that's close to a medical center, the regional medical center.
It is in a building where there's rogue Valley physicians and that's a PC in and of itself. So how did it work to transition from your practice as an internal medicine physician with a group?
Yeah, I think in lots of ways I was really lucky because I was in this group of, you know, with me, seven docs, there were a couple of other clinics and other locations that were part of the PC, but I really just brought up to them. This is what I'm planning to do. Are you guys cool with that? And they said, sure, it did mean me separating from the PC or, you know, the clinic, but there was this separate partnership of owning the building, which I still own to this day with them.
So I own a 7th and so in a way that made everything easier is they didn't really see a problem in me leaving the practice. It wouldn't affect their finances. You know, if anything, maybe they'd get some patients that didn't want to join me in DPC. And then there was the building that we all still shared.
So it was this automatic transition to say, yep, you can carve out this, whatever it was, 900 square feet of, you know, the space that you need and we have no issue. So in a lot of ways, things were easier for me because I know people that want to make this transition and they're working for a big clinic that's owned by a health system, et cetera.
I mean, all kinds of barriers are put in their way, right? For me. I was able to draft a beautiful letter, send it out to all my patients, you know, nobody was blocking me from doing that because they didn't care. It didn't affect them in any way. So I was very lucky and I was able to keep that space and just work kind of alongside them as this own separate business entity.
Definitely lucky there because, you know, depending on where the listeners are listening from, they might be dealing with non competes in different states, and especially if you are working for a larger corporation versus a small group, so that's fantastic that that was your experience. Now, one of the things that I wanted to ask here goes into how you envisioned your DPC because online, you know, Google reviews tend to stay forever in a day.
And nine years ago, so definitely before you opened your DPC, there was a patient who had left a review about driving for over an hour and he was told he had to reschedule even though he got there on time. And the comment was about how, you know, there was one person who Was the front office for you and there was another medical assistant involved and it was, again, nothing about your care as a doctor.
It was everything to do with the front office and scheduling. And so when you were envisioning, okay, cool, I'm going to do DPC and this is how I want to make my DPC in terms of patient experience from the get go, how did you use experiences like. Google reviews that were having nothing to do with your doctoring.
And how did you incorporate those into planning your DPC?
I don't know that I had a very specific picture other than wanting to make or knowing that I was going to be able due to, you know, less patient numbers, et cetera, to actually accommodate people, meaning be able to schedule them in a much more appropriate way.
Timewise. The big question for me was staffing. And so I went into it with, well, I need to have an MA. How, how is it ever going to work without an MA? And I did have a part time MA for the first nine months. And she was very helpful in, you know, getting all records into the new HR system and all that jazz after nine months, we sat down and said, well, you answer about three to five phone calls a day, max.
And I can room my own patients and it helped that she was moving on anyway to kind of do other things. So when the first 9 months were over since that time, I never had staff again. And I feel like in some ways that was the beauty for me of the practice. Yes, sure. I scheduled patients. I roomed patients.
But when you have, my max number was 400 patients. You can do that. And when you have good technology, like an amazing EHR, easy to use other tech for things like faxing and replying to faxes, then it actually works. And I never felt burdened or overwhelmed with administrative work at all. So for me. The micro practice concept of no staff was the absolute beautiful, but, you know, again, depending on how many patients you want to have and all that kind of stuff that may not work for everybody, but I can highly recommend it.
Awesome. And in terms of you getting to this place where you were functioning without any staff, other than yourself being the wearer of all hats, how did you develop your workflows? Because with you not having, you know, Opened your own independent micro practice before, but having been involved in fee for service clinics as well as what you saw in your group of seven, how did you develop workflows so that you could more quickly get to that spot where you could be the wearer of all hats rather than having to outsource to different people?
You know, I think it kind of just happened because of the EHR I use that incorporated all the, you know, managing the subscriptions, some of the patients, the medication dispensing, and of course, the charting all under 1 thing that made it easy. And so I didn't really sit down and, you know, work out policies and procedures for myself or really structured workflows.
It all just kind of. Happened and it worked. So I didn't question it. Something as simple as the faxes that, you know, sometimes can be overwhelming because you get things from home health and pharmacies and all that stuff. If you have an easy app to use, where you can literally just sign it on your phone and just hit reply and it takes you.
You know, 5 minutes to go through 20 faxes, then you don't need staff for that. And it. It helps because you know everything the way you want to do it and you don't have to train anybody in the way you want to do it. So yeah, it just, I didn't plan a whole lot. It just kind of happened.
Awesome. And just going to drop this there because I still meet people who aren't aware, but even on your phone, like if you're using an app, uh, whether it be just a native app in your phone or it be a medical app, you can save your signature and put that into documents.
Like if you have a document that has the requirement of seven signatures, that is completely duplicitous, but you can save yourself. Listen to a podcast while you're like, click, click, click, click, click. So love that. And I love that it came organically. You know, I asked that question. Some people have, well, everybody has different answers, but some people have more organic answers and some people have, Oh, I planned because blah, blah, blah, blah.
And I love that, you know, it's again, if you've seen one DPC, you've seen one DPC and that's how it worked for you, which is great. So tell us about your practice. You said that your, your panel was full at 400. How long did it take for you from opening to getting to 400?
So again, I was lucky in the, in the way that I had an existing practice that I could, you know, I could tell people about it.
And when I went to, I remember the, at the DPC summit, very specifically, it was like, 5 to 10 percent of your patients will probably stay with you was kind of the general accepted number. I don't know if that's changed over the years, but. And sure enough, I think I hit probably even a little more than 10%.
So I was very lucky that within the first, you know, weeks of opening 220 of my existing patients followed me. And this is the other aspect that we didn't really talk about yet is the whole business aspect, right? Because I, I had talked to one of my colleagues that I worked with in the building when I knew I was going to close, because I was kind of like, you want to take this over?
You know, you're kind of a younger guy and you're just kind of working like crazy. And the first thing he said to me, You know, I kind of do, but I'm just so afraid of the business side of things. The business side of things was the easiest thing for me. I mean, and maybe I didn't know this ahead of time, but in any kind of business model where you have a certain number of clients, let's call them, and they pay you the exact same amount every month.
There's not a whole lot of fluctuation with, you know, your profit margin. It's pretty stable and pretty predictable. So once I knew I had 220 patients, I could calculate, all right, here's my income and I was actually good. So I was able to pay myself a salary from the get go. Now, I guess I wanted to go up a little further cause I wanted to hire a salary, but I was safe and I was I'm one of those plan B people. So I came up with all these things. Okay, I could do telehealth. I'm not making enough money. I could maybe work in a local nursing home. I could I mean, I had all these ideas at the local county jail. They are always looking for doctors to have. So I had all these things in place and I really didn't use any of them or very little.
And yeah, so I was lucky. And then within, I think, 6 to 9 months after that. I kind of grew to a max of 400 and that was all either some latecomers from my existing practice previously, or then I would say word of mouth because I never did real hard marketing. I had a Facebook page, which I don't think I really ever used.
I did 1 town hall meeting in the beginning and this was really more for my patients to inform them outside of the letter, which really went well, but I wouldn't say I got any new people from that. So word of mouth, I think and everybody probably knows this is still the best marketing tool, especially when it comes to medical practice and Google reviews.
Fortunately, influence it very little.
Awesome. And let me ask there. Did you opt out of Medicare once you opened your doors or did you wait to opt out?
No, I planned that right away because I knew that was, especially with me transitioning from an internal medicine practice, I knew I had to make this available to my Medicare patients.
So I knew I was going to opt out and I, that was all in place, um, right on time.
Got it. And when it came to that letter, how you said that, you know, it, it went pretty, it went over pretty well with your patients. Do you have any advice as to how to approach a letter if you're able to send something out?
Because some people are like, do I go into detail about direct primary care? Like. How do I explain it? Or, you know, do I create a very general page and then have a link so that people can watch a video, you know, that I can't put in a letter? How did you approach that letter?
Yeah, there's so many, I don't even know if I still have that letter, but I was, yeah, I was very honest, you know, as far as the reasoning.
And I think the reasoning is going to be very similar for most people thinking about this transition. And, and I did try to. Provide quite a bit of detail because I wanted people to understand at least the broad concept. Of course, there's still this issue of some people just don't get the value of it, but that's fine.
Some people never will. So I, yeah, I don't think I, I'm trying to remember. I think I did in the letter already mentioned there will be a town hall and whether I already had the date set up or not, I don't remember, but I did want to give that additional opportunity for asking questions because, you know, you can put as much as you want in the letter.
There's probably going to be some questions that people are going to have. So. And I think I'm glad I did that at the time. I was a little bit stressed about doing the town hall meeting, but I just found a spot at the local library. That was virtually free and a good number of people showed up. I can't tell you the exact amount, but I know the room was full.
So that was kind of gratifying and, and everything was positive. I never got a real bad, you know, complaint or whining response to the letter either. I mean, some people might've thought it, but they didn't say it to me, to my face. So that was nice. I think the funniest thing I remember from the town hall meeting is one person, and I don't think I even knew her, got up and complained.
I was doing a one fee for all, I didn't do age based payments. But I did a little couple's discount. So if husband and wife signed up, it was, I mean, it was really small, like five, 10 percent max one person got up and like, you're discriminating against single people by not, you know, I'm like, what should I, I didn't know what to say.
But the funny thing was that then others in the audience sort of, you know, kind of tore her down and said, you know, just basically told her to be quiet. So I remember that very vividly.
It's interesting, you know, you can't, like you said, you can't win them all and when you were at that town hall, what were, you know, from the other people who were, you know, in alignment with what you were doing and, and presenting and who were, you know, wanting to listen to more and more, what were the, the most common questions that you got from that meeting as well as anybody who would join the practice?
So interesting. Nobody ever said anything negative or bad about the actual amount, you know, that I was planning to charge a month, which at the time was 75 a month. And then I think during my years went up to 85 at one point, but that's it. I mean, they just wanted to understand kind of what's included.
They wanted to understand was this somehow negating their health insurance that they had, you know, just concerns and worries that they had about would something not work because they were joining my practice. Unfortunately, I could give reassurance. I did already, I knew I was going to offer discounted labs and dispense medications.
So I was able to throw that out already, which I think helped a lot because it just gives these nice little real life examples of, Oh, this is my med list. And even though I have insurance or not, um, you know, this is what I'm paying for it. And this guy's telling me I could get it for this much. Wow. And so you, if you have those selling points that are just more.
Tangible. I mean, you can tell people I'll be available to you and we'll have longer appointments, but there's always that, will we though, but if you have something real tangible, like you're going to pay this much for lab work or this much for your medicines, I think that helps a lot.
It's so interesting.
Cause I was talking to one of my dearest friends from residency. She is a paper service doctor in a large corporation. And I think that anybody who talks to me, who's not doing DPC tends to like. Do the justification of like, oh yeah, I love my life. And this is why I love the life. And I'm like, cool. I just wanted to call to see like, Hey, it's been a while.
We didn't necessarily need to talk about like, you know, what, what's going on at the corporation, but it was interesting because, you know, I was thinking about this this morning before we got on the recording, like when I talked to doctors, medical students, residents about. You know, autonomy and about how you know you can have the time with your patients that you need.
I tend to forget mentioning like the financial harm and the financial lack of harm that can be in fee for service or DPC depending on how you present something to the patient. So, for example, I had a, a patient who was coming to me for a, A one-off physical through the fire department. And, you know, we're, we're going through medical history because I'm doing a physical and the, the price of medication came up and I was like, this is like, I never talk about this during meet and greets because this question never comes up for us.
It's always like, well, I'm so tired. I can't get into my doctor. Got to go urgent care. It's so expensive, which are absolutely very concerning issues on their own. But this patient in particular was saying how, you know, the price of the medication that they were typically on was 300 plus per month. And then, you know, so I went on to an online coupon site and I was like, or you could pay 54 per month by using this free coupon or in wholesale pharmacy access through direct primary care, it'd be 15 a month.
So this is an example of how. You know, the cost per year of care really can actually be a savings and not, you know, Oh, I'm going to pay more in addition to my insurance. And I think I've mentioned this on the podcast before, but there was a patient who has joined the practice who paid like 1, 800 for an ER visit.
And they were like, you're telling me that I could pay less than 800, 1, 800 for a whole year of having you as my doctor. And like, you could have taken care of that over the phone. And I'm like, yes, and there's so many people listening who are like, yeah, I do that all the time, which is amazing. And so, you know, I love that your community had this new access to what does medicine actually cost and like, what does access.
So when you were open, what did your typical week look like?
In the beginning, I think I had pretty much a four day work week, which I actually had all my life since residency. Fortunately, in every practice that I worked, I had a four day work week, so that's good. And I think I actually kind of turned it more into a three and a half to four day work week in the beginning.
And of course, in the beginning, there was a lot of additional work of just Getting charts moved from one system to the next. So that took some time, you know, even though the 220 patients were all my previous patients, they were kind of new patients in the way of the EHR. And just getting used to the workflow that came naturally, but still have to get used to it.
I did try to though, have, I think it was Mondays off and used Mondays sometimes for some meet and greets and things like that. But yeah, so it was, I think it was a good schedule. I can't recall really ever staying much later than 3 or 4 PM, uh, which was new because usually before that I would get home more 5 to 6 PM.
Uh, nevermind that I gave up all my many, many board responsibilities that for some reason I had acquired over the years of working in an insurance based practice, which I don't miss, haven't missed for a single second, so.
Love it. And in terms of offerings at your clinic, did you do procedures in terms of, you know, pap smears, biopsies?
Did you offer those services in your practice and were they part of the membership if you did?
I did. So very basic stuff. Yes, pap smears, skin biopsies that they were part of it. Yeah, I'm trying to think. Yeah, pretty much all of them are part of it. Obviously, if I sent the biopsy out for pathology, then that cost would be separate.
But again, with some of the lab discounts, pretty amazing cost savings there, but yeah, like EKGs, pap smears and the actual biopsy I just included because honestly, I felt that was reasonable. First of all, I didn't have a high volume necessarily, and it didn't take that much time. Yeah, I'm trying to think.
I think those were the main procedures that I did. I didn't do any joint injections or stuff like
that. Great. And I ask that because there are some internal medicine doctors who go into DPC who are like, I used to do those things. I totally would love to do those things again. And I haven't done them for a bit because of, you know, the way that the system has allowed me to practice or
not allowed me to practice, depending on how you look at it. And you know, for those types of things, there are so many resources, like it's a different, uh, world out there compared to even 2017 in terms of even DPC physicians learning or relearning, or just re upping on how to do things like that in the office.
So thank you for that. Now, in terms of, you know, as you look back on your practice, what was the number one value proposition that you could say your patients took from?
In the end, it was just the, the access and by that, again, I don't just mean getting an appointment, although that was a big one too, but I was very open when it came to doing things by email and text.
Um, I know that some people, and this was also my worry in the beginning, and some people are like, Oh, aren't you going to just get texts 24 7 every day? And, and, and didn't, I mean, I think 99. 9 percent of patients totally respected at least approximately, you know, working hours. There was a couple of outliers, but that was fine.
But just to have that, even just. Small questions that I wouldn't even consider an issue or that we're just able to reassure them within, you know, a few minutes or even half an hour. If it took me a minute to reply after closing. Now, I think I've probably heard that more than even during the practice is just that, were we ever going to find somebody who just is there?
Like, if we just have a question, we don't even need full on medical care. We just have a question. Can you reassure us about this? Can you give us information about this? And we don't have to wait for it for a week for somebody to call us back. That really seemed to be the biggest thing, especially for Medicare patients that probably have just statistically more questions, more medical issues.
For them, it was huge, and I don't think they are receiving, as a general statement, really good care, good access to care in our healthcare system right now.
Especially when it comes to not only having access to your primary, like that could take months, but then having the time within that visit. But when you do finally see your primary to actually flesh out what the concerns are, addressing them appropriately to address them appropriately, and then the weight to a referral if you need to.
So even just going back to you providing like, Yes, you can actually do a pap smear. You do not have to see a gynecologist to do that. Like I had that, I have that, uh, conversation with patients and they're like, but isn't that like a specialty thing? And I'm like, uh, it's a doctor thing. And so like we actually all rotate in obstetrics and gynecology is one of our required rotations as you know, as medical students, even so that people are still blown away by that.
And it's like, I love educating them on. Actually, the, the truth about the matter is like lots of us primary care docs are able to do a pap smear. So when it comes to the patients loving your practice, and clearly there were so many people who joined on immediately, but then also it grew to 400 and people left reviews like one of them commenting about how they had left the state, but then came back after three or four years being away.
And this person was so grateful to find you again as your, as their doctor. And so I wanted to ask now about when you decided that you were going to close your practice with knowing that your patients loved having access to a doctor who knew them, who had the time to spend with them, what was, you know, what was going on in your mind space of the thoughts about like, okay, I think it's ready for me to close the practice.
And this is how I'm going to approach it with my patients who I still care about. Yeah, I mean, you obviously think about the fact that this is going to impact people, but I also had to tell myself, can't, the buck can't stop with me. So there has to be alternatives for them out there. And I did try my best or come up with a plan to try to help them find those alternatives.
And I think in the end, it worked out pretty well. There may be a handful of patients out there that Disagree with me on that, but they didn't let me know. Yeah. So in the end, while I had some thoughts about that's a real shame that they're not going to have the same access to care. I just, it was something I had to do for myself.
So, and no shame there whatsoever. And there is no shame in that whatsoever. You know, I learned very on, I think this was an undergrad at a golf tournament where there was a, a couple of people at the golf tournament. We were hosting a golf tournament to raise money for our Filipino veterano clinic, a free clinic.
And the golf cart with these two people fell over and I was like running up the hill, screaming like, help, help, help. And I remember a doctor who was a neurosurgeon turning to me and saying, Hey, you know what? I totally get that. Like that was a situation where you needed help, but like, in terms of, you know, losing your mind, freaking out, like if you can't take care of yourself, you can't take care of others.
And it's so interesting that, you know, from that situation, just that sentiment of like, wow, if I am not. You know, showing up as a person who can be calm and think and be, you know, open to hearing all of the different things or, you know, not being irritable because of, uh, not having sleep or whatever the things that I experienced in fee for service, like if, if you're showing up better for your patients.
It definitely makes a difference in terms of their care, but also, you know, there always is, you have to take care of yourself before you can take care of others. So when you decided to close the practice, I want to ask about how you went about letting people know. Did you slowly do it through visits as people were seeing you or how did you let them know differently than you had when you were opening the practice?
Yeah, I didn't. I didn't do it sort of slowly because then, you know, where I live is a relatively small community. Um, it's not a big city. So I knew that if that if I was going to do that, there would just be this spreading of the information without me controlling it. So I decided, no, I'm going to send an email actually, in this case, not a letter to everybody.
And I picked the time frame to be 3 months before my closing, which I felt was, you know, way more than the kind of required 30 days, which for a practice closing seems a bit tight. Especially knowing in our area, the finding a new primary care doc wasn't going to be super easy. Yeah, and I think that was, I think that was a good amount of time.
I think it was generous. You know, yes, there was a handful of patients who said it wasn't, but I said, honestly, anything longer than that would not make sense for me. Certainly. Yeah, so I sent out the email and I actually made sure that I touched base with every single person. You know, some people replied, so I knew that they got it, but anybody who didn't reply.
I touch base with each one of them to make sure, did you get the email? Do you have any questions? So that in the end, I had a long list of, well, at that time it was only 300 patients that I could check off. You know, everybody has been informed. And not just with letters like, like you're describing, but also just Messages back and forth in general, that's something I'm grateful for to have in our EMR.
Like it says like patient opened, you know, whatever. And it's so important because like sometimes you'll have patients who are so busy and they forget stuff. And some patients are like, they respond right away. But amongst the spectrum, like if you're trying to get that out, the word having some way where you're not, you know, manually having to contact every single person, even an email CRMs, you can see, you know, what.
Who opened whatever was sent. So just a tip out there if you're looking for that, not necessarily in closing the practice, but just to have in your DPC in general. Now, in terms of looking back, when you, when you talk about how you're the type of person who, you know, every five to six years is like, cool. I, you know, I, I want to do something else or add something else to the plate.
At what point did you start thinking beyond DPC and what are you planning? In terms of, are you still doctoring or are you going to take a break from doctoring for a bit now that you've closed Rogue DPC?
Yes, I'm still going to be doctoring. I'm going to be fully virtual. So I'm, I've decided to do basically full time telemedicine.
And I can get into that a little more here in a minute. Even probably three years ago, I started to do a little bit of telemedicine on the side. Not because I wasn't making enough money with DPC or something like that, but just... Because this particular company interested me because they were doing it with a couple of different facets, using some AI type stuff for, you know, taking a good history and things like that.
And also making the telemedicine mostly text based, chat based, whatever you want to call it, as opposed to phone video. Way before that, I did some telemedicine just for some extra income when I transitioned, and that was mostly phone and video calls. And I felt them kind of to be, I don't know, a little bit laborious and painful and low income.
So this text based part, especially because I've been texting like crazy for years with my DPC patients, and I felt it was wonderful, and they did, intrigued me. So I kind of started part time with that company, and I think that sort of... Was there for a little while and maybe pushed me a little bit to say, hey, I can do this probably more full time.
And I think when I want to talk about why I ended up deciding to close, it's it was never because I didn't like DPC anymore because I think I thought I made the wrong decision. It was basically just a. Oh, twofold. Now I have a full time job with a telemedicine company. I work in shifts. And when I clock out, I clock out, there's a wonderful thing about always being there for your patients and DPC.
But at some point, it's also nice. You know, it's, it's, it can be difficult sometimes where you're always like, oh, you're got another text message, you know, and it wasn't necessarily you. In the middle of the night, but after 6 years, sometimes I was like, uh, it'd be nice to not always be on call, even though it was never near anywhere like burning out or anything like that.
Um, so there's that definitely nice aspect in addition to being part of a kind of cool new technology company in medicine. The other big thing was. Not having a brick and mortar allows me to take my work on the road. I'm born and raised German. My wife's born and raised Northern Irish. We see ourselves spending at least several months a year in Europe to kind of get back there more.
And I can do that with this setup because you can do that from pretty much anywhere. So.
I love it. I ran into a doctor who stopped by the office of the future when, uh, last year, um, there was, I think seven of us were at office of the future of the AFP FMX and we were talking to just, you know, our fellow physicians, medical students, residents, whoever came up about DPC and it was wonderful because people were, you know, really learning what DPC is, how it's different from concierge.
That it can work in any community that you can do it, you know, at any age, if you're 60 and you want to open a DPC, you can still do that. But one of the doctors I spoke with said, you know, I just got back from Italy. Like I was on, you know, I was on the Amalfi coast and like I was working and then I stopped working and then I did my next tour.
And so, you know, that lifestyle, I mean, we worked our butts off to get to where we are and it's, you know, we. We get to decide our futures just like we got to decide whether we wanted to be doctors or not. And so again, I just, I put that out there because I don't believe in the stigma that like if you close a DPC that you are a failure that is like far, far, far from the truth.
So when you talk about travel and you talk about spending time with your wife, you know, I think about also all of the doctors who unfortunately we trained with, you know, who dedicated their entire lives to you. Fever service. They were burned out. They did not know their families. And clearly that's not You know, that's not everybody in fee for service, but the, the people that we were exposed to a couple of them, when they finally retired, they got cancer and died within the first like two years.
And it's like, you know, it's one thing I think about in terms of how, like, you know, my husband, he transitioned to DPC because he was in a place where his role was eliminated to be replaced by a non physician model. And he was, that bandaid was ripped off and he's like, well, I'm doing DPC now. And I'm like, cool.
Like, I wish she would have done this earlier because he's way happier. And you know, just when you are happier, you're also able to evaluate what you want to do with life differently than when you're just like, I just have to survive today. So love that. Now, when you had decided you were going to close and you had told your patients, how else did you prepare your practice in terms of making sure that you could have your files accessible for seven years?
Like how did you prepare to close the practice? I mean, other than making a very long to do list for my first thought was, is there some way I can, first of all, have somebody take over the practice for two reasons, first of all, that would be great for patients to just stay where they are and just meet a new doctor and maybe get a little bit of a financial, you know, gain from having built this thing and, you know, maybe selling it on.
So I looked into all that. Unfortunately, it just didn't work out. Thank you. I actually talked to a colleague and was it Idaho? I think who did the wholesale and for him, it did work out. But the problem for me was. Nobody locally wanted it again. I talked to a couple of people, but they were either scared of the business side, or just didn't want to risk it.
And then I was contacted by 2 colleagues, not local, but from Portland and from California who wanted to consider buying the practice, but not actually practicing there, but having it to hire physicians on because there's certainly physicians out there. I think that are considering the DPC model, but maybe not having their own shop, but maybe working for somebody that has the shop and they can just.
Have a nicer work life, but be either salaried or, you know, some kind of system like that. So these two docs that contacted me were looking into that, and that would have been great. The problem was, where was that doc they were going to hire to actually see my patients? And that just never, that doc just never was found either by me or by them.
So neither of those attempts worked out. And in the end, I just, you know, had to close without kind of the benefit of making a little bit of money from closing the practice. Having my patients have that continuity of just a new doctor outside of that. It was just all the usual stuff. I found a record management company that now has all the records, which is surprisingly not cheap, but at least you don't have to worry about it, you know, because I wasn't going to be sending out records for the next several years.
And then just all the little stuff I had to obviously talk to my building owner partners about, you know, I'm not going to be basically occupying the space anymore. So if you guys want to put somebody in there, and I'm still looking for somebody who might want to lease the space, rent the space. Hasn't happened yet, but that's just another part of it.
Gotcha. And when we talk finances, I want to stop here and ask about how you valued your practice, uh, financially, because some people, you know, when they're talking online about like, Oh, you know, I want to buy a practice. It's a fee for service practice and they're charging this much. How did you come to the numbers of, of like what your practice was worth when you were reaching out to people to potentially sell your practice?
So the first thing I did very early on is actually talk to a professional service that does these kind of valuations and even just starting to talk to them. It sounded very complicated and very expensive. I mean, just paying them for evaluating my practice would have been so much money that I just at that point said, no, thank you.
I talked to this colleague who successfully sold his practice and it almost sounded a bit like. You know, look at your number of patients times your subscription fee. So basically, you're, you're gross income and then minus overhead and then do a certain percentage of that, whether that's 50 percent or 30 percent because there's obviously going to be 2 issues.
One is people are still going to leave, you know, they're like, well, I was going there because of this particular doctor and don't want a new one. So, and I think that's essentially how he did it and therefore came up with an amount that's how I was considering doing it. So, you know, maybe 30 to 50 percent of what that gross income was, but it never really came down to that.
The one actual offer I got that didn't work out because there was no doctor to see my patients. Was way lower than that, which was another thing where I was like, is it worth kind of that stress of there's no doctor yet? I think in the end the main it would have been nice to make a little money off a sale of a practice but the main thing for me was to have my patients taken care of which was why I sent the letter out three months early and With this other scenario, I just wouldn't have had that Reassuring kind of okay patients are you know being taken care of?
And it wasn't worth even getting a little bit of money for the practice for that risk. Gotcha. And in terms of you having the space that you own a seventh of, are you advertising it as a medical space or are you advertising it at all to anybody who would want to come in and On top of that, I'm totally stuck in questions.
Do you have a plan or is there a plan in place at the building for people to help with build out if a renter comes in?
Yeah, so we did advertise in a couple of different ways. Um, and I did, I've, I've shown it twice and then there's still. This was really funny. So pretty much after I closed, I think a colleague that works at one of the big health care system, primary care practices reached out to me and said, I really think about, I want to do DPC.
I'm like, couldn't you have just called 4 months ago? We could have made this a smooth sailing transition. But so, you know, so he may still look at the space. So, you know, Yeah, at this point, we're just looking for, to find somebody to use the space. There is a little bit of wiggle room to, you know, use one or two other rooms that are in the building, but I don't think the other colleagues in the internal medicine practice are currently looking at expanding.
So, but there's also not this desperate need to, to fill it right away. Obviously, you don't want to have unused space if possible, but it is a relatively small space in the whole building. So. Not a huge deal.
And as we talk about that, you and any other doctor who closes a practice like Dr. Donna Gibbons closed her practice and grants pass, I believe a year or two before you did.
And she's loving life. I believe in Wyoming, you know, you guys are not failures. Dr. Erica Bliss closed QLiants and she is not a failure. She's up and running in her own Equinox primary care now in Seattle. So. That aside, when I was prepping for this interview, I had actually Googled, can a DPC fail? And so when we talk about not the physician, but this idea that the practice, can it fail or not?
And when we hear people saying like, Oh, you know, a DPC could fail if, do you think a DPC could fail in the definition of not be a practice that attracts people and grows over time? And if so. What do you think contributes to those factors? I mean, I think like any small business startup, it can fail, and I don't think I've ever met a particular physician that had that, you know, unfortunate thing happen to them.
But I've heard of them, so I know it happens, and it's just logical that it does. I think a lot of it depends on how you're starting. If you're starting from an existing practice, I think chances are better because you have this patient panel to kind of feed from, as opposed to, you know, you're moving into a brand new area, and nobody knows your name, and you're just starting to...
That doesn't mean it's going to fail, but I think the chances are a bit... Higher. So the geography plays a big role, whether you have an existing practice, if DPC is known in the area, right? And of course, a need. So here is very interesting because there's 2 neighboring towns that each have a DPC practice.
But in my, in the town where I was practicing, which is kind of the bigger 1 in this area, there is really not 1. There's a few nurse practitioners that are doing some things that are, I wouldn't call classic DPC. It's more a lot of medical aesthetics mixed in with some primary care. And there's one naturopathic physician, but there's no MDDO in in that town.
So I think there is a need, you know, in my last few months, I got calls probably still weekly, at least for people that were looking for primary care and some, I would say 50 percent of them looking specifically for DPC.
And, you know, this is definitely, uh, I'm jaded because I just did the, I think it was the Columbia River Gorge.
I know it's a different area, but right on Peloton. And it was like, I was thinking that Medford's not a bad place to live, man. It's beautiful. Yeah. So definitely, if you are, you know, at OHSU or if you're somewhere where you're like, I would love to live in Oregon, I love biking, I love being outdoors, I love Oregon as a state, you know, there's a need in a community out in Medford.
So, you know, throughout this whole interview, you've, you've shared how, you know, you don't regret your time in DPC. I want to ask specifically. What would you say to other people if they're asking why was it worth it?
I think it was worth it to me because I did something that was outside of my comfort zone.
And by that I mean not DPC specifically, but just starting my own business, doing all those things that I've never done before. And having that experience is just, you know, it'll always be there for me, um, whatever I plan to do over the next 5, 10, 15 years. And then apart from that, from a medical professional perspective, it was just great to see how much you can actually achieve, do, you know, provide for patients.
If you're just changing up the model a little bit and going out of that, that green that we're unfortunately all kind of, um, accustomed to. So, yeah, it was, it was well worth it.
Love it. And I know you touched on a little bit about what you and your wife are looking forward to going into the future, but if you, you know, if someone is listening and they're five, 10 years into DPC and they're thinking, you know, what, could I see myself retiring from my own DPC and selling the practice, closing the practice, whatever, what advice would you have for those people to think about if they're even considering closing or selling their practice?
Yeah, I mean, I think the selling part, which is great, I think if you have built something, it would be nice to, you know, get a little bit of a financial reward. You want to plan really early. So if closing your practice is a last minute decision, that's going to be tricky unless you're in an area where there's just loads of doctors around just, you know, really wanting to start a DPC practice, which was not the case here.
So planning a sale super early, as early as possible is huge. And then just being really kind to your patients and giving them a good heads up. And as far as the what's next, I don't know that I can answer that because that's going to be so different for everybody. Some people are actually going to retire.
And this was hilarious because so many of my patients are like, well, happy retirement. I'm like, you realize I'm late forties. I'm not retiring. I wish I could. But no, that's not going to happen. So I didn't make such, you know, that amazing of a financial decision throughout my life. So, so yeah, that the what's next is going to be all across the, all these possibilities and my wife's already laughing at me because yes, sure.
I just started this new full time job and I'm working for our company now. So it's kind of cool because I have health insurance again, which. What health insurance health insurance sucks, but this is actually the best health insurance I've ever had. I'm can't believe it It's like low deductible and covering all this stuff.
It's just amazing So that does actually exist apparently, but I'm already kind of I've started to do a little bit of expert witness work you know very Low volume, but I'm already looking at that possibility and then there's, oh, you can collaborate with practices, kind of be medical director for practices.
And now that I have 24 state licenses for my telehealth business, I can do all kinds of stuff all across the US. So, so I guess that's just me, but I think there's a lot of cool stuff happening in medicine. And there's, that's the 1 nice thing about our profession. I think we've never been really tied to just being a practicing doctor in a practice or a hospital.
There's so much cool stuff we can do outside of DPC even, so I hope everybody finds their, their cool niche.
Love it. And speaking to the audience from, you know, taking care of yourself and making sure that you are, you know, present with yourself before taking care of others, what advice would you have to others to make sure that they protect as they open DPC, plan DPC, close DPC, as they just continue being themselves?
Yeah, so try to even if you think in your brain that you love the idea of DPC and that you're pretty confident that you'll have, you know, more free time or personal time, still plan on how you're going to achieve it. Because I think. I've heard people complain or at least mentioned that I'm still so bogged down by either people reaching out by a text message, et cetera.
So you know, there's the big boundary issue that's talked a lot about on all the DPC Facebook groups and stuff like that. So think about it ahead of time. I was very comfortable texting with my patients and I actually enjoyed it and they enjoyed it and I think it was helpful, but for some people that's just not the way to go.
So set boundaries early with every new patient. Even though we're actually existing patients, I had a helpful tip sheet where I were very clearly spelled out, you know, this is how you contact me for this reason at this time, you know, not this way. And so those kinds of things are super important. Make your schedule yours and, and just think about all those things ideally ahead of time, although you can always adjust course.
Amazing. Thank Olsasson for joining us today.
You're welcome.
Next week, look forward to hearing from Dr. Amber Beckenhauer of the Healthy Human DPC in Blair and Ashland, Nebraska, and yours truly, as we have a candid conversation about life, DPC, and what's been going on over the past year at Big Trees MD. If you've enjoyed the podcast, tell someone about it. There are still lots of physicians who have not yet heard about DPC, and you can help change that.
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*Transcript generated by AI so please forgive errors.
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