Episode 57: Dr. Lara Briseño Kenney (She/Her) of Leeton Medical - Leeton, MO

Direct Primary Care Doctor, Hematologist/Oncologist

Dr. Lara Briseño Kenney of Leeton Medical - Leeton, MO

Dr. Lara Briseño Kenney is a board certified Internal Medicine physician with additional specialty training and board certifications in Hematology, Oncology, Hospice and Palliative Care. Her practice is Leeton Medical.

Born and raised on the West Coast, she first moved to the Midwest in 1997 to attend Medical School.

After graduating from the University of Missouri Kansas City School of Medicine, she entered into active duty in the United States Army and completed her Internal Medicine training at Ft. Sam Houston. During her 7 years of Army service she deployed several times in support of the Military Police Corp.

She returned to the University of Kansas City to complete additional years of specialized medical training in Hematology Oncology and met and married her husband. In 2014 they moved back to his hometown of Clinton Missouri, to raise a family.

Patients have described her as smart, down to earth, honest, and practical. She prides herself in taking a true personal interest in caring for each and every patient.

Apart from medicine, her other interests include delicious food, family, fellowship and everything to do with horses.

Dr. Kenney shares how she is able to run a Hematology/Oncology practice driven by the DPC model. She shares how even in her small town her practice continues to be the dream practice she always envisioned!

Resources Mentioned by Dr. Kenney

Live DPC Events:

DPC Alliance Masterminds: Click HERE to register.

Use code MYDPCSTORY for $50 off registration to any of the events!

BOOKS:

- The Official Guide to Opening Your Own Direct Primary Care Practice by Dr. Doug Farrago.

- Sparks Start Fires: A Guide for Dreamers Who Are Also Doctors by Dr. Julie Gunther

- Direct Primary Care: The Cure To Our Broken Healthcare System by Dr. Paul Thomas

WEBSITES/ONLINE COMMUNITIES:

- The Direct Specialty Care Alliance

- The FB Groups "Specialists for direct care" and "Direct Specialty Care Alliance

CONTACT:

Leetonmedical.com

Facebook

Leeton Medical in pictures

Dr. Kenney's clinic in Leeton, MO. She purchased the home (see HERE for the original Zillow listing) for around 19K in the foreclosure sale.She has done creative things with her space including turning a walk in closet into an exam room. It is a renovation she continues work on and, as mentioned in her interview, she has a beautifully painted blue door and the shutters she made one clinic day... because she can.

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TRANSCRIPT*

Welcome to the podcast,

Dr. Kenny,

I am happy to be here.

You are from the west coast originally, and then you ended up in the Midwest going to medical school.

So I definitely could relate to that journey is my journey out to the Midwest was for the same reason to go to Creighton. So can you tell us how that will happen? That you went from the west coast to the middle.

Sure. Did your family think you were crazy too? Yeah, so actually

my parents were like, there's nowhere else.

You can go. You must go to Creighton because Laura Freberg, she was one of the administrative assistants when they went out to Omaha and they checked out Creighton to see, you know, what is this Creighton business about? Why are we paying so much for her to go to school here? They were completely lost in the hallway and Laura Freberg walked up to them and she was like you look lost.

Can I help you? And so when they got a taste of that Midwestern, oh yeah. Yup. And so they were like, yep, you're going to Creighton period.

deal done. Take care of my baby. You're going to green. Yeah. Yeah. I um, I was born and raised in California and then we moved to Oregon.

And I knew from a very early age, I wanted to be a doctor. I don't really remember ever wanting to be anything else, honestly. And so when I was in high school, like many of us, I was overachiever, straight A's, all of that stuff. And I applied to a number of programs that had guaranteed and I pretty much had my heart going to write with a guarantee to Baylor.

Because similarly, when we went to visit, it was like awesome experience. And I really liked Texas And I really thought that's what I was going to do. And then my. I was on a flight to Alaska for one of his hunting, fishing trips. I don't know what, and in the back seat pocket of the airplane that he was sitting on, he found the brochure for the university of Missouri, Kansas city six year program.

And he brought it home from that trip. And he said, you know, I think you should apply to this. It's only six years. It's direct. You don't have to worry about getting into medical school. You don't have to worry about all the strings attached and everything. And gosh, if I remember it was like days before the deadline, I scratched it out.

I didn't even type it. And you know, all the other, other applications have great attention to detail and proofreading and typing my mom typed them up and all of these things that would, I just got down something on paper and got it in before it was due. And the brochure said something about only accepting 10 out of state a year.

I don't know something small. And I thought whatever. And then a couple months later I got a packet saying that they wanted to interview me. And I flew out with my mom to Kansas city. Having never been farther east than probably New Mexico, maybe. Both sides of my family are from California.

Everybody I know lives in California. So my mom and I fly into Kansas city similar experience. Everybody's super nice. They pick us up from the airport. Everybody's just salt of the earth. And we got to the interviews and everybody had their parents with them. Cause we were all, 17, 18 year old kids and my mom.

Very I'd assume, you know, my whole family knew none of us there. We're all pretty like humble working class and everybody else was from out of state as well. And they all had both parents with them and they were super assertive. And like my kid, this, my kid that my mom didn't say a word. I was just kinda like, all right, whatever.

I mean, They had like full business suits on, I think I was in a turtleneck and a pair of black jeans. If I remember correctly, totally differently. And I just, went through the thing, did my interview. I told my mom, I thought that it was a good interview, came home and I got offered the spot and none of them did.

So I guess it was meant to be. But that's how I ended up in the Midwest. I came out for medical school. There's no other reason for me to come out here and then now I live here, but that's another

it's amazing how things happen for a reason.

And, the idea of us Californians moving anywhere else. I still think about wow, like I never would have expected to leave California for any reason. And then, the heart of the Midwest is truly like I if I could choose a second place where I didn't care, if I had blood family or not, I would move to superior Nebraska or Blair Nebraska I've promised.

And I go back

to Texas, but my husband's absolutely not. And COVID, it's pretty much sealed the deal on one, for sure. For sure. I love food.

Does the medical school still offer a six-year program?

Yeah. They've restructured the curriculum a little bit.

I think so when I was in the program and they accepted about a hundred a year that, plus, or minus a dozen or so they're chartered like the way they were able to get funding for an additional medical school in the state was they really had to focus on in-state students. And they're supposed to deliver like a certain amount of primary care to rural Missouri.

So that was why they limited the out-of-state students rather severely. And the, we did our first year, our second year, and then when we were going into our third year they offered the spots for the attrition, we'd lost like a dozen people or so. And they filled some of those spots with traditional students, but usually it was like two, three, it wasn't, it really wasn't enough to change the character of the experience.

I went back there for fellowship when it had changed quite a bit. It's much more of a mix of some six year and more traditional students. They've pivoted some for whatever reason, but,

I'm glad you mentioned that though, because especially if there's somebody who knows a person that is looking to apply to medical school, to mention that as an option is really, yeah.

It was really a good thing because, had I ever heard of Creighton university? Heck no. Before, before my friend told me, Hey, they, for me, they have a post-bac program. So that's how I ended up at Now you are an internal medicine doctor by training and then did fellowship in hematology, oncology.

So I want to ask when you were in training and when you were in residency, when you did your fellowship, what was that life like for.

So part of the thing that was unique, give it up steer for program. I think there's a few other in the country that they all do their own thing at the time that I was at young Casey, the emphasis was on a heavy clinical.

So we started clinicals our first year. So we had clinicals for six years and very heavy in internal medicine. So every single year I had two months of inpatient internal medicine, and then we had a continuity clinic with a one day a week clinic with the same doctor for that whole time we had, we were set up in like small teams.

So when I graduated, I was on an army scholarship actually. And I went straight into active duty in the army. I moved to San Antonio, Texas, and that's actually where I did my internal medicine residency. I was fortunate that I had excellent internal medicine, clinical experience as a student, I would say more than many of my peers.

I was essentially already functioning as the intern by the last two years of medical school, because that's just the way the program was set up like the hierarchy. And so when I went into insurance ship, I felt quite comfortable. And then in addition it was it's the biggest hospital in the army with the highest acuity level.

So I got really stellar drain I think really second to none. I feel like I got an amazing internal medicine background, especially for inpatient, tons of procedures, lots of high-acuity, lots of critical care. Lots of autonomy, that was before some of the workout restrictions. So we were like the only people in the hospital, a fair amount of time which is priceless, honestly, when you're training.

And then on top of that the war was going on by then in Afghanistan and Iraq. So we were also getting additional training because we were, we knew we were probably going to be somewhere by ourselves having to do things that were at the edge of our scope of practice or completely outside of it.

Morning reports included like expedient just to them sessions and things that typical internal medicine programs don't have to do. So I, I feel like I got a really excellent training luckily,

again really. Points to bring up, especially like for myself, I went to an unopposed family medicine residency, where similar to your experience, definitely nothing is as intense as yours But the idea that the family medicine doctor is the only doctor to do XYZ or to see XYZ. I definitely encourage people if they're early on in their medical school training or if they're, thinking about what am I going to do after if you like Fullscope care, definitely look for an unopposed program or, talk to residents about the scope of practice that they get.

Because I remember at one hospital I was at, it was an opposed hospital where the internal medicine doctors and the family medicine doctors got the bottom of the barrel when it came to pathology, like the basic things that we would see in clinic rather than things that would actually be challenging because those went to all the specialists.

So that's really great that you had that training and that exposure to autonomy. I want to go there because. Now you're a direct care physician. And so when you were doing your internal medicine training, and then you did fellowship, did you maintain autonomy when you did fellowship?

So I finished my internal medicine residency, and then I continued on active duty for former years. I deployed twice during that time. So I was in a situation where again, I was autonomy. I mean, I was in chain of command, but I was often the only position. And so that really shaped how I practice both ways.

I think, luckily I was prepared to practice that way, because that was my background. I had been fortunate that I had all that clinical experience in medical school. And we were given a lot of autonomy as students. And then again, in, in internship and residency, and then in my professional career as an internal medicine doctor.

So I spent two and a half years of those four, essentially oversee that's a lot. Autonomy and medically, there was no one else to tell me what's the weather I was doing it right. Or whatnot. And then when I was stateside, I was staff and teaching hospital and not for me, so right. I was very comfortable with that.

I got out and I went back to the university of Missouri to do my fellowship. And I had a fair amount of her time with this fall fellowship program. The director knew me since I was a student. In fact, she was one of the first inpatient rotations I ever did. That's when I fell in love with among cology I'll all those years ago and it was coming back to it.

And I think she'd always thought pretty highly of, I think she respected names. It was weird cause I was, I was certainly learning hemo, but I'd already been in Italian internal medicine

and Laura, you mentioned that you fell in love with hematology. And so you know that when those little bits of our history leak out and we fall in love with things so hard. Like for me, it's family medicine and for you. hematology. When you said that, what did you find in your training that made you fall in love with hematology?

I mean,

I really like internal medicine to be honest. I probably could have gone into any of the subspecialties in child life and I'm perfectly happy. Typical to the stereotype, I just nerd out on that stuff.

It's so fascinating, the physiology, the pathology, but hematology, oncology, and really the oncology part of it. What spoke to me was the interpersonal skills necessary to do that? Not all hematologists oncologists have those interpersonal skills, but that was a strength of mine and something that it was part of how I was raised, talking about difficult subjects then and whatnot.

And so spoke to me and that really fulfilled my sense of purpose to be able to offer that to people at such a difficult time in their lives that I could be the one to deliver that news in hopefully a way that was appropriate. And, And, you know, when you're a student and then subsequently a fellow or resident fellow there's a hierarchy in medicine, and so oftentimes I would be in the room with people who didn't feel comfortable with those things And I'd watch them stumble through these conversations. And just, there was just terrible, so frustrating because I was just watching the whole thing fall apart and I wanted to just shove them out of the way and say here, listen, let me tell you.

Um, Cause um, but I couldn't write because I was junior on the team. And so anyways, I just fell in love with it and I know it sounds more fun, but it's not it's just fascinating to me as like a fo you know, like, we're all gonna die and it's inescapable, but it's just, I don't know. There's just something about that really connects with me and really gets me going as far as the interest in reading.

I don't know if I'd gone into anything else, if I'd be like self motivated to read on it, the way I am on hematology and oncology and in hospice, palliative care, it all goes together. That didn't really exist when I was in training. If it had, I very well might have ended up in that rather than hem-onc but I have both the best of both worlds because I have a hospice palliative care approach and I also get to back a few months.

So it's really, that's what I was meant to do.

it's so lovely. And when you were done with your last year in fellowship, when you were deciding, okay, this is clearly my passion. Did you open up your direct care doors at that point

I'd never heard of direct care till about three years ago, to be honest. I was actually pregnant with my first child like very pregnant when I graduated fellowship in that June or July, he was born in August. I'd already taken an offer from a very large corporate health care system that I won't mention their name, but lots of people work for them going across this country.

They offered me a really nice salary for two day a week. Part-time in my husband's hometown, which is where we live now is the small town of about 9,000 people. And I, that's what I wanted to do. I wanted to be like the only doctor, small town community, close medical staff. The, I could walk down the hall and talk to the radiologist or the surgeon.

I could run into my patients in the grocery store produce section or at soccer games or whatever. And so I took that job and I was, I'm actually pretty happy with it. I had a really nice mix of the support from the community, but I was just far enough away from the actual corporation that I had a lot of the times.

I was under the radar and I liked it that way. And I really had a chance. Those ended up working there for four and a half years for the first three and a half ish years. We really built, like I, we built the clinic, like we were seeing patients in empty inpatient rooms when I started.

And by the time I left, we had a full treatment center infusion. We had gotten it staffed up with the appropriate, like social work and chemotherapy pharmacists and things that I thought were critical to delivering really good care. I really felt passionate and I still do so. It's interesting that it's led me to this place of DPC.

I really felt passionate that people deserve to have the best of care without having to drive to Kansas city and that they deserve someone who was honest and had enough integrity that if I couldn't offer that, I could tell them where they needed to go. But if they were going to get the same thing there, that we would be giving them, in their hometown that I could offer them the ability to, stay near their friends, their family, the community that they knew.

And I think we were achieving that. I really, I wasn't unhappy to be honest. And then couple of things happened, the proverbial EMR change occurred. So the electronic medical record was switched over and I had actually had a fair amount of input against what they ended up switching over to I, I don't want to speak out of term, but I think I was one of the, I probably had worked the most number of places of the doctors there.

I done a lot of locums. I'd been all over with the army. So I was pretty familiar with the different systems that were on the market at that point. And I didn't agree with what they chose. And in my opinion, I'm right, because everything changed after that. That was the first blow I was there till, nine o'clock at night, 10 o'clock at night fighting with this system, weekends, trying to write notes that erased.

And I really got to my width with that, that, that really took some joy out. And then somewhere in that timeframe as well there were some administrative changes that took place basically behind my back. Frankly and I just had this seminal moment where I realized that I wasn't doing what I thought I was doing, or I was, but it wasn't ever going to build what I intended to build because it was my thing and they didn't care about me, like that wasn't their thing.

And that was the, that was a big turning point. That was the attorney. And that's what I found out about direct primary care. I had never heard of it before that

it's just, it's heartbreaking to hear that though, because, you know, when you talk about your love for hematology oncology and the fact that you could be an interpersonal doctor and be able to talk with your patients about extremely serious and in a lot of cases end of life care that you were in this situation where, the surroundings, the EMR, the administration, wasn't supporting your future dream, so to speak.

So when you say that you learned about direct primary care, how did you come to learn about the movement?

So this is all happening. And I don't think I'd even put my resignation in. I was really just trying to figure out what to do. So the downside to moving to a small rural area is that you've moved to a small rural area.

There is no other hospital in town. And it's my husband's hometown. Like his whole family's here. So to quit that job, I'm not, that would, that was going to be a huge upheaval. And I was really um,

That's the word empty. Like, I was just really miserable to be honest, because I knew I couldn't do what I was doing, but I didn't know. I didn't know what else I could. I didn't know what other option I could find or what was doable. And then on top of that, as I think most doctors relate to, I had all of the guilt of like, how could I leave my patients?

These are people that literally trust me with their life. Some of them are in the middle of treatment. Some of them just found out that they had cancer. Some of them just found out they'd come back and that's a pretty heavy weight to carry. So I was trying to figure out how to get myself out of this situation.

And there's actually a friend of mine from medical school. We were in the army together and I saw on Facebook of all things that she'd opened her practice. And I called her up. We talked to each other once, every couple of years maybe. And I called her up and I said, her name's Andrea. She knows.

I said, Andrea, like I saw you opened a practice. Like what the heck? I mean, Nobody opens practices. That's unheard of right. Everybody sold out at the time. And she goes, oh yeah, there's this thing it's called direct primary care. I went she's family practice. So that's why she knew about it. You guys are ahead of us as far as that, because you were having lectures with some of your conferences and stuff.

And so she had attended one of these and it was a light bulb moment for her. And she came back to her hometown and did what she needed to do and opened up. And so she's the one that told me about that. And it was on my way home from work, I was, crying. I was upset. I called her, she told me this and it was like, the more I heard about it, I stopped.

I stopped on the road to hear the rest of it. It was where I lost my cell phone. The more I heard about it, I was like, no, this is that's exactly what I want to do. And she had the same medical school background as me. We went to, we were classmates and the same arm, essentially our army background, although she was family practice and I was internal medicine.

So I, as she's telling me these things, I'm like, wait, that's what I was already doing in the army. We just spent, we've got our own aid patients. We ordered the supplies, we keep an inventory. We dispense, I mean that's right up easy. And she's yeah, you can totally do the systems exactly what we were doing.

Trust me, you can do there. And that was in the fall of 2018, like around the holidays and I incorporated in January.

Once you had heard about the model and when you were, you said you hadn't left your job yet, what was your exit strategy?

So I think I'd already resigned. I didn't really have a plan yet.

I just knew I couldn't, I was really just profoundly unhappy at that point. I'm not good at like sugarcoating things. Maybe that's why I'm a good oncologist. And I'm not going to keep my mouth shut. So once I realized that was then an tenable situation, I had to leave.

I'm not the kind of person that can just put their head down and do their job. That's not me. So I had resigned already. I think at the time I talked to Andrea or right. There's about and so then I, this was like a light at the end of the tunnel for me, honestly.

I was in a pretty dark place. I didn't, I was like, what am I going to do? This is the only thing I've ever wanted to do in my life is be a doctor. And, I wanted to practice like this. I wanted to be in a small town. I was doing it. And my patients are relying on me. My community trusts me and I find out I can't trust the people around me essentially.

So anyway so I just, I saw this light, literally, it was like, okay there's a crack, if I can sneak through it. And I just, I threw myself into that. I went and visited the practice, I think within probably a week or two. I got on the internet, the power of Google. Cause like I said, I'd never even heard of DPC, so it was pure ignorance and I ordered dying Farrago or progress.

I'm sorry, I don't know how you spell his name, his book there, you know, that DPC manual. I read it and gosh, I don't even know. Not even a half a day probably gave it to my husband and he gave it to my father-in-law read. Cause part of why he retired when he did is cause this really kind of thing starting to happen and he was disillusioned as well.

And I just knew I had to figure out a way to do it. I didn't know how I was going to, but I knew I had to, I filed my incorporation papers. I, you know, I just really, there was no other way, honestly. I mean there just wasn't I did end up taking a job for another corporate health care system in the county, just to our north um, which is a little bit of a farther commute, but still in our area.

I was profoundly unhappy there. I didn't even make it a year before I resigned. But by then I had already started my DPC. I had a small panel. I had my office functional. It was, I won't say it looked great, but was functional. And I had a lifeline or I would tell people at the time and I still feel this way more.

So with everything that's happened with COVID I told people I'm building an art like this, the ship is going down. I have zero doubts about that. I think most of us feel that way. It's just, it's sad, but it's we're watching it fall apart before. Like the Titanic. And and I just said, I don't know how I can fix that, but I'm going to get off and I'm taking my family with me and my patient.

And that's all I can do is say that group of people that's my arc and then everybody else, unfortunately going to have to figure it out. And a lot of people are going to drown in the process badly.

It's an interesting, comparison your practice as an arc, because I think it really goes back to how, when people think about when they leave a practice, especially if it's a large practice to open a DPC.

At the end of the day I can't save everybody, but really? Yeah, absolutely. We all do. I'm sure, but the idea that like, I need to recenter and do what's right for me. And what's right for the patients who believe in the same vision and the same dream and the same arc.

And I think that when people remind themselves of that the question of the questions of, what should my pricing be? I should lower my prices or, maybe I should make this wheel and deal, offer for my patients. I challenge people to take a step back and think about, the space of you.

You really cannot take care of everybody unless you are taking care of yourself

I think one of the status, one of the most tragic things about the whole current healthcare system is that the more conscientious you are, the more integrity you have, the more you're in it for what I would consider the right reasons.

The more miserable you are and the faster you burn out, unless you can ignore all the duplicity going around, about you and the corners being cut and the dishonesty from those corporations, with the patients, not from you necessarily personally, but everyone around you from dishonest billing practices to misleading advertising.

I I mean, All of those things if you're the kind of person that can't stomach that you leave. I mean, and, And a lot of people are leaving medicine. Because they're just, they're done with it. They just, they can't find their happiness in it anymore. They feel gross.

They feel like they're part of the problem. They're disillusioned, they're suicidal. I think that's the tragedy because unfortunately, what will then happen is more people are in it for the wrong reason or who are willing to compromise will stay and you're going to self-select.

And so you're going to have these big cattle production, factories of healthcare with people who are don't care or under-trained, or maybe they used to care and there's dead inside now, but that's not who I want taking care of me and my family. And so I felt like I'm getting off the ship. I, it's that, I'm that I'm getting for myself and that's not going to help anybody.

And I'm not going to risk my family. Like, I'm not going to do this again. That, that first experience, I'm not doing this again. We're not going to go from job to job, trying to find the proverbial utopia that no longer exists. So I just felt like you gotta do this yourself or forget about it.

Yeah, no. When you were mentioning you had your DPC open and you were also working for the company and the Northern part of the county had you opted out of Medicare or were you still opted in at that point?

No, I'm still opted in now, actually. So I um, when I negotiated that contract with them, I included an addendum of the current employment Which included my locums, because some contracts try to tell you, you have to ask permission, to take their jobs. Then I don't look kindly on that. I think it's none of their business since it's my life and in my education. So I had included my locums company that I'd worked with for decades.

I included the hospice agency that I was a medical director and I included my own corporation, my own LLC that I had already founded, but the address was my now shuttered house. And they didn't, I don't think they paid attention. It was not six months into that job that I got another panicky call from the medical director that they'd found my website and the lawyers were going to be calling me.

And I was like I'm pretty sure it's in my contract actually. And I never heard anything else after that um, until I resigned but I did not opt out and I'm still not opted out because that's probably a personality thing. I've always been one of these people. I don't ever have one plan, I've got my name plan B Campsie, lots of fallback plan.

And I really enjoy doing locums and I wasn't willing to give that out as an option. And frankly at the time I had not envisioned yet that this could be for a specialty model. So I was so unhappy that I was willing to give up hematology, oncology, essentially, except for possibly doing some locum.

And just go back to practice internal medicine because. I thought that was the only way, this is what I had stumbled upon. This was the light. And if I didn't do that, then I lived there and have that options.

Wow. Just after hearing, what you had been through and what love you found in hematology, oncology.

It's so sad to hear that, I want shift to, the entrepreneurial side of your journey now, and when you mentioned that your house was shuttered. So can you clarify that because your house actually has shutters on it shell because you made your own shutters recently.

So can you tell us about your clinic space and about what you are doing now as a specialist in direct care?

Sure. So my clinic space is a journey, so I decided I went back and forth. I'd worked at the town, just ourselves. That was that first job I was coming out of the town, just to our north. I had patients from that whole catchment area that I wanted to be able to find me and come to me.

So I settled on this little tiny town between the two, essentially it's 500 people. It has a gas station about it. And there was a house that's the gas station that had been in foreclosure for goodness knows how long. My small children kindly referred to it as the broken house. Mom's broken house.

I bought it. It was actually, ironically, I think this is another one of those meant to be, it was a VA loan, foreclosure. So I, anyways, so I negotiate with the VA. I bought it for a fairly small amount of cash and it was pretty broken. I was pretty terrible looking. Nobody had done anything inside or outside for probably years.

You could barely see the house because of the brush grown up around it. The inside was not much better. I think it had been a rental probably for some time before the foreclosure. So it was a pretty rough condition. And what I did was I chose to pay for everything as I went. So I remodeled the inside half of the front half of the house first, because that's what I could afford to do.

I didn't touch the outside, except for we had a weekend cleanup where we cut down the brush. And I left the there's a back two bedrooms to the house. I just left that. I still haven't gotten back to that. But it was really cool because a former patient of mine had the floor refinishing business units and refinished the floors.

They're beautiful. Another patient of mine has a window glass repair business. He repaired the old wood sash windows, like in the old homes, the songs probably from like the forties or fifties he repaired the glass for me that was broken out, put new storm windows on. Another patient of mine did the painting inside, repainted the walls for many.

I'm a daughter of a patient of mine. Who's the patient since deceased in cancer. His daughter's a illustrator. She painted a mural for me. It's really a labor of love. I Everywhere I look, part of it comes from somebody. There's been a part of my life as a patient or a loved one of a patient.

But the outside still looks pretty darn bad. So because I chose to ignore that wasn't material to being able to be open and see people. And that's probably my personality anyways, I'm pretty pragmatic. So I just was like we'll get to when we get to it, first thing is we gotta get this done so we can be open.

Just recently my medical assistant, who's amazing painted the door for me, blue, which like drastically improved the look of the house by itself. And then this past week I went and bought some fence boards from Lowe's and screwed them together in my garage after work. And then national day Wednesday morning I didn't have any patients scheduled.

It's just how it worked out. I was open. And so I took my ladder in my pickup truck down to my broken house and my power screwdriver and I, it was in my scrubs, my scope gap, and I hung them up while all of the gentleman driving to the gas station to fill up their trucks were leering, trying to figure out what the heck I was doing.

I got him up and it looks really cool and it doesn't really look like a broken house anymore. So I was pretty proud

of myself. That's awesome. And I'll make sure to include a picture of your shutters and your blog post, because I should

send you a picture of what it looked like before.

Definitely.

I'm sitting thinking because you can like you widget just made shutters because you can, so that's amazing. And when you talk about all of these people who helped contribute to your broken house, not being, not so broken anymore and beautifying the inside and making it functional for your clinic space, did you barter with these people or were you able to did they just offer their services

a little bit of everything, to be honest.

I got most of my equipment from my family practice doctor who started his doors. I'm after being the only doctor in his town for a number of decades. Everybody was just happy to do it, honestly. I think they felt what I sell. I think they saw the possibility and they saw my intention, intention is so important.

And I think it was so obvious what my intention was and I think, and because of that, thankfully, so many people were willing to just get behind that because it was the right thing to do. It was. It still is. I it's just cool. It's neat to have that, people it's really a community, a family it's not just a business.

It's not just, pushing papers or counting, being counting RBU's nonmedical. People won't know what those are, but I think if the average public understood that their new cancer diagnosis was worth 2.5 RBU's, on piece of paper, somewhere in the manager's office, they'd be pretty disgusted by.

Yeah. And just to throw just a tidbit out, because if there are patients listening who aren't familiar, RVU stands for relative value unit. And so for all of the care that an insurance compensated doctor is giving, or is delivering every bit of care is is assigned the still down. Yeah. A certain number and those numbers equate to number of dollars that the typically the corporation gets compensated for for the doctor's work.

It just it's so reminiscent Dr. Hailey Miller, who was previously on the podcast, who is probably, drooling because of your bartering. But she had mentioned the upsell when, whenever we, do a Medicare wellness, physical, and then, we talk about, a skin.

Skin spot or something it's upselling, it's more codes, more RV use and more billing. Well, and you know,

I don't think patients realize that we're not really directly responsible for the terrible billing that they get. But in some ways we are, because when you're a part of the system and you are doing that right.

Because our employment's based on frankly, to some degree. And so you're trying to capture all of that. When you code that level five visit, you don't necessarily think about the fact that you just pass that person the extra $200 or whatever, because it's monopoly money. What's an RVU, that's not an actual dollar amount, but I find it pretty disgusting that I could spend like an hour telling someone that they have incurable cancer, talking them through what that means, talking to them about their goals in life, talking about how long they have calling their daughter to tell them the news, because they can't, you know, I often offer to do that for them if they want, because it's such a heavy, thing to carry staying after work to call people, to give them results of a scan that shows their cancer's back.

And to think that hour spent with that family holding their hand is worse than our, a 2.5 RVU or whatever it was like, I just, I'm not, I can't get right with that. It just feels dirty. Yeah. Yeah.

and this is why when I heard about direct primary care myself, and I don't know if it was similar for you, it was like, wait a minute.

So you literally. I can give care to people like what we went to medical school for. There's no, I have what

I wanted to be when I grew up. Yeah. I didn't want to get reports on my RBU's. And I don't think people realize that like I go into the off, both employment places I go into the office, they've got charts with your names, posted with the doctor's showing who's producing more and becomes like a video game.

And I think I've seen it happen in multiple colleagues where I did CA I did think they were doing a good job initially. And then several years then they've just, they bought into the video game and they're so busy racking up the, the Mario coin. And they're proud of it. They're like I had been the top producer for the last year or six months, and I'm thinking who the hell cares?

That side, how does not opting out of Medicare play a role at Leeton medical?

Because I had been in this community for, by then five plus years I chose to stay opted in from my locums, but because of the connection I had with patients who had followed me already to multiple practices I chose to accept Medicare because if I excluded it altogether from my practice, that meant excluding some people that I'd been a pretty big part of my life and their lives for years at this point.

And I didn't feel right doing that. So I do bill Medicare. That's the only the only payer I bill and it's really just out of practicality. I can see how it'd be easier to be opted out. And I would love to do that, but it's just not feasible with the way things are set up right now.

And especially, I just can imagine, like you're a hematologist oncologist and that, that is, adult medicine with

people elderly.

Yeah. I would see it really challenging. And I appreciate you sharing that just because, if as the direct specialty care movement is growing. If there's a person who's internal medicine or hematology, oncology listening, and they're like how would I do that? I love when people share these details about like, how it's actually possible.

And so when you have patients who are billed under Medicare does everybody, who's a Medicare beneficiary use their how do I work that

on a

ground level? Yeah.

So all of their visits are billed to Medicare, right? So the, the actual medical visits, medical services are built and out of Medicare including home visits, I do home visits.

So if I have a debilitated or elderly patient, which I have quite a few, I'm the, all I go to their home and I bill Medicare for that home visit. And I just have a biller that I have to do it cause it's easier. Although it's on my short list to learn how to do it myself, because I hear it's really easy and I like doing things myself, but that's how I do the medical visits.

And then for any like ancillary things I leave it up to them. So most of the time we use their Medicare and that's nice. I can send them well, we county hospital just up the road and we don't have to worry about the inflated ridiculous prices because they're Medicare patients. They don't need a prior auth, they're able to get the services they need and that, that works really well for them.

And it makes my life a little more convenient. If they need little things like oh gosh, if they come into a vital signs check or they send me their blood pressure numbers for the last two weeks, they email them to me or texted to me or whatever. I don't bother capturing those charges, frankly.

It's just not worth it to me to nickel and dime it. It's more work on my part. And it just doesn't ever feel right. I mean, I just feel like that's continuity of care. Same with, especially with COVID, lots of people have been hesitant to go into the bigger centers for things like lab draws and stuff that they wouldn't have thought twice about.

For COVID the way I, that it was, if you want to use your Medicare, I'll send the orders to the hospital because this wasn't worth me dealing with it. Um, But if you want to not use your Medicare and pay the $2 for the CDC, because it's just easier than that's fine, but I w I didn't want to be in the middle of that.

I've been a little more lenient with COVID because understandably, I don't want my patients sitting in those waiting rooms either. It's unnecessary. So I've allowed them to go Medicare occasionally, and I just submit it through the lab or whatnot. It's worked out pretty good. The way that I see that it would be wonderful to be able to opt out of Medicare is it'd be even better than it already is.

So I think it's working pretty well and I'm happy with it. I think the patients are happy with it, but if I could opt out of Medicare I think it'd actually be cheaper for them in the long run than the copays and things that they're paying right now. It would certainly be cheaper for the system because I can do all their care for pennies on the dollar, what they're getting.

And my life would be simpler. Cause I wouldn't even have to walk this line. I could just say, a hundred dollars a month and includes everything. I can just be done with it. And that's really tempting, but I high school, I'm doing locums. I still do locum multiple times a year and I like it.

So I don't know.

Can you share for the listeners, what is your pricing breakdown like?

Sure. I just redid it actually. So I have the same DPC, monthly membership price I have when I opened, I said $50. For context I'm in the middle of rural Missouri, cost of living is pretty low. And I had a target audience.

I particularly enjoy caring for the honorary old cattle farmers and blue collar hardworking people that's who I enjoy serving the most. And I didn't want to discourage them from coming to my house. and, And money's tight for a lot of people and that's even before COVID, I that's a fairly decent commitment for someone who's on a tight house, full budget.

So I really picked that price because I thought it didn't sound like too much. I didn't think I thought it would be a price that people could digest. I didn't use, I should use Josh numbers algorithm that I'd probably be doing a lot better, but I think if I had my price would be higher and that wouldn't come out somewhere between 75 and a hundred.

And I just, I think that would have changed my demographic. And I'm pretty happy with the patient panel I have right now. So that price is still the same. I do charge a enrollment fee. I call it a window knocker fee and I explain it to the patients that way. Look, I hate to have to do this, but if I don't, you're going to get everybody in here, just to see what it's all about.

And I put a lot of effort into those first couple of appointments as I'm sure we all do. Hours and hours of sorting through a terribly disorganized, electronic medical record charts, trying to figure out if people even have the diagnosis that Facebook they have or whatnot. So that one 50 is that cover that, that time put in and it's still, that's still a pretty conservative amount.

I don't feel bad. And then I just restructured it. So I had patients that followed me. I had cancer patients who followed me to what is now my third practice. Hopefully my last and I didn't want to deal with the duplicate practice team. So initially I just price it the same, which for specialists out there that probably think I'm insane, but they were paying $50 a month for comprehensive oncology care.

And I was fine with that. I love these people, so I don't mind, but as I pivoted and continue to pivot where I really have, I've done enough of the direct primary care now that I feel I can see the possibilities for direct specialty care. I couldn't initially, as we talked about. I've just restructured the ICU and now I'm charging 150 to book the consult, which is also functioning as a no-show fee.

Cause that happens fairly often. And then 150 at the time of the appointment. So I bet it's basically a total of $300 for a new consult. I thought that was a fair price to me because frankly, 150 for a full hematology, oncology consult, isn't really reasonable. But the reason that I broke it up like that is because out of respect for people who are working paycheck to paycheck with the household budget, coming up with $300 on the spot, that's a pretty big.

But if they pay 150 and then they can choose when to book their appointment. So if they know that the next page, they got to wait till the next paycheck for a pay cycle for that next 150 it's respectful of that they can do that. They can call, get the consult and put the ones 50 down to, for the consult.

And then they know full well that the appointment is going to cost one 50 so they can plan around that. I thought that made it fair to both of us. And then I'm right now doing a hundred dollars a month and the way I've, I don't know. I think I'll stay with this. It seems to be working, but the way I've had it set up is that first $300.

And then at the end of that appointment, when I have a handle on what kind of care they're going to need long-term or otherwise we agree whether they're going to need a membership to be seen multiple times in the year, or if it's a one-off and then we're good at that 300. Cause sometimes it is, their primary care doctors.

Then for something that I'm not worried about. And I say, Hey, you don't need these things for this again. Or if it's something where it's very clear that it really only needs to be seen once or twice a year, it doesn't really require like close. Then I am going to just treat them more like fee for service.

I'm just gonna charge them 150 at their subsequent appointment. But I didn't think it would be fair for that, that once a year, platelet. To cost them $100 a month. That just didn't make sense. So that's how I figured it out so far. And I'm happy with that at this point.

And since you opened fleet and medical, is this the first time you've restructured your pricing?

Yeah. And when you were at that point of developing this new price scale, what was it that made you say, okay, this is actually something that I need to reassess, and this is something that I need to actively change. So as

people are starting to realize that they can come see me for hematology oncology.

So initially, so patients that I've had have followed me to this third practice, which is amazing. I need I really appreciate that, that loyalty, but as I'm fielding more new consults now people are starting to ask to see me and fed, their primary care doctors putting in just the run of the mill system console.

And they're saying Hey, can I go see Dr. Kenny? My sisters saw her and she's great, or whatever the case might be. And as I'm getting consults just from some primary care doctors to realize that maybe I'm a better fit for that patient than the other options in town. I just needed something that made more sense.

It just doesn't make sense for $50 a month to take care of someone who's on chemotherapy. And I'm seeing them once a week. That's just. That's not fair to anybody. It's not fair to my regular patients, my maybe BC patients that are paying $50 a month. So I tried to split the difference much like I did with the $50.

And I

tried to follow Josh's algorithm. But in fairness that if I followed that they'd be charging like somewhere around $200 a month. And I just, I don't think that I just don't think that's fair. I want to qualify that because this comes up with the doctors a lot and maybe more so in the specialty, as you might imagine, there's a lot of this but I'm worth it, but I but I'm, hematology, oncology, they should be paying me $500 a consult and yeah, I get it.

Shoot, I have four boards. There's certifications. That's a lot of money, but but that's not how it, that's not life though. That's just not how it works. I, I can sit there and say, do you know what I've done? I have all this experience. You should be paying E $400 a month.

You can't find anybody like me and, turn your mouth. Nobody cares the cattle farm doesn't care about that. And nobody's going to pay me $400 a month. Even though that makes a lot more business, then I think a hundred dollars makes more sense just for the community and everything.

And I don't know, my husband will disagree with this, but my way of thinking about this and the whole point of this is that I should be able to feed my family and. A reasonably secure lifestyle. I, I worked for it, but I don't need to be rich. I don't need to be making a million dollars a year.

That's, nobody really does. That's really not a reasonable expectation. And if you're going to chase that then yeah. You're probably going to be in the system racking up argues because that's what that's about. And that's not what I'm about.

So when you talk about this this idea of living a comfortable life, you don't have to make a million dollars a year. I want to bring up, and this is the list that you had sent me. So this is how I know it's accurate. You have three kids, all boys. So that's a whole hand basket of Judy. You have a husband, you have four horses, 10 chickens, two turkeys, three barn cats, three indoor cats and a dog.

So with that said, and you previously mentioned your, your shutters and not that you are. How amazing, how is life for you being an entrepreneur and being a mom preneur and being a person who chooses how to run their practice.

I don't want to mislead people, but I don't want to sugar coat it, but I'm happiest I've ever been as far as that balance.

It's not easy. None of it is, but it wasn't going to be easy. And I was still going to be miserable if I hadn't done this. I worked three days a week from nine to three, essentially. I frequently block out half days or a day for a horse riding clinic or a show or something with the kids or my husband can't watch the kids that day or whatever.

And I'm able to do that. I think it's fabulous and it really fulfills a lot more things for me. So not only am I back to doing what I feel I was meant to do, and I've always wanted to do as far as the way I practiced medicine. And really, I really feel like I take care of people. I don't feel any doubts in who I'm serving or whether I'm doing it with integrity and that's really important to me.

So that's amazing. I That's a good enough feeling by. But I'm also able to balance it with my life and my PR my patients don't even care. They appreciate it. They're like, yeah, go home. Go take care of your kid. Like no problem. Because they're invested, we're invested in each other's life.

That's the relationship. So that's amazing. And then I guess I didn't realize what a big part, what a big part of me it was, or as big a part, but I've always figured out how to do things, that's a big part of being a doctor. A lot of it without getting into too much of the army service, some of it, I can't really share a lot of what I did in the times that I was in the army.

And some of my toughest situations was like logistic planning and an organization, and coming up with ways to do things that didn't seem possible to do and figuring out how to make it happen, because that's what you had to do. And that, part's it's so fulfilling to be able to do those things, to make decision, then change things.

And I don't know, that's, it's like a whole nother hobby to be able to run that.

Yeah, that's so cool. Uh, Dr. Jenna silica was on the podcast previously and she had mentioned logistics was a huge part of her training also. And for her, she was mentioning how the pandemic when it hit, she was prepared already.

Oh girl, let me tell you, I had full MOPP gear. I was ready if it had been the zombie apocalypse. I had everything I needed at my home and in the clinic to serve like the entire town. I could have triaged every day. I was ready.

When a person looks at their inventory, especially in preparation for flu season, what would you say? You have to get this if you don't have it already.

There's different levels of paranoia here, right? So in February of last year, was it February of last year? It's all a blur January, February of last year, where we were starting here, rippled of this.

If you were paying attention to what was going on over here that's when I started preparing for that, because I was concerned we were going to have an outbreak like we ended up having but I was also very concerned. The supply chain was going to be affected and it was, but it didn't falter quite as bad as it could have.

So what I did, like in February, I had, I ordered three months of medications on all of my patients moved my medications to a different location in case things got bad or an arrest, and somebody broke into the clinic or something. I stocked up on stuff that I wouldn't normally keep an inventory for, you know, like not major emergencies, but moderate, minor, moderate things that I could take care of, ID, fluids, Sam splints, so people didn't have to go to the hospital.

I could splint plant a fracture. Things like that. Antiemetics, simple things that, just going down on you, I ordered some medications that I knew if the supply faltered people would have to have I ordered some basic anti-epileptics and stocked up, backstops them, influence things like that.

That if it did come to it, people were going to need them know they can't go without those medications. And then I stocked up on PPE. I was never without PPE. And that by itself was one of the first like aha moments that I was on the right track because I was still at my employed position, trans transitioning out.

Um, And I used to refer to the like 20 year old managers at the clinic. There were like 10 of them and they're all our ends of some sort. I used to refer to them all as Brittany, cause I didn't bother to learn their names. And Brittany was telling me what I could and couldn't do.

And how many pairs of gloves I could have and all this stuff pretty much over that. But guess what, in my clinic I could do what I was trained to do. And I had received that training in the military. I mean, I knew how to operate operate in like a full nuclear environment. So I sourced all of that stuff off the internet.

A lot of it wasn't traditional medical equipment, but I, I can put it together. I had all of that available and when I was like doing COVID testing, I'm sure I looked like a fool. So I, you couldn't get at that point you couldn't get gallons or anything anymore. I'm sure everybody remembers that.

So what I could get was Kim gear, like for industrial workers. So I had Kim's gloves that came up to my shoulders, which was awesome because you could just dip them in bleach. You don't have to throw them away. They're not, the latex gloves you can get right there. I had the lashes, the white industrial worker galoshes that came up to my knees and I had a essentially a modified mop suit or rubber, hood.

And then it went down to below my philosophies and then I had. Face cover. So I was quite the site. I'm sure if I was doing COVID testing, but I had what I needed. Firstly, I don't know. I have no idea that this winter is going to look like I still have quite a lot of backup medication on hand and I still have all of my isolation equipment.

And now that PPE has been available. Like a month ago, two months ago I had my ma I said, get out every mask we have in the clinic. I want to know exactly how many we have. I want a minimum of 52 per for each of us. That's one a week. If it really comes down to it for a year. Same with, with gloves, although we still have our acumen gloves or if it came to, we don't really even need the latex gloves.

And same with our medicines for my patients who were on critical chronic medications. I'm pretty much keeping three months at all times because it didn't falter as terrible as I think it could have. It still might, but you couldn't get stupid things for awhile. Like ARB couldn't get an ARB for, this amount of time and couldn't get us up there, my son for a while.

And it was supposedly the heroin black Medallia. I have patients who actually need their black, but now so anyway, so I've kept that three month kind of rule until till we know what the heck's going to happen with all

this. Yeah. And I hope that your words, make a difference in someone's preparation, if they're concerned about their community going into the fall.

Thanks for sharing your mindset with regards to how you stock your clinic now, when it comes specialists. So you and Dr.

Deanna granita, who's a rheumatologist in Palo Alto, California have created the direct specialty care Alliance. So can you tell us about what the DSE a is and what is it going to look like in the future?

So the honor, and I started talking after virtually meeting, cause we were both, we are both involved in the DPC community.

And we hooked up, we called each other about a year ago on the phone and shared with each other, what we envisioned for those of us who practice the specialty to be able to enjoy some of the same autonomy that the direct primary care doctors have found. And be able to make that same kind of difference because as you appreciate for us to have truly a successful medical care system, it's an ecosystem.

You can't have all of one thing, right? We need a little bit of everything to be able to practice. Anyways, that conversation, gosh, I think it ended up being like over an hour long and we were both like super excited and saying the same things and really felt like we found someone else who had that same passion, that same vision, that same drive and that desire to, to find a way to make a difference.

And and that's what started it. And I, gosh, I can't even remember on that first phone call if we even conceptualize an actual organization, but we just had this passion, this drive, this desire to take what the DPC community has been able to do and extrapolate it to the specialty community.

Because although there's always been that sort of love, hate relationship between primary care, particularly family practice and internal medicine, which is the majority of the sub-specialists. At the end of the day, we're all miserable, right? Like we all, like everybody wants off that shit. And they want to off now.

It's like rats jumping from a ship. Everybody wants. My buddies who were, ER, one out my buddies who were surgeons went out. Everybody wants off I don't know anybody. Who's happy, frankly. So that's what started, it was just that idea that, that seed. And then we have obviously had multiple conversations.

I've never even met her in person for the record. We've never met in person. We have had multiple zoom conversations and phone calls and we ended up conceptualizing a organization of sorts that would allow us to bring the same type of awareness and assistance to specialists looking to go into direct care that the DPC Alliance has been able to do, run by doctors for doctors, only physicians only looking out for each other, sharing knowledge for the sake of helping one another off the sinking ship.

And not for the sake of capitalizing, right? Because just as in the DPC world, there's just a million different people that are like, oh, take my course. I'll show you how to do. And that's fine. That's they're entrepreneurs and have their own. But that's just not, that's not what we're about.

And that's not what we're about. We don't want to be Rubicon. We don't want to be another tele med platform. Like we're not trying to form like a multi-million dollar, organization where we capture all these things. We really just want to find a way to create somewhat of a pathway for people looking to get out.

And so that, that's where it came from. And then we're both busy. She's a mom too. I'm a mom, we're both, we both have our own practices. We're running, picking up kids from school. And so it's just taken us a year of these, snippets and conversation and she's done so much legwork.

Her kids are a little bit older than mine. She's done so much legwork to get like the articles of incorporation done. We've got bank account, all of the essentials and the website. And so the once we had a reasonable amount of things in place, we felt like it was safe to go public at that point.

And it's a work in progress. I don't know exactly what it's gonna look like when it's all done. I know what we want it to look like, but I don't know exactly how that's going to evolve. it's a little bit scary because it's like having the only well on the desert. People, I think within a week of even seeing it on Facebook, we had, I don't know, 500 people or something want to join.

People are starving, and so it's a little bit intimidating to be like the one place that's offering something but it's gotta be done. Someone's got to do it.

because you guys are so active on Facebook can you talk about like where people should go to connect online through Facebook as well as where is your website for the Drucker specialty care Alliance?

Sure.

A big part of my heart is still a DPC. I'm my DPC Alliance member. I feel very strongly about that. I've been to two of the mastermind yeah, I'm in the DPC doc Facebook page. And I'm sure they don't want to be overrun with specialists, but but I feel like that's where I learned how, what this is all about.

And I don't intend to give that up. And and for the direct specialty Caroline's we have a Facebook group we're trying, it's definitely positionally. No, if ands or buts about that there are some DPC doctors who were foundational and us figuring this out that are on there, but we are trying to limit that particular Facebook page to specialists because we want that to be more like a working group of, how to do this and then that one specialist for direct care.

And then we now have a DSP, a direct specialty Caroline's Facebook page. That's more of a public page. So anybody's welcome to go on that. And one of the first things we're working on is to create a mapper, a directory, so that as as a specialist or more importantly as a primary care doctor, particularly if you're an independent or direct primary care that you'll be able to go on there and say, I need a hematologist and you can search for that and you can see what states I'm licensed in or whoever else and be able to create that network, that web, we keep referring to it that can create that actual working medical care system that we need to take care of our patients and vice versa, because sometimes people present as specialists and I need a primary care doctor I can trust.

So just the same way the DPC community works so well, you know, Hey, I've got a friend in North Carolina who's practicing there. That's really the most Seminole thing probably we're working on right now is to create that for the specialist. That way patients can find us, but also their primary care doctors would be able to find someone they can trust.

That's a work in progress, but that's one of our biggest pushes the actual website. So the actual website for the direct specialty care lines is DSP Alliance dot word. And that's our open, that's an open site. And again, it's a work in progress. The biggest thing that we're working towards is putting together the information for directory so that it can serve that purpose.

Actually designed the logos. You guys can let me know what you think about it.

The Facebook group for the specialist to join the hidden Facebook group is specialist for direct care and anyone who's already a member can invite. And we're trying to limit that to its physician online. No questions asked, but we're also trying to limit it to active and practicing.

So earlier you had mentioned when you were learning about the direct primary care movement from an, from Andrea and, from somebody who had gone to medical school with you had been in the army with you who had very similar training, as you was talking with you on that level of, Hey, all of this experience that we had, as veterans, as medical students, this allows you to easily run your own practice.

Some people, most people are not necessarily in that boat where they have all of that extra training and that, clear understanding of autonomy and that they have the confidence to do something like as, as risky as running their own business. So I want to ask when you talk with people, whether it be through your guys's Facebook group or through the direct specialty care Alliance, when you talk to specialists who are thinking about drug specialty care, and they don't have that same experience that you and Andrea had, what do you, how do you approach direct primary care?

How do you share with them that this is a model that could work for specialists as well? So

I'm pretty upfront person and I don't want to mislead anybody. So I am definitely not selling them the rosy picture. What I've been saying to many of their questions are, is, look, this is not yet.

That's fine. We literally create, like we created this term in the last year. Th this is not this, there's not a book. There's not a manual. You can't go buy a course on this and set up your practice to. That's the honest answer. Now we want to create something along those lines. DPC university is an example of what the DPC community has done to try to address that.

And there's books that the DPC community, can look to. Doug's book was one of the first ones, Paul Thomas has written to us in the book, Julie, Gunther's written an excellent book. There's a lot of resources now that you can go to. We're hoping to develop that for the direct specialty care, which is why we felt we needed to also have our own Alliance to address that.

But the honest answer right now is if you're not the type of person that is naturally an innovator I wouldn't say a risk taker because I am not a risk taker, but I'm a CA I'm a calculated risk taker. And so if I can plan and have a plan B, plan C, then I will, do something. So I, it's not like I just ran out on a limb.

This was a calculated risk I took. So if someone's willing to educate themselves, visit practices visit primary care, direct care practices, they're more established. They have a lot to teach us as specialists. If people are willing to put in that time, get to know the DPC world, how that works network with people that are already doing some version of direct care, because there is actually a fair amount.

They're coming out of the woodwork, but because they've been. you know, Some of them are fee for service, a more of a fee for service model but it is a thing, and this is allowing us to find each other, which is really powerful. But at the end of the day, this is not it's that path.

It's not like you can graduate residency and find a contract and be DSP. You just can't, unfortunately, that's just not how it is. So for those people who are going to be opening practices, probably for the next couple of years, you're going to have to be an entrepreneur.

You're going to have to be an innovator. You're going to have to be able to think through some of these things. If you don't want to fall flat on your face you're going to have to take some calculated risks. You're going to have to cut back on your lifestyle. I know that talked about a lot of, for DPC, but it's, unfortunately it's even more so for DFC.

Not to be uncouth, working part time, I was making four times I'm making right now because I was a desired specialist in the rural area. And I, I still get recruiting emails like every day for over a half million dollars just to work like four days a week. That's disgusting, frankly.

I mean, It's awesome, but it's disgusting, but I'm probably never going to see those kinds of figures, even when my, even if my DPC DSP is wildly successful and I'm okay with that, but they're going to have to be okay with that. If they're making a million dollars doing pain management right now, and they're not okay with making 200,000, it's probably not going to be.

And that's okay. Everybody has their own thing. Some people will join practices that do get up and running just like we've seen in DPC. Some people probably choose to do some sort of hybrid or fee for service or maybe work for like a multi-specialty group or, you know, there's lots of different options.

And I think the beauty of this is Deanna. And I've talked about,

we're not ever going to be for everybody just as DPC that doesn't work for everybody, frankly. And that's okay because all we need to do is talk about what we're about and for people that want that, then they'll come to us. And for people that don't, that's fine. Maybe we're just the stopping their journey or maybe as again, as we see in DVC, maybe they reach out cause they're miserable, but they're not quite miserable enough yet.

Maybe in two years they come back to it because at that point, the trade off makes sense. So the important thing, and the reason we did this though, is to have that there, because there, there isn't anything or there wasn't anything. So to throw that out into the universe is the important first step because people have to be able to, they have to at least be able to Google direct specialty here in has this somewhere in real life.

If anybody's going to have a chance to put their teeth into it,

And have you guys just like how direct primary care is a legal term. How about direct specialty care? You guys addressing that? Not so here's the problem with that. So if we extrapolate

from the direct primary care facet, then I guess if you will, then it's probably going to be a bit too restrictive to encompass all the different specialties.

For instance, the surgical specialties, there's very few instances in a surgical specialty where a true membership's going to make them so to restrict them to that is, is not going to be reasonable. And that is part of the direct primary care definition, a very big part of it on the flip side, as somebody who's passionate about direct primary care, I'm very thankful for having bound it.

I think that those specialties that can have membership really need to entertain that because that is one of the elegant, beautiful things about direct primary care. That affords so much freedom and and ability to not live paycheck to paycheck. And, you know, it just facilitates the whole process significantly you know, in regards to overhead and not complicating your life, if you're trying to do bookkeeping and all of those things that I think if the medical specialties, so ones that branch off of internal medicine, most of them have membership model of some sort makes them, taking care of chronic full spectrum, long standing, patients.

If they don't understand the value of a membership model, I can, I think there's a likely, there'll be a lot more failure and disappointment because if you just try to run this like a private practice, they're going to run into all the same barriers that have made private practices and endangered species.

Yeah. And there's already that out there, we don't need to teach people how to do private practice. They can figure that out. That's not the point. So to get back to your question, I don't know exactly what it's gonna look like. Cause I think it's a little bit complicated and I'm not sure exactly how we're going to sort that out.

Might have to have separate umbrellas for specialties surgical or procedural based specialties versus the internal medicine. Certification like rheumatology oncology and cardiology, pulmonology. I think it's gonna look a little bit, there's gonna be a couple of different versions and that might be challenging from a legal standpoint, but start somewhere.

Sure, now I want to go into talking about the masterminds, because you said that you've already attended two DPC Alliance masterminds. And you were just at the last mastermind that Jack Forbush and company hosted in Bangor, Maine. So what was your experience like at these masterminds? Because there's quite a few coming up.

So last year, myself and my RN, who's an amazing individual. Who's now followed me to three practices. Attended the one based out of the Kansas city area. So that included a lot of pretty well-established practices, Ryan Newcastle I'm blanking on everybody's names.

I some famous people in the DPC movement. It was fabulous. That was an amazing weekend. Just, it just feels really good to have people who are all about the same thing in a room together. It's a really empowering feeling. So very energizing, but obviously very informative. We visited, I think generators practices.

I was Jen Kylie man-to-man in Kansas city. Ryan knew Phil van laughy, and I feel like I'm missing for months. I'm sorry, wherever I'm this county. But anyways, those practices have all been established for quite some time and been very successful there. They have multiple employees. Most of them have multiple physicians or medical care people.

So you know, I'm nosy, right? I just went through everybody's offices. I asked a ton of questions. We had great social times and great learning. We exchanged them teaching on procedures. Just sorta thing how the office is laid out. That's something that I'm sure is going to evolve right now.

The way my office is laid out. I'll bet you in five years, it's not laid out that way, even if I'm staying in the same building because the workflow changes. And when you add people, it was me by myself and then it was me and my RN and now it's me and my RN and my ma in each time you, you add somebody, it changes the workflow.

But yeah, it was an incredible experience. And I took my RN with me and she was just as blown away as I was. And we would just, it felt like we, this sounds super corny, but it felt like we were changing the world. It really did it, it really had that feel to it. So you have all those people who are all passionate, intelligent, educated, powerful people, and we're all trying to push the same direction.

It felt really good. I've never felt like that at any medical conference before. Let me, that, the bar scene from star wars that people reference, like when they were feeling awkward in a, in an environment. So that's how I felt when I would walk into ACP meeting with 2000 other internal medicine doctors.

And I'm sitting there looking around and thinking, is there a bunch of weird people? I would not talk to these people on the street. Didn't feel like that at all. It was like being at home. And then my husband and I actually went to the one in Bangor, Maine. What was that? Just this past weekend. It was just as amazing.

Everybody's just, everybody comes to the table. With the same goals and desires and mindset, and it's just a really refreshing experience. And Jack and his wife were great. It was amazing how we had a big lobster dinner. I think that's the first time I've ever had that. And I'm spending, I'm paid with my medical assistant and my RN to the one in Hermann, Missouri with Dr.

Jennifer rotor Allen, who I would have gone to that. No offense Jack, because it's nearby. It's where I live and her practice is structured somewhat similarly to what I've been going towards. But I had that conflict. So I'm sending my office staff to that one. That's how valuable I think it is.

That's great. And I'm glad you brought that up, that it's not just for DPC physicians. Without that staff can also attend these masterminds. So that's wonderful. And if you are interested, there are still quite a few DPC Alliance masterminds all over the country.

And so if you go to DPC alliance.org you can see the offerings. You can see the masterminds that are coming in the future. And then also for people who are not. DPC Alliance members. Just remember that the code, my DPC story, all caps, one word can get you $50 off of registration. So keep that in mind, but definitely I encourage people to check out the masterminds cause there's still quite a few all over the country.

Yeah. I think there's all the ones I've been to. There's been quite a few attendees to are still employed. They're just thinking about doing this or that, they have a goal in the next year or two. I think it's priceless. It was $100, something like that. You can't go to a medical conference for that and have that kind of experience.

I think it's completely worth it. And if you can't make one because of the scheduling conflict or whatnot, but on your calendar for next year, I I was looking at the dates like eight months ago because I was so excited after last one. But you can find on the DPC Alliance that you can find the directory, find a practice that's within driving distance for you to call them up.

Everybody I've ever talked to has been nothing but welcoming and go hang out at their practice for a day. The first practice I ever visited was, and I'm blanking on her name, just so bad. She's in Columbia, Missouri. Anyways, I just cold called her out of the blue and I said, Hey, my name's, large kitty.

And I think I just Googled her practice at the time. Cause it was right after I'd heard about DPP. And I said, do you mind if I come see what you're doing? Of course, she was like, no, no problem at all. And I just drove down there one morning and hung out for the day. And I asked her a million questions.

She following third 50 million times. Um, But she was nothing but gracious. She showed me the office. She told me why she was there and what was working and what wasn't. And I visited a ton of practices that way. I just recently, within this past year, I visited Kylie Bannerman's practice again in Kansas because I added that Emay.

And, every, like I said, the workflow changes every time and she's got a bigger office with more staff. And I said, I just need you to come sit in your office for half a day and just take notes. I need to see how you guys are doing things. Cause I don't know if we're doing them the best way or, I just need those ideas.

And everybody's sure, come on. Come on over. We got coffee and every single person I've talked to in the direct primary care world has been amazing. Bridget render. I have to give her credit for that. At Liberty, family medicine in Columbia, Missouri.

She was my, she didn't know it, but she was the first practice.

I second that encouragement to reach out to somebody, especially if you do have somebody local to you, because it really does make a difference. Like for me, my, my person was Dr. Janine wrote hymns in Santa Cruz.

She has Santa Cruz DPC. And I had heard about DPC. I talked to her about DPC. I had gone to the hint summit, but the thing I remember specifically, and this is why on my DPC practice website, I have the hours listed as by appointment only is because that's what I remember so vividly seeing with this beautiful logo on Dr.

Janine wrote hymns door. And I was like legit. That is saying that she is her own boss by writing by appointment only she is able to make her own hours work for her. And that was the, the icing on the cake for me in addition to seeing her beautiful clinic and how it's designed and how she needs it to work for her, as well as how it allows her to grow her practice.

But yeah, it's such a different experience when you are in a room with other DPC physicians or direct specialty physicians. And you're just talking about the model of DPC or doing direct care. It is so addictive.

I think any of us feel that way which is why it's such a joy to be part of such a passionate group of people who share the same passion as you do. There's just really nothing else like that.

And for those people who find that resonates well with them, and they want to reach out to you after this podcast, what's the best way to do

you can go to my website that has all my numbers and emails on it. That is Leeton medical.com, L E T O N. medical.com. The spelling of my name throws people off. So if you don't mind, I'll spell it for me. Because I think I'm probably the only person in the world with my exact name. I'm certainly the only doctor.

So my first name is Lara, L AR a. And my last name is , which is spelled B as in boy, R I S as in Sam, P as in ed and as in Nancy O and then a space, and then Kenny, which is spelled K E N E Y. So unfortunately all three of my names have a little bit of a spelling thing in them. If you get that spelling you pretty much can't help, but find me and I am more than willing to talk, email call.

You can hit me up on Facebook. My staff knows that if any physician calls me for any reason there to give them my personal cell phone. Cause that's one of my pet peeves when I'm trying to get a hold of someone and they give me the office number and I have to go through a phone tree that usually ends in me saying I'm not talking to that doctor.

Cause we're calling, I feel like doctor, she talked to doctors that shouldn't be a barrier. So by all means if you find me on Google and you call the practice you will easily get a hold of me. There's no phone tree. I refuse. I might even just answer the phone. I still do.

Amazing. Thank you so much, Dr.

Kenney for joining us.

Thank you. I appreciate this opportunity. I hope somebody gets excited like I did when I heard about it.

*Transcript generated by AI so please excuse errors.