Direct Primary Care Doctor
Dr. Brian Blank grew up in the small town of Waterford, PA, delivering newspapers before leaving for the midwest to study broadcast journalism at the University of Missouri. He then spent the next several years working in cable news in both Atlanta and New York. In New York, he met his wife and father-in-law, a longtime primary care physician at the Cleveland Clinic. After many late-night conversations with him, he decided to switch careers to pursue family medicine. After stops in Boston and Costa Rica, he moved to Chapel Hill, NC, where he completed medical school at UNC. He then did my residency in family medicine down the street at Duke University Hospital.
In 2021, he opened Ember Modern Medicine, a practice he had dreamt about for more than a decade. By eliminating overpriced insurance restrictions, he can spend more time connecting with my patients and focusing on their health and wellbeing instead of rushing through 7-minute visits checking government boxes.
Dr. Blank and his wife Laura are now blessed with two beautiful daughters. In his free time, he enjoys competing in endurance sports. He's run more than a dozen marathons, finished 2nd in a 50-mile ultramarathon, and barely survived an Ironman Triathlon. Lately, he's been attending Swamp Rabbit CrossFit. In 2021, he started a running streak, attempting to run at least one mile every single day.
In this Halloween episode, Dr. Blank shares his story of how his love for family medicine drove him to change careers and how, after ten years, he has finally opened his clinic Ember Modern Medicine. He shares about his buildout, his staffing and so much more in today's episode!
Resources Mentioned By Dr. Blank:
- Keylight Communications (Laura Blank's Company)
- Josh Umbehr Article on pricing
- HINT
- Spruce
- Elation
CONTACT:
Website: Ember Modern Medicine
phone: 864.702.2365
TRANSCRIPT*
Welcome to the podcast, Dr. Blank.
Thanks for having me. This is great.
So like you said, in your intro, you have been wanting to do DPC for a long time and February of 2021 rolled around and you finally did it, you opened up your practice, you opened up Ember, modern medicine, and I want to ask.
Yeah. And I wanted to say congratulations for
first of all. Oh, so it's so exciting. And hopefully as we get more patients, they will also be excited. They'll share the enthusiasm
and I want to just say, if you haven't gone and seen Dr. Blanks, social media posts, please go check out his Instagram, because you can see that not only is his practice named under modern medicine, there are actual embers in the front of his building, which is pretty incredible.
It's true. We have some gas lanterns out there, which I think are really cool and we've turned the flame up as high as they can go. Just like in our hearts, it's the Ember of our hearts. It's blooming and blossoming. It's becoming this wildfire. It's going to take over healthcare as we know it,
That is what all of us are pulling for, for sure.
And what all of us are working towards every day with every patient. Now I want, I wanted to ask in terms of this idea that you had thought about DPC for the last 10 years, can you share with us, what was that experience like in terms of how did you come to learn about DPC and what things were you thinking about through the years as you worked your way towards opening?
That's a great question. Medicine was a career change for me. So I was originally in journalism. And when I made the decision to go into medicine, I knew I wanted to do primary care. I had met my wife and her father, who is a longtime internist, the Cleveland clinic, and was talking to him about what he liked about primary care and what I liked about journalism.
And we saw this sort of overlap. So we decided to, make the plunge, so switch careers. But I was trying to find a way to make primary care work because I was talking with so many folks and they were talking about, oh you're going into medicine. You've gotta be, an orthopedist or some specialist and do something really fun, but that's not really ever what I wanted to do, but I had trouble figuring out how is it feasible to do primary care?
Because it sounds like so many of, and this was 15 years ago, so many primary care docs out there were getting burnout. And we're leaving the field altogether just didn't make sense. But you had alone as a, like an early med student. I knew many of my classmates were going into medicine because they were really pumped about these ideas of primary care.
So it was through the North Carolina academy of family physicians. They had a program for folks who were interested in family medicine, where they basically gave us that first summer after first year, a bunch of opportunities to look into different types of. So I built this elective with their help and where I got to spend a few weeks with a bunch of different types of primary care practices, including a straight up concierge practice.
So I was at a MD VIP. I got to see a traditional private primary care practice spent some time with submit paeds docs and that sort of thing. And so we got to see how that worked part of a another, each completely independent doctor and then direct primary care doctor Brian forest in apex, North Carolina.
And it was at his practice that I first discovered or heard about primary care. And I thought, holy smokes, this is everything that I've ever thought you could get in primary care, basically all this time. It was just this amazing experience. It was this apifany like, aha, this is how it should be.
And he was, he'd been doing it at that time for at least 10 years. I couldn't believe it. There was no one else that I'd heard of who was doing it at the time. And and he had been doing it for so long and it was his vision, as a resident. And he went straight out of residency and opened it up and it's just been doing great ever since.
And so yeah, since I saw that, I knew, okay, this is what I need to do. We gotta find a way to make this happen. And so I've, yeah, I've spent pretty much every waking hour. It seems like over the last 10 or 12 years, daydreaming about making this work and it can work. And I'm so excited about it too, because.
No, a lot of those friends who I started medical school with, who were really excited about primary care. And then they ended up specializing. I think if we can make a show that this really is an exciting way of doing primary care, it's a legitimate way. It's a it's it's really the dream of, I think what primary care can be, then I think we will get more med students going into that.
The pipeline is going to expand. We're going to get this sort of renewed enthusiasm towards primary care because we need it. So hopefully it's going to happen.
It's interesting because when you talk to people, even younger people about a family doctor one of the ways that I feel is effective when direct primary care physicians speak to patients when they're marketing or. Pitching their elevator pitch is to say it's just like medicine used to be. It's just like how a doctor used to come into your house and help you at your house rather than you having to go to a clinic.
And with this idea that the movement is growing actively and as we inspire each other, as we inspire others to do direct consumer care in the future, it's so interesting that is at the same time, going back to our roots as physicians, especially in primary care and refocusing on, on patients, but using that history to help people understand where we're coming from,
oh, totally. And I, I get that question a lot because patients will come up and ask about our name, which is Ember modern medicine. And they're like, what is modern medicine? What does that mean? And I go through this whole spiel about primary care, but really I'd say we're calling it modern. It feels modern.
It seems modern, but really it does seem it's old passionate heart. This is really how medicine used to be used to have. Visits with our doctors, we used to be able to be more in touch with them and, we, weren't always burdened with things like paperwork and and these gigantic hospital systems.
And yeah, it's modern, but it's retro at the same time we could call our practice and for retro medicine and it would still have the same effect.
It's definitely something to consider if there's somebody listening who is working on their name, it's something to do, they give out.
And I also think about the idea that, you know that people have had to change their names sometimes because of trademark issues sometimes because of just a change of heart or change of location. But I feel that no matter what your name is, you're right. That you literally can name yourself anything. And what you put behind the name is really what matters.
Totally. Oh yeah.
What pushed you to the point of today is the day today's the day that I'm going to do this and make DPC a reality for me.
Have
you ever seen the Avengers? Yes. It's like fan I am inevitable. Even if the decision for direct primary care, it just felt like it was inevitable. As soon as I saw it, there was just no turning back.
It was this unstoppable force. It's got to happen. So just thinking about this reminds me of, I feel like a lot of a lot of folks, when they're in med school they come up with this idea of what it is that they want to do and, or they come up with a checklist, and then they cross things off and, primary care gets crossed off because it just doesn't seem practical.
But for me, it always felt like you should figure out what it is that you want to do, even if it's not practical. And then just find a way to make it practical, find a way to make it work because you don't, do you really want to spend your whole career as a dermatologist? If you don't get joy out of it?
Maybe it pays well or whatever, but you've got to really enjoy, I think, waking up and going to work if that's what you're going to do for your whole life. And so I find primary care is just so much more meaningful and, getting to spend and know patients over a long period of time, I think it's worth it, and so maybe you have to make some radical decisions and how you structure your life and your career. Maybe you're going to be independent, which doctors just aren't doing anymore. But maybe you've got to think differently. And in the end it works out. Hopefully, but yeah, it's gonna take some big thinking, I think, to follow those dreams
And in the era of COVID, it just made things like grand openings, an odd thing to plan, do you want a big party? How are people going to take that?
If it's a doctor's office, do you really want to have a big, mass lists event or something? Do you want to do it online? Is it still a grand opening? If it's an online party, do we even need a grand opening? These are all sorts of questions, but yeah, we we opened the doors and we're still getting everything in place, but yeah, we decided, I think it would be, it's going to be helpful for us, I think, to just commemorate it, even if it's not that big of a party, we'll see my wife's planning event.
I think it's gonna be, it's gonna be a lot of fun
And your wife, who is the owner of Keala communications sent me a downloadable link where I can find all of the information that I needed about you prior to your interview, just in one magic Dropbox folder with sub folders.
And so a huge compliment goes out to her,
yeah, she she and I both met in journalism and she has started a public relations company.
So it's been just invaluable having her as part of this startup. In fact, I was telling her last night, I wish we could have her full-time at our practice and find a way of making it work. So she's just donating all this time and it's just been, it's just been so helpful.
There's all these things to think about. And not enough time in the day to think about them all to push, he keeps us organized.
So the building where your clinic is located, was a regular brick front building initially, so did you, oh,
okay.
And the bank has left its vaults with us. So we have on the ground floor where our clinic is on Baltz in there with a giant vault door and we tell, all the kids that it's going to be, where all the bad kids are seeing there, they get locked in the vault. And the bank was nice enough to leave us two giant safes in that vault, including a six foot tall, safe, I could walk in where they kept all their safety deposits.
And that safe is probably like 4,000 pounds. And I have no idea what to do with it. There was like, basically this gift, but I got a quote just to move it and it would be $1,500. And then where do you take it? Even if you were to bring it home, you've got to have some pretty strong floors to be able to support a safe bet, weighs that much.
So I don't know if you know of anyone who needs a safe, let me know, because we've got two giant ones.
If you do keep it, I think you should call it Alcatraz. And the second thing that I think of is that would make a great interactive social media posts for your patients, as well as the world of DPC, because I feel that you would get a lot of interesting answers to that.
Yeah. We did make a post actually, when we locked ourselves out of the safe. And so it got locked somehow. I still know how it happened, but it it's big. It would just would not budge, like a safe should should respond. And so I ended up, I called the company that built the door and then I called the company that bought that company.
Then I called the company that bought that company. Then I bought, I called the company that made the little dial that you spin, on the door. And they're like, we have no idea. And then I called the bank and they didn't know. And then they call the second bank and then second bank was like, just try turning it left a 50 and then all the way right until it stops.
And that was it. That would, they have reset that's the generic. Walk if you're ever in a bank and wandering around you, whenever impress somebody, try that combination because it might work. And then it opens up the door at 1.1 of those companies, they were like, you know what these things are.
So rigorous, probably the cheapest thing for you to do is just go through the wall next to the door, just go around the door and then you'll get back in there. I was like, oh, okay. We can try that. We'll call that plan B
you could just go watch the Italian job and get the details as to how to manage that job.
Oh my goodness. That's intense. Maybe you could use the vault to rent out to house medical records. Since we have to keep them for seven years after closing practices change the default
code controlled substances, maybe who knows we could start everything in there.
Actually, this is interesting. One of the suggestions that the bank had given us for what to do with the volts, they said, wait for legalized marijuana in South Carolina, because this dispensary's apparently you can't keep a bank account. So they actually buy up these old bank vaults because they have to keep a lot of their stuff in cash.
So the, they said this was off the record, but now that we're talking it's on the record, they said, if you just wait until, marijuana ever becomes legal in South Carolina, I bet dispensary's will be popping up in there. They'll need something like a giant bank vault, not the vault, I guess I should say the safe in the vault, they could take the safe and use it in their place.
Interesting
idea. There you go.
Thank you bank.
In addition to this lovely safe that has been included in your hand, your building can you share about how you decided that was going to be your clinic space?
Okay. COVID really helps with it, actually. It the Greenville real estate market has just been booming and it has been for decades, you know, 2008, things never really seemed to slow down around here.
We moved here about three years ago and we were looking for a spot that was in our neighborhood. Cause ideally it would love to have this practice that's walkable. And plus the neighborhood that we live in is there's really no primary care or urgent care in the area.
It's underserved in a sense. So there was a little lot that had, that was on the market and that we were looking at, but it would involve building a whole new building. So we spent a lot of time looking at it. We drew up plans for it. We had, we just could not make the parking work and make it make sense.
And so finally, right as COVID was basically starting to shut everything down, we stepped away from that and we're like, all right, we're going to need a plan B. That same day that we stepped away, this building came on the market. And like I said, it had been a bank, it was two stories. It's 7,500 square feet.
So it was way bigger than we would really need for our clinic. And we took a look at it, decided we were going to make an offer and then COVID shut everything down. So no one else was able to look at it or make an offer. So we, by the time everything opened up again, it really, it was the we had made the only offer on it, which was awesome.
And and then, so we got in there. You know, Our goal is to rent out some of the unused space on the second floor and even some empty exam rooms on the first floor. If we can find some other, health and wellness related folks to, to partner with there's a massage therapist who I think is going to use one of our rooms, there was an acupuncturist who was going to look at maybe one of the other rooms.
And there's a counselor who's upstairs. So there that's really great. And yeah, so we're trying to make the best use of the space, but we've purposely built on the second floor, a big room that we want to use for teaching and shared events and uh, even cooking demonstrations and that sort of thing.
So we really want to make it accessible to the community and open and and hopefully a lot of fun.
When you guys were envisioning your practice, did you want to have space for the communal events and for cooking classes like you're describing?
Totally. Yeah, that was always one of the plans.
We tried to find ways to make it work. Even if it's just doubling over as a waiting room, it with DPAC practice who typically don't need a huge waiting room or anything like that. But cause you don't have patients who are sitting, waiting around for all that long, like a traditional practice.
Yeah, our, we really want to have a space like that and make it work and for it to be a place that's comfortable for folks that they, maybe enjoy coming to. So we're trying to get some events lined up now. And my wife's really that's, she's so excited about it. We've talked to so many nutritionists and other folks people at local gyms who can come give demonstrations to the physical therapist who wants to, do a class over there, maybe we could even do some meditation stuff.
I think it would be, it's a fun use of a clinic. I think.
For the acupuncturist, for the massage therapist, for other people who might be physically sharing the space with you now, or in the future, have you guys talked in the sense of yes, here's a space that you could absolutely rent.
And also let's talk about if we can come up with packages for a number of modern medicine, a patient who also sees you as a physical therapist or
yeah. Make it kinda like a little hub if we can and make it so that, those things are optional, but especially with the counselor who's in there right now upstairs, they've just got a great practice and they're new as well.
And so we really want to help feed each other as best as we can. So yeah, any way that we can make that work, I think it'll be.
When you were doing your build out, when you were personalizing the space to make it, what you envisioned, can you share about what the experience was like working with contractors.
Yeah, as I'm sure a lot of folks would know there's definitely pluses and minuses to all that, but it's overall been a pretty smooth experience. I will say one of the things that excited us in starting this was we have been working with a great architect and, they had come up with maybe a vision for how this would look.
And we went to some local interior designers that came up with a package for our clinic. And as I'm sure most of us, if we ever talked to any of these folks, we all say, we don't want our clinics to really look like a clinic. Let's make it look cool and not so sterile, like a lot of the hospital-based clinics and all that sort of thing.
And they put together a package. You said it was pretty cool, but it looks just like every other hospital clinic that I've ever seen. Very sterile everything's made to be very cleanable, probably meets certain OSHA standards or whatever. And it was super expensive, this furniture, which did not look great.
So pricey and for the same price, we're like, gosh, we could go to basically like a luxury designer and get some really nice furniture from a place like restoration hardware and throw that all in there for the same price. And it looks a lot nicer. It looks a lot cooler and and the way that they make those things they're easy enough to clean now that for a low volume clinic, I think it makes more sense.
So that's what we did. We're like, gosh, if we're going to be paying a lot of money for furniture, let's just get some nice stuff. It's the same price. Yeah. Might as well. So that's been fun for us.
Can you think back on any particular challenges and how you overcame them when it comes to the build-out process
The builders told us that there, there's three things to think about when you're building something. And you can't have all three of them. You can have two of the three, but you can have it done fast. You can have it done cheaply and you can have it done. well, I guess maybe I'm not remembering it, but basically, yeah, you can have two of the three, but you can't have all three.
And so for ours, we had the benefit of having some time because I was employed. And so I could continue that job really until the practice was up and running. So we decided, we're not really concerned about the time, so we'd rather spend our time and, make it all work out. And and it doesn't need to be super expensive, but it doesn't have to be done in four weeks or whatever.
And so that for us was really helpful to, to be in a position where we could continue to work and, wait for everything to come together. But overall, the building. Pretty smooth. I want to say it was maybe for four months. That's not bad. Oh, one frustrating thing though. So this was helpful.
I've seen different posts about this in the DPC group. So we ended up taking out an SBA, small business loan from a local bank and they have just been really a godsend for us. It was so great working with them. And COVID helped with that process actually. So when COVID happened, it really loosened a lot of the lending requirements from the government.
And so the bank was able to take a bigger risk on us or, take a bigger take them to take on more risk, because the government was shouldering a lot of it for them. And so that was really helpful. So I would encourage folks if you're thinking about something like this, maybe reach out to local banks and consider, the SBA route.
If you need to it's it can take a lot of, you have to lock on it, knock on a lot of doors. I think to find the right bank, that's willing to take the time to understand direct primary care and what it means and what it can look like. But when we found the right one, everything just clicked. So that was really helpful.
That's a great tip. And I hope as the movement continues to grow that if people are not sure which bank to approach, they can potentially reach out to another DPC in their community to get advice as to where to look first.
Yeah.
Yeah. Don't look at the big banks, don't look at SunTrust truest and those sorts of things. I think it's really going to be a smaller community bank. That's going to take the time to really understand the model and what it can mean for the community.
Yeah. And I wonder if that's also because just being closer to the community versus being closer to the corporate world, if that makes sense that they're more aligned with the community values.
Totally. Yup. I think that's exactly right.
with you mentioning this idea of restoration hardware and finding pieces of furniture that were really nice, still easily cleanable, but really brought home what you wanted to make your clinic look like. I wanted to ask how did the marketing happen for your clinic in terms of, did you come up with your colors and designs and what you wanted the clinic to look like before you came up with the name or did it happen in the opposite fashion?
We actually, so we reached out to a marketing company before we even had thought of a name and they helped us with the whole process and I would encourage, so I've gotten different advice from other doctors about this over the year, about how much to invest in marketing and an advertising thing.
Because at the end of the day, a lot of docs, they'll say, it's really word of mouth that sort of drives things. But for us and starting the practice, we would like it to be a brand, like I really want this to be something that really hangs out in the community for a long time.
And so reaching out to a local group that was also willing to work with us, I think has made all the difference. So they helped us come up with a name and logo and a website. They are helping us with advertising right now. And I think it's worth investing in that. And it's, if you're gonna do it at the start, it's so much harder.
If you come up with a name and a logo, it's just by yourself for a year or two, until you get established. And then you decide to go back and start to work with a company to get all this stuff off the ground. If you can do it all from the get-go, it's a little hard, more workup. But I think it's going to pay off in the end.
It's just going to make things easier. It's going to, you're going to come off as more polished, I think, when you do open, so that can make a big difference if that's what you're going for. If you're truly starting a micropractice and that sort of stuff, isn't important to you.
You're not really thinking, I w you know, you want to hire other docs are really expanded in the future. That's totally fine, too. But, if you really want to establish a clinic or maybe even have multiple sites in the future, I think it, it pays off to, to invest in that upfront.
What did the finances look like in terms of budgeting for the build-out as well as the marketing piece, as well as potentially looking for staff, because you have Alison who's your
yeah.
Alison Smith. Yeah. She's our nurse. Yup. Yup. Yup. No, she's been great. So yeah, it's it's been tough, we I'm not going to lie. We've put it all on the line. There we've drained all of our life savings, and if this doesn't work out, then we've got no. But it's been an exciting gamble.
So if a year from now, if we're continuing this and I'm doing it from the the bread line downtown, then we'll know that it wasn't a great idea but I think it's going to be, I think it's going to be a lot of fun. We had to make some tough decisions and I think it was really important for me and my wife, Laura, to be on the same page about what, how we were going to spend our S our, basically our savings and what that's gonna look like.
And, it's so terrifying being in the medical field and starting with a lot of just training debts to begin with. Maybe it's good in a sense that it prepares you for living with this overwhelming debt sort of things is hanging over your head all the time. But but then adding to that with a building or a practice, it's just, it's a lot to think about.
So maybe sometimes it's worth not thinking about, but pressing ahead, I think despite all that can you just got to do it sometimes you just got to take a jump and so we're taking that jump and we'll see how it pans out.
In addition to Laura's company for you, are you doing any side gigs right now?
Totally. Yep. I am working at a couple of the local urgent cares, PRN as much as I can get. Yeah, that part's tough. And I am just counting down the days to when I don't have to do that anymore, but luckily they've been really flexible with their schedules. So right now, what I'm trying to do is work every weekend day that I can find so that I can be in our clinic during the week, still trying to find one day off during the week, just to, for my own sanity.
But for the most part, yeah, working weekends or weeknights, if I can, so maybe, sometimes I'll see patients in my clinic in the morning and then I'll go over to the urgent care, in the afternoon or evening. So far it's worked out, but yeah it's exhausting. So like I spent all day in a windowless room and an urgent care and really wishing I could be in my practice or at home, but, eventually that will hopefully be the case.
Are you giving yourself a salary right now or not? Yeah,
not from the clinic. So we have yeah, we've taken probably the opposite approach from all the advice that we've ever gotten before, where we do have a lot of overheads to begin with. And so I think it's going to be a while before we're the clinic's able to support itself, it doesn't have to be that way.
I think you can definitely start out a practice and I've heard some folks say you could do it with $5,000. You could start a micropractice. Yes, I think it will be awhile before we have a salary. So I'm going to probably be doing the moonlighting thing for a while, which is fine.
Do you foresee your practice maxing out at a particular point?
In terms of number of patients that you wish to handle as a doctor?
Yeah. I would say it's right now, I'm setting that target for somewhere between six and 800 patients.
So we'll just see, it's really just going to depend on if we get to a point where we feel like we're not able to still provide that sort of same day or next day service, it seems like things are just too busy then, maybe we'll cap it before then, but that's just generally what we're aiming at to see if it feels sustainable
How did you determine your pricing?
A bunch of different. Factors went in there. It was definitely helpful to be on the like all the great work that Josh umber has done with the resources that are available through Atlas, on how to determine pricing. Now that's all been super helpful and studying that stuff for years.
Also just looking around in our community and seeing what sort of the community seems to support. There are other direct primary care practices in our area. And then there were also full-on concierge. And so trying to find some middle ground between that I think was helpful. So we've landed at right now at about a hundred dollars a month for patients in $20 a month for for kids.
If you're doing month to month and then, discounts for yearly stuff. So we'll see, we can always tweak that as needed, which is one of the nice things about direct primary care. You just adjust as you go, but that feels like it's a sweet spot. I think in the middle it's affordable for just about everybody.
But if we hear that it's not, then you know, we can always change it.
In terms of the offerings you have listed on your website you have listed urgent care in depth, annual physicals, body composition analysis and prescription programs. And so I was wondering for things.
An urgent care after his visit or a body composition analysis, are those things included in your membership or are those things separate?
Yeah, those are included. So the body comp analysis is really it's it's basically just a machine, that we bought that can really help us with that.
And I think it's a lot of fun. It gives us a lot more information than a traditional sort of BMI. And that's something too where I feel like it's a good draw for the clinic, so one of the great things about direct primary care, I feel like we can experiment with these technologies. We don't have to wait around for Medicare to figure out if it's going to reimburse us for it or not.
We don't have to just use a scale anymore. We can use these these types of machines and, give us a sense of what our body fat is, which is by the way, also a very humbling experience to, to get that sort of feedback on how small my arms are and how much smaller my legs were.
Then I thought that they were in terms of muscle mass. But anyway no, that's it's been super fun and that's a way that's a draw for the clinic. I think it's a fun thing for us to be able to go to gyms and say, Hey, by the way, if you have anyone out there, who's going through a a get fit sort of program.
And they w you want to send them for a body analysis. We're happy to do that. We get to partner with gyms that way. So it's definitely a fun outreach. And then for the urgent care stuff we want to be able to do that for, our members. As it's become available. So that's another reason that I'm really eager to stop this sort of outside Moonlight moonlighting thing so that I can really be available as needed for my own patients on the weekends or after hours.
But we haven't had to deal with it yet, but when we do, I hope to be able to just be able to pull over and see folks in clinic or do house visits as needed.
When you're describing how you came up with your price point and looking to the local community for what was a good middle ground for you, I want to ask you also about your market research when it came to insurance prices, because you have a table on your website where you compare what it costs in your direct primary care to what it costs in your community.
If you were to use insurance, and I'm wondering, with your experience or the urgent care? Did you know some of those prices beforehand before making the infographic? Or how did you find that?
Yeah, totally stole that from the urgent care that I was working at, because we do have a list of the cash pay prices.
And that I think is still so fascinating that if you go into a hospital-based urgent care, now they've got these cash prices that might be as much as 72% off of the insurance rate for these procedures. But it's still nowhere near the sort of the wholesale cost of what these things cost.
Like I saw, I've seen a patient the other day at at this moonlighting clinic and she's a medical student, she's a second year medical student, but she's away from home because of COVID. So she's studying for her boards and she had a question about some muscle cramps. And so I thought great.
Let's just get a BNP. So she's technically, she uninsured with where we were, she was cash pay and she's what's the price for it? BNP? And I said let me go check. So I go out, I pull out the list and was flabbergasted to see that the BMP was $55 for the cash pay patients. And the CMP was $77.
And I told her, I was like, I don't think it's worth us getting it. It was pretty minor when she was in there for it. I was like, let's not get the lab because it's so expensive in my clinic. That lab is a dollar 50 and the CMP is a dollar 70, why is there market? And that's for cash price, the insurance, what would get billed for insurance is just absolutely astounding.
The way people get ripped off in the traditional healthcare system. It just makes me mad. So yeah. I don't know.
The discount off of expensive is still expensive,
right? Yeah. And that was eye opening for me to learn. I learned that from Brian Forrest and his practice that, the reason.
You can't just walk in off the street. Let's just say, my brother owned a primary care clinic and I didn't have insurance. And I wanted to go in and he's oh, you're my brother. I'll give you this great discount on your health care or whatever. He can't charge me wholesale prices for things because he signed these insurance contracts with blue cross or whoever they won't let him do it.
You can still give a discount to cash pay, but still it's nowhere near the actual cost of delivering these things. Primary care does not have to be expensive. It's insurance that makes it expensive. Man, I wish I could just shout it from the rooftops. It's really, it's destroying healthcare.
I just want to highlight what you said in terms of that you had this information from your urgent care.
And so if you are looking to develop pricing for your own practice, that is definitely something that you can do is literally call your local urgent care and ask them because you technically are a patient as well. If you potentially would mean something and have to go there, you would want to know the pricing.
So you can transparently find out pricing from urgent cares around you by just calling. And it goes beyond just getting the cash pricing from imaging and love centers.
And I found what feels the best is for that sort of thing. I like the idea of just including it with the membership and not really even just charging that dollar 70 or whatever it is, onto the patient.
So I try to roll as much of that really into the membership for free, as basically a covered cost. I know there's different fields of thought on, whether we should do that or not. But for me, it just, I feel like it feels better and it, to my patients, it's just been astounding. They're like, I just walk in and I get these labs done and there's no extra costs at all.
It's just fun to be able to say no, we got that. That's what we're here for.
I wanna point out too when someone's even looking for the price of a medicine in particular, something that you can also do to find out your local prices on medications is.
Contact your pharmacy and make friends with the pharmacist and, you can call them and ask them, how much does Metformin cost if you were just going to pay cash for 30 days, just from your perspective you can always find on good RX, you can type it in. But I found that in our local pharmacies, there's two major companies and the pharmacist, when I have spoken with both of them, it's sometimes different than what good RX has listed.
And so it would be interesting. Yeah. It's another tool to have in the toolbox to, to make good friends with with people who are in the system still to know what your competition is like.
Yeah. And I've found in talking with pharmacists too, that they seem to be just as frustrated with the system as we are, it's, I feel like I have this conversation every time I accidentally send in the wrong eardrops for swimmer's ear, for my patients, when they get to the pharmacy and they're like $280 for separate exit, it makes no sense.
And then they call me and they say, would you like us to switch it to the $8 alternative? And I say, yes, please. That would be fantastic. I wish I could know that ahead of time. Whenever I send this stuff in and the pharmacists, they're just as frustrated, I feel because we are at this sort of cloud of secrecy over
pricing.
Absolutely. I go back to Dr. Natalie Gentilly, how she's working with blueberry pharmacy, which is a cash based pharmacy. And they have a collaboration between her clinic and the patients who go to blueberry pharmacy because of that frustration.
Exactly. And, I think about it, my best friend from high school. She is a pharmacist and she, during my years in medical school and residency would occasionally have a conversation with me about a certain medication and would be exasperated that this exactly what you're talking about.
Like, how does this pill, this generic pill that's been on the market for decades? How does it cost this much when a person uses their insurance? And it highlights the point to that. As DPC positions, the mindset is not to, make the most money by upcharging on every medication that we have available to our patients are upcharging for the fact that you have a body composition analysis.
And pharmacists also are not sitting there, like, how could I make the most money off of this,
yeah. Stroking their mustaches. Evily no, it doesn't work that way. It's just the way the systems are built that are obviously skating, this important information.
And I wonder if you're opening a practice or even if you're already in practice, if you haven't reached out to your pharmacy needs that the, if you hadn't reached out to a pharmacist who might be in a bigger corporation, I just wonder if I can imagine it making a big difference in terms of you standing out to that pharmacist as, wow.
This doctor actually called me about a particular medicine and asked me to contact them. I noticed that there could be a cheaper option for their patient. And so just opening that line of communication could be really helpful in terms of getting information easier or getting better prices, especially for your patients in the future.
Totally. I'm sure you've seen this in your practice too, but I've even just yesterday, I was on the phone with a patient who needs to be seen urgently with by endocrinology. We're concerned that maybe she has thyroid cancer. We don't really know, but it, I was on the phone myself with the endocrinologist and their scheduling team trying to get this scheduled.
And I was texting my patient by the way while it was going on, just telling her, when it would all happen when her appointment would be and all that sort of stuff. And just, I feel like being the physician and being on the call, it's not it's not scutwork, it's, that makes a huge difference doors open magically.
I think when we are able to spend the time and pick up the phone and make these connections for our patients and plus it connects us with the local specialist community and that sort of thing or pharmacist or whoever. So I do think I want to, still maintain that sort of personal connection and not just the asking my nurse all the time to be able to make those calls or those sorts of things, because there's value.
I think in us doing it.
What I'm hearing is it also fills your cup and that it's an extension of how you can help people, not just over the phone or in person.
Totally. Yeah, absolutely. It just felt like a service. And and I think the patient felt that way too.
Now when a patient signs up for your practice on your website, there's a button that says sign up.
And so what happens on the backend after a patient hits that signup button, then they sign up to be a member of your practice.
Yeah, it it does, it creates a little file for them in our member management software, hints, like you said, and then that does connect with our EHR, which is Alation. And so it creates a little file there. And then it also creates a file in our member messaging system, which is called spruce. So those three are all tied together, which is really helpful.
And and they're linked. So we can pull that information from one program to the other. So yeah, all that was on. And and then we just try to do our best to make sure that we are shepherding the, our patients through that process and identifying what these different programs are, because they're probably going to start getting emails from the EHR has separate emails than the, our messaging system.
So there is an educational process to onboarding the patients to these programs. But so far it's gone pretty smoothly. It could be a little smoother, but it's been pretty good so far.
And do you find most of your patients are signing up before having a meet and greet visit or do you find that patients want to have that meet and greet visit before they sign up?
That's a good question. So far I would say 80, 80% of our patients have we've talked ahead of time, so we schedule sort of 15 minute free consults, about our practice or we will invite them over to the practice and have those talks in person. And that's been really helpful.
So there are a few folks who just randomly wander into the website and sign up and I've never heard of 'em. I don't quite know, you know exactly who they've been talking to or how they heard about us. And that's fun to see, where, how did they, how did that happen? But yeah, for the most part, I do think spending some time with patients ahead of time and introducing yourself and, the style of practice pays off a lot.
Fantastic. And one of the ways I'm sure that people have met you to establish that relationship before they officially sign up is when you've done public things like tabling. And one of the pictures that you have in your social media is of you tabling with your band or with the QR code, which I thought was genius because everybody has a cell phone these days.
And in terms of, if you were busy talking with somebody, somebody can still be learning about your practice by scanning that QR code. So I wanted to ask, was this a marketing strategy that your marketing team said? Or how did that all happen where you'd have a QR code on your banner?
That was my wife's plan.
She's going to be so excited that you're talking about that QR code. Oh my gosh. I'm never going to hear the end of it. That's a, yeah, no, C a C helped design all that and tried to put a lot of thought into it as well. So yeah, I think that's fun too. I think the fun thing about DPC is that there are for younger folks who know what QR codes are and have iPhones and things like that and understand how all this works.
We want it to feel like second nature for them. For older folks who don't quite get that and we also want to be accessible to them. So I think that's, what's fun about ourselves. As we can spend more time with folks who may not have a cell phone who knows and really walk them through that process.
And maybe it does take a little bit longer, but I do feel like we have the ability to be all more like all things to all people, with when it comes to technology and reach people where they're at.
It's interesting that you talk about the differences in age and the adoption of technology there.
I was speaking with my cousin who does graphic design on the side and one of the things she said was, especially for a medical clinic, think about that generational difference and think about the people who might not have internet, who might not have a cell phone who might have a cell phone, but it is a flip phone and have your phone number easily accessible.
So if there is a barrier to accessing you in terms of contacting you, that potentially is a lost patient. So have that phone number directly on your on your header page so that at wherever somebody finds you, they can still contact you without having to scroll down to the contact us at the bottom.
Yeah. We've had this debate too, about things like refrigerator magnets. Is that a good idea? It's, it seems like it would be convenient. My wife is pretty sure that it seems a little outdated and that people aren't as excited about refrigerator magnets, as I may remember.
But maybe stickers or something like that would be a little better of a tool there, but yeah, that, I think that can make a difference too, especially for somebody who's not able to, who does have a flip phone because I, I've seen patients, who've got the phones and they're pulling them out and they're rifling through them.
And so yeah, maybe magnets would be the way to go.
I will say that my patients who love their flip phones, for the most part the handful of people that I'm thinking of, they're so attached to their flip phones because they feel confident using it. And so I feel that whether that be fridge, magnets or something else in addition to fridge, magnets finding out what your patients are using or what they're liking is definitely helpful.
And how do you achieve that? You could ask them. At their visit, you can ask them in a, quarterly questionnaire about your practice. There's lots of ways to do it, but I feel that, just the fact that you're paying attention to that and debating over it is really a different world than if you were in fee for service and you would never, ever debate fridge magnet or not.
When you talk about how a person can need some onboarding to understand what's going to happen in the initial days of the practice, do you have patients who still after they've been enrolled don't remember that they have these services that you offer accessible to them?
Yes. And it is frustrating. We don't offer a lot of urgent care straight in, off the street for people who aren't patients. However, we have started working with some local chiropractors and physical therapists who might be seeing somebody in clinic and, have something medical going on and need to be seen quickly.
There's a patient that I can think of who was technically an urgent care patient. They'd come from a chiropractor a couple of weeks ago and they saw them. And the way we're doing that right now is we do enroll them at a discount. And we talk about how this is a monthly membership.
I'd be proud to be your doctor, that sort of thing, you can count. After a month, but basically this visit and any visits you need for follow-up for the next month, they're all included in the membership and the whole nine yards, you can text me all this sort of stuff. And so then there was a patient that I saw who they needed some imaging and we got that done.
And we're having a lot of pain and then probably needed to see a specialist. And I had done what I thought we had done a good job, following up with them, even though they were likely to drop off as a patient. And then I just happened to be checking the electronic health record of the hospital system here recently for a different patient.
And I saw their name pop up. It's fair enough. They had gone to the emergency department for ongoing pain related to the issue that we had seen together. And then from the emergency department, they really hadn't done much except also refer them out to a specialist. But, so that was frustrating because that was I felt like we had spent a lot of time talking about, Hey, I'm here for you.
Don't go to the emergency department, don't go to urgent care. We'll get all this sorted out, to the best of our ability and it still happened. So I feel like that will probably happen. And but I do want our folks to know that we're here to try and keep that from happening.
Yeah.
It's definitely a culture shift, right? We're so used to, is this covered by my insurance and that mentality. We are changing that as the direct primary care movement is changing that mentality. There definitely is some of that residual, even when patients sign up for DPC.
So I remember Dr. Rebecca how're said, she tries to impress upon her patients. If you have any medical question asked me first, because there's a high likelihood that I can help you and then think about, going off to somebody else. But I think that having that general sense of asked me first is very easy to remember for a patient when it comes to anything medical.
And I do. I hear you when you know, that is very frustrating, especially when you're capable of handling the, certain situations, especially something that you had already been working on with a patient. And it's it goes back to also how we have to not train our patients, but we have to impress upon them.
This is when it's appropriate to call. Like you don't need an urgent refill of Tylenol at Friday at 5:00 PM. So it all goes together with. Relearning, of, how your clinic works and how you work as a physician with them because you are working for your patients now.
Yeah. I find that it's such a rewarding mindset. I've found since leaving residency and having worked in the urgent care for a few years while I was getting my footing in this new area that we moved to. It's, there's it's different. I feel like when you're seeing a patient in an urgent care setting and you know that they're not your patient, you still want to provide good care for them, but that sense of responsibility I think, is not there just inherent.
And the patients pick up on that and it's been so rewarding to be back in this primary care world and feel like these are my patients. And I really do care about what's happening with them. And I want to help them even after they leave the clinic. And I will spend time thinking about them at night.
Whereas I feel like the urgent care setting, it's easy to compartmentalize that for me, it is anyway. But I missed it. I feel like that's so rewarding. That's why we went into primary care. I think to begin with, we thrive on that sort of responsibility. So it's fun to be there.
It is absolutely fun.
And it's such a cool. Profession and calling to be in primary care. And when you say that, what I think about is how, when I was on maternity leave, my husband would ask about a patient of mine. He would see in clinic. And I would say all of these things about their backstory, did you ask about blah, blah, blah, because did you know that she or he does blah, blah, blah for work or that three years ago we had a referral out to blah, blah, blah.
And he's that's really good information to know because I did not know that. And when a person is in primary care and is capable as a physician of taking care of 85 to 90% of of issues. It is very much rooted in the fact that we know our patients. And so when a patient continues to work with us and know us and the direct primary care physician is the first person to go to.
When you have a medical question, it just really hones in on how valuable this model is to save healthcare in America.
I a hundred percent agree. yeah, it's what we should've been doing from the beginning. And it's sad that we got away from it, but I think it's making a comeback.
When you were hiring Alison, did you post jobs where you were trying to explain the mission of Ember modern medicine, or did she find you, how did that all work out?
I got insanely lucky in that I had worked with her previously at our local urgent care.
So she we knew each other. I knew she was a great worker and and she just happened to be looking for a change as well. And yeah we talked about the model because I don't think she was familiar with it to start with. No, she's just been great. And so luckily everything has really worked out well.
I anticipate, because I hear this from other doctors like Shane Purcell who's here locally, there can be trouble hiring in the future as you grow as a practice and how tricky that can be finding somebody who's onboarding. And that can be a nurse, or that can be a doctor, whoever.
But I anticipate that's going to get a lot more difficult if we grow, to be able to find somebody who sort of shares that same vision, and it's going to take a lot more work than it did take for me with Alison.
And in terms of the way that you guys manage your practice, is Alison serving as a medical RN, in addition to doing things like back office front office type roles.
Yes. She, and we talked about this from the beginning that this would probably be a role that would need some flexibility in it because even at its busiest, if I had a full panel, I anticipate that still going to be often a quieter day than it was back when we were working.
And our urgent here. But she's been great and really hopped on board. In fact, one of the big projects for us has been figuring out how this vaccine rollout is going to go for the COVID vaccine. And I basically was able to put all of that on our shoulders, and she's done a great job managing that because golly, that is a complicated process registering with the state and having to document where all these vaccines are going on multiple different websites on a daily basis.
And then making sure that our refrigerator is at the right temperature and our freezer twice a day, every day. She's just been invaluable in having to figure that out. And it's been one less thing that I've had to figure out as the clinic's been getting off the ground. So yeah, it just, I could not say enough great things about her and how great she's been for the team.
But I do think, yeah, it's, I don't think people from a traditional medical world are going to have an easy time making the change because this is just for every role in the clinic, I think is going to need some flexibility and need to be able to roll with the punches and grow and change and adapt, which some people find fun.
And some people are terrified of that and probably want nothing to do with it. So finding that right person, I think is challenging.
How did you handle her contract in terms of how do you reflect all of those roles in a contract?
That is a good question. I don't think we actually have a written contract, so we didn't have to have we done?
Nope. Just hired her. Don't have a contract, but now that you mentioned that we probably should put one together. Thank you. This is actually been very helpful.
It's an honest answer. So that's that's great. It just food for thought, especially just even as you grow having something that changes with your practice over time, as your roles change and potentially get finer or broader.
She is part-time with us too, I should say. So that has been also pretty helpful because we really, it would be hard to hire her on full-time from the get-go along with the rest of our other overheads. So she's been pretty flexible as far as that goes.
And in terms of your practice in the future, what do you think you're going to focus on for your clinic in the next six months versus the next.
I think what we would like to do, one of the goals that we have is really helping grow this sort of health and wellness community in our town of Greenville. And so we've been really trying to identify other business partners that we could come alongside with and would be able to offer sort of member benefits to our members.
So we really want to grow the sort of health community and make it a little more interconnected. And so I think as we identify more and more of these businesses really trying to make use of this teaching, the shared teaching space that we have and really get an event calendar going and and really come inside, their businesses too, in any ways that we can.
Like there's a local CrossFit group that, we've been partnering with, who I hope to, they have a 40 days to fit a program and being able to come in there as a doctor and be able to say, be able to help follow these patients slash CrossFitters, through this process of getting back into the swing of things I think is can be a valuable service.
So I think that's, I think how we're going to really spend the next few months is networking, growing and identifying other businesses that we can partner with and try and help as much as we can.
Beyond the first year of your practice.
My goal is as soon as we can afford to do so to bring on a female physician so that we have a male and a female in the office. Cause I think that's going to be really helpful for attracting patients and just for our community in general.
And then we do have space to grow in our building. So we do, I'm by myself at the moment, but I'm eager to have other folks there with me. I think that's going to be a fun for us as we can grow. So I think, hopefully within a year we're able to maybe bring someone on at least part-time and then continue to grow that.
But I think really, I don't know if your community is like this, it must be, but there are, I feel like you could have a primary care office on every street corner in the same way in our community. Right now there are a dentist's office, like every bridge, you can't throw a stone and there's, it doesn't hit a dentist's office in our town or chiropractors, same sort of thing.
But primary care should be that way. It could be that way. So I really feel like if in the future, this goes well that, we could expand and there's just a huge need for it here,
and I just think about how, as you're working in this first year in terms of getting the word out about your practice, getting your expertise out there as a physician.
I think that you never know who's going to listen. And so you could potentially have already started that chain of events that leads you to your female physician joining you or your next nurse joining you, or the next, chiropractor to refer someone to you. So I think that it goes back to just any time you get a chance to tell about your clinic is it's not a bad thing.
Totally. And the other thing that I've found in starting up a clinic here is having worked at the urgent care. You just see, tons of people. And as I was trying to get the business off the ground and talking with local banks and stuff that I can think of at least three key times when I was talking to somebody who had seen me in clinic at an urgent care, and I had no recollection of the event and they would say, Hey, I think I saw you.
Or so whoever, or my banker, it was like his key assistant had seen me and I go, gosh, I hope it was a good experience. And they said, yes, because it might not have been, but I think it pays to be nice, in every circumstance, because if any of those three key people, if they had a bad experience when they were in there, I don't think that we would have gotten the approvals that we've gotten and that sort of thing.
And sometimes those were years in the past that I had seen them, but they still remembered me. And gosh, so you've really got to, you can never really let your guard down. You just gotta be who you are and hope for the best.
Very cool. And along your journey, in addition to the resources that you've mentioned like Laura's company, like Josh numbers, article and pricing how you found your pricing in your local community from your urgent care work, as well as the tech that you use to run your practice.
Are there any other resources that you found useful or helpful along your journey? Especially coming from a journalist perspective. I throw that question out there as a wide net, because I feel that you might have a resource that you've used for years and you might not think about sharing it unless someone directly asked you that.
So that's why I love this question.
That is a good question. So here's something that I've found. I think that my experience in journalism, I was in broadcast. And so we would have this need to find people to become on air at the last second to talk about whatever the story of the day was.
And what I found was it was way more valuable to find somebody who was available when you needed them, then whether or not they were great on camera, that availability covers over a multitude of on-air sins as it were, so I think if a journalist, if you have any relationship with a journalist and they come to you for a story or for a question, if you can, don't say no and try to get back to them, if you can, it might mean in some cases, canceling your clinic for the after.
And going into be ready to work with the local radio station or TV station or something, but those opportunities are just absolutely golden. And if you can get in the good graces of one of the bookers that you're working with then by all means do it because it will pay off in ways that you can't even imagine.
And I've seen it happen, a hundred times. And that would be my advice, I think, from a journalism perspective, if that opportunity arises, don't turn your back on it. And I know the thoughts, you don't have that much experience on being on air. You're going to say the wrong thing, whatever everyone's got those thoughts, but you gotta start from somewhere.
So don't let those get in the way.
Excellent advice. And I think that it, it just reminds me how all of our experiences feed into who we are as people. And so the fact that you were a journalist prior to becoming a physician, I think that you just dropped a gem on people, especially if they're struggling to get exposure in the media.
Yeah. And it doesn't take much. You don't have to reach out to the New York times for anything really. There can be the way journalism is working right now. There's a lot of overlap in every field imaginable. And you could be talking to somebody from what you would consider like an obscure website, but they happen to be a freelance writer and they do work for a major organization.
You would never know it. And it's usually. Pursuing those opportunities when they arise, if they arise.
Awesome. And Dr. Blink, what is the best way for others to reach out to you after this podcast? If they want to connect,
you can call or email. I'm happy to take any talks or take any calls. My phone number is
8 6 4 7 0 2 2 3 6 5.
That's our clinic number. It goes straight to my cell phone. I'm happy to chat and go over any questions. Anyone has. My email is Brian@embermodernmedicine.com.
Thank you so much Dr. Blank for joining us today. Hey,
this is my pleasure. This is so much fun.
Trancript generated by AI so please forgive errors.
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