Direct Specialty Care Doctor
Dr. Becky Kaufman Lynn is the CEO and founder of Evora Women’s Health.
A southern California “valley girl”, Dr. Lynn completed her undergraduate degree in Economics and Spanish at the University of California, Berkeley. She graduated from medical school at Georgetown University in Washington, D.C., and completed her residency at Washington University in St. Louis. She also received her MBA from Saint Louis University.
She is a board certified gynecologist and a world-renowned expert in menopause and sexual health. She is a frequently invited guest speaker on women’s sexual health and appears regularly on numerous podcasts, television shows, radio shows, and in print. Known for her patient/partner education YouTube channel, and her research on the effects of cannabis on the sexual experience, she has been featured in MORE magazine, SELF magazine and Martha Stewart Living.
Dr. Lynn is an International Fellow of the International Society for the Study of Women’s Sexual Health (ISSWSH), where she serves as the advocacy chairman and a member of the Board. She is the Immediate Past President of the St. Louis Gynecologic Society and on the Advocacy Committee of the North American Menopause Society. She is also an Adjunct Associate Professor of Obstetrics and Gynecology at Saint Louis University School of Medicine.
Dan Savage Podcast with Dr. Lynn:
ARTICLES BY DR. LYNN
Resources mentioned by Dr. Lynn:
- Emsella
CONTACT:
Website:Evora Women’s Health
Phone: 3149340551
TRANSCRIPT*
Welcome to the podcast. Dr. Lynn, thank you. Thanks for having me. I'm so excited to be here. It's such a pleasure talking with you. I went to Creighton and so St. Louis is not too far away, so it's, it's not something to speak with you. Yeah, and I was born in Omaha. Oh my gosh. I grew up in California, so, yep.
Born in Omaha. That's awesome. We switched paths. I was born in Sacramento, went to Omaha for medical school. That's so crazy. Yeah. Thank you so much for joining us today. And I wanted to start off with. Something that I found really beautiful on your website. And one of the very first things that you read on your website is the quote, helping women find solutions to uncomfortable problems in a comfortable environment.
And I just love that because I feel like that is the type of energy and inclusion that I would love to feel as a patient. And I would love to have all of my family members be a part of. So I wanted to ask, how did you come up with this? And what does it mean to. So a lot of what I do as a gynecologist is I specialize in sexual problems in women and menopause.
That's my niche. And as you can imagine, talking about sex is really difficult for people. It's not difficult for me as a gynecologist. I can say the words, but for many women we've been taught, oh, it's shameful. You're not supposed to enjoy it. And so a lot of what I do and, and where I think. My skills are, is I feel like I can put people at ease and I'm nonjudgmental and I make people feel comfortable.
And when I sat down to do my website, I was just trying to come up with something. How do I put all of what I do and what I can provide for patients in one sentence, it's not very easy. And I have a really good friend who I run with all the time. I'm a runner, and she's listening to me talk about starting up my direct care practice.
And she really understands what I do for women. And she came up with that tagline. And when she said it, I was like, oh my gosh, that's it. That is definitely it because it just encompasses and embodies what I can do for people. And what I enjoy doing for people kudos to her and kudos to you for practicing what is behind that statement?
Before you opened Avara woman's health. What was your life like in terms of your experience as a physician that pushed you into opening your own? You know, I've been in practice for 17 years and when I started practice it, wasn't what it is today. I had spent the last oh 10, 11 years in academic medicine.
I love teaching. I love academics, but it had become so burdensome and so cumbersome, even in academics, because this is my opinion, because reimbursement goes down each year, big hospital systems need to do more, to bring in the same revenue. And so what was going on in my institution was you need to see more patients.
You need to see more patients. They took away our academic time, teaching time. They took away our research time and they said, you need to see more patients. And so I would see tons of patients during the day. I was, I did deliver babies at that time. I don't now. So I work overnight. We had to work the next day a half a day, which I'm not a good physician on no sleep.
I didn't like that either. Every other institution I had been at, they let you have the next day off, but it's all about the revenue, right? If you don't work the next day, you're not bringing in revenue. And then I did all of this. I don't even know how many hours a week that I worked. And then I would come home at night and I would have to do all my charting.
So my life was working all day, minimal sleep, charting, working on my electronic medical records at night. And it was like, this is not. You can't do this for the long term. And because there were so many, there were so many things that were going on and I don't want to say negative things about my organization, but there were a lot of things going on that need that lifestyle.
Unsustainable. And the other thing that I didn't like, there were a couple of things that happened that made me say I can't do this anymore. One in particular. So I see a lot of women with sexual pain that is not a five minute visit. You're not going to be a good doctor. If you try and uncover what's going on in five minutes.
And I remember that I saw a patient and I was in a rush because I had people waiting because you're overbooked and I left the room and I'm like, that was not good care. I didn't have the time that I needed to devote to her. And I felt so horrible about it. I emailed her later. I'm like, did we not get a chance to discuss this?
Did we not get a chance to discuss that? And I was like, It can't be done that the care that women need, and especially on embarrassing things like sexual problems or menopause, which like there's a long list of symptoms that happen to women. When they go through menopause, it can't be done in a five to seven minute visit.
And I just really wanted to practice good medicine and give patients the time that they needed and deserved. So that's why I left. It just makes me think how, when you share that part of your story, when you share that part of your history, I'm picturing none of that is what you envisioned your life would be like in medicine, in the real world, those of us who went into medicine to be caregivers as a profession and as a calling, it is so heartbreaking to hear those words and those words evoke in all of us that frustration.
That we've experienced in a system that's employed and run by insurance because it, it makes me also think that the administrators, the people who are pushing us and not standing up for us and our patients don't feel that guilt that you described when you were feeling so terrible about your care for another person because of time.
Yeah. No, they don't. They're very far removed from that. And it's all about the money for the big, I call it corporate medicine. It's not about patients and there's, yeah. It's not a system that is patient centered at all. It's not patient-centered absolutely. And I we've talked about this on the podcast before, but I want to see again, I am very glad that patients are becoming more and more aware of that, especially because of the.
Nope. Now I want to ask you about teaching, because you said that you loved the academic part of your career, and that was taken away from you little by, little as you were pushed. So when you were exploring direct patient care, direct specialty care? What did you envision in the realm of academic medicine when you decided to transition over?
I feel like there's two parts to academic medicine. One is research and one is teaching and I love them both. And I felt like our teaching time was being taken away. Our research time was taken away and I also am a big believer in. Conferences and networking. Like I consider myself a specialist, I'm a specialist in menopause and sexual medicine, Lana, a gynecologist.
And I really believe that part of calling yourself a specialist is knowing what the latest data shows, knowing what the evidence shows and truly being an expert. And you get a certain amount of CME time. And when I started my organization, we had two weeks, they took away one week, we had one week they gave you limited funds to go and you, and so I really felt I was, I remember when I found out that they were taking away CME time and I was so flustered because in general, Physicians in academic medicine make less money than in private practice in general.
But we do that because we love teaching and we love research and we love conferences and we love evidence-based medicine. So when they took away that CME, I was so upset because one of the joys that I get from practicing medicine is learning. I'm a lifelong learner is learning. What is the evidence show learning about something new learning about the latest treatments.
And, and I really was very flustered with losing that. And I also really had no flexibility within my schedule. And that was another issue I had to give them two months notice before taking any time off. Yeah. Okay. Conferences in advance when they are, but like I have two children. And so I didn't always know two months in advance when something was going to happen.
And I feel like that was really tough. And I understand why they do that because you don't want to have to reschedule so many patients, but that really got in the way of me being able to. Do the kind of networking and conferences and learning that I wanted to do. So that was another reason or how I envisioned going into practice myself is that I had control of my schedule when I wanted to do a conference.
I didn't have to ask anybody if it was okay. I just went to, that was, that was something that was really important to me. Cause like I said, I am a lifelong learner. Can you share with us some of your most treasured experiences as a teacher? Yeah, I would say I've taught a lot of medical students in my time.
And when people come back to me and say, you're the reason I went into OB GYN, or I remember that night when I was on call and you were on call and we had this great delivery like that. The most rewarding thing ever, because you feel like you just, you it's almost like we're, we've become physicians because we like to help people.
So it's almost like I helped them like get to where they wanted to be in their career. But I do love that. I love, I'm always interested to know where my medical students got their residencies. Where are they practicing? I love it when my former students or residents will like text me or email and ask me a question about a sexual problem in a woman.
I just, I love it. Super rewarding. I just, I think back on my days in residency and I think less so in medical school, but definitely in residency for me, your attendings, especially if you are in a very close knit program, they become like a big sister or big brother to you. And they really. I mean it, especially if you're lucky enough to be in a program where you feel that you are so supported and your attendings are helping advocate for you getting the best training and the best education possible.
And those experiences are absolutely life-changing. I still there's one doctor who is in his eighties and he he's a former attending who goes skiing up the hill where I am, and he stops by and we have in a non pandemic year, we would have dinner together every time he would be around here. And I just, I love that because you're really describing that the relationship that you have because of your passion for teaching others and because of your passion for being involved in moving other people's careers forward.
So I just really love that. And again, it just, it makes me feel the same feeling as when I read that statement on your website, it was so how did you learn about drug specialty? So I actually really didn't know much about direct specialty care. I knew nothing about DPC. And I knew though that people in my specialty, especially in sexual medicine, there are a couple of very smart, very successful, very well known physicians.
And on the coast, I'm in Missouri and I knew they didn't take insurance. And I always thought, oh, I can't do that. No one's going to pay like they don't. But with all that was going on, I was like, other people are doing it. Other people are not taking insurance. So I started looking into it. I started talking about it and the, what does, she's like one of the marketing people at my organization, my prior organization she's oh, Dr.
Lou just left and she opened a direct primary care practice. And I didn't know anything about direct primary care. So I called her, I emailed her, something got in touch. She told me all about it. She left my same organization about six months before I did. And she's the one that introduced me to the DPC Facebook group, which has just been a godsend of wonderful information.
So I guess that the answer is that I really didn't know about DPC, but I knew that there were gynecologists who were not taking insurance. And so I knew it was possible, but then I found out about DPC later and I'm so glad I did. That's awesome. It makes me think about my conversation with Dr. Katherine Agricola, who said DPC found me.
And so I really love that, that you, as a specialist, Heard about this movement and are actively a part of it. That's wonderful. And I want to say like for I'm sure your guests have said this over and over again, but like DPC cut out the middleman. There's so much cost savings. If you just go directly between you and your physician and you don't end up with those same time constraints or nobody calling you back for three days, because they're so busy, there's so many benefits to the patient to being a part of DPC or direct specialty care.
There's just so many. And with you mentioning how part of your academic career has been in research and just being interested in research and ever-changing medicine. I want to ask, how do you keep up on things now with your practice? Not necessarily always being in an academic center. Yeah, I still keep really close ties to academics.
I still take medical students, but I still work really closely with some of my former partners whom I love by the way. So my organization has a pelvic pain center and I still, we send patients back and forth between us because they do, they have a MIGS program with minimally invasive gynecologic surgery for endometriosis.
And then I deal with the painful sex due to endometriosis. I'm also a sexual counselor, so I can talk about the relationship and work on that aspect, but we go back and forth. And before the pandemic I was going to grant. Which I love, but then the pandemic hit. And so I stopped going to grand rounds and then they started them up again, like in the fall I went to one or two and then they went away or went just virtual.
So I do try and maintain ties to academics. And I love doing that. And I had just wrote a paper with one of my former residents. Who's now an attending at my former organization and we wrote it on what we know about cannabis and pelvic pain. So it was super fascinating and it just got accepted for publication.
So I do try and maintain those ties. And even just today, I had a patient I'm not a Euro gynecologist, I'm a general gynecologist and she had some major bladder issues. So I'm just texting my friends, my former partners. And they're like, okay, we'll try this. So there's still that exchange of information that allows both of us to learn wonderful.
Hopefully. Those words can provide some reassurance to people who are also in academia or heavily involved in academic medicine. That could be and stepping away from that or doing less of that could be potentially something that's scary for them. So I hope those words help inspire others to say it. It can be scary, but this is one way that I'm dealing with it.
I think the scariest thing about stepping away really is starting a new business from scratch. That is the scariest part, right? Like you go from being a salaried employed physician with health insurance to being, you have no income when you start. And like you might, if you were the person who provided health insurance for your family, you may not have health insurance after Cobra ends.
But I think that is the scariest thing for, it was for me leaving, walking away and going, I'm not going to have a paycheck in two weeks here a month. I'm not going to be getting that paycheck. That's, it's scary if you're supporting your family, the point that you made the decision to open up a Varroa women's health.
What was your financial status in terms of, did you have loans to worry about when you decided to open up your, I did not. So I, when I got out of residency, I went, I left St. Louis. I went to Jefferson city where I'm, the salaries were much higher because it was hard to get physicians to go just cities, pretty rural.
And I was so lucky in that I paid off my medical school loans and my husband's law school loans before I went into academics. So I did private practice paid off loans. Then I went into academics and I took a pay cut to do that, but I loved it. I'm not sorry I did that at all. So, no, I feel fortunate in that when I left, I didn't have burdensome huge amounts of debt at all.
So that's very helpful. And as a specialist, just thinking about family medicine, residency versus somebody who's in specialty medicine. I know that the training can definitely be longer in terms of actual years in training, especially if you do a sub fellowship, but do you have any words of advice for those people who might be in specialty care or specialty and some specialty care who are looking to do direct here who do have loans or do have debts that they have say, number one, money's not everything.
Happiness is really important. And if you're miserable in your day job, and you're making lots of money, is it really worth it? But I do understand the financial stress of having a lot of loans. And I think it's, I think it's hard and you, because even when you start a new business, you're not gonna make any money.
Like the first year I didn't bring home a dime and every little bit that came into my business. Put it back in my business to grow it and get it started. And in my mind, and I don't, this is not evidence-based in my mind. I have this three years out where things are going to be good. They're not anywhere near what I was when I was in academics.
I'm still not making a lot of money. So you almost have to, I feel like you almost have to accept that it's going to be what it is for your own personal happiness and wellbeing. And if you're a happier person, you're gonna be happier at home. You're gonna be a better mother. You're going to be a better spouse or partner, or it's just happiness means a lot.
When you work for an organization, you just have a straight salary. Whereas if you work for yourself, one month could be really good and another month could be horrible. So you almost have to have a little bit of stomach for that kind of stress. But the way that I look at it is it's better than the stress I had before.
Now, when you talk about that particular space of being a little bit uncomfortable as your practice grows, how did you approach your own clinic when it came to pricing and when it came to your offerings? Because one of the things that you do offer, which I, it just blew me out of the water. When I had read about it is your pay, what you can Tuesdays.
So how did you go about that aspect of your clinic? Yeah. Setting your prices is really hard. And what I didn't want to do is be a volume based practice, which is what I left. I didn't want my income to depend really on seeing as many patients as possible, because that's exactly what I didn't like. And I really wanted to spend time with my patients.
I really wanted to give people the time they deserve. So I set my. I think it's on the higher side, but I couldn't abandon my patients. Like I couldn't, I just couldn't do that. And it bothered me, even though I did it, it bothered me that, oh, in this country, if you have money, you get an hour with your doctor.
And if you don't, you get five minutes. And that whole concept bothers me a lot. And I just, I had so many patients that I cared about and I didn't want to say, sorry, you can't afford me anymore. So I created our giving back to the community day, which is the first Tuesday or the second Tuesday of every month.
We've been doing it since I started. And I'll see whomever, anybody, they can come in, they can pay me nothing. They can pay me whatever they think is appropriate. I always say you can bring me a box of cookies. Nobody's ever brought me cookies and I'm still waiting. And I'm just kidding. But I love doing it.
I have a couple patients that have never paid a dime because they can't, and I don't care. It makes me happy that I can do that for the community. That's where that. That's awesome. And the idea that you can do whatever you want. That's awesome. And I'm sure it feeds. And I mean that, that idea of just feeding your soul because you are able to help the people that you want to help.
However, that looks like financially. I think that's really, that's so amazing to hear that you can still do that in this world that we live in. Now, I want to go into the other pillars or focus points of your practice on your website. You have categories, comprehensive wellness, menopausal symptoms, sustainable weight loss, improving sexual health, and you mentioned cannabis and pelvic pain.
And so I was wondering if you could share a little bit about how the practice of medicine looks like in your. Yeah, I think sometimes it gets confusing that I have, I'm wearing all these hats, like menopause sexual health, weight loss. So I'll tell you how all that came about. I started many years ago in just sexual medicine, so low libido, painful sex, but as you can imagine, there's a big overlap with menopause.
And so I ended up becoming a north American menopause certified physician and specializing in menopause and sexual health. But menopausal symptoms are not just hot flashes and night sweats. There's hot flashes, night sweats, weight gain, brain fog, anxiety, depression. And so many of my patients were coming in saying they just can't lose weight.
I'm not eating anything. I can't lose weight. And in my old practice in academics, I did, I always was interested in. Learning more about helping menopausal women or women in general lose weight. But I never really had the time. I only had so many CME days and not even got cut back. And so I, on those CME days, I would always go to the north American menopause society conference.
I would go to , which is the international society for the study of women's sexual health. So like I only had limited time to go to these conferences and to learn these things. So when I got into direct care, And then the pandemic hit. I started in February of 20, 20, the month of April. I was basically at home and I wasn't really seeing patients.
And I was like, now's the time that I can learn obesity medicine. And so I found the obesity medicine association. I did one of their courses. I did conferences. I would download webinars and I, and actually the obesity medicine conference starts tomorrow. And I'm going to it there truly, but I had time to learn obesity medicine, and then they also hook you up with a mentor if you want one.
And once I started helping people with their weight loss journey, if I ever got to a point where I'm like, I'm not really sure what to do with this. I have a mentor who's been doing it for years and I just text her email call and she'll answer my questions. So it seems like I'm doing all these disparate things, but they all over.
They all like sexual medicine, menopause, weight loss, they all overlap. And then part of menopause and part of direct care is you have time to focus on prevention. So in your five minute visit my five minute annual exam. Like you do your pap, your breast exam out the door. But I have time to go talk about exercise and nutrition and mental health.
I've come to realize asking about mental health is so important and maybe it's just the pandemic. And my primary, my previous life, or my annual, I didn't really ask about depression or anxiety or really get into those deep conversations. And now I have time and it really comes out and I love that. I can say, oh, we can refer you to a therapist or a psychiatrist.
We can help all aspects of wellness and wellbeing. So that's how I ended up in the prevention because prevention should be part of medicine in general, just in general. We don't do that in typical standard medicine. It's all about what's your symptom and let's treat it. And I feel like that's where we've gone wrong.
So they all overlap the SIC codes, not the health codes that we, that we work under insurance. Now in your practice, there are, I guess there are separate offerings that you have available on your website. And I'm wondering if you could share with us about what those offerings are as well as who are the staff that helps support those aspects of your practice.
We have a membership program, which is very similar to DPC where it's just a monthly fee and it's unlimited visits, direct access, things like that.
But we also do fee for service where you just pay for each visit separately. But I do have other offerings and it's, I have to laugh because when I decided that I was going to do this, I sat down and I wrote a business plan and I have my MBA also. And I like made a big Excel spreadsheet and these are my projections and this is how my business has gone on.
Nothing like that. Totally nothing. How I thought it would be granted. We had a pandemic right when I started, but it's nothing like that. So what happened was once I started helping women lose weight, I was like, we need a nutritionist. We need our registered dietician because I can't do everything. And so actually a running friend of mine.
Is a registered dietician. And she was very interested in weight loss and she had just gone to an obesity conference and we were running one day and I'm like, you should come work with me. She did. And so then we had a registered dietician that would see our patients and you didn't have to be trying to lose weight to see the dietician.
It's just healthy eating. And then I was like, well, we need a personal trainer because it's so important to strength, train and do cardio when you're trying to lose weight to maintain your muscle mass, to keep your metabolism up. So then we had a personal trainer, so then it just grew exponentially from there.
They're part-time, but, but quickly they filled up. So then we had another dietician. So we have two dieticians, two personal trainers, and then we added a mental health therapist. Who's amazing. Love her so much. And she just provides she's a mental health therapist and a life coach. And I already have learned.
So I love it when she comes and sees patients in the office, because then we it's integrated care. We can talk about it so we can come up with a cohesive plan, but also I learned so much. And then I sit there and I like, she has all these great things. I write them down and post them on social media because there's such good information.
And then we, because I do sexual medicine and dyspareunia, we added a pelvic floor, physical therapy. And then we ju this is all over a year, so it's not overnight. We added a massage therapist because one of my patients whom I love dearly, she's a great patient of mine and she's a massage therapist and she was like, you really need a massage therapist.
Maybe we do. And so we have a massage therapist and I love it because it's all important. It's all. Prevention diet, exercise and anxiety management massage. One of the things that is also noted on your website as an offering that you have is this idea of e-health and I don't mean to be, I don't mean to be campy when I say this, but literally what I envisioned is. DPC doctors getting groups of women together as if we were at a nail wrap party or a Tupperware party and zooming in to have a discussion with you about a particular topic that's prominent to the group of DPC patients.
And so I'm just wondering, have you already done this with DPC physicians or is this something that you're reaching out to build? Because I sure as heck would love to, I can think of a group of women just in my own practice right now, who would absolutely die for that opportunity. Yeah. Yeah. I have just one with, through DPC and it wasn't a group that was just one person, but she found me through her DPC doctor.
But yeah, I feel if you're out of Missouri, I don't have a license to practice medicine, so I can't be your doctor if you're in another state, but especially when it comes to sexual health and medical. It's not talked about and women always feel like they're broken. What's wrong with me? Why am I having this problem?
Or they didn't learn about menopause or is this normal? Why can I not remember why I walked into the kitchen? Why can't I remember what I did yesterday? And so it really grew out of this desire to teach, right? So to make sure that every woman has all the information that they need to make an informed decision about their healthcare and what they might want to do as they go through life.
Yes, I focus on mid-life I'm a basic gynecologist too. So it was really built out of built because I wanted to reach more people on your website, which I think is great because it protects you as well. It says. Type of session does not establish a relationship medically with you. How does that work out legally for you in that you're not establishing a relationship that you have to take care of them for a minimum of 30 days after you do a talk through. So it's more designed to, I don't want to be practicing medicine in a state where I'm not licensed.
That's really where that came from when I started this. Through my lawyer and talked about how, how can you do, and there's not a precedent, right? And there's a fine line between being between giving direct medical advice versus saying, this is how I treat my patients. This is how I manage hormones. This is what we know about hormone replacement therapy.
That's why I want to be very clear when I talk to people because I do get calls from all over the United States because people find me on the internet and I, and they don't people don't, they don't know which is totally fine, but I can't be a doctor. I can't practice medicine in California cause I don't have a California license.
But so I just, I don't, I want to be clear about what it is and it's not a patient physician relationship. And we also have them sign a release just saying that they understand that it's not, that I'm not their doctor. Another thing that you offer for patients who are consider for people who are considering becoming a patient is that you have a 15 minute free consult. And so I'd like to ask, what does that look like? And how do you, what are the nuts and bolts of that type of it's really important that I do this because people are coming and they're paying cash and it's expensive.
And so you want to know as a patient that you're actually you like this doctor, you trust this doctor and that they can actually help you because you want to know that whatever issue you're having is something that they can have. So I offer a free 15 minute visit and we do them in office or via tele-health and basically it's meet and greet it's.
What can I help you with? What can I tell you about our practice? What are the issues that you're having? And it just gives them a chance to meet me before they come in and have to pay money. And then maybe it wasn't the right fit. I liked doing it, at the end of the visit, do you just direct the P the person back to your website?
If they wish to? Oh no. If they want to schedule, then I'll just have my assistant get them scheduled. Yeah. Gotcha. You mentioned your assistant. I want to ask about how do you get your team and your coworkers to understand the mission that you have and how do you get them?
Not only to understand it, but to express it to potential patients. Yeah. So it's interesting that you would ask that I've noticed, I found my dieticians and personal trainers through common friends and things like that, or common acquaintances. But when I found my mental health therapist, my massage therapist and the pelvic floor, physical therapist, actually just the first two, I put an ad on indeed.
And the people that applied would tell, I think almost everybody, they read my website and they're like, this is me. I totally want to do this for women. So in a way, they came to me having the same mission. Which I think is great. And, and yes, I think there is a little bit of learning to do. And anybody who comes to work with me, like our, our therapist has learned so much now about sexual health and menopause that she didn't know before she was in women's health, but she had done mostly OB obstetrics.
The end. I don't know. I feel like. Yeah. I feel like most people who've joined my team have the same mission and vision in mind. I feel, I want to say, I feel really lucky right now because the bigger you get, maybe you'll end up hiring someone who really doesn't fit and knock on wood. I've been really lucky with who I have working with me.
And for me, I do want to add that my assistant she's a pre-med student. So I hired her when she was in her fourth year of undergrad. She was part-time because I had just opened my doors. So I wasn't very busy. So she worked part-time with me and then she's taking a gap year, but then she decided to end up taking two gap years.
She's going to work with me on another year. She's actually taking the M cat tomorrow and I'm wishing her good luck, but. She has been fantastic to work with. She is so smart. She is so motivated. She really wants to learn. She takes ownership of her job and in return, she's learning a lot, but we also, we published a case report.
She's got a paper and I'm so proud that I could get her name on a paper. And it, that just, I love doing that. And hopefully we'll make, we'll do an abstract for the north American menopause society, but she's an amazing amazingly smart woman and hardworking. And I just love her. I'll be sad when she leaves, but I think that was a great idea.
Going to the, like to the pre-med undergrad campus to find somebody that's excellent and potentially she can she's she might go away for a while and then come back and join you after she's done with residency. That's awesome. What is the website again? In indeed as for finding employees. So you can put up job listings and it's free, but they don't make it clear that it's free. Like the first time I did it, I signed up and then I got to the point. I didn't know if it was worth it. So I got to the point where you pay and I'm like, no, I'm not going to do it, but it posted my job anyway for free.
So they make it look like it gets not free,
And I have a good physician friend. Who's an ER doc and she's found several side gigs on indeed.
So it's really, for everybody, it's a good resource.
With you describing everything that is offered to your patients and your way of practicing medicine, I want to ask you about your space. Can you tell us about how you found your space and about what does the physical space. Yeah. So I was very lucky in getting my space. I share my office with a dermatologist.
He has three separate offices and he had rented this office, but he was in the process of hiring two other dermatologists. They hadn't gotten there yet. And so he had this, it's like almost 3000 square feet of office space and it's, and he wasn't using it at all. And so he was looking to sublease it and he was very kind to me and I couldn't pay rent for a 3000 square foot space.
When I opened his, you can rent. I have an office like where I sit, where my assistant sits. I have one exam room and then we share common space, the front desk, the kitchen, the refrigerator, all that. And, but over time, I'm still outgrowing the one room that I have, we have an M Selah, which is a chair that you sit on that contracts relaxes your pelvic floor.
So we put that in one of his rooms and he lets us use his rooms when he's not there, but now he has hired two new dermatologists. And so he's really over in my office. Now he's there Monday, Thursdays, and he's going to be there Wednesday. So I've started to look for new space and I'm really excited about having my own space.
Starting by subleasing in his office was perfect. And I have a month to month. I didn't have to sign five years or anything. So when you start a practice, that was definitely the way to go. But now that I've been in practice for a little bit over a year, we were looking at spaces and I'm hopefully going to rent my own space so I can.
Make it how I want it to be, but I don't have to be like, oh, can I borrow his room? So I'm really excited about the new space and we've narrowed it down to two and hopefully by August, I'll have some new space. So we'll see I'm in the process of negotiations right now. How exciting. In terms of the negotiation process, do you have any words of wisdom for other people to consider as they're, as they are also looking for?
Absolutely because I knew nothing when I started. So when I started, I just asked around, I put it out on Facebook groups. If anybody know of any office space, a sublease or whatever. And I also looked around on the internet and called a couple of spaces, but they want five or 10 year leases. And I didn't know anything.
I didn't know anything. So luckily I ended up where I am, but now over the last year I found out and probably most people know this, but I didn't that you can have a commercial real estate realtor. I have a realtor and there's two of them that work, but mostly one. And he basically tells me how the process works.
So he took me, we looked at all these spaces. He tried to get an idea of what I was looking for. Take me to several locations. And then he's okay, next step. We put out a request for proposals. So we narrowed it down. We sent out and he had it all. He has a template, was send out requests for proposals. Then those places come back and say, this is what we'll offer you.
And then he knows the next step. So one place that I'm looking at is just wall walls. It has been built out yet. I wouldn't know what to do with that. So he's okay. Next step. We do like a test fit. You have an architect come and just, and the landlord pays for this. Get, get an idea of how you want the space to look.
And then you can get an idea of how much it would cost. So you know that before you rent the space and obviously it's an estimate and estimates are, in my opinion for construction are always under estimates, but then you have some idea of how much it's going to cost to build it out. And the other thing about the realtors is they know like the, one of the spaces that I'm looking.
The realtors. I know they just gave a really good deal to this guy in this suite. So maybe they would take lower rent. Whereas honestly, like if it were just me, I'd be like, oh, that's the rent. Okay. I wouldn't, I didn't know. I didn't know. You can negotiate these things. The landlord sometimes will pay for part of your building, the office space out or redoing the current office space.
So they, what I found in the proposals that I've done is they give you a certain dollar amount per square foot that they'll put towards building out or redoing and that's negotiable. And I, I would assume that if a person is working with a commercial realtor in their locale, that commercial realtor will know the tips and tricks for their zip code or their county or state, whatever, wherever a person is looking.
Yep. And that could even be helpful. That could be especially helpful if you're moving to practice DPC in a state that you have not been in to live or to go to school. And you spoke about how you determined your pricing. You spoke about these community Tuesdays.
One of the things that you also offer is the ability to redeem a coupon or gift certificate. So I wanted to ask about what does that look like in your practice and how does one gift a package to another. So you can purchase gift cards on my website. And occasionally we run specials where you can buy a gift card for a certain dollar amount, which is less than the value of the gift card.
So you actually saved money. So, yeah, and yeah, we just sell gift cards. And part of that I think came out of, because I do sexual medicine in my old practice, I very much had wanted to be able to offer certain, I don't want to say sex toys, certain things. There's a lot of things out there to help with people's sex, life, sex toys.
And so I couldn't really sell those things in my old practice. So when I moved to my new practice and I could do what I wanted, I invested in some products that we sell. And so we put those on our web. And so then we were like, we should have gift cards. And so we sell gift cards that patients can use them for their visit, or they can use them to purchase anything.
And they just, they come in different dollar amounts and you can use them for anything that we do. We do some procedures for seeing me for any products that we sell, things like that. And with the service offerings you have, I think that's a really great way to also market by word of mouth, because say somebody's sister is in St.
Louis and doesn't really get what your patient her sister is talking about, but Hey, you can actually have a counseling session or a yoga session or meet with the team out of our women's health and experience at firsthand on my box. So I think that's a really, that's a really unique way of doing that, doing marketing with that potential word of mouth strategy and involved.
I've learned a lot about marketing. So speaking of marketing, I've learned so much about marketing just by doing it. And like when you're a physician, the way you write, like the write your content is one way, but I've learned that marketing, writing. So different. And so actually I also have a marketing consulting business called the Bora med and I put together a pretty amazing team.
Me and a woman named Kate Alaria, who she's. She used to work for a big box marketing firm. And she didn't like it as much as we didn't like working for the big or the healthcare organization. Cause she couldn't do what she wanted to do creatively. So she left she's on our team. And then one of my former marketing professors, he does market research he's on our team.
And so I feel like we each bring to the table a different aspect of marketing. What I bring is a complete understanding of the system of direct primary care, direct specialty care. And then. My marketing background, just from my MBA and then doing it. And then Kate brings in like the strategy and all the wonderful knowledge that she has from working in marketing.
First, she's been in marketing for 20 years and same with Brett he's. He is a PhD marketing professor, and we do things like website design, Google ads, social media, marketing content, copy, copy, editing, all sorts of things. So with a good understanding of DPC in general, I love that you opened up your own DPC as well as your own marketing practice.
That is pretty much the equivalent in terms of going away from the big box marketing operations. So that is so cool. And so that website is Eve aura med.com. E V O R a M E d.com. Perfect. Now what about in terms of consulting when it comes to women's health? I know you said you have a license in Missouri.
And you're mindful of when people contact you from out of state, but if a person were to be in Missouri versus using something like Rubicon, MD, do you have offerings where people can consult with you? For example, other DPC physicians in Missouri who would like a consult about a patient? I don't have anything specifically where I say, okay, this doctor can call me, but I do curbside all the time.
I did do e-health for a patient. She wanted information just about hormones and she was referred from a direct care patient or physician in a different state, but I don't have any specific programs set up directly for people to consult with me. But like I said, I'm always happy. I'm happy to do curbside.
And I need you guys to, I need some primary cares that I can curbside. Cause I don't do that. That's awesome. There's lots of people who would I'm sure. Volunteer for helping out with that too. I love the Facebook group. It's so helpful. Definitely. Definitely. What about when you have patients who need lab testing, hormone testing, what do you have set up for labs and what do you have set up for things like.
Yeah. So I work a little bit differently than many DPC practices. I don't run the labs through me. I send them to their local lab, whether it's lab Corp request and it goes through their insurance. And I liked doing it that way because I feel like people appreciate the fact that they can use their insurance for something.
So when they call and ask about the practice, we always explain that they pay for the visit for me. Although we do give them super bills that they can submit to their own insurance for reimbursement, but all their labs, imaging, pap, smears, mammograms, all that still goes through traditional insurance. And I think people are like, okay, good.
Cause I can't pay for everything. So. And that leads me into the two videos that you have on the bottom of your website, which I feel are very effective in that they are not, you know, marathons to watch, but they're also very effective in the language that you use. And I was wondering if you could share about the videos you have, the one that is, um, entitled how to get paid, how to get your visit paid for, and then the other one, why do you need concierge care?
So can you share a little bit about those videos? Yeah. So I made those videos because I feel like a lot of people, like you mentioned, are not even aware that this exists or what it is. And like, for example, we had somebody call not too long ago and she said, do you take United health care? And my assistants, no, we don't take insurance.
This is how we work. And then a couple of sentences later, the woman's do you take insurance? Like people don't understand the air or we've had people ask and I always answer and explain why people say, why don't you take insurance? They've not heard of that before they don't understand. And so I really wanted to, in the short videos, you know why you need concierge care, point out why there's a benefit to doing concierge care and to having a physician.
Takes the middleman out, no insurance that is only devoted to the patient. I work for my patients, not for their insurance company. I need, I'm sure you've heard that sentence, but it is so true. I work for my patients, not for their insurance companies, but because it's a new model, I felt like I needed to do some explaining.
And so I made that video. The other video I made, because I wanted people to know that there are ways to get your visit paid for. And when you do fee for service, HSA or FSA accounts, a lot of people use those and people do submit to their insurance and we give them all the documentation that they need so they can be reimbursed.
And we always explain, we don't know if your insurance will reimburse you and if they do, we don't know how much, but it's worth a shot. And many people will ask for a super. You are able to, as a specialist, have a practice where some of your patients are paying month to month, but I want to ask you, how do you keep your patients engaged between visits if they don't actually see you month to month?
Yeah, I think that's really important when it comes to. So I do a newsletter. Oh, we have a cooking show. I forgot to mention that. I don't know if you saw that on my website, but it's called eat. Laura's eats. And it's you it's once a month. And I work with my personal trainer who also runs a personal chef business and we'll pick a healthy recipe and we do a Facebook live.
So we do that. So we do Facebook, we do Instagram, we do a newsletter. We do the Facebook live, the Boras eat. We do try and keep people engaged that way. We like to have. When we can, it's been a pandemic, but like we had an open house, a couple, like in March, was it March on March sometime? And we did one Facebook live where we had some makeup artists from the Chanel counter and they came and we asked two of our patients if they would want to be volunteers to have their makeup done.
And so they did that. We've done. I like doing events. I think it's fun. And it is it's you have to keep people engaged. And sometimes the other thing that I try and do. To keep people engaged. And I just like doing this is checking in with them. So typically on a Sunday evening, like when I'm watching TV and like the weekend is wrapping up, I'll go through my patients for that week and the week before and just shoot them an email being like, were you able to get your medicine just checking in?
And I really think people like that because sometimes people had trouble. They didn't, they couldn't get what I prescribed, but then they're so busy. They don't have time to let me know, but then they get this email and they're like, oh yeah, this happened. And I just, I like to check in with people.
Because one of my patients she's so cute. She said she, I can't remember where she, I think she wrote us a testimonial and she was like, Dr. Lynn checks in with you, like your mother would.
That's great. And how do you go about asking patients for testimonials? We have some patients who we've seen a lot. I don't ask everybody cause I don't want to, I don't want to be like pushing that, but there are certain patients who are like, oh my God, I'm so grateful. You changed my life. We love you all my, I told, I sent all my friends to you and I'm like, would you mind giving us a Google review?
Would you mind writing us a testimonial? And usually. You have been featured in a significant amount of notable publications. And so I, and I want to ask, do you have any advice to other physicians, whether they be in specialty care or primary care, how do others harness the media to spread the word about direct care and about the work that each physician is doing for their local communities?
Yeah. So I think I was in self magazine and more magazine and honestly don't know how they found me, but anybody who calls me any reporter, I always say yes. And I'm trying to think back to those. I'm not sure how they found that. They found me maybe on social media, I do a lot of social media, so I know people have found me there, but anybody who calls, who wants to do media, I always think, and it's free advertising and I liked doing it anyway.
Cause I like talking, I'll take them up on it. So I feel like taking people up on all the offers where they offer you because there are PR firms and I haven't paid anybody for PR. And when I first started my business, I got an estimate. They want $10,000 and I can't do that. I'm a small startup company.
And so I don't know. I think just when people want to interview you let them, and if somebody's talking to you, tell them, oh yeah, if you ever have another article you want, give me a call. I'm happy to answer things like. I was just attending a score business meeting on Facebook and using Facebook business today.
And one of the things that they were talking about was how, no matter what type of marketing there is out there, the majority of people will use the leads that they hear about from other people. And so I really think that that is in line with that idea of, Hey, if you know somebody else who might want to talk to me, I'm open to speaking with more people.
I'm sure that sticks out in their mind as reporters or as PR people, because I'm sure there are those who will say. I will talk with you for a fee, or I want to talk with you. So that's really something, especially if you have the time to do it and you like doing it, that's a great way to consider as your step into getting media exposure.
Yeah. And then one other thing I want to say about that, my research is in marijuana and sex and I, that just fell into my lap. That's a long story, how that fell into my lap, but I did publish a paper which was very unique, kind of a landmark paper because it really hadn't been done the way that we did it.
And so when that paper was published, I was getting calls left and right from media resources. And I think because first of all, marijuana is a hot topic. And so it's Xcel's so the media was all over this and I even actually got a call. From, I dunno if you've ever listened to Dan Savage, he has a podcast and they wanted to interview me, which I was just floored because I liked Dan Savage a lot, but that one I've never had that happen.
Like people were calling my prior organization and being like, we want to talk to you. And so I said yes to everybody I possibly could. And people still find me about that study that I did. And one interview me about cannabis and sex. And I always say, yes, so if you Google Becky Lynn marijuana, my, I have, I did two papers.
So one on women's perceptions of the sexual experience when they use marijuana before sex. And the other one is a review of cannabinoids and female sexual function. So they're open access. Anybody can read them. Perfect. And I'll make sure to link those on your accompanying blog as well. So there's a lot of chatter on the DPC docs, Facebook groups, about how frustrating it is to find coverage for things So what do you guys do for.
Do you use United States larks versus Canadian larks? Because in direct primary care access to LARCs can be somewhat tricky, especially when you're dealing with something like a Nexplanon versus an IUD.
So can you touch on, do you have any tips or tricks with regards to accessibility when it comes to getting LARCs for your patients? So the short answer is no, because I've tried and it's about near impossible. I've tried Nexplanon, I've tried ID. So complicated and you jumped through so many hoops, I've never been successful.
And my patients who need LARCs, which isn't many, because most women I see are like 45 and older, but some of them have IUD. I end up sending them back to my old practice to have that done, because it is so much simpler. And I don't have the staff and the resources to spend the time to jump through hoops, to get, to, to get an IUD into the office.
Yeah. It's unfortunate. I wish it was easier. I wish there was a way that I could just order an ID and then just insert it. But there's not, I haven't really been successful with getting LARCs and maybe if you know how to get them, that would, I, I would love the information, but I haven't been successful. Do you have any thoughts on obtaining things like Paraguard from Canada versus. The United States. So I've never done that before, but I used to order Premarin vaginal cream from Canada because it was $12 a tube as opposed to 200.
That really bothers me about our system too. But then they came out with indexy and Intrarosa, which used to be $35. Now they're like 50 to 85, but so I stopped ordering the Premarin cream from Canada recently I saw on and meds. I think that Estrace cream, I wanted to say that one of their wholesalers had it for $50.
But so I guess in answer to your question, I haven't gotten anything from Canada in several years, but I'm not against it. What about pelvic floor strengthening? Like, for example, LV has a pelvic floor trainer where it's associated with an app where you can squeeze the pelvic muscles as the, as the app makes it surges on, on, on your phone.
So what are your feelings because you were sharing about the chair that you have in your office, as well as a therapist who's working specifically in pelvic health, what is your, what are your thoughts on the at-home devices? Like pelvic more strength? Yeah, I think they're okay. I really do think first-line treatment should be pelvic floor physical therapy.
It's not the chair. That's not first-line treatment, but I think pelvic floor, physical therapy, they really know how to help you isolate those muscles and strengthen those muscles and figure out where your weaknesses, if you can't afford the chair, cause it's expensive, you there's no harm in doing those.
I just don't think there's a lot of data to say that they really work on. There's so many different types of them. So do we know which one's the best? No, there's lots of different ones out there. I like the chair because it really provides super strong contraction of all the muscles. It helps you recruit all the muscles and the contraction is stronger than you could do on your own.
And it's you're fully closed. Nothing goes in the vagina. No fingers, no. You know, anything, nothing goes in the vagina. People can just come in, sit on the chair for 28 minutes and leave fully clothed. And it contracts and relaxes your pelvic floor for. And if there is in the chance that there is a patient, even listening to this, I think that it's just, it could potentially lower that anxiety about pelvic physical therapy.
I get that question all the time. What does that mean? When you say pelvic physical therapy, what does that actually look like? And so I'm really glad that's coming from a physician with experience as well as expertise. And so one thing about that I'll say is because my patients had the same reaction to pelvic floor physical therapy. I created a video and I have a YouTube channel and I interviewed one of the St. Louis, pelvic floor, physical therapist, just, and I refer my patients to that video just to give them an idea of what to expect and what all pelvic floor physical therapists can do.
And what's your YouTube channel. If you search on YouTube, Dr. Becky Lynn, you'll find it. What advice do you have for other physicians who are considering leaving their practices or jumping into direct patient care or direct primary? I would say take the plunge. It's really scary when you're thinking about whether or not you want to leave your safe, secure job. That's making them miserable.
Just take the plunge and do it because you might have that little voice in the back of your head saying, it's not going to work. It's not going to work. It's not going to be how I want it to be, but I feel like you have to take the plunge. You'll be so happy that you did and just stick with it. And every day, just keep trying to build, keep trying to grow, except the fact that it takes time to build a practice and just go with it on that note.
So what is the best way for others to reach out to you if they want to continue the conversation after this? Yeah. So anybody is welcome to email me. You all can call me my email. Probably the best one to use is med llc@gmail.com. That's the one that you have. If you lose that one, there's a way, if you do contact us via my website, which is Evora women.com that contact us goes directly to my email.
My office number is 3 1 4 9 3 4 0 5 5 1. Yeah, that's probably, those are probably the best ways to reach me is email. Go through the website or call.
Perfect. Thank you so much, Dr. Lynn for joining us today. Oh, thank you so much for having me. It was fun.
* Transcript generated by AI so please forgive errors.
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