Direct Primary Care Doctor
Dr. Christina Gonzalez is a board-certified family physician. She grew up in the Adirondack Mountains area of upstate new york. Then, after earning a BA in Psychology from Gordon College she lived and worked in Boston for a few years, while completing her pre-med classes at Harvard University, before heading off to med school.
She graduated from New York College of Osteopathic Medicine, just outside of New York cavity, and went on to Kansas to train at the Via Christi Family Medicine residency program.
While she is far away from where she grew up, she loves the life she’s built in El Dorado (pronounced El Dor-AY-do), KS with her husband, Pablo, and their gaggle of children. When not seeing patients you might find her chasing after her kids, cooking, enjoying time out on the lake, or going on adventures with her husband and kids.
In her interview, Dr. Gonzalez shares about how she never wanted to be a physician and how ended up going to medical school anyways! She then talks about how she trained for residency in a place she never would have considered, based on where she grew up, and how she happened to then transition to entrepreneurship and opening her own DPC in rural El Dorado, KS!
Resources Mentioned by Dr. Gonzalez:
PODCASTS:
CONTACT:
Website: Hope Family Medicine DPC
Phone: (316) 323-4436
TRANSCRIPT*
So Direct Primary Care to me is a modern approach to old fashioned family medicine. It is breaking down the barriers and things that get in the way of the doctor patient relationships so that we can focus on what really matters for the true health and wellness of our patients, for their families and for our community. I am Dr. Christina Gonzalez of Hope Family Medicine and this is my DPC story.
Welcome to the podcast Dr. Gonzalez.
Thank you. I'm really glad to be here.
You have had such a unique journey because you grew up in New York and along your medical training and your medical journey to opening up your DBC, you've had experiences overseas. So can you please share with the listeners about your journey in medicine that led you to eventually learn about DPC?
Yeah. So the story of how I became a doctor, I think it really intertwines with how I became a direct primary care doctor. Like. Kind of almost one in the same, I can't say doctor and then became DPC or doctor and then became primary care because they really kind of flow together. I could probably take your whole podcast to explain the whole story, but I'll try to be really succinct and tell kind of the highlights.
I actually, when I was really young, I was six years old and I made my first diagnosis. I got out of the bathtub and I said, mom, look, I have Lyme disease. And I had bull's eye rash. And I said, look, I have lung disease, just like you do. So my mom, my dad and I all had Lyme disease growing up. And that kind of was defined our lives a lot because back then they didn't really know how to treat people.
There was a lot of kind of longterm sequella, especially, especially for my mom. And so health and wellness was kind of always in our. Our, um, history. I actually remember writing a journal entry where I said, I would never want to be a doctor who would want to be around sick people all the time. So that kind of went again, not against, but, so I kind of had that in my background, but at the same time, I was really interested in it.
I kind of always had that. If something is broke, I want to be the one to fix it. So I saw problems with how healthcare was when I was a kid and I really wanted to, to do something about it, but I didn't actually want to be a doctor. So growing up, I thought maybe I would do physical therapy. Maybe I would be a psychologist.
I went to college and I had a degree in psychology because I figured whatever. Doing that psychology was an important part of that. And so I graduated from college with a psychology degree and moved to Boston. And when I was in Boston, I went on my, I went on a mission trip with my church and we went to Ethiopia.
And what I will say is this there kind of two big defining, I guess, three things. So when I was in that kind of defined how I. I discovered what my like vocational purpose in life was. I remember learning about Maslow's hierarchy of needs. And I remember learning that physical needs were at the bottom of the pyramid.
If you remember, it's like a pyramid and at the top is self-actualization, but physical needs were at the bottom and I am a Christian. And so my faith was important to me, but I never wanted to be a missionary. I didn't want to be, you know, out there evangelizing sort of thing I wanted to address, I guess I always knew I wanted to like show love rather than tell love if that makes sense.
So Maslow's hierarchy of needs in eighth grade. And then in college, I, there was a quote by, I think it's Frederick Buckner. That was our theme for, we had a. Convocation one year where it said the place that God calls you to is where your deep gladness and the world's deep hunger meet. And so I, at that time, I didn't really know what I wanted to do, but I knew it was going to be helping people.
It was in health care and it was definitely not a doctor. So I just said, well, I need to figure out where that deep need is. So when. After college went to Ethiopia. I've had this moment where I was literally standing on the road, walking from the guest house to the hospital. And it was just like this like, wave of like, this is it like, this is that intersection.
This is where deep gladness and deep hunger meet. This is where, you know, physical needs and emotional needs and spiritual needs. They all come together. It was a really cool place that I was at. They, um, and this kind of where it sorta ties into DPC a little bit, not so much. Financial model of it. But the concept of it is they worked with women and children who had HIV and aids, and that was their kind of identifier.
And they took care of the whole person. They had counseling, they had financial classes, they helped people with small business loans. They did peer to peer counseling. Basically. They just, they initially had started out as an HIV aids organization, but then once part therapy came out and they were able to help people live longer.
They said we really need to just not be a hospice program essentially, but be a program that takes care of these people and it just changed lives. And so I was like, gosh, if I could do this in the United States, not that I didn't want to live in another country, it just kind of was like, well, if I could do this forever, I wound up.
That's what I want to do like it, where, where people recognize that physical needs and psychologic needs were equally important and equally affected each other. So, so that trip was pretty amazing. But what was actually kind of the funny story about it is that on my flight back, I had this true epiphany.
Like I was like, fix, this is what I need to do. And, you know, I guess I'm supposed to be a doctor, even though I never wanted to be, but on my flight back, there was a doctor. I think his name was, I think Dr. Irv for Irving. And he was a doctor from Texas. And in hindsight, I can see he was burnt out. He was like burnt to a crisp, and I remember being on the plane and this was.
What does that back in 2006, 2007, being on the plane, on the flight back, I said, gosh, I'm thinking maybe I want to be a doctor. And he launched into this 10 point, you know, lesson on all the things wrong with health care about, you know, Documentation and insurance and, and administration and all these things that were wrong with healthcare and ended it by saying, and if you want to go help the poor, then you should just be a PA that's good enough.
And I have nothing against PAs. I think there's absolutely can be a role for them, but I hated, I mean, it just like nod at me to the core that he said, you know, if you, if that's what you want to do, you should just go be a PA. And that just felt so wrong because I had thought about being a PA at one point, because I didn't think that I.
I didn't think I was cut out to be a doctor in a lot of ways. And so I was like, well, gosh, I mean, I do want to help the poor and I don't want to be what that guy just said. So I, um, went home and applied to med school and figured I wouldn't get in. And then I did. So that's how I became a doctor. I think maybe that didn't fully answer your question because I totally tangented.
This is another example of how this podcast is really highlighting the individual journeys of these, of DPC physicians all over the country. Because the journey that we all take to get to being a part of the movement is, is absolutely unique for all of us.
And when you talk about. What you saw and what you didn't want to see. And you know, this idea that how could you have expected to sit on doc to sit next to Dr. Irving or Dr. Irv on the plane? It's just, it's, it's pretty crazy how all of that happened. And, and, you know, they, the idea that at the time you were in Ethiopia, you were seeing the transition from them thinking about HIV as a chronic disease, rather than as a life ending disease.
Like we used to, to it's just, you know, it's, it's great that you were in these places at the right time and that you had your epiphany. And so I want to ask now, after you applied to medical school, you thought you weren't going to get in, and then you got in, how did you. Learning about direct primary care as a business model and as, uh, a type of model that you wanted to pursue after residency.
Yeah. So I went to medical school in New York and I found out about this program called via Christi, which is in Wichita, Kansas. And then I, um, I actually met Nick Thompson, um, as a med student and he told me, I said, so what do people do for fun there? And I joke about this with him all the time is that he said, uh, what do people do for fun there?
And he said, well, we have a really nice YMCA. And that was the saddest thing I'd ever. It's like, really? You're going to try to convince me to move to Wichita because of what I'm saying anyway. So, um, I proceeded to try to find a program that was similar to the, uh, Kersey that had that. That kind of cowboy mentality, where you learn how to do everything.
And you were like a family doctor who knew what you were doing rather than a family doctor who was like the bottom of the barrel couldn't get in anywhere else. So I was like, I can find that anywhere else. And I couldn't. So I wound up going to Kansas and said, I will be there for two, three years tops, and then I'll get out of there.
So probably. Second year of residency, Nick Thompson said that he was going to have like a pizza dinner with people. These people who had this different kind of healthcare, um, there was this guy who was supposed to be special or famous or something like that with this program called Atlas and he was going to be in town.
So that was how I first heard about DPC. And I didn't go to the pizza dinner. So I tucked the ideal way, but I thought conch, that sounds like not such a bad. Bad idea, but it's way too new. And so, yes, I went to residency with these two doctors, Nick Thompson, and Brandon almond, who they opened up a direct primary care in Wichita, saw how things went with them.
And then I actually started, I met, had met my husband, my second year of residency. We got married at the end of residency and we were planning on staying. So we had found what I really thought was going to be like my dream job. And I knew realistically, nobody, most people don't find their dream job right out of residency, but it was everything.
So I did OB I could do like minor surgeries. I could do inpatient. Adult, you know, cradle to grave. I delivered babies. I did C-sections I did everything. And so I was doing that, but there were some problems with the practice and about two years into a very long contract that I would never recommend anybody else have redo a contract that long.
I was starting to think maybe my practice wouldn't, wouldn't be able to support me and then wound up not actually doing anything with it. Just kind of tucked it away in the back of my mind. And at that I went to lunch with them. And at that lunch, I was saying like, Hey, maybe at some point maybe you'll have a job opening for me.
I'm kind of thinking, you know, that seems like a really good idea. Now you've proven that you haven't, you know, gone, you're not starving. You're doing okay. And they said, yeah, well, let's see kind of what it, what is possible at that point. But you should really think about doing your own practice. And I was like, no, no, no, no, no, no, no.
Do you understand, like I am a doctor. I am not a business owner, so I completely like wrote that idea off. So that's how I found out about it.
What eventually led to the decision to open up hope family matters.
Yeah. So I, um, I should have clarified, I live about 40 minutes, half an hour, 40 minutes from them. So I'm kind of like, they're the big town, but where we've got a whole lot of farm in between us. So I was kind of going along and, um, at the very beginning of 2020, I found out I was pregnant with our son. And then shortly thereafter, I, um, in the very end of March, it's actually a pretty awesome story that I love to tell people is that.
Um, I had actually gone back up a little bit further in the fall. I went to, um, not symbols in Orlando in 2019. And I went there with this, like, not ten-year plan, but like this two year plan, like I'm just going to learn everything. I know I want to do CPC, but I did not want to open my own practice, but I had that kind of idea in my head then.
So I, that was what November of 2019. And then we found out we were pregnant and then this pandemic hit. And in March we have these good friends who own a whole bunch of businesses in town and they will periodically, they're actually patients at another DPC in the, in Wichita. And they knew that I sort of had this idea and.
Sort of encouraging. So they said you should open a DPC here and you should rent out this building that we have for your DPC. And I said, well, that's nice, but you know, I'm not going to do that. And then they said it again and I say, well, that's nice. I don't think I'm going to do that. And then they said it again and I was like, that's nice, but I don't see that happening anytime soon.
So in March they said something to my husband instead of me. And so he said, sure, we'll go see this building. And I said, honey, I told them, no, you, why did you say yes, you should have checked with me first. So he said, well, there's no harm in going to look at, at this building. So I said, okay, fine. We'll go look at this building on my day off on Wednesday, on Friday.
I said, yeah, I think something's happening. And then on Monday I no longer had a job. So the timing was just amazing that I went to this place and I said, yeah, Wonderful. Like, we'll do just these tiny little modifications, but it's not going to be anytime soon. So just think about it. And then literally it was less than a week later that I suddenly was like, okay, well now I don't have a job.
So, um, let's just do this. So we thought to ourselves at the time, you know, I was pregnant. Nobody knew what really at that point, how safe it was for pregnant women and COVID, and I wasn't going to go start another, like try to get a job, but we couldn't afford for me to not have a job. So we said, well, let's just, you know, do some telemedicine to get by and like hustle and try to put something together.
Really our question was, do we want to open before I have a baby or after? And I decided it would be way less stressful to just open the practice first than to try to be worried to, I didn't want to spoil the, the newborn phase with opening a practice. So, yeah, so that was in April, may and June. I actually, by June, I was already ready to open my practice, but I, the building wasn't ready yet.
So I spent, I hustled for two months. And so I don't really know what it was that made me switch. I think it was just, I think that was probably, it was that it just seems like, I don't know that it was even a conscious decision as opposed to mentally like it just, everything just like lined up. Right. And it just felt like the right thing to do.
So I I've always operated under the impression that like, well, we'll just figure it out. Like we'll, if we're, if that's what, you know, if I feel like this is what I'm supposed to be doing, then I, then, you know, God will take care of it. We'll figure it out. And, and so far that's, that's proven true. So.
That's a wonderful, and I think that, you know, especially for people who are listening, who are in that space of like, oh, I'm a doctor, I'm not a business owner, but I'll learn about DPC. You know, it's it's I was in that same place of like, I eventually want to open up a DPC, but it's not, it's not now. And then for me, it was.
When I got threatened with being fired, it was like, oh, this is the day that I'm going to make the decision to do DPC. So I just, I say that as, you know, as a reminder to people collect all the information you can, because you never know if the time is right for you, you'll be armed with all of this information and empowered to be able to make decisions towards, you know, making your own DPC potentially.
And I'll say that the business aspect of owning a practice, I, that was what I was most fearful of. And I have loved it. Like I would never have thought it. I know someone recently said something about, I forget the word, but somebody who like continually likes to learn new things.
And I apparently that's me because now I'm just like devouring, everything there is to know, not about, not just about like a deep about DPC, there was that season two, but now. Business plans and not even business plans, but like the, you know, how to run a business. Well, and I just I've loved learning it. I really have, so I would never have thought that I, I mean, never have thought that I would want to do that.
I remember when I started at my previous, uh, employed physician, he said something about my contract. Lawyer said something about putting a provision in there to become a partner. And I was like, well, you can put that in there, but I don't want to be a partner. I want nothing to do with the business of medicine.
And now I'm like, Hey, let's talk all about the business of medicine.
I want to ask about hope family medicine, the name and where it came from. Because on your website, you do share a little bit about the history of the, of the clinic's name, but I would love if you could share with the list of. How family medicine came to be.
Yeah. So one thing that my patients know is that they I'm always, I've always been very open with them and I'm not afraid to share my story as a patient, as well as my story is a doctor. So they, I think that's something that my patients really, I mean, I know it is cause they bring it up that they really appreciate that.
I'm. I relate to them and I understand where they're coming from. You know, I was just talking to an OB patient of mine, uh, this week, who is stressed out because she's post dates and doesn't want to be induced. And, and they just said, gosh, I just feel so much better because you can tell me you've been there, you've been this new, you understand?
So, um, so I've always been really upfront about kind of our medical stuff. So I have it right on my website that when my husband and I first got married, um, pretty soon after it was actually just a couple of weeks after I started my first real job where I am in my town now, um, that we found out we were pregnant.
And it's crazy because I knew from the beginning of that pregnancy, that it was not. There was something wrong. We didn't know until our, like our 18 week anatomy scan, we found out that I had an, a confidence cervix. So long story short, we wound up having a, a very, very dramatic, very complicated, very hard first pregnancy.
With me having a stillborn and me winding up in the ICU and our daughter that we had her knee, we had named her hope. And so I kind of had always, it's always been important for me to have something that we named that just that we would name after her, that would kind of just be sort of her legacy and also.
I think just the name, like I didn't want, cause we knew her whole pregnancy that we were going to, it was unlikely that it was, it was just a hard thing that people could get really depressed and down about. And we just said, no, we just have hope. Like we just w it's going to be okay. And even though I did not think that she was gonna make it and she didn't, but so, um, I think hope signifies a lot.
It's obviously first and foremost named after our first daughter, but I think it means a lot just hope about medicine in general. That, that, I mean, really DPC has been a lot of hope for me because there's so much, that's frustrating in healthcare. There's so much, that's frustrating in family medicine.
And then also so many of my patients struggle with mental health issues with depression and anxiety. And I just had a couple of different variations of the word hope that we considered, but there was no question in my mind that. What the name was going to be. In fact, even when I thought about, do I want to have a partner from the beginning?
I said, well, if I have a partner, they might want a different name. Thank you so
much for sharing that. And I think it's, it's a wonderful tribute because not only does it stand out on your sign, but when your patients find your care to be helping them find hope in whatever their, you know, their health issue or mental issue is, I think that's wonderful.
So thank you for sharing that. In addition to hope, family medicine, you're also doing locums and so you're not opted out of Medicare. So can you share about how that decision came to be? And then also has opting has not opting out of Medicare impacted your practice at all?
Yeah. So quick to answer to that is a little bit, but it's definitely not the end of the world.
So I initially, because I had, I had a plan, I had a one-year plan. It was all mapped out. It didn't happen at all the way that was when I unexpectedly had a pandemic happened while I was four months pregnant and lost my job and didn't know what was going on. And so the financial plan that we had in order to save that money for this practice, didn't didn't even come close to happening.
So we knew right off of that, that I had to find a different way to be able to pay bills while I was building up the practice. So initially we thought we were going to do telemedicine and there was such a need for telemedicine. And then. It's such an overflow of doctors trying to do telemedicine. So that did not at all.
So I started doing locums with this group that I'd actually been with since I graduated residency. Um, so I had an established relationship with them and then when my son. When it kind of had come out of that new, the postpartum maternity leave. There you go. When I came out of maternity leave, he, uh, we said, okay, we need to do something else.
So after my sort of pseudo maternity leave, I decided to start picking up some locum shifts. I talked with the organization and said, I was just playing done with, ER, I decided there are some things that just have to go. And I knew that would DPC. I still wanted to do something with maternity, but I didn't want to deliver babies.
And I knew that I didn't want to do ER anymore. So they had some shifts for me, where I was covering in. So basically I've done. I'm now on my third one where. Sometimes things blow up and sometimes it's not so dramatic, but basically a doctor and they need a doctor to fill in. They usually have like a nurse practitioner full of nurse practitioners.
And then we come in and kind of fill in the gap for the physician part of it. And so I am opted in because of that, but really the only thing is that I've had a few people call. I get people who call and want to become patients and they're on Medicare. And I just say, Hey, I'm not ready yet. I'm not there yet, but I can put you on a wait.
So I have one and exactly one patient who was my patient before who continue to be my patient and she's on Medicare. And I see her for free because she basically came to me in tears, like the third time. And so I was like, you know what, I'm just going to see you. And then outside of that, I just, I just will tell people when I, when I opt out, I'll let them know.
And you're able to see your patient because you can see your patient for free. And it's not taking away from the patients who are paying in your practice.
Yeah. Yeah. I think a lot of it is, you know, you, you just kind of do it. So I didn't plan on seeing I'm not advertising that I'm seeing people for free.
I'm not, you know, I have had patients who asked to be patients and they had Medicare and I told them no, but this one I told yes. And so you don't have to feel encumbered to say, well, if I say yes to this one, I have to say yes to everyone. If you can do things on a case by case basis, I just had a patient who said, sent me a message tonight saying, what's your re-enrollment fee.
And with this one, I was tempted to say, um, $5,000. I don't know, but you know, you can, you know, you don't have to say you can change your policy all the time if you want.
Absolutely. And that's a great strategy in terms of when you're building out your legal documents for your patients to sign as like a membership agreement, you can have, you know, referencing the member agreement in addendum a or appendix a, and that is the document that you can change all the time.
So it absolutely gives you that ability to pivot wherever you need to. Now, I want to ask with regards to your patient who you are seeing for free, how do you handle a membership agreement for that patient?
People, gave me several contracts. I looked them over. I picked one and adjusted it for myself. And then I had a lawyer look it over. So I think that's a really reasonable and affordable way to do it. And I think there's just a disclaimer in there that I'm not opted out.
And then I put in there a note under membership price, you can't, you can't like ask them, you can let see people for free, but you can't ask them for like, yeah. So I just, I just put a line through the price and just put zero there. And then she, I just told her like, literally verbally, I just said, so, you know, I hope that when I 10 start charging you that you won't quit at that point.
And she's like, well, no, that would not be the point, but I understand. And if she does, oh, wow.
In terms of your practice and for the patients who are not needing to worry about, if you're opted in or opted out on your FAQ, you have a piece about saving money and it says, no copays, no inflated costs breaking down barriers to get quick.
And high quality care may mean an everted hospital stare at ER visit. And since our focus can shift from treating illness to promoting wellness, that means an overall healthier you, which certainly saves you money. So I wanted to ask there, when you have had patients come to your practice, how have they found you and how have you explained your value proposition to people about hope family medicine, given that you're, you know, in the Midwest only 40 minutes away from.
It's been a smattering. It's pretty much I'm in a small town. It's kind of big news. It's not tiny town. So it's not that real, real rural, but it's a small town where people, not, everybody knows each other, but word spreads fast. And so in our town, we have. 1, 2, 3 family practices outside of mine and then an internal medicine and then a solo pediatrician, a surgeon, and two OB GYN.
So just to get kind of an idea, we have where the county seat. So we have a hospital and it's a small community hospital. It's not a critical access hospital, but everything is all in one spot. They said that there have been people in the past who haven't been in the hospital, but so I disappeared for a few months.
People thought that I left, some people thought that I was having pregnancy complications, but kind of people knew that I left. And then people knew that I popped up in a new place. And so I think that word spreads pretty quickly, but even so I'd get people now who are like, oh, we didn't realize you were still here.
I just went to community event today. And I had somebody who was a former patient. Hey, Hey, like you're here. So I think. A lot of my patients, it's word of mouth. A lot of them have said they found me on Facebook, which is funny because I don't, I'm not very good at all or consistent at all at social media.
And then I have an employer group. I have some people who were patients at Atlas or Antioch or some of the other DPCs in the area who just were excited that I was close because they liked DPC, but, but it was attrac. So to get to the big city,
How often do you have patients then who don't know about DPC and how do you talk with them about your practice? So
I would say some do, but the majority of time they don't, I have had people who there's a registry on the hospital website of all the doctors.
I've had several patients, who've called me up just saying, I'm new to the area. I'm looking for a doctor. And I say, well, are you aware of that? Our practice is different than. No, I was just calling you from the list. And so I say, okay, well here's what our practice is. And they'd never heard it before. And I've had patients sign up as members.
I think probably the majority of the time when that happens, they're uninsured patients to begin with a lot of times people. Yeah, I think that's just where it is. So sometimes people will get, if they have Medicaid, they'll like call the name on their card or something like that. But if they're uninsured, they just kind of cold call or the urgent care has passed me a few patients, but they pass me patients saying, Hey, you don't have insurance go to this doctor.
So, so I do sometimes have to do some re-education where they think that I am the doctor for people who don't have insurance, but they don't really understand. You can come here if you do have insurance or this is not fee, you know, it's not a cash based. Dr. It's a direct primary care doctor. It's not a one time.
They say, well, do you just want to see me? You know, can I just see you one time? But overall, I think people, I have a pretty decent, I think conversion rate. I really just say, Hey, you know, I'm a family doctor. I think being a family doctor is really valuable. And part of that is knowing my patients. So I think if we really want to get to the root of this problem, you just told me about, I need to know you and it might not take one visit.
It might take a couple of visits. And then once we get through that, you might have something else going on. So, you know, if you pay this monthly membership one or two urgent care visits, and that's a year's worth of your membership and you can come in as many times as you need to in order to get your problems solved and get you back to back to healthy.
Yeah. So I think that goes over pretty well with a lot of people.
With you mentioning urgent care, how much does it cost for an uninsured patient to go to your guys's local urgent care per visit?
So it's, I think it depends. It depends on what it is. So our urgent care in our town is through our hospital.
So they just bought a location and opened up an urgent care, like on the fly a couple of years back. So it's basically, it's run by ATPs and, um, it's kind of just like a mini branch of the hospital. It isn't a separate location though, but they, it depends on what it is that they go in there for. I've had patients sometimes tell me what, what it is and it's, I just kind of put it in my head as a ballpark of three, $400
if people are listening and they, they weren't aware.
Cause I wasn't aware until I heard this from my lawyer Apollonia Udall, that you can actually call the urgent care locally and just. How, how much does it cost for me to be seen at urgent care? Because you don't have insurance. And so at our urgent care locally, it's $247 to walk in the door. And then depending on the codes that goes up from there.
So it's a, it's a good tool to have in your, in your decision box as you're building out your business.
Yeah. I just ballpark tell people two trips to the urgent care. Cause they'll actually, I'd say a lot of times when someone comes to me from the urgent care, it's when they went to the urgent care, they didn't get better.
They went back to the urgent care and then they were told to come to me. So I say, you know, those two trips to the urgent care equals like a year's worth of membership.
Yeah. So with you mentioning that, I want to ask how did you come to your pricing?
Yeah, so I. I thought a lot about it. Like a lot of people do, I looked at calculations of what my per member per month needed to be. I thought of all these things.
And then ultimately I said, you know what, I'm close enough to several other DPCs I probably just need to match them pretty closely. And so, but then I thought I rounded down a little bit, but I didn't really, so I initially had age-based pricing and it was roughly comparable to them, not higher. So if there was a debate between two practices, I kind of went with the lower option and I kind of thought, well, I'm, I'm more, they can pull from more people, whereas I'm more a very blue collar, lower average income location.
So I just don't think that I can. I don't think that it would go over well, for me to be more expensive than the big, big town nearby. And so initially I was age based, but I didn't like the idea of age basis. So, you know, if you're, I mean, even in fee for service, you know, a 9, 9 2, 1 3 is going to be a nine and two and three, no matter their age, when I hit the one-year mark, I flipped it to be just child, adult, and family.
I really wanted to simplify it. I wanted to be able to say in a one-liner that's how I wanted about switch, switching it a little bit. I actually considered switching at six months and I posted it actually in the DPC women's group. And got, I think basically people said, don't do it yet.
That's not what they said, but I read between the lines. They basically said it doesn't sound like you need to switch. So I didn't, and I'm glad that I didn't because I got my first business then. And so I like exploded. I almost doubled like overnight, literally on January 1st. And so I'm glad that I didn't switch it then.
But what I found was I. I, I still do have a majority of like single people, not single, but you know, one person in the family or a single person, and I really want to take care of family. So I wanted something that was, I wanted to change it up so that, because I realized I'm really good at giving out discounts and things.
And so I needed more buffer so that I could afford those. And I really wanted to emphasize family. So I switched it up so that I actually kept the same family max, but the way I think that it was worded on my website, I feel like it was more family oriented maybe by saying. Individual couple or family rather than this age, this, this age, this, this age, this, but no more than this for a family by just saying single family cup, you know, single couple family.
As soon as I made that switch, I had like three families sign up within two weeks and it was, it was awesome. And it also was reaffirming that I really do love taking care of the whole family. So that's been nice.
That's awesome. And in terms of your demographics, can you break down your patient population for,
yeah, so right now I have about 130 patients and about a third of them are company and two thirds of them are from, you know, just from the community.
I'd say probably. To two thirds of them have, I should have specific numbers, but I've never been a big numbers person by about half to two thirds of them have insurance. I'd say if you account cost sharing programs, it's probably two thirds of them have cost sharing program or insurance. And then about a third of them are uninsured.
When you're an entrepreneur, and you're talking about people with your business about growth, about retention, about churn. How do you handle when people are like, this is the way to do it. And this is if you don't do it this way, it's not a, that's not a good decision.
Yeah. I want to say that in at least in our women's group, I don't think people are so much of the, this is the way to do it sometimes.
And other groups you certainly get that. I have never been really, I guess I really like one of the things I miss about having my own practice is I really like collaborating with people. So I always like to bounce ideas off people. And so I will bounce an idea off it and see if I agree with that idea.
Usually I don't throw things out there to see what other people think, but to affirm what I'm thinking. And I think that's important as a doctor too. I mean, you, you don't want to just, well, I don't know. And I'm going to look this up, you think, okay, this is what I'm thinking.
Let me go see if this is affirming that or if this, if you need to rethink it. So. I try to be, be confident in my own decisions. And I think I, a lot of times I am, but sometimes I just need that. Well, just like the doctor on the airplane, on the way back from Ethiopia where I kind of thought, I think I need to do this.
And he said, no, don't do it. And it just affirmed that I needed to do it. You know, you can have people say yes or no, and it'll confirm, you know, if, if, if you get this knee-jerk reaction that no, they're wrong, then you better just go with what your, what your, you were planning. That was the opposite of what they just recommended.
It's such a cool place to be in though, especially in the DBC women's group, because you have people coming from all different backgrounds and. I agree with you that the support and the collaboration that we might not get as micro practitioners is very welcome in a lot of senses.
And I, today also at some, I love listening to podcasts, especially with my locums. I love my little like time to just sit and listen to podcasts and definitely my DVC stories on the roster.
But I realized that there are things that don't. That are just in the, my business podcast or just not applicable to being a family doctor business. So, and, and it's not supposed to, but sometimes there's there's areas where it's just, you can't get that information from there because their, their goal is to make money.
And our goal is to take care of people and we want to make money while we're doing it. But, you know, with that, we have the, the end goal is different. And so it really is valuable to have a network of people who are in the same line of business, um, to be able to bounce ideas off of.
I love that. I want to go back to when you were saying that in January of 2021, your business just pretty much doubled overnight.
What was going on internally at that time in terms of how you were figuring out how you're going to handle that good situation to be.
So I would not recommend that people do what I did in January. Rowing is great and actually had this conversation with my parents earlier today, where my mom is worried that I don't, I'm not growing fast enough.
And other people are amazed at how quickly I've grown. And I say, you know, I'm going as fast as I can handle. And I have not really advertised because I haven't, I've been growing as fast as I can handle. And maybe if I had more, you know, W our family had more financial buffer than I could grow faster.
And then, you know, but I've had to do the locums. And so I could only manage to grow so much at once. And what happened in January is I, um, had a, uh, a company that wanted to work with me and they were bigger than I want. They were the higher end and they wanted to start on January 1st and I'd already committed to starting a new job on January.
So I. Uh, for whatever reason, probably because other people had their own insurances start over at the beginning of the year. I just had all these private people. I had this new company and I had a new locums position all started at the beginning of the year. And it was, it was way overwhelming. Like it was way too much.
I just kept this perspective that I knew. I knew it wasn't going to be like this forever. We were going to. We were going to get through getting all these people onboarded. And I would probably make a mistake or two, but I was going to make a mistake or two, no matter what. And I did on January 1st, new year's day at eight o'clock in the morning, I got a notification that all of my employees from my new employer group, their charges all went through and I was like, hold on a second.
None of them were supposed to get charges. What is this? And then I got. Lurry of like message, like the person who I worked with at the company. So there was a button that you there's like someplace that nobody ever told me about where it was like switched over to the, the patients, all being charged rather than the company all being charged.
I didn't know about this button until I accidentally charged like 40 new employees all at once. So that was, that was an exciting thing. But I have to say the customer support. I mean, the guys over at Atlas, they were, they were phenomenal. I mean, it's new year's day and by 10 o'clock. So that happened at eight by 10 30.
It was all better.
That's amazing. Just amazing. And that is the, uh, the common thread over at Atlas and, and with Kirk's support. So, yeah, so that's, that's incredible. Now, when you mentioned. That you were growing as, as fast as you wanted, as you wanted to. And as you can handle, I want to ask about that being a mom of little ones and.
Having a position in the locums, having your DPC practice, how do you decide what you can handle? Yeah.
So I will say that in high school, I did too much as I think most doctors in high school, they did too much in college. Gave me the idea that you should like, not do too much. And I don't know why, but I took it really to heart.
And so I always wanted to like, create balance and make sure that I didn't overdo it. I said I wanted to do one thing for me and one thing for others in college. And that's what I did. I didn't sign up for a million groups. I signed up for one group for myself or one thing for myself. And then one thing that was like outwardly focused and I've always kind of kept that principle.
I love the concept of. Like work-life balance is not 50 50. It is like being present where you are and being focused on the right, the right thing in that moment where, when you're here, you are hearing like be here now. And, and that we'll go through seasons where we need to spend more time on this or more time on that.
So we may need to be more in work at one time and being more in home at another time. So I balance, like a teeter-totter. It is. It is just focusing in the right places. And, and also just having that margin. These are, I think all things that are hard concepts, they may be easy in, um, in concept, but in actually applying it, especially with the typical doctor mentality of like, I can do that.
I can do that. I can do that. It's a hard thing to do, but I have gotten very comfortable with saying no. Like I waited a long time for this family and I am not going to miss these moments with my kids, or I waited a long time to meet my husband. And I'm not going to, you know, these are priorities for me.
So it's, even though I would say. Absolutely a busy season in life. I still feel like I am get able to choose the time with my family that I want. So one of the things that I'm struggling with right now is with locums I'm away overnight. And I hate that because no one sleeps, no one sleeps. I don't sleep because I'm worried about them.
They don't sleep because I'm not there. My husband doesn't sleep cause they don't sleep. So it's hard. But at the same time, I don't feel like I'm missing out on their life because it's a, you know, Tuesday morning and it's my daughter's first day of preschool and I'm there. I'm not, you know, rushing in and, um, The daycare that my kids are at right now.
I didn't go to them when I was employed because they pick up was five 30 and my husband worked, his hours were later. So I knew he couldn't do pickup and I couldn't get off for pickup at five 30 and now they're there and I'm out the door at five 15, so I can get there for pickup at five 30. And that's something that like, I literally couldn't do it before and now it's, that's just the way it is and that's the priority.
And I feel like that's important. So that's, what's happening. I love
that. And for, you know, if you have kids or not, If you have, you know, some hobby that you cherish or you have something that adds to that ability to balance your life out, to, you know, to fill your soul. I just, I challenge people who are listening to think about, you know, what, what matters to them.
Because every time I see DPC doctors celebrating the, uh, the practice bus run with my kid, who's going into first grade today because I can, because I'm a DPC doctor or, you know, I was able to like yourself, pick my kids up from daycare or make a school play or whatever it is.
Clearly those examples are family-related. But the idea to ha to have the days and the hours that you choose. So empowering compared to a lot of employed positions where like you're sharing, you don't have that autonomy to make those decisions all the time and employed positions.
I just had a
conversation with my husband about going to visit my family back on the east coast. And I love that we can just talk about when it's going to work best for us and when it's going to work best for my family, rather than when my cross is going to give me permission to go. And I love that, you know, I have a really nice moment with one of the other DPC docs in solo docs in the area.
It really hasn't happened, but someday I am going to cash in on it. And so, you know, we, we can trade all for each other if we need to. But a lot of times we just don't even do it because if I'm out of town for, you know, my locums, a lot of times I'll, I'll answer those calls over my lunch break or before I go in or after I'm done.
And then if they need to be seen, we'll either do a telemedicine visit or we'll do, or we'll set something up for the next day. And like, they don't, you know, like I said, I'm very upfront with my patients and most of them know I do something else, but they, I don't, I don't announce it every time I go out of town because it's still relatively seamless.
Absolutely. And you know, patients I find in my own area are still wrapping their heads around that care does not have to be delivered in an in-person visit in the clinic that, you know, through the pandemic, we've all been exposed to telemedicine, but I still have patients who are like, oh, so you don't need to see me in person to go over my lab results.
And I'm like, yes, that's correct. So, so yeah, it's a, it's great that you can still, you know, like you're like most DPC doctors do give, give care, even though you're not maybe physically able to see a person that day. Yeah.
Yeah. And they still don't also, they also do not get the concept that they don't have to pay a no show fee.
So they are like, I'm so sorry. I'll pay for the visit anyway. I said, you already did, you know, if they have to cancel like the day before, I'm like, it's fine. Let's just move it. Hey, more time for me to do other stuff. So they'll say I'll pay the no show. I'll still pay for the visit. Like you already did no
more.
Now what about vacation? I'm assuming your patients still pay the membership, even if you're on vacation, if you don't take the calls personally, and you have someone covering you.
Yeah. So I have a little spiel that I'll tell them. I just say, you know, I am, you know, if you need to reach me in the evenings or on the weekends, I wouldn't, I love saving people, urgent care visit.
I am still a human and I still have family. So I'm not 24, 7, 365 days a year. So if I go out of town, Um, I'm often able to just still address whatever needs you have. That's why it's so great that you can reach me on my cell phone if for some reason, or at some point I do find like, it's take that vacation.
And then I usually make a joke about how the only vacation I've taken so far was, is maternity leave, which is obviously not a vacation. Yeah. So I've, I've done little things here and there, but I, I tell them, I will, you still call the same number? I just routed onto the other doctor and don't worry. It's not like, you'll be surprised.
I'll send out an email. So check your emails. So, so yeah, so I just give them, I tell them, I'll give them a heads up if I'm going to be out in long enough where I feel like I need to have someone to cover for me. But otherwise, if I think it's something that I can handle remotely, then
I, I will awesome. I want to ask because you've, you've mentioned Eldorado, not Eldorado is a small town.
You're 40 minutes from Wichita. And I want to go back to the fact that you are a rural DPC solo doctor. So what are some words of wisdom that you can share with others who may be thinking about opening in a rural location and are hesitant because they're fearful that might not work or they're fearful about they won't, they won't have a rapid growth.
What are some words of wisdom that you found out of practicing in a rural DPP?
I think it can be done anywhere. And I don't think, oh, you can make it work anywhere. I think that it does work anywhere. I think I took to heart that there are, I am not the first one. And that's where I think it's been helpful that I can see, I know some of the towns where some of the very seasoned DPC docs where they have their practices.
And I knew that some of them were more remote than ours. I'm close enough to a larger place where DPC is. Well-known where I feel like I ride a little bit on their coattails. Really, to me, my goal was to. And this is why it made sense for me to open where I am and not somewhere else. My goal was to reach those people in the middle of the people who were small business owners, who were, you know, we think classically of farmers.
But what I found is I have people like farriers, which if you don't know their courts shoers, I have, you know, like handyman, a lot of people who kind of just work for themselves. And so I think that it works. It's, uh, it's, it meets a need for people in small towns and in rural communities. And I think it's just in that regard, it's about just explaining, educating, because there are plenty, if you think about.
You know, even if your goal is 600 people, there's a whole lot more than 600 people, even in rural communities and rural counties, there's still more than 600 people. So you think like a lot of these people need what we've got. And so I think if you go into it with that mentality of, I just need to explain to them how I'm addressing their need when I'm filling their, that, that Boyd in what they have, I'm helping them.
I'm, I'm breaking down that barrier. I'm helping them get to the healthcare that they want to have and they haven't previously had the access to. So I don't think there's necessarily something magical about it. I do think that a lot of rural folks are they still have that like. Even fee for service doctors in some communities will do house calls, I think more than in other places.
And so I think they still kind of have, I think it's more recent memory for a lot of people. Like, yeah, I did grow up with a doctor who did all these things or, or, yeah, my, our family doctor did everything. And so it's, it's more recent that doctors in our area stopped doing a lot of those things. Um, but outside of that, I think, I mean, I think that you just, it is a different beast, but it's not, you know, the people, the culture is different.
The people are different, but, but caring for people's the same.
Growing up in Sacramento, which is a very big town compared to my town of 4,000. I completely agree with that because, you know, even if you in our town, for example, and I'm sure it's the same in Eldorado for you. If your car is not in your driveway for a few days, like people start asking like, oh, are they on vacation?
You know? So it is a very different culture and this idea that. When you're sharing that, like you're giving people the healthcare that they deserve and are, and are looking for it's, you're going back to, you're giving them hope that they can have the care that they are in, need of. And well-deserving of.
So that's
great. So little funny story about that. So we, this is how I knew I was in a small town, is that our post man, he knew that we were opening the practice and he knew that I wasn't. In there all the time. So he's like, Hey, do you want me to just bring, bring your mail to your house? Instead if I see that the office is closed and I was like, great, that's wonderful.
He's like, well, I already started doing it. I was like, yeah, I was wondering how that patches got in our apples. And then the other funny thing is that our, the FedEx guy is not local. And, but he still has that vibe. Uh, there were a couple times where I started getting these, sorry. Do you notes on our door?
And I was like, I don't understand. I was here all day. How could you miss me? I realized what he was doing was I live really close to my office. And so sometimes I'll walk. I like, I try whenever I can to walk. And so he didn't realize that just because my car wasn't there, he knew my car and he would say, oh, her car's not there.
She's not there, but I was just walking. And so I finally caught him. I was like, Hey, you can't just assume that because my car is not there, that I'm not there. So it does happen where people are like, Hey, I noticed your car was missing. I had a patient yesterday. He called and said, Hey, I saw you leaving the clinic.
And so I thought I'd just call and update you. I did finally make it in to see my counselor. It's like, great. That's wonderful. Thank you for updating me. I'm running late for daycare. That's
awesome. Oh my gosh. I love it. Love it. Now you've mentioned Atlas. What are the tools that you use for your DPC to run the everyday functions?
So I do use Atlas. I just recently started using some self scheduling through Calendly and I just use the free version. I don't really see a reason why not. And it's actually been a nice workflow. I debated that one way too long and then I just did it and it's been fine. So they still text me. I'm still got that complete hands-on and complete control.
I do have a virtual assistant who works a few hours a week, but I don't, they don't really do anything patient facing. Um, it's all. Office work type stuff like vaccines and referrals, but so scheduling is all still through me. So they text me or call me, I decide, yeah, you do need to be seen here's your link.
And so they'll do that. So that's been a really nice feature to kind of save on a lot of that back and forth as far as other. I guess tech and tools. I do have a cardia six lead. I like it. It's not a substitute for an EKG, so I haven't used it quite as much as I thought that I would, or this I started to at first, never underestimate the power of exam paper.
Yeah, exam paper has come to the rescue so many times. I know that sounds crazy. This is not tech your tools, but it is true so today I went to my first vendor, not vendor event, but like a community event where I actually had a table. I was a sponsor and I couldn't find the tablecloth.
So I just got some exam paper and put that as my tablecloth. And it worked out just fine. The first day that I did a pap smear in my office, I realized there was a food truck that was set up outside the window. And I hadn't thought to put any window coverings on. So I just got some tape and some table paper, and I had an Institute I've had crazy kids and you just rip off some paper and they can color.
Table paper. That is my,
no, I did invest in a good at scale, but I'm a pretty low tech office. I'd say I am very simple. I think it would be amazing to get a butterfly IQ at some point, but I really don't know that I can justify it. I
love that. And then, you know, everybody has, I think that's a genius tip. I honestly do because it's a very realistic tip in terms of everyone who's worked with exam table paper, can, can just picture everything that you just described.
I'm going to mention a couple of things that I know that the people who I'm pulling these examples from are going to laugh at, but having batteries, like that's a tool to backup your, your equipment. Um, having. Like, you know, tampons or sanitary pads in the bathroom. That's something somebody had mentioned on DBC women's group.
So the exam table paper is genius. And so, so useful. So wonderful. And
oh, I will say it is super valuable having a kids table. I know with COVID we, there's not tons and tons of toys out there, but I. My move that I'm going to go ahead and call as genius. Um, I took the kids corner and I moved it out of the waiting room and put it into the exam room.
So now, cause you know, when mom is getting her pelvic exam or whatever, that's when you want to have something for the kids, not necessarily when they're in the waiting room where they don't actually need to wait. So we moved that out and now it's perfect because I've got a little copying that then my husband is working on building and there's more room for that and kids are happy in the exam room.
So yeah, so that, that's a big thing.
Awesome. And then in terms of resources, you had mentioned business podcasts that are not aren't necessarily doctor and business combined, but what are some of the podcasts that you love in that library of yours when you're listening and you're looking to. Yeah.
So I will say I have, uh, so my like just women in business contests, I've got biz chicks and, uh, the Christy Wright show used to be business boutique when it was business boutique.
There was a lot of really, really great episodes, especially the original initial couple of seasons where there were some just like gold in there. And now she does a little bit more like life advice type stuff, but still, also helpful. And then kind of medical business focused would probably the main one is the social dentist.
I listened to her as far as that stuff goes. Although I don't know that how much of it I I'm applying now, but it's all going into the back of my mind for when I have tons more time. And then just, I think other things that are interesting, what do I have like. White coat investor and paradoxes. I think those are some of the big ones.
An advice to other physicians, who are looking to start a DPC practice, what additional words of wisdom can you say? Can you share with them in
closing? Yeah. So not anything completely unique or original.
I would just say, I think that you just need to be confident that you are, you made it through med school and you know how to do this. And just because somebody else did it one way does not mean that that's how you have to do it. And just because something worked for someone else doesn't mean that it works for you.
And, um, I think that that's something that we are really good at comparing ourselves to other people and you just need to figure out what's what's right for you. What's right for your community. It's going to be different. I, my practice is completely different than the practices that I really in a lot of ways modeled myself after, just for the sake of who I am, what my personality is, um, what my town demographics are like and things that I couldn't have even necessarily anticipated.
So I think, I think mainly I see people all the time, way overthinking. Like I have to have everything ready. I have to have everything planned out. I have to have this much money in the bank. I have to have all these markers and get all these goals and have all this equipment. I had zero when I started and I had all these ideas, but no plans.
And I just, you know, that totally cliche, like build your wings on the way down. I just figured it out as I went. Like, I, I mean, it wasn't clueless, but I just made it happen. And I checked in with people along the way. I utilize the resources, but I also utilize them knowing that, okay, that's how they did it now.
How do I want to do it based off of what they did. So.
I love that. And, you know, just, just being in the space of being about to open it's I've I wasn't expecting it because I've been in too many weeks of just overwhelm with regards to what to finish before opening day. But I feel that what you're saying is really Sage advice that you, you take what you have learned, you build out what you need to do for your clinic.
And it, it, it almost from, for me, and I don't know if it was the same for you, the things that you have to do, sort of narrows down as you get more clarity and closer to opening day.
Yeah. Yeah. He still feel, even if everything is perfect and everything is going, according to plan, you'll still get imposter syndrome.
That's just reality. There's still times where I feel like, oh gosh, I'm not really owning this business. I'm not really this doctor. And then there's other times where I was like, who's telling me not, I can totally do that. That it is because I said it is, and you just kind of have to have this like confidence.
Really. A lot of it is just about being competent, even when you're not feeling confident, acting confident and not in an arrogant way, but in a decision making. Let's get things done. You know what? Maybe there's not a precedent and I'm just going to build this now, or maybe there is a precedent and I'm just going to prove that I'm going to do it.
I'm going to do it my way too.
Now, for those who would like to reach out to you after this podcast, what is the best way to reach
you? Okay, so on Instagram hope, family medicine, DPC on Facebook. It's Dr. Christina Gonzales and it's Christina. Oh, DEO. So Christina with a C, H and Gonzales with twosies one in the middle one at the end, or you can reach out to me through my website.
Hope family medicine, dpc.com. It's a mouthful, but I think you can figure it out.
Perfect. Thank you so much, Dr. Gonzalez for joining
us
today. Yes, it was so good to talk with you and yeah, I feel like we're old friends, even in that
soon.
Transcript generated by AI so please forgive errors.
Comments