Welcome to DPC Pediatrician. We’re Dr. Phil Boucher and Dr.
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Marina Capella,
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two DPC pediatricians who are on a mission to share our love of direct primary care with you. Hey everyone, welcome back to another episode of DPC Pediatricians. Today, we’re just gonna give a little update on what’s going on in our clinics because
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people have told us they like to know just kind of the nitty gritty of what’s going on behind the scenes. I feel like that’s a great way for me at least to come up with new ideas is hearing what other people are doing and what’s working for them.
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And so we were just going to share back and forth a couple of different ideas. So I didn’t, we didn’t talk about this, the format in advance, but I was thinking we could just do one and then one and then one and then one and one and share some different ideas.
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So Marina, what’s going on and what’s new in your clinic right now?
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Yeah. I would say my biggest update, uh, it’s pretty exciting is that I purchased a building for my practice and that was about a five months long, painful process last year. We finally got the keys at the end of October to the building. And then I thought we would be able to move in pretty quickly,
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but some electrical repairs and getting new flooring in some rooms and doors for some of the rooms and just getting furnishings ready and stuff took a lot longer than I expected. But we were able to finally move in just a few days ago, so I’m really excited. It’s an old historic home that was renovated.
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a couple of years ago and it’s just beautiful. It has a beautiful staircase and this like fireplace in the waiting room and a lot of natural light. And yeah, I’m really excited. So my goal is really to make it kind of not just a pediatric clinic,
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we have three physicians working out of this space so I have myself Margie who’s my clinic partner she has her own DPC but we kind of help each other out we partner with a lot of stuff and then after I purchased the building a family doctor who
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used to be my family doctor actually when I first moved to Salt Lake City she reached out and said hey I remember you said you were leaping into DPC when I last saw you a few years ago I’m making the leap into DPC and I’d love to pick your brain.
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She said, I want to specialize in women’s health and I’m looking for a space. And I said, hey, come check out this building. I have some units for lease. And so she’s going to be there and it’ll be awesome because like our patients whose moms say, hey, do you have someone like you who can see me?
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We say, yes, like right over there. So that’ll be amazing. DPC partnership community. And then we would love to get a mental health therapist in the space and either physical therapists or occupational therapists in the space as well. So really excited. It’s a beautiful building. People walk in and they’re like, oh, you know, it just feels different.
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It feels like a beautiful, welcoming, therapeutic environment instead of like a clinic. Right. And I think that’s really fun to have that. It’s been a lot of pain. It’s been a lot of expense.
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Oh, I’m sure.
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I think my, you know, financially, I’ve taken a hit, of course, trying to like make that purchase and everything. But it’s kind of the next step, right? Like I was growing, growing, growing, doing well. finally to the point where I had money to reinvest in the business through acquiring a building. And it’s really exciting. Congratulations.
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We’ll have to put the pictures up on the Substack page for this so people can see it or they can look on Facebook, but so cool. I love the space.
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Yeah. So yeah, that’s my biggest update recently. What about you, Phil?
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I think one of the big things that we’ve been doing this year so far is really focusing on what we’re good at. I think in DPC, especially at the beginning, you really want to be anything to anyone that has a pulse and a payment method and a problem to solve. And now I think we’re finding, okay,
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these are the patients that we take really good care of and the ones that really stick around for a long time. And so for us this year, the two big areas is one is newborns. And what we love about newborns, I mean, they’re sweet and we love just kind of like having them grow up with us,
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but also parents love our model and they use us a ton and get a ton of benefit from the direct primary care model. I think as kids get older, oftentimes the parents do the math and find it harder and harder to necessarily support the cost of the membership when their kid might not be coming in very often.
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And we kind of have to keep figuring out how to make sure that they feel like it’s worth it for them to stay members. Whereas newborns feel like they’re bothering us. And we’re like, no, we love all of your friends. newborn questions. We don’t mind when you send us pictures of your baby’s poop.
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Like that’s what we’re here for. And so please keep doing that. Maybe not quite as many poop pictures, like just kind of a synopsis of the poop pictures is fine. So we’re really focusing on newborns and then we do a lot of mental health too.
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And I think that’s a big place where we’re able to shine for a lot of different reasons. We do a lot of ADHD because we all like taking care of ADHD patients. But we do lots of anxiety and mental health and our nurse practitioner does a lot
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of more of the complex mental health issues where they’re needing to use more medications or medications outside of the typical toolkit when they can’t get in to see child psych for years. We’re able to handle a lot of that. So we’ve kind of decided, okay,
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we’re going to focus on these rather than trying to be everything for everybody. We’ll still happily take new school aged or high school kids that need direct primary care home. But we’re going to focus our advertising and our marketing efforts specifically on these two areas. And we really enjoyed that.
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And it’s able to kind of dive in deeper rather than feel like we can talk about newborns. We also have to talk about toddlers. We also have to talk about school aged kids. We can just focus on where we’re really good at.
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And so that’s kind of been one of our big things that we’ve been focused on so far this year.
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Yeah. Excellent. I would agree with that sentiment that like the parents of like younger kids tend to appreciate the DPC model more. And so that’s often, you know, I’ve had families who also struggle to justify the cost with their older kids who are completely healthy.
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Yeah.
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Yeah. all right another thing that’s new with me i was thinking a lot recently about kind of like restructuring i i offer a lot and one of the since i’m an integrative pediatrician i feel like can can offer a lot of different things and not everyone necessarily wants that like more holistic integrative approach but there are some
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families who absolutely love it and seek me out because of that there are other families they’re like we just want a pediatrician who is more accessible right and so I’ve struggled for a long time. I’ve kind of waffled, you know, with like, should I change my prices? Should I do this? Should I do that?
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What about those kids who really need more behavioral health support? And I’m having to see them like every week or every two weeks. It’s just the risk pooling just gets kind of messy and say, how do I? address that issue. So I finally decided that I was just going to have different levels of service.
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And I just tried to make it as simple as possible. So I have my basic like essentials membership. And that’s the one that’s like all the well visits. Plus, I actually put a cap on it. Is it up to six, six visits a year? I think I got that idea from you, Phil, actually,
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because you said something in a past episode where you do have some sort of cap. Is that true?
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No.
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Or not really. Okay. Maybe I got it from someone else.
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Sorry. I love to take credit for great ideas, but that was not my idea.
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But yeah, I just realized that it’s much more affordable, that Essentials Membership. And it just makes it so that there are realistic expectations because I was also falling into the trap of only charging someone a hundred dollars a month and then seeing them every two weeks for behavioral health. And I was like, that doesn’t work.
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Just I do the math. It doesn’t work. And so I have my essentials membership. Then I have my sort of complex care membership and I say it’s between this and this, but I have to see you. I have to meet with you and figure out what your kids needs are.
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And then we can come up with a custom price. Right. And that’s really more for like the behavioral health kind of concerns where I do the hypnosis. I do the myofascial release therapy. I can do a lot to help them, but I have to charge because otherwise it just doesn’t work.
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And then I have like a concierge home visit package. Cause I do have one family who’s like more celebrity status and they have a lot of money and they asked me, Hey, we want, can we pay you more and get like home visits and they live close to me. So it works perfectly. So yeah, just,
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I decided to finally put it out there and revise my contracts and just have those three levels. That way people feel like they have more options also, and they can choose what’s right for them. but I’m also not trying to offer way too much for like $100 a month, right?
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You price yourself out or you price patience out when you try and do all that. So I love that idea. I think that’s, I’m just, I’m gonna be processing that for a while now, that concept, because people love options. And they love choices too. And if you have the little thing that says, here’s our essentials package,
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and then here’s our plus package or complex care package, then people can decide what they want. And it gives them a little bit more autonomy over not to directly compare your services to a car wash. But when I go to the car wash, there’s four different options. And I don’t even know what the other options do.
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I never pick the most basic one. I never pick the most expensive one. I always pick the middle one, not really knowing if I’m going to, like if they’re actually going to wash the undercarriage or the tires or whatever it is. But having those options makes me actually pick a more expensive one than if there
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was just one option. So people love that control.
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Yeah, absolutely. And then there’s something about like the valuation. Sometimes when we have those options, it’s like, oh, like I want. the the best or not or like i don’t know or some people are the mentality that i just always want the most economical thing right and so you can kind of cater to
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like you know different mindsets around that so yeah that’s the the most recent change i made in my pricing model within my essentials i still try to keep it minimal i know a lot of people have like multiple tiers like based on age I just have two.
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I have like a zero to two and I have two plus. I just feel like that keeps it simpler. So because with giving options, it’s true that people like options, but they don’t like too many options because then it’s like decision fatigue. And so it’s kind of trying to find that sweet spot.
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So that’s my next experiment with my service levels and pricing.
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I love it. That’s so cool. The next one that I wanted to share was we kind of along similar lines are launching a virtual care option for families. So we have a lot of families that live in our state that we can care for, you know, just with our medical licenses being for the state,
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but they’re not close enough by. And they want that personal touch. They might live in a health care sort of desert and we can’t do everything for them, but we can do more than nothing for them and often help them. And so that’s the newest thing that we’re launching in terms of like offerings is a virtual membership.
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It’s priced much more economically than if you are coming into the office, if you are maybe gonna need an appointment this afternoon, so I have to like mentally keep the space for you in the schedule. Like these are families that live far enough away that if their kid, you know, needs to get swabbed for strep throat or,
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you know, needs a broken bone reset or stitches or something like that, they’re gonna go to their local urgent care ER. primary care doctor, but they do want that extra touch of the pediatrician in their back pocket. And so we kind of developed the program similar to what’s it called? Blueberry,
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which is kind of a national company that does overnight care, urgent care sort of things virtually. Our price point is much higher than Blueberry, which is like $20 a year or something like that. Yeah. Like how does anyone compete against that? But it does allow families to have access to us.
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And then they can go, like we do a lot of parenting support too. So not just the rashes and sore throats and stuffy noses, but like potty training or sleep issues or behavioral challenge, like kind of the more basic behavioral challenges of like, you know,
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try to do less rewards or try to do less punishments and try to be more an authoritative parent, kind of more of the big picture stuff that you could read in a parenting book. Yeah. and working through that with them. So that’s our newest thing that we’ve kind of soft launched.
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We haven’t really started talking about it yet much, but it’s kind of something that we’ve been working towards this past quarter to start offering.
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Yeah. Exciting. I think I saw that you posted about that. And I thought about that as I was kind of thinking about my service levels. I was like, I wonder if maybe someday right now, I don’t think I have the bandwidth for that, but I think eventually if I, you know, end up adding a provider someday,
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that would be a cool option. Cause I also have those families that I had one family who lives an hour away. Yeah. Actually, no, now they live an hour away. They used to live maybe 20 minutes away and then they moved an hour away and they said, Hey, we love you, but.
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an hour is just kind of too much for us to be able to drive do you have like a virtual option yeah and i said well i could probably come up with something for you
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um but as a matter of fact we do exactly a napkin to write out what that looks like
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but it made me think of that and then i have a lot of people have asked who are like sort of 45 minutes south in utah county versus salt lake county And a friend of mine was like, oh, you know, I love your model. I love what you do.
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But like, the price is just like too much of our family. Do you have like a virtual care option that would include like two virtual visits a year or whatever,
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you know?
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So that made me think about it. So maybe down the line right now, it doesn’t feel right. But I love that you’re doing that. You’re at the point where that works. And I love that.
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I also like to try things to share with other pediatricians. Like, hey, here’s another thing that you can do. Like, I feel like we’re good at testing the market and seeing what the market will do. And so like part of it is just to be able to share with other pediatricians, like, hey,
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if you’re struggling or if people are leaving, what if instead of them leaving, you just converted them to a virtual membership and you could still play a role in their kid’s life and take good care of them. But they also had a regular pediatrician that they saw for the stuffy noses and checkups,
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but you were able to keep making a difference for them and creating a revenue opportunity. So we kind of like to try things out too. It’s kind of a sandbox for testing.
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I love it. And I love that you share. Let’s see. Last thing for me, we finally got vax care about two weeks ago. Thanks in part to that. pilot program with you. And there have been some pain points. Overall, we’re very happy with having it and being able to offer vaccines through insurance to more people.
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Before we were absorbing, Margie and I were absorbing the cost of vaccines for our member families. And it is sometimes painful that Prevnar is $250. So I think our profit margins will increase. It is more time on my staff, I think, because so it’s a little bit balanced, but I still think overall, totally worth it. And yeah,
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we’re excited to be able to have, we’re still kind of working out some of the kinks and like figuring out the workflow and like how to input the data efficiently into like two systems because we have to put it into our state vaccine registry and then we
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have to put it into our into vax care and everything and into our emr so that’s a little bit painful but i think overall having insurance pay the bill for these really expensive childhood vaccines and some of the teen vaccines like menopause
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totally worth it
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yeah yeah for sure and the rsv vaccine which is ridiculously expensive like 400 500 i don’t know how people do it otherwise yeah and actually margie recently did a home visit and she she’s my clinic partner but she said that she was impressed that
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the little cell phones the little hubs that they give you um they have a service plan and so she was able to use it on a home visit and that was amazing
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I just realized that too, because we did a home visit and usually sometimes we’ll just scan them out before we go on the home visit so that like they’re, they aren’t there, but we were doing a daycare flu drive, like where we had like 40 kids at a daycare that were doing flu.
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So we wanted to bring it then so we can scan them as we went and it worked perfect. I didn’t realize that either, that like it wasn’t tied to wifi.
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Uh-huh. yeah so we’re excited to have vax care at long last after like three years of having to find alternate solutions and this really is a pain point hopefully it can become more accessible over time to smaller practices starting out i know it’s it’s
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hard because it’s a risk on you know their business side if like you have too many hpv vaccines hanging in your fridge and you don’t use them when they expire like they lose money so i know that that’s it’s a balance they’re a business just like we’re a business they have to like
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weigh their you know risks and benefits yeah so that’s my newest update excited to finally have vax care it didn’t exist in utah until just like a few months ago i
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know that’s awesome i’m so glad that it exists there and that you’re able to get on
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Yeah, all right.
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Our last thing is we added a part-time speech language pathologist to our team. This was like my original dream had been to have the whole dream lineup on day one of kind of all of the different players in the pediatric health space. And it’s just taken time as things do. to actually get to that point.
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But we started on day one with a play therapist who does mental health in our office. She’s pretty much full now. And so then somebody came and they said, I love your model and want to be able to help more families. And so we figured out how to add her in.
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Essentially, she rents the space from us and then is co-located with us. So it works really well for our families to get in to see her. And then she can bring in her own patients and her own patient panel from where she previously worked. And so She’s got her room set up and space set up.
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And so that’s the new exciting thing for us is adding on a speech language pathologist who likes infant feeding a lot. She likes the typical kind of general speech delays and those sorts of things. But then she does a lot of autism too and AACs and all of those sorts of things.
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So we’re excited to have her as somebody, a resource for us and for our patients as well. So that’s our new cool thing.
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That’s amazing. Excellent. Did you just have like a room, a spare room that she could use? Or are you having to like share spaces?
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We had a spare room. We had a room that we use for our autism evaluations that we just decided we can just do those in whichever room we need to or her room when she’s not there and schedule around that. So that kind of, there was the space available.
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So nice. That’s amazing. I love how you have this, like you’re creating this multidisciplinary team. Cause it’s so convenient for families to just have to go to one place and like, you know, everything is there. It’s really nice. It’s, you know, we talk about medical homes and, and this, you know,
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we can also create medical homes within DPC. I think you’re an example of someone who’s doing that. I’m working on getting there.
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Yeah. It’s been really cool to have others because then it’s just more people to bounce ideas off of because I have my silo of the things that I know and that I’m good at, but then I can ask our therapist, you know, what’s their approach for this or what do you think about this patient?
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And then same with speech language pathologists, like I have my kind of things that I think about speech, but they’re probably out of date and they’re probably not as nuanced as they should be. And so then getting her input on that or having us get to both see the families, super cool.
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yeah well thanks for sharing your updates phil it was fun to learn about all right
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hopefully people can process on these and see what would work in their clinic like i’m already processing on what you were saying about your different tiers and just
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i’ll be thinking on that for a while so yeah all right until next time everyone bye
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everyone
