Link to podcast: ThriveWell Pediatrics
Welcome to DPC Pediatrician. We’re Dr. Phil Boucher and Dr.
Marina Capella, two DPC pediatricians who are on a mission to share our love of direct primary care
with you.
Welcome, everyone. I’m delighted to introduce Dr. Danus and Dr. Valerie Miles of ThriveWell Pediatrics, which is located in Jacksonville, Florida. I’m happy to have them on today because they are a really wonderful example of how you can do direct pediatric care in a partnership model. There are lots of ways of doing partnerships.
but they truly started as a real partnership. They both came from a background of having their own private practices in the fee-for-service world and met each other through the world of integrative medicine, already knew they got along and decided to open their practice together in Jacksonville. So thank you so much for being here, both of you.
Thank you for having us. Thank you for having us, yes.
Yeah, so I want to get just a little bit of a feeling for, or I want our audience to hear a little bit of your backstory. So starting with you, Danu, tell us a little bit about what your life was like before you started ThriveWell.
Yeah, thank you. So I’m originally from Columbus, Ohio. That’s where I was raised, and I went to college there. I went to Ohio State University, did all my training there, did my pediatric training at Columbus Children’s Hospital, and then I joined a really large pediatric practice. There were almost 18 pediatricians in that group.
And so I was the junior partner and then eventually I became a partner there. And I just got to a place where I was really just struggling with the amount of prescriptions I was writing. And I was trying to figure out like how I could have more time to address the things that I thought were important,
like nutrition and sleep for my patients, especially for kids with ADHD. I just felt like that was really foundational. And so through my yoga practice, I was just beginning to explore the world of integrative medicine. And I’ve always been a little bit part of that world because my family’s from India.
And so there’s a lot of Ayurvedic traditions, a lot of homeopathic traditions that are used in my family. And so I was always very much having that in the back of my mind. And so then I opened my own integrated practice, a pediatric primary care practice in Columbus.
And that was, as I was opening that practice, that’s how I met Valerie. I had found a holistic medicine conference that I thought would be a good jumping out point for me to just begin to get my feet wet in this area. And they had a pediatric track and that’s how I met Valerie.
And she kind of took me under her wing and introduced me to a few people. And then she had already had her practice, which she’ll tell you her story about that. And it was helpful for me to get my practice off the ground in Columbus.
And that’s where I was for 12 years in that integrated pediatric primary care practice. And then eventually my husband and I decided we’ve been talking for a long time about moving south, getting out of the winter. And my winters are, they’re not terrible, but in Columbus, it’s very gray.
And it’s just not sunny very much in the summer. I mean, the winter rather for three to four months. And it’s just like, and anyways, my parents also needed more help. My mom was not doing well with Alzheimer’s. And so they needed to move with us. And my dad had ever somehow some,
this Indian man from India ended up in one of the coldest, well, not the coldest climate, but in cold climate. And so every winter, he would always say, I want to live in Florida. I want to live in Florida. We’re moving, we’re moving. Of course, 50 plus years later, never did. So.
Anyway, so then in 2019, we came to both of our practices kind of came to our crossroads. We started talking about this move that we wanted to do and what could our practices look like. And so through that conversation, we decided that we wanted to work together and we had a very similar vision.
And I had always been looking for a partner, just could not find an MD who had very similar viewpoints and just similar perspectives. And so that’s how we were able to forge a discussion about starting this practice. So I’ll turn that over to Valerie for the her story, but that’s how we sort of came together.
Wonderful. Thank you. Yeah. So now the other side of the puzzle, Valerie, what was your life like before ThriveWell?
Well, I trained in Salt Lake City, which was a fabulous children’s program and great training. And I felt, we say in the South, I felt very called to pediatrics because I hated all the basic rotations except for pediatrics. And I loved pediatrics, so I knew that it loved me.
So I did training in Salt Lake City and then started chief residency. So I did four years in Salt Lake city. And then I, we do so much chief teaching as chief president because we’re associate professor or whatever the title is. And on,
on call rotations with the faculty and you really get to kind of practice being a faculty member. And I love that. And I was doing a general pediatric academic fellowship, which is two years long. And I did the first year during that chief year. And I just loved being able to
the research and all of that was really something that attracted me but the teaching part i was teaching well the general pediatricians outside of the hospital do this and then they send kids to us if this and i started feeling very just inauthentic that i didn’t really know how to be a general pediatrician in the world
and so i had a friend who we had about 12 or 15 on in each year in our residency program and one of my co-residency mates had gone to Durango, Colorado, which at the time was a town of about say 25,000 in town, maybe 40 or 50,000 in the region and fairly isolated just being in Southwest Colorado.
And she, they needed somebody like now and it just, the timing was perfect. So they had three pediatricians already, including her and I was the fourth and it was a small hospital associated practice. So it was actually attached to the regional hospital there, our Catholic hospital at the time. And we just did general peds.
But the interesting place of it was very interesting place in that there were already people who were very integrative minded and holistic minded there when we didn’t get taught any of that in residency. So it was literally day two of my first practice. which was down there with people asking questions that I couldn’t answer.
I had a baby in the hospital whose mom was a older primate and was super extra holistic, which is where it was difficult in the late nineties. Honestly, nobody was approving any of this. Right. And so, and she wanted the baby who was born big and had a dystocia and had insults.
and wanted a chiropractor to come to the hospital and adjust him and i was just like so all of it was very new to me but step by step i learned little things the first thing was garlic oil for ear infections which already had a good study from
israel and i then got curious because i saw that first child get better when i didn’t think he would i thought he needed antibiotics and he came back two days later and he was better with just garlic oil. So I had to really research because with all this research background, I didn’t, I,
that was the only thing that was real for me.
Yeah.
And there were, it was at a time when there weren’t a lot of studies in the United States for these kinds of things that people were asking about, but they were, there were plenty in Germany and Scandinavia and places that are perfectly civilized and smart people live there and
So that’s where I really got my training was just like looking at international research. And then a few years later, the first conference appeared that I was able to go to and kind of learn more of that stuff. So I spent four years there doing that. And I really felt like this kind of transformed doctor,
like a rubber band that stretched and won’t go back. to, to the just more tunnel vision of mainstream medicine, because there, this was all science, mostly science backed stuff that I was seeing be helpful for the kids and the parents loved it. And so I had to,
I had to move to Florida where we are now in Jacksonville in 99, because my husband’s work took us there, here. And I I was really afraid because it’s so close to Georgia, we can throw a stone to Georgia. And I thought, oh my gosh, I’m going back to the South,
which is where I did college and med school and had lived most of my life on this coast. But knowing what the South is like, I was very afraid that I’d learned I’m not going back, but who’s going to want this?
And what I found was I just contacted the only home birth midwife in this city of a million plus people. thinking at least she’d send me the breastfeeders. 96% of our moms in Durango initiated breastfeeding at the time and stuck with it for at least six months, if not 12 or more.
So I was really, I knew that was making the healthiest kids. So that’s what I wanted. was looking for and that she connected me with everybody else who was of this integrative world here. And it created a great network. And I was able to come here and work for a year for somebody else,
but then start my own practice in 2000. So I’ve been doing this. this integrative approach since 2000, when I also got board certified in integrative medicine, needing the credential, because worried about the academic world here, were they going to even respect me. And so that helped me, but it’s not necessary, really.
And, and then that was 17 years of running an insurance-based practice. And Danu had, I had, of course, she told the story, but we had stayed connected because we were, we felt, even though I had a partner, I felt like a solo practitioner in this insurance model because it was just,
it just wasn’t the greatest relationship as far as being a team. And so she and I would talk on the phone with like having the struggle or whatever. And we’re very much sounding boards for each other and supporting each other. So we already had this sense that it was a good fit.
And then just about the time I needed it, she moved or wanted to move and said, I’m not moving to Florida unless you tell me. to Jacksonville, unless you tell me that you’re going to practice with me. And we’re like, okay, we’re winging it at this point because we didn’t know what we were going to do.
We just knew we were going to practice together. And we started looking at cash-based model and this and that. And then we met, we We heard, I heard from the doc that I was seeing at the time, who was also a friend of mine, but kind of a family practice type doc.
He said, well, you guys should really look at direct primary care. And we’re like, what’s that? And that was 2019. That was 2019. We opened our practice in 2020, but what was so great about him sharing that was that Donnie was on her way down for a visit to just kind of get everything ready.
And the nuts and bolts DPC conference was like right at the same time as she was going to be coming down. And so we just drove to Orlando and that set us off on the right foot. There were probably what, 200 people in that room?
if not, and we had 10 pediatricians, I think eight or 10 that we gathered at this one table. So there’s not as many of us, but it really has been, I can’t imagine doing this, not all by myself. Now I did, I bootstrapped my first practice, so I know I could do it,
but we’re a little bit older and having a partner is just, it’s just huge. So I do think it does need to be the right fit. Cause it’s kind of like getting married, of course. But we, we really have been able to balance out our strengths in terms of what the way we’ve divided up the work,
the accounting work or the phones and the this and the that. And we sort of have a way of balancing that all out. So it’s been great not to have to do it all.
Uh huh. Yeah.
Yeah.
Fantastic. Now tell me, so you had a great relationship. I think that’s one of the prerequisites for, of course, considering a partnership of any kind, right? It was that great relationship. Similar, you were similarly minded in the integrative medicine world and probably similarly minded in terms of like, we have to escape the fee-for-service world.
There has to be something better, right? And experiencing the frustrations of private practice ownership in the fee-for-service world. I imagine there were some trepidations. I mean, that’s like natural, right? To say, oh my gosh, I’m like tying myself together to this person, not just through a friendship,
but through this business model where we have to make it work. What were some of the ways that you navigated that?
I think that, yeah, go ahead. No,
I was going to say that I think that we, what was great was that Danu had been a part of a big practice with multiple partners. So we knew that we wanted a legal agreement, business partner agreement. So we needed, and we needed a lawyer for that. We needed to not do that ourselves. Don’t do that yourself.
And then we needed all of the other things that go along with that. So that’s where you can take it away, Danu. I mean, I think that’s the main thing that’s important because it’s a lot of sometimes not so comfortable conversations like what if you die or what if you leave or what if
one of the other person does and you gotta talk about that stuff. And so, but then what you end up with in the end is this document that you feel very protected and you feel very safe, even though bad things can happen.
everybody’s going to be okay because it was what we worked out was fair for each other. So.
So I was going to say, even before you get to the legal agreement, which I think is really important, I think it is imperative to put it in writing so that everybody’s very clear about what could happen, what could not happen, what are the contingencies and all of that.
But I also think that the conversations that Valerie is referring to, of having those really sometimes difficult, uncomfortable conversations, we had to come to an agreement about the percentage ownership of the practice. Valerie had had some challenges with her previous partner that were coming to play in our conversation.
I also was coming from having been completely solo, having nobody else to answer to. Now I was going to take on answering to a partner and how is that going to work? I was also coming to a new city where my name was not known. So what was that going to look like?
But I was also bringing all of the physical assets from the office that I had in Ohio. So what was the fairness around that? She had the reputation here, the know-how, how to navigate the children’s hospital system here, and just all of those things. So I was going to tap into that information.
But I was also bringing physical assets. So what was the fairness about the percentage of that? So we had to have some pretty, we had to have very, very concrete kind of just non-emotional kind of conversations and just say, look, we’re coming at this with the best of intentions.
We know we can work together from a clinical perspective and take care of our patients. That really was never the question. It is really what is the percentage of ownership? What feels fair? What doesn’t? I’m sure that both of us at one point thought, well, I should probably have the 51% ownership and you should have 49.
And I’m sure we thought about that or less or more, whatever. And all kinds of scenarios, I’m sure each of us ran through in our head. And ultimately we found that both the assets that we’re bringing to the table her intangibles, if you will, in terms of community connections and goodwill and all that.
And then the stuff that I was bringing was equal. So we settled on a 50-50% partnership, and that may not work for everybody for a number of reasons, but for us, it felt like the most equal, equitable decision to make. And so that’s what got written into our legal agreement.
both from a compensation standpoint as well as the ownership. And so as we take kind of financial distributions when we can do that, those are people partnership distributions that we take. So yeah, those are the conversations that you have to be willing to have. Otherwise, partnership is difficult,
especially if we didn’t want to ruin a friendship over this either. We had both things kind of in play and we still sometimes have to navigate that. Okay, we’re friends, so we could maybe you’re nicer about something because it’s your friend, but The business stuff’s got to get done, right?
And so you just navigate and talk through the things that are still challenging. So, but that’s when we came to our agreement of creating the partnership, the actual legal entity, if you will. Yeah.
Gotcha. And did you guys start out as just an LLC partnership with 50-50 distribution? Yeah.
Yes. We have, we’re taxed as an S corp, which is important, but we are a limited liability corporation.
Yeah. Each of our individual LLC. So I have whole kids pediatrics, which is my company in Ohio, which is now a Florida company. Valerie has her PA or LLC that, so we are the LLCs are the owners of thrive. Well, so. Thrival is an umbrella, and so we are the owners.
Our LLCs are the owners, and then we are employees of the practice. So there’s various ways to set all of that up from a tax standpoint. Yeah, but like Valerie said, we’re taxed as a desk corporation with ownership of two PAs. Gotcha.
Yeah. And that percentage, I think, as you mentioned, is a very important conversation because you have to, like, if the paperwork says 50, 50, then the, everything has to be 50, 50. Right. And that was, I’m curious, like, has it been difficult to navigate? You both want to take vacations at different times, maybe
Um, Valerie, you ha you were, you had been in Jacksonville for quite a while. And so you might’ve known more people in the beginning. How did you kind of make it so that it felt like you both were doing about the same amount of work?
Maybe you can never make it exactly the same, but you can make it pretty darn close. Right.
Well, as far as patients go, it was, it was interesting because I’d been doing urgent care kind of as this buffer in between in this transition. And, and so my patients, my former patients, there was no way to really tell them. Right. So anyway, so, but everybody was looking for me.
So at first, what we did was we opened basically the beginning of March in 2020. And so then like a week and a half later, the country shut down. And now we’re all scared and nobody wants to leave their house, but we had built home visits into our model.
So what we did is we started, we had started, we had one live in-person meet and greet to kick off kind of thing. And our plan was to do that monthly, but then we ended up doing all the rest of them on zoom.
So at the same time, we were like all day long, you’re trying to think, how can I network? How can I know? I can’t go see anybody. So we, we did zoom calls with all these, with different people, like the lactation consultants and midwives, everybody, or phone calls, everybody I could think of that would
be to announce the practice and then to send us people. And we, I had, I had created a website for us. My, my, I’m a little more on the techie side than Danu. So we split, split that over.
And so they had a place to go to the website to learn about us and to get in touch with us. And we didn’t have an assistant at all through this. We were doing everything the first year, almost, I think, or two years. Yeah. And so, and so that networking was what brought babies in and newborn babies,
primates, they don’t know, they don’t have a pediatrician already. So those would all go to, I mean, we kept it, we tried to keep it very balanced. There are just more patients finding me for my old practice, which would have been weird to send to her. So there was probably, it took, I don’t know,
you probably know how long Danu before the patient numbers were even, that was upside down for a little while.
Yeah, I think the first six months, I mean, I knew that I was going to have to network heavily to get my name out. I would say that one of the best things that you can do in investing in a practice, whether you’re solo or partnership, is to have a really strong social media presence.
And that social media starts with a really good website that’s very clear about what you do, what you offer, who you are. The about page is really important to announce who you are. I think that a lot of the interest that came to me was that I had this herbal training.
I had some of the more unique kind of training. that, oh, maybe she does kind of fit this model that she’s in practice with Dr. Miles with whatever. So I think having a really strong website is really critical, no matter who you are anymore, because everybody’s looking online.
And I think that especially when COVID, when the pandemic hit, people were online even more. And looking for the right kind of physician for them. And somebody who’s going to do home visits was like a godsend for these moms with new babies. And so the fact that we were offering that.
So I think differentiating ourselves a little bit was really critical to our success. So I think for me, it took me about, it was somewhere in the six month range before we felt like patient numbers were starting to equalize. And we just had to be mindful about not, my biggest thing is never to nickel and dime things.
And I hate that. So I tend to look at very big picture of like, what’s going to serve the practice the best and still serve us as partners. And so I really was not all about like, okay, I utilize 10% of the resources you utilize 30%. So you get paid X amount or Y amount.
I just, I personally don’t like that. And I think Valerie has kind of come along with that now. But initially that was one of our differences that I was very much looking at that bigger picture of things. She was more in that kind of microbe space.
And so we had to just kind of figure out what’s going to feel comfortable kind of with that. But yeah, that’s how we grew.
And part of it was too, just working through my trauma, honestly, from my former partner who was very micromanaging. And so that, that was how I’d been doing it for years, just because of how she tended to be. And it’s interesting that because a lot of us have been doing other work before we
come to DPC and that, and a lot of times we’re completely burned out or traumatized by it. And those things do enter into this conversation. If you’ve got a partner and just knowing to be able to separate it out from who you actually are and what your intention actually is, your big,
big picture intention for the practices to be successful is, not to. And so finding middle ground became really easy once she, but she had to say, you’re this, I don’t want to be nickel and dimed. And I had that soundbite in my head. And every time I’d think about something, I’d hear her say, I’m like, okay,
I got to figure out a different way to do that. So it’s good. It’s personal growth, really.
Yeah. Well, I love it. I think as long as both people, the sense I get anyway, is that as long as both people are willing to be flexible to some degree, I think partnerships is probably not a good thing if you are really, really just type A and want everything to be perfectly fair 100% of the time,
because it’s just not possible. You have to be a little flexible. Is that correct in your experience? Yeah. Oh yeah.
I think that the biggest thing that for me is that I had been doing this solo practice for 12 plus years. Vacation was always a challenge. I mean, I took vacation, but I had to make sure about coverage. It was sometimes challenging to do that. I wanted that to be easy.
So that kind of the balance of having this direct pediatric care practice to have somebody to cover for me with call, having to be able to take vacation, know that patients were taken care of, know that the office was going to run, nothing was going to burn down and
So even though we may have different styles around certain things, just knowing that the basics were really going to be always attended to and that we both had our best interests at heart, it was really huge. And so that coverage piece of it and just all that was really,
I think both of us just reached a stage where we didn’t want to do that by ourselves anymore. Yeah. And just to have ideas, somebody else to bounce ideas off of, like, can I get a new perspective? I’m always learning from Valerie. And so there’s always something new that comes to patient care through a partnership, I think,
which is really nice as opposed to being solo, where you’re just kind of in your own headspace and And I’m sure we all have friends that we can call, but it’s not the same thing as when you’re seeing the same group of patients. Yeah.
Yeah. And also we were able to start to cover for each other to get an afternoon off because we were working, working, working, working at this. And then as the patients really started coming, we felt a need to like not have the texts going off all the time. And that’s been really great covering for each other.
And now we have our third family.
And we’re working out her partnership track because she does want to be a part. And we do want her to be a partner.
We’re 20 years older than her. And so it’s a nice dovetail into something really special for her and for us. It’s a real win-win situation. So it’s a nice dovetail into something really special for her and for us. It’s a real win-win situation. And we just, it’s the same similar thing where somebody who’s just very like-minded,
very much about the care of patients and the high touch, just like direct primary care is she finds perfect for her. She can do all that.
And I think that’s really smart to kind of have this succession planning is something that we don’t talk about too much so far in PEDS-DPC because it’s such a new world, but it’s something that we should have in the back of our minds.
The one last thing, would either of you ever go back to the fee for service?
Heck no. No, no, no, no. A thousand times. No, not a chance. It’s being an entrepreneur is not easy, but it is so worth it. It is so worth it. And having a whole band of brothers and sisters who know more than you do and are ahead of you has just been priceless, really.
Oh, yeah. Wonderful. Your building, Marina, has just been amazing.
Thank you. Thank you. Well, I want to give you a minute to just put a plug in for your brand new course. It’s sort of a mini integrative medicine course for primary care pediatricians. So tell me a little bit about it and how can people find out more?
Yeah, so we wanted to create something. We know that general pediatricians, especially in the direct pediatric world, because we have more time to spend with patients, are asking, what else can I do? Or they’re reading more today and understanding that prescription medicines may not always be the best, especially for children.
So we knew that people were getting asked questions. And so we really wanted to create a course that was going to provide a foundational toolbox. I always call it a toolbox. When I came to integrated medicine, that was what I felt.
was like all of a sudden I had a whole bunch more tools to be able to care for my patients. And so we wanted to create a course that pediatricians could learn how to build that toolbox. And when they got asked questions, to be able to answer them. And so we focused this course on four modules.
That is a foundation module. There’s an immune health, gut health, and mental health module that addresses a lot of those basic kind of natural remedies and supplements that a pediatrician could use. So, yeah. Right. And so when you go in there,
you’ll be able to see the whole outline of say under immune health, coughs or colds or otitis. What are you, what are you, what are you seeing today that you’d like to know in advance might help? Because I had a pediatrician tell me recently, I, I really don’t want to be prescribing
antibiotics all the time, but I don’t know what else to do. And that’s so valuable. Or is it, if you have done it or you do, you do not prescribe antibiotics all the time, it’s like, well, what else can I do and what is safe and all of that.
And so we’ve got all the scientific references for every video. So little bite videos, five minutes each up to two hours or so of, of total content, but they’re all five minutes each and videos along with all the scientific references at every lesson. So, and a giant document at the end with all the scientific references and then
handouts of just reinforcing the things in print form. Everything has transcripts so you can read or listen or watch. So we hope it’s super valuable. A lot of people have jumped on it already and already started it. So we’re really looking forward to the feedback because we feel like this is really
a place where we can really serve. And we always had the idea from the before the time we started this practice that we wanted to do digital courses because it’s just a way to reach the wider world with this is really the way to do medicine. It’s all science backed.
Why aren’t we all doing it if it’s safer? Right. Or it’s a great adjunct to what you’re already doing and it helps people get better faster or whatever. So we feel really passionate about it.
Yeah. So you can find us on social media. Certainly we’re on Instagram at thrivewellpediatrics. But this course specifically, if you go to thrivewellpediatrics.com. Go to our courses section and you will see the Thrive Well Pediatrician Effect. That’s what this course is called. And it’s intended to affect pediatricians. And that’s what we wanted to do.
So it’s called the Thrive Well Pediatrician Effect at thrivewellpediatrics.com. And we are actually, we’ll have that up on our course page for the foreseeable future. Right.
And then Instagram and Facebook at thrivewellpediatrics.com. Yep.
Wonderful. Well, thank you so much for putting that resource out there for pediatricians, because I think it’s true what you say. So many people are hungry to learn more. It’s just like we don’t know where to go. Right. And you don’t have to do a two year long integrative medicine fellowship course, in my opinion,
to start practicing some of these things. Thank you both so much for sharing your story, for your time and for being an inspiration in the world of integrative pediatrics as well. Thank you.
Thank you so much. Thank you. Same to you, Marina. Thanks so much. All right. Bye-bye.
