Listen to the podcast here: Marina & Phil’s practice updates
Episode Summary: In this episode of the DPC Pediatricians podcast, Phil and Marina share candid updates on their own practices, including growth challenges and reaching patient capacity. They discuss the complexities of hiring, building the right compensation structure, and aligning new team members with the mission of direct primary care. The conversation offers a behind-the-scenes look at the operational decisions and mindset shifts involved in scaling a DPC practice.
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.
Hey everyone, welcome to another episode of DPC Pediatricians. Today we were thinking one of the things we don’t talk a lot about is our own practices all that much. Sometimes we’ll talk in the big picture about we do it this way or we do it that way.
But I thought it would be fun to just kind of talk about where we’re at with our practices, what Marina and I in particular are doing. especially knowing that we’re going to all be together soon at the DPC mastermind and so this is just a chance to kind of hear from us about our practices so Marina can you start us off and share a little about what’s going on in your practice right now what you’re working on what’s what’s on the top of your list how things are going any big picture updates or nitty gritty stuff.
Yeah big picture updates let’s see I feel like I’m reaching capacity and I definitely felt that for a couple months now so I made the decision to hire a new pediatrician just barely started to get the word out but whoa that’s exciting It is exciting, but also a little intimidating because I’ve never done that before.
And of course, there’s that question of how am I going to find someone who’s as motivated and loves this and is as invested in my own practice as I am. I think that’s That’s one of the things that I’m grappling with. But also how do, especially thinking about some of the econ classes and managerial accounting
classes that I’ve taken through my MBA program, thinking about how do I create a structure that incentivizes a compensation structure and just kind of a working relationship that incentivizes someone to work hard and feel the reward for it but kind of be aligned with the greater aims
of me and my practice and i think that there’s a lot that you can do within a contract to ensure that in fact i have a dpc physician friend who had hired i think two years ago she’s not my dpc physician she’s in family medicine but she had hired an acupuncturist in her clinic but she hired her just on a kind of base salary model and so there was no incentive within that kind of contract for her to do any of the marketing and to do any of the work to get patients or track patients or
keep patients and so she learned the hard way she shared that with me and I thought oh great so whenever I come to that point of hiring someone I want to make sure to avoid that trap of just saying okay I’m going to pay you this much and then they have no incentive to
to work really hard because I’ve poured my heart, my soul, my bank accounts into creating this practice. And it’s really important to find someone who is aligned, who is motivated to learn and take off with the integrative medicine stuff, but also interested in the business stuff and really continuing to grow the practice slowly over time.
So that’s, I would say the biggest update and also just feeling at capacity. I’ve also, because I’ve recognized actually my mentor this morning had a conversation with me about, okay, if you’re feeling at capacity, you need to start interviewing patients for the privilege of being your patients instead of
it’s kind of just shifting from that mindset of like begging people to come to me so it’s like it’s a privilege to work with me and it’s okay if you raise your prices to create the kind of budgetary I don’t know to basically enable me to hire
another pediatrician I need to have some funds in the bank right and raising my prices on new members going forward because I am mostly at capacity and so I can yeah those are some of the things that are on my mind and I’m planning for in the next year that’s exciting so you’ve made the decision to hire but you haven’t started interviewing or anything along those lines just yet
yeah I’ve posted a job listing I actually created a page on dpcpediatrician.com if anyone else is looking for a pediatrician and wants to post a job there that’s a great way to do it I just realized when I came to that point of like where do I
even advertise this the traditional places don’t seem right because this is the world of DPC and it’s such a great model plus they charge a ridiculous amount of money to put a job listing so yeah I said hey I’m not the only one who’s going to need it so it’s there if anyone wants to use it
i like that because i i agree with you completely like if i’m a pediatrician looking for a job i’m not going to go to like indeed or monster.com or wherever like the job websites are i’m going to be like calling offices or scouting facebook
groups right or something along those lines so the fact that that this isn’t wasn’t an intentional ad for the website but that’s a really great idea because i bet there are others out there that are either on that path looking for a job or approaching that concept in the coming years that that would be beneficial to yeah
so anyway and I also through the American Academy of Pediatrics they have a job listings page but those are usually huge corporations like Kaiser and Cleveland Clinic and Children’s Hospital of Philadelphia that are advertising through those channels I’m not huge like they are so I didn’t I didn’t feel aligned but yeah so that’s one thing about me what about what’s one thing for you looking at your practice looking forward to this year
We’ve gotten to near capacity too. I think it comes up seasonally as to how busy are we because like three or four weeks ago when we were in the like height of flu season, it was like, oh, this is pretty darn busy. And now that we’re out of that, it’s like, oh,
we have some big gaps in the schedule, which I like because it gives us freedom to like create new things or figure out better systems and all of that. um but we have intentionally had a wait list for the past like six to nine months
not necessarily like a long wait list where it takes months and months to get in because we are not at that place and we also don’t like to make people wait that long but it has been a good way to actually drum up more interest in people that
are ready and understand the model because to get on the wait list means you’re not going to get in right away which means you have to plan ahead so these are parents that are planning ahead or they’re looking forward to getting in and getting off the waitlist. And so that’s been a really good play for us.
And it also allows us to make special exceptions to, oh, this person is sick and needs a new doctor and we’re going to get them in lickety split. Yeah, yeah, yeah. I know that there’s a waitlist, but we’re going to make it extra special for you because we can tell you really need us,
which helps us to grow our practice, but also helps patients to feel well taken care of when We can understand that they’re on the waitlist, but they have an acute need that we have the time to manage. So that’s been helpful. We’ve always stayed open to new babies.
Like new babies has never been a thing that we’ve put a waitlist around because we like to grow the practice that way. They’re the best. They’re the best. They’re great patients. They stay for a long time because they get used to texting the attrition and so it’s an easy once they’re in the
practice they’re going to stick around and figure out how to make it work whereas somebody that is bouncing from pediatrician to pediatrician is more likely to also bounce away like we talked about in our video on attrition but I think that’s one of the big things that we’re doing another big thing so basically what happened a
couple of years ago is we started to have a few patients reaching out to us about pans and pandas and that wasn’t something that I knew a ton about but there were two good doctors nearby that were seeing these patients subsequently both of them have retired and luckily we knew that they were going to retire and we
said this is a clinical area that we have an interest in and we have the bandwidth to learn and grow and all those sorts of things and worked with them as kind of a mentee mentor in these PANS patients relationship and so now we’ve had an influx of PANS and PANDAS patients from these two doctors that
both retired within a year or two of each other that had sizable pans and pandas patients we’ve also gotten to work so in nebraska before the legislative body this year was a bill requiring ivig coverage for pans and pandas patients like insurance mandated coverage which has successfully rolled out
in a number of states across the country and so we got to act at the legislature and like testify at the legislature about pans and pandas and ivig and those sorts of things so that was a cool like not specifically clinical but patient advocacy angle that is
still ongoing as of this recording like it’s still before the legislative body for a vote Nebraska because nobody actually cares about this, but I’m going to say it because it’s interesting, is the only state in the union that has a single legislative body. So we don’t have a House of Representatives and a Senate.
We have a unicameral single legislative body, which seems to get stuff done faster because it doesn’t have to go through two different legislative bodies.
Very cool. That’s cool. And that’s a great example of how you can get involved in advocacy as a dpc physician right whatever side of the political aisle you’re on you have that prerogative you have that ability you have a little more freedom and ability to be an advocate for your patients right maybe that’s awesome
well i think that goes a long way with patients too and i think in DPC it’s much easier because if i’m working in four day five day per week practice seeing 20 to 30 patients a day and you’re asking me to go downtown to find a parking space to
wait at the capital for three other bills to be presented that’s a half day out of clinic which is a huge ask for a pediatrician and it’s a huge revenue loss for the pediatrician or the practice to have them out of the practice whereas for us i mean we can pop down there we
just block our schedule we don’t lose any revenue we just take care of patients virtually and say hey i’ll be back at the office in a little bit you can swing over it’s a totally different opportunity for dpc pediatricians to continue to provide value we’re also doing those things that that help to advocate for our patients and
for our community
Yeah, that’s awesome. Actually, last year in January is our legislative session in Utah, and I cared about an issue. And so I went to Capitol Hill and I brought my office manager and my medical assistant and my medical student with me, obviously made it optional. I didn’t make it mandatory,
but they’ve all eagerly came along and we watched the arguments go back and forth in a session on a controversial, important topic. and as sobering as it was from a political perspective it was also really educational for me and my team to go there and to feel like we can be involved in
those sorts of things once you go there and do that it becomes like oh these are just like normal people that are talking through questions that they have yeah i last legislative season so like a year ago i also was at the lead capital
for a bill and took my kids with me so that they could just like my older kids not my young kids they could see what the how a bill becomes a law sort of process went and they did it was kind of boring in like three hours of sitting in a really
stuffy hearing room but it was a good opportunity for them to learn i like to tell myself that they learned about the legislative process just a little bit and My side, our medical group side was successful on that bill. So that also felt good of like, Hey,
I helped in a small way to implement some change that our Nebraska Medical Association was trying to protect patients and families about.
Yeah, that’s great. That’s great. trying to think if there’s anything else new on the horizon for my practice well actually one big thing saw it as part of kind of part and parcel with hiring another pediatrician is this recognition that I need more support right that I’ve
been doing it all for five years I’m starting to get a little tired right and that’s I think just part of like you you reach a new step and you reach a new step and you reach a new step and each step comes with unique opportunities and
challenges right so part of me I have been inspired to write a book after I finished my MBA program in May. Wow. I had to recognize the fact that if I want to write a book, if I actually want to get to the point of publishing this book that’s in my brain,
I need to set aside a significant amount of time for that. And so I was like, okay, I need two days a week, a couple hours each. How am I going to do that? And so I’ve decided that part of the reason I’m bringing in this pediatrician is I want to strictly work three days a week
Maybe take phone texts like another extra day or two, but share that call more consistently and truly have that time off.
That’s amazing.
Part of that process that I’ve engaged in is I need to find a way to find more balance in my own life. Because as much as I’m a person that I want to do it all, everything is exciting. Like every opportunity seems amazing and I want to do it all. I’m also human.
I need to take a step back. I need to give myself more time to recharge and to do the other things that I care about, such as writing this book.
now that’s amazing and I’m sure you’ll be super successful with it and I love the idea because of blocking some time to do that because if you don’t it’ll it’ll sit on Apple Notes or Google Docs for years but if you actually like commit to two days
a week to work on it then it’s going to happen and it will just flow and happen as time goes on I love that I think that’s so is it a pediatric book is it a direct primary care book is it a murder mystery like what kind of book are we talking here
So the big theme of the book is recognizing how our system of medical education and medical training and work in the insurance-based healthcare industry actually traumatizes the very people that are supposed to be society’s healers. it’s telling it is telling my own story but with the lens of kind of sharing and
helping other people connect to the ways in which they maybe have not fully recognized their own trauma through their education training and work and what can we do about it how can we heal ourselves as the healers of society so that we can be better healers and just also be okay ourselves because we’re tending we’re out
there tending to the wounds of society who comes to tend to our wounds right
love that that’s amazing have you been watching the pit by chance i have yes i feel like i mean i don’t want to do any spoilers or anything like that but i think there’s a lot of good examples of the way of what you spoke there that the not just
seeing patients go through dramatic or horrible things or hearing about the things or experiencing those sorts of things but just the way that the system itself is so often traumatic to the healer so i think that absolutely in fact we were just
watching it the other night and there was a quote dr says something to one of the residents that’s basically you have to leave your you you cannot bring your personal life into work at all and I just I actually took out
my phone and I said rewind it I need to record this because I need to because this is a perfect example perfect illustration obviously it’s fictional but it’s based in real experiences that we’re not allowed to be human at the same time that we’re trying to
help foster other people’s humanity we’re not allowed to be human and there’s
something deeply wrong with that I remember that exact scene because I had the exact same thought as when he was talking to Dr Mohan and he’s like you have to build a wall it has to be a tall wall out there is everything else and in here is
you doing your thing and it was just so like I I think they did a really good job of illustrating how her personal life was affecting her work and yeah the healthcare system’s response is build a bigger wall, block your notifications,
all sorts of things.
So I love that. That’s awesome. Wow. How exciting. Okay. Do you have a title yet? Because I feel like that is pretty pivotal.
I have a couple of ideas, but I won’t say them yet. I think it’s going to take me about a year. It’s okay. but I think actually my mentor encouraged me to do this and she said the process of writing your own story will help you heal from some of your own trauma from your
patient training and I think that we don’t allow enough spaces amongst us as physicians to really share those things right because instead we have these training programs that are telling us build walls right well we have all built very effective walls around our own trauma in order to try to survive and keep going
It’s like, when do we get to break those down? When do we get to actually witness each other in that suffering that sometimes happens?
Amen. Well, that’s great. I’m super excited for that.
Thanks. Any other big things on your horizon?
Well, no, I can’t think of it. So something really big that I’ll share on our next episode when we talk about summertime growth is a new idea that I’ve had for bringing in more patients that don’t necessarily need a primary care physician straight away.
because I think one of the things that I find when I talk to other dpcpediatricians is that there’s often times where we have a way that we can serve families but they might not need our total primary care just yet and so what I’m going to do and I’m
not trying to just like hold y’all in suspense like wait till the next week
is create a ADHD tune up,
which is essentially an opportunity in the summer in the off season to get in and put some strategies in place around your child’s ADHD, something that they might not be able to get at their regular pediatrician that can help dpcpediatricians.com yeah because their kid is fine they’re playing outside they’re watching youtube and
all the different things but if we can instead say okay you don’t need an adhd evaluation but let’s find all those kids that do have adhd and figure out how to get them to a better place when it’s not the olympics when we’re in the training
area so yeah that’s kind of one of the big things that i’ve been working on at the
practice level all right well we won’t spoil it further we’ll save that all for the next episode but that’s awesome yeah so hopefully everyone you learn a little bit about how our practices are going as you see we’re not just stagnant it’s not like you just open up a DPC and then it is a certain way forever
for the rest of your life we continue growing evolving changing tracks a little bit finding different things to be interested in hopefully you can too in your own practice
yeah and please share on the Substack like if you look in the show notes you’ll find our Substack comment and share what’s going on in your practice because we would love to hear from you and hear what’s going on in your neck of the woods yeah definitely all right everyone thanks for listening until next time
