Listen to the Podcast here: What does “Direct Primary Care” mean for Families?
Summary: This episode of the DPC Pediatricians Podcast, hosted by Dr. Phil Boucher and Dr. Marina Capella, explores the unique benefits of Pediatric Direct Primary Care (DPC) from the patient’s perspective and emphasizes why families embrace the DPC model.
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 back to another episode of the DPC Pediatricians Podcast. FYI, as we get started,
don’t forget the first ever Pediatric Direct Care Virtual Summit is coming up in September. And so if you want to hear from a bunch of different speakers, whether you’re DPC curious, whether you have a mature practice, you’re launching, you’re somewhere in between, come and get to hear from your fellow DPC pediatricians that are doing this,
that are learning, that are sharing and practicing in such a cool way. And if so, if you want, it’ll be in the show notes, obviously, but go to summit.dpcpediatrician.com. Now, today we’re going to be talking specifically about what it feels like on the patient side and what we hear from patients who
who go to a pediatric direct primary care office. Like what does it look like? And so as I’m thinking about this, and I don’t know if you do surveys, but when we have done surveys in the past, And this is what I tell families as well. Like, yes,
I think I’m pretty funny and we have great bedside manner and our office is nice and comfortable and calm and all those sorts of things. But honestly, what people love is being able to text their doctor. And by far the feature that gets the most positive feedback is being able to text.
It might be something about these millennial and Gen Z parents, but they don’t like calling on the phone. And I frankly don’t like answering my phone all that much. And so it works out really well for me as like a, I think I would be an elder millennial to have a very text forward practice.
But I think one of the things that really stands out in pediatric direct primary care is being able to text your doctor. I can’t think of anybody that doesn’t do some form of easier communication when it comes to their practice. For us, what that looks like is when patients have questions or concerns before booking an appointment,
before calling, they’ll usually text us and say, hey, this is what’s going on. And I would say, and I’d be curious to know, Marina, what your experience is, I would say probably 60 to 75% of the questions do not require them to come into the office automatically.
Whether it’s, when can my kid go back to daycare with hand, foot, and mouth? Or what’s the deal with this rash? Or is my baby’s poop normal? Or how do I start solid foods? Or does my kid have a urinary tract infection? A lot of these questions can be handled virtually over text message that saves them
an office visit. So I don’t know, Marina, share a little bit about the texting aspect in your practice and what patients often see, I suppose.
Yeah, definitely. I mean, similar to, I think most, well, a majority of concerns can be dealt with over text, or sometimes if it’s a little more involved, I might say, hey, this might be easier to talk about over a phone call. Let me call you in 15 minutes at my next break or in an hour or whatever.
But generally, in fact, I just had a mom the other day text me that her little girl had gotten a cut between her toes and she had texted. She’s relatively new to the practice. And so she texted, hey, can I get an appointment for Wednesday? This thing happened. And then she texted me a picture and I said,
hey, I just looked at the picture and actually this doesn’t really need any intervention. Just make sure to keep the area clean, use some antibiotics. ointment if you have some but those heal really nicely because the toes just stay nice and together and you don’t really need anything and so she said oh that’s
wonderful to hear thank you so much we’ll just do that and I said just let me know if anything’s getting worse and then we can talk about a visit if necessary so I That was a pleasant surprise for the parent to hear that, oh,
I don’t have to take time off work and get my kid out of school and do all that stuff. I can just get some reassurance via text from my doctor. So I would say the vast majority of parents, they appreciate that. It’s a rare parent who wants to be in the office all of the time.
And so that’s a really nice feature. And I just saw a newborn the other day and I’m a little worried about the feeding. And so I wasn’t going to be in the office until Friday. And so I said, I’ll just check in with you because you can ask over text, hey, how many wet diapers, how many stools?
How’s the breastfeeding going? And then if I really needed to come in more urgently because I felt like the baby was really losing weight and getting jaundiced, like I can come if needed. But it’s really nice to be able to have that option.
And sometimes when I’m up in the mountains in my cabin or like out of town, I can still be fielding some of those messages. Which I mean, that becomes another issue, which we’ll talk about in terms of avoiding burnout. But it’s nice to be able to do that.
And up until the point where I’ve gotten really busy, it’s been very manageable. It’s only recently that I’m thinking I need to find out a new system where I can like take more genuine time off. But I would say most pediatricians, we understand, I would say way more than the internal medicine docs and the family medicine docs.
We understand the importance of being available to our parents because when do kids start to complain of ear pain? It’s At bedtime. Or when do things happen? They kind of happen at random times. And we may not promise our parents availability overnight, but we can still usually be available for really urgent things most of the time.
And we get to decide what that availability looks like.
Yeah, I think that’s huge. And I think that’s something that, especially parents these days, because of all the different things, are anxious about their kids’ health and are confused often about their kids’ health. And so having a reliable resource makes a huge difference to say, okay, I’m seeing this on the internet.
Is this something I need to be worried about? I would say, like that statistic that I gave, like 75% of… questions can be handled without a visit. And probably at least 50% of those messages are simply versions of, is this normal or is this something I need to worry about?
And so being able to synthesize that really quickly and easily and say, no, that’s not anything to worry about, or yeah, we see this rash all the time, or this is definitely going around and here’s what we look for and here’s what to do if that pops up, gives parents that reassurance.
That makes them feel much more comfortable and confident without like constantly feeling like they have to check in or, or be on top of things. Just knowing if something comes up, I have this pediatrician in my diaper bag and my, the back,
my back pocket that I can reach out to that will respond in a reasonable amount of time that will synthesize all of the stuff that I’m hearing and seeing. and the worries that I have. And I think that’s huge, especially for anxious parents to have that availability that we can provide that reassurance.
And I think one thing that I’ve noticed, and I’d be curious from your perspective too, is these checkups. When I was in private practice and a busy practice, the parents would come in and they would pull out their iPhone with all of their notes. And they’d say, is this a thing? Is this a thing?
Is this a thing? What do we do about this? What do we do about this? And I don’t see that very much anymore because they ask questions as they go and they know that we have time for them when they have questions or concerns. And so it’s not like, let me try and get through,
let me just claw any healthcare, any FaceTime that I can get with you. Like, let me just hold onto that. There isn’t this scarcity mindset of I only get this much healthcare. It’s I can relax because I don’t really need to worry about that.
And if this thing comes up, I’ll just text them and they’ll be able to help me through it.
Uh-huh. Yeah, definitely. And that also helps us too. It’s a side effect that, for example, sometimes I totally forget to talk about vitamin D at those newborn visits because we’re talking about so much other stuff. And so afterwards I text them, Hey, I forgot to mention vitamin D. This is what I recommend.
Let me know if you have any questions. And on the other side of the coin is Parents can also help to remind us. So if I ordered, for example, imaging and it took them a couple of weeks to get around to it, I just say, hey, text me once you’ve actually done it.
That way I can be on the lookout for those results. Right. Or if you haven’t heard back by a certain time about this, just text me because sometimes I we have like a lot of things that we have to kind of be following.
Right.
up on and so just the parents knowing that they can text us and just remind us about something is really nice and that helps me and they feel like oh I don’t just have to wait and wait and wait and wait and someday someone will get back to me
right like I can ask and it’s really easy to do that
Similarly, along the same lines is sometimes I’m worried about a kid a little bit, like not enough to do something extreme, put them in the hospital or anything. But I do want to know how last night went. I don’t want to forget to check in. And so what I’ll do,
which works well for me to just be like, okay, I know that we’re going to discuss it tomorrow, is when I’m seeing them, I’ll just pull up my spruce and I’ll… put a, how’s Jimmy doing now message scheduled for 7 AM. And then I can mentally check that off.
I don’t have to remember to circle back because I’ve got this automation that’s going to circle back. And I know that the parent will then text me and let me know how they’re doing. Um, and one thing that I, added maybe a year or two ago to that because the,
the tricky thing is if they text overnight and then they like, he has another fever and then you just text, how’s Jimmy doing? It sounds like you didn’t see that. So I always add the now, which just gives that a like, okay, I, I, it just is okay. How are things now? Yeah.
20 minutes after you just updated me, how are things now? Or three hours after you sent that last message, how are things now? And that allows me, the one that checks in on them and shows that I care and that I’m interested and that we’re kind of doing the higher touch point of my doctor reached out first
thing in the morning to check in on little Jimmy who had a fever yesterday. But it also helps me then to close the loop really easily that I’m going to find out and figure out if there’s anything more that I need to do without having to be reminded.
Yeah. Yeah. I would say that apart from the text messages, one of the things that parents really appreciate about the DPC model in general is just more time with their doctors. So when they are coming in for those visits, for me, my physicals are, and now this can be different for different practices, but for me,
I have an hour for physicals. 30 minutes for sick visits and so it’s never that 10 to 15 minutes slot right and and it’s just so nice because you can actually have conversations about their personal lives or just like random things and you can develop that relationship on
a deeper level and the parents over the course of that 45 minutes to an hour right they actually feel like, oh, I just remembered another question. I didn’t have to write it down. I didn’t have to come in with this scarcity mindset checklist because I know I only have 15 minutes with my doctor. And yeah, it just,
everything is just so much nicer when it comes to those kids, those like toddlers who tend to be a little bit afraid of being in the office. Often what I do, I have toys in the room. The toddler gets to go and explore and play with some toys while I’m talking to the parents.
And then I don’t even check vitals until halfway through the visit because that way the child has gotten an opportunity to, To feel calm, to feel safe, to feel like, okay, this is no longer a stranger. My parents been talking to this person for a while.
And that just brings down the anxiety level for a lot of kids as well as just having that time. being able to take a little more time to get comfortable as opposed to a busy practice where the MA is dragging them back and just like getting vitals as quickly as they can.
And the kid is crying on the scale or, and then you come in and they’re already upset because I was just dragged really quickly through this new place and, and made to do these weird things. And then now here’s this other stranger coming in. Right. So I love that. And I think parents really appreciate that as well.
What about you? Do you feel like because you’re able to take more time than you were in your other practice, that that creates a different experience for your parents as well?
Oh, totally. We know what’s going on with them. I know what their specific concerns or worries are. It’s so much easier to just circle around to those and to know the context of their life. And this mom just started a new business or this dad’s getting deployed or whatever it might be like.
We have the time to get into the weeds of those things and really know what’s going on and then fine tune our messaging, our recommendations. Here’s things that you don’t even need to think about right now because you got all this on your plate right now.
It just makes it so much easier to know the patients and develop that comfort level. And I think another benefit that I’ve seen is that… Patients are much happier to play by the rules when it comes to the way the practice works because they know you and they trust you and they trust that
relationship that you’ve built up to. So it’s not like they’re calling for every little piece of health care and they’re frustrated when they have to wait 10 minutes. Or in a big practice, they’re waiting for 45 minutes or an hour or something like that. No one expects to do that in our office.
And if for some reason they did, they would say there must be a good reason. He must be really helping somebody do something to do that. So I think just the level of patient satisfaction and happiness is so different. because they’re able to have that relationship with you. And they don’t just feel like a number.
Like when somebody says Leo called or Leo’s mom called, I know who Leo’s mom is. And I know what she’s probably calling about because this time of year, Leo’s asthma acts up. And so I bet that’s what it’s about before, rather than like, here’s this number, this patient number and all the different things.
And so I think parents feel that too when with them, because you don’t have-
2000 patients that you’re trying to yeah exactly and not just not just 2000 patients but also like 10 providers or physicians or clinicians and you’re just kind of like bouncing from one to the other to the other and nobody ever actually gets to know you they’re just trying to decipher the last person’s notes and trying
to figure out what’s going on so I mean, that’s not to say that in DPC, you can’t also have a partner or hire someone eventually to help you out. But even then, it tends to be just two people who get to know the family and the child, as opposed to a dozen people in a big practice, right?
Right.
Yep. I was just talking with somebody about that this morning physician that was bringing on a nurse practitioner and was concerned that people wouldn’t want to see them. And what we’ve done is we’ve created a home where all the different people that are here
And so it doesn’t feel like you’re just getting passed off to whomever is available. It’s, there’s a specific reason why you might want to see Lindsay for this because she’s really good at asthma and has 10 years of allergy experience or Clara does a ton of anxiety work with families.
And so I think that you should see her. It makes for a totally different experience than just their goal. You can see them today, that sort of thing. And the families feel that and they request my, my, colleagues, Lindsay and Clara, as much as they request me because they have developed those relationships and it
doesn’t feel like they’re getting passed off or second string or anything like that.
Yeah. Yeah. And for busy families, it is important sometimes for them to just be able to see who’s available soon. But again, that team really works a lot closer. I mean, even though I don’t have another provider working for me, I do have a pediatrician who works out of…
the same office as i’ve mentioned before and we help cover for each other so i was recently gone for a week i was out of the country and she was fielding my patient needs and and taking care of them and and and my practice even lists her they said
hey it kind of introduces her and i talk to my patients about her when they enroll so they know hey I am sometimes out of the country or visiting family or at a conference and I have another pediatrician who helps cover. She’s great. I have full confidence in her.
And so they’re starting to get to know her as well. Right. And they’re happy with her. Is there anything else, Phil, you can think of that from the family’s perspective is really just a benefit of direct pediatric care?
I think one thing that right now is a benefit that you see more frequently in direct primary care than in fee-for-service model is the ease of scheduling. So we have a little notification thing that we get when people schedule appointments. And so I kind of always have a pulse on when people are scheduling and it is always
the most random times. And so I know that at a lot of fee-for-service practices, you got a call, you have to wait in line in the queue, you have to pray that they have an appointment spot available. People book checkups at two in the morning for three months from now because the
mom or dad was up with the baby at two in the morning and remembered, oh, we need to get a checkup on the calendar. Or it’s Saturday afternoon and they know they need their physical schedule. Like the most random times patients schedule appointments. And so from the family standpoint,
the ease of scheduling makes a huge difference in the midst of the busy life that everybody has and overscheduling and constant stimulation and all those sorts of things is being able to make it really easy for families to book those appointments when they need to, when it’s relevant to them.
So they don’t have to put it on the to-do list because for me, if you tell me you got a call and wait on hold and make an appointment, that appointment just got knocked down the road at least two months. because of like not having the mental space to be like, okay,
now I’ve slotted in time to call my dentist to schedule my dental checkup. Okay, that got pushed for two months off the to-do list and now I’m finally doing it versus I could just go on the website, click book, find a time that works and have it off my radar.
Yeah, definitely. I mean, thinking about myself, I have my own DPC physician locally, and I actually found a DPC dentist as well, which is nice. Well, yeah, the equivalent of DPC in dentistry. And it’s nice because I can text the system and I’m terrible about remembering to
send messages during daytime hours because those daytime hours are the times when I’m the busiest. I’m either getting ready for work or at work seeing patients or on Zoom calls or doing the stuff that I have to do. And so I’m the one who’s remembering at like 10 p.m. in the evening. Oh, shoot.
I had that on my to-do list and I didn’t text my dentist, my doctor. And I still try not to send text messages at two in the morning because… I don’t want to bug anyone, but it’s okay. I mean, because especially if you use automations in your system and you have like an
overnight message or you just train your parents to say, Hey, I’m not necessarily going to respond at 2 a.m., but in the morning I’m going to see your message and I’m going to respond and feel free to just send it. That’s lovely for them.
And they don’t, they don’t have to worry about remembering to send a message at a certain time. They know that we’re going to see it eventually. Right. And we’ll get back to them.
That’s one of the things that I always tell people or parents when I’m doing like a meet and greet is here’s what it looks like overnight. If your baby is sick, here’s what you do. And if you just have a random question that you think of because you’re up at two
in the morning and you don’t want to put it on a to-do list or trying to remember, you can just text us. Texting me, texting at two in the morning is not going to wake me up. I’ll see you in the morning and we’ll get back to when we’re open. But if it helps…
you to remove that from your list, just text us and say, Hey, I don’t remember when I can start peanut butter with my four month old. Like, when can I do that? Just text us and we’ll, we’ll get back to you in the morning. So I think that then,
and that just frees them up of one less thing on the to-do list, which is a huge win for them.
Yep, exactly. Well, anything else to add, Phil? I think we’ve made the biggest benefits of DPC for families clear. And actually I’m curious, do you have, are you the only DPC person? pediatrician in your area. So do your kids see someone in your practice or like what you do for your own family? Yeah.
So for my own, so there aren’t any other DPC pediatricians in the, in the area, in the state, actually for my kids, one of my residency, my co-residents from residency sees them. So we still do go to a fee for service practice for my own kids. Having said that, I mean, as most pediatricians know,
It takes a lot to get to take your own kid in to the doctor.
That’s true.
I’m just going to swap them for strep at home. I’m going to tell them to rub some dirt on their scraped knee and those sorts of things. So we don’t utilize her services all that much, but we do still go there for that purpose. Yeah.
Gosh, I mean, it makes sense. Like you can do so much yourself. I think that most pediatricians would see it that way as well. Yeah. All right. Well, everyone, we hope this was helpful. Don’t forget to register for our Pediatric Direct Care Summit happening in the middle of September. I believe it’s September 17th through 19th.
The free registration window has passed, but it’s not too much to register. And you can also opt in to get access to the recordings afterwards if you can’t make it live. We hope to see you there, especially if you’re newer to this DPC community,
if you have a lot of questions about how do I make the finances work and how do I market and just what is this really going to look like day to day, our summit will have answers to all those questions and more, as well as just an opportunity to get to know what other people in the pediatric
DPC space are doing out there and how they’re running their practices and getting to enjoy freedom and autonomy and work-life balance and all of those things again so we hope you join us and thanks for listening.
