My medical practice growth reminds me of a train.

At first the going was slow, educating people about our unique DPC (Direct Primary Care) practice, waiting for prospective patients to call. But word is spreading, and patients are loving the prompt personalized health care. Our numbers are growing. We are getting several new patients per week. The train is cruising along faster and faster.

I’m planning on limiting my practice to about 500 patients so I can continue to provide good care. At this rate, it won’t be long until we’re full!

Dave was a new patient to my DPC (Direct Primary Care) practice, but he had been my patient previously when I was a traditional doctor.

After I had addressed his knee pain, there was a lull. He said, “I have another question.” Then he rolled his eyes and said, “I know you’ll have to charge me an extra co-pay.” We both laughed.

Yes, in traditional medical practices we had to make sure we billed for everything we did. It was as much fraud to under-charge as to over-charge. Random charts would be reviewed to make sure we were “compliant” with all the regulations. We spent time in meetings discussing ICD10 codes and various regulations. It didn’t help patient care, but it was part of making sure we got paid by insurances for our services.

One of the frustrations for patients is when they would be seen for a “wellness exam.” If any other problem was addressed, such as a cough or a pain, they would be billed an extra co-pay.

Oh, how great it is to be free of insurance requirements. In my DPC (Direct Primary Care) practice, patients pay a monthly membership fee, and in exchange they get unlimited office visits and communication. So Dave’s extra questions didn’t cost him anything.

It was 5 minutes before closing time when 3-year-old Emma’s mom called with an urgent request. Was there any way we could see Emma? She just fell off her bike and there had been a lot of blood. Mom was afraid she had knocked a tooth loose. They were 5 minutes away. Sure, c’mon in.

I remember when I first met Emma last fall. She would hide her face from me, crying, barely letting me examine her. And when Kallie, our mascot dog, would come near her, she would shriek in terror! But over the last few months, Emma had been in the office several times with her siblings, often playing with Sue, picking out stickers or little toys, proudly displaying them. And she has enjoyed playing with the dog.

Today she came in alone, carried by her mom. Her face had a couple streaks of blood but no cuts. Her face was serious as she sat quietly on mom’s lap, facing me, allowing my exam. There was some blood between her teeth, but there didn’t seem to be anything that needed stitches or special care. But were her teeth loose? It was hard to tell with my gloved finger, so I got a pair of forceps to push gently. I explained what I was doing, and Emma sat calmly, eyes watching me, allowing me to push on her teeth. They seemed to be fine.

Within about 5 minutes of arriving, she was on her way home, grasping the plastic whale she chose from our box of goodies. As she turned to wave at Sue and me and the dog, I smiled, loving how this environment lets me provide great prompt personalized care. Medicine the way it should be!

I was in the exam room with a patient and could hear my next patient chatting with Sue, the receptionist. He was quite early.

When I asked him about it later, he said “Well, they usually ask you to arrive 15 minutes early.”

We’re not your typical doctor’s office. At the traditional office, most people stand in line at the front desk, then answer questions, confirming their insurance and personal info. Then they sit and wait a few minutes until the nurse calls them back, asking her own questions and checking vital signs. Then more waiting until the doctor arrives.

In my office, patients usually are escorted to the exam room on arrival, rarely having time to sit in the waiting room. We don’t bill insurance, and I don’t have a nurse. I have longer appointment times (30 to 60 minutes) so I can stay on time. I used to be that doctor that ran late when I was in the traditional medical practice. It’s so refreshing to be on time!

I love my DPC (Direct Primary Care) practice, where patients pay a monthly membership fee, and in exchange they receive unlimited office visits and communication. Personalized health care, the way it should be!

I was sure John’s problem was gluten sensitivity, but I was wrong.

He came to me as a new patient, frustrated that his previous doctor just kept adding various medicines for his stomach symptoms, and nothing seemed to help. With many things he ate, like a bagel and milk, or a sandwich, he would start coughing afterward and have reflux symptoms.

He had tried different foods, various stomach pills, apple cider vinegar, probiotics, but nothing seemed to help. His bowels would churn (Fun fact… that’s called borborygmi), and he would belch a lot. He had been scoped top and bottom, diagnosed with gastritis. More pills were added, but he still didn’t feel right. As a busy professional, his symptoms were bothersome, and he just didn’t feel good.

I ordered a GI Map test on his first visit. I love this stool test, since it helps detect imbalances in the gut microbiome, which consists of trillions of bacteria in the bowel. I’ve seen many people with H. pylori in the stomach (often not detected on standard medical tests), as well as overgrowth of “bad” bacteria. The beneficial bacteria are often out of balance, leading to “leaky gut,” or irritable bowel syndrome. The GI Map test also indicates problems with digestion, intolerance to gluten, and problems with the gut immune function.

In John’s case, he didn’t have gluten intolerance (anti-gliadin was normal). But he had issues with fat and protein digestion (Steatocrit and Elastase-1). He started good digestive enzymes and probiotics, as well as another supplement, and he feels much better!

I love my Direct Primary Care (DPC) medical practice, where I have TIME to learn new things and work with patients from a different perspective than I used to in a traditional practice.

I was in my exam room with one patient when I heard the distinct sound of Kallie the dog trotting quickly down the hall toward the front door. Then I heard some voices. I had to peak out.

In our waiting room were two smiling kids, leaning toward the dog. And mom announced, “We came early to play with Kallie and see Sue.”

Yes, we have quite a unique medical office!

If I’m calculating right, we gained 15 new patients just in the last week! We have 3 more new patients scheduled for tomorrow, and 2 or 3 “Meet and Greets” later in the week, where people come check out our DPC (Direct Primary Care) practice to see if it’s a good fit for them.

Momentum is picking up. People are hearing about this unique medical model, where we don’t bill insurance so we’re not answering to insurance companies. Patients pay a monthly membership fee, and in exchange they get unlimited office visits and communication. I’m able to spend TIME with my patients, providing personalized medical care. This is the way medicine should be!

Kyle’s veins seemed to be playing Hide and Seek. They were so visible, yet when I inserted the needle, nothing came out. He was accumulating a few Band-Aids. We laughed that it looked like he had been in a fight! He was a good sport about it, searching for another site to try.

I’m not a phlebotomist. I’m a Family Practice doctor with my own practice, trying to save him money. He didn’t have insurance, so he knew my price would be so much better than going to the lab. He is a trucker, needing to show that his diabetes is under control. He needed a simple A1C, which would cost him $12.92 through me ($2.92 for the A1C and my $10 drawing fee – yes, that’s all!). He needed the results that week, and the day we tried to draw his labs was the only time he would be in town.

Finally, after several tries I gave up. He promised he would remove the Band-Aids, evidence of my failed attempts, before he headed to the lab for a phlebotomist to draw his blood.

When I next saw him, Kyle told me what the A1C had cost him at the lab — $161 – more than 12 times what it would have cost in my office!

I hope next time his veins are more cooperative. I have more labs I want to check on him.

If I’d had a Direct Primary Care practice a couple years ago, I would have seen my friend’s horribly bruised leg, in my office, several times if needed.

A horse ended up dumping her on some stones, then running away. She was left with an impressive multi-colored bruise on her leg, which she posted multiple times on Facebook. I was her doctor, and we kept in touch as friends. But I never saw the injury in person.

With the traditional medical practice I was part of, she would have had to make an appointment (hopefully with me), waiting in the waiting room and exam room before finally being seen. The visit would have been billed to insurance, and with her high deductible, she figured she would owe quite a lot. So she carried on without me seeing her in person.

But now, with my DPC (Direct Primary Care) practice, as a patient she would pay a monthly membership and in exchange have unlimited office visits and communication. She could pop in for me to check the bruise, or she could send me texts or photos with updates. If I had concerns, I could order more tests, trying to find the best prices for her. And since I am limiting my practice to about 500 patients, rather than the usual 2000 patients that Family Practice doctors have, I would have more availability to see her as needed.

I love working for my patients rather than the insurance companies. This is the way medicine should be!

One year ago today we had our Opening Day. What a great adventure it has been!

We have met many new patients, spending TIME to get to know them and help them improve their health.

And we have loved being free of the constraints of Medical Insurances dictating what we do. Here’s to many more years!