Interview with Dr. David Townsend – 419
In this week's episode, Dr. David Townsend describes how he shifted from traditional employment model internal medicine to his own peaceful DPC (Direct Primary Care) practice four years ago. The shift was triggered by corporate buyouts, mounting productivity pressures, and the feeling that he wasn't connecting with patients the way he would like to.
Dr. Townsend went from covering a panel of 2,500 patients to 500, and from about 25 daily visits to 8-10, allowing him to practice the kind of medicine that inspired him to become a doctor in the first place.
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Breaking Free from Corporate Medicine
Dr. Townsend's started his practice in an academic setting. He later moved to be closer to his extended family as his own family was growing. That move resulted working for a hospital in a nonacademic role. His employer merged with another organization and was later acquired by a large corporate entity. Each transition brought new productivity demands, RVU pressures, and administrative burdens that made it impossible to be the doctor he wanted to be.
The constant struggle between quality patient care and corporate metrics created a situation where he could make correct medical decisions but still feel like a poor doctor due to time constraints and paperwork demands. Both he and his partner reached the point where continuing until age 65 seemed impossible.
Building a Sustainable Peaceful DPC Practice
Dr. Townsend's DPC practice operates with minimal overhead. He and his practice partner provide medical care, and their wives handle nonclinical duties. The physicians perform their own vital signs, EKGs, and phlebotomy, creating a personal touch that patients love while keeping costs low.
The practice reached a capacity of 500 patients for each partner within five months, requiring them to close their panels. The physicians are available by texting, phone calls, same-day appointments, and the flexibility to handle appropriate cases remotely, thereby reducing unnecessary office visits.
Summary
David is very happy with his current practice. And he recommends other physicians to consider adopting the model. He used Atlas MD as a resource for learning the business aspects of starting a DPC practice and endorses using them for other physicians considering the shift to direct priary care. He can be reached through his website at classicdpc.com or via LinkedIn.
Links for today's episode:
- Classic DPC
- Atlas.md
- Rediscover Your Purpose When You Embrace Direct Primary Care
- How to Be Happy and Appreciated: Switch to Direct Primary Care – Part 1
- How to Be Happy and Appreciated: Thrive with Direct Primary Care – Part 2
- Triumph With An Awesome Direct Primary Care Practice
- Dr. David Townsend's LinkedIn
- The Nonclinical Career Academy
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Transcription PNC Podcast Episode 419
Why Shift From Oppressive IM Practice to Peaceful DPC Now?
- Interview with Dr. David Townsend
John: In my quest to learn more about direct primary care, I'm really happy to have today's guest with me today. He actually converted from traditional practice into DPC practice four years ago, so he'll of course explain why he did that and maybe how he did that. So with that, Dr. David Townsend, welcome to the PNC podcast.
Dr. David Townsend: John, thank you so much for having me here and I appreciate you inviting me. This is a pleasure.
John: Good, because I'm going to learn a lot from you and so are our listeners and we're going to push as many people into DPC as we can.
Dr. David Townsend: I love that idea.
John: All right, well, let's see. Why don't we start with just the basics and tell us a little bit about your training education and what you did initially after leaving residency and then how your career went for, let's say, the next few years after that.
Dr. David Townsend: Oh, sure. Undergraduate at the University of Georgia, so go dogs. Then did medical school at Medical College of Georgia. Did my residency in internal medicine at Wake Forest in North Carolina. Finished there in 2008. Stayed on for a chief year there and then I stayed on faculty at Wake Forest for about five or six years or so doing kind of a little everything.
I had my own clinic. I did teaching wards with the residents, continuity clinic, lots of med student resident teaching. And then in 2013, we moved here. I'm in Athens, Georgia right now, mainly to be closer to family, all our families close around here. Joined an outpatient internal medicine practice that went through a lot of transitions. So when I joined, they were completely independent.
Very shortly after getting here, they were bought out by the local big hospital. And so then we were owned by the hospital. And then shortly after that, we were bought out by a very large corporate conglomerate entity.
And so, stayed there until 2021. And then in 2021, myself and my friend and colleague here both left to start this direct primary care practice. So this June was four years since we've opened our door.
John: All right. Yeah, I wasn't sure. I saw the website and I saw there were two of you there and I didn't know if that had started from the beginning or he and you and he were working together before you converted to DPC then, right?
Dr. David Townsend: That's correct. We actually, he was a few years ahead of me and was my chief during residency. So I've known him for a long time, kept in contact. That was actually my contact when getting a job back here. So we were both in the same clinic and both kind of simultaneously were, had our frustrations with the medical system and found out about DPC. So yeah, we both left together and started this together.
John: So what was going on for the two of you? I assume is related to that big buyout and things changed and just how was that discussion? Who brought that up first? And did you look at other options? Like, well, we'll just bail and go somewhere else. So how did that pan out?
Dr. David Townsend: Yeah. Yeah. So I'm sure our frustrations match a lot of frustrations from your listeners too. There's a constant struggle between the doctor that you want to be and the doctor that you feel like you're being told to be in kind of traditional medicine the way it is these days. And so many reasons for that. I mean, you find yourself doing a lot of things that aren't doctor related and that's taking up a lot of your time.
And then just the pressures of seeing numbers and the pressures of coding and getting the RVUs up and things like that. It was just, it was very, very hard to be the doctor that you want to be. And it just, it's, it takes a toll on you over time.
Both of us have been practicing for a long time. So, I mean, from 2008 to 2021, we were both full-time and then did traditional kind of practice. So we both simultaneously were getting to the point where we were like, I'm not, I'm not sure that we can do this for the rest of my career.
I don't know if I can go to 65 with this pace and with this feeling like a cog in a wheel. And a lot of times we'd leave the day, I'd leave the day after a long day of clinic and I felt like I made a lot of good, correct medical decisions, but I didn't feel like a good doctor. You know, it was just that feeling of, I just didn't have time to spend with my patients and all this backlog of paperwork stuff you have to do.
Anyway, we discovered Direct Primary Care. We started looking into it for a few years, almost came to the point maybe earlier, maybe 2018, 2019, where we pulled the trigger on it. At that point, we had just been bought out by that big sort of corporate conglomerate.
And at that point, they were kind of saying all the right things. And so we decided to just give it a try. Ended up where we were kind of back in the same spot. And so, at that point 2020 or so, we decided that that's what we wanted to do. Honestly, it's a little bit of a leap of faith. I mean, so we both have, he has three kids.
I have four and kind of the middle high school, college age. And we went from stable job, stable salary to zero overnight. It's a little bit of a leap of faith, but we both came to the point where we said we are okay. If this doesn't work out, we just have to try something different. I did consider non-clinical careers for a while. I'm just trying to do something different to get out of the situation I was in.
I'm very grateful that we found direct primary care because I still felt like I needed to be a doctor. I still feel like that's why I'm here and that's what I'm hopefully good at, decent at. And so I'm grateful that finding this literally did save my career because it gave me a way to do what I felt like I wanted to do.
John: I'm happy to hear that. And that's what I've heard from others doing DPC so far. And so that's good. But on the one hand, you don't have to worry about billing insurance if you're a traditional DPC, but how did you learn about the other things? Because you had someone who was basically running your practice or you were part of a huge practice. And so, how did that happen?
Dr. David Townsend: Yeah. I tell folks that the when we made the transition into this clinic, the easiest part about the whole thing was being a doctor. Cause I knew how to do that. That was not a problem. The business stuff was new. What we used a resource that I would really highly recommend that if anybody's interested in looking at DPC it's a group called Atlas MD.
They're based out of Kansas. They were kind of the front runners of direct primary care and have kind of made it their mission to assist physicians in making that transition. They basically have a step-by-step.
If you're interested in this, here are things that you need to do in this order. Here are some contacts that you can use that covers all aspects of kind of starting the business and owning it. So the two of us who have tons of medical experience, but zero small business ownership experience, that was an unbelievable resource. They're also extremely approachable. So talk to them on the phone, send them emails, things like that. So we use them a lot to learn a lot of the things, read all the stuff we could.
I went on some Facebook groups that were directed to direct primary care, asked a bunch of questions and that's, that's basically kind of how we learned. I feel like you kind of do need a honorary small business degree or something like that, but believe it or not, it wasn't as hard as we expected it to be. There are definitely things you have to do and steps you have to take, but it was outlined so well by them. We just kind of followed it and everything worked out well.
John: What about space? Did you, I'm assuming you had to leave the previous office and find a place to see patients and how did you manage that one?
Dr. David Townsend: The toughest part about that is we did have a non-compete clause with our current employer. Okay, here we go. Initially, we gave them plenty of lead time. We wanted to leave on good terms. We wanted to make sure they had time to find replacements for us in our clinic and things like that.
And initial conversations were very positive, but as we kind of got close to it, they really started to push on the non-compete stuff. And so paid it, but we ended up having to get a lawyer involved to go through the contract and talk with them and things like that. There were ways basically we were able to, there was a radius clause we couldn't practice and within a certain radius.
The unfortunate part is that my partner and I were in the same practice, but at two different locations. So if you overlap the radius, we would have had to go so far away. Anyway, gratefully we were able to negotiate out of that part.
We were just basically asked, we couldn't advertise. We couldn't, I'm sorry, let me rephrase that because we could advertise. We could not directly tell our current patients what we were doing and when.
Now we could advertise. And if they contacted us, we were free to say what we want, but we couldn't go to a clinic and just say, Hey, I'm about to leave and go here. We just couldn't say anything to anybody. That was a tough part about that. But once we got out of the radius clause of it, there was a, we found a local space. Thankfully, we were able to purchase it. We own the building that we have now and that's where we do our clinic.
John: Nice. Oh, so you purchased a building.
Dr. David Townsend: We did.
John: Okay. That's not a simple, I throw in some real estate it's a mix. Right, right. But that's worked out well.
Dr. David Townsend: That's worked out perfectly. We love our location. We love our place. You mentioned overhead earlier. Our overhead is next to nothing. Happy to talk about some of the business stuff of it, but our employees currently are myself, my partner, and then my wife and his wife run the front desk and answer the phones and greet people and say hi to people.
We do our own phlebotomy. I do our own vital signs. We do our own EKGs or whatever. We've got no medical assistant, no nurse. We are, we are a good example of simplicity really does work well. And patients absolutely love it because they get a hundred percent FaceTime with either us or our wives who know them and greet them when they come in and answer the phones. It's a friendly face. So patients absolutely love it too.
John: You had to start basically from scratch. I suppose there was some word of mouth that eventually made it back to some of your old patients. Did they find you?
Dr. David Townsend: They did. We feel very fortunate and blessed in that regard. We practiced here long enough where we had a good reputation in the community. Folks knew us. And so when they found out we were leaving and we couldn't say anything, but we basically were just like keep your ears open. We couldn't say anything directly, but they did find us.
We actually were fortunate enough to have pre-registrations, a lot of them, hundreds of patients pre-register before we opened doors. And we were just really lucky. We had a, had a big plan on, on marketing and advertising and things like that. And frankly didn't have to use any of that. It was all word of mouth. I'm not sure if, if our experience was completely typical of a new practice that's going to open.
We've seen that we saw estimates that it generally takes about two to three years for a new direct primary care practice to kind of reach capacity. And we filled and reached capacity in about five months. And so we were just really grateful that the community was absolutely ready for it.
We've had to close our wait list. That the another word of encouragement for folks out there is that I think people are very ready for things like this and they want something different. They want more of a traditional way to see their doctor and have direct access and time with their doctor. And so, people were kind of knocking down the doors to the patients here. We very grateful for that.
John: Well, you were talking about how miserable you and your partner were before you did this. And what I was going to comment and forgot was that the patients are just as miserable. They're like, I didn't even get to see the guy. He came in, he flew through the visit. I don't know what's happening. He didn't have time to explain anything to me, he or she, whatever. I think both sides of that equation are like, come on, let's do something different here.
Dr. David Townsend: A hundred percent. We tell people DPC is the biggest win-win in medicine. I mean, Eric and I are really happy and enjoy our job and patients love it. And they go tell all their friends and kind of tell them the experience that they have. And a lot of them, a lot of disbelief out there. It's like, you can, you can text directly with your doctor and they get right back with you. And we think this is a better way to do things.
John: I want to mention something to my listeners right now too, because when you mentioned the issue about the consolidation and then the buyout by a bigger organization and the non-compete. As I'm recording this, my next episode, which will be released actually before this is seen, but it was about those things that happen when you're, particularly when you're a new physician, we're going to happen to any physician where things just change and the non-competes a big one. And if you're thinking of leaving, I think if it might've been possible with enough lead time thinking about it, like to try and change your contract a little bit before resigning to where it was a little softer and then maybe you leverage that and make it a little easier. But oftentimes the contracts are so boiler plate that you really don't have much choice.
Dr. David Townsend: Yeah. We tried that and looked into that and this, the big corporation that, that we were owned by, it literally was, this is the contract and we don't vary it for anyone. So yeah, we had zero choice on it.
John: Well, let's see. You're kind of a full practice now. What does that mean for you? And maybe we can compare, do you have any idea, like, well, how big your, your practice was when you were with the previous employer? I mean, most of us don't, we just show up. We know we have a lot of patients, but we don't know if it's 5,000, 3,000. But what does that look like now compared?
Dr. David Townsend: Where we were before, we each had about 2,500 patients in our panel, which is fairly typical for an internal medicine clinic. And right now we're capped at 500 each. So from 2,500 down to 500, which obviously adds a lot of margin in your day and a lot more time spent with patients.
John: Now what does that look like from a day in the office or a week in the office? Because obviously you're not sitting there seeing patients every 15 minutes if and you have all these other options of how to interact with them. What's, what does it look like to your practice?
Dr. David Townsend: Right. Total number of patients per day is a big deal. So you went from seeing 25 or so patients per day down to maybe, maybe 10, eight to 10, which almost, I'm almost embarrassed to say, cause I know a lot of folks listening to this, think about that. And we're spending a lot of time with patients, a lot of face time with patients too. So from the minute they walk in the door, I come and greet them. I come back, I do their vital signs.
If they need an EKG, I do it. If they need blood drawn, I do it. So the visits take a little longer, but man, in terms of patient and job satisfaction for me, it's, it's, it's fantastic. So, less, less, less patients overall, but way more communication really. So they have direct access to us in terms of our email address and our, our phone number that they can text and call and email whenever comes directly to us. So there's no middleman. It doesn't go through a nurse practitioner or anything like that. And that's another thing we can kind of get into later as one of the tough parts about DPC. Frequently, I'll see patients and then have plenty of times in between patients to answer emails, answer text messages respond with results of labs and radiology and things like that.
We typically schedule where physicals and routine follow-ups, we kind of load our mornings with that and early afternoons, save plenty of space. So we've got openings for urgent care visits or anything like that. So we got, so if people call and need an appointment, we can see them usually same day.
The other advantage of direct primary care clinic in terms of what your day looks like is in a traditional clinic, it's kind of set up for patients to be sick and to come into the physical building because that's the only way you can really bill for them. I know now you can do video stuff and things like that, but with the direct primary care being a subscription model, that kind of flips it on its head. So it doesn't matter from our perspective in a billing and stuff like that, we can see one patient a day or 20, it doesn't matter. It frees you to just do the right thing. If someone calls and they're at the beach and they have a rash on their leg, we'll just text me a picture of it and I'll take a look at it and usually can determine the right things. Or if there's a clear virus going around town with typical symptoms, I don't have to drag people in there away from work, away from family.
We talk on the phone, we can text back and forth. So a lot of medicine is done now that way too, when it's appropriate. And then my patients trust me, I say, I will tell you if you ever need to come in.
If they call us something and I need to listen to their heart and lungs, we'll just bring you right on in and we can do that. So the day looks, it's just so much more manageable with this. You've got a lot of margin in your day.
I'm still busy. I'm working a whole time when I'm here. There's never a time where I'm sitting around trying to find something to do, but the difference is now is number one, everything that I'm doing feels like it matters. I'm doing doctor stuff. I'm not doing paperwork. I'm not doing billing and coding.
I'm not correcting stuff that a computer system is incorrectly done or whatever. So everything I'm doing feels like that it matters. And I also don't feel that pressure of just the time. Where I was before my 10 minute internal clock was so finely tuned. It's like, I could tell to the second when that 10 minute was up because I knew I had three or other people waiting on me to clean. That's gone. And that's just a massive, just mental improvement for being at work.
John: Yeah. Now you mentioned this issue of working people in under the old system where, cause you couldn't get paid. You had to have a code and I quit doing clinical before there were even codes for telemedicine or other variations of that.
I felt stupid pulling people in. It was like, you got to come in or I can't build. If I can't build, there's no point me trying to deal with this because it's going to take 10 minutes, 20 minutes, and just didn't make sense.
It makes so much more sense the way you're describing and everyone's happier again, because you're doing, that's right. You do what needs to be done, not some artificial insurance driven process.
Dr. David Townsend: Correct.
John: So let's see. So you're capped at 500 and that sounds like it's a pretty good level for you. And of course, as soon as several people leave, move away, you just got a backlog of people waiting to come in.
Dr. David Townsend: We do. We've had to, we've had to close our waiting list because it frankly got too long and there's not a ton of turnover. Generally, people have to move away, fortunately pass away, or for financial reasons, some people have to stop doing it too. Not a lot of turnover and folks who stay generally, once they get in the door and see what it's like, they're in and we're grateful for that.
John: And let's see, as an internist, who's been in practice a long time, you probably have a fairly elderly population of patients. And so, I mean, they're fairly complex, I'm assuming.
Dr. David Townsend: Absolutely. Yeah. So, my patients range from 16 to have a hundred year old. They all in there. There is a kind of a refreshing mix of patients, both in terms of age and complexity, but also something we didn't really anticipate was even socioeconomically as well. We were a little worried about that, that we would be seen as quote unquote concierge, which we are different from concierge medicine, direct primary care is a different model from that, but we were a little worried about that.
But as it turns out, there are lots of people out there who either have very bad insurance with high deductibles or really no insurance, or they have cost-sharing ministries like MediShare or Christian Healthcare Ministries and never really sought routine medical care because of the lack of transparency about what anything costs. I mean, so there's a fear of going in and having no idea what a doctor's visit would cost or anything like that. This makes it a hundred percent predictable and budgetable.
We have a one fixed cost per month and we don't charge any extra. We don't do co-pays, nothing that happens inside our clinic, we charge extra for it. So we don't do all the cart stuff, basically it covers everything.
We see a lot of people who previously have never had a primary care doctor before, because they really couldn't afford the typical system, the way it was. And also this is completely transparent and fixed and budgetable. So really nice variety in both age and complexity and socioeconomic status. We're really pleased with that too.
John: Yeah, it sounds like fun to some extent. And actually, the younger people are more the ones that want to just get in and get out when it's time to when they need something and they're not there's such a high co-pays and, and other fees built into our insurance plans that a lot of times we just go out of network and get something done. Are you doing labs? Are you doing labs in-house or through like a lab core or something? And are you also including imaging of some sort in kind of your package?
Dr. David Townsend: Yes. We've negotiated with Quest Labs and a lot of folks are really surprised about how cheap blood work can be when you don't involve insurance companies. So we get a full yearly physical panel CBC, CMP, lipids, thyroid, prostate, all that for about $12. And so, yes, we do our phlebotomy right here in-house. We send it to Quest Labs. We don't have any in-house radiology.
A lot of places do. That's the other nice thing about this is you can add or not add anything that you kind of want in your clinic. We have negotiated cash pay rates for all kinds of radiology services with a lot of our local providers.
For a lot of people, that's the smartest bet. But another thing people don't realize about direct primary care, even though we opt out of insurance and we don't do anything related to insurance, we can still order things that'll be covered by insurance. So I can order CTs, MRIs.
I can send referrals to people, order lab work elsewhere that'll be covered by their insurance, just like they're used to. And so our function is complete, full functionality. We just have a little bit more options in terms of cash pay options, if that works best for the patient.
John: Do you do any med dispensing? I hear some DPCs do that.
Dr. David Townsend: We do, yeah. We carry a stock here of a lot of urgent care meds, antibiotics, anti-inflammatories, things like that. That was one thing that changed a little in our practice.
A lot of DPC practices do chronic medication dispensing. All your blood pressure and things. And we do have a contract to be able to order all those kinds of things. For us, it just turned out that we didn't end up using that as much. Our patients just preferred to just get a prescription sent to their pharmacy. To be frank, that made life easier for us too. We generally do dispensing of acute care kind of things, but not so much of chronic medications. But that is absolutely an option if you wanted to.
John: Now, you mentioned earlier, and it's on my list of questions here about the downsides, if any, what are the difficulties that maybe you can't resolve by going to DPC or maybe new ones?
Dr. David Townsend: Yeah. Probably the biggest difficulty with DPC is it's also tied to the advantage of DPC and that's just the patient access to you. That's kind of our shtick. That's what separates us is that our patients have direct access to us. They can text, they can email, it comes directly to me. Any response they get, I'm the one that typed it out. It doesn't go through a medical assistant or anything like that. And then 24 hour, seven days a week access. Patients absolutely love that. It's absolutely refreshing to be able to practice that way. You really feel like you're doing a good job, but that does make it difficult. So that was something we had to kind of mentally get used to a mental shift in that.
Just being sort of on call all the time can be a little tough. And it took a while for us to sort of kind of retrain our brain into what we're doing. There are many days where if I don't get a lot of workings or something like that, I can be done in the early afternoon.
I love going to the gym. I'll go to the gym every day and I'll be at the gym at 2.30. And initially I would get annoyed if I would get an email or a text from a patient or I'm trying to work out. But then I had to remind myself, I was like, it's 2.30. It's still business hours. And would I rather be here taking care of a patient or sitting at the office in between five other patients? So if you kind of reframe, you almost have to retrain what practicing medicine looks like. It just took a little while to get there.
It is absolutely worth it though. And actually the amount of contact that we get is not as much as you think it would. A lot of people are scared. I'm just at home constantly answering emails and texts. And it's really not like that.
John: Yeah. I don't think 500 patients can generate that much. When you're used to 2,500 or more, calling you not to mention the hospital if you have to do inpatient and all that kind of thing. Well, you have a partner. There are times like if, hey, if your kid's getting married or something, can you get at least to say, hey, my partner is going to cover your calls and texts for the next 48, 20, 36 hours, whatever.
Dr. David Townsend: Yeah, absolutely. We do that. Our medical record system is set up really easily where patients, you still use my same contact information, but it will automatically be forwarded to him. We do that vacations. And we've started to trading weekends, we'll have one day where we'll just transfer everything over. And our patients know that just little mental break. It's important. But yes, we absolutely do that. I'm not sure if you were going to directly ask this or not, but there are huge advantages to doing this with a partner if you can.
I know a lot of people do this solo, and it's absolutely doable. But I'm really grateful for my colleague here. We have a complimentary skill set in terms of business stuff. And then just the social aspect of being here running stuff by each other and being able to cover for each other and things like that. That's been a huge advantage.
John: All right. What have I failed to ask? Is there anything else you would like to have the listeners who are thinking about doing DPC, they're in a practice they may not be feeling really great about? What else do they need to know that maybe we haven't talked about?
Dr. David Townsend: The biggest encouragement I would say is that if you're feeling similar to the way I did is just to look into it. I just encourage you to really strongly consider it as an option. There are probably a lot of people out there like me who considered leaving clinical medicine when you have a lot to offer to patients still out there.
And so, like I said before, this really did save my career, being able to do this. I'm really happy doing what I'm doing. So, just encourage you to really just give it a good look and sometimes take that leap of faith if it's possible and you can.
The other thing I get asked this a lot because we do have residents here is doing it fresh out of residency, being able to do that. That's a tough one. I routinely, to be perfectly honest, have encouraged residents to not do it directly out of residency.
The challenges of the business aspect of it, as well as the fact that what we're doing patients are paying out of pocket to come and get a service here. And so you want to make sure that the service you provide is top-notch medical care. And all of us who've practiced for a while know that it does take a few years outside of residency to really get comfortable with the practice of medicine.
And I think you'd also potentially miss out on learning from other doctors around you. Like if you join a group or if you stay at an academic medical center. I learned so much from two colleagues that literally sat on the left and right of me for three or four years after residency. That's where I really learned how to be a doctor. So at the point where we were ready to do this, kind of like I mentioned before, I was completely comfortable with the doctor aspect of it. You know, it doesn't matter what walked in the door. I knew what to do and how to take care of it. And I could concentrate on the aspects of the business and how we wanted to run things. I also had a good idea on how we thought a clinic should be run.
We've been in it long enough. We knew good ideas and bad ideas. I would find it to be a little difficult to just hang up a shingle and do this directly out of residency for a variety of reasons. I think it absolutely can be done, but I think your path will probably be easier if you get really comfortable being a doc first and then jump into this.
John: I think that's a really good bit of advice. When I came out of residency, I was so happy I joined a two-person group. I was the third person and I was asking them something every day that I hadn't seen or had seen one of or whatever. Yeah, really to go out and this is the thing used to kill me. I was the chief medical officer for a hospital. And so, we would occasionally like hire a physician out of residency and put them in a rural clinic 20 miles away. It's like this, this is not good for the patients because they're going to just, they just don't have the experience because you don't get your complete experience in three years of residency, obviously, right?
Dr. David Townsend: Right, right. No, I totally agree. I totally agree. I think it wouldn't be fair to the physician too. I mean, because, I mean, I think it would be very hard. So I can't imagine doing this with the pressures of we got to get patients signed up.
We got to figure out how to run the business. And on top of that, kind of figuring out how you want to practice medicine. I don't think it's fair for them either. It's the other aspect of it too, is that you really appreciate direct primary care after you've done all the other stuff for a while and kind of seen it. And then this is such a breath of fresh air that that's the other advantage too.
John: You probably would agree that maybe some of the advice would be okay, go into something a larger group or academics or whatever you're going to do for four or five years or thereabouts, but try and make it so your contract gives you a little wiggle room. So you don't have to move to a new state. It's a practice.
Dr. David Townsend: Gosh, if you've got any ability to negotiate that, absolutely. A hundred percent. And that stuff, unfortunately, you just, you just don't know early in your career. You're just happy to have a job and actually make a paycheck. And you don't, don't necessarily think about those kinds of things.
John: A lot of physicians, they're kind of in a hurry. Like, oh, I'm running out of time. I have to do interviews and I get, I get, now I have a contract. I got a few weeks at the most to decide whether to sign it. And a lot of people that I know, physicians have talked to me, they don't even hire an attorney. It's like, eh, it's not that complicated. It's like you might consider getting an attorney. That's my simple advice, but it's expensive and it slows the process down. So I understand.
I got to let you go soon. You know, we're probably over, but I had this idea in my mind that anybody that's teaching residents and fellows and so forth, of course, this doesn't really apply to specialists so much, but like, they don't want you to know this exists. Like they they're bought into the system and we're going to get you out there and in practice.
And you're going to have this academic background and so forth. But I don't know, do you feel like you can just people you've taught recently and so forth that you can just say, hey, this is an option and you really should consider it without getting some kind of blowback?
Dr. David Townsend: Yeah, honestly, we really haven't gotten any blowback either from a patient perspective or from our colleagues here professionally. Really none. I mean, the only difficulty was with the corporate kind of side of it in our previous employers. They're not crazy about the model. Interestingly, insurance companies are, I don't know, I think they're trying to figure out what to do with this. But most of our patients are insured that we have here.
And if you look at if you look at it, our patients who are still paying for their insurance, they go to the emergency room a whole lot less. They utilize the system a whole lot less. I mean, direct primary care has the potential to save even the insurance companies a ton of money because we are paying much more closer attention to our patients. And they're not going to an urgent care and emergency room. They're coming to me and just paying me the monthly thing. And the insurance company doesn't have to pay for anything.
Let's figure if a lot of insurance companies and other things kind of actually took time to look and realize what we did and how we could help the system in general. I mean, they'd be they'd be all on board.
John: Well, I think it sounds like you're helping them more education or explanation about what you're doing, why you're doing it that might the meds, how that interfaces with their diet, whatever those things would be. In the past, you didn't really have time to do that. Now you're doing all that. So, you're kind of trying to get towards that optimal care.
Dr. David Townsend: Oh, absolutely. I have conversations with every single one of my patients about nutrition and exercise. And I'll go into detail about their diet and macronutrients and how many calories and calculate stuff. And there's no way I could have had time to do that before. And on top of that, the other part of just feeling like you're a good doctor is that you'll see somebody with 75 years old is on a boatload of medicines and their knee hurts today and you're trying to go over all that. You have plenty of time for all that.
And they're super proud because their grandson just hit their first home run and they want to talk to you about that. And it previously that would just I would just start to get super antsy because I knew I was already late and had to get to the next one. Now we just we talked to him about it and let her show me pictures on her phone and stuff. And that's the personal aspect of just being a doc that is really nice to have back.
John: That sounds like I think some people might want to reach out to you and kind of see what you're doing, maybe ask a question. It's OK to have them reach you through LinkedIn.
Dr. David Townsend: Yeah, sure. And our website to a classic DPC, the DPC is in direct primary care. Classic DPC.com. There's an email address on there that comes right to me.
John: So, yeah, let me know if folks can use that to you. I forgot. I looked at your website briefly, but you post your prices there.
Dr. David Townsend: We do. Yeah. Prices are posted on there and what we charge is in keeping kind of with national averages on direct primary care practices. Most direct primary care practices are family medicine and so which involve pediatrics. We are internal medicine. And so, the fee schedule for a family practice direct primary care is a little bit different because of the addition of children.
And also we mentioned that we cap at 500 patients for a family medicine practice. I think the average is closer to 700 because there's a lot more children who typically have well child. I don't know, but they typically have a little bit higher patient panels than internal medicine. Just in case you were family or internal and thinking about it, those are average patient panels for direct primary care practice.
John: That makes sense. They have left the kids have less illnesses. Generally, they don't come in. Sometimes they don't even do a yearly. All right, Dave, this has been fantastic and learning more and more about DPC all the time. Yeah, I don't have any other questions. And since we're a little over, I want to thank you for being here today. It's been great and I really appreciate it.
Dr. David Townsend: John, I really appreciate you having me. I'd love to get the word out about direct primary care from I think it's like I said, a win for the patients and the doctors.
John: Absolutely. All right. With that, I'll say bye-bye.
Dr. David Townsend: Thank you, John. Bye.
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Transcription PNC Podcast Episode 419
Why Shift From Oppressive IM Practice to Peaceful DPC Now?
- Interview with Dr. David Townsend
John: In my quest to learn more about direct primary care, I'm really happy to have today's guest with me today. He actually converted from traditional practice into DPC practice four years ago, so he'll of course explain why he did that and maybe how he did that. So with that, Dr. David Townsend, welcome to the PNC podcast.
Dr. David Townsend: John, thank you so much for having me here and I appreciate you inviting me. This is a pleasure.
John: Good, because I'm going to learn a lot from you and so are our listeners and we're going to push as many people into DPC as we can.
Dr. David Townsend: I love that idea.
John: All right, well, let's see. Why don't we start with just the basics and tell us a little bit about your training education and what you did initially after leaving residency and then how your career went for, let's say, the next few years after that.
Dr. David Townsend: Oh, sure. Undergraduate at the University of Georgia, so go dogs. Then did medical school at Medical College of Georgia. Did my residency in internal medicine at Wake Forest in North Carolina. Finished there in 2008. Stayed on for a chief year there and then I stayed on faculty at Wake Forest for about five or six years or so doing kind of a little everything.
I had my own clinic. I did teaching wards with the residents, continuity clinic, lots of med student resident teaching. And then in 2013, we moved here. I'm in Athens, Georgia right now, mainly to be closer to family, all our families close around here. Joined an outpatient internal medicine practice that went through a lot of transitions. So when I joined, they were completely independent.
Very shortly after getting here, they were bought out by the local big hospital. And so then we were owned by the hospital. And then shortly after that, we were bought out by a very large corporate conglomerate entity.
And so, stayed there until 2021. And then in 2021, myself and my friend and colleague here both left to start this direct primary care practice. So this June was four years since we've opened our door.
John: All right. Yeah, I wasn't sure. I saw the website and I saw there were two of you there and I didn't know if that had started from the beginning or he and you and he were working together before you converted to DPC then, right?
Dr. David Townsend: That's correct. We actually, he was a few years ahead of me and was my chief during residency. So I've known him for a long time, kept in contact. That was actually my contact when getting a job back here. So we were both in the same clinic and both kind of simultaneously were, had our frustrations with the medical system and found out about DPC. So yeah, we both left together and started this together.
John: So what was going on for the two of you? I assume is related to that big buyout and things changed and just how was that discussion? Who brought that up first? And did you look at other options? Like, well, we'll just bail and go somewhere else. So how did that pan out?
Dr. David Townsend: Yeah. Yeah. So I'm sure our frustrations match a lot of frustrations from your listeners too. There's a constant struggle between the doctor that you want to be and the doctor that you feel like you're being told to be in kind of traditional medicine the way it is these days. And so many reasons for that. I mean, you find yourself doing a lot of things that aren't doctor related and that's taking up a lot of your time.
And then just the pressures of seeing numbers and the pressures of coding and getting the RVUs up and things like that. It was just, it was very, very hard to be the doctor that you want to be. And it just, it's, it takes a toll on you over time.
Both of us have been practicing for a long time. So, I mean, from 2008 to 2021, we were both full-time and then did traditional kind of practice. So we both simultaneously were getting to the point where we were like, I'm not, I'm not sure that we can do this for the rest of my career.
I don't know if I can go to 65 with this pace and with this feeling like a cog in a wheel. And a lot of times we'd leave the day, I'd leave the day after a long day of clinic and I felt like I made a lot of good, correct medical decisions, but I didn't feel like a good doctor. You know, it was just that feeling of, I just didn't have time to spend with my patients and all this backlog of paperwork stuff you have to do.
Anyway, we discovered Direct Primary Care. We started looking into it for a few years, almost came to the point maybe earlier, maybe 2018, 2019, where we pulled the trigger on it. At that point, we had just been bought out by that big sort of corporate conglomerate.
And at that point, they were kind of saying all the right things. And so we decided to just give it a try. Ended up where we were kind of back in the same spot. And so, at that point 2020 or so, we decided that that's what we wanted to do. Honestly, it's a little bit of a leap of faith. I mean, so we both have, he has three kids.
I have four and kind of the middle high school, college age. And we went from stable job, stable salary to zero overnight. It's a little bit of a leap of faith, but we both came to the point where we said we are okay. If this doesn't work out, we just have to try something different. I did consider non-clinical careers for a while. I'm just trying to do something different to get out of the situation I was in.
I'm very grateful that we found direct primary care because I still felt like I needed to be a doctor. I still feel like that's why I'm here and that's what I'm hopefully good at, decent at. And so I'm grateful that finding this literally did save my career because it gave me a way to do what I felt like I wanted to do.
John: I'm happy to hear that. And that's what I've heard from others doing DPC so far. And so that's good. But on the one hand, you don't have to worry about billing insurance if you're a traditional DPC, but how did you learn about the other things? Because you had someone who was basically running your practice or you were part of a huge practice. And so, how did that happen?
Dr. David Townsend: Yeah. I tell folks that the when we made the transition into this clinic, the easiest part about the whole thing was being a doctor. Cause I knew how to do that. That was not a problem. The business stuff was new. What we used a resource that I would really highly recommend that if anybody's interested in looking at DPC it's a group called Atlas MD.
They're based out of Kansas. They were kind of the front runners of direct primary care and have kind of made it their mission to assist physicians in making that transition. They basically have a step-by-step.
If you're interested in this, here are things that you need to do in this order. Here are some contacts that you can use that covers all aspects of kind of starting the business and owning it. So the two of us who have tons of medical experience, but zero small business ownership experience, that was an unbelievable resource. They're also extremely approachable. So talk to them on the phone, send them emails, things like that. So we use them a lot to learn a lot of the things, read all the stuff we could.
I went on some Facebook groups that were directed to direct primary care, asked a bunch of questions and that's, that's basically kind of how we learned. I feel like you kind of do need a honorary small business degree or something like that, but believe it or not, it wasn't as hard as we expected it to be. There are definitely things you have to do and steps you have to take, but it was outlined so well by them. We just kind of followed it and everything worked out well.
John: What about space? Did you, I'm assuming you had to leave the previous office and find a place to see patients and how did you manage that one?
Dr. David Townsend: The toughest part about that is we did have a non-compete clause with our current employer. Okay, here we go. Initially, we gave them plenty of lead time. We wanted to leave on good terms. We wanted to make sure they had time to find replacements for us in our clinic and things like that.
And initial conversations were very positive, but as we kind of got close to it, they really started to push on the non-compete stuff. And so paid it, but we ended up having to get a lawyer involved to go through the contract and talk with them and things like that. There were ways basically we were able to, there was a radius clause we couldn't practice and within a certain radius.
The unfortunate part is that my partner and I were in the same practice, but at two different locations. So if you overlap the radius, we would have had to go so far away. Anyway, gratefully we were able to negotiate out of that part.
We were just basically asked, we couldn't advertise. We couldn't, I'm sorry, let me rephrase that because we could advertise. We could not directly tell our current patients what we were doing and when.
Now we could advertise. And if they contacted us, we were free to say what we want, but we couldn't go to a clinic and just say, Hey, I'm about to leave and go here. We just couldn't say anything to anybody. That was a tough part about that. But once we got out of the radius clause of it, there was a, we found a local space. Thankfully, we were able to purchase it. We own the building that we have now and that's where we do our clinic.
John: Nice. Oh, so you purchased a building.
Dr. David Townsend: We did.
John: Okay. That's not a simple, I throw in some real estate it's a mix. Right, right. But that's worked out well.
Dr. David Townsend: That's worked out perfectly. We love our location. We love our place. You mentioned overhead earlier. Our overhead is next to nothing. Happy to talk about some of the business stuff of it, but our employees currently are myself, my partner, and then my wife and his wife run the front desk and answer the phones and greet people and say hi to people.
We do our own phlebotomy. I do our own vital signs. We do our own EKGs or whatever. We've got no medical assistant, no nurse. We are, we are a good example of simplicity really does work well. And patients absolutely love it because they get a hundred percent FaceTime with either us or our wives who know them and greet them when they come in and answer the phones. It's a friendly face. So patients absolutely love it too.
John: You had to start basically from scratch. I suppose there was some word of mouth that eventually made it back to some of your old patients. Did they find you?
Dr. David Townsend: They did. We feel very fortunate and blessed in that regard. We practiced here long enough where we had a good reputation in the community. Folks knew us. And so when they found out we were leaving and we couldn't say anything, but we basically were just like keep your ears open. We couldn't say anything directly, but they did find us.
We actually were fortunate enough to have pre-registrations, a lot of them, hundreds of patients pre-register before we opened doors. And we were just really lucky. We had a, had a big plan on, on marketing and advertising and things like that. And frankly didn't have to use any of that. It was all word of mouth. I'm not sure if, if our experience was completely typical of a new practice that's going to open.
We've seen that we saw estimates that it generally takes about two to three years for a new direct primary care practice to kind of reach capacity. And we filled and reached capacity in about five months. And so we were just really grateful that the community was absolutely ready for it.
We've had to close our wait list. That the another word of encouragement for folks out there is that I think people are very ready for things like this and they want something different. They want more of a traditional way to see their doctor and have direct access and time with their doctor. And so, people were kind of knocking down the doors to the patients here. We very grateful for that.
John: Well, you were talking about how miserable you and your partner were before you did this. And what I was going to comment and forgot was that the patients are just as miserable. They're like, I didn't even get to see the guy. He came in, he flew through the visit. I don't know what's happening. He didn't have time to explain anything to me, he or she, whatever. I think both sides of that equation are like, come on, let's do something different here.
Dr. David Townsend: A hundred percent. We tell people DPC is the biggest win-win in medicine. I mean, Eric and I are really happy and enjoy our job and patients love it. And they go tell all their friends and kind of tell them the experience that they have. And a lot of them, a lot of disbelief out there. It's like, you can, you can text directly with your doctor and they get right back with you. And we think this is a better way to do things.
John: I want to mention something to my listeners right now too, because when you mentioned the issue about the consolidation and then the buyout by a bigger organization and the non-compete. As I'm recording this, my next episode, which will be released actually before this is seen, but it was about those things that happen when you're, particularly when you're a new physician, we're going to happen to any physician where things just change and the non-competes a big one. And if you're thinking of leaving, I think if it might've been possible with enough lead time thinking about it, like to try and change your contract a little bit before resigning to where it was a little softer and then maybe you leverage that and make it a little easier. But oftentimes the contracts are so boiler plate that you really don't have much choice.
Dr. David Townsend: Yeah. We tried that and looked into that and this, the big corporation that, that we were owned by, it literally was, this is the contract and we don't vary it for anyone. So yeah, we had zero choice on it.
John: Well, let's see. You're kind of a full practice now. What does that mean for you? And maybe we can compare, do you have any idea, like, well, how big your, your practice was when you were with the previous employer? I mean, most of us don't, we just show up. We know we have a lot of patients, but we don't know if it's 5,000, 3,000. But what does that look like now compared?
Dr. David Townsend: Where we were before, we each had about 2,500 patients in our panel, which is fairly typical for an internal medicine clinic. And right now we're capped at 500 each. So from 2,500 down to 500, which obviously adds a lot of margin in your day and a lot more time spent with patients.
John: Now what does that look like from a day in the office or a week in the office? Because obviously you're not sitting there seeing patients every 15 minutes if and you have all these other options of how to interact with them. What's, what does it look like to your practice?
Dr. David Townsend: Right. Total number of patients per day is a big deal. So you went from seeing 25 or so patients per day down to maybe, maybe 10, eight to 10, which almost, I'm almost embarrassed to say, cause I know a lot of folks listening to this, think about that. And we're spending a lot of time with patients, a lot of face time with patients too. So from the minute they walk in the door, I come and greet them. I come back, I do their vital signs.
If they need an EKG, I do it. If they need blood drawn, I do it. So the visits take a little longer, but man, in terms of patient and job satisfaction for me, it's, it's, it's fantastic. So, less, less, less patients overall, but way more communication really. So they have direct access to us in terms of our email address and our, our phone number that they can text and call and email whenever comes directly to us. So there's no middleman. It doesn't go through a nurse practitioner or anything like that. And that's another thing we can kind of get into later as one of the tough parts about DPC. Frequently, I'll see patients and then have plenty of times in between patients to answer emails, answer text messages respond with results of labs and radiology and things like that.
We typically schedule where physicals and routine follow-ups, we kind of load our mornings with that and early afternoons, save plenty of space. So we've got openings for urgent care visits or anything like that. So we got, so if people call and need an appointment, we can see them usually same day.
The other advantage of direct primary care clinic in terms of what your day looks like is in a traditional clinic, it's kind of set up for patients to be sick and to come into the physical building because that's the only way you can really bill for them. I know now you can do video stuff and things like that, but with the direct primary care being a subscription model, that kind of flips it on its head. So it doesn't matter from our perspective in a billing and stuff like that, we can see one patient a day or 20, it doesn't matter. It frees you to just do the right thing. If someone calls and they're at the beach and they have a rash on their leg, we'll just text me a picture of it and I'll take a look at it and usually can determine the right things. Or if there's a clear virus going around town with typical symptoms, I don't have to drag people in there away from work, away from family.
We talk on the phone, we can text back and forth. So a lot of medicine is done now that way too, when it's appropriate. And then my patients trust me, I say, I will tell you if you ever need to come in.
If they call us something and I need to listen to their heart and lungs, we'll just bring you right on in and we can do that. So the day looks, it's just so much more manageable with this. You've got a lot of margin in your day.
I'm still busy. I'm working a whole time when I'm here. There's never a time where I'm sitting around trying to find something to do, but the difference is now is number one, everything that I'm doing feels like it matters. I'm doing doctor stuff. I'm not doing paperwork. I'm not doing billing and coding.
I'm not correcting stuff that a computer system is incorrectly done or whatever. So everything I'm doing feels like that it matters. And I also don't feel that pressure of just the time. Where I was before my 10 minute internal clock was so finely tuned. It's like, I could tell to the second when that 10 minute was up because I knew I had three or other people waiting on me to clean. That's gone. And that's just a massive, just mental improvement for being at work.
John: Yeah. Now you mentioned this issue of working people in under the old system where, cause you couldn't get paid. You had to have a code and I quit doing clinical before there were even codes for telemedicine or other variations of that.
I felt stupid pulling people in. It was like, you got to come in or I can't build. If I can't build, there's no point me trying to deal with this because it's going to take 10 minutes, 20 minutes, and just didn't make sense.
It makes so much more sense the way you're describing and everyone's happier again, because you're doing, that's right. You do what needs to be done, not some artificial insurance driven process.
Dr. David Townsend: Correct.
John: So let's see. So you're capped at 500 and that sounds like it's a pretty good level for you. And of course, as soon as several people leave, move away, you just got a backlog of people waiting to come in.
Dr. David Townsend: We do. We've had to, we've had to close our waiting list because it frankly got too long and there's not a ton of turnover. Generally, people have to move away, fortunately pass away, or for financial reasons, some people have to stop doing it too. Not a lot of turnover and folks who stay generally, once they get in the door and see what it's like, they're in and we're grateful for that.
John: And let's see, as an internist, who's been in practice a long time, you probably have a fairly elderly population of patients. And so, I mean, they're fairly complex, I'm assuming.
Dr. David Townsend: Absolutely. Yeah. So, my patients range from 16 to have a hundred year old. They all in there. There is a kind of a refreshing mix of patients, both in terms of age and complexity, but also something we didn't really anticipate was even socioeconomically as well. We were a little worried about that, that we would be seen as quote unquote concierge, which we are different from concierge medicine, direct primary care is a different model from that, but we were a little worried about that.
But as it turns out, there are lots of people out there who either have very bad insurance with high deductibles or really no insurance, or they have cost-sharing ministries like MediShare or Christian Healthcare Ministries and never really sought routine medical care because of the lack of transparency about what anything costs. I mean, so there's a fear of going in and having no idea what a doctor's visit would cost or anything like that. This makes it a hundred percent predictable and budgetable.
We have a one fixed cost per month and we don't charge any extra. We don't do co-pays, nothing that happens inside our clinic, we charge extra for it. So we don't do all the cart stuff, basically it covers everything.
We see a lot of people who previously have never had a primary care doctor before, because they really couldn't afford the typical system, the way it was. And also this is completely transparent and fixed and budgetable. So really nice variety in both age and complexity and socioeconomic status. We're really pleased with that too.
John: Yeah, it sounds like fun to some extent. And actually, the younger people are more the ones that want to just get in and get out when it's time to when they need something and they're not there's such a high co-pays and, and other fees built into our insurance plans that a lot of times we just go out of network and get something done. Are you doing labs? Are you doing labs in-house or through like a lab core or something? And are you also including imaging of some sort in kind of your package?
Dr. David Townsend: Yes. We've negotiated with Quest Labs and a lot of folks are really surprised about how cheap blood work can be when you don't involve insurance companies. So we get a full yearly physical panel CBC, CMP, lipids, thyroid, prostate, all that for about $12. And so, yes, we do our phlebotomy right here in-house. We send it to Quest Labs. We don't have any in-house radiology.
A lot of places do. That's the other nice thing about this is you can add or not add anything that you kind of want in your clinic. We have negotiated cash pay rates for all kinds of radiology services with a lot of our local providers.
For a lot of people, that's the smartest bet. But another thing people don't realize about direct primary care, even though we opt out of insurance and we don't do anything related to insurance, we can still order things that'll be covered by insurance. So I can order CTs, MRIs.
I can send referrals to people, order lab work elsewhere that'll be covered by their insurance, just like they're used to. And so our function is complete, full functionality. We just have a little bit more options in terms of cash pay options, if that works best for the patient.
John: Do you do any med dispensing? I hear some DPCs do that.
Dr. David Townsend: We do, yeah. We carry a stock here of a lot of urgent care meds, antibiotics, anti-inflammatories, things like that. That was one thing that changed a little in our practice.
A lot of DPC practices do chronic medication dispensing. All your blood pressure and things. And we do have a contract to be able to order all those kinds of things. For us, it just turned out that we didn't end up using that as much. Our patients just preferred to just get a prescription sent to their pharmacy. To be frank, that made life easier for us too. We generally do dispensing of acute care kind of things, but not so much of chronic medications. But that is absolutely an option if you wanted to.
John: Now, you mentioned earlier, and it's on my list of questions here about the downsides, if any, what are the difficulties that maybe you can't resolve by going to DPC or maybe new ones?
Dr. David Townsend: Yeah. Probably the biggest difficulty with DPC is it's also tied to the advantage of DPC and that's just the patient access to you. That's kind of our shtick. That's what separates us is that our patients have direct access to us. They can text, they can email, it comes directly to me. Any response they get, I'm the one that typed it out. It doesn't go through a medical assistant or anything like that. And then 24 hour, seven days a week access. Patients absolutely love that. It's absolutely refreshing to be able to practice that way. You really feel like you're doing a good job, but that does make it difficult. So that was something we had to kind of mentally get used to a mental shift in that.
Just being sort of on call all the time can be a little tough. And it took a while for us to sort of kind of retrain our brain into what we're doing. There are many days where if I don't get a lot of workings or something like that, I can be done in the early afternoon.
I love going to the gym. I'll go to the gym every day and I'll be at the gym at 2.30. And initially I would get annoyed if I would get an email or a text from a patient or I'm trying to work out. But then I had to remind myself, I was like, it's 2.30. It's still business hours. And would I rather be here taking care of a patient or sitting at the office in between five other patients? So if you kind of reframe, you almost have to retrain what practicing medicine looks like. It just took a little while to get there.
It is absolutely worth it though. And actually the amount of contact that we get is not as much as you think it would. A lot of people are scared. I'm just at home constantly answering emails and texts. And it's really not like that.
John: Yeah. I don't think 500 patients can generate that much. When you're used to 2,500 or more, calling you not to mention the hospital if you have to do inpatient and all that kind of thing. Well, you have a partner. There are times like if, hey, if your kid's getting married or something, can you get at least to say, hey, my partner is going to cover your calls and texts for the next 48, 20, 36 hours, whatever.
Dr. David Townsend: Yeah, absolutely. We do that. Our medical record system is set up really easily where patients, you still use my same contact information, but it will automatically be forwarded to him. We do that vacations. And we've started to trading weekends, we'll have one day where we'll just transfer everything over. And our patients know that just little mental break. It's important. But yes, we absolutely do that. I'm not sure if you were going to directly ask this or not, but there are huge advantages to doing this with a partner if you can.
I know a lot of people do this solo, and it's absolutely doable. But I'm really grateful for my colleague here. We have a complimentary skill set in terms of business stuff. And then just the social aspect of being here running stuff by each other and being able to cover for each other and things like that. That's been a huge advantage.
John: All right. What have I failed to ask? Is there anything else you would like to have the listeners who are thinking about doing DPC, they're in a practice they may not be feeling really great about? What else do they need to know that maybe we haven't talked about?
Dr. David Townsend: The biggest encouragement I would say is that if you're feeling similar to the way I did is just to look into it. I just encourage you to really strongly consider it as an option. There are probably a lot of people out there like me who considered leaving clinical medicine when you have a lot to offer to patients still out there.
And so, like I said before, this really did save my career, being able to do this. I'm really happy doing what I'm doing. So, just encourage you to really just give it a good look and sometimes take that leap of faith if it's possible and you can.
The other thing I get asked this a lot because we do have residents here is doing it fresh out of residency, being able to do that. That's a tough one. I routinely, to be perfectly honest, have encouraged residents to not do it directly out of residency.
The challenges of the business aspect of it, as well as the fact that what we're doing patients are paying out of pocket to come and get a service here. And so you want to make sure that the service you provide is top-notch medical care. And all of us who've practiced for a while know that it does take a few years outside of residency to really get comfortable with the practice of medicine.
And I think you'd also potentially miss out on learning from other doctors around you. Like if you join a group or if you stay at an academic medical center. I learned so much from two colleagues that literally sat on the left and right of me for three or four years after residency. That's where I really learned how to be a doctor. So at the point where we were ready to do this, kind of like I mentioned before, I was completely comfortable with the doctor aspect of it. You know, it doesn't matter what walked in the door. I knew what to do and how to take care of it. And I could concentrate on the aspects of the business and how we wanted to run things. I also had a good idea on how we thought a clinic should be run.
We've been in it long enough. We knew good ideas and bad ideas. I would find it to be a little difficult to just hang up a shingle and do this directly out of residency for a variety of reasons. I think it absolutely can be done, but I think your path will probably be easier if you get really comfortable being a doc first and then jump into this.
John: I think that's a really good bit of advice. When I came out of residency, I was so happy I joined a two-person group. I was the third person and I was asking them something every day that I hadn't seen or had seen one of or whatever. Yeah, really to go out and this is the thing used to kill me. I was the chief medical officer for a hospital. And so, we would occasionally like hire a physician out of residency and put them in a rural clinic 20 miles away. It's like this, this is not good for the patients because they're going to just, they just don't have the experience because you don't get your complete experience in three years of residency, obviously, right?
Dr. David Townsend: Right, right. No, I totally agree. I totally agree. I think it wouldn't be fair to the physician too. I mean, because, I mean, I think it would be very hard. So I can't imagine doing this with the pressures of we got to get patients signed up.
We got to figure out how to run the business. And on top of that, kind of figuring out how you want to practice medicine. I don't think it's fair for them either. It's the other aspect of it too, is that you really appreciate direct primary care after you've done all the other stuff for a while and kind of seen it. And then this is such a breath of fresh air that that's the other advantage too.
John: You probably would agree that maybe some of the advice would be okay, go into something a larger group or academics or whatever you're going to do for four or five years or thereabouts, but try and make it so your contract gives you a little wiggle room. So you don't have to move to a new state. It's a practice.
Dr. David Townsend: Gosh, if you've got any ability to negotiate that, absolutely. A hundred percent. And that stuff, unfortunately, you just, you just don't know early in your career. You're just happy to have a job and actually make a paycheck. And you don't, don't necessarily think about those kinds of things.
John: A lot of physicians, they're kind of in a hurry. Like, oh, I'm running out of time. I have to do interviews and I get, I get, now I have a contract. I got a few weeks at the most to decide whether to sign it. And a lot of people that I know, physicians have talked to me, they don't even hire an attorney. It's like, eh, it's not that complicated. It's like you might consider getting an attorney. That's my simple advice, but it's expensive and it slows the process down. So I understand.
I got to let you go soon. You know, we're probably over, but I had this idea in my mind that anybody that's teaching residents and fellows and so forth, of course, this doesn't really apply to specialists so much, but like, they don't want you to know this exists. Like they they're bought into the system and we're going to get you out there and in practice.
And you're going to have this academic background and so forth. But I don't know, do you feel like you can just people you've taught recently and so forth that you can just say, hey, this is an option and you really should consider it without getting some kind of blowback?
Dr. David Townsend: Yeah, honestly, we really haven't gotten any blowback either from a patient perspective or from our colleagues here professionally. Really none. I mean, the only difficulty was with the corporate kind of side of it in our previous employers. They're not crazy about the model. Interestingly, insurance companies are, I don't know, I think they're trying to figure out what to do with this. But most of our patients are insured that we have here.
And if you look at if you look at it, our patients who are still paying for their insurance, they go to the emergency room a whole lot less. They utilize the system a whole lot less. I mean, direct primary care has the potential to save even the insurance companies a ton of money because we are paying much more closer attention to our patients. And they're not going to an urgent care and emergency room. They're coming to me and just paying me the monthly thing. And the insurance company doesn't have to pay for anything.
Let's figure if a lot of insurance companies and other things kind of actually took time to look and realize what we did and how we could help the system in general. I mean, they'd be they'd be all on board.
John: Well, I think it sounds like you're helping them more education or explanation about what you're doing, why you're doing it that might the meds, how that interfaces with their diet, whatever those things would be. In the past, you didn't really have time to do that. Now you're doing all that. So, you're kind of trying to get towards that optimal care.
Dr. David Townsend: Oh, absolutely. I have conversations with every single one of my patients about nutrition and exercise. And I'll go into detail about their diet and macronutrients and how many calories and calculate stuff. And there's no way I could have had time to do that before. And on top of that, the other part of just feeling like you're a good doctor is that you'll see somebody with 75 years old is on a boatload of medicines and their knee hurts today and you're trying to go over all that. You have plenty of time for all that.
And they're super proud because their grandson just hit their first home run and they want to talk to you about that. And it previously that would just I would just start to get super antsy because I knew I was already late and had to get to the next one. Now we just we talked to him about it and let her show me pictures on her phone and stuff. And that's the personal aspect of just being a doc that is really nice to have back.
John: That sounds like I think some people might want to reach out to you and kind of see what you're doing, maybe ask a question. It's OK to have them reach you through LinkedIn.
Dr. David Townsend: Yeah, sure. And our website to a classic DPC, the DPC is in direct primary care. Classic DPC.com. There's an email address on there that comes right to me.
John: So, yeah, let me know if folks can use that to you. I forgot. I looked at your website briefly, but you post your prices there.
Dr. David Townsend: We do. Yeah. Prices are posted on there and what we charge is in keeping kind of with national averages on direct primary care practices. Most direct primary care practices are family medicine and so which involve pediatrics. We are internal medicine. And so, the fee schedule for a family practice direct primary care is a little bit different because of the addition of children.
And also we mentioned that we cap at 500 patients for a family medicine practice. I think the average is closer to 700 because there's a lot more children who typically have well child. I don't know, but they typically have a little bit higher patient panels than internal medicine. Just in case you were family or internal and thinking about it, those are average patient panels for direct primary care practice.
John: That makes sense. They have left the kids have less illnesses. Generally, they don't come in. Sometimes they don't even do a yearly. All right, Dave, this has been fantastic and learning more and more about DPC all the time. Yeah, I don't have any other questions. And since we're a little over, I want to thank you for being here today. It's been great and I really appreciate it.
Dr. David Townsend: John, I really appreciate you having me. I'd love to get the word out about direct primary care from I think it's like I said, a win for the patients and the doctors.
John: Absolutely. All right. With that, I'll say bye-bye.
Dr. David Townsend: Thank you, John. Bye.
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